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Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00757-8. [PMID: 38642570 DOI: 10.1016/s0140-6736(24)00757-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/07/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. METHODS The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. FINDINGS Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021. INTERPRETATION Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. FUNDING Bill & Melinda Gates Foundation.
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Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00367-2. [PMID: 38582094 DOI: 10.1016/s0140-6736(24)00367-2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation.
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Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00476-8. [PMID: 38484753 DOI: 10.1016/s0140-6736(24)00476-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/08/2023] [Accepted: 03/06/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period. METHODS 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5-65·1] decline), and increased during the COVID-19 pandemic period (2020-21; 5·1% [0·9-9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98-5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50-6·01) in 2019. An estimated 131 million (126-137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7-17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8-24·8), from 49·0 years (46·7-51·3) to 71·7 years (70·9-72·5). Global life expectancy at birth declined by 1·6 years (1·0-2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67-8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4-52·7]) and south Asia (26·3% [9·0-44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING Bill & Melinda Gates Foundation.
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4
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Sartelli M, Coccolini F, Labricciosa FM, Al Omari AH, Bains L, Baraket O, Catarci M, Cui Y, Ferreres AR, Gkiokas G, Gomes CA, Hodonou AM, Isik A, Litvin A, Lohsiriwat V, Kotecha V, Khokha V, Kryvoruchko IA, Machain GM, O’Connor DB, Olaoye I, Al-Omari JAK, Pasculli A, Petrone P, Rickard J, Sall I, Sawyer RG, Téllez-Almenares O, Catena F, Siquini W. Surgical Antibiotic Prophylaxis: A Proposal for a Global Evidence-Based Bundle. Antibiotics (Basel) 2024; 13:100. [PMID: 38275329 PMCID: PMC10812782 DOI: 10.3390/antibiotics13010100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/03/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
In the multimodal strategy context, to implement healthcare-associated infection prevention, bundles are one of the most commonly used methods to adapt guidelines in the local context and transfer best practices into routine clinical care. One of the most important measures to prevent surgical site infections is surgical antibiotic prophylaxis (SAP). This narrative review aims to present a bundle for the correct SAP administration and evaluate the evidence supporting it. Surgical site infection (SSI) prevention guidelines published by the WHO, CDC, NICE, and SHEA/IDSA/APIC/AHA, and the clinical practice guidelines for SAP by ASHP/IDSA/SIS/SHEA, were reviewed. Subsequently, comprehensive searches were also conducted using the PubMed®/MEDLINE and Google Scholar databases, in order to identify further supporting evidence-based documentation. The bundle includes five different measures that may affect proper SAP administration. The measures included may be easily implemented in all hospitals worldwide and are based on minimal drug pharmacokinetics and pharmacodynamics knowledge, which all surgeons should know. Antibiotics for SAP should be prescribed for surgical procedures at high risk for SSIs, such as clean-contaminated and contaminated surgical procedures or for clean surgical procedures where SSIs, even if unlikely, may have devastating consequences, such as in procedures with prosthetic implants. SAP should generally be administered within 60 min before the surgical incision for most antibiotics (including cefazolin). SAP redosing is indicated for surgical procedures exceeding two antibiotic half-lives or for procedures significantly associated with blood loss. In principle, SAP should be discontinued after the surgical procedure. Hospital-based antimicrobial stewardship programmes can optimise the treatment of infections and reduce adverse events associated with antibiotics. In the context of a collaborative and interdisciplinary approach, it is essential to encourage an institutional safety culture in which surgeons are persuaded, rather than compelled, to respect antibiotic prescribing practices. In that context, the proposed bundle contains a set of evidence-based interventions for SAP administration. It is easy to apply, promotes collaboration, and includes measures that can be adequately followed and evaluated in all hospitals worldwide.
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Affiliation(s)
- Massimo Sartelli
- Department of Surgery, Macerata Hospital, 62100 Macerata, Italy;
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Unit, Pisa University Hospital, 56124 Pisa, Italy;
| | | | - AbdelKarim. H. Al Omari
- Department of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Lovenish Bains
- Department of General Surgery, Maulana Azad Medical College, New Delhi 110002, India;
| | - Oussama Baraket
- Department of General Surgery, Bizerte Hospital, Bizerte 7000, Tunisia;
| | - Marco Catarci
- General Surgery Unit, Sandro Pertini Hospital, 00157 Rome, Italy;
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin 300052, China;
| | - Alberto R. Ferreres
- Department of Surgery, University of Buenos Aires, Buenos Aires 1428, Argentina;
| | - George Gkiokas
- Department of Surgery, Medical School, “Aretaieio” Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Carlos Augusto Gomes
- Department of Surgery, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Hospital Universitário Terezinha de Jesus, Juiz de Fora 25520, Brazil;
| | - Adrien M. Hodonou
- Department of Surgery, Faculty of Medicine, University of Parakou, Parakou 03 BP 10, Benin;
| | - Arda Isik
- Department of Surgery, Istanbul Medeniyet University, Istanbul 34000, Turkey;
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, 246000 Gomel, Belarus;
| | - Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | - Vihar Kotecha
- Department of General Surgery, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Vladimir Khokha
- General Surgery Unit, Podhalanski Specialized Hospital, 34-400 Nowy Targ, Poland;
| | - Igor A. Kryvoruchko
- Department of Surgery No. 2, Kharkiv National Medical University, 61000 Kharkiv, Ukraine;
| | - Gustavo M. Machain
- Department of Surgery, Universidad Nacional de Asuncion, San Lorenzo 1055, Paraguay;
| | - Donal B. O’Connor
- Department of Surgery, School of Medicine, Trinity College, D02 PN40 Dublin, Ireland;
| | - Iyiade Olaoye
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin 240101, Nigeria;
| | - Jamal A. K. Al-Omari
- Medical College, Al-Balqa Applied University, Al-Hussein Hospital, Zarqa 13313, Jordan;
| | - Alessandro Pasculli
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Unit of Academic General Surgery “V. Bonomo”, University of Bari “A. Moro”, 70125 Bari, Italy;
| | - Patrizio Petrone
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital—Long Island, Mineola, NY 11501, USA;
| | - Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Ibrahima Sall
- Department of General Surgery, Military Teaching Hospital, Dakar 3006, Senegal;
| | - Robert G. Sawyer
- Department of Surgery, School of Medicine, Western Michigan University, Kalamazoo, MI 49008, USA;
| | - Orlando Téllez-Almenares
- General Surgery Department of Saturnino Lora Provincial Hospital, University of Medical Sciences of Santiago de Cuba,
26P2+J7X, Santiago de Cuba 90100, Cuba;
| | - Fausto Catena
- Department of Surgery, “Bufalini” Hospital, 47521 Cesena, Italy;
| | - Walter Siquini
- Department of Surgery, Macerata Hospital, 62100 Macerata, Italy;
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5
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Sartelli M, Barie PS, Coccolini F, Abbas M, Abbo LM, Abdukhalilova GK, Abraham Y, Abubakar S, Abu-Zidan FM, Adebisi YA, Adamou H, Afandiyeva G, Agastra E, Alfouzan WA, Al-Hasan MN, Ali S, Ali SM, Allaw F, Allwell-Brown G, Amir A, Amponsah OKO, Al Omari A, Ansaloni L, Ansari S, Arauz AB, Augustin G, Awazi B, Azfar M, Bah MSB, Bala M, Banagala ASK, Baral S, Bassetti M, Bavestrello L, Beilman G, Bekele K, Benboubker M, Beović B, Bergamasco MD, Bertagnolio S, Biffl WL, Blot S, Boermeester MA, Bonomo RA, Brink A, Brusaferro S, Butemba J, Caínzos MA, Camacho-Ortiz A, Canton R, Cascio A, Cassini A, Cástro-Sanchez E, Catarci M, Catena R, Chamani-Tabriz L, Chandy SJ, Charani E, Cheadle WG, Chebet D, Chikowe I, Chiara F, Cheng VCC, Chioti A, Cocuz ME, Coimbra R, Cortese F, Cui Y, Czepiel J, Dasic M, de Francisco Serpa N, de Jonge SW, Delibegovic S, Dellinger EP, Demetrashvili Z, De Palma A, De Silva D, De Simone B, De Waele J, Dhingra S, Diaz JJ, Dima C, Dirani N, Dodoo CC, Dorj G, Duane TM, Eckmann C, Egyir B, Elmangory MM, Enani MA, Ergonul O, Escalera-Antezana JP, Escandon K, Ettu AWOO, Fadare JO, Fantoni M, Farahbakhsh M, Faro MP, Ferreres A, Flocco G, Foianini E, Fry DE, Garcia AF, Gerardi C, Ghannam W, Giamarellou H, Glushkova N, Gkiokas G, Goff DA, Gomi H, Gottfredsson M, Griffiths EA, Guerra Gronerth RI, Guirao X, Gupta YK, Halle-Ekane G, Hansen S, Haque M, Hardcastle TC, Hayman DTS, Hecker A, Hell M, Ho VP, Hodonou AM, Isik A, Islam S, Itani KMF, Jaidane N, Jammer I, Jenkins DR, Kamara IF, Kanj SS, Jumbam D, Keikha M, Khanna AK, Khanna S, Kapoor G, Kapoor G, Kariuki S, Khamis F, Khokha V, Kiggundu R, Kiguba R, Kim HB, Kim PK, Kirkpatrick AW, Kluger Y, Ko WC, Kok KYY, Kotecha V, Kouma I, Kovacevic B, Krasniqi J, Krutova M, Kryvoruchko I, Kullar R, Labi KA, Labricciosa FM, Lakoh S, Lakatos B, Lansang MAD, Laxminarayan R, Lee YR, Leone M, Leppaniemi A, Hara GL, Litvin A, Lohsiriwat V, Machain GM, Mahomoodally F, Maier RV, Majumder MAA, Malama S, Manasa J, Manchanda V, Manzano-Nunez R, Martínez-Martínez L, Martin-Loeches I, Marwah S, Maseda E, Mathewos M, Maves RC, McNamara D, Memish Z, Mertz D, Mishra SK, Montravers P, Moro ML, Mossialos E, Motta F, Mudenda S, Mugabi P, Mugisha MJM, Mylonakis E, Napolitano LM, Nathwani D, Nkamba L, Nsutebu EF, O’Connor DB, Ogunsola S, Jensen PØ, Ordoñez JM, Ordoñez CA, Ottolino P, Ouedraogo AS, Paiva JA, Palmieri M, Pan A, Pant N, Panyko A, Paolillo C, Patel J, Pea F, Petrone P, Petrosillo N, Pintar T, Plaudis H, Podda M, Ponce-de-Leon A, Powell SL, Puello-Guerrero A, Pulcini C, Rasa K, Regimbeau JM, Rello J, Retamozo-Palacios MR, Reynolds-Campbell G, Ribeiro J, Rickard J, Rocha-Pereira N, Rosenthal VD, Rossolini GM, Rwegerera GM, Rwigamba M, Sabbatucci M, Saladžinskas Ž, Salama RE, Sali T, Salile SS, Sall I, Kafil HS, Sakakushev BE, Sawyer RG, Scatizzi M, Seni J, Septimus EJ, Sganga G, Shabanzadeh DM, Shelat VG, Shibabaw A, Somville F, Souf S, Stefani S, Tacconelli E, Tan BK, Tattevin P, Rodriguez-Taveras C, Telles JP, Téllez-Almenares O, Tessier J, Thang NT, Timmermann C, Timsit JF, Tochie JN, Tolonen M, Trueba G, Tsioutis C, Tumietto F, Tuon FF, Ulrych J, Uranues S, van Dongen M, van Goor H, Velmahos GC, Vereczkei A, Viaggi B, Viale P, Vila J, Voss A, Vraneš J, Watkins RR, Wanjiru-Korir N, Waworuntu O, Wechsler-Fördös A, Yadgarova K, Yahaya M, Yahya AI, Xiao Y, Zakaria AD, Zakrison TL, Zamora Mesia V, Siquini W, Darzi A, Pagani L, Catena F. Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action. World J Emerg Surg 2023; 18:50. [PMID: 37845673 PMCID: PMC10580644 DOI: 10.1186/s13017-023-00518-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/23/2023] [Indexed: 10/18/2023] Open
Abstract
Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or "golden rules," for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice.
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Pawlak N, Dart C, Aguilar HS, Ameh E, Bekele A, Jimenez MF, Lakhoo K, Ozgediz D, Roy N, Terfera G, Ademuyiwa AO, Alayande BT, Alonso N, Anderson GA, Anyanwu SNC, Aregawi AB, Bandyopadhyay S, Banu T, Bedada AG, Belachew AG, Botelho F, Bua E, Campos LN, Dodgion C, Drejza M, Durieux ME, Dutta R, Erdene S, Vaz Ferreira R, Gathuya Z, Ghosh D, Jawa RS, Johnson WD, Khan FA, Navas Leon FJ, Long KL, Macleod JBA, Mahajan A, Maine RG, Malolos GZC, McClain CD, Nabukenya MT, Nthumba PM, Nwomeh BC, Ojuka DK, Penny N, Quiodettis MA, Rickard J, Roa L, Salgado LS, Samad L, Seyi-Olajide JO, Smith M, Starr N, Stewart RJ, Tarpley JL, Trostchansky JL, Trostchansky I, Weiser TG, Wobenjo A, Wollner E, Jayaraman S. Correction: Academic global surgical competencies: A modified Delphi consensus study. PLOS Glob Public Health 2023; 3:e0002414. [PMID: 37708095 PMCID: PMC10501557 DOI: 10.1371/journal.pgph.0002414] [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: 09/16/2023]
Abstract
[This corrects the article DOI: 10.1371/journal.pgph.0002102.].
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7
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Alayande BT, Forbes CW, Iradakunda J, Majyambere JP, Hey MT, Powell BL, Perl J, McCall N, Paul T, Ingabire JA, Shimelash N, Mutabazi E, Kimto EO, Danladi GM, Tubasiime R, Rickard J, Karekezi C, Makiriro G, Bigirimana SP, Harelimana JG, ElSayed A, Ndibanje AJ, Mpirimbanyi C, Masimbi O, Ndayishimiye M, Ntabana F, Haonga BT, Anderson GA, Byringyiro JC, Ntirenganya F, Riviello RR, Bekele A. Determining Critical Topics for Undergraduate Surgical Education in Rwanda: Results of a Modified Delphi Process and a Consensus Conference. Cureus 2023; 15:e43625. [PMID: 37600431 PMCID: PMC10433784 DOI: 10.7759/cureus.43625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 08/22/2023] Open
Abstract
Background Developing a contextually appropriate curriculum is critical to train physicians who can address surgical challenges in sub-Saharan Africa. An innovative modified Delphi process was used to identify contextually optimized curricular content to meet sub-Saharan Africa and Rwanda's surgical needs. Methods Participants were surgeons from East, Central, Southern, and West Africa and general practitioners with surgical experience. Delphi participants excluded or prioritized surgical topic areas generated from extensive grey and formal literature review. Surgical educators first screened and condensed identified topics. Round 1 screened and prioritized identified topics, with a 75% consensus cut-off based on the content validity index and a prioritization score. Topics that reached consensus were screened again in round 2 and re-prioritized, following controlled feedback. Frequencies for aggregate prioritization scores, experts in agreement, item-level content validity index, universal agreement and scale-level content validity index based on the average method (S-CVI/Ave) using proportion relevance, and intra-class correlation (ICC) (based on a mean-rating, consistency, two-way mixed-effects model) were performed. We also used arithmetic mean values and modal frequency. Cronbach's Alpha was also calculated to ascertain reliability. Results were validated through a multi-institution consensus conference attended by Rwanda-based surgical specialists, general practitioners, medical students, surgical educators, and surgical association representatives using an inclusive, participatory, collaborative, agreement-seeking, and cooperative, a priori consensus decision-making model. Results Two-hundred and sixty-seven broad surgical content areas were identified through the initial round and presented to experts. In round 2, a total of 247 (92%) content areas reached 75% consensus among 31 experts. Topics that did not achieve consensus consisted broadly of small intestinal malignancies, rare hepatobiliary pathologies, and transplantation. In the final round, 99.6% of content areas reached 75% consensus among 31 experts. The highest prioritization was on wound healing, fluid and electrolyte management, and appendicitis, followed by metabolic response, infection, preoperative preparation, antibiotics, small bowel obstruction and perforation, breast infection, acute urinary retention, testicular torsion, hemorrhoids, and surgical ethics. Overall, the consistency and average agreement between panel experts was strong. ICC was 0.856 (95% CI: 0.83-0.87). Cronbach's Alpha for round 2 was very strong (0.985, 95% CI: 0.976-0.991) and higher than round 1, demonstrating strong reliability. All 246 topics from round 4 were verbally accepted by 40 participants in open forum discussions during the consensus conference. Conclusions A modified Delphi process and consensus were able to identify essential topics to be included within a highly contextualized, locally driven surgical clerkship curriculum delivered in rural Rwanda. Other contexts can use similar processes to develop relevant curricula.
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Affiliation(s)
- Barnabas T Alayande
- General Surgery, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
- Global Health and Population, Harvard School of Public Health, Boston, USA
| | - Callum W Forbes
- Anesthesiology, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Jules Iradakunda
- School of Medicine, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | - Jean Paul Majyambere
- General Surgery, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Surgery, Butaro District Hospital, Kigali, RWA
| | - Matthew T Hey
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Brittany L Powell
- Surgery, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, USA
| | - Juliana Perl
- Biodesign, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | - Natalie McCall
- Division of Clinical Medicine, University of Global Health Equity, Kigali, RWA
| | - Tomlin Paul
- Educational Development and Quality Center, University of Global Health Equity, Kigali, RWA
| | - Jc Allen Ingabire
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
| | - Natnael Shimelash
- Biodesign, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | - Emmanuel Mutabazi
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
| | | | | | | | | | - Claire Karekezi
- Surgery, Neurosurgery Unit, Rwanda Military Hospital, Kigali, RWA
| | - Gabriel Makiriro
- Division of Clinical Medicine, University of Global Health Equity, Kigali, RWA
| | - Simon Pierre Bigirimana
- School of Medicine, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | - James G Harelimana
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
| | | | | | | | - Ornella Masimbi
- Simulation, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | | | - Frederick Ntabana
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
| | - Billy Thomson Haonga
- Orthopaedic Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TZA
| | - Geoffrey A Anderson
- Trauma, Burns, and Critical Care, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
- Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, USA
| | - Jean Claude Byringyiro
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
- Orthopedics, University Teaching Hospital of Kigali, Kigali, RWA
| | - Faustin Ntirenganya
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
- Surgery, University Teaching Hospital of Kigali, Kigali, RWA
- NIHR Research Hub on Global Surgery, University of Rwanda, Kigali, RWA
| | - Robert R Riviello
- Trauma, Burns, and Critical Care, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
- Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Kigali, RWA
| | - Abebe Bekele
- Cardiothoracic Surgery, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
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8
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Pawlak N, Dart C, Aguilar HS, Ameh E, Bekele A, Jimenez MF, Lakhoo K, Ozgediz D, Roy N, Terfera G, Ademuyiwa AO, Alayande BT, Alonso N, Anderson GA, Anyanwu SNC, Aregawi AB, Bandyopadhyay S, Banu T, Bedada AG, Belachew AG, Botelho F, Bua E, Campos LN, Dodgion C, Drejza M, Durieux ME, Dutta R, Erdene S, Ferreira RV, Gathuya Z, Ghosh D, Jawa RS, Johnson WD, Khan FA, Leon FJN, Long KL, Macleod JBA, Mahajan A, Maine RG, Malolos GZC, McClain CD, Nabukenya MT, Nthumba PM, Nwomeh BC, Ojuka DK, Penny N, Quiodettis MA, Rickard J, Roa L, Salgado LS, Samad L, Seyi-Olajide JO, Smith M, Starr N, Stewart RJ, Tarpley JL, Trostchansky JL, Trostchansky I, Weiser TG, Wobenjo A, Wollner E, Jayaraman S. Academic global surgical competencies: A modified Delphi consensus study. PLOS Glob Public Health 2023; 3:e0002102. [PMID: 37450426 PMCID: PMC10348592 DOI: 10.1371/journal.pgph.0002102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/02/2023] [Indexed: 07/18/2023]
Abstract
Academic global surgery is a rapidly growing field that aims to improve access to safe surgical care worldwide. However, no universally accepted competencies exist to inform this developing field. A consensus-based approach, with input from a diverse group of experts, is needed to identify essential competencies that will lead to standardization in this field. A task force was set up using snowball sampling to recruit a broad group of content and context experts in global surgical and perioperative care. A draft set of competencies was revised through the modified Delphi process with two rounds of anonymous input. A threshold of 80% consensus was used to determine whether a competency or sub-competency learning objective was relevant to the skillset needed within academic global surgery and perioperative care. A diverse task force recruited experts from 22 countries to participate in both rounds of the Delphi process. Of the n = 59 respondents completing both rounds of iterative polling, 63% were from low- or middle-income countries. After two rounds of anonymous feedback, participants reached consensus on nine core competencies and 31 sub-competency objectives. The greatest consensus pertained to competency in ethics and professionalism in global surgery (100%) with emphasis on justice, equity, and decolonization across multiple competencies. This Delphi process, with input from experts worldwide, identified nine competencies which can be used to develop standardized academic global surgery and perioperative care curricula worldwide. Further work needs to be done to validate these competencies and establish assessments to ensure that they are taught effectively.
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Affiliation(s)
- Natalie Pawlak
- Tufts University, Boston, Massachusetts, United States of America
| | - Christine Dart
- Virginia Commonwealth University, Richmond, Virginia, United States of America
| | | | - Emmanuel Ameh
- National Hospital Division of Paediatric Surgery, Abuja, Nigeria
| | - Abebe Bekele
- University of Global Health Equity, Butaro, Rwanda
- Addis Ababa University, Addis Ababa, Ethiopia
| | - Maria F. Jimenez
- Department of Surgery, Hospital Universitario Mayor Mederi, Universidad del Rosario, Bogota, Colombia
| | | | - Doruk Ozgediz
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Nobhojit Roy
- The George Institute for Global Health, New Delhi, India
| | - Girma Terfera
- Univ of Wisconsin, Madison, Wisconsin, United States of America
| | - Adesoji O. Ademuyiwa
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | | | | | | | - Soham Bandyopadhyay
- Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, United Kingdom
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Tahmina Banu
- Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
| | | | | | - Fabio Botelho
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children’s Hospital, Montreal, Canada
- Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Emmanuel Bua
- Busitema University Mbale Hospital, Mbale, Uganda
| | - Leticia Nunes Campos
- Faculty of Medical Sciences, Universidade de Pernambuco, Recife, Pernambuco, Brasil
| | - Chris Dodgion
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Michalina Drejza
- Specialty Trainee in Obstetrics and Gynaecology, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Marcel E. Durieux
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Rohini Dutta
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sarnai Erdene
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | - Dhruva Ghosh
- NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, India
| | | | - Walter D. Johnson
- Loma Linda University, Loma Linda, California, United States of America
| | | | | | - Kristin L. Long
- Univ of Wisconsin, Madison, Wisconsin, United States of America
| | - Jana B. A. Macleod
- Kenyatta University, Nairobi, Kenya
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Anshul Mahajan
- Global Surgery Fellow, WHO Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in LMICs’, Mumbai, India
| | - Rebecca G. Maine
- Department of Surgery, University of Washington, Seattle, Washington, United States of America
| | | | - Craig D. McClain
- Department of Anesthesiology, Critical Care and Pain Medicine, Program in Global Surgery, Harvard Medical School, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | | | - Peter M. Nthumba
- Department of Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Benedict C. Nwomeh
- Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | | | - Norgrove Penny
- Branch for Global Surgical Care, University of British Columbia, Vancouver, Canada
| | | | - Jennifer Rickard
- University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Lina Roa
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Lubna Samad
- Interactive Research and Development (IRD) Global, Singapore, Singapore
| | | | - Martin Smith
- University of the Witwatersrand, Johannesburg, South Africa
| | - Nichole Starr
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Richard J. Stewart
- Global Initiative for Children’s Surgery, Portland, Oregon, United States of America
| | - John L. Tarpley
- Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Vanderbilt University, Nashville, Tennessee, United States of America
| | | | | | - Thomas G. Weiser
- Department of Surgery, Stanford University, Palo Alto, California, United States of America
| | | | - Elliot Wollner
- Peter MacCallum Cancer Center and University of California, San Francisco, San Francisco, California, United States of America
| | - Sudha Jayaraman
- Department of Surgery, Center for Global Surgery, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, United States of America
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Navarro SM, Stewart K, Tessier KM, Berhane A, Alvarado SP, Tafirei T, Abdi H, Keil EJ, Tuttle T, Rickard J. Medical Students' Perceptions of Clinical and Research Training: An International Needs Assessment of 26 Countries. Int J Transl Med Res Public Health 2023; 7:e454. [PMID: 37854359 PMCID: PMC10583816 DOI: 10.21106/ijtmrph.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Objective Despite calls to incorporate research training into medical school curriculum, minimal research has been conducted to elucidate trends in research knowledge, opportunities, and involvement globally. This study aims to: (1) assess medical students' perceptions of the level of training they received on research based on their medical school training, and (2) evaluate the obstacles related to conducting research as part of medical students' training. Methods A 94-question, bilingual survey designed by a small focus group of individuals from medical schools across the globe and administered to medical students from different parts of the world, distributed via social media networks (Twitter, Now X, Facebook) and email distributions via international partnerships from November 1 to December 31, 2020. The survey collected demographic information including age, gender, medical institution and country, degree, year in training, clinical rotations completed, plans for specialization, and additional graduate degrees completed. Statistical analysis included a summary of survey participant characteristics, and a comparison between regions, with a variety of comparison and logistic regression models used. Results A total of 318 medical students from 26 countries successfully completed the survey. Respondents were majority female (60.1%), from Latin America (LA) (53.1%), North America (NA) (28.6%), and Other world regions (Other) (18.2%). Students felt research was an important component of medical training (87.7%), although many reported lacking research support from their institution (47.5%). There were several reported barriers to research, including lack of research opportunities (69.4%), lack of mentors (56.6%), lack of formal training (54.6%), and barriers due to the coronavirus disease 2019 (COVID-19) pandemic (49.3%). Less frequent were barriers related to financial resources (41.6%), physical resources (computer or internet access) (18%), and English language ability (6.9%). Students from Latin America and Other were more likely to report a desire to pursue research later in their medical careers compared with students from North America. Conclusions and Implications for Translation Despite significant interest in research, medical students globally report a lack of formal research training, opportunities, and several barriers to conducting research, including the COVID-19 pandemic. The study highlights the need for student research training internationally and the role of further regional-specific and institutional-specific evaluation of research training needs.
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Affiliation(s)
| | - Kelsey Stewart
- University of Minnesota, Department of Obstetrics and Gynecology, Minneapolis, MN, US
| | - Katelyn M. Tessier
- Masonic Cancer Center, Biostatistics Core, University of Minnesota, Minneapolis, MN, US
| | - Aemon Berhane
- Medicine at College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Tavonga Tafirei
- National University of Science and Technology, Zimbabwe, Bulawayo, Zimbabwe
| | - Hodan Abdi
- Brigham and Women’s Hospital, Department of Surgery, Boston, MA
| | - Evan J. Keil
- University of Michigan, Department of Obstetrics, Ann Arbor, MI, US
| | - Todd Tuttle
- University of Minnesota, Department of Surgery, Minneapolis, MN, US
| | - Jennifer Rickard
- University of Minnesota, Department of Surgery, Minneapolis, MN, US
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
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Adisa A, Bahrami-Hessari M, Bhangu A, George C, Ghosh D, Glasbey J, Haque P, Ingabire JCA, Kamarajah SK, Kudrna L, Ledda V, Li E, Lillywhite R, Mittal R, Nepogodiev D, Ntirenganya F, Picciochi M, Simões JFF, Booth L, Elliot R, Kennerton AS, Pettigrove KL, Pinney L, Richard H, Tottman R, Wheatstone P, Wolfenden JWD, Smith A, Sayed AE, Goswami AG, Malik A, Mclean AL, Hassan A, Nazimi AJ, Aladna A, Abdelgawad A, Saed A, Abdelmageed A, Ghannam A, Mahmoud A, Alvi A, Ismail A, Adesunkanmi A, Ebrahim A, Al-Mallah A, Alqallaf A, Durrani A, Gabr A, Kirfi AM, Altaf A, Almutairi A, Sabbagh AJ, Ajiya A, Haddud A, Alnsour AAM, Singh A, Mittal A, Semple A, Adeniran A, Negussie A, Oladimeji A, Muhammad AB, Yassin A, Gungor A, Tarsitano A, Soibiharry A, Dyas A, Frankel A, Peckham-Cooper A, Truss A, Issaka A, Ads AM, Aderogba AA, Adeyeye A, Ademuyiwa A, Sleem A, Papa A, Cordova A, Appiah-Kubi A, Meead A, Nacion AJD, Michael A, Forneris AA, Duro A, Gonzalez AR, Altouny A, Ghazal A, Khalifa A, Ozair A, Quzli A, Haddad A, Othman AF, Yahaya AS, Elsherbiny A, Nazer A, Tarek A, Abu-Zaid A, Al-Nusairi A, Azab A, Elagili A, Elkazaz A, Kedwany A, Nuhu AM, Sakr A, Shehta A, Shirazi A, Mohamed AMI, Sherif AE, Awad AK, Abbas AM, Abdelrahman AS, Ammar AS, Azzam AY, Ciftci AB, Dural AC, Sanli AN, Rahy-Martín AC, Tantri AR, Khan A, Al-Touny A, Tariq A, Gmati A, Costas-Chavarri A, Auerkari A, Landaluce-Olavarria A, Puri A, Radhakrishnan A, Ubom AE, Pradhan A, Turna A, Adepiti A, Kuriyama A, Kassam AF, Hassouneh A, El-Hussuna A, Habeebullah A, Ads AM, Mousli A, Biloslavo A, Hoang A, Kirk A, Santini A, Melero AV, Calvache AJN, Baduell A, Chan A, Abrate A, Balduzzi A, Sánchez AC, Navarrete-Peón A, Porcu A, Brolese A, Barranquero AG, Saibene AM, Adam AA, Vagge A, Maquilón AJ, Leon-Andrino A, Sekulić A, Trifunovski A, Mako A, Bedada AG, Broglia A, Coppola A, Giani A, Grandi A, Iacomino A, Moro A, D’amico A, Malagnino A, Tang A, Doyle A, Alfieri A, Haynes A, Wilkins A, Baldwin A, Heriot A, Laird A, Lazarides A, O'connor A, Trulson A, Rokohl AC, Caziuc A, Triantafyllou A, Anesi A, Nikova A, Andrianakis A, Charalabopoulos A, Tsolakidis A, Chirca A, Arnaud AP, Narvaez-Rojas AR, Kavalakat A, Spina A, Recordare A, Annicchiarico A, Conti A, Mohammed AD, Kocataş A, Almhimid A, Arnaout A, Fahmy A, Mangi A, Modabber A, Ulas AB, Mohamedahmed AYY, Frontali A, Moynihan A, Yunus A, Ahmad A, Kent AJ, Khamees A, Ugwu AO, Turan A, Mohammed AAK, Navarro-Barrios A, Yebes A, De Sousa ÁFL, Moreno A, Sethi A, Dawson AC, Othman AAA, Kaur A, Wolde A, Antonelli A, Scifo A, Alhamad A, Davis A, Alderazi A, Harky A, Mohammed-Durosinlorun A, Seguya A, Okhakhu A, Chamakhi A, Sebai A, Souadka A, Asla A, Agrawal A, Persad A, Gupta A, Elgazar A, Kulkarni A, Coates A, Bellés AC, Hadzibegovic AD, Jotic A, Kowark A, Martins A, Pineda AM, Peral A, Gollarte AS, Senent-Boza A, Camarena AIA, Castaño-Leon AM, Bravo AMM, Moro AMG, Musina AM, Tapia-Herrero AM, Kothari A, Gupta A, Raja A, Aljaiuossi A, Taha A, Majbar AM, Prodromidou A, Kanatas A, Gupte A, Zakaria AD, Balla A, Barberis A, Bondurri A, Bottari A, Costantino A, Figus A, Lauretta A, Mingoli A, Romanzi A, Sagnotta A, Scacchi A, Picchetto A, Valadez AEC, Luzzi AP, Älgå A, Fontalis A, Hecker A, Demetriades AK, Serban AM, Văcărașu AB, Cokan A, Isaza-Restrepo A, Beamish A, Schache A, Stevenson A, Yiu A, Cockbain AJ, Litvin A, Abad-Motos A, Becerra A, Ramos ÁC, Chiaradia A, Dell A, Romano A, Pascale A, Marra AA, Dimas A, Kolias A, Cerovac A, Koneru A, Tidjane A, Agbeko AE, Bajaj A, Gosain A, Allan A, Carreras-Castañer A, D'amore A, Dare A, Maffioli A, Palepa A, Paspala A, Konney A, Gatta AND, Ezanno AC, Yiallourou A, Kinnair A, Rayner A, Scafa AK, Bowan AB, Veglia A, Russo A, Maniaci A, Castaldi A, Gil-Moreno A, Maffuz-Aziz A, Meola A, Nenna A, Ferrer AP, Bonilla AR, Ramos-De La Medina A, Infante AR, Santoro A, Laganà AS, Bateman A, Michael ALR, Abozid A, Seidu AS, Lowery A, Tantraworasin A, Rasheed A, Picciariello A, Isik A, Saif A, Anjum A, Ioannidis A, Abeldaño A, Hussain A, Nathan A, Bedzhanyan A, Perfecto A, De Virgilio A, Galvan A, Sablotzki A, Böttcher A, Pellacani A, Gatti A, Ibrahimli A, Menon A, Sahni A, Mwenda AS, Choudhry A, Jayawardane A, Gupta A, Ramasamy A, Mitul AR, Bawa A, Nugur A, Rammohan A, Sachdeva A, Mehraj A, Yildirim A, Alqaseer A, Radwan A, Sallam A, Syllaios A, Tampakis A, Alwael A, Samara A, Eroglu A, Rahman A, Ulkucu A, Zaránd A, Dulskas A, Tawiah A, Zani A, Vas A, Lukosiute-Urboniene A, Adamu A, Aujayeb A, Malik AA, İplikçi A, Mahmud A, Cil AP, Makanjuola A, Akwaisah A, Galandarova A, Saracoglu A, Regan A, Barlas AM, Alhassan BAB, Mostafa B, Hamida BB, Torun BC, Abdullah B, Balagobi B, Banky B, Singh B, Alegbeleye B, Yigit B, Hajjaj BN, Burgos-Blasco B, Seeliger B, Alayande B, Alhazmi B, Enodien B, Torre B, Pérez BG, Tamayo BV, De Andrés-Asenjo B, Quintana-Villamandos B, Girgin B, Barmayehvar B, Beisenov B, Creavin B, Dunne B, Marson B, Waterson B, Martin B, Zucker B, Wong BNX, Ozmen BB, Hammond B, Mbwele B, Núñez B, Dhondt B, Gafsi B, Mcleish B, Lieske B, Tailor B, La Pira B, Picardi B, Zampogna B, Casagranda B, Festa BM, Panda B, Kirmani B, Sulaiman B, Gurung B, Zacharia B, Bette B, Ayana B, Nikolovska B, Vilaró BC, De Vega Sánchez B, Hameed BZ, Diaconescu B, Kovacevic B, Bumber B, Sakakushev B, Tadic B, Malek B, Alrayes B, Thomas B, Gális B, Gallagher B, Knowles B, Cunningham B, Daley B, Mishra B, Ashford B, Pirozzi BM, Berselli B, Martinez-Leo B, Sensi B, Nardo B, Celik B, Giray B, Abud B, Almiqlash B, Pramesh CS, Taskiran C, De Campos Prado CA, Cipolla C, Kumar C, English C, Riccetti C, Vanni C, Brasset C, Downey C, Duffy C, Chwat C, Cutmore C, Sars C, Ratto C, Pacilio CA, De La Infiesta García C, Moreno CG, Magalhães C, Prada C, Zapata CS, Senni C, Flumignan CDQ, Martinez-Perez C, Duarte CL, Garcia CSR, Anderson C, Hing C, Cullinane C, Cina C, Zabkiewicz C, Sohrabi C, Guldogan CE, Ciubotaru C, Desai C, Raut C, Demetriou C, Handford C, Okpani C, Paranjape C, Koh C, Khatri C, Parmar C, Mok CW, Caricato C, Marafante C, Echieh CP, Tan CY, Ong CS, Conso C, Jardinez C, Konrads C, Warner C, Makwe CC, Henein C, Fleming C, Roland CL, Maurus C, Nitschke C, Mittermair C, Mallmann C, Andro C, Harmston C, Kuppler C, Lotz C, Nahm C, Rowe C, Ryalino C, Wallis C, Millward CP, Anthoulakis C, Apostolou C, Chouliaras C, Kalfountzos C, Kaselas C, Vosinakis C, Okereke C, Chean CS, Barlow C, Tatar C, Clancy C, Forde C, Sharpin C, Mccarthy C, Nestor C, Warden C, Ávila CC, Massaguer C, Fang CEH, Martins CP, Guerci C, Mauriello C, Holzmeister C, Miller C, Weber C, Wiesinger CG, Kenington C, Noel C, Sue-Chue-Lam C, Adumah C, Neary C, Sen C, Fitzgerald C, Ezeme C, Nastos C, Mesina C, Bombardini C, Torregrosa C, Valdespino CP, Don CP, Wickramasinghe D, Milanesi D, Armijos D, Asiimwe D, Beswick D, Clerc D, Cox D, Doherty D, Martínez DF, Lechuga DG, Gero D, Gil-Sala D, Lindegger D, Reim D, Shaerf D, Shmukler D, Branzan D, Filipescu D, Rega D, Bernardi D, Bissacco D, Fusario D, Morezzi D, Sabella D, Zimak DM, Vinci D, Sale D, Khan DZ, Thereska D, Andreotti D, Tartaglia D, Abdulai DR, Mukherjee D, Verdi D, Idowu D, John D, Johnson D, Moro-Valdezate D, Naumann D, Omar D, Proud D, Roberts D, Guzmán DS, Watson D, Bergkvist DJ, Lumenta DB, Ferrari D, Rizzo D, Degarege D, Castillo DFC, Douglas D, Wright D, Nanjiani D, Bratus D, Altun D, Sievers D, Vaysburg D, Katechia D, Ghosh D, Azize DA, Rodrigues D, Pachajoa DAP, Hayne D, Mutter D, Raimondo D, Eskinazi D, Sasia D, Corallino D, Muduly D, Grewal D, Hadzhiev D, Peristeri D, Pournaras D, Raptis DA, Angelou D, Haidopoulos D, Magouliotis D, Moris D, Schizas D, Symeonidis D, Tsironis D, Korkolis D, Tatsis D, Thekkinkattil D, Bulian DR, Pandey D, Vatansever D, Parker D, Wiedemann D, Borselle D, Pedini D, Schweitzer D, Venskutonis D, Otokwala J, Adamu KM, Pk P, Garod M, Ellafi AAD, Zivkovic D, Jelovac D, Wijeysundera D, Mcpherson D, Ryan É, Ugwu E, Baidoo EI, Shaddad E, Memişoğlu E, Naranjo EPL, Brodkin E, Segalini E, Viglietta E, Hendriks E, Bonci EA, Sá-Marta E, Ortega EN, Gomez EGL, Joviliano EE, Clune E, Horwell E, Mains E, Vasarhelyi E, Caruana EJ, Nevins EJ, Yenli EMTA, Baili E, Lostoridis E, Morgan E, Shiban E, Latif E, Tampaki EC, Ezenwa E, Irune E, Borg E, Eisa E, Gialamas E, Parvez E, Theophilidou E, Toma EA, Arnaoutoglou E, Samadov E, Kantor E, Ulman EA, Colak E, Cassinotti E, Bannone E, Sarjanoja E, Yates E, Vincent E, Lun EWY, Cerovac E, Dif ES, Alkhalifa E, Daketsey E, Fayad EA, Sheikh E, Pontecorvi E, Cammarata E, La Corte E, Rausa E, Odai ED, Guasch E, Cano-Trigueros E, Uldry E, Ros EP, Matthews E, Donmez EE, Giorgakis E, Kapetanakis E, Stamatakis E, Bua E, Schneck E, Nachelleh EA, Ofori EO, Akin E, Gönüllü E, Kirkan EF, Çelik E, Wong E, Capozzi E, Pinotti E, Colás-Ruiz E, González E, Fekaj E, Ohazurike E, Kebede E, Erginöz E, Duran EES, Scott E, Aytac E, Albanese E, Castro EJ, Albayadi E, Kriem E, Siddig E, Otify E, El Tayeb EEABH, Hong EH, Saguil E, Belzile E, Tuyishime E, Panieri E, Martínez EG, Myriokefalitaki E, Wong EG, Samara E, Agbeno EK, Drozdov E, Tokidis E, Shah FA, Barra F, Carbone F, Ferreli F, Marino F, Martinelli F, D'acapito F, Masciello F, Bàmbina F, Issa F, Salameh FT, Kethy F, Mahmood F, Gareb F, Idrees F, Karimian F, Ashraf F, Haji F, Inayat F, Begum F, Nabil F, Rosa F, Haider F, Parray F, Calculli F, Ferracci F, Saraceno F, Coppola F, Coccolini F, Fusini F, Migliorelli F, Pecoraro F, Alconchel F, Coimbra FJF, Trivik-Barrientos F, Naegele F, Almarshad F, Agresta F, Fleming F, Mendoza-Moreno F, Brzeszczyński F, Carannante F, Wu F, Aljanadi F, Hayati F, Campo F, Sorbi F, Milana F, Takeda FR, Shekleton F, Gessler F, Recker F, Grama F, Cherbanyk F, Faponle F, Angelis F, Calabretto F, Gaino F, Toia F, Bianco F, Bussu F, Cammarata F, Castagnini F, Colombo F, Ferrara F, Fleres F, Guerrera F, Litta F, Mongelli F, Pata F, Roscio F, Mulita F, Ardura F, Tejero-Pintor FJ, Calvo FJR, Escobedo FJB, Camacho FJB, Odicino F, Schmitt F, Bloemers F, Hölzle F, Gyamfi FE, Messner F, Koh F, Cáceres F, Smolle-Juettner FM, Herman F, Ayeni F, Djedovic G, De Oliveira GP, Rodrigues G, Wagner G, Bellio G, Giarratano G, Capolupo GT, Budd G, Marom G, Poillucci G, Thiruchandran G, Nicholson G, Groot G, Hoey G, Bass GA, Sachdev G, Agarwal G, Aggarwal G, Cormio G, Mazzarella G, Perrone G, Osterhoff G, Singer G, Dejeu G, Fowler G, Garas G, Gradinariu G, Theodoropoulos G, Tzimas G, Babis G, Wong GKC, Cross GWV, Micha G, Chrysovitsiotis G, Koukoulis G, Peros G, Tsoulfas G, Kapetanios G, Karagiannidis G, Verras GI, Ekwen G, Perrotta G, Petruzzi G, Bertelli G, Calini G, Fiacchini G, Pirola GM, Dolci G, Mendiola G, Baiocchi GL, Palini GM, Prucher GM, D'andrea G, Maggiore G, Cassese G, Franceschini G, Pellino G, Saponaro G, Pattacini GC, Pantuso G, Iannella G, Bonsaana GB, Lever G, Brachini G, Giraudo G, Lisi G, Russo GI, Aprea G, Pascale G, Tomasicchio G, Sandri GBL, Armatura G, Turri G, Zaccaria G, Barugola G, Lantone G, Gasparini G, Iacob G, Sozzi G, Zancana G, Mercante G, Bianco G, Brisinda G, Consorti G, Currò G, Giannaccare G, Palomba G, Pascarella G, Rotunno G, Spriano G, Vizzielli G, Cucinella G, Sica G, Campisi G, Baiocchi G, Guerra GR, Pacheco GMF, Atis G, Augustin G, Šantak G, Chauhan GS, Branagan G, Harris G, Stewart GD, Padmore G, Kocher GJ, Di Franco G, De Jesus Labrador Hernandez G, Christodoulidis G, Neal-Smith G, Yim G, Piozzi GN, Claret G, Yanowsky-Reyes G, Dhaity GD, Cakmak GK, Mohamed G, Kucuk GO, Ancans G, Banipal GS, De Bacco Marangon G, Laporte G, Martinez-Mier G, Recinos G, V GMM, Benshetrit G, Vijgen G, Pickett G, Rodriguez HA, Shiwani H, Derilo H, Awad H, El Assaad H, Raji HO, Hardgrave H, Karakullukcu HK, Abdussalam HO, Mustafa H, Parwaiz H, Khan H, Arbab H, Naga H, Salem H, Ulgur HS, Perez-Chrzanowska H, Greenlee H, Javanmard-Emamghissi H, Lederhuber H, Osman H, Adamou H, Majid HJ, Van Goor H, Spiers HVM, Manesh HF, Mushtaq H, Aljaaly H, Hasan HB, Ahmed HTA, Martinez-Said H, Aguado HJ, Consani H, Chaplin H, Mohan H, Van Vliet H, Lohse HAS, Shah H, Claireaux H, Lule H, Juara H, Abozied H, Bayo HL, Alibrahim H, Kroon HM, Ulman H, Khan H, Yonekura H, Abou-Taleb H, Wong HYF, Carpenter H, Majd HS, Zenha H, Mayer HF, Elghadban H, Abdou H, Elfeki H, Yusefi H, Gomez-Fernandez H, Horsfall HL, Meleiro H, Sungurtekin H, Junior HFL, Moloo H, Bayhan H, Şevi̇k H, Embarek H, Hamid HKS, Pradeep IHDS, Donkin I, Ateca IV, Jafarov I, Salisu I, Abdalaal I, Garzali IU, Sall I, Adebara I, Aghadi I, Ugwu I, Zapardiel I, Reis I, Nwafor I, Fakhradiyev I, Surya IU, Robo I, Njokanma I, Iannone I, Khan I, Correia I, Königsrainer I, Seiwerth I, Linero IB, Kadiri I, Florian IA, Tzima I, Akrida I, Baloyiannis I, Gerogiannis I, Katsaros I, Tsakiridis I, Valioulis I, Negoi I, Yadev I, De Haro Jorge I, Vázquez IO, Dajti I, Russo IS, Afzal I, Wasserman I, Chukwu I, Gracia I, Oliver IM, Hughes I, Mondi I, Ncogoza I, Bsisu I, Rashid I, Balasubramanian I, Omar I, Dominguez-Rosado I, Smati I, Vokshi I, Al-Badawi IA, Saleh IA, 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Balogh ZJ. Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries. Br J Surg 2023; 110:804-817. [PMID: 37079880 PMCID: PMC10364528 DOI: 10.1093/bjs/znad092] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. METHODS This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. RESULTS In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. CONCLUSION This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries.
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Sartelli M, Boermeester MA, Cainzos M, Coccolini F, de Jonge SW, Rasa K, Dellinger EP, McNamara DA, Fry DE, Cui Y, Delibegovic S, Demetrashvili Z, De Simone B, Gkiokas G, Hardcastle TC, Itani KMF, Isik A, Labricciosa FM, Lohsiriwat V, Marwah S, Pintar T, Rickard J, Shelat VG, Catena F, Barie PS. Six Long-Standing Questions about Antibiotic Prophylaxis in Surgery. Antibiotics (Basel) 2023; 12:antibiotics12050908. [PMID: 37237811 DOI: 10.3390/antibiotics12050908] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Surgical site infections (SSIs) are the most common adverse event occurring in surgical patients. Optimal prevention of SSIs requires the bundled integration of a variety of measures before, during, and after surgery. Surgical antibiotic prophylaxis (SAP) is an effective measure for preventing SSIs. It aims to counteract the inevitable introduction of bacteria that colonize skin or mucosa into the surgical site during the intervention. This document aims to guide surgeons in appropriate administration of SAP by addressing six key questions. The expert panel identifies a list of principles in response to these questions that every surgeon around the world should always respect in administering SAP.
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Affiliation(s)
| | - Marja A Boermeester
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 1105AZ Amsterdam, The Netherlands
| | - Miguel Cainzos
- Department of Surgery, Hospital Clínico Universitario, 15706 Santiago de Compostela, Spain
| | - Federico Coccolini
- Department of Emergency and Trauma Surgery, Pisa University Hospital, University of Pisa, 55126 Pisa, Italy
| | - Stijn W de Jonge
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 1105AZ Amsterdam, The Netherlands
| | - Kemal Rasa
- Department of Surgery, Anadolu Medical Center, 41200 Kocaeli, Turkey
| | | | - Deborah A McNamara
- Department of Colorectal Surgery, Beaumont Hospital, D09V2N0 Dublin, Ireland
| | - Donald E Fry
- Department of Surgery, Northwestern University, Chicago, IL 60208, USA
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin 300100, China
| | - Samir Delibegovic
- Department of Surgery, University Clinical Center of Tuzla, 75000 Tuzla, Bosnia and Herzegovina
| | - Zaza Demetrashvili
- Department General Surgery, Kipshidze Central University Hospital, Tbilisi 0162, Georgia
| | - Belinda De Simone
- Department of Emergency and Metabolic Minimally Invasive Surgery, Centre Hospitalier Intercommunal de Poissy/Saint Germain en Laye, 78300 Poissy CEDEX, France
| | - George Gkiokas
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Timothy C Hardcastle
- Department of Surgery, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, Mayville 4058, South Africa
| | - Kamal M F Itani
- Department of Surgery, VA Boston Health Care System, Boston University and Harvard Medical School, Boston, MA 02118, USA
| | - Arda Isik
- Division of General Surgery, School of Medicine, Istanbul Medeniyet University, 34700 Istanbul, Turkey
| | | | - Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Sanjay Marwah
- Department of Surgery, BDS Post-Graduate Institute of Medical Sciences, Rohtak 124001, India
| | - Tadeja Pintar
- Department of Abdominal Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Vishal G Shelat
- Department of Hepato-Pancreatic-Biliary Surgery, Tan Tok Seng Hospital, Singapore 308433, Singapore
| | - Fausto Catena
- Department of Surgery, "Bufalini" Hospital, 47023 Cesena, Italy
| | - Philip S Barie
- Department of Surgery, Weill Cornell Medicine, E. Northport, New York, NY 11731, USA
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Zhou Q, Meng W, Ren Y, Li Q, Boermeester MA, Nthumba PM, Rickard J, Zheng B, Liu H, Shi Q, Zhao S, Wang Z, Liu X, Luo Z, Yang K, Chen Y, Sawyer RG. Effectiveness of intraoperative peritoneal lavage with saline in patient with intra-abdominal infections: a systematic review and meta-analysis. World J Emerg Surg 2023; 18:24. [PMID: 36991507 DOI: 10.1186/s13017-023-00496-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
Intraoperative peritoneal lavage (IOPL) with saline has been widely used in surgical practice. However, the effectiveness of IOPL with saline in patients with intra-abdominal infections (IAIs) remains controversial. This study aims to systematically review randomized controlled trials (RCTs) evaluating the effectiveness of IOPL in patients with IAIs.
Methods
The databases of PubMed, Embase, Web of Science, Cochrane library, CNKI, WanFang, and CBM databases were searched from inception to December 31, 2022. Random-effects models were used to calculate the risk ratio (RR), mean difference, and standardized mean difference. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the quality of the evidence.
Results
Ten RCTs with 1318 participants were included, of which eight studies on appendicitis and two studies on peritonitis. Moderate-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (0% vs. 1.1%; RR, 0.31 [95% CI, 0.02–6.39]), intra-abdominal abscess (12.3% vs. 11.8%; RR, 1.02 [95% CI, 0.70–1.48]; I2 = 24%), incisional surgical site infections (3.3% vs. 3.8%; RR, 0.72 [95% CI, 0.18–2.86]; I2 = 50%), postoperative complication (11.0% vs. 13.2%; RR, 0.74 [95% CI, 0.39–1.41]; I2 = 64%), reoperation (2.9% vs. 1.7%; RR,1.71 [95% CI, 0.74–3.93]; I2 = 0%) and readmission (5.2% vs. 6.6%; RR, 0.95 [95% CI, 0.48–1.87]; I2 = 7%) in patients with appendicitis when compared to non-IOPL. Low-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (22.7% vs. 23.3%; RR, 0.97 [95% CI, 0.45–2.09], I2 = 0%) and intra-abdominal abscess (5.1% vs. 5.0%; RR, 1.05 [95% CI, 0.16–6.98], I2 = 0%) in patients with peritonitis when compared to non-IOPL.
Conclusion
IOPL with saline use in patients with appendicitis was not associated with significantly decreased risk of mortality, intra-abdominal abscess, incisional surgical site infection, postoperative complication, reoperation, and readmission compared with non-IOPL. These findings do not support the routine use of IOPL with saline in patients with appendicitis. The benefits of IOPL for IAI caused by other types of abdominal infections need to be investigated.
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13
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Forrester JD, Bekele A, Stefan AM, Tshokey T, Berndtson AE, Beyene RT, Chou J, Sawyer RG, Valenzuela JY, Rickard J. Components of Existing National Surgical Site Infection Surveillance Programs Based on a Case Series of Low- and Middle-Income Countries: Building Blocks for Success and Opportunities for Improvement. Surg Infect (Larchmt) 2023; 24:112-118. [PMID: 36629853 DOI: 10.1089/sur.2022.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Surgical site infection (SSI) surveillance programs are recommended to be included in national infection prevention and control (IPC) programs, yet few exist in low- or middle-income countries (LMICs). Our goal was to identify components of surveillance in existing programs that could be replicated elsewhere and note opportunities for improvement to build awareness for other countries in the process of developing their own national surgical site infection surveillance (nSSIS) programs. Methods: We administered a survey built upon the U.S. Centers for Disease Control and Prevention's framework for surveillance system evaluation to systematically deconstruct logistical infrastructure of existing nSSIS programs in LMICs. Qualitative analyses of survey responses by thematic elements were used to identify successful surveillance system components and recognize opportunities for improvement. Results: Three respondents representing countries in Europe and Central Asia, sub-Saharan Africa, and South Asia designated as upper middle-income, lower middle-income, and low-income responded. Notable strengths described by respondents included use of local paper documentation, staggered data entry, and limited data entry fields. Opportunities for improvement included outpatient data capture, broader coverage of healthcare centers within a nation, improved audit processes, defining the denominator of number of surgical procedures, and presence of an easily accessible, free SSI surveillance training program for healthcare workers. Conclusions: Outpatient post-surgery surveillance, national coverage of healthcare facilities, and training on how to take local SSI surveillance data and integrate it within a broader nSSIS program at the national level remain areas of opportunities for countries looking to implement a nSSIS program.
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Affiliation(s)
- Joseph D Forrester
- Section of Acute Care Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Abebe Bekele
- School of Medicine, University of Global Health Equity, Kigali, Rwanda
| | | | - Tshokey Tshokey
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Allison E Berndtson
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California, San Diego, San Diego, California, USA
| | - Robel T Beyene
- Division of Acute Care Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Jesse Chou
- Department of Plastic and Maxillofacial Surgery, University of Virginia, Charlottesville, Virgina, USA
| | - Robert G Sawyer
- Department of Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Julie Y Valenzuela
- Department of Surgery, Jamaica Hospital Medical Center, New York, New York, USA
| | - Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Bonane A, Nshimiyimana A, Nzeyimana I, Nyirimodoka A, Nyirimodoka A, Muhawenimana A, Hategekimana T, Rickard J. Predictors of delayed consultation in undescended testis patients at a Rwandan referral hospital. rmj 2022. [DOI: 10.4314/rmj.v79i4.8] [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: 02/05/2023]
Abstract
INTRODUCTION: Delayed management of undescended testes (UDT) is associated with an increased risk of malignancy and impaired fertility. To identify causes of delayed consultation of patients with UDT at a Rwandan referral hospitalMETHODS: This was a retrospective study of patients with delayed UDT presentations from 2012 to 2016. A delayed UDT presentation was defined as any patient presenting with UDT at >1 year of age. RESULTS: There were 44 cases of delayed UDT presentations. Most patients (n = 35, 79.5%) were born at a hospital; the rest (n = 9, 20.5%) were born at home. The patient’s parent with higher education in the family was considered. Most of the patients’ parents (n = 29, 65.9%) had a primary education, 6 (13.6%) had a secondary education (high school graduate), 1 (2.3%) had a university education, and 8 (18.2%) never went to school. The reported reasons for delays as they appear in the patient chart were 16 (36.4%) patients due to ignorance, 12 (27.3%) due to poor physical examination at birth, 7 (15.9%) due to poor guidance, 4 (9.0%) due to poverty and 5 (11.4%) due to long appointments. There were no overlapping reasons for delay reported. Patients born at home were more likely to identify ignorance as a reason for the delay (p = 0.007). Of the 16 patients who reported a delay due to ignorance, 12 of their parents had primary education, and 3 had no education. Most (n = 34, 77.3%) patients were fertile in adulthood, but 9 (20.4%) presented with infertility and 1 (2.3%) presented with testicular torsion. CONCLUSION: A number of reasons are responsible for delayed consultation in patients with UDT, including ignorance, poor physical examination, poor guidance, and poverty. Most of the causes are preventable. The urgent need for awareness of UDT and collaboration between physicians is paramount for early consult and management.
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Twahirwa I, Ndayiragije C, Nyundo M, Rickard J, Ntaganda E. Pediatric intestinal obstruction: analysis of etiologies and factors influencing short-term outcomes in Rwanda. World J Pediatr Surg 2022; 5:e000424. [PMID: 36474731 PMCID: PMC9716890 DOI: 10.1136/wjps-2022-000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 08/07/2022] [Indexed: 11/07/2022] Open
Abstract
Background Intestinal obstruction is a common presentation in pediatric surgical emergencies and presents with different etiologies depending on country or region. Its morbidity and mortality are high in low-income and middle-income countries, with variable influencing factors. The aims of this study were to determine the etiologies, morbidity and mortality of pediatric intestinal obstruction and to assess the factors associated with the outcomes of these conditions in Rwanda. Methods This was a cross-sectional study conducted on pediatric patients with intestinal obstruction in two Rwandan university teaching hospitals. The patients were followed from admission until discharge, and we documented their basic characteristics, diagnosis, operative details and postoperative outcomes. Data were collected using data collection form and were electronically captured and analysed using SPSS software. Results A total of 65 patients were enrolled in this study. They were predominantly male (n=49, 75.4%), and the majority of patients (86.2%) were below age 6 years. Intussusception was the most common etiology (n=22, 33.8%). Other common etiologies were Hirschsprung's disease (n=13, 20%), incarcerated inguinal and umbilical hernias (n=6, 9.2%), intestinal worms' impaction (n=5, 7.7%) and adhesions (n=5, 7.7%). Mortality and morbidity were 9.2% and 39.7%, respectively. The most common complications were surgical site infection (n=6, 9.5%) and sepsis (n=6, 9.5%). Preoperative anemia (p=0.001), finding of gangrenous bowels (p=0.003) and bowel resection at the time of laparotomy (p=0.039) were factors associated with postoperative complications. Conclusions The etiologies of intestinal obstruction are variable and common in children below 6 years in Rwanda. The associated morbidly is high and is influenced by the preoperative anemia, finding of gangrenous bowels and bowel resection.
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Affiliation(s)
- Isaie Twahirwa
- Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | | | - Martin Nyundo
- Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
- Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Jennifer Rickard
- Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
- Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Edmond Ntaganda
- Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
- Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
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16
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Frostad JJ, Nguyen QP, Baumann MM, Blacker BF, Marczak LB, Deshpande A, Wiens KE, LeGrand KE, Johnson KB, Abbasi-Kangevari M, Abdoli A, Abolhassani H, Abreu LG, Abrigo MRM, Abu-Rmeileh NME, Adekanmbi V, Agrawal A, Ahmed MB, Al-Aly Z, Alanezi FM, Alcalde-Rabanal JE, Alipour V, Altirkawi KA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amegah AK, Amini S, Amiri F, Amugsi DA, Ancuceanu R, Andrei CL, Andrei T, Antriyandarti E, Anvari D, Arabloo J, Arab-Zozani M, Athari SS, Ausloos M, Ayano G, Aynalem YA, Azari S, Badiye AD, Baig AA, Balakrishnan K, Banach M, Basu S, Bedi N, Bell ML, Bennett DA, Bhattacharyya K, Bhutta ZA, Bibi S, Bohlouli S, Boufous S, Bragazzi NL, Braithwaite D, Burugina Nagaraja S, Butt ZA, Caetano dos Santos FL, Car J, Cárdenas R, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Cerin E, Chattu SK, Chattu VK, Chaturvedi P, Chaturvedi S, Chen S, Chu DT, Chung SC, Dahlawi SMA, Damiani G, Dandona L, Dandona R, Darwesh AM, Das JK, Dash AP, Dávila-Cervantes CA, De Leo D, De Neve JW, Demissie GD, Denova-Gutiérrez E, Dey S, Dharmaratne SD, Dhimal M, Dhungana GP, Diaz D, Dipeolu IO, Dorostkar F, Doshmangir L, Duraes AR, Edinur HA, Efendi F, El Tantawi M, Eskandarieh S, Fadhil I, Fattahi N, Fauk NK, Fereshtehnejad SM, Folayan MO, Foroutan M, Fukumoto T, Gaidhane AM, Ghafourifard M, Ghashghaee A, Gilani SA, Gill TK, Goulart AC, Goulart BNG, Grada A, Gubari MIM, Guido D, Guo Y, Gupta RD, Gupta R, Gutiérrez RA, Hafezi-Nejad N, Hamadeh RR, Hasaballah AI, Hassanipour S, Hayat K, Heibati B, Heidari-Soureshjani R, Henry NJ, Herteliu C, Hosseinzadeh M, Hsairi M, Hu G, Ibitoye SE, Ilesanmi OS, Ilic IM, Ilic MD, Irvani SSN, Islam SMS, Iwu CCD, Jaafari J, Jakovljevic M, Javaheri T, Jha RP, Ji JS, Jonas JB, Kabir A, Kabir Z, Kalhor R, Kamyari N, Kanchan T, Kapil U, Kapoor N, Kayode GA, Keiyoro PN, Khader YS, Khalid N, Khan EA, Khan M, Khan MN, Khatab K, Khater MM, Khatib MN, Khayamzadeh M, Khubchandani J, Kim GR, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Knibbs LD, Koul PA, Koyanagi A, Krishan K, Kumar GA, Kumar M, Kusuma D, La Vecchia C, Lacey B, Lami FH, Lan Q, Lasrado S, Lauriola P, Lee PH, Lewycka S, Li S, Machado DB, Mahasha PW, Maheri M, Majeed A, Maleki A, Malekzadeh R, Malta DC, Mansouri B, Mansournia MA, Martinez NM, Martini S, Martins-Melo FR, Mayala BK, Mehndiratta MM, Mendoza W, Menezes RG, Mengesha EW, Meretoja TJ, Mestrovic T, Michalek IM, Mirrakhimov EM, Mirzaei M, Mirzaei R, Moazen B, Mohammad Y, Mohammadian-Hafshejani A, Mohammed S, Mokdad AH, Monasta L, Moradi-Lakeh M, Moraga P, Morawska L, Mosapour A, Mouodi S, Mousavi Khaneghah A, Mukhopadhyay S, Munro SB, Murray CJL, Nagarajan AJ, Naghavi M, Nair S, Nangia V, Nascimento BR, Nazari J, Negoi I, Netsere HB, Ngunjiri JW, Nguyen HLT, Noubiap JJ, Oancea B, Ogbo FA, Oh IH, Olagunju AT, Olusanya BO, Olusanya JO, Omar Bali A, Onwujekwe OE, Otstavnov N, Otstavnov SS, Owolabi MO, P A M, Pandey A, Park EC, Park EK, Patel SK, Pham HQ, Pilgrim T, Pirsaheb M, Pokhrel KN, Postma MJ, Quazi Syed Z, Rabiee N, Radfar A, Rahim F, Rahman MHU, Rahman MA, Rahmani AM, Ranabhat CL, Rao SJ, Rasella D, Rastogi P, Rath GK, Rawaf DL, Rawaf S, Rawal L, Rawassizadeh R, Renzaho AMN, Reshmi B, Rezaei N, Rezaei N, Rezapour A, Rickard J, Roever L, Ronfani L, Rostamian M, Rubagotti E, Rwegerera GM, Saddik B, Sadeghi E, Saeedi Moghaddam S, Sagar R, Sahebkar A, Sahiledengle B, Salem MR, Samy AM, Santric-Milicevic MM, Saraswathy SYI, Sathian B, Sathish T, Schwebel DC, Sepanlou SG, Shahabi S, Shaheen AA, Shahid I, Shaikh MA, Shalash AS, Shams-Beyranvand M, Shannawaz M, Sharafi K, Sheikh A, Sheikhbahaei S, Shetty RS, Shiferaw WS, Shigematsu M, Shin JI, Shivakumar KM, Siabani S, Siddiqi TJ, Singh BB, Singh JA, Sintayehu Y, Sorrie MB, Soyiri IN, Spurlock EE, Sreeramareddy CT, Stockfelt L, Sufiyan MB, Suliankatchi Abdulkader R, Tabarés-Seisdedos R, Tabuchi T, Taherkhani A, Temsah MH, Thankappan KR, Tovani-Palone MR, Traini E, Ullah S, Unnikrishnan B, Upadhyay E, Valadan Tahbaz S, Varughese S, Violante FS, Vo B, Vu GT, Waheed Y, Wang YP, Welgan CA, Werdecker A, Yahyazadeh Jabbari SH, Yaya S, Yazdi-Feyzabadi V, Yilma MT, Yonemoto N, Younis MZ, Yousefinezhadi T, Yu C, Yu Y, Zaman SB, Zhang Y, Zhang ZJ, Brauer M, Hay SI, Reiner RC. Mapping development and health effects of cooking with solid fuels in low-income and middle-income countries, 2000-18: a geospatial modelling study. Lancet Glob Health 2022; 10:e1395-e1411. [PMID: 36113526 PMCID: PMC9638039 DOI: 10.1016/s2214-109x(22)00332-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/17/2022] [Accepted: 07/21/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehensively analysed. We estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels. METHODS We did a geospatial modelling study to map the prevalence of solid-fuel use for cooking at a 5 km × 5 km resolution in 98 LMICs based on 2·1 million household observations of the primary cooking fuel used from 663 population-based household surveys over the years 2000 to 2018. We use observed temporal patterns to forecast household air pollution in 2030 and to assess the probability of attaining the Sustainable Development Goal (SDG) target indicator for clean cooking. We aligned our estimates of household air pollution to geospatial estimates of ambient air pollution to establish the risk transition occurring in LMICs. Finally, we quantified the effect of residual primary solid-fuel use for cooking on child health by doing a counterfactual risk assessment to estimate the proportion of deaths from lower respiratory tract infections in children younger than 5 years that could be associated with household air pollution. FINDINGS Although primary reliance on solid-fuel use for cooking has declined globally, it remains widespread. 593 million people live in districts where the prevalence of solid-fuel use for cooking exceeds 95%. 66% of people in LMICs live in districts that are not on track to meet the SDG target for universal access to clean energy by 2030. Household air pollution continues to be a major contributor to particulate exposure in LMICs, and rising ambient air pollution is undermining potential gains from reductions in the prevalence of solid-fuel use for cooking in many countries. We estimated that, in 2018, 205 000 (95% uncertainty interval 147 000-257 000) children younger than 5 years died from lower respiratory tract infections that could be attributed to household air pollution. INTERPRETATION Efforts to accelerate the adoption of clean cooking fuels need to be substantially increased and recalibrated to account for subnational inequalities, because there are substantial opportunities to improve air quality and avert child mortality associated with household air pollution. FUNDING Bill & Melinda Gates Foundation.
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Katabogama JB, Mpirimbanyi C, Cyuzuzo T, Muvunyi V, Urimubabo C, Rickard J. Costs Associated With Surgical Infections at a Tertiary Referral Hospital in Rwanda. J Surg Res 2022; 280:94-102. [PMID: 35964487 DOI: 10.1016/j.jss.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/04/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In low-income and middle-income countries, there is a high demand for surgical care, although many individuals lack access due to its affordability, availability, and accessibility. Costs are an important metric in healthcare and can influence healthcare access and outcomes. The aim of this study was to determine the financial impact of infections in acute care surgery patients and factors associated with inability to pay the hospital bill at a Rwandan referral hospital. MATERIALS AND METHODS This was a prospective observational study of acute care surgery patients at a tertiary referral hospital in Rwanda with infections. Data were collected on demographics, clinical features, hospital charges, and expenses. Factors associated with inability to pay the hospital bill were analyzed using Chi-squared and Wilcoxon rank sum tests. RESULTS Over 14 mo, 191 acute care surgery patients with infections were enrolled. Most (n = 174, 91%) patients had health insurance. Median total hospital charges were 414.24 United States Dollars (interquartile range [IQR]: 268.20, 797.48) and median patient charges were 41.53 USD (IQR: 17.15, 103.09). At discharge, 53 (28%) patients were unable to pay their hospital bill. On a univariate analysis actors associated with inability to pay the bill included transportation via ambulance, occupation as a farmer, diagnosis, complications, surgical site infection, and length of hospital stay. On a multivariable analysis, intestinal obstruction (adjusted odds ratio 4.56, 95% confidence interval 1.16, 17.95, P value 0.030) and length of hospital stay more than 7 d (adjusted odds ratio 2.95, 95% confidence interval 1.04, 8.34, P value 0.042) were associated with inability to pay the final hospital bill. CONCLUSIONS Although there is broad availability of health insurance in Rwanda, hospital charges and other expenses remain a financial burden for many patients seeking surgical care. Further innovative efforts are needed to mitigate expenses and minimize financial risk.
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Affiliation(s)
| | | | - Thierry Cyuzuzo
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Vital Muvunyi
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Christian Urimubabo
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda; Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Jennifer Rickard
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda; Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda; Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
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Rickard J, Boulware DR, Guan W, Ntirenganya F, Kline S. Has There Been Exacerbation of Disparities in Antimicrobial Resistance during the SARS-Cov-2 Pandemic? Surg Infect (Larchmt) 2022; 23:613-615. [PMID: 35904537 DOI: 10.1089/sur.2022.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jennifer Rickard
- Department of Surgery, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - David R Boulware
- Division of Infectious Disease and International Medicine, Department of Medicine, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Weihua Guan
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Susan Kline
- Division of Infectious Disease and International Medicine, Department of Medicine, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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Gutama B, Wothe JK, Xiao M, Hackman D, Chu H, Rickard J. Splenectomy versus Imaging-Guided Percutaneous Drainage for Splenic Abscess: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2022; 23:417-429. [PMID: 35612434 DOI: 10.1089/sur.2022.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Splenic abscess (SA) is a rare, life-threatening illness that is generally treated with splenectomy. However, this is associated with high mortality and morbidity. Recently, percutaneous drainage (PD) has emerged as an alternative therapy in select patients. In this study, we compare mortality and complications in patients with SA treated with splenectomy versus PD. Patients and Methods: A systematic literature search of 13 databases and online search engines was conducted from 2019 to 2020. A bivariate generalized linear mixed model (BGLMM) was used to conduct a separate meta-analysis for both mortality and complications. We used the risk of bias in non-randomized studies of interventions (ROBINS-I) tool to evaluate risk of bias in non-randomized studies, and the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach for assessing quality of evidence and strength of recommendations. Results were presented according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results: The review included 46 retrospective studies from 21 countries. For mortality rate, 27 studies compared splenectomy and PD whereas 10 used PD only and nine used splenectomy only. Data for major complications were available in 18 two-arm studies, seven single-arm studies with PD, and seven single-arm studies with splenectomy. Of a total of 589 patients, 288 were treated with splenectomy and 301 underwent PD. Mortality rate was 12% (95% confidence interval [CI], 8%-17%) in patients undergoing splenectomy compared with 8% (95% CI, 4%-13%) with PD. Complication rates were 26% (95% CI, 16%-37%) in the splenectomy group compared with 10% (95% CI, 4%-17%) in the PD group. Conclusions: Percutaneous drainage s associated with a trend toward lower complications and mortality rates compared with splenectomy in the treatment of SA, however, these findings were not statistically significant. Because of the heterogeneity of the data, further prospective studies are needed to draw definitive conclusions.
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Affiliation(s)
- Barite Gutama
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Jillian K Wothe
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Mengli Xiao
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Dawn Hackman
- University of Minnesota Health Sciences Library, Minneapolis, Minnesota, USA
| | - Haitao Chu
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Pohl L, Naidoo M, Rickard J, Abahuje E, Kariem N, Engelbrecht S, Kloppers C, Sibomana I, Chu K. Surgical Trainee Supervision During Non-Trauma Emergency Laparotomy in Rwanda and South Africa. J Surg Educ 2021; 78:1985-1992. [PMID: 34183277 DOI: 10.1016/j.jsurg.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/21/2021] [Accepted: 05/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The primary objective was to describe the level of surgical trainee autonomy during non-trauma emergency laparotomy (NTEL) operations in Rwanda and South Africa. The secondary objective was to identify potential associations between trainee autonomy, and patient mortality and reoperation. DESIGN, SETTING, AND PARTICIPANTS This was a prospective, observational study of NTEL operations at 3 teaching hospitals in South Africa and Rwanda over a 1-year period from September 1, 2017 to August 31, 2018. The study included 543 NTEL operations performed by the acute care and general surgery services on adults over the age of 18 years. RESULTS Surgical trainees led 3-quarters of NTEL operations and, of these, 72% were performed autonomously in Rwanda and South Africa. Notably, trainee autonomy was not significantly associated with reoperation or mortality. CONCLUSIONS Trainees were able to gain autonomous surgical experience without impacting mortality or reoperation outcomes, while still providing surgical support in a high-demand setting.
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Affiliation(s)
- Linda Pohl
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Megan Naidoo
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Jennifer Rickard
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda; Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Egide Abahuje
- Department of Surgery, University of Rwanda, Kigali, Rwanda; Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nazmie Kariem
- Department of Surgery, University of Cape Town, Cape Town, South Africa; Department of Surgery, New Somerset Hospital, Cape Town, South Africa
| | | | - Christo Kloppers
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Isaie Sibomana
- Department of Surgery, University of Rwanda, Kigali, Rwanda
| | - Kathryn Chu
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
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21
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Ward JL, Azzopardi PS, Francis KL, Santelli JS, Skirbekk V, Sawyer SM, Kassebaum NJ, Mokdad AH, Hay SI, Abd-Allah F, Abdoli A, Abdollahi M, Abedi A, Abolhassani H, Abreu LG, Abrigo MRM, Abu-Gharbieh E, Abushouk AI, Adebayo OM, Adekanmbi V, Adham D, Advani SM, Afshari K, Agrawal A, Ahmad T, Ahmadi K, Ahmed AE, Aji B, Akombi-Inyang B, Alahdab F, Al-Aly Z, Alam K, Alanezi FM, Alanzi TM, Alcalde-Rabanal JE, Alemu BW, Al-Hajj S, Alhassan RK, Ali S, Alicandro G, Alijanzadeh M, Aljunid SM, Almasi-Hashiani A, Almasri NA, Al-Mekhlafi HM, Alonso J, Al-Raddadi RM, Altirkawi KA, Alvis-Guzman N, Amare AT, Amini S, Aminorroaya A, Amit AML, Amugsi DA, Ancuceanu R, Anderlini D, Andrei CL, Androudi S, Ansari F, Ansari I, Antonio CAT, Anvari D, Anwer R, Appiah SCY, Arabloo J, Arab-Zozani M, Ärnlöv J, Asaad M, Asadi-Aliabadi M, Asadi-Pooya AA, Atout MMW, Ausloos M, Avenyo EK, Avila-Burgos L, Ayala Quintanilla BP, Ayano G, Aynalem YA, Azari S, Azene ZN, Bakhshaei MH, Bakkannavar SM, Banach M, Banik PC, Barboza MA, Barker-Collo SL, Bärnighausen TW, Basu S, Baune BT, Bayati M, Bedi N, Beghi E, Bekuma TT, Bell AW, Bell ML, Benjet C, Bensenor IM, Berhe AK, Berhe K, Berman AE, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhattacharyya K, Bhattarai S, Bhutta ZA, Bijani A, Bikbov B, Biondi A, Birhanu TTM, Biswas RK, Bohlouli S, Bolla SR, Boloor A, Borschmann R, Boufous S, Bragazzi NL, Braithwaite D, Breitborde NJK, Brenner H, Britton GB, Burns RA, Burugina Nagaraja S, Butt ZA, Caetano dos Santos FL, Cámera LA, Campos-Nonato IR, Campuzano Rincon JC, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Catalá-López F, Cerin E, Chandan JS, Chang HY, Chang JC, Charan J, Chattu VK, Chaturvedi S, Choi JYJ, Chowdhury MAK, Christopher DJ, Chu DT, Chung MT, Chung SC, Cicuttini FM, Constantin TV, Costa VM, Dahlawi SMA, Dai H, Dai X, Damiani G, Dandona L, Dandona R, Daneshpajouhnejad P, Darwesh AM, Dávila-Cervantes CA, Davletov K, De la Hoz FP, De Leo D, Dervenis N, Desai R, Desalew A, Deuba K, Dharmaratne SD, Dhungana GP, Dianatinasab M, Dias da Silva D, Diaz D, Didarloo A, Djalalinia S, Dorostkar F, Doshi CP, Doshmangir L, Doyle KE, Duraes AR, Ebrahimi Kalan M, Ebtehaj S, Edvardsson D, El Tantawi M, Elgendy IY, El-Jaafary SI, Elsharkawy A, Eshrati B, Eskandarieh S, Esmaeilnejad S, Esmaeilzadeh F, Esteghamati S, Faro A, Farzadfar F, Fattahi N, Feigin VL, Ferede TY, Fereshtehnejad SM, Fernandes E, Ferrara P, Filip I, Fischer F, Fisher JL, Foigt NA, Folayan MO, Fomenkov AA, Foroutan M, Fukumoto T, Gad MM, Gaidhane AM, Gallus S, Gebre T, Gebremedhin KB, Gebremeskel GG, Gebremeskel L, Gebreslassie AA, Gesesew HA, Ghadiri K, Ghafourifard M, Ghamari F, Ghashghaee A, Gilani SA, Gnedovskaya EV, Godinho MA, Golechha M, Goli S, Gona PN, Gopalani SV, Gorini G, Grivna M, Gubari MIM, Gugnani HC, Guimarães RA, Guo Y, Gupta R, Haagsma JA, Hafezi-Nejad N, Haile TG, Haj-Mirzaian A, Haj-Mirzaian A, Hall BJ, Hamadeh RR, Hamagharib Abdullah K, Hamidi S, Handiso DW, Hanif A, Hankey GJ, Haririan H, Haro JM, Hasaballah AI, Hashi A, Hassan A, Hassanipour S, Hassankhani H, Hayat K, Heidari-Soureshjani R, Herteliu C, Heydarpour F, Ho HC, Hole MK, Holla R, Hoogar P, Hosseini M, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hsairi M, Huda TM, Humayun A, Hussain R, Hwang BF, Iavicoli I, Ibitoye SE, Ilesanmi OS, Ilic IM, Ilic MD, Inbaraj LR, Intarut N, Iqbal U, Irvani SSN, Islam MM, Islam SMS, Iso H, Ivers RQ, Jahani MA, Jakovljevic M, Jalali A, Janodia MD, Javaheri T, Jeemon P, Jenabi E, Jha RP, Jha V, Ji JS, Jonas JB, Jones KM, Joukar F, Jozwiak JJ, Juliusson PB, Jürisson M, Kabir A, Kabir Z, Kalankesh LR, Kalhor R, Kamyari N, Kanchan T, Karch A, Karimi SE, Kaur S, Kayode GA, Keiyoro PN, Khalid N, Khammarnia M, Khan M, Khan MN, Khatab K, Khater MM, Khatib MN, Khayamzadeh M, Khazaie H, Khoja AT, Kieling C, Kim YE, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Kivimäki M, Koolivand A, Kosen S, Koyanagi A, Krishan K, Kugbey N, Kumar GA, Kumar M, Kumar N, Kurmi OP, Kusuma D, La Vecchia C, Lacey B, Lal DK, Lalloo R, Lan Q, Landires I, Lansingh VC, Larsson AO, Lasrado S, Lassi ZS, Lauriola P, Lee PH, Lee SWH, Leigh J, Leonardi M, Leung J, Levi M, Lewycka S, Li B, Li MC, Li S, Lim LL, Lim SS, Liu X, Lorkowski S, Lotufo PA, Lunevicius R, Maddison R, Mahasha PW, Mahdavi MM, Mahmoudi M, Majeed A, Maleki A, Malekzadeh R, Malta DC, Mamun AA, Mansouri B, Mansournia MA, Martinez G, Martinez-Raga J, Martins-Melo FR, Mason-Jones AJ, Masoumi SZ, Mathur MR, Maulik PK, McGrath JJ, Mehndiratta MM, Mehri F, Memiah PTN, Mendoza W, Menezes RG, Mengesha EW, Meretoja A, Meretoja TJ, Mestrovic T, Miazgowski B, Miazgowski T, Michalek IM, Miller TR, Mini GK, Mirica A, Mirrakhimov EM, Mirzaei H, Mirzaei M, Moazen B, Mohammad DK, Mohammadi S, Mohammadian-Hafshejani A, Mohammadifard N, Mohammadpourhodki R, Mohammed S, Monasta L, Moradi G, Moradi-Lakeh M, Moradzadeh R, Moraga P, Morrison SD, Mosapour A, Mousavi Khaneghah A, Mueller UO, Muriithi MK, Murray CJL, Muthupandian S, Naderi M, Nagarajan AJ, Naghavi M, Naimzada MD, Nangia V, Nayak VC, Nazari J, Ndejjo R, Negoi I, Negoi RI, Netsere HB, Nguefack-Tsague G, Nguyen DN, Nguyen HLT, Nie J, Ningrum DNA, Nnaji CA, Nomura S, Noubiap JJ, Nowak C, Nuñez-Samudio V, Ogbo FA, Oghenetega OB, Oh IH, Oladnabi M, Olagunju AT, Olusanya BO, Olusanya JO, Omar Bali A, Omer MO, Onwujekwe OE, Ortiz A, Otoiu A, Otstavnov N, Otstavnov SS, Øverland S, Owolabi MO, P A M, Padubidri JR, Pakshir K, Palladino R, Pana A, Panda-Jonas S, Pandey A, Panelo CIA, Park EK, Patten SB, Peden AE, Pepito VCF, Peprah EK, Pereira J, Pesudovs K, Pham HQ, Phillips MR, Piradov MA, Pirsaheb M, Postma MJ, Pottoo FH, Pourjafar H, Pourshams A, Prada SI, Pupillo E, Quazi Syed Z, Rabiee MH, Rabiee N, Radfar A, Rafiee A, Raggi A, Rahim F, Rahimi-Movaghar V, Rahman MHU, Rahman MA, Ramezanzadeh K, Ranabhat CL, Rao SJ, Rashedi V, Rastogi P, Rathi P, Rawaf DL, Rawaf S, Rawal L, Rawassizadeh R, Renzaho AMN, Rezaei N, Rezaei N, Rezai MS, Riahi SM, Rickard J, Roever L, Ronfani L, Roth GA, Rubagotti E, Rumisha SF, Rwegerera GM, Sabour S, Sachdev PS, Saddik B, Sadeghi E, Saeedi Moghaddam S, Sagar R, Sahebkar A, Sahraian MA, Sajadi SM, Salem MR, Salimzadeh H, Samy AM, Sanabria J, Santric-Milicevic MM, Saraswathy SYI, Sarrafzadegan N, Sarveazad A, Sathish T, Sattin D, Saxena D, Saxena S, Schiavolin S, Schwebel DC, Schwendicke F, Senthilkumaran S, Sepanlou SG, Sha F, Shafaat O, Shahabi S, Shaheen AA, Shaikh MA, Shakiba S, Shamsi M, Shannawaz M, Sharafi K, Sheikh A, Sheikhbahaei S, Shetty BSK, Shi P, Shigematsu M, Shin JI, Shiri R, Shuval K, Siabani S, Sigfusdottir ID, Sigurvinsdottir R, Silva DAS, Silva JP, Simonetti B, Singh JA, Singh V, Sinke AH, Skryabin VY, Slater H, Smith EUR, Sobhiyeh MR, Sobngwi E, Soheili A, Somefun OD, Sorrie MB, Soyiri IN, Sreeramareddy CT, Stein DJ, Stokes MA, Sudaryanto A, Sultan I, Tabarés-Seisdedos R, Tabuchi T, Tadakamadla SK, Taherkhani A, Tamiru AT, Tareque MI, Thankappan KR, Thapar R, Thomas N, Titova MV, Tonelli M, Tovani-Palone MR, Tran BX, Travillian RS, Tsai AC, Tsatsakis A, Tudor Car L, Uddin R, Unim B, Unnikrishnan B, Upadhyay E, Vacante M, Valadan Tahbaz S, Valdez PR, Varughese S, Vasankari TJ, Venketasubramanian N, Villeneuve PJ, Violante FS, Vlassov V, Vos T, Vu GT, Waheed Y, Wamai RG, Wang Y, Wang Y, Wang YP, Westerman R, Wickramasinghe ND, Wu AM, Wu C, Yahyazadeh Jabbari SH, Yamagishi K, Yano Y, Yaya S, Yazdi-Feyzabadi V, Yeshitila YG, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yousefinezhadi T, Yu C, Yu Y, Yuce D, Zaidi SS, Zaman SB, Zamani M, Zamanian M, Zarafshan H, Zarei A, Zastrozhin MS, Zhang Y, Zhang ZJ, Zhao XJG, Zhu C, Patton GC, Viner RM. Global, regional, and national mortality among young people aged 10-24 years, 1950-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2021; 398:1593-1618. [PMID: 34755628 PMCID: PMC8576274 DOI: 10.1016/s0140-6736(21)01546-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [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: 02/14/2021] [Revised: 05/07/2021] [Accepted: 06/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10-24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. METHODS We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10-24 years by age group (10-14 years, 15-19 years, and 20-24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10-24 years with that in children aged 0-9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10-24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). FINDINGS In 2019 there were 1·49 million deaths (95% uncertainty interval 1·39-1·59) worldwide in people aged 10-24 years, of which 61% occurred in males. 32·7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32·1% were due to communicable, nutritional, or maternal causes; 27·0% were due to non-communicable diseases; and 8·2% were due to self-harm. Since 1950, deaths in this age group decreased by 30·0% in females and 15·3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10-14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15-19 years was 1·3% in males and 1·6% in females, almost half that of males aged 1-4 years (2·4%), and around a third less than in females aged 1-4 years (2·5%). The proportion of global deaths in people aged 0-24 years that occurred in people aged 10-24 years more than doubled between 1950 and 2019, from 9·5% to 21·6%. INTERPRETATION Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10-24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group. FUNDING Bill & Melinda Gates Foundation.
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22
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Twahirwa I, Niyonshuti N, Uwase C, Rickard J. Comparison of Outcomes of Emergency Laparotomies Performed During Daytime Versus Nights and Weekends in Rwandan University Teaching Hospitals. World J Surg 2021; 46:61-68. [PMID: 34581844 DOI: 10.1007/s00268-021-06327-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Emergency laparotomy is a common procedure with high morbidity and mortality. The aim of this study was to assess if the time of surgery (day versus night and weekend) affects the morbidity and mortality in a low-resource setting. METHODS A retrospective study was conducted in 2 university teaching hospitals in Rwanda. Patient characteristics, time of laparotomy, operative details and postoperative outcomes were recorded. Chi-square and Wilcoxon rank sum tests were used to determine factors and outcomes associated with time of surgery. Logistic regression was used to determine factors associated with mortality. RESULTS In 309 patients, who underwent emergency laparotomy, 147 (48%) patients were operated during the daytime, 123 (40%) patients were operated during the night shift and 39 (12%) patients were operated on the weekend. Common diagnoses were intestinal obstruction (n = 141, 46%), peritonitis (n = 101, 33%) and abdominal trauma (n = 40, 13%). The overall mortality rate was 16% with 14% in patients operated during day and 17% in patients operated during night and weekends (p = 0.564). Overall, the morbidity rate was 30% with 27% in patients operated during the day compared with 32% in patients operated during night/weekends (p = 0.348). After controlling for confounding factors, there was no association between time of operation and mortality or morbidity. CONCLUSION Morbidity and mortality associated with emergency laparotomy are high but the time of day for emergency laparotomy did not affect outcome in Rwandan referral hospitals.
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Affiliation(s)
- Isaie Twahirwa
- University of Rwanda, Kigali, Rwanda
- University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Norbert Niyonshuti
- University of Rwanda, Kigali, Rwanda
- University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Clement Uwase
- University of Rwanda, Kigali, Rwanda
- University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Jennifer Rickard
- University of Rwanda, Kigali, Rwanda.
- University Teaching Hospital of Kigali, Kigali, Rwanda.
- University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA.
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Mvukiyehe JP, Tuyishime E, Ndindwanimana A, Rickard J, Manzi O, Madden GR, Durieux ME, Banguti PR. Improving hand hygiene measures in low-resourced intensive care units: experience at the Kigali University Teaching Hospital in Rwanda. Int J Infect Control 2021; 17. [PMID: 37275665 PMCID: PMC10237047 DOI: 10.3396/ijic.v17.20585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Background Proper hand hygiene (HH) practices have been shown to reduce healthcare-acquired infections. Several potential challenges in low-income countries might limit the feasibility of effective HH, including preexisting knowledge gaps and staffing. Aim We sought to evaluate the feasibility of the implementation of effective HH practice at a teaching hospital in Rwanda. Methods We conducted a prospective quality improvement project in the intensive care unit (ICU) at the Kigali University Teaching Hospital. We collected data before and after an intervention focused on HH adherence as defined by the World Health Organization '5 Moments for Hand Hygiene' and assuring availability of HH supplies. Pre-intervention data were collected throughout July 2019, and HH measures were implemented in August 2019. Post-implementation data were collected following a 3-month wash-in. Results In total, 902 HH observations were performed to assess pre-intervention adherence and 903 observations post-intervention adherence. Overall, HH adherence increased from 25% (222 of 902 moments) before intervention to 75% (677 of 903 moments) after intervention (P < 0.001). Improvement was seen among all health professionals (nurses: 19-74%, residents: 23-74%, consultants: 29-76%). Conclusions Effective HH measures are feasible in an ICU in a low-income country. Ensuring availability of supplies and training appears key to effective HH practices.
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Affiliation(s)
- Jean Paul Mvukiyehe
- Department of Anesthesia, Critical Care and Emergency Medicine, University of Rwanda, Kigali, Rwanda
| | - Eugene Tuyishime
- Department of Anesthesia, Critical Care and Emergency Medicine, University of Rwanda, Kigali, Rwanda
| | | | - Jennifer Rickard
- Department of Surgery, University of Minnesota, Minnesota, USA
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Olivier Manzi
- Department of Internal Medicine, Kigali University Teaching Hospital, Kigali, Rwanda
| | - Gregory R Madden
- Department of Internal Medicine, Division of Infectious Diseases, University of Virginia, Charlottesville, USA
| | - Marcel E Durieux
- Department of Anesthesiology, University of Virginia, Charlottesville, USA
| | - Paulin R Banguti
- Department of Anesthesia, Critical Care and Emergency Medicine, University of Rwanda, Kigali, Rwanda
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Paulson KR, Kamath AM, Alam T, Bienhoff K, Abady GG, Abbas J, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abd-Elsalam SM, Abdoli A, Abedi A, Abolhassani H, Abreu LG, Abu-Gharbieh E, Abu-Rmeileh NME, Abushouk AI, Adamu AL, Adebayo OM, Adegbosin AE, Adekanmbi V, Adetokunboh OO, Adeyinka DA, Adsuar JC, Afshari K, Aghaali M, Agudelo-Botero M, Ahinkorah BO, Ahmad T, Ahmadi K, Ahmed MB, Aji B, Akalu Y, Akinyemi OO, Aklilu A, Al-Aly Z, Alam K, Alanezi FM, Alanzi TM, Alcalde-Rabanal JE, Al-Eyadhy A, Ali T, Alicandro G, Alif SM, Alipour V, Alizade H, Aljunid SM, Almasi-Hashiani A, Almasri NA, Al-Mekhlafi HM, Alonso J, Al-Raddadi RM, Altirkawi KA, Alumran AK, Alvis-Guzman N, Alvis-Zakzuk NJ, Ameyaw EK, Amini S, Amini-Rarani M, Amit AML, Amugsi DA, Ancuceanu R, Anderlini D, Andrei CL, Ansari F, Ansari-Moghaddam A, Antonio CAT, Antriyandarti E, Anvari D, Anwer R, Aqeel M, Arabloo J, Arab-Zozani M, Aripov T, Ärnlöv J, Artanti KD, Arzani A, Asaad M, Asadi-Aliabadi M, Asadi-Pooya AA, Asghari Jafarabadi M, Athari SS, Athari SM, Atnafu DD, Atreya A, Atteraya MS, Ausloos M, Awan AT, Ayala Quintanilla BP, Ayano G, Ayanore MA, Aynalem YA, Azari S, Azarian G, Azene ZN, B DB, Babaee E, Badiye AD, Baig AA, Banach M, Banik PC, Barker-Collo SL, Barqawi HJ, Bassat Q, Basu S, Baune BT, Bayati M, Bedi N, Beghi E, Beghi M, Bell ML, Bendak S, Bennett DA, Bensenor IM, Berhe K, Berman AE, Bezabih YM, Bhagavathula AS, Bhandari D, Bhardwaj N, Bhardwaj P, Bhattacharyya K, Bhattarai S, Bhutta ZA, Bikbov B, Biondi A, Birihane BM, Biswas RK, Bohlouli S, Bragazzi NL, Breusov AV, Brunoni AR, Burkart K, Burugina Nagaraja S, Busse R, Butt ZA, Caetano dos Santos FL, Cahuana-Hurtado L, Camargos P, Cámera LA, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Cerin E, Chang JC, Chanie WF, Charan J, Chatterjee S, Chattu SK, Chattu VK, Chaturvedi S, Chen S, Cho DY, Choi JYJ, Chu DT, Ciobanu LG, Cirillo M, Conde J, Costa VM, Couto RAS, Dachew BA, Dahlawi SMA, Dai H, Dai X, Dandona L, Dandona R, Daneshpajouhnejad P, Darmstadt GL, Das JK, Dávila-Cervantes CA, Davis AC, Davletov K, De la Hoz FP, De Leo D, Deeba F, Denova-Gutiérrez E, Dervenis N, Desalew A, Deuba K, Dey S, Dharmaratne SD, Dhingra S, Dhungana GP, Dias da Silva D, Diaz D, Dorostkar F, Doshmangir L, Dubljanin E, Duraes AR, Eagan AW, Edinur HA, Efendi F, Eftekharzadeh S, El Sayed I, El Tantawi M, Elbarazi I, Elgendy IY, El-Jaafary SI, Emami A, Enany S, Eyawo O, Ezzikouri S, Faris PS, Farzadfar F, Fattahi N, Fauk NK, Fazlzadeh M, Feigin VL, Ferede TY, Fereshtehnejad SM, Fernandes E, Ferrara P, Filip I, Fischer F, Fisher JL, Foigt NA, Folayan MO, Foroutan M, Franklin RC, Freitas M, Friedman SD, Fukumoto T, Gad MM, Gaidhane AM, Gaidhane S, Gaihre S, Gallus S, Garcia-Basteiro AL, Garcia-Gordillo MA, Gardner WM, Gaspar Fonseca M, Gebremedhin KB, Getacher L, Ghashghaee A, Gholamian A, Gilani SA, Gill TK, Giussani G, Gnedovskaya EV, Godinho MA, Goel A, Golechha M, Gona PN, Gopalani SV, Goudarzi H, Grivna M, Gugnani HC, Guido D, Guimarães RA, Gupta RD, Gupta R, Hafezi-Nejad N, Haider MR, Haj-Mirzaian A, Hamidi S, Hanif A, Hankey GJ, Hargono A, Hasaballah AI, Hasan MM, Hasan SS, Hassan A, Hassanipour S, Hassankhani H, Havmoeller RJ, Hayat K, Heidari-Soureshjani R, Henry NJ, Herteliu C, Hole MK, Holla R, Hossain N, Hosseini M, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Huang J, Humayun A, Hwang BF, Iavicoli I, Ibitoye SE, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Inamdar S, Inbaraj LR, Iqbal K, Iqbal U, Islam MM, Islam SMS, Iso H, Iwagami M, Iwu CCD, Jaafari J, Jacobsen KH, Jagnoor J, Jain V, Janodia MD, Javaheri T, Javanmardi F, Jayaram S, Jayatilleke AU, Jenabi E, Jha RP, Ji JS, John O, Jonas JB, Joo T, Joseph N, Joukar F, Jozwiak JJ, Jürisson M, Kabir A, Kabir Z, Kalankesh LR, Kamyari N, Kanchan T, Kapoor N, Karami Matin B, Karch A, Karimi SE, Kassahun G, Kayode GA, Kazemi Karyani A, Kemmer L, Khalid N, Khalilov R, Khammarnia M, Khan EA, Khan G, Khan M, Khan MN, Khang YH, Khatab K, Khater AM, Khater MM, Khayamzadeh M, Khosravi A, Kim D, Kim YE, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Kissoon N, Kopec JA, Kosen S, Koul PA, Koulmane Laxminarayana SL, Koyanagi A, Krishan K, Krishnamoorthy V, Kuate Defo B, Kucuk Bicer B, Kulkarni V, Kumar GA, Kumar M, Kumar N, Kurmi OP, Kusuma D, La Vecchia C, Lacey B, Lalloo R, Lami FH, Landires I, Larsson AO, Lasrado S, Lassi ZS, Lauriola P, Lee PH, Lee SWH, Lee YH, Leigh J, Leonardi M, Lewycka S, Li B, Li S, Liang J, Lim LL, Limenih MA, Lin RT, Liu X, Lodha R, Lopez AD, Lozano R, Lugo A, Lunevicius R, Mackay MT, Madhava Kunjathur S, Magnani FG, Mahadeshwara Prasad DR, Maheri M, Mahmoudi M, Majeed A, Maled V, Maleki A, Maleki S, Malekzadeh R, Malik AA, Malta DC, Mamun AA, Mansouri B, Mansournia MA, Martinez G, Martini S, Martins-Melo FR, Masoumi SZ, Maulik PK, McAlinden C, McGrath JJ, Medina-Solís CE, Mehrabi Nasab E, Mejia-Rodriguez F, Memish ZA, Mendoza W, Menezes RG, Mengesha EW, Mensah GA, Meretoja A, Meretoja TJ, Mersha AM, Mestrovic T, Miazgowski B, Miazgowski T, Michalek IM, Miller TR, Mini GK, Miri M, Mirica A, Mirrakhimov EM, Mirzaei H, Mirzaei M, Moazen B, Moghadaszadeh M, Mohajer B, Mohamad O, Mohammad Y, Mohammadi SM, Mohammadian-Hafshejani A, Mohammed S, Mokdad AH, Molokhia M, Monasta L, Mondello S, Moni MA, Moore CE, Moradi G, Moradi M, Moradzadeh R, Moraga P, Morawska L, Morrison SD, Mosser JF, Mousavi Khaneghah A, Mustafa G, Naderi M, Nagarajan AJ, Nagaraju SP, Naghavi M, Naghshtabrizi B, Naimzada MD, Nangia V, Narasimha Swamy S, Nascimento BR, Naveed M, Nazari J, Ndejjo R, Negoi I, Negoi RI, Nena E, Nepal S, Netsere HB, Nguefack-Tsague G, Ngunjiri JW, Nguyen CTY, Nguyen CT, Nguyen HLT, Nigatu YT, Nigussie SN, Nixon MR, Nnaji CA, Nomura S, Noor NM, Noubiap JJ, Nuñez-Samudio V, Nwatah VE, Oancea B, Odukoya OO, Ogbo FA, Olusanya BO, Olusanya JO, Omar Bali A, Onwujekwe OE, Ortiz A, Otoiu A, Otstavnov N, Otstavnov SS, Owolabi MO, P A M, Padubidri JR, Pakhale S, Pakshir K, Pal PK, Palladino R, Pana A, Panda-Jonas S, Pandey A, Pandey A, Pandi-Perumal SR, Pangaribuan HU, Pardo-Montaño AM, Park EK, Patel SK, Patton GC, Pawar S, Pazoki Toroudi H, Peden AE, Pepito VCF, Peprah EK, Pereira J, Pérez-Gómez J, Perico N, Pesudovs K, Pilgrim T, Pinheiro M, Piradov MA, Pirsaheb M, Platts-Mills JA, Pokhrel KN, Postma MJ, Pourjafar H, Prada SI, Prakash S, Pupillo E, Quazi Syed Z, Rabiee N, Radfar A, Rafiee A, Rafiei A, Raggi A, Rahimzadeh S, Rahman MHU, Rahmani AM, Ramezanzadeh K, Rana J, Ranabhat CL, Rao SJ, Rasella D, Rastogi P, Rathi P, Rawaf DL, Rawaf S, Rawasia WF, Rawassizadeh R, Reiner Jr RC, Remuzzi G, Renzaho AMN, Reshmi B, Resnikoff S, Rezaei N, Rezaei N, Rezapour A, Riahi SM, Ribeiro D, Rickard J, Roever L, Ronfani L, Rothenbacher D, Rubagotti E, Rumisha SF, Ryan PM, Saddik B, Sadeghi E, Saeedi Moghaddam S, Sagar R, Sahebkar A, Salahshoor MR, Salehi S, Salem MR, Salimzadeh H, Salomon JA, Samodra YL, Samy AM, Sanabria J, Santric-Milicevic MM, Saraswathy SYI, Sarker AR, Sarrafzadegan N, Sarveazad A, Sathian B, Sathish T, Sattin D, Saxena S, Saya GK, Saylan M, Schiavolin S, Schlaich MP, Schwebel DC, Schwendicke F, Senthilkumaran S, Sepanlou SG, Serván-Mori E, Sha F, Shafaat O, Shahabi S, Shahbaz M, Shaheen AA, Shahid I, Shaikh MA, Shakiba S, Shalash AS, Shams-Beyranvand M, Shannawaz M, Sharafi K, Sheikh A, Sheikhbahaei S, Shiferaw WS, Shigematsu M, Shin JI, Shiri R, Shiue I, Shuval K, Siddiqi TJ, Sidemo NB, Sigfusdottir ID, Sigurvinsdottir R, Silva JP, Silverberg JIS, Simonetti B, Singh BB, Singh JA, Singhal D, Sinha DN, Skiadaresi E, Skryabin VY, Skryabina AA, Sleet DA, Sobaih BH, Sobhiyeh MR, Soltani S, Soriano JB, Spurlock EE, Sreeramareddy CT, Steiropoulos P, Stokes MA, Stortecky S, Sufiyan MB, Suliankatchi Abdulkader R, Sulo G, Swope CB, Sykes BL, Szeto MD, Szócska M, Tabarés-Seisdedos R, Tadesse EG, Taherkhani A, Tamiru AT, Tareque MI, Tehrani-Banihashemi A, Temsah MH, Tesfay FH, Tessema GA, Tessema ZT, Thankappan KR, Thapar R, Tolani MA, Tovani-Palone MR, Traini E, Tran BX, Tripathy JP, Tsapparellas G, Tsatsakis A, Tudor Car L, Uddin R, Ullah A, Umeokonkwo CD, Unim B, Unnikrishnan B, Upadhyay E, Usman MS, Vacante M, Vaezi M, Valadan Tahbaz S, Valdez PR, Vasankari TJ, Venketasubramanian N, Verma M, Violante FS, Vlassov V, Vo B, Vu GT, Wado YD, Waheed Y, Wamai RG, Wang Y, Wang Y, Wang YP, Ward P, Werdecker A, Westerman R, Wickramasinghe ND, Wilner LB, Wiysonge CS, Wu AM, Wu C, Xie Y, Yahyazadeh Jabbari SH, Yamagishi K, Yandrapalli S, Yaya S, Yazdi-Feyzabadi V, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yousefi Z, Yousefinezhadi T, Yu C, Yusuf SS, Zaidi SS, Zaman SB, Zamani M, Zamanian M, Zastrozhin MS, Zastrozhina A, Zhang Y, Zhang ZJ, Zhao XJG, Ziapour A, Hay SI, Murray CJL, Wang H, Kassebaum NJ. Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019. Lancet 2021; 398:870-905. [PMID: 34416195 PMCID: PMC8429803 DOI: 10.1016/s0140-6736(21)01207-1] [Citation(s) in RCA: 180] [Impact Index Per Article: 60.0] [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: 01/11/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. METHODS We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. FINDINGS Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3-74·0) in 2000 to 37·1 (33·2-41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8-29·5) in 2000 to 17·9 (16·3-19·8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05-10·30) in 2000 and 5·05 million (4·27-6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million [95% UI 3·53-4·02]) in 2000 to 48% (2·42 million; 2·06-2·86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0·80 (95% UI 0·71-0·86) deaths per 1000 livebirths and U5MR to 1·44 (95% UI 1·27-1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35-2·58; 37% [95% UI 32-43]) of 5·05 million more deaths of children younger than 5 years than the survival potential frontier. INTERPRETATION Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. FUNDING Bill & Melinda Gates Foundation.
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Nzeyimana I, Nyirimodoka A, Ngendahayo E, Bonane A, Muhawenimana E, Umurangwa F, Gasana A, Sibomana AM, Teplitsky S, Rusatira C, Rickard J, Hategekimana T, Rwamasirabo E. Diagnosis of advanced prostate cancer at the community level in Rwanda. Int Urol Nephrol 2021; 53:1977-1985. [PMID: 34191229 DOI: 10.1007/s11255-021-02921-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 06/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prostate cancer is the second most common cancer in men and sixth leading cause of mortality. If not recognized early, patients with advanced prostate cancer can experience debilitating complications which can otherwise be prevented by early androgen deprivation therapy. This research intends to define clear diagnostic tools that will guide practitioners in the rural community setting toward early management of advanced prostate cancer. METHODS We conducted a cross-sectional observational study at three referral hospitals in Kigali, Rwanda on patients who presented with clinical suspicion of advanced prostate cancer over a period of 6 months. All patients underwent prostate biopsy as well as metastatic work up (CT or MRI), for those who were eligible. Statistical analysis was done using STATA 14.2. RESULTS 114 patients were included in the study. The median age was 70 years (interquartile range: 65-79 years). In total 14 (12.3%) patients were found to have benign disease, while 100 (87.7%) patients were found to have cancer. Among those who had cancer, 85 (85%) had advanced prostate cancer. 110/114 (96.5%) were symptomatic at presentation. Common presenting symptoms were lower urinary tract symptoms (80.7%), back pain (54.4%), and urinary retention (36.8%). Abnormal digital rectal examination (DRE) was a strong risk factor for both cancer and advanced disease. Prostate cancer was found in 92.2% of those with abnormal DRE compared to 41.7% in those with normal DRE (p = 0.001). Also, cancer was found in 96.1% of those with multinodular prostate on DRE (p = 0.02) and had high odds (OR 14.6; CI 3.41-62.25) of having advanced prostate cancer (p < 0.001). The mean (± SD) PSA was 643.3 ± 1829.8 ng/ml and the median (range) was 100 ng/ml (9.05-10,000 ng/ml) for the whole study population. All patients with prostatic-specific antigen (PSA) of 100 ng/ml or above had advanced prostate cancer. CONCLUSION The results show that there is a significant correlation between clinical findings and advanced prostate cancer. All patients with abnormal DRE and PSA above 100 ng/ml had advanced prostate cancer. Diagnosis of advanced prostate cancer is possible at the community level if PSA testing is utilized and practitioners are well trained.
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Affiliation(s)
- Innocent Nzeyimana
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
- University Teaching Hospital of Butare, Huye, Rwanda.
| | - Alexandre Nyirimodoka
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Rwanda Military Hospital, Kigali, Rwanda
| | | | - Alex Bonane
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- University Teaching Hospital of Kigali, Kigali, Rwanda
| | | | | | | | | | - Seth Teplitsky
- Department of Urology, University of Kentucky, Lexington, USA
| | | | | | | | - Emile Rwamasirabo
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- King Faisal Hospital, Kigali, Rwanda
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Muvunyi V, Mpirimbanyi C, Katabogama JB, Cyuzuzo T, Nkubana T, Mugema JB, Musoni E, Urimubabo C, Rickard J. Community- and Hospital-Acquired Infections in Surgical patients at a Tertiary Referral Hospital in Rwanda. World J Surg 2021; 44:3290-3298. [PMID: 32535645 DOI: 10.1007/s00268-020-05634-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) are increasing in globally. The aim of this study was to compare community-acquired infections (CAIs) and hospital-acquired infections (HAIs) and determine the rate of third-generation cephalosporin resistance and ESBL-PE at a tertiary referral hospital in Rwanda. METHODS This was a cross-sectional study of Rwandan acute care surgery patients with infection. Samples were processed for culture and susceptibility patterns using Kirby-Bauer disk diffusion method. Third-generation cephalosporin resistance and ESBL-PE were compared in patients with CAI versus HAI. RESULTS Over 14 months, 220 samples were collected from 191 patients: 116 (62%) patients had CAI, 59 (32%) had HAI, and 12 (6%) had both CAI and HAI. Most (n = 178, 94%) patients were started on antibiotics with third-generation cephalosporins (ceftriaxone n = 109, 57%; cefotaxime n = 52, 27%) and metronidazole (n = 155, 81%) commonly given. Commonly isolated organisms included Escherichia coli (n = 62, 42%), Staphylococcus aureus (n = 27, 18%), and Klebsiella spp. (n = 22, 15%). Overall, 67 of 113 isolates tested had resistance to third-generation cephalosporins, with higher resistance seen in HAI compared with CAI (74% vs 46%, p value = 0.002). Overall, 47 of 89 (53%) isolates were ESBL-PE with higher rates in HAI compared with CAI (73% vs 38%, p value = 0.001). CONCLUSIONS There is broad and prolonged use of third-generation cephalosporins despite high resistance rates. ESBL-PE are high in Rwandan surgical patients with higher rates in HAI compared with CAIs. Infection prevention practices and antibiotic stewardship are critical to reduce infection rates with resistant organisms in a low-resource setting.
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Affiliation(s)
- Vital Muvunyi
- Department of Surgery, University of Rwanda, Kigali, Rwanda
| | - Christophe Mpirimbanyi
- Department of Surgery, University of Rwanda, Kigali, Rwanda.,Department of Surgery, Kibungo Referral Hospital, Kibungo, Rwanda
| | | | | | - Theoneste Nkubana
- Clinical Laboratory, University Teaching Hospital of Kigali, Kigali, Rwanda
| | | | - Emile Musoni
- Clinical Laboratory, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Christian Urimubabo
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Jennifer Rickard
- Department of Surgery, University of Rwanda, Kigali, Rwanda. .,Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda. .,Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA.
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Klinger A, Mueller A, Sutherland T, Mpirimbanyi C, Nziyomaze E, Niyomugabo JP, Niyonsenga Z, Rickard J, Talmor DS, Riviello E. Predicting mortality in adults with suspected infection in a Rwandan hospital: an evaluation of the adapted MEWS, qSOFA and UVA scores. BMJ Open 2021; 11:e040361. [PMID: 33568365 PMCID: PMC7878147 DOI: 10.1136/bmjopen-2020-040361] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RATIONALE Mortality prediction scores are increasingly being evaluated in low and middle income countries (LMICs) for research comparisons, quality improvement and clinical decision-making. The modified early warning score (MEWS), quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA), and Universal Vital Assessment (UVA) score use variables that are feasible to obtain, and have demonstrated potential to predict mortality in LMIC cohorts. OBJECTIVE To determine the predictive capacity of adapted MEWS, qSOFA and UVA in a Rwandan hospital. DESIGN, SETTING, PARTICIPANTS AND OUTCOME MEASURES We prospectively collected data on all adult patients admitted to a tertiary hospital in Rwanda with suspected infection over 7 months. We calculated an adapted MEWS, qSOFA and UVA score for each participant. The predictive capacity of each score was assessed including sensitivity, specificity, positive and negative predictive value, OR, area under the receiver operating curve (AUROC) and performance by underlying risk quartile. RESULTS We screened 19 178 patient days, and enrolled 647 unique patients. Median age was 35 years, and in-hospital mortality was 18.1%. The proportion of data missing for each variable ranged from 0% to 11.7%. The sensitivities and specificities of the scores were: adapted MEWS >4, 50.4% and 74.9%, respectively; qSOFA >2, 24.8% and 90.4%, respectively; and UVA >4, 28.2% and 91.1%, respectively. The scores as continuous variables demonstrated the following AUROCs: adapted MEWS 0.69 (95% CI 0.64 to 0.74), qSOFA 0.65 (95% CI 0.60 to 0.70), and UVA 0.71 (95% CI 0.66 to 0.76); there was no statistically significant difference between the discriminative capacities of the scores. CONCLUSION Three scores demonstrated a modest ability to predict mortality in a prospective study of inpatients with suspected infection at a Rwandan tertiary hospital. Careful consideration must be given to their adequacy before using them in research comparisons, quality improvement or clinical decision-making.
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Affiliation(s)
- Amanda Klinger
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ariel Mueller
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Tori Sutherland
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Christophe Mpirimbanyi
- Department of Surgery, Kigali University Teaching Hospital, Kigali, Rwanda
- University of Rwanda College of Medicine and Health Sciences, School of Medicine and Pharmacy, Kigali, Rwanda
| | - Elie Nziyomaze
- Department of Surgery, Kigali University Teaching Hospital, Kigali, Rwanda
- University of Rwanda College of Medicine and Health Sciences, School of Medicine and Pharmacy, Kigali, Rwanda
| | - Jean-Paul Niyomugabo
- University of Rwanda College of Medicine and Health Sciences, School of Medicine and Pharmacy, Kigali, Rwanda
| | - Zack Niyonsenga
- University of Rwanda College of Medicine and Health Sciences, School of Medicine and Pharmacy, Kigali, Rwanda
| | - Jennifer Rickard
- Department of Surgery, Kigali University Teaching Hospital, Kigali, Rwanda
- Division of Critical Care/Acute Care Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel S Talmor
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Elisabeth Riviello
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Rickard J, Chu K. Author's Reply: Indications and Outcomes for Non-Trauma Emergency Laparotomy: A Comparison of Rwanda, South Africa, and the USA. World J Surg 2021; 45:1609-1610. [PMID: 33502564 PMCID: PMC7839619 DOI: 10.1007/s00268-021-05955-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Jennifer Rickard
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda. .,Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA.
| | - Kathryn Chu
- Department of Surgery, University of Cape Town, Cape Town, South Africa.,Department of Surgery, New Somerset Hospital, Cape Town, South Africa.,Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Abstract
INTRODUCTION Malnutrition is prevalent in hospitalized surgical patients and has been shown to significantly alter outcomes including length of hospital stay, complications, and mortality. Different tools for nutrition assessment were developed and are being used. The aim of this study was to characterize the nutritional status of acute care surgery patients, determine risk factors for malnutrition, and describe outcomes in patients with malnutrition. METHODS This was a prospective, descriptive study of malnutrition in acute care surgery patients at CHUK. Over a 6-month time period, we collected data on demographics, diagnosis, operation, and patient outcomes. We assessed the incidence of malnutrition using the American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines and Subjective Global Assessment (SGA). We reported frequencies and percentages for categorical variables and median and interquartile range (IQR) for continuous variables. RESULTS We analyzed data for 279 acute care surgery patients. Most (n = 209, 73%) patients were male. The median duration of symptoms was 5 days (IQR 2, 14). The most common diagnoses were trauma (n = 83, 30%), intestinal obstruction (n = 76, 27%), and peritonitis (n = 49, 18%). Most (n = 210, 73%) patients underwent operation. The median length of hospital stay was 6 days (IQR 4, 11). Using ASPEN guidelines, 99 (35%) patients had evidence of malnutrition on hospital admission and 76 (27%) had evidence of malnutrition using SGA. After 1 week of hospital stay, 48 (41%) patients had evidence of malnutrition. Overall mortality was 3%, with higher mortality seen in patients with malnutrition (8% vs. 0.6%, p = 0.001). The length of hospital stay was longer in patients with malnutrition on hospital admission (6 days vs. 5 days, p = 0.044). CONCLUSIONS Acute care surgical patients present to the hospital at high-risk for malnutrition. Efforts are needed to ensure that surgical patients receive adequate nutrition support to improve patient outcomes and minimize complications.
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Affiliation(s)
- Egide Abahuje
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda.
- Kigali University Teaching Hospital, Kigali, Rwanda.
| | - Irenee Niyongombwa
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - David Karenzi
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | | | - Eugene Tuyishime
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Faustin Ntirenganya
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
- Kigali University Teaching Hospital, Kigali, Rwanda
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Rickard J, Pohl L, Abahuje E, Kariem N, Englbrecht S, Kloppers C, Malatji S, Sibomana I, Robbins AJ, Chu K. Indications and Outcomes for Non-Trauma Emergency Laparotomy: A Comparison of Rwanda, South Africa, and the USA. World J Surg 2020; 45:668-677. [PMID: 33225391 DOI: 10.1007/s00268-020-05862-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emergency conditions requiring exploratory laparotomy (EL) can be challenging. The objective of this study is to describe indications, outcomes, and risk factors for perioperative mortality (POMR) after non-trauma EL. METHODS This was a prospective study of patients undergoing non-trauma EL at four hospitals in Rwanda, South Africa, and the USA. Multivariate logistic regression was used to determine factors associated with POMR. RESULTS Over one year, there were 632 EL with the most common indications appendicitis (n = 133, 21%), peptic ulcer disease (PUD) (n = 101, 16%), and hernia (n = 74, 12%). In Rwanda, the most common indications were appendicitis (n = 41, 19%) and hernia (n = 37, 17%); in South Africa appendicitis (n = 91, 28%) and PUD (n = 60, 19%); and in the USA, PUD (n = 16, 19%) and adhesions from small bowel obstruction (n = 16, 19%). POMR was 11%, with no difference between countries (Rwanda 7%, South Africa 12%, US 16%, p = 0.173). Risk factors associated with increased odds of POMR included typhoid intestinal perforation (adjusted odds ratio (aOR): 16.48; 95% confidence interval (CI): 4.31, 62.98; p value < 0.001), mesenteric ischemia (aOR: 13.77, 95% CI: 4.21, 45.08, p value < 0.001), cancer (aOR: 5.84, 95% CI: 2.43, 14.05, p value < 0.001), other diagnoses (aOR: 3.97, 95% CI: 3.03, 5.20, p value < 0.001), high ASA score (score ≥ 3) (aOR: 3.95, 95% CI: 3.03, 5.15, p value < 0.001), peptic ulcer disease (aOR: 2.82, 95% CI: 1.64, 4.85, p value < 0.001), age > 60 years (aOR: 2.32, 95% CI: 1.41, 3.83, p value = 0.001), and ICU admission (aOR: 2.23, 95% CI: 1.24, 3.99, p value = 0.007). Surgery in the US was associated with decreased odds of POMR (aOR: 0.41, 95% CI: 0.21, 0.80, p value = 0.009). CONCLUSIONS Indications for EL vary between countries and POMR is high. Differences in mortality were associated with patient and disease characteristics with certain diagnoses associated with increased risk of mortality. Understanding the risk factors and outcomes for patients with EL can assist providers in judicious patient selection, both for patient counselling and resource allocation.
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Affiliation(s)
- Jennifer Rickard
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda. .,Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA.
| | - Linda Pohl
- Department of Surgery, University of Cape Town, Cape Town, South Africa.,Department of Surgery, New Somerset Hospital, Cape Town, South Africa
| | - Egide Abahuje
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda.,Department of Surgery, University of Rwanda, Kigali, Rwanda
| | - Nazmie Kariem
- Department of Surgery, University of Cape Town, Cape Town, South Africa.,Department of Surgery, New Somerset Hospital, Cape Town, South Africa
| | - Surita Englbrecht
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Christo Kloppers
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Sekoaere Malatji
- Department of Surgery, New Somerset Hospital, Cape Town, South Africa
| | - Isaie Sibomana
- Department of Surgery, University of Rwanda, Kigali, Rwanda
| | - Alexandria J Robbins
- Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA
| | - Kathryn Chu
- Department of Surgery, University of Cape Town, Cape Town, South Africa.,Department of Surgery, New Somerset Hospital, Cape Town, South Africa.,Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Lozano R, Fullman N, Mumford JE, Knight M, Barthelemy CM, Abbafati C, Abbastabar H, Abd-Allah F, Abdollahi M, Abedi A, Abolhassani H, Abosetugn AE, Abreu LG, Abrigo MRM, Abu Haimed AK, Abushouk AI, Adabi M, Adebayo OM, Adekanmbi V, Adelson J, Adetokunboh OO, Adham D, Advani SM, Afshin A, Agarwal G, Agasthi P, Aghamir SMK, Agrawal A, Ahmad T, Akinyemi RO, Alahdab F, Al-Aly Z, Alam K, Albertson SB, Alemu YM, Alhassan RK, Ali M, Ali S, Alipour V, Aljunid SM, Alla F, Almadi MAH, Almasi A, Almasi-Hashiani A, Almasri NA, Al-Mekhlafi HM, Almulhim AM, Alonso J, Al-Raddadi RM, Altirkawi KA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amini S, Amini-Rarani M, Amiri F, Amit AML, Amugsi DA, Ancuceanu R, Anderlini D, Andrei CL, Androudi S, Ansari F, Ansari-Moghaddam A, Antonio CAT, Antony CM, Antriyandarti E, Anvari D, Anwer R, Arabloo J, Arab-Zozani M, Aravkin AY, Aremu O, Ärnlöv J, Asaad M, Asadi-Aliabadi M, Asadi-Pooya AA, Ashbaugh C, Athari SS, Atout MMW, Ausloos M, Avila-Burgos L, Ayala Quintanilla BP, Ayano G, Ayanore MA, Aynalem YA, Aynalem GL, Ayza MA, Azari S, Azzopardi PS, B DB, Babaee E, Badiye AD, Bahrami MA, Baig AA, Bakhshaei MH, Bakhtiari A, Bakkannavar SM, Balachandran A, Balassyano S, Banach M, Banerjee SK, Banik PC, Bante AB, Bante SA, Barker-Collo SL, Bärnighausen TW, Barrero LH, Bassat Q, Basu S, Baune BT, Bayati M, Baye BA, Bedi N, Beghi E, Behzadifar M, Bekuma TTT, Bell ML, Bensenor IM, Berman AE, Bernabe E, Bernstein RS, Bhagavathula AS, Bhandari D, Bhardwaj P, Bhat AG, Bhattacharyya K, Bhattarai S, Bhutta ZA, Bijani A, Bikbov B, Bilano V, Biondi A, Birihane BM, Bockarie MJ, Bohlouli S, Bojia HA, Bolla SRR, Boloor A, Brady OJ, Braithwaite D, Briant PS, Briggs AM, Briko NI, Burugina Nagaraja S, Busse R, Butt ZA, Caetano dos Santos FL, Cahuana-Hurtado L, Cámera LA, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Castro F, Catalá-López F, Causey K, Cederroth CR, Cercy KM, Cerin E, Chandan JS, Chang AY, Charan J, Chattu VK, Chaturvedi S, Chin KL, Cho DY, Choi JYJ, Christensen H, Chu DT, Chung MT, Ciobanu LG, Cirillo M, Comfort H, Compton K, Cortesi PA, Costa VM, Cousin E, Dahlawi SMA, Damiani G, Dandona L, Dandona R, Darega Gela J, Darwesh AM, Daryani A, Dash AP, Davey G, Dávila-Cervantes CA, Davletov K, De Neve JW, Denova-Gutiérrez E, Deribe K, Dervenis N, Desai R, Dharmaratne SD, Dhungana GP, Dianatinasab M, Dias da Silva D, Diaz D, Dippenaar IN, Do HT, Dorostkar F, Doshmangir L, Duncan BB, Duraes AR, Eagan AW, Edvardsson D, El Sayed I, El Tantawi M, Elgendy IY, Elyazar IRF, Eskandari K, Eskandarieh S, Esmaeilnejad S, Esteghamati A, Ezekannagha O, Farag T, Farahmand M, Faraon EJA, Farinha CSES, Farioli A, Faris PS, Faro A, Fazlzadeh M, Feigin VL, Fernandes E, Ferrara P, Feyissa GT, Filip I, Fischer F, Fisher JL, Flor LS, Foigt NA, Folayan MO, Fomenkov AA, Foroutan M, Francis JM, Fu W, Fukumoto T, Furtado JM, Gad MM, Gaidhane AM, Gakidou E, Galles NC, Gallus S, Gardner WM, Geberemariyam BS, Gebrehiwot AM, Gebremeskel LG, Gebremeskel GG, Gesesew HA, Ghadiri K, Ghafourifard M, Ghashghaee A, Ghith N, Gholamian A, Gilani SA, Gill PS, Gill TK, Ginindza TG, Gitimoghaddam M, Giussani G, Glagn M, Gnedovskaya EV, Godinho MA, Goharinezhad S, Gopalani SV, Goudarzian AH, Goulart BNG, Gubari MIM, Guimarães RA, Guled RA, Gultie T, Guo Y, Gupta R, Gupta R, Hafezi-Nejad N, Hafiz A, Haile TG, Hamadeh RR, Hameed S, Hamidi S, Han C, Han H, Handiso DW, Hanif A, Hankey GJ, Haro JM, Hasaballah AI, Hasan MM, Hashi A, Hassan S, Hassan A, Hassanipour S, Hassankhani H, Havmoeller RJ, Hay SI, Hayat K, Heidari G, Heidari-Soureshjani R, Hendrie D, Herteliu C, Hird TR, Ho HC, Hole MK, Holla R, Hollingsworth B, Hoogar P, Hopf KP, Horita N, Hossain N, Hosseini M, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hsieh VCR, Hu G, Huda TM, Humayun A, Hwang BF, Iavicoli I, Ibitoye SE, Ikeda N, Ilesanmi OS, Ilic IM, Ilic MD, Inbaraj LR, Iqbal U, Irvani SSN, Irvine CMS, Islam MM, Islam SMS, Islami F, Iso H, Iwu CJ, Iwu CCD, Jaafari J, Jadidi-Niaragh F, Jafarinia M, Jahagirdar D, Jahani MA, Jahanmehr N, Jakovljevic M, Janjani H, Javaheri T, Jayatilleke AU, Jenabi E, Jha RP, Jha V, Ji JS, Jia P, John-Akinola YO, Jonas JB, Joukar F, Jozwiak JJ, Jürisson M, Kabir Z, Kalankesh LR, Kalhor R, Kamath AM, Kanchan T, Kapoor N, Karami Matin B, Karanikolos M, Karimi SM, Kassebaum NJ, Katikireddi SV, Kayode GA, Keiyoro PN, Khader YS, Khammarnia M, Khan M, Khan EA, Khang YH, Khatab K, Khater AM, Khater MM, Khatib MN, Khayamzadeh M, Khubchandani J, Kianipour N, Kim YE, Kim YJ, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek K, Kivimäki M, Kneib CJ, Kocarnik JM, Kochhar S, Kohler S, Kopec JA, Korotkova AV, Korshunov VA, Kosen S, Kotlo A, Koul PA, Koyanagi A, Krishan K, Krohn KJ, Kugbey N, Kulkarni V, Kumar GA, Kumar N, Kumar M, Kurmi OP, Kusuma D, Kyu HH, La Vecchia C, Lacey B, Lal DK, Lalloo R, Landires I, Lansingh VC, Larsson AO, Lasrado S, Lau KMM, Lauriola P, Lazarus JV, Ledesma JR, Lee PH, Lee SWH, Leever AT, LeGrand KE, Leigh J, Leonardi M, Li S, Lim SS, Lim LL, Liu X, Logroscino G, Lopez AD, Lopukhov PD, Lotufo PA, Lu A, Ma J, Madadin M, Mahasha PW, Mahmoudi M, Majeed A, Malagón-Rojas JN, Maleki S, Malta DC, Mansouri B, Mansournia MA, Martini S, Martins-Melo FR, Martopullo I, Massenburg BB, Mastrogiacomo CI, Mathur MR, McAlinden C, McKee M, Medina-Solís CE, Meharie BG, Mehndiratta MM, Mehrabi Nasab E, Mehri F, Mehrotra R, Mekonnen T, Melese A, Memiah PTN, Mendoza W, Menezes RG, Mensah GA, Meretoja TJ, Meretoja A, Mestrovic T, Miazgowski B, Michalek IM, Mirrakhimov EM, Mirzaei M, Mirzaei-Alavijeh M, Mitchell PB, Moazen B, Moghadaszadeh M, Mohamadi E, Mohammad Y, Mohammad DK, Mohammad Gholi Mezerji N, Mohammadian-Hafshejani A, Mohammed S, Mohammed JA, Mokdad AH, Monasta L, Mondello S, Moradi M, Moradi-Lakeh M, Moradzadeh R, Moraga P, Morgado-da-Costa J, Morrison SD, Mosapour A, Mosser JF, Mousavi Khaneghah A, Muriithi MK, Mustafa G, Nabhan AF, Naderi M, Nagarajan AJ, Naghavi M, Naghshtabrizi B, Naimzada MD, Nangia V, Nansseu JR, Nayak VC, Nazari J, Ndejjo R, Negoi I, Negoi RI, Neupane S, Ngari KN, Nguefack-Tsague G, Ngunjiri JW, Nguyen CT, Nguyen DN, Nguyen HLT, Nnaji CA, Nomura S, Norheim OF, Noubiap JJ, Nowak C, Nunez-Samudio V, Otoiu A, Ogbo FA, Oghenetega OB, Oh IH, Okunga EW, Oladnabi M, Olagunju AT, Olusanya JO, Olusanya BO, Oluwasanu MM, Omar Bali A, Omer MO, Ong KL, Onwujekwe OE, Ortega-Altamirano DVV, Ortiz A, Ostojic SM, Otstavnov N, Otstavnov SS, Øverland S, Owolabi MO, Padubidri JR, Pakhale S, Palladino R, Pana A, Panda-Jonas S, Pangaribuan HU, Pathak M, Patton GC, Paudel S, Pazoki Toroudi H, Pease SA, Peden AE, Pennini A, Peprah EK, Pereira J, Pigott DM, Pilgrim T, Pilz TM, Pinheiro M, Piradov MA, Pirsaheb M, Pokhrel KN, Postma MJ, Pourjafar H, Pourmalek F, Pourmirza Kalhori R, Pourshams A, Prada SI, Pribadi DRA, Pupillo E, Quazi Syed Z, Radfar A, Rafiee A, Rafiei A, Raggi A, Rahim F, Rahman MA, Rajabpour-Sanati A, Rana SM, Ranabhat CL, Rao SJ, Rasella D, Rashedi V, Rath GK, Rathi P, Rawaf S, Rawaf DL, Rawal L, Rawassizadeh R, Razo C, Renjith V, Renzaho AMN, Reshmi B, Rezaei N, Riahi SM, Ribeiro DC, Rickard J, Roberts NLS, Roever L, Romoli M, Ronfani L, Roshandel G, Rubagotti E, Rwegerera GM, Sabour S, Sachdev PS, Saddik B, Sadeghi M, Sadeghi E, Safari Y, Sagar R, Sahebkar A, Sahraian MA, Sajadi SM, Salahshoor MR, Salem MRR, Salem H, Salomon J, Samadi Kafil H, Samy AM, Sanabria J, Santric-Milicevic MM, Saraswathy SYI, Sarmiento-Suárez R, Sartorius B, Sarveazad A, Sathian B, Sathish T, Sattin D, Savic M, Sawyer SM, Saxena D, Sbarra AN, Schaeffer LE, Schiavolin S, Schmidt MI, Schutte AE, Schwebel DC, Schwendicke F, Seedat S, Sha F, Shahabi S, Shaheen AA, Shaikh MA, Shamsizadeh M, Shannawaz M, Sharafi K, Sharara F, Sharifi H, Shaw DH, Sheikh A, Sheikhtaheri A, Shetty BSK, Shibuya K, Shiferaw WS, Shigematsu M, Shin JI, Shiri R, Shirkoohi R, Shivakumar KM, Shrime MG, Shuval K, Siabani S, Sierpinski R, Sigfusdottir ID, Sigurvinsdottir R, Silva DAS, Silva JP, Simonetti B, Simpson KE, Singh JA, Singh P, Sinha DN, Skryabin VY, Smith EUR, Soheili A, Soltani S, Soofi M, Sorensen RJ, Soriano JB, Sorrie MB, Soyiri IN, Spurlock EE, Sreeramareddy CT, Stanaway JD, Steel N, Stein C, Stokes MA, Sufiyan MB, Suleria HAR, Sultan I, Szumowski Ł, Tabarés-Seisdedos R, Tabuchi T, Tadakamadla SK, Taddele BW, Tadesse DB, Taherkhani A, Tamiru AT, Tanser FC, Tareque MI, Tarigan IU, Teagle WL, Tediosi F, Tefera YGG, Tela FG, Tessema ZT, Thakur B, Titova MV, Tonelli M, Topor-Madry R, Topouzis F, Tovani-Palone MRR, Tran BX, Travillian R, Troeger CE, Tudor Car L, Uddin R, Ullah I, Umeokonkwo CD, Unnikrishnan B, Upadhyay E, Uthman OA, Vacante M, Valdez PR, Varughese S, Vasankari TJ, Vasseghian Y, Venketasubramanian N, Violante FS, Vlassov V, Vollset SE, Vongpradith A, Vos T, Waheed Y, Walters MK, Wamai RG, Wang H, Wang YP, Weintraub RG, Weiss J, Werdecker A, Westerman R, Wilner LB, Woldu G, Wolfe CDA, Wu AM, Wulf Hanson S, Xie Y, Xu R, Yahyazadeh Jabbari SH, Yamagishi K, Yano Y, Yaya S, Yazdi-Feyzabadi V, Yearwood JA, Yeshitila YG, Yip P, Yonemoto N, Younis MZ, Yousefi Z, Yousefinezhadi T, Yusefzadeh H, Zadey S, Zahirian Moghadam T, Zaidi SS, Zaki L, Zaman SB, Zamani M, Zamanian M, Zandian H, Zastrozhin MS, Zewdie KA, Zhang Y, Zhao XJG, Zhao Y, Zheng P, Zhu C, Ziapour A, Zlavog BS, Zodpey S, Murray CJL. Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1250-1284. [PMID: 32861314 PMCID: PMC7562819 DOI: 10.1016/s0140-6736(20)30750-9] [Citation(s) in RCA: 251] [Impact Index Per Article: 62.8] [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: 12/31/2019] [Revised: 03/05/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. METHODS Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0-100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target-1 billion more people benefiting from UHC by 2023-we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. FINDINGS Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2-47·5) in 1990 to 60·3 (58·7-61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9-3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010-2019 relative to 1990-2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6-421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0-3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5-1040·3]) residing in south Asia. INTERPRETATION The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people-the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close-or how far-all populations are in benefiting from UHC. FUNDING Bill & Melinda Gates Foundation.
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Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abdelalim A, Abdollahi M, Abdollahpour I, Abolhassani H, Aboyans V, Abrams EM, Abreu LG, Abrigo MRM, Abu-Raddad LJ, Abushouk AI, Acebedo A, Ackerman IN, Adabi M, Adamu AA, Adebayo OM, Adekanmbi V, Adelson JD, Adetokunboh OO, Adham D, Afshari M, Afshin A, Agardh EE, Agarwal G, Agesa KM, Aghaali M, Aghamir SMK, Agrawal A, Ahmad T, Ahmadi A, Ahmadi M, Ahmadieh H, Ahmadpour E, Akalu TY, Akinyemi RO, Akinyemiju T, Akombi B, Al-Aly Z, Alam K, Alam N, Alam S, Alam T, Alanzi TM, Albertson SB, Alcalde-Rabanal JE, Alema NM, Ali M, Ali S, Alicandro G, Alijanzadeh M, Alinia C, Alipour V, Aljunid SM, Alla F, Allebeck P, Almasi-Hashiani A, Alonso J, Al-Raddadi RM, Altirkawi KA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amini S, Amini-Rarani M, Aminorroaya A, Amiri F, Amit AML, Amugsi DA, Amul GGH, Anderlini D, Andrei CL, Andrei T, Anjomshoa M, Ansari F, Ansari I, Ansari-Moghaddam A, Antonio CAT, Antony CM, Antriyandarti E, Anvari D, Anwer R, Arabloo J, Arab-Zozani M, Aravkin AY, Ariani F, Ärnlöv J, Aryal KK, Arzani A, Asadi-Aliabadi M, Asadi-Pooya AA, Asghari B, Ashbaugh C, Atnafu DD, Atre SR, Ausloos F, Ausloos M, Ayala Quintanilla BP, Ayano G, Ayanore MA, Aynalem YA, Azari S, Azarian G, Azene ZN, Babaee E, Badawi A, Bagherzadeh M, Bakhshaei MH, Bakhtiari A, Balakrishnan S, Balalla S, Balassyano S, Banach M, Banik PC, Bannick MS, Bante AB, Baraki AG, Barboza MA, Barker-Collo SL, Barthelemy CM, Barua L, Barzegar A, Basu S, Baune BT, Bayati M, Bazmandegan G, Bedi N, Beghi E, Béjot Y, Bello AK, Bender RG, Bennett DA, Bennitt FB, Bensenor IM, Benziger CP, Berhe K, Bernabe E, Bertolacci GJ, Bhageerathy R, Bhala N, Bhandari D, Bhardwaj P, Bhattacharyya K, Bhutta ZA, Bibi S, Biehl MH, Bikbov B, Bin Sayeed MS, Biondi A, Birihane BM, Bisanzio D, Bisignano C, Biswas RK, Bohlouli S, Bohluli M, Bolla SRR, Boloor A, Boon-Dooley AS, Borges G, Borzì AM, Bourne R, Brady OJ, Brauer M, Brayne C, Breitborde NJK, Brenner H, Briant PS, Briggs AM, Briko NI, Britton GB, Bryazka D, Buchbinder R, Bumgarner BR, Busse R, Butt ZA, Caetano dos Santos FL, Cámera LLAA, Campos-Nonato IR, Car J, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Castle CD, Castro F, Catalá-López F, Causey K, Cederroth CR, Cercy KM, Cerin E, Chandan JS, Chang AR, Charlson FJ, Chattu VK, Chaturvedi S, Chimed-Ochir O, Chin KL, Cho DY, Christensen H, Chu DT, Chung MT, Cicuttini FM, Ciobanu LG, Cirillo M, Collins EL, Compton K, Conti S, Cortesi PA, Costa VM, Cousin E, Cowden RG, Cowie BC, Cromwell EA, Cross DH, Crowe CS, Cruz JA, Cunningham M, Dahlawi SMA, Damiani G, Dandona L, Dandona R, Darwesh AM, Daryani A, Das JK, Das Gupta R, das Neves J, Dávila-Cervantes CA, Davletov K, De Leo D, Dean FE, DeCleene NK, Deen A, Degenhardt L, Dellavalle RP, Demeke FM, Demsie DG, Denova-Gutiérrez E, Dereje ND, Dervenis N, Desai R, Desalew A, Dessie GA, Dharmaratne SD, Dhungana GP, Dianatinasab M, Diaz D, Dibaji Forooshani ZS, Dingels ZV, Dirac MA, Djalalinia S, Do HT, Dokova K, Dorostkar F, Doshi CP, Doshmangir L, Douiri A, Doxey MC, Driscoll TR, Dunachie SJ, Duncan BB, Duraes AR, Eagan AW, Ebrahimi Kalan M, Edvardsson D, Ehrlich JR, El Nahas N, El Sayed I, El Tantawi M, Elbarazi I, Elgendy IY, Elhabashy HR, El-Jaafary SI, Elyazar IRF, Emamian MH, Emmons-Bell S, Erskine HE, Eshrati B, Eskandarieh S, Esmaeilnejad S, Esmaeilzadeh F, Esteghamati A, Estep K, Etemadi A, Etisso AE, Farahmand M, Faraj A, Fareed M, Faridnia R, Farinha CSES, Farioli A, Faro A, Faruque M, Farzadfar F, Fattahi N, Fazlzadeh M, Feigin VL, Feldman R, Fereshtehnejad SM, Fernandes E, Ferrari AJ, Ferreira ML, Filip I, Fischer F, Fisher JL, Fitzgerald R, Flohr C, Flor LS, Foigt NA, Folayan MO, Force LM, Fornari C, Foroutan M, Fox JT, Freitas M, Fu W, Fukumoto T, Furtado JM, Gad MM, Gakidou E, Galles NC, Gallus S, Gamkrelidze A, Garcia-Basteiro AL, Gardner WM, Geberemariyam BS, Gebrehiwot AM, Gebremedhin KB, Gebreslassie AAAA, Gershberg Hayoon A, Gething PW, Ghadimi M, Ghadiri K, Ghafourifard M, Ghajar A, Ghamari F, Ghashghaee A, Ghiasvand H, Ghith N, Gholamian A, Gilani SA, Gill PS, Gitimoghaddam M, Giussani G, Goli S, Gomez RS, Gopalani SV, Gorini G, Gorman TM, Gottlich HC, Goudarzi H, Goulart AC, Goulart BNG, Grada A, Grivna M, Grosso G, Gubari MIM, Gugnani HC, Guimaraes ALS, Guimarães RA, Guled RA, Guo G, Guo Y, Gupta R, Haagsma JA, Haddock B, Hafezi-Nejad N, Hafiz A, Hagins H, Haile LM, Hall BJ, Halvaei I, Hamadeh RR, Hamagharib Abdullah K, Hamilton EB, Han C, Han H, Hankey GJ, Haro JM, Harvey JD, Hasaballah AI, Hasanzadeh A, Hashemian M, Hassanipour S, Hassankhani H, Havmoeller RJ, Hay RJ, Hay SI, Hayat K, Heidari B, Heidari G, Heidari-Soureshjani R, Hendrie D, Henrikson HJ, Henry NJ, Herteliu C, Heydarpour F, Hird TR, Hoek HW, Hole MK, Holla R, Hoogar P, Hosgood HD, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hoy DG, Hsairi M, Hsieh VCR, Hu G, Huda TM, Hugo FN, Huynh CK, Hwang BF, Iannucci VC, Ibitoye SE, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Inbaraj LR, Ippolito H, Irvani SSN, Islam MM, Islam M, Islam SMS, Islami F, Iso H, Ivers RQ, Iwu CCD, Iyamu IO, Jaafari J, Jacobsen KH, Jadidi-Niaragh F, Jafari H, Jafarinia M, Jahagirdar D, Jahani MA, Jahanmehr N, Jakovljevic M, Jalali A, Jalilian F, James SL, Janjani H, Janodia MD, Jayatilleke AU, Jeemon P, Jenabi E, Jha RP, Jha V, Ji JS, Jia P, John O, John-Akinola YO, Johnson CO, Johnson SC, Jonas JB, Joo T, Joshi A, Jozwiak JJ, Jürisson M, Kabir A, Kabir Z, Kalani H, Kalani R, Kalankesh LR, Kalhor R, Kamiab Z, Kanchan T, Karami Matin B, Karch A, Karim MA, Karimi SE, Kassa GM, Kassebaum NJ, Katikireddi SV, Kawakami N, Kayode GA, Keddie SH, Keller C, Kereselidze M, Khafaie MA, Khalid N, Khan M, Khatab K, Khater MM, Khatib MN, Khayamzadeh M, Khodayari MT, Khundkar R, Kianipour N, Kieling C, Kim D, Kim YE, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Kissimova-Skarbek K, Kivimäki M, Kneib CJ, Knudsen AKS, Kocarnik JM, Kolola T, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko MA, Krishan K, Krohn KJ, Kuate Defo B, Kucuk Bicer B, Kumar GA, Kumar M, Kumar P, Kumar V, Kumaresh G, Kurmi OP, Kusuma D, Kyu HH, La Vecchia C, Lacey B, Lal DK, Lalloo R, Lam JO, Lami FH, Landires I, Lang JJ, Lansingh VC, Larson SL, Larsson AO, Lasrado S, Lassi ZS, Lau KMM, Lavados PM, Lazarus JV, Ledesma JR, Lee PH, Lee SWH, LeGrand KE, Leigh J, Leonardi M, Lescinsky H, Leung J, Levi M, Lewington S, Li S, Lim LL, Lin C, Lin RT, Linehan C, Linn S, Liu HC, Liu S, Liu Z, Looker KJ, Lopez AD, Lopukhov PD, Lorkowski S, Lotufo PA, Lucas TCD, Lugo A, Lunevicius R, Lyons RA, Ma J, MacLachlan JH, Maddison ER, Maddison R, Madotto F, Mahasha PW, Mai HT, Majeed A, Maled V, Maleki S, Malekzadeh R, Malta DC, Mamun AA, Manafi A, Manafi N, Manguerra H, Mansouri B, Mansournia MA, Mantilla Herrera AM, Maravilla JC, Marks A, Martins-Melo FR, Martopullo I, Masoumi SZ, Massano J, Massenburg BB, Mathur MR, Maulik PK, 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Zandian H, Zangeneh A, Zastrozhin MS, Zewdie KA, Zhang Y, Zhang ZJ, Zhao JT, Zhao Y, Zheng P, Zhou M, Ziapour A, Zimsen SRM, Naghavi M, Murray CJL. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1204-1222. [PMID: 33069326 PMCID: PMC7567026 DOI: 10.1016/s0140-6736(20)30925-9] [Citation(s) in RCA: 6299] [Impact Index Per Article: 1574.8] [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: 11/16/2019] [Revised: 02/27/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. METHODS GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. FINDINGS Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. INTERPRETATION As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. FUNDING Bill & Melinda Gates Foundation.
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Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, Abd-Allah F, Abdelalim A, Abdollahi M, Abdollahpour I, Abegaz KH, Abolhassani H, Aboyans V, Abreu LG, Abrigo MRM, Abualhasan A, Abu-Raddad LJ, Abushouk AI, Adabi M, Adekanmbi V, Adeoye AM, Adetokunboh OO, Adham D, Advani SM, Agarwal G, Aghamir SMK, Agrawal A, Ahmad T, Ahmadi K, Ahmadi M, Ahmadieh H, Ahmed MB, Akalu TY, Akinyemi RO, Akinyemiju T, Akombi B, Akunna CJ, Alahdab F, Al-Aly Z, Alam K, Alam S, Alam T, Alanezi FM, Alanzi TM, Alemu BW, Alhabib KF, Ali M, Ali S, Alicandro G, Alinia C, Alipour V, Alizade H, Aljunid SM, Alla F, Allebeck P, Almasi-Hashiani A, Al-Mekhlafi HM, Alonso J, Altirkawi KA, Amini-Rarani M, Amiri F, Amugsi DA, Ancuceanu R, Anderlini D, Anderson JA, Andrei CL, Andrei T, Angus C, Anjomshoa M, Ansari F, Ansari-Moghaddam A, Antonazzo IC, Antonio CAT, Antony CM, Antriyandarti E, Anvari D, Anwer R, Appiah SCY, Arabloo J, Arab-Zozani M, Ariani F, Armoon B, Ärnlöv J, Arzani A, Asadi-Aliabadi M, Asadi-Pooya AA, Ashbaugh C, Assmus M, Atafar Z, Atnafu DD, Atout MMW, Ausloos F, Ausloos M, Ayala Quintanilla BP, Ayano G, Ayanore MA, Azari S, Azarian G, Azene ZN, Badawi A, Badiye AD, Bahrami MA, Bakhshaei MH, Bakhtiari A, Bakkannavar SM, Baldasseroni A, Ball K, Ballew SH, Balzi D, Banach M, Banerjee SK, Bante AB, Baraki AG, Barker-Collo SL, Bärnighausen TW, Barrero LH, Barthelemy CM, Barua L, Basu S, Baune BT, Bayati M, Becker JS, Bedi N, Beghi E, Béjot Y, Bell ML, Bennitt FB, Bensenor IM, Berhe K, Berman AE, Bhagavathula AS, Bhageerathy R, Bhala N, Bhandari D, Bhattacharyya K, Bhutta ZA, Bijani A, Bikbov B, Bin Sayeed MS, Biondi A, Birihane BM, Bisignano C, Biswas RK, Bitew H, Bohlouli S, Bohluli M, Boon-Dooley AS, Borges G, Borzì AM, Borzouei S, Bosetti C, Boufous S, Braithwaite D, Breitborde NJK, Breitner S, Brenner H, Briant PS, Briko AN, Briko NI, Britton GB, Bryazka D, Bumgarner BR, Burkart K, Burnett RT, Burugina Nagaraja S, Butt ZA, Caetano dos Santos FL, Cahill LE, Cámera LLAA, Campos-Nonato IR, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Castro F, Causey K, Cederroth CR, Cercy KM, Cerin E, Chandan JS, Chang KL, Charlson FJ, Chattu VK, Chaturvedi S, Cherbuin N, Chimed-Ochir O, Cho DY, Choi JYJ, Christensen H, Chu DT, Chung MT, Chung SC, Cicuttini FM, Ciobanu LG, Cirillo M, Classen TKD, Cohen AJ, Compton K, Cooper OR, Costa VM, Cousin E, Cowden RG, Cross DH, Cruz JA, Dahlawi SMA, Damasceno AAM, Damiani G, Dandona L, Dandona R, Dangel WJ, Danielsson AK, Dargan PI, Darwesh AM, Daryani A, Das JK, Das Gupta R, das Neves J, Dávila-Cervantes CA, Davitoiu DV, De Leo D, Degenhardt L, DeLang M, Dellavalle RP, Demeke FM, Demoz GT, Demsie DG, Denova-Gutiérrez E, Dervenis N, Dhungana GP, Dianatinasab M, Dias da Silva D, Diaz D, Dibaji Forooshani ZS, Djalalinia S, Do HT, Dokova K, Dorostkar F, Doshmangir L, Driscoll TR, Duncan BB, Duraes AR, Eagan AW, Edvardsson D, El Nahas N, El Sayed I, El Tantawi M, Elbarazi I, Elgendy IY, El-Jaafary SI, Elyazar IRF, Emmons-Bell S, Erskine HE, Eskandarieh S, Esmaeilnejad S, Esteghamati A, Estep K, Etemadi A, Etisso AE, Fanzo J, Farahmand M, Fareed M, Faridnia R, Farioli A, Faro A, Faruque M, Farzadfar F, Fattahi N, Fazlzadeh M, Feigin VL, Feldman R, Fereshtehnejad SM, Fernandes E, Ferrara G, Ferrari AJ, Ferreira ML, Filip I, Fischer F, Fisher JL, Flor LS, Foigt NA, Folayan MO, Fomenkov AA, Force LM, Foroutan M, Franklin RC, Freitas M, Fu W, Fukumoto T, Furtado JM, Gad MM, Gakidou E, Gallus S, Garcia-Basteiro AL, Gardner WM, Geberemariyam BS, Gebreslassie AAAA, Geremew A, Gershberg Hayoon A, Gething PW, Ghadimi M, Ghadiri K, Ghaffarifar F, Ghafourifard M, Ghamari F, Ghashghaee A, Ghiasvand H, Ghith N, Gholamian A, Ghosh R, Gill PS, Ginindza TGG, Giussani G, Gnedovskaya EV, Goharinezhad S, Gopalani SV, Gorini G, Goudarzi H, Goulart AC, Greaves F, Grivna M, Grosso G, Gubari MIM, Gugnani HC, Guimarães RA, Guled RA, Guo G, Guo Y, Gupta R, 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Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1223-1249. [PMID: 33069327 PMCID: PMC7566194 DOI: 10.1016/s0140-6736(20)30752-2] [Citation(s) in RCA: 3208] [Impact Index Per Article: 802.0] [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: 11/28/2019] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. METHODS GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. FINDINGS The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51-12·1) deaths (19·2% [16·9-21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12-9·31) deaths (15·4% [14·6-16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11·6% [10·3-13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. INTERPRETATION Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. FUNDING Bill & Melinda Gates Foundation.
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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 N, Pigott DM, Pilgrim T, Pilz TM, Piradov MA, Pirsaheb M, Pokhrel KN, Postma MJ, Pourjafar H, Pourmalek F, Pourshams A, Poznańska A, Prada SI, Prakash S, Preotescu L, Quazi Syed Z, Rabiee M, Rabiee N, Radfar A, Rafiei A, Raggi A, Rahman MA, Rajabpour-Sanati A, Ram P, Ranabhat CL, Rao SJ, Rasella D, Rashedi V, Rastogi P, Rathi P, Rawal L, Remuzzi G, Renjith V, Renzaho AMN, Resnikoff S, Rezaei N, Rezai MS, Rezapour A, Rickard J, Roever L, Ronfani L, Roshandel G, Rostamian M, Rubagotti E, Rwegerera GM, Sabour S, Saddik B, Sadeghi E, Sadeghi M, Saeedi Moghaddam S, Safari Y, Safi S, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Sajadi SM, Salahshoor MR, Salama JS, Salamati P, Salem MRR, Salimi Y, Salomon JA, Salz I, Samad Z, Samy AM, Sanabria J, Santric-Milicevic MM, Saraswathy SYI, Sartorius B, Sarveazad A, Sathian B, Sathish T, Sattin D, Saylan M, Schaeffer LE, Schiavolin S, Schwebel DC, Schwendicke F, Sekerija M, Senbeta AM, Senthilkumaran S, Sepanlou SG, Serván-Mori E, Shabani M, Shahabi 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, Veisani Y, Venketasubramanian N, Vidale S, Violante FS, Vlassov V, Vollset SE, Vos T, Vujcic IS, Vukovic A, Vukovic R, Waheed Y, Wallin MT, Walters MK, Wang H, Wang YP, Watson S, Wei J, Weiss J, Weldesamuel GT, Werdecker A, Westerman R, Whiteford HA, Wiangkham T, Wiens KE, Wijeratne T, Wiysonge CS, Wojtyniak B, Wolfe CDA, Wondmieneh AB, Wool EE, Wu AM, Wu J, Xu G, Yamada T, Yamagishi K, Yano Y, Yaya S, Yazdi-Feyzabadi V, Yearwood JA, Yeheyis TY, Yilgwan CS, Yip P, Yonemoto N, Yoon SJ, Yoosefi Lebni J, York HW, Younis MZ, Younker TP, Yousefi Z, Yousefinezhadi T, Yousuf AY, Yusefzadeh H, Zahirian Moghadam T, Zakzuk J, Zaman SB, Zamani M, Zamanian M, Zandian H, Zhang ZJ, Zheng P, Zhou M, Ziapour A, Murray CJL. 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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James SL, Castle CD, Dingels ZV, Fox JT, Hamilton EB, Liu Z, Roberts NLS, Sylte DO, Bertolacci GJ, Cunningham M, Henry NJ, LeGrand KE, Abdelalim A, Abdollahpour I, Abdulkader RS, Abedi A, Abegaz KH, Abosetugn AE, Abushouk AI, Adebayo OM, Adsuar JC, Advani SM, Agudelo-Botero M, Ahmad T, Ahmed MB, Ahmed R, Eddine Aichour MT, Alahdab F, Alanezi FM, Alema NM, Alemu BW, Alghnam SA, Ali BA, Ali S, Alinia C, Alipour V, Aljunid SM, Almasi-Hashiani A, Almasri NA, Altirkawi K, Abdeldayem Amer YS, Andrei CL, Ansari-Moghaddam A, T Antonio CA, Anvari D, Yaw Appiah SC, Arabloo J, Arab-Zozani M, Arefi Z, Aremu O, Ariani F, Arora A, Asaad M, Ayala Quintanilla BP, Ayano G, Ayanore MA, Azarian G, Badawi A, Badiye AD, Baig AA, Bairwa M, Bakhtiari A, Balachandran A, Banach M, Banerjee SK, Banik PC, Banstola A, Barker-Collo SL, Bärnighausen TW, Barzegar A, Bayati M, Bazargan-Hejazi S, Bedi N, Behzadifar M, Belete H, Bennett DA, Bensenor IM, Berhe K, Bhagavathula AS, Bhardwaj P, Bhat AG, Bhattacharyya K, Bhutta ZA, Bibi S, Bijani A, Boloor A, Borges G, Borschmann R, Borzì AM, Boufous S, Braithwaite D, Briko NI, Brugha T, Budhathoki SS, Car J, Cárdenas R, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Catalá-López F, Cerin E, Chandan JS, Chapman JR, Chattu VK, Chattu SK, Chatziralli I, Chaudhary N, Cho DY, Choi JYJ, Kabir Chowdhury MA, Christopher DJ, Chu DT, Cicuttini FM, Coelho JM, Costa VM, Dahlawi SMA, Daryani A, Dávila-Cervantes CA, Leo DD, Demeke FM, Demoz GT, Demsie DG, Deribe K, Desai R, Nasab MD, Silva DDD, Dibaji Forooshani ZS, Do HT, Doyle KE, Driscoll TR, Dubljanin E, Adema BD, Eagan AW, Elemineh DA, El-Jaafary SI, El-Khatib Z, Ellingsen CL, Zaki MES, Eskandarieh S, Eyawo O, Faris PS, Faro A, Farzadfar F, Fereshtehnejad SM, Fernandes E, Ferrara P, Fischer F, Folayan MO, Fomenkov AA, Foroutan M, Francis JM, Franklin RC, Fukumoto T, Geberemariyam BS, Gebremariam H, Gebremedhin KB, Gebremeskel LG, Gebremeskel GG, Gebremichael B, Gedefaw GA, Geta B, Getenet AB, Ghafourifard M, Ghamari F, Gheshlagh RG, Gholamian A, Gilani SA, Gill TK, Goudarzian AH, Goulart AC, Grada A, Grivna M, Guimarães RA, Guo Y, Gupta G, Haagsma JA, Hall BJ, Hamadeh RR, Hamidi S, Handiso DW, Haro JM, Hasanzadeh A, Hassan S, Hassanipour S, Hassankhani H, Hassen HY, Havmoeller R, Hendrie D, Heydarpour F, Híjar M, Ho HC, Hoang CL, Hole MK, Holla R, Hossain N, Hosseinzadeh M, Hostiuc S, Hu G, Ibitoye SE, Ilesanmi OS, Inbaraj LR, Naghibi Irvani SS, Mofizul Islam M, Shariful Islam SM, Ivers RQ, Jahani MA, Jakovljevic M, Jalilian F, Jayaraman S, Jayatilleke AU, Jha RP, John-Akinola YO, Jonas JB, Jones KM, Joseph N, Joukar F, Jozwiak JJ, Jungari SB, Jürisson M, Kabir A, Kahsay A, Kalankesh LR, Kalhor R, Kamil TA, Kanchan T, Kapoor N, Karami M, Kasaeian A, Kassaye HG, Kavetskyy T, Kayode GA, Keiyoro PN, Kelbore AG, Khader YS, Khafaie MA, Khalid N, Khalil IA, Khalilov R, Khan M, Khan EA, Khan J, Khanna T, Khazaei S, Khazaie H, Khundkar R, Kiirithio DN, Kim YE, Kim YJ, Kim D, Kisa S, Kisa A, Komaki H, Kondlahalli SKM, Koolivand A, Korshunov VA, Koyanagi A, Kraemer MUG, Krishan K, Defo BK, Bicer BK, Kugbey N, Kumar N, Kumar M, Kumar V, Kumar N, Kumaresh G, Lami FH, Lansingh VC, Lasrado S, Latifi A, Lauriola P, Vecchia CL, Leasher JL, Huey Lee SW, Li S, Liu X, Lopez AD, Lotufo PA, Lyons RA, Machado DB, Madadin M, Abd El Razek MM, Mahotra NB, Majdan M, Majeed A, Maled V, Malta DC, Manafi N, Manafi A, Manda AL, Manjunatha N, Mansour-Ghanaei F, Mansournia MA, Maravilla JC, Mason-Jones AJ, Masoumi SZ, Massenburg BB, Maulik PK, Mehndiratta MM, Melketsedik ZA, Memiah PTN, Mendoza W, Menezes RG, Mengesha MM, Meretoja TJ, Meretoja A, Merie HE, Mestrovic T, Miazgowski B, Miazgowski T, Miller TR, Mini GK, Mirica A, Mirrakhimov EM, Mirzaei-Alavijeh M, Mithra P, Moazen B, Moghadaszadeh M, Mohamadi E, Mohammad Y, Darwesh AM, Mohammadian-Hafshejani A, Mohammadpourhodki R, Mohammed S, Mohammed JA, Mohebi F, Mohseni Bandpei MA, Molokhia M, Monasta L, Moodley Y, Moradi M, Moradi G, Moradi-Lakeh M, Moradzadeh R, Morawska L, Velásquez IM, Morrison SD, Mossie TB, Muluneh AG, Musa KI, Mustafa G, Naderi M, Nagarajan AJ, Naik G, Naimzada MD, Najafi F, Nangia V, Nascimento BR, Naserbakht M, Nayak V, Nazari J, Ndwandwe DE, Negoi I, Ngunjiri JW, Nguyen TH, Nguyen CT, Nguyen DN, Thi Nguyen HL, Nikbakhsh R, Anggraini Ningrum DN, Nnaji CA, Ofori-Asenso R, Ogbo FA, Oghenetega OB, Oh IH, Olagunju AT, Olagunju TO, Bali AO, Onwujekwe OE, Orpana HM, Ota E, Otstavnov N, Otstavnov SS, P A M, Padubidri JR, Pakhale S, Pakshir K, Panda-Jonas S, Park EK, Patel SK, Pathak A, Pati S, Paulos K, Peden AE, Filipino Pepito VC, Pereira J, Phillips MR, Polibin RV, Polinder S, Pourmalek F, Pourshams A, Poustchi H, Prakash S, Angga Pribadi DR, Puri P, Syed ZQ, Rabiee N, Rabiee M, Radfar A, Rafay A, Rafiee A, Rafiei A, Rahim F, Rahimi S, Rahman MA, Rajabpour-Sanati A, Rajati F, Rakovac I, Rao SJ, Rashedi V, Rastogi P, Rathi P, Rawaf S, Rawal L, Rawassizadeh R, Renjith V, Resnikoff S, Rezapour A, Ribeiro AI, Rickard J, Rios González CM, Roever L, Ronfani L, Roshandel G, Saddik B, Safarpour H, Safdarian M, Mohammad Sajadi S, Salamati P, Rashad Salem MR, Salem H, Salz I, Samy AM, Sanabria J, Riera LS, Santric Milicevic MM, Sarker AR, Sarveazad A, Sathian B, Sawhney M, Sayyah M, Schwebel DC, Seedat S, Senthilkumaran S, Seyedmousavi S, Sha F, Shaahmadi F, Shahabi S, Shaikh MA, Shams-Beyranvand M, Sheikh A, Shigematsu M, Shin JI, Shiri R, Siabani S, Sigfusdottir ID, Singh JA, Singh PK, Sinha DN, Soheili A, Soriano JB, Sorrie MB, Soyiri IN, Stokes MA, Sufiyan MB, Sykes BL, Tabarés-Seisdedos R, Tabb KM, Taddele BW, Tefera YM, Tehrani-Banihashemi A, Tekulu GH, Tesema Tesema AK, Tesfay BE, Thapar R, Titova MV, Tlaye KG, Tohidinik HR, Topor-Madry R, Tran KB, Tran BX, Tripathy JP, Tsai AC, Tsatsakis A, Car LT, Ullah I, Ullah S, Unnikrishnan B, Upadhyay E, Uthman OA, Valdez PR, Vasankari TJ, Veisani Y, Venketasubramanian N, Violante FS, Vlassov V, Waheed Y, Wang YP, Wiangkham T, Wolde HF, Woldeyes DH, Wondmeneh TG, Wondmieneh AB, Wu AM, Wyper GMA, Yadav R, Yadollahpour A, Yano Y, Yaya S, Yazdi-Feyzabadi V, Ye P, Yip P, Yisma E, Yonemoto N, Yoon SJ, Youm Y, Younis MZ, Yousefi Z, Yu C, Yu Y, Moghadam TZ, Zaidi Z, Zaman SB, Zamani M, Zandian H, Zarei F, Zhang ZJ, Zhang Y, Ziapour A, Zodpey S, Dandona R, Dharmaratne SD, Hay SI, Mokdad AH, Pigott DM, Reiner RC, Vos T. Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study. Inj Prev 2020; 26:i125-i153. [PMID: 32839249 PMCID: PMC7571362 DOI: 10.1136/injuryprev-2019-043531] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 10/14/2019] [Revised: 11/29/2019] [Accepted: 12/06/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. METHODS In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. RESULTS GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. CONCLUSIONS GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.
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Affiliation(s)
- Spencer L James
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chris D Castle
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Zachary V Dingels
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jack T Fox
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erin B Hamilton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Zichen Liu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nicholas L S Roberts
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Dillon O Sylte
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Gregory J Bertolacci
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Matthew Cunningham
- 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
| | - Kate E LeGrand
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Ibrahim Abdollahpour
- Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Aidin Abedi
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Kedir Hussein Abegaz
- Biostatistics and Health Informatics, Madda Walabu University, Bale Robe, Ethiopia
- Radiotherapy Center, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | - Jose C Adsuar
- Sport Science Department, University of Extremadura, Badajoz, Spain
| | - Shailesh M Advani
- Social Behavioral Research Branch, National Institute of Health, Bethesda, MD, USA
- Cancer Prevention and Control, Georgetown University, Washington, DC, USA
| | - Marcela Agudelo-Botero
- School of Medicine, Center for Politics, Population and Health Research, National Autonomous University of Mexico, Mexico City, Mexico
| | - Tauseef Ahmad
- Department of Epidemiology and Health Statistics, Southeast University Nanjing, Nanjing, China
- Microbiology Department, Hazara University, Mansehra, Pakistan
| | | | - 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, Dhaka, Bangladesh
| | | | - Fares Alahdab
- Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, MN, USA
| | - Fahad Mashhour Alanezi
- Department of Computer Sciences, Imam Abdulrehman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Biresaw Wassihun Alemu
- Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
- Midwifery Department, Arba Minch University, Injbara, Ethiopia
| | - Suliman A Alghnam
- Department of Population Health Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | - Saqib Ali
- Department of Information Systems, College of Economics and Political Science, Sultan Qaboos University, Muscat, Oman
| | - Cyrus Alinia
- Department of Health Care Management and Economics, Urmia University of Medical Science, Urmia, Iran
| | - Vahid Alipour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Health Economics Department, 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
| | | | - Nihad A Almasri
- Physiotherapy Department, The University of Jordan, Amman, Jordan
| | | | - Yasser Sami Abdeldayem Amer
- Clinical Practice Guidelines Unit, King Saud University, Riyadh, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
| | | | | | - Carl Abelardo T Antonio
- Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Davood Anvari
- Department of Parasitology, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Microbiology and Immunology, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Seth Christopher Yaw Appiah
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Center for International Health, Ludwig Maximilians University, Munich, Germany
| | - Jalal Arabloo
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, 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
| | - Filippo Ariani
- Regional Centre for the Analysis of Data on Occupational and Work-related Injuries and Diseases, Local Health Unit Tuscany Centre, Florence, Italy
| | - Amit Arora
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
- Oral Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Malke Asaad
- Plastic Surgery Department, University of Texas, Houston, TX, USA
| | - 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
| | - Getinet Ayano
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Martin Amogre Ayanore
- Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Ghana
| | - Ghasem Azarian
- Department of Environmental Health Engineering, Hamadan University of Medical Sciences, Hamadan, 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
| | - Ashish D Badiye
- Department of Forensic Science, Government Institute of Forensic Science, Nagpur, India
| | - Atif Amin Baig
- Biochemistry Unit, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
- School of Health Sciences, Univeristi Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | - Mohan Bairwa
- Institute of Health Management Research, Indian Institute of Health Management Research University, Jaipur, India
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Ahad Bakhtiari
- Health Policy and Management Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Arun Balachandran
- Department of Demography, University of Groningen, Groningen, Netherlands
- Population Research Centre, Institute for Social and Economic Change, Bengaluru, India
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
- Polish Mothers' Memorial Hospital Research Institute, Lodz, Poland
| | | | - Palash Chandra Banik
- Department of Noncommunicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
| | - Amrit Banstola
- Department of Research, Public Health Perspective Nepal, Pokhara-Lekhnath Metropolitan City, Nepal
| | | | - Till Winfried Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Akbar Barzegar
- Occupational Health Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Bayati
- Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Neeraj Bedi
- Department of Community Medicine, Gandhi Medical College Bhopal, Bhopal, India
- Jazan University, Jazan, Saudi Arabia
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Habte Belete
- Psychiatry Department, Bahir Dar University, Bhair Dar, Ethiopia
| | - Derrick A Bennett
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Isabela M Bensenor
- Department of Internal Medicine, University of São Paulo, São Paulo, Brazil
| | - Kidanemaryam Berhe
- Department of Nutrition and Dietetics, Mekelle University, Mekelle, Ethiopia
| | - Akshaya Srikanth Bhagavathula
- Department of Internal Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
- Social and Clinical Pharmacy, Charles University, Hradec Kralova, Czech Republic
| | - Pankaj Bhardwaj
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
- Department of Community Medicine, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Anusha Ganapati Bhat
- Internal Medicine Department, University of Massachusetts Medical School, Springfield, MA, USA
| | - Krittika Bhattacharyya
- Department of Statistical and Computational Genomics, National Institute of Biomedical Genomics, Kalyani, India
- Department of Statistics, University of Calcutta, Kolkata, India
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, University of Toronto, Toronto, Ontario, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sadia Bibi
- Institute of Soil and Environmental Sciences, University of Agriculture, Faisalabad, Pakistan
| | - Ali Bijani
- Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Archith Boloor
- Department of Internal Medicine, Manipal Academy of Higher Education, Mangalore, India
| | - Guilherme Borges
- Department of Epidemiology and Psychosocial Reseach, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Rohan Borschmann
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Antonio Maria Borzì
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Soufiane Boufous
- Transport and Road Safety (TARS) Research Department, University of New South Wales, Sydney, New South Wales, Australia
| | - Dejana Braithwaite
- Division of Hematology and Oncology, Georgetown University, Washington DC, USA
| | - Nikolay Ivanovich Briko
- Department of Epidemiology and Evidence Based Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Traolach Brugha
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - 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
| | - Félix Carvalho
- Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
| | | | - 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
| | - Giulio Castelpietra
- Primary Care Services Area, Central Health Directorate, Region Friuli Venezia Giulia, Trieste, Italy
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Ferrán Catalá-López
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - 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
| | - Joht S Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jens Robert Chapman
- Swedish Neuroscience Institute, Swedish Brain and Spine Specialists, Seattle, WA, USA
| | | | | | - Irini Chatziralli
- 2nd Department of Ophthalmology, University of Athens, Haidari, Greece
- Ophthalmology Independent Consultant, Athens, Greece
| | - Neha Chaudhary
- Pediatrics Department, Harvard University, Boston, MA, USA
- Neonatology Department, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel Youngwhan Cho
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA, USA
| | - Jee-Young J Choi
- Department of Biochemistry and Biomedical Science, Seoul National University Hospital, Seoul, South Korea
| | - Mohiuddin Ahsanul Kabir Chowdhury
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | | | - Dinh-Toi Chu
- Faculty of Biology, Hanoi National University of Education, Hanoi, Vietnam
| | - Flavia M Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - João M Coelho
- Centro Hospitalar Universitário do Porto - Serviço de Oftalmologia, University of Porto, Porto, Portugal
| | - Vera M Costa
- Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
| | - Saad M A Dahlawi
- Department of Environmental Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmad Daryani
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Mount Gravatt, Queensland, Australia
| | | | - Gebre Teklemariam Demoz
- School of Pharmacy, Aksum University, Aksum, Ethiopia
- Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Kebede Deribe
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rupak Desai
- Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | | | | | | | - Hoa Thi Do
- Center of Excellence in Public Health Nutrition, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Kerrie E Doyle
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University, Bundoora, Victoria, Australia
| | - Tim Robert Driscoll
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | | | - Bereket Duko Adema
- Public Health Department, Hawassa University, Hawassa, Ethiopia
- Curtin University, Perth, Western Australia, Australia
| | - Arielle Wilder Eagan
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
- Department of Social Services, Tufts Medical Center, Boston, MA, USA
| | | | | | - Ziad El-Khatib
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- World Health Programme, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Christian Lycke Ellingsen
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Sharareh Eskandarieh
- Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Oghenowede Eyawo
- Epidemiology and Population Health, York University, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Pawan Sirwan Faris
- Biology Department, Salahaddin University-Erbil, Erbil, Iraq
- Department of Biology and Biotechnology "Lazzaro Spallanzani", University of Pavia, Pavia, Italy
| | - Andre Faro
- Department of Psychology, Federal University of Sergipe, Sao Cristovao, Brazil
| | - Farshad Farzadfar
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed-Mohammad Fereshtehnejad
- Department of Neurobiology, Karolinska Institutet, Stockholm, Sweden
- Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Pietro Ferrara
- Research Centre on Public Health (CESP), University of Milan Bicocca, Monza, Italy
| | - Florian Fischer
- Department of Population Medicine and Health Services Research, Bielefeld University, Bielefeld, Germany
| | | | | | - Masoud Foroutan
- Abadan School of Medical Sciences, Abadan University of Medical Sciences, Abadan, Iran
| | - Joel Msafiri Francis
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard Charles Franklin
- College of Public Health, Medical and Veterinary Science, James Cook University, Douglas, Queensland, Australia
- Royal Life Saving Society, Sydney, New South Wales, Australia
| | - Takeshi Fukumoto
- Department of Dermatology, Kobe University, Kobe, Japan
- Gene Expression & Regulation Program, The Wistar Institute, Philadelphia, PA, USA
| | | | - Hadush Gebremariam
- Department of Nutrition and Dietetics, Mekelle University, Mekelle, Ethiopia
| | | | - Leake G Gebremeskel
- School of Pharmacy, Aksum University, Aksum, Ethiopia
- Pharmacy Department, Mekelle University, Mekelle, Ethiopia
| | | | | | - Getnet Azeze Gedefaw
- Bahir Dar University, Bahir Dar, Ethiopia
- Haramaya University, Dire Dawa, Ethiopia
| | - Birhanu Geta
- Department of Pharmacy, Wollo University, Dessie, Ethiopia
| | | | - Mansour Ghafourifard
- Department of Medical Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farhad Ghamari
- Occupational Health Department, Arak University of Medical Sciences, Arak, Iran
| | - Reza Ghanei Gheshlagh
- Department of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Asadollah Gholamian
- Science and Research Branch, Islamic Azad University, Tehran, Iran
- Young Researchers and Elite Club, Islamic Azad University, Rasht, Iran
| | - Syed Amir Gilani
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
- Chairman BOG, Afro-Asian Institute, Lahore, Pakistan
| | - Tiffany K Gill
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | | | - Alessandra C Goulart
- Center for Clinical and Epidemiological Research, University of São Paulo, Sao Paulo, Brazil
- Internal Medicine Department, University of São Paulo, Sao Paulo, Brazil
| | - Ayman Grada
- Department of Dermatology, Boston University, Boston, MA, USA
| | - Michal Grivna
- Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Rafael Alves Guimarães
- Instituto de Patologia Tropical e Saúde Pública, Federal University of Goias, Goiânia, Brazil
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Epidemiology and Biostatistics, Zhengzhou University, Zhengzhou, China
| | - Gaurav Gupta
- Non-Communicable Diseases (NCD), World Health Organization (WHO), New Delhi, India
| | - Juanita A Haagsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Brian James Hall
- Global and Community Mental Health Research Group, University of Macau, Macao, China
| | - Randah R Hamadeh
- Department of Family and Community Medicine, Arabian Gulf University, Manama, Bahrain
| | - 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
| | - Amir Hasanzadeh
- Department of Microbiology, Maragheh University of Medical Sciences, Maragheh, Iran
- Department of Microbiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Shoaib Hassan
- Centre for International Health and Section for Ethics and Health Economics, University of Bergen, Bergen, Norway
| | - Soheil Hassanipour
- Gastrointestinal and Liver Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Guilan University of Medical Sciences, Rasht, Iran
| | - Hadi Hassankhani
- School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
- Independent Consultant, Tabriz, Iran
| | - Hamid Yimam Hassen
- Department of Public Health, Mizan-Tepi University, Tepi, Ethiopia
- Unit of Epidemiology and Social Medicine, University Hospital Antwerp, Wilrijk, Belgium
| | - Rasmus Havmoeller
- Department of Clinical Sciences, Karolinska University Hospital, Stockholm, Sweden
| | - Delia Hendrie
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Fatemeh Heydarpour
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Martha Híjar
- Research Coordination, AC Environments Foundation, Cuernavaca, Mexico
- CISS, National Institute of Public Health, Cuernavaca. Mexico
| | - Hung Chak Ho
- Department of Urban Planning and Design, University of Hong Kong, Hong Kong, China
| | - Chi Linh Hoang
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Michael K Hole
- Department of Pediatrics, Dell Medical School, University of Texas Austin, Austin, TX, USA
| | - Ramesh Holla
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Naznin Hossain
- Department of Pharmacology and Therapeutics, Dhaka Medical College, Dhaka, Bangladesh
- Department of Pharmacology, Bangladesh Industrial Gases Limited, Tangail, Bangladesh
| | - Mehdi Hosseinzadeh
- Department of Computer Engineering, Islamic Azad University, Tehran, Iran
- Computer Science Department, University of Human Development, Sulaymaniyah, Iraq
| | - Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Legal Medicine Department, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
| | - Guoqing Hu
- Department of Epidemiology and Health Statistics, Central South University, Changsha, China
| | | | | | | | - Seyed Sina Naghibi Irvani
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Mofizul Islam
- School of Psychology and Public Health, La Trobe University, Bundoora, Melbourne, Victoria, Australia
| | - 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
| | - Rebecca Q Ivers
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Mihajlo Jakovljevic
- Department for Health Care and Public Health, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Farzad Jalilian
- Social Development & Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sudha Jayaraman
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Achala Upendra Jayatilleke
- Institute of Medicine, University of Colombo, Colombo, Sri Lanka
- Faculty of Graduate Studies, University of Colombo, Colombo, Sri Lanka
| | - Ravi Prakash Jha
- Department of Community Medicine, Banaras Hindu University, Varanasi, India
| | | | - Jost B Jonas
- Department of Ophthalmology, Heidelberg University, Mannheim, Germany
- Beijing Ophthalmology & Visual Science Key Laboratory, Beijing Tongren Hospital, Beijing, China
| | - Kelly M Jones
- Auckland University of Technology, Auckland, New Zealand
| | - Nitin Joseph
- Community Medicine Department, Manipal Academy of Higher Education, Mangalore, India
| | - Farahnaz Joukar
- Gastrointestinal and Liver Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Jacek Jerzy Jozwiak
- Department of Family Medicine and Public Health, University of Opole, Opole, Poland
| | | | - Mikk Jürisson
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - 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
| | - Leila R Kalankesh
- Department of Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rohollah Kalhor
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
- Health Services Management Department, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Teshome Abegaz Kamil
- School of Public Health, Department of Health informatics and Health Innovation, A.C.S. Medical College and Hospital, Mekelle, Ethiopia
| | - Tanuj Kanchan
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India
| | - Neeti Kapoor
- Department of Forensic Science, Government Institute of Forensic Science, Nagpur, India
| | - Manoochehr Karami
- Department of Epidemiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amir Kasaeian
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Taras Kavetskyy
- Department of Applied Physics, The John Paul II Catholic University of Lublin, Lublin Voivodeship, Poland
- Department of Biology and Chemistry, Drohobych Ivan Franko State Pedagogical University, Drohobych, Ukraine
| | - Gbenga A Kayode
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Julius Centre for Health Sciences and Primary Care, Utrecht University, Utrecht, Netherlands
| | | | | | - Yousef Saleh Khader
- Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
| | - Morteza Abdullatif Khafaie
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nauman Khalid
- School of Food and Agricultural Sciences, University of Management and Technology, Lahore, Pakistan
| | - Ibrahim A Khalil
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Rovshan Khalilov
- Department of Physiology, Baku State University, Baku, Azerbaijan
| | - Maseer Khan
- Epidemiology, Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
| | - Ejaz Ahmad Khan
- Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
| | - Junaid Khan
- Department of Population Studies, International Institute for Population Sciences, Mumbai, India
| | - Tripti Khanna
- Department of Health Research, Indian Council of Medical Research, New Delhi, India
- Centre for Ethics, Jawahar Lal Nehru University, New Delhi, India
| | - Salman Khazaei
- Department of Epidemiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Habibolah Khazaie
- Department of Psychiatry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roba Khundkar
- Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, UK
| | | | - Young-Eun Kim
- Department of Preventive Medicine, Korea University, Seoul, South Korea
| | - Yun Jin Kim
- School of Medicine, Xiamen University Malaysia, Sepang, Malaysia
| | - Daniel Kim
- Department of Health Sciences, Northeastern University, Boston, MA, USA
| | - Sezer Kisa
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Adnan Kisa
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Hamidreza Komaki
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Brain Engineering Research Center, Institute for Research in Fundamental Sciences, Tehran, Iran
| | - Shivakumar K M Kondlahalli
- Public Health Dentistry Department, Krishna Institute of Medical Sciences Deemed to be University, Karad, India
| | - Ali Koolivand
- Environmental Health Engineering, Arak University of Medical Sciences, Arak, Iran
| | - Vladimir Andreevich Korshunov
- Department of Epidemiology and Evidence Based Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Ai Koyanagi
- CIBERSAM, San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Moritz U G Kraemer
- Department of Zoology, University of Oxford, Oxford, UK
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Kewal Krishan
- Department of Anthropology, Panjab University, Chandigarh, India
| | - Barthelemy Kuate Defo
- Department of Demography, University of Montreal, Montreal, Quebec, Canada
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Burcu Kucuk Bicer
- Department of Public Health, Yuksek Ihtisas University, Ankara, Turkey
- Department of Public Health, Hacettepe University, Ankara, Turkey
| | - Nuworza Kugbey
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
- Department of Psychology and Health Promotion, University of KwaZulu-Natal, Durban, South Africa
| | - Nithin Kumar
- Community Medicine Department, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Vivek Kumar
- Department of Medicine Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Narinder Kumar
- Orthopaedics Department, Base Hospital Lucknow Cantt, Lucknow, India
| | - Girikumar Kumaresh
- Mechanical and Industrial Engineering, Indian Institute of Technology, Roorkee, India
| | - Faris Hasan Lami
- Department of Community and Family Medicine, University of Baghdad, Baghdad, Iraq
| | - Van C Lansingh
- HelpMeSee, New York, NY, USA
- International Relations, Mexican Institute of Ophthalmology, Queretaro, Mexico
| | - Savita Lasrado
- Department of Otorhinolaryngology (ENT), Father Muller Medical College, Mangalore, India
| | - Arman Latifi
- Department of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Paolo Lauriola
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Carlo La Vecchia
- Clinical Medicine and Community Health, University of Milan, Milano, Italy
| | - Janet L Leasher
- College of Optometry, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University, Bandar Sunway, Malaysia
- School of Pharmacy, Taylor's University Lakeside Campus, Subang Jaya, Malaysia
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Xuefeng Liu
- Department of Systems, Populations and Leadership, University of Michigan, Ann Arbor, MI, USA
| | - Alan D Lopez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Paulo A Lotufo
- Department of Medicine, University of São Paulo, Sao Paulo, Brazil
| | - Ronan A Lyons
- Health Data Research UK, Swansea University, Swansea, UK
| | - Daiane Borges Machado
- Center for Integration of Data and Health Knowledge, FIOCRUZ: Cidacs Center for Integration of Data and Health Knowledge, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, England
| | - Mohammed Madadin
- Pathology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | | | - Marek Majdan
- Department of Public Health, Trnava University, Trnava, Slovakia
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Venkatesh Maled
- Health Education and Research Department, SDM College of Medical Sciences & Hospital, Dharwad, India
- Health University, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Navid Manafi
- Ophthalmology Department, Iran University of Medical Sciences, Tehran, Iran
- Ophthalmology Department, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amir Manafi
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Ana-Laura Manda
- Surgery Department, Emergency University Hospital Bucharest, Bucharest, Romania
| | - Narayana Manjunatha
- Psychiatry Department, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Joemer C Maravilla
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Seyedeh Zahra Masoumi
- Department of Midwifery-Reproductive Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Benjamin Ballard Massenburg
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA, USA
| | - Pallab K Maulik
- Research Department, The George Institute for Global Health, New Delhi, India
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Man Mohan Mehndiratta
- Neurology Department, Janakpuri Super Specialty Hospital Society, New Delhi, India
- Department of Neurology, Govind Ballabh Institute of Medical Education and Research, New Delhi, India
| | | | - Peter T N Memiah
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland, Baltimore, MD, 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
| | | | - Tuomo J Meretoja
- Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Atte Meretoja
- Neurocenter, Helsinki University Hospital, Helsinki, Finland
- School of Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | | | - Tomislav Mestrovic
- Clinical Microbiology and Parasitology Unit, Zora Profozic Polyclinic, Zagreb, Croatia
- University Centre Varazdin, University North, Varazdin, Croatia
| | - Bartosz Miazgowski
- Center for Innovation in Medical Education, Pomeranian Medical University, Szczecin, Poland
- Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Miazgowski
- Department of Propedeutics of Internal Diseases & Arterial Hypertension, Pomeranian Medical University, Szczecin, Poland
| | - Ted R Miller
- School of Public Health, Curtin University, Perth, Western Australia, Australia
- Pacific Institute for Research & Evaluation, Calverton, MD, USA
| | - G K Mini
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
- Global Institute of Public Health (GIPH), Ananthapuri Hospitals and Research Centre, Trivandrum, India
| | - Andreea Mirica
- Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania
- President's Office, National Institute of Statistics, Bucharest, Romania
| | - Erkin M Mirrakhimov
- Faculty of Internal Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
- Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan
| | - Mehdi Mirzaei-Alavijeh
- Social Development & Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Prasanna Mithra
- Community Medicine Department, Manipal Academy of Higher Education, Mangalore, India
| | - Babak Moazen
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Institute of Addiction Research (ISFF), Frankfurt University of Applied Sciences, Frankfurt, Germany
| | - Masoud Moghadaszadeh
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Efat Mohamadi
- Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Mohammad
- Internal Medicine Department, King Saud University, Riyadh, Saudi Arabia
| | - Aso Mohammad Darwesh
- Department of Information Technology, University of Human Development, Sulaymaniyah, Iraq
| | | | | | - Shafiu Mohammed
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
| | | | - Farnam Mohebi
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Iran National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad A Mohseni Bandpei
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - 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
| | - Masoud Moradi
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Department of Epidemiology and Biostatistics, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Shane Douglas Morrison
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA, USA
| | | | - Atalay Goshu Muluneh
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Kamarul Imran Musa
- School of Medical Sciences, Science University of Malaysia, Kubang Kerian, Malaysia
| | - Ghulam Mustafa
- Department of Pediatric Medicine, Nishtar Medical University, Multan, Pakistan
- Department of Pediatrics & Pediatric Pulmonology, Institute of Mother & Child Care, Multan, Pakistan
| | - Mehdi Naderi
- Clinical Research Development Center, 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
| | - Gurudatta Naik
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mukhammad David Naimzada
- Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
- Experimental Surgery and Oncology Laboratory, Kursk State Medical University of the Ministry of Health of the Russian Federation, Kursk, Russia
| | - Farid Najafi
- Department of Epidemiology & Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Bruno Ramos Nascimento
- Hospital of the Federal University of Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Morteza Naserbakht
- Mental Health Research Center, IUMS, Tehran, Iran
- Preventive Medicine and Public Health Research Center, IUMS, Tehran, Iran
| | - Vinod Nayak
- Department of Forensic Medicine and Toxicology, Manipal Academy of Higher Education, Manipal, India
| | - Javad Nazari
- Department of Pediatrics, Arak University of Medical Sciences, Arak, Iran
- Iranian Ministry of Health and Medical Education, Tehran, Iran
| | | | - Ionut Negoi
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | | | - Trang Huyen Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam
| | - Diep Ngoc Nguyen
- Project of ADB, National Institute of Nutrition, Hanoi, Vietnam
- Industrial Management Department, Hanoi University of Science and Technology, Hanoi, Vietnam
| | | | - Rajan Nikbakhsh
- Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Heidelberg University Hospital, Heidelberg, Germany
| | - Dina Nur Anggraini Ningrum
- Public Health Department, Universitas Negeri Semarang, Kota Semarang, Indonesia
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City, Taiwan
| | - Chukwudi A Nnaji
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Richard Ofori-Asenso
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
- Independent Consultant, Accra, Ghana
| | | | - Onome Bright Oghenetega
- Reproductive Health Sciences, Department Obstetrics and Gynecology, University of Ibadan, Ibadan, Nigeria
| | - In-Hwan Oh
- Department of Preventive Medicine, Kyung Hee University, Dongdaemun-gu, South Korea
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry, University of Lagos, Lagos, Nigeria
| | - Tinuke O Olagunju
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ahmed Omar Bali
- Diplomacy and Public Relations Department, University of Human Development, Sulaimaniyah, Iraq
| | - Obinna E Onwujekwe
- Department of Pharmacology and Therapeutics, University of Nigeria Nsukka, Enugu, Nigeria
| | - Heather M Orpana
- Applied Research Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Erika Ota
- Department of Global Health Nursing, St. Luke's International University, Chuo-ku, Japan
| | - Nikita Otstavnov
- Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
- Academic Department, Unium Ltd, Moscow, Russia
| | - Stanislav S Otstavnov
- Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
- Department of Project Management, National Research University Higher School of Economics, Moscow, Russia
| | - Mahesh P A
- Department of Respiratory Medicine, Jagadguru Sri Shivarathreeswara Academy of Health Education and Research, Mysore, India
| | | | - Smita Pakhale
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Keyvan Pakshir
- Parasitology and Mycology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Eun-Kee Park
- Department of Medical Humanities and Social Medicine, Kosin University, Busan, South Korea
| | - Sangram Kishor Patel
- Research and Evaluation Department, Population Council, New Delhi, India
- Indian Institute of Health Management Research University, Jaipur, India
| | - Ashish Pathak
- Department of Pediatircs, RD Gardi Medical College, Ujjain, India
- Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Sanghamitra Pati
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, India
| | - Kebreab Paulos
- Department of Midwifery, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amy E Peden
- Royal Life Saving Society, Sydney, New South Wales, Australia
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Jeevan Pereira
- Department of Orthopedics, Yenepoya Medical College, Mangalore, India
| | - Michael R Phillips
- Department of Psychiatry, Department of Epidemiology, Columbia University, New York, NY, USA
- Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China
| | - Roman V Polibin
- Department of Epidemiology and Evidence-Based Medicine, Sechenon University, Moscow, Russia
| | - Suzanne Polinder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Farshad Pourmalek
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Akram Pourshams
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Swayam Prakash
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | - Parul Puri
- Department of Population Studies, International Institute for Population Sciences, Mumbai, India
| | - Zahiruddin Quazi Syed
- Department of Community Medicine, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Navid Rabiee
- Department of Chemistry, Sharif University of Technology, Tehran, Iran
| | - Mohammad Rabiee
- Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
| | - Amir Radfar
- College of Medicine, University of Central Florida, Orlando, FL, USA
- College of Graduate Health Sciences, A.T. Still University, Mesa, AZ, USA
| | - Anwar Rafay
- Department of Epidemiology & Biostatistics, Contech School of Public Health, Lahore, Pakistan
| | - Ata Rafiee
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Alireza Rafiei
- Department of Immunology, Mazandaran University of Medical Sciences, Sari, Iran
- Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fakher Rahim
- Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Metabolomics and Genomics Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Siavash Rahimi
- Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Muhammad Aziz Rahman
- School of Nursing and Healthcare Professions, Federation University Australia, Berwick, Victoria, Australia
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | | | - Fatemeh Rajati
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ivo Rakovac
- European Office for the Prevention and Control of Noncommunicable Diseases, World Health Organization (WHO), Moscow, Russia
| | - Sowmya J Rao
- Department of Oral Pathology, Srinivas Institute of Dental Sciences, Mangalore, India
| | - Vahid Rashedi
- School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Tehran, Iran
| | - Prateek Rastogi
- Department of Forensic Medicine, Manipal Academy of Higher Education, Manipal, India
| | - Priya Rathi
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Salman Rawaf
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Academic Public Health Department, Public Health England, London, UK
| | - Lal Rawal
- School of Health, Medical and Applied Sciences, CQ University, Sydney, New South Wales, Australia
| | - Reza Rawassizadeh
- Department of Computer Science, Metropolitan College, Boston University, Boston, USA
| | - Vishnu Renjith
- Neurology Department, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Serge Resnikoff
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
- Organization for the Prevention of Blindness, Paris, France
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ana Isabel Ribeiro
- EPIUnit - Public Health Institute University Porto (ISPUP), University of Porto, Porto, Portugal
| | - Jennifer Rickard
- Surgery Department, University of Minnesota, Minneapolis, MN, USA
- Surgery Department, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Carlos Miguel Rios González
- Research Directorate, Nihon Gakko University, Fernando de la Mora, Paraguay
- Research Direction, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
| | - 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
| | - Basema Saddik
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Hamid Safarpour
- Department of Health in Disasters and Emergencies, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Safdarian
- Department of Neuroscience, Iran University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hosni Salem
- Urology Department, Cairo University, Giza, Egypt
| | - Inbal Salz
- Health and Disability Intelligence Group, Ministry of Health, Wellington, New Zealand
| | - Abdallah M Samy
- Department of Entomology, Ain Shams University, Cairo, Egypt
| | - Juan Sanabria
- Department of Surgery, Marshall University, Huntington, WV, USA
- Department of Nutrition and Preventive Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Lidia Sanchez Riera
- Rheumatology Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Institute of Bone and Joint Research, University of Sydney, Syndey, New South Wales, Australia
| | - Milena M Santric Milicevic
- Institute of Social Medicine, University of Belgrade, Belgrade, Serbia
- Centre-School of Public Health and Health Management, University of Belgrade, Belgrade, Serbia
| | - Abdur Razzaque Sarker
- Health Economics, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Arash Sarveazad
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Brijesh Sathian
- Surgery Department, Hamad Medical Corporation, Doha, Qatar
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
| | - Monika Sawhney
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Mehdi Sayyah
- Education Development Center, Faculty Member of Education Development Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | | | | | - Feng Sha
- Center for Biomedical Information Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Faramarz Shaahmadi
- Department of Health Promotion and Education, Alborz University of Medical Sciences, Karaj, Iran
| | - Saeed Shahabi
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Aziz Sheikh
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
- Division of General Internal Medicine, Harvard University, Boston, MA, USA
| | | | - Jae Il Shin
- College of Medicine, Yonsei University, Seodaemun-gu, South Korea
- Division of Cardiology, Emory University, Atlanta, GA, USA
| | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Soraya Siabani
- Department of Health Education & Promotion, Kermanshah University of Medical Sciences, Kermanshah, Iran
- School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Inga Dora Sigfusdottir
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
- Department of Health and Behavior Studies, Columbia University, New York, NY, USA
| | - Jasvinder A Singh
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Medicine Service, US Department of Veterans Affairs (VA), 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
| | - Amin Soheili
- Medical Surgical Nursing Department, Urmia University of Medical Science, Urmia, Iran
- Emergency Nursing Department, Semnan University of Medical Sciences, Semnan, Iran
| | - Joan B Soriano
- Hospital Universitario de la Princesa, Autonomous University of Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | | | - Ireneous N Soyiri
- Hull York Medical School, University of Hull, Hull City, UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Mark A Stokes
- Department of Psychology, Deakin University, Melbourne, Victoria, Australia
| | | | - Bryan L Sykes
- Department of Criminology, Law and Society, University of California Irvine, Irvine, CA, USA
| | - Rafael Tabarés-Seisdedos
- Department of Medicine, University of Valencia, Valencia, Spain
- Carlos III Health Institute, Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain
| | - Karen M Tabb
- School of Social Work, University of Illinois, Urbana, IL, USA
| | | | - Yonatal Mesfin Tefera
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
- Department of Environmental Health, Wollo University, Dessie, Ethiopia
| | - Arash Tehrani-Banihashemi
- 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
| | | | | | | | - Rekha Thapar
- Community Medicine Department, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Mariya Vladimirovna Titova
- Timiryazev Institute of Plant Physiology, Russian Academy of Sciences, Moscow, Russia
- Biology Department, Moscow State University, Moscow, Russia
| | | | - Hamid Reza Tohidinik
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Kerman University of Medical Sciences, Kerman, Iran
| | - Roman Topor-Madry
- Institute of Public Health, Krakow, Poland
- The Agency for Health Technology Assessment and Tariff System, Warszawa, Poland
| | - Khanh Bao Tran
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
- Clinical Hematology and Toxicology, Military Medical University, Hanoi, Vietnam
| | - Bach Xuan Tran
- Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam
| | - Jaya Prasad Tripathy
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
| | - Alexander C Tsai
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - 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
| | - Saif Ullah
- Institute of Soil and Environmental Sciences, University of Agriculture, Faisalabad, Pakistan
| | | | - Era Upadhyay
- Amity Institute of Biotechnology, Amity University Rajasthan, Jaipur, India
| | | | - Pascual R Valdez
- Argentine Society of Medicine, Buenos Aires, Argentina
- Velez Sarsfield Hospital, Buenos Aires, Argentina
| | | | - 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
| | - Vasily Vlassov
- Department of Health Care Administration and Economics, National Research University Higher School of Economics, Moscow, Russia
| | - Yasir Waheed
- Foundation University Medical College, Foundation University, Islamabad, Pakistan
| | - Yuan-Pang Wang
- Department of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Taweewat Wiangkham
- Department of Physical Therapy, Naresuan University, Meung District, Thailand
| | - Haileab Fekadu Wolde
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Dawit Habte Woldeyes
- Department of Human Anatomy, Histology, and Embryology, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Adam Belay Wondmieneh
- Department of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Nursing, Wollo University, Dessie, Ethiopia
| | - Ai-Min Wu
- Department of Orthopaedics, Wenzhou Medical University, Wenzhou, China
| | - Grant M A Wyper
- Public Health Science Directorate, NHS Health Scotland, Glasgow, Scotland
| | - Rajaram Yadav
- Department of Population Studies, International Institute for Population Sciences, Mumbai, India
| | - Ali Yadollahpour
- Medical Physics Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Yuichiro Yano
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Vahid Yazdi-Feyzabadi
- Health Services Management Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Department of Health Management, Policy and Economics, Kerman University of Medical Sciences, Kerman, Iran
| | - Pengpeng Ye
- Division of Injury Prevention and Mental Health Improvement, National Center for Chronic and Noncommunicable Disease Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - 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
| | - Engida Yisma
- School of Allied Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Naohiro Yonemoto
- Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Seok-Jun Yoon
- Department of Preventive Medicine, Korea University, Seoul, South Korea
| | - Yoosik Youm
- Department of Sociology, Yonsei University, Seoul, South Korea
| | - Mustafa Z Younis
- Department of Health Policy & Management, Jackson State University, Jackson, MS, USA
- School of Medicine, Tsinghua University, Beijing, China
| | - Zabihollah Yousefi
- Department of Environmental Health, Mazandaran University of Medical Sciences, Sari, Iran
- Environmental Health, Academy of Medical Science, Sari, Iran
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Yong Yu
- School of Public Health and Management, Hubei University of Medicine, Shiyan, China
| | - 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
| | - Zoubida Zaidi
- Department of Epidemiology, University Hospital of Setif, Setif, Algeria
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Department of Medicine, School of Clinical Sciences at Monash Health, 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
| | - Fatemeh Zarei
- Faculty of Medical Sciences, Department of Health Education, Tarbiat Modares University, Tehran, Iran
| | - Zhi-Jiang Zhang
- Department of Preventive Medicine, Wuhan University, Wuhan, China
| | - Yunquan Zhang
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
| | - Arash Ziapour
- Department of Health Education & Promotion, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sanjay Zodpey
- Indian Institute of Public Health, Public Health Foundation of India, Gurugram, India
| | - Rakhi Dandona
- 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
- Public Health Foundation of India, Gurugram, India
| | - Samath Dhamminda Dharmaratne
- 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
- Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - 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
| | - 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
| | - David M Pigott
- 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
| | - 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
| | - 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
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James SL, Lucchesi LR, Bisignano C, Castle CD, Dingels ZV, Fox JT, Hamilton EB, Henry NJ, McCracken D, Roberts NLS, Sylte DO, Ahmadi A, Ahmed MB, Alahdab F, Alipour V, Andualem Z, Antonio CAT, Arabloo J, Badiye AD, Bagherzadeh M, Banstola A, Bärnighausen TW, Barzegar A, Bayati M, Bhaumik S, Bijani A, Bukhman G, Carvalho F, Crowe CS, Dalal K, Daryani A, Nasab MD, Do HT, Do HP, Endries AY, Fernandes E, Filip I, Fischer F, Fukumoto T, Gebremedhin KBB, Gebremeskel GG, Gilani SA, Haagsma JA, Hamidi S, Hostiuc S, Househ M, Igumbor EU, Ilesanmi OS, Irvani SSN, Jayatilleke AU, Kahsay A, Kapoor N, Kasaeian A, Khader YS, Khalil IA, Khan EA, Khazaee-Pool M, Kokubo Y, Lopez AD, Madadin M, Majdan M, Maled V, Malekzadeh R, Manafi N, Manafi A, Mangalam S, Massenburg BB, Meles HG, Menezes RG, Meretoja TJ, Miazgowski B, Miller TR, Mohammadian-Hafshejani A, Mohammadpourhodki R, Morrison SD, Negoi I, Nguyen TH, Nguyen SH, Nguyen CT, Nixon MR, Olagunju AT, Olagunju TO, Padubidri JR, Polinder S, Rabiee N, Rabiee M, Radfar A, Rahimi-Movaghar V, Rawaf S, Rawaf DL, Rezapour A, Rickard J, Roro EM, Roy N, Safari-Faramani R, Salamati P, Samy AM, Satpathy M, Sawhney M, Schwebel DC, Senthilkumaran S, Sepanlou SG, Shigematsu M, Soheili A, Stokes MA, Tohidinik HR, Tran BX, Valdez PR, Wijeratne T, Yisma E, Zaidi Z, Zamani M, Zhang ZJ, Hay SI, Mokdad AH. Epidemiology of injuries from fire, heat and hot substances: global, regional and national morbidity and mortality estimates from the Global Burden of Disease 2017 study. Inj Prev 2020; 26:i36-i45. [PMID: 31857422 PMCID: PMC7571358 DOI: 10.1136/injuryprev-2019-043299] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [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: 05/07/2019] [Revised: 08/14/2019] [Accepted: 08/18/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Past research has shown how fires, heat and hot substances are important causes of health loss globally. Detailed estimates of the morbidity and mortality from these injuries could help drive preventative measures and improved access to care. METHODS We used the Global Burden of Disease 2017 framework to produce three main results. First, we produced results on incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years from 1990 to 2017 for 195 countries and territories. Second, we analysed these results to measure mortality-to-incidence ratios by location. Third, we reported the measures above in terms of the cause of fire, heat and hot substances and the types of bodily injuries that result. RESULTS Globally, there were 8 991 468 (7 481 218 to 10 740 897) new fire, heat and hot substance injuries in 2017 with 120 632 (101 630 to 129 383) deaths. At the global level, the age-standardised mortality caused by fire, heat and hot substances significantly declined from 1990 to 2017, but regionally there was variability in age-standardised incidence with some regions experiencing an increase (eg, Southern Latin America) and others experiencing a significant decrease (eg, High-income North America). CONCLUSIONS The incidence and mortality of injuries that result from fire, heat and hot substances affect every region of the world but are most concentrated in middle and lower income areas. More resources should be invested in measuring these injuries as well as in improving infrastructure, advancing safety measures and ensuring access to care.
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Affiliation(s)
- Spencer L James
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Lydia R Lucchesi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Catherine Bisignano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Chris D Castle
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Zachary V Dingels
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Jack T Fox
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Erin B Hamilton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Nathaniel J Henry
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Darrah McCracken
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Nicholas L S Roberts
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Dillon O Sylte
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Alireza Ahmadi
- Department of Anesthesiology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Fares Alahdab
- Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, MN, USA
| | - Vahid Alipour
- Health Management and Economics Research Center, Tehran, Iran
- Health Economics Department, Iran University of Medical Sciences, Tehran, Iran
| | - Zewudu Andualem
- Environmental and Occupational Health and Safety Department, University of Gondar, Gondar, Ethiopia
| | - Carl Abelardo T Antonio
- Department of Health Policy and Administration, University of the Philippines Manila, Manila, 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
| | - Ashish D Badiye
- Department of Forensic Science, Government Institute of Forensic Science, Nagpur, India
| | | | - Amrit Banstola
- Department of Research, Public Health Perspective Nepal, Pokhara-Lekhnath Metropolitan, Nepal
| | - Till Winfried Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Akbar Barzegar
- Occupational Health Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Bayati
- Health Human Resources Research Center, Department of Health Economics, School of Management & Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ali Bijani
- Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Gene Bukhman
- Department of Global Health and Social Medicine, Harvard University, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Félix Carvalho
- Applied Molecular Biosciences Unit, University of Porto, Porto, Portugal
- Institute of Public Health, University of Porto, Porto, Portugal
| | | | - Koustuv Dalal
- Institute of Public Health Kalyani, Kalyani, India
- School of Health Science, Orebro University, Orebro, Sweden
| | - Ahmad Daryani
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Hoa Thi Do
- Center of Excellence in Public Health Nutrition, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Huyen Phuc Do
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Aman Yesuf Endries
- Public Health Department, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Irina Filip
- Psychiatry Department, Kaiser Permanente, Fontana, California, USA
- School of Health Sciences, A.T. Still University, Mesa, Missouri, USA
| | - Florian Fischer
- School of Public Health Medicine, Bielefeld University, Bielefeld, Germany
| | - Takeshi Fukumoto
- Gene Expression & Regulation Program, Cancer Institute (W.I.A), Philadelphia, Pennsylvania, USA
- Department of Dermatology, Kobe University, Kobe, Japan
| | | | - Gebreamlak Gebremedhn Gebremeskel
- Nursing Department College of Health Science, Aksum University, Aksum, Ethiopia
- Nursing Department, Mekelle University, Mekelle, Ethiopia
| | - Syed Amir Gilani
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
- Chairman BOG, Afro-Asian Institute Lahore, Pakistan
| | - Juanita A Haagsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Samer Hamidi
- School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | - Sorin Hostiuc
- Faculty of Dentistry, Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Legal Medicine Department, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
| | - Mowafa Househ
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
- Qatar Foundation for Education, Science, and Community Development, Doha, Qatar
| | - Ehimario U Igumbor
- School of Public Health, University of the Western Cape, Bellville, South Africa
- Department of Public Health, Walter Sisulu University, Mthatha, South Africa
| | | | - Seyed Sina Naghibi Irvani
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Achala Upendra Jayatilleke
- Institute of Medicine, University of Colombo, Colombo, Sri Lanka
- Faculty of Graduate Studies, University of Colombo, Colombo, Sri Lanka
| | - Amaha Kahsay
- Department of Nutrition and Dietetics, Mekelle University, Mekelle, Ethiopia
| | - Neeti Kapoor
- Department of Forensic Science, Government Institute of Forensic Science, Nagpur, India
| | - Amir Kasaeian
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Hematologic Malignancies Research Center, 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
| | - Ibrahim A Khalil
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Ejaz Ahmad Khan
- Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
| | - Maryam Khazaee-Pool
- Department of Public Health, School of Health, Mazandaran University of Sciences, Sari, Iran
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Alan D Lopez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- University of Melbourne, Melbourne, Victoria, Australia
| | - Mohammed Madadin
- Pathology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Marek Majdan
- Department of Public Health, Trnava University, Trnava, Slovakia
| | - Venkatesh Maled
- Health Education and Research Department, SDM College of Medical Sciences & Hospital, Dharwad, India
- Health University, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - 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
| | - Navid Manafi
- Ophthalmology Department, Iran University of Medical Sciences, Tehran, Iran
- Ophthalmology Department, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ali Manafi
- Plastic Surgery Department, Iran University of Medical Sciences, Tehran, Iran
| | - Srikanth Mangalam
- Public Risk Management Institute, Mississauga, Ontario, Canada
- Trade and Competitiveness, World Bank, New York city, New York, USA
| | | | | | - Ritesh G Menezes
- Forensic Medicine Division, Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Tuomo J Meretoja
- Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
| | - Bartosz Miazgowski
- Center for Innovation in Medical Education, Pomeranian Medical University, Szczecin, Poland
| | - Ted R Miller
- Pacific Institute for Research & Evaluation, Calverton, Maryland, USA
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | | | | | | | - Ionut Negoi
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Trang Huyen Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Son Hoang Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam
| | - Molly R Nixon
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry, University of Lagos, Lagos, Nigeria
| | - Tinuke O Olagunju
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jagadish Rao Padubidri
- Forensic Medicine and Toxicology Department, Manipal Academy of Higher Education, Mangaluru, India
| | - Suzanne Polinder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Navid Rabiee
- Department of Chemistry, Sharif University of Technology, Tehran, Iran
| | - Mohammad Rabiee
- Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
| | - Amir Radfar
- College of G raduate Health Sciences, A.T. Still University, Mesa, Arizona, USA
- Medichem, Barcelona, Spain
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Salman Rawaf
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Academic Public Health Department, Public Health England, London, UK
| | - David Laith Rawaf
- WHO Collaborating Centre for Public Health Education and Training, Imperial College London, London, UK
- University College London Hospitals, London, UK
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jennifer Rickard
- Surgery Department, University of Minnesota, Minneapolis, Minnesota, USA
- Surgery Department, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Elias Merdassa Roro
- Public Health Department, Wollega University, Nekemte, Ethiopia
- Public Health Department, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nobhojit Roy
- Public Health Planning and Evidence Practice Area, National Health Systems Resource Centre, New Delhi, India
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Roya Safari-Faramani
- Faculty of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - 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
| | - Abdallah M Samy
- Department of Entomology, Ain Shams University, Cairo, Egypt
| | - Maheswar Satpathy
- UGC Centre of Advanced Study in Psychology, Utkal University, Bhubaneswar, India
- Udyam-Global Association for Sustainable Development, Bhubaneswar, India
| | - Monika Sawhney
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, 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
| | | | - Amin Soheili
- Medical Surgical Nursing Department, Urmia University of Medical Science, Urmia, Iran
- Emergency Nursing Department, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mark A Stokes
- Department of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Hamid Reza Tohidinik
- HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Bach Xuan Tran
- Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam
| | - Pascual R Valdez
- Argentine Society of Medicine, Buenos Aires, Argentina
- Velez Sarsfield Hospital, Buenos Aires, Argentina
| | - Tissa Wijeratne
- Department of Psychology and Counselling, University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, St Albans, Victoria, Australia
| | - Engida Yisma
- School of Allied Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zoubida Zaidi
- Department of Epidemiology, University Hospital of Setif, Setif, Algeria
| | - Mohammad Zamani
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Zhi-Jiang Zhang
- Department of Preventive Medicine, Wuhan University, Wuhan, China
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
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James SL, Castle CD, Dingels ZV, Fox JT, Hamilton EB, Liu Z, S Roberts NL, Sylte DO, Henry NJ, LeGrand KE, Abdelalim A, Abdoli A, Abdollahpour I, Abdulkader RS, Abedi A, Abosetugn AE, Abushouk AI, Adebayo OM, Agudelo-Botero M, Ahmad T, Ahmed R, Ahmed MB, Eddine Aichour MT, Alahdab F, Alamene GM, Alanezi FM, Alebel A, Alema NM, Alghnam SA, Al-Hajj S, Ali BA, Ali S, Alikhani M, Alinia C, Alipour V, Aljunid SM, Almasi-Hashiani A, Almasri NA, Altirkawi K, Abdeldayem Amer YS, Amini S, Loreche Amit AM, Andrei CL, Ansari-Moghaddam A, T Antonio CA, Yaw Appiah SC, Arabloo J, Arab-Zozani M, Arefi Z, Aremu O, Ariani F, Arora A, Asaad M, Asghari B, Awoke N, Ayala Quintanilla BP, Ayano G, Ayanore MA, Azari S, Azarian G, Badawi A, Badiye AD, Bagli E, Baig AA, Bairwa M, Bakhtiari A, Balachandran A, Banach M, Banerjee SK, Banik PC, Banstola A, Barker-Collo SL, Bärnighausen TW, Barrero LH, Barzegar A, Bayati M, Baye BA, Bedi N, Behzadifar M, Bekuma TT, Belete H, Benjet C, Bennett DA, Bensenor IM, Berhe K, Bhardwaj P, Bhat AG, Bhattacharyya K, Bibi S, Bijani A, Bin Sayeed MS, Borges G, Borzì AM, Boufous S, Brazinova A, Briko NI, Budhathoki SS, Car J, Cárdenas R, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Catalá-López F, Cerin E, Chandan JS, Chanie WF, Chattu SK, Chattu VK, Chatziralli I, Chaudhary N, Cho DY, Kabir Chowdhury MA, Chu DT, Colquhoun SM, Constantin MM, Costa VM, Damiani G, Daryani A, Dávila-Cervantes CA, Demeke FM, Demis AB, Demoz GT, Demsie DG, Derakhshani A, Deribe K, Desai R, Nasab MD, da Silva DD, Dibaji Forooshani ZS, Doyle KE, Driscoll TR, Dubljanin E, Adema BD, Eagan AW, Eftekhari A, Ehsani-Chimeh E, Sayed Zaki ME, Elemineh DA, El-Jaafary SI, El-Khatib Z, Ellingsen CL, Emamian MH, Endalew DA, Eskandarieh S, Faris PS, Faro A, Farzadfar F, Fatahi Y, Fekadu W, Ferede TY, Fereshtehnejad SM, Fernandes E, Ferrara P, Feyissa GT, Filip I, Fischer F, Folayan MO, Foroutan M, Francis JM, Franklin RC, Fukumoto T, Geberemariyam BS, Gebre AK, Gebremedhin KB, Gebremeskel GG, Gebremichael B, Gedefaw GA, Geta B, Ghafourifard M, Ghamari F, Ghashghaee A, Gholamian A, Gill TK, Goulart AC, Grada A, Grivna M, Mohialdeen Gubari MI, Guimarães RA, Guo Y, Gupta G, Haagsma JA, Hafezi-Nejad N, Bidgoli HH, Hall BJ, Hamadeh RR, Hamidi S, Haro JM, Hasan MM, Hasanzadeh A, Hassanipour S, Hassankhani H, Hassen HY, Havmoeller R, Hayat K, Hendrie D, Heydarpour F, Híjar M, Ho HC, Hoang CL, Hole MK, Holla R, Hossain N, Hosseinzadeh M, Hostiuc S, Hu G, Ibitoye SE, Ilesanmi OS, Ilic I, Ilic MD, Inbaraj LR, Indriasih E, Naghibi Irvani SS, Shariful Islam SM, Islam MM, Ivers RQ, Jacobsen KH, Jahani MA, Jahanmehr N, Jakovljevic M, Jalilian F, Jayaraman S, Jayatilleke AU, Jha RP, John-Akinola YO, Jonas JB, Joseph N, Joukar F, Jozwiak JJ, Jungari SB, Jürisson M, Kabir A, Kadel R, Kahsay A, Kalankesh LR, Kalhor R, Kamil TA, Kanchan T, Kapoor N, Karami M, Kasaeian A, Kassaye HG, Kavetskyy T, Kebede HK, Keiyoro PN, Kelbore AG, Kelkay B, Khader YS, Khafaie MA, Khalid N, Khalil IA, Khalilov R, Khammarnia M, Khan EA, Khan M, Khanna T, Khazaie H, Shadmani FK, Khundkar R, Kiirithio DN, Kim YE, Kim D, Kim YJ, Kisa A, Kisa S, Komaki H, M Kondlahalli SK, Korshunov VA, Koyanagi A, G Kraemer MU, Krishan K, Bicer BK, Kugbey N, Kumar V, Kumar N, Kumar GA, Kumar M, Kumaresh G, Kurmi OP, Kuti O, Vecchia CL, Lami FH, Lamichhane P, Lang JJ, Lansingh VC, Laryea DO, Lasrado S, Latifi A, Lauriola P, Leasher JL, Huey Lee SW, Lenjebo TL, Levi M, Li S, Linn S, Liu X, Lopez AD, Lotufo PA, Lunevicius R, Lyons RA, Madadin M, El Razek MMA, Mahotra NB, Majdan M, Majeed A, Malagon-Rojas JN, Maled V, Malekzadeh R, Malta DC, Manafi N, Manafi A, Manda AL, Manjunatha N, Mansour-Ghanaei F, Mansouri B, Mansournia MA, Maravilla JC, March LM, Mason-Jones AJ, Masoumi SZ, Massenburg BB, Maulik PK, Meles GG, Melese A, Melketsedik ZA, N Memiah PT, Mendoza W, Menezes RG, Mengesha MB, Mengesha MM, Meretoja TJ, Meretoja A, Merie HE, Mestrovic T, Miazgowski B, Miazgowski T, Miller TR, Mini GK, Mirica A, Mirrakhimov EM, Mirzaei-Alavijeh M, Mithra P, Moazen B, Moghadaszadeh M, Mohamadi E, Mohammad Y, Mohammad KA, Darwesh AM, Gholi Mezerji NM, Mohammadian-Hafshejani A, Mohammadoo-Khorasani M, Mohammadpourhodki R, Mohammed S, Mohammed JA, Mohebi F, Molokhia M, Monasta L, Moodley Y, Moosazadeh M, Moradi M, Moradi G, Moradi-Lakeh M, Moradpour F, Morawska L, Velásquez IM, Morisaki N, Morrison SD, Mossie TB, Muluneh AG, Murthy S, Musa KI, Mustafa G, Nabhan AF, Nagarajan AJ, Naik G, Naimzada MD, Najafi F, Nangia V, Nascimento BR, Naserbakht M, Nayak V, Ndwandwe DE, Negoi I, Ngunjiri JW, Nguyen CT, Thi Nguyen HL, Nikbakhsh R, Anggraini Ningrum DN, Nnaji CA, Nyasulu PS, Ogbo FA, Oghenetega OB, Oh IH, Okunga EW, Olagunju AT, Olagunju TO, Bali AO, Onwujekwe OE, Asante KO, Orpana HM, Ota E, Otstavnov N, Otstavnov SS, A MP, Padubidri JR, Pakhale S, Pakshir K, Panda-Jonas S, Park EK, Patel SK, Pathak A, Pati S, Patton GC, Paulos K, Peden AE, Filipino Pepito VC, Pereira J, Pham HQ, Phillips MR, Pinheiro M, Polibin RV, Polinder S, Poustchi H, Prakash S, Angga Pribadi DR, Puri P, Syed ZQ, Rabiee M, Rabiee N, Radfar A, Rafay A, Rafiee A, Rafiei A, Rahim F, Rahimi S, Rahimi-Movaghar V, Rahman MA, Rajabpour-Sanati A, Rajati F, Rakovac I, Ranganathan K, Rao SJ, Rashedi V, Rastogi P, Rathi P, Rawaf S, Rawal L, Rawassizadeh R, Renjith V, N Renzaho AM, Resnikoff S, Rezapour A, Ribeiro AI, Rickard J, Rios González CM, Ronfani L, Roshandel G, Saad AM, Sabde YD, Sabour S, Saddik B, Safari S, Safari-Faramani R, Safarpour H, Safdarian M, Sajadi SM, Salamati P, Salehi F, Zahabi SS, Rashad Salem MR, Salem H, Salman O, Salz I, Samy AM, Sanabria J, Riera LS, Santric Milicevic MM, Sarker AR, Sarveazad A, Sathian B, Sawhney M, Sawyer SM, Saxena S, Sayyah M, Schwebel DC, Seedat S, Senthilkumaran S, Sepanlou SG, Seyedmousavi S, Sha F, Shaahmadi F, Shahabi S, Shaikh MA, Shams-Beyranvand M, Shamsizadeh M, Sharif-Alhoseini M, Sharifi H, Sheikh A, Shigematsu M, Shin JI, Shiri R, Siabani S, Sigfusdottir ID, Singh PK, Singh JA, Sinha DN, Smarandache CG, R Smith EU, Soheili A, Soleymani B, Soltanian AR, Soriano JB, Sorrie MB, Soyiri IN, Stein DJ, Stokes MA, Sufiyan MB, Rasul Suleria HA, Sykes BL, Tabarés-Seisdedos R, Tabb KM, Taddele BW, Tadesse DB, Tamiru AT, Tarigan IU, Tefera YM, Tehrani-Banihashemi A, Tekle MG, Tekulu GH, Tesema AK, Tesfay BE, Thapar R, Tilahune AB, Tlaye KG, Tohidinik HR, Topor-Madry R, Tran BX, Tran KB, Tripathy JP, Tsai AC, Car LT, Ullah S, Ullah I, Umar M, Unnikrishnan B, Upadhyay E, Uthman OA, Valdez PR, Vasankari TJ, Venketasubramanian N, Violante FS, Vlassov V, Waheed Y, Weldesamuel GT, Werdecker A, Wiangkham T, Wolde HF, Woldeyes DH, Wondafrash DZ, Wondmeneh TG, Wondmieneh AB, Wu AM, Yadav R, Yadollahpour A, Yano Y, Yaya S, Yazdi-Feyzabadi V, Yip P, Yisma E, Yonemoto N, Yoon SJ, Youm Y, Younis MZ, Yousefi Z, Yu Y, Yu C, Yusefzadeh H, Moghadam TZ, Zaidi Z, Zaman SB, Zamani M, Zamanian M, Zandian H, Zarei A, Zare F, Zhang ZJ, Zhang Y, Zodpey S, Dandona L, Dandona R, Degenhardt L, Dharmaratne SD, Hay SI, Mokdad AH, Reiner RC, Sartorius B, Vos T. Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017. Inj Prev 2020; 26:i96-i114. [PMID: 32332142 PMCID: PMC7571366 DOI: 10.1136/injuryprev-2019-043494] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [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: 09/29/2019] [Revised: 11/29/2019] [Accepted: 12/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. METHODS We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). FINDINGS In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). INTERPRETATION Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.
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Affiliation(s)
- Spencer L James
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chris D Castle
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Zachary V Dingels
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jack T Fox
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erin B Hamilton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Zichen Liu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nicholas L S Roberts
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Dillon O Sylte
- 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
| | - Kate E LeGrand
- 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
| | - Ibrahim Abdollahpour
- Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Aidin Abedi
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | | | | | - Oladimeji M Adebayo
- Department of Medicine, University College Hospital, Ibadan, Ibadan, Nigeria
| | - Marcela Agudelo-Botero
- School of Medicine Center for Politics, Population and Health Research, National Autonomous University of Mexico, Mexico City, Mexico
| | - Tauseef Ahmad
- Department of Epidemiology and Health Statistics, Southeast University Nanjing, Nanjing, China
- Department of Microbiology, Hazara University Mansehra, Mansehra, Pakistan
| | - 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
| | | | | | - Fares Alahdab
- Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, MN, USA
| | | | - Fahad Mashhour Alanezi
- Department of Computer Sciences, Imam Abdulrehman Bin Faisal University, Dammam, Saudi Arabia
| | - Animut Alebel
- Department of Nursing, Debre Markos University, Debre Markos, Ethiopia
| | | | - Suliman A Alghnam
- Department of Population Health Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Samar Al-Hajj
- Faculty of Health Sciences - Health Management and Policy, American University of Beirut, Beirut, Lebanon
- British Columbia Injury Research Prevention Unit, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Beriwan Abdulqadir Ali
- Medical Technical Institute, Erbil Polytechnic University, Erbil, Iraq
- Faculty of Pharmacy, Ishik University, Erbil, Iraq
| | - Saqib Ali
- Department of Information Systems, College of Economics and Political Science, Sultan Qaboos University, Muscat, Oman
| | - Mahtab Alikhani
- School of Health Management and Information Sciences, Department of Health Services Management, Iran University of Medical Sciences, Tehran, Iran
| | - Cyrus Alinia
- Department of Health Care Management and Economics, Urmia University of Medical Science, Urmia, Iran
| | - Vahid Alipour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Health Economics Department, 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
| | | | - Nihad A Almasri
- Physiotherapy Department, The University of Jordan, Amman, Jordan
| | | | - Yasser Sami Abdeldayem Amer
- Clinical Practice Guidelines Unit, King Saud University, Riyadh, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
| | - 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, Philippines
- Online Programs for Applied Learning, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Carl Abelardo T Antonio
- Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Seth Christopher Yaw Appiah
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Center for International Health, Ludwig Maximilians University, Munich, Germany
| | - Jalal Arabloo
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, 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
| | - Filippo Ariani
- Regional Centre for the Analysis of Data on Occupational and Work-related Injuries and Diseases, Local Health Unit Tuscany Centre, Florence, Italy
| | - Amit Arora
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
- Oral Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Malke Asaad
- Department of Plastic Surgery, University of Texas, Houston, TX, USA
| | - Babak Asghari
- Department of Microbiology, Hamedan University of Medical Sciences, Azad Tabriz University, Iran
| | - Nefsu Awoke
- Department of Nursing, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Beatriz Paulina Ayala Quintanilla
- The Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
- General Office for Research and Technological Transfer, Peruvian National Institute of Health, Lima, Peru
| | - Getinet Ayano
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Martin Amogre Ayanore
- Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Ghana
| | - Samad Azari
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ghasem Azarian
- Department of Environmental Health Engineering, Hamadan University of Medical Sciences, Hamadan, 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
| | - Ashish D Badiye
- Department of Forensic Science, Government Institute of Forensic Science, Nagpur, India
| | - Eleni Bagli
- Department of Ophthalmology, University Hospital of Ioannina, Ioannina, Greece
- Institute of Molecular Biology & Biotechnology, Foundation for Research & Technology, Ioannina, Greece
| | - Atif Amin Baig
- Biochemistry Unit, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
- School of Health Sciences, Univeristi Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | - Mohan Bairwa
- Institute of Health Management Research, Indian Institute of Health Management Research University, Jaipur, India
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Ahad Bakhtiari
- Health Policy And Management Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Arun Balachandran
- Department of Demography, University of Groningen, Groningen, Netherlands
- Population Research Centre, Institute for Social and Economic Change, Bengaluru, India
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
- Polish Mothers' Memorial Hospital Research Institute, Lodz, Poland
| | | | - Palash Chandra Banik
- Department of Noncommunicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
| | - Amrit Banstola
- Department of Research, Public Health Perspective Nepal, Pokhara-Lekhnath Metropolitan City, Nepal
| | | | - Till Winfried Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Lope H Barrero
- Department of Industrial Engineering, Pontifical Javeriana University, Bogota, Colombia
| | - Akbar Barzegar
- Occupational Health Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Bayati
- Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Neeraj Bedi
- Department of Community Medicine, Gandhi Medical College Bhopal, Bhopal, India
- Jazan University, Jazan, Saudi Arabia
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Tariku Tesfaye Bekuma
- Institute of Health Sciences, School of Public Health, Wollega University, Nekemte, Ethiopia
| | - Habte Belete
- Department of Psychiatry, Bahir Dar University, Bahir Dar, Ethiopia
| | - Corina Benjet
- Department of Epidemiology and Psychosocial Reseach, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Derrick A Bennett
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Isabela M Bensenor
- Department of Internal Medicine, University of São Paulo, São Paulo, Brazil
| | - Kidanemaryam Berhe
- Department of Nutrition and Dietetics, Mekelle University, Mekelle, Ethiopia
| | - Pankaj Bhardwaj
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
- Department of Community Medicine, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Anusha Ganapati Bhat
- Department of Internal Medicine, University of Massachusetts Medical School, Springfield, MA, USA
| | - Krittika Bhattacharyya
- Department of Statistical and Computational Genomics, National Institute of Biomedical Genomics, Kalyani, India
- Department of Statistics, University of Calcutta, Kolkata, India
| | - Sadia Bibi
- Institute of Soil and Environmental Sciences, University of Agriculture, Faisalabad, Faisalabad, Pakistan
| | - Ali Bijani
- Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Muhammad Shahdaat Bin Sayeed
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
- Department of Clinical Pharmacy and Pharmacology, University of Dhaka, Dhaka, Bangladesh
| | - Guilherme Borges
- Department of Epidemiology and Psychosocial Reseach, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Antonio Maria Borzì
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Soufiane Boufous
- Transport and Road Safety (TARS) Research Department, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Nikolay Ivanovich Briko
- Department of Epidemiology and Evidence Based Medicine, I M Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Josip Car
- Centre for Population Health Sciences, Nanyang Technological University, Singapore
- Global eHealth Unit, Imperial College London, London, UK
| | - Rosario Cárdenas
- Department of Population and Health, Metropolitan Autonomous University, Mexico City, Mexico
| | - Félix Carvalho
- Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
| | | | - 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
| | - Giulio Castelpietra
- Primary Care Services Area, Central Health Directorate, Region Friuli Venezia Giulia, Trieste, Italy
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Ferrán Catalá-López
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Joht S Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | | | - Irini Chatziralli
- 2nd Department of Ophthalmology, University of Athens, Haidari, Greece
- Ophthalmology Private Practice Office, Independent Consultant, Athens, Greece
| | - Neha Chaudhary
- Department of Pediatrics, Harvard University, Boston, MA, USA
- Department of Neonatology, Beth Israel Deaconess Medical center, Boston, MA, USA
| | - Daniel Youngwhan Cho
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA, USA
| | - Mohiuddin Ahsanul Kabir Chowdhury
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Dinh-Toi Chu
- Faculty of Biology, Hanoi National University of Education, Hanoi, Vietnam
| | - Samantha M Colquhoun
- Research School of Population Health, Australian National University, Action, ACT, Australia
| | - Maria-Magdalena Constantin
- Department of Dermatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- 2nd Department of Dermatology, Colentina Clinical Hospital, Bucharest, Romania
| | - Vera M Costa
- Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
| | - Giovanni Damiani
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA
- Department of Dermatology, University of Milan, Milan, Italy
| | - Ahmad Daryani
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | | | | | - Asmamaw Bizuneh Demis
- Department of Nursing, Woldia University, Woldia, Ethiopia
- School of Nursing, Jimma University, Jimma, Ethiopia
| | - Gebre Teklemariam Demoz
- School of Pharmacy, Aksum University, Aksum, Ethiopia
- Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Kebede Deribe
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rupak Desai
- Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | | | | | | | - Kerrie E Doyle
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University, Bundoora, VIC, Australia
| | - Tim Robert Driscoll
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | | | - Bereket Duko Adema
- Public Health Department, Hawassa University, Hawassa, Ethiopia
- Curtin University, Perth, WA, Australia
| | - Arielle Wilder Eagan
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
- Department of Social Services, Tufts Medical Center, Boston, MA, USA
| | - Aziz Eftekhari
- Department of Pharmacology and Toxicology, Maragheh University of Medical Sciences, Maragheh, Iran
- Department of Pharmacology and Toxicology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elham Ehsani-Chimeh
- National Institute for Health Researches, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Ziad El-Khatib
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- World Health Programme, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Christian Lycke Ellingsen
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - Mohammad Hassan Emamian
- Ophthalmic Epidemiology Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | | | - Sharareh Eskandarieh
- Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pawan Sirwan Faris
- Biology Department, Salahaddin University-Erbil, Erbil, Iraq
- Biology and Biotechnolaniogy"L Spallanzani", University of Pavia, Pavia, Italy
| | - Andre Faro
- Department of Psychology, Federal University of Sergipe, Sao Cristovao, Brazil
| | - Farshad Farzadfar
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Fatahi
- Pharmaceutical Nanotechnology, Tehran University of Medical Sciences, Tehran, Iran
| | - Wubalem Fekadu
- Department of Psychiatry, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tomas Y Ferede
- Nursing Department, Hawassa University, Hawassa, Ethiopia
| | - Seyed-Mohammad Fereshtehnejad
- Department of Neurobiology, Karolinska Institutet, Stockholm, Sweden
- Division of Neurology, University of Ottawa, Ottawa, ON, Canada
| | | | - Pietro Ferrara
- Research Centre on Public Health (CESP), University of Milan Bicocca, Monza, Italy
| | - Garumma Tolu Feyissa
- Department of Health Education & Behavioral Sciences, Jimma University, Jimma, Ethiopia
| | - Irina Filip
- Psychiatry Department, Kaiser Permanente, Fontana, CA, USA
- School of Health Sciences, A T Still University, Mesa, AZ, USA
| | - Florian Fischer
- Department of Population Medicine and Health Services Research, Bielefeld University, Bielefeld, Germany
| | | | - Masoud Foroutan
- Abadan School of Medical Sciences, Abadan University of Medical Sciences, Abadan, Iran
| | - Joel Msafiri Francis
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard Charles Franklin
- College of Public Health, Medical and Veterinary Science, James Cook University, Douglas, QLD, Australia
- Royal Life Saving Society, Sydney, NSW, Australia
| | - Takeshi Fukumoto
- Department of Dermatology, Kobe University, Kobe, Japan
- Gene Expression & Regulation Program, The Wistar Institute, Philadelphia, PA, USA
| | | | | | | | | | | | - Getnet Azeze Gedefaw
- Bahir Dar University, Bahir Dar, Ethiopia
- Haramaya University, Dire Dawa, Ethiopia
| | - Birhanu Geta
- Department of Pharmacy, Wollo University, Dessie, Ethiopia
| | - Mansour Ghafourifard
- Department of Medical Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farhad Ghamari
- Occupational Health Department, Arak University of Medical Sciences, Arak, Iran
| | - Ahmad Ghashghaee
- Department of Health Services Management, Iran University of Medical Sciences, Tehran, Iran
| | - Asadollah Gholamian
- Science and Research Branch, Islamic Azad University, Tehran, Iran
- Young Researchers and Elite Club, Rasht Branch, Islamic Azad University, Rasht, Iran
| | - Tiffany K Gill
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Alessandra C Goulart
- Department of Internal Medicine, University of São Paulo, São Paulo, Brazil
- Center for Clinical and Epidemiological Research, University of São Paulo, Sao Paulo, Brazil
| | - Ayman Grada
- Department of Dermatology, Boston University, Boston, MA, USA
| | - Michal Grivna
- Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - Rafael Alves Guimarães
- Instituto de Patologia Tropical e Saúde Pública, Federal University of Goias, Goiânia, Brazil
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Epidemiology and Biostatistics, Zhengzhou University, Zhengzhou, China
| | - Gaurav Gupta
- Non-Communicable Diseases (NCD), World Health Organization (WHO), New Delhi, India
| | - Juanita A Haagsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Nima Hafezi-Nejad
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Brian James Hall
- Global and Community Mental Health Research Group, University of Macau, Macao, China
| | - Randah R Hamadeh
- Department of Family and Community Medicine, Arabian Gulf University, Manama, Bahrain
| | - 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
| | - Md Mehedi Hasan
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, Australia
| | - Amir Hasanzadeh
- Department of Microbiology, Maragheh University of Medical Sciences, Maragheh, Iran
- Department of Microbiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Hassanipour
- Gastrointestinal and Liver Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Hadi Hassankhani
- School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
- Independent Consultant, Tabriz, Iran
| | - Hamid Yimam Hassen
- Department of Public Health, Mizan-Tepi University, Tepi, Ethiopia
- Unit of Epidemiology and Social Medicine, University Hospital Antwerp, Wilrijk, Belgium
| | - Rasmus Havmoeller
- Department of Clinical Sciences, Karolinska University Hospital, Stockholm, Sweden
| | - Khezar Hayat
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
- Department of Pharmacy Administration and Clinical Pharmacy, Xian Jiaotong University, Xian, China
| | - Delia Hendrie
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Fatemeh Heydarpour
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Martha Híjar
- Research Coordination, AC Environments Foundation, Cuernavaca, Mexico
- CISS, National Institute of Public Health, Cuernavaca, Mexico
| | - Hung Chak Ho
- Department of Urban Planning and Design, University of Hong Kong, Hong Kong, China
| | - Chi Linh Hoang
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Michael K Hole
- Department of Pediatrics, Dell Medical School, University of Texas Austin, Austin, TX, USA
| | - Ramesh Holla
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Naznin Hossain
- Department of Pharmacology and Therapeutics, Dhaka Medical College, Dhaka, Bangladesh
- Department of Pharmacology, Bangladesh Industrial Gases Limited, Tangail, Bangladesh
| | - Mehdi Hosseinzadeh
- Department of Computer Engineering, Islamic Azad University, Tehran, Iran
- Computer Science Department, University of Human Development, Sulaymaniyah, Iraq
| | - Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Legal Medicine Department, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
| | - Guoqing Hu
- Department of Epidemiology and Health Statistics, Central South University, Changsha, China
| | | | | | - Irena Ilic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milena D Ilic
- Department of Epidemiology, University of Kragujevac, Kragujevac, Serbia
| | | | - Endang Indriasih
- Center for Health Resource and Services Research and Development, National Institute of Health Research & Development, Jakarta, Indonesia
| | - Seyed Sina Naghibi Irvani
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, VIC, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - M Mofizul Islam
- School of Psychology and Public Health, La Trobe University, Bundoora, Melbourne, VIC, Australia
| | - Rebecca Q Ivers
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Kathryn H Jacobsen
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | | | - Nader Jahanmehr
- School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mihajlo Jakovljevic
- Department for Health Care and Public Health, I M Sechenov First Moscow State Medical University, Moscow, Russia
| | - Farzad Jalilian
- Social Development & Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sudha Jayaraman
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Achala Upendra Jayatilleke
- Institute of Medicine, University of Colombo, Colombo, Sri Lanka
- Faculty of Graduate Studies, University of Colombo, Colombo, Sri Lanka
| | - Ravi Prakash Jha
- Department of Community Medicine, Banaras Hindu University, Varanasi, India
| | | | - Jost B Jonas
- Department of Ophthalmology, Heidelberg University, Mannheim, Germany
- Beijing Ophthalmology & Visual Science Key Laboratory, Beijing Tongren Hospital, Beijing, China
| | - Nitin Joseph
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Farahnaz Joukar
- Gastrointestinal and Liver Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Jacek Jerzy Jozwiak
- Department of Family Medicine and Public Health, University of Opole, Opole, Poland
| | | | - Mikk Jürisson
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rajendra Kadel
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Amaha Kahsay
- Department of Nutrition and Dietetics, Mekelle University, Mekelle, Ethiopia
| | - Leila R Kalankesh
- Department of Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rohollah Kalhor
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
- Health Services Management Department, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Teshome Abegaz Kamil
- School of Public Health, Department of Health Informatics and Health Innovation, A C S Medical College and Hospital, Mekelle, Ethiopia
| | - Tanuj Kanchan
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India
| | - Neeti Kapoor
- Department of Forensic Science, Government Institute of Forensic Science, Nagpur, India
| | - Manoochehr Karami
- Department of Epidemiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amir Kasaeian
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Taras Kavetskyy
- Department of Applied Physics, The John Paul II Catholic University of Lublin, Lublin Voivodeship, Poland
- Department of Biology and Chemistry, Drohobych Ivan Franko State Pedagogical University, Drohobych, Ukraine
| | | | | | | | - Bayew Kelkay
- Department of Midwifery, University of Gondar, Gondar, Ethiopia
| | - Yousef Saleh Khader
- Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
| | - Morteza Abdullatif Khafaie
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nauman Khalid
- School of Food and Agricultural Sciences, University of Management and Technology, Lahore, Pakistan
| | - Ibrahim A Khalil
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Rovshan Khalilov
- Department of Physiology, Baku State University, Baku, Azerbaijan
| | - Mohammad Khammarnia
- Health Care Management, Zahedan University of Medical Sciences, zahedan, Iran
| | - Ejaz Ahmad Khan
- Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
| | - Maseer Khan
- Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
| | - Tripti Khanna
- Department of Health Research, Indian Council of Medical Research, New Delhi, India
- Centre for Ethics, Jawahar Lal Nehru University, New Delhi, India
| | - Habibolah Khazaie
- Department of Psychiatry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Roba Khundkar
- Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, UK
| | | | - Young-Eun Kim
- Department of Preventive Medicine, Korea University, Seoul, South Korea
| | - Daniel Kim
- Department of Health Sciences, Northeastern University, Boston, MA, USA
| | - Yun Jin Kim
- School of Medicine, Xiamen University Malaysia, Sepang, Malaysia
| | - Adnan Kisa
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Sezer Kisa
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Hamidreza Komaki
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Brain Engineering Research Center, Institute for Research in Fundamental Sciences, Tehran, Iran
| | | | - Vladimir Andreevich Korshunov
- Department of Epidemiology and Evidence Based Medicine, I M Sechenov First Moscow State Medical University, Moscow, Russia
| | - Ai Koyanagi
- CIBERSAM, San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Moritz U G Kraemer
- Department of Zoology, University of Oxford, Oxford, UK
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Kewal Krishan
- Department of Anthropology, Panjab University, Chandigarh, India
| | - Burcu Kucuk Bicer
- Department of Public Health, Yuksek Ihtisas University, Ankara, Turkey
- Department of Public Health, Hacettepe University, Ankara, Turkey
| | - Nuworza Kugbey
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
- Department of Psychology and Health Promotion, University of KwaZulu-Natal, Durban, South Africa
| | - Vivek Kumar
- Department of Medicine, Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Nithin Kumar
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - G Anil Kumar
- Public Health Foundation of India, Gurugram, India
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK
| | - Girikumar Kumaresh
- Mechanical and Industrial Engineering, Indian Institute of Technology, Roorkee, Roorkee, India
| | - Om P Kurmi
- Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Oluwatosin Kuti
- Health and Nutrition Section, United Nations Childrens' Fund (UNICEF), Accra, Ghana
| | - Carlo La Vecchia
- Department of Clinical Medicine and Community Health, University of Milan, Milano, Italy
| | - Faris Hasan Lami
- Department of Community and Family Medicine, University of Baghdad, Baghdad, Iraq
| | | | - Justin J Lang
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Van C Lansingh
- HelpMeSee, New York, NY, USA
- International Relations, Mexican Institute of Ophthalmology, Queretaro, Mexico
| | | | - Savita Lasrado
- Department of Otorhinolaryngology (ENT), Father Muller Medical College, Mangalore, India
| | - Arman Latifi
- Department of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Paolo Lauriola
- Institute of Clinical Physiology, Italian National Research Council, Pisa, Italy
| | - Janet L Leasher
- College of Optometry, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University, Bandar Sunway, Malaysia
- School of Pharmacy, Taylor's University Lakeside Campus, Subang Jaya, Malaysia
| | | | - Miriam Levi
- Regional Centre for the Analysis of Data on Occupational and Work-related Injuries and Diseases, Local Health Unit Tuscany Centre, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Shai Linn
- School of Public Health, University of Haifa, Haifa, Israel
| | - Xuefeng Liu
- Department of Systems, Populations and Leadership, University of Michigan, Ann Arbor, MI, USA
| | - Alan D Lopez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Paulo A Lotufo
- Department of Medicine, University of São Paulo, Sao Paulo, Brazil
| | - Raimundas Lunevicius
- Department of General Surgery, Aintree University Hospital National Health Service (NHS) Foundation Trust, Liverpool, UK
- Department of Surgery, University of Liverpool, Liverpool, UK
| | - Ronan A Lyons
- Health Data Research UK, Swansea University, Swansea, UK
| | - Mohammed Madadin
- College of Medicine, Pathology Department, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | | | - Marek Majdan
- Department of Public Health, Trnava University, Trnava, Slovakia
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Jeadran N Malagon-Rojas
- Public Health Research Department, National Health Institute Colombia, Bogota, Colombia
- Faculty of Medicine, El Bosque University, Bogota, Colombia
| | - Venkatesh Maled
- Health Education and Research Department, SDM College of Medical Sciences & Hospital, Dharwad, India
- Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - 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
| | - Navid Manafi
- Department of Ophthalmology, Iran University of Medical Sciences, Tehran, Iran
- Ophthalmology Department, University of Manitoba, Winnipeg, MB, Canada
| | - Amir Manafi
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Ana-Laura Manda
- Surgery Department, Emergency University Hospital Bucharest, Bucharest, Romania
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Borhan Mansouri
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Joemer C Maravilla
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia
| | - Lyn M March
- Institute of Bone and Joint Research, University of Sydney, St Leonards, NSW, Australia
| | | | - Seyedeh Zahra Masoumi
- Department of Midwifery-Reproductive Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Benjamin Ballard Massenburg
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA, USA
| | - Pallab K Maulik
- Research Department, The George Institute for Global Health, New Delhi, India
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Addisu Melese
- Department of Medical Laboratory Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Peter T N Memiah
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland, Baltimore, MD, 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
| | - Meresa Berwo Mengesha
- College of Health Science, Department of Midwifery, Adigrat University, Adigrat, Ethiopia
| | | | - Tuomo J Meretoja
- Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Atte Meretoja
- Neurocenter, Helsinki University Hospital, Helsinki, Finland
- School of Health Sciences, University of Melbourne, Parkville, VIC, Australia
| | | | - Tomislav Mestrovic
- Clinical Microbiology and Parasitology Unit, ZoraProfozic Polyclinic, Zagreb, Croatia
- University Centre Varazdin, University North, Varazdin, Croatia
| | - Bartosz Miazgowski
- Center for Innovation in Medical Education, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Miazgowski
- Department of Propedeutics of Internal Diseases & Arterial Hypertension, Pomeranian Medical University, Szczecin, Poland
| | - Ted R Miller
- School of Public Health, Curtin University, Perth, WA, Australia
- Pacific Institute for Research & Evaluation, Calverton, MD, USA
| | - G K Mini
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
- Global Institute of Public Health (GIPH), Ananthapuri Hospitals and Research Centre, Trivandrum, India
| | - Andreea Mirica
- Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania
- President's Office, National Institute of Statistics Romania, Bucharest, Romania
| | - Erkin M Mirrakhimov
- Faculty of Internal Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
- Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan
| | - Mehdi Mirzaei-Alavijeh
- Social Development & Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Babak Moazen
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Institute of Addiction Research (ISFF), Frankfurt University of Applied Sciences, Frankfurt, Germany
| | - Masoud Moghadaszadeh
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Efat Mohamadi
- Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Mohammad
- Internal Medicine Department, King Saud University, Riyadh, Saudi Arabia
| | | | - Aso Mohammad Darwesh
- Department of Information Technology, University of Human Development, Sulaymaniyah, Iraq
| | | | | | - Milad Mohammadoo-Khorasani
- Department of Clinical Biochemistry, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | | | - Shafiu Mohammed
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
| | | | - Farnam Mohebi
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Iran National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - 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
| | - Masoud Moradi
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Department of Epidemiology and Biostatistics, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Moradpour
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, QLD, Australia
| | | | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Setagaya, Japan
| | - Shane Douglas Morrison
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA, USA
| | | | - Atalay Goshu Muluneh
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kamarul Imran Musa
- School of Medical Sciences, Science University of Malaysia, Kubang Kerian, Malaysia
| | - Ghulam Mustafa
- Department of Pediatric Medicine, Nishtar Medical University, Multan, Pakistan
- Department of Pediatrics & Pediatric Pulmonology, Institute of Mother & Child Care, Multan, Pakistan
| | - Ashraf F Nabhan
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
- Knowledge Translation and Utilization, Egyptian Center for Evidence Based Medicine, Egypt
| | - Ahamarshan Jayaraman Nagarajan
- Research and Analytics, Initiative for Financing Health and Human Development, Chennai, India
- Research and Analytics, Bioinsilico Technologies, Chennai, India
| | - Gurudatta Naik
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mukhammad David Naimzada
- Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
- Experimental Surgery and Oncology Laboratory, Kursk State Medical University of the Ministry of Health of the Russian Federation, Kursk, Russia
| | - Farid Najafi
- Department of Epidemiology & Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Bruno Ramos Nascimento
- Hospital of the Federal University of Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Morteza Naserbakht
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
- Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Vinod Nayak
- Department of Forensic Medicine and Toxicology, Manipal Academy of Higher Education, Manipal, India
| | | | - Ionut Negoi
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | | | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam
| | | | - Rajan Nikbakhsh
- Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Heidelberg University Hospital, Heidelberg, Germany
| | - Dina Nur Anggraini Ningrum
- Public Health Department, Universitas Negeri Semarang, Kota Semarang, Indonesia
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City, Taiwan
| | - Chukwudi A Nnaji
- Cochrane Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Peter S Nyasulu
- Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Felix Akpojene Ogbo
- Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
| | - Onome Bright Oghenetega
- Reproductive Health Sciences, Department Obstetrics and Gynecology, University of Ibadan, Ibadan, Nigeria
| | - In-Hwan Oh
- Department of Preventive Medicine, Kyung Hee University, Dongdaemun-gu, South Korea
| | | | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Department of Psychiatry, University of Lagos, Lagos, Nigeria
| | - Tinuke O Olagunju
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Ahmed Omar Bali
- Diplomacy and Public Relations Department, University of Human Development, Sulaimaniyah, Iraq
| | - Obinna E Onwujekwe
- Department of Pharmacology and Therapeutics, University of Nigeria Nsukka, Enugu, Nigeria
| | - Kwaku Oppong Asante
- Department of Psychology, University of Ghana, Accra, Ghana
- Discipline of Psychology, University of KwaZulu-Natal, Durban, South Africa
| | - Heather M Orpana
- Applied Research Division, Public Health Agency of Canada, Ottawa, ON, Canada
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Erika Ota
- Department of Global Health Nursing, St Luke's International University, Chuo-ku, Japan
| | - Nikita Otstavnov
- Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
- Academic department, Unium Ltd, Moscow, Russia
| | - Stanislav S Otstavnov
- Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
- Department of Project Management, National Research University Higher School of Economics, Moscow, Russia
| | - Mahesh P A
- Department of Respiratory Medicine, Jagadguru Sri Shivarathreeswara Academy of Health Education and Research, Mysore, India
| | | | - Smita Pakhale
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa ON, Canada
| | - Keyvan Pakshir
- Parasitology and Mycology, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Eun-Kee Park
- Department of Medical Humanities and Social Medicine, Kosin University, Busan, South Korea
| | - Sangram Kishor Patel
- Research and Evaluation, Population Council, New Delhi, India
- Indian Institute of Health Management Research University Delhi, Jaipur, India
| | - Ashish Pathak
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatircs, RD Gardi Medical College, Ujjain, India
| | - Sanghamitra Pati
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, India
| | - George C Patton
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Population Health Theme, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Kebreab Paulos
- Department of Midwifery, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amy E Peden
- Royal Life Saving Society, Sydney, NSW, Australia
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Jeevan Pereira
- Department of Orthopedics, Yenepoya Medical College, Mangalore, India
| | - Hai Quang Pham
- Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam
| | - Michael R Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China
- Department of Psychiatry, Department of Epidemiology, Columbia University, New York City, NY, USA
| | - Marina Pinheiro
- Department of Chemistry, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Roman V Polibin
- Department of Epidemiology and Evidence-Based Medicine, Sechenon University, Moscow, Russia
| | - Suzanne Polinder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Hossein Poustchi
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Swayam Prakash
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | - Parul Puri
- Department of Population Studies, International Institute for Population Sciences, Mumbai, India
| | - Zahiruddin Quazi Syed
- Department of Community Medicine, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Mohammad Rabiee
- Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
| | - Navid Rabiee
- Department of Chemistry, Sharif University of Technology, Tehran, Iran
| | - Amir Radfar
- College of Medicine, University of Central Florida, Orlando, FL, USA
- College of Graduate Health Sciences, A T Still University, Mesa, AZ, USA
| | - Anwar Rafay
- Department of Epidemiology & Biostatistics, Contech School of Public Health, Lahore, Pakistan
| | - Ata Rafiee
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Alireza Rafiei
- Department of Immunology, Mazandaran University of Medical Sciences, Sari, Iran
- Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fakher Rahim
- Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Metabolomics and Genomics Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Siavash Rahimi
- Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Muhammad Aziz Rahman
- School of Nursing and Healthcare Professions, Federation University Australia, Berwick, VIC, Australia
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
| | | | - Fatemeh Rajati
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ivo Rakovac
- European Office for the Prevention and Control of Noncommunicable Diseases, World Health Organization (WHO), Moscow, Russia
| | | | - Sowmya J Rao
- Department of Oral Pathology, Srinivas Institute of Dental Sciences, Mangalore, India
| | - Vahid Rashedi
- School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Tehran, Iran
| | - Prateek Rastogi
- Forensic Medicine, Manipal Academy of Higher Education, Mangalore, India
| | - Priya Rathi
- Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Salman Rawaf
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Academic Public Health Department, Public Health England, London, UK
| | - Lal Rawal
- School of Health, Medical and Applied Sciences, CQ University, Sydney, NSW, Australia
| | - Reza Rawassizadeh
- Department of Computer Science, Metropolitan College, Boston University, Boston, USA
| | - Vishnu Renjith
- Neurology Department, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | | | - Aziz Rezapour
- Organization for the Prevention of Blindness, Paris, France
| | - Ana Isabel Ribeiro
- EPIUnit - Public Health Institute University Porto (ISPUP), University of Porto, Porto, Portugal
| | - Jennifer Rickard
- Surgery Department, University of Minnesota, Minneapolis, MN, USA
- Surgery Department, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Carlos Miguel Rios González
- Research Directorate, Nihon Gakko University, Fernando de la Mora, Paraguay
- Research Direction, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
| | - 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
| | - Anas M Saad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Yogesh Damodar Sabde
- National Institute for Research in Environmental Health, Indian Council of Medical Research, Bhopal, India
| | - Siamak Sabour
- Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Basema Saddik
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Saeed Safari
- Emergency Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roya Safari-Faramani
- Faculty of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hamid Safarpour
- Department of Health in Disasters and Emergencies, Shahid Beheshti University of Medical Sciences, Tehran, 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
| | | | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farkhonde Salehi
- Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saleh Salehi Zahabi
- Radiology and Nuclear Medicine Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Research Deputy, Taleghani Hospital, Kermanshah, Iran
| | | | - Hosni Salem
- Department of Urology, Cairo University, Cairo, Egypt
| | - Omar Salman
- Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Inbal Salz
- Health and Disability Intelligence Group, Ministry of Health, Wellington, New Zealand
| | - Abdallah M Samy
- Department of Entomology, Ain Shams University, Cairo, Egypt
| | - Juan Sanabria
- Department of Surgery, Marshall University, Huntington, WV, USA
- Department of Nutrition and Preventive Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Lidia Sanchez Riera
- Rheumatology Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Institute of Bone and Joint Research, University of Sydney, Syndey, NSW, Australia
| | - Milena M Santric Milicevic
- Institute of Social Medicine, University of Belgrade, Belgrade, Serbia
- Centre-School of Public Health and Health Management, University of Belgrade, Belgrade, Serbia
| | - Abdur Razzaque Sarker
- Health Economics, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Arash Sarveazad
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Brijesh Sathian
- Surgery Department, Hamad Medical Corporation, Doha, Qatar
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
| | - Monika Sawhney
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Susan M Sawyer
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
| | - Mehdi Sayyah
- Faculty member of Education Development Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | | | - 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
| | | | - Feng Sha
- Center for Biomedical Information Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Faramarz Shaahmadi
- Department of Health Promotion and Education, Alborz University of Medical Sciences, Karaj, Iran
| | - Saeed Shahabi
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Morteza Shamsizadeh
- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Aziz Sheikh
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
- Division of General Internal Medicine, Harvard University, Boston, MA, USA
| | | | - Jae Il Shin
- College of Medicine, Yonsei University, Seodaemun-gu, South Korea
- Division of Cardiology, Emory University, Atlanta, GA, USA
| | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Soraya Siabani
- Department of Health Education & Promotion, Kermanshah University of Medical Sciences, Kermanshah, Iran
- School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Inga Dora Sigfusdottir
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
- Department of Health and Behavior Studies, Columbia University, New York, NY, USA
| | | | - Jasvinder A Singh
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Medicine Service, US Department of Veterans Affairs (VA), 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
| | - Catalin-Gabriel Smarandache
- 2nd Department of Surgery-SUUB, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- 2nd Surgery Department, Bucharest Emergency Hospital, Bucharest, Romania
| | - Emma U R Smith
- Pain Management Research Institute (PMRI), Northern Clinical School, University of Sydney, St Leonards, NSW, Australia
- Michael J Cousins Pain Management & Research Centre, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Amin Soheili
- Department of Medical Surgical Nursing, Urmia University of Medical Science, Urmia, Iran
- Emergency Nursing Department, Semnan University of Medical Sciences, Semnan, Iran
| | - Bija Soleymani
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Reza Soltanian
- Department of Biostatistics, Hamedan University of Medical Sciences, Hamadan, Iran
| | - Joan B Soriano
- Hospital Universitario de la Princesa, Autonomous University of Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | | | - Ireneous N Soyiri
- Hull York Medical School, University of Hull, Hull City, UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Mark A Stokes
- Department of Psychology, Deakin University, Burwood, VIC, Australia
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- Department of Criminology, Law and Society, University of California Irvine, Irvine, CA, USA
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- Department of Medicine, University of Valencia, Valencia, Spain
- Carlos III Health Institute, Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain
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- School of Social Work, University of Illinois, Urbana, IL, USA
| | - Biruk Wogayehu Taddele
- Department of Public Health, Arbaminch College of Health Sciences, Arbaminch town sikela, Ethiopia
| | - Degena Bahrey Tadesse
- Department of Nursing, Aksum University, Aksum, Ethiopia
- Axum College of Health Science, mekelle, Ethiopia
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- Center for Health Resource and Services Research and Development, National Institute of Health Research & Development, Jakarta, Indonesia
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- School of Public Health, University of Adelaide, Adelaide, SA, Australia
- Department of Environmental Health, Wollo University, Dessie, Ethiopia
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- 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
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- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
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- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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- Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
- The Agency for Health Technology Assessment and Tariff System, Warszawa, Poland
| | - 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
| | - Jaya Prasad Tripathy
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
| | - Alexander C Tsai
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Saif Ullah
- Institute of Soil and Environmental Sciences, A T Still University, Faisalabad, Pakistan
| | - 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
| | - Maida Umar
- Research Department, National Institute of Population Studies (NIPS), Islamabad, Pakistan
| | - Bhaskaran Unnikrishnan
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Era Upadhyay
- Amity Institute of Biotechnology, Amity University Rajasthan, Jaipur, India
| | | | - Pascual R Valdez
- Argentine Society of Medicine, Buenos Aires, Argentina
- Velez Sarsfield Hospital, Buenos Aires, Argentina
| | | | - Narayanaswamy Venketasubramanian
- Raffles Neuroscience Centre, Raffles Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of 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
| | - Vasily Vlassov
- Department of Health Care Administration and Economics, National Research University Higher School of Economics, Moscow, Russia
| | - Yasir Waheed
- Foundation University Medical College, Foundation University, Islamabad, Pakistan
| | | | - Andrea Werdecker
- Demographic Change and Ageing Research Area, Federal Institute for Population Research, Wiesbaden, Germany
- Center of Population and Health, Wiesbaden, Germany
| | - Taweewat Wiangkham
- Department of Physical Therapy, Naresuan University, Meung District, Thailand
| | - Haileab Fekadu Wolde
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Dawit Habte Woldeyes
- Department of Human Anatomy, Histology, Embryology, Bahir Dar University, Bahir Dar, Ethiopia
| | - Dawit Zewdu Wondafrash
- Department of Pharmacology and Toxicology, Mekelle University, Mekelle, Ethiopia
- Department of Pharmacology, Addis Ababa University, Addis ababa, Ethiopia
| | | | - Adam Belay Wondmieneh
- Department of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Nursing, Wollo University, Dessie, Ethiopia
| | - Ai-Min Wu
- Department of Orthopaedics, Wenzhou Medical University, Wenzhou, China
| | - Rajaram Yadav
- Department of Population Studies, International Institute for Population Sciences, Mumbai, India
| | - Ali Yadollahpour
- Medical Physics Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Yuichiro Yano
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa ON, Canada
| | - Vahid Yazdi-Feyzabadi
- Health Services Management Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Department of Health Management, Policy and Economics, Kerman University of Medical Sciences, Kerman, Iran
| | - 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
| | - Engida Yisma
- School of Allied Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Naohiro Yonemoto
- Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Seok-Jun Yoon
- Department of Preventive Medicine, Korea University, Seoul, South Korea
| | - Yoosik Youm
- Department of Sociology, Yonsei University, Seoul, South Korea
| | - Mustafa Z Younis
- Department of Health Policy & Management, Jackson State University, Jackson, MS, USA
- School of Medicine, Tsinghua University, Beijing, China
| | - Zabihollah Yousefi
- Department of Environmental Health, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Environmental Health, Academy of Medical Science, Sari, Iran
| | - Yong Yu
- School of Public Health and Management, Hubei University of Medicine, Shiyan, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Hasan Yusefzadeh
- Department of Health Care Management and Economics, Urmia University of Medical Science, Urmia, 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
| | - Zoubida Zaidi
- Department of Epidemiology, University Hospital of Setif, Setif, Algeria
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Mohammad Zamani
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Maryam Zamanian
- Department of Epidemiology, Arak University of Medical Sciences, Arak, 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
| | - Ahmad Zarei
- Department of Environment Health Engineering, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Fatemeh Zare
- Faculty of Medical Sciences, Department of Health Education, Tarbiat Modares University, Tehran, Iran
| | - Zhi-Jiang Zhang
- Department of Preventive Medicine, Wuhan University, Wuhan, China
| | - Yunquan Zhang
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
| | - Sanjay Zodpey
- Indian Institute of Public Health, Public Health Foundation of India, Gurugram, India
| | - Lalit Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Public Health Foundation of India, Gurugram, India
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Rakhi Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Public Health Foundation of India, Gurugram, India
| | - Louisa Degenhardt
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Samath Dhamminda Dharmaratne
- 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
- Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - 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
| | - 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
| | - 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
| | - 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
| | - 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
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SW, Tekle MG, Temsah MH, Tesfay BE, Tesfay FH, Tessema ZT, Thankappan KR, ThekkePurakkal AS, Thomas N, Thompson RL, Thomson AJ, Topor-Madry R, Tovani-Palone MR, Traini E, Tran BX, Tran KB, Ullah I, Unnikrishnan B, Usman MS, Uthman OA, Uzochukwu BSC, Valdez PR, Varughese S, Veisani Y, Violante FS, Vollmer S, W/hawariat FG, Waheed Y, Wallin MT, Wang YP, Wang Y, Wangdi K, Weiss DJ, Weldesamuel GT, Werkneh AA, Westerman R, Wiangkham T, Wiens KE, Wijeratne T, Wiysonge CS, Wolde HF, Wondafrash DZ, Wonde TE, Worku GT, Yadollahpour A, Yahyazadeh Jabbari SH, Yamada T, Yaseri M, Yatsuya H, Yeshaneh A, Yilma MT, Yip P, Yisma E, Yonemoto N, Younis MZ, Yousof HASA, Yu C, Yusefzadeh H, Zadey S, Zahirian Moghadam T, Zaidi Z, Zaman SB, Zamani M, Zandian H, Zar HJ, Zerfu TA, Zhang Y, Ziapour A, Zodpey S, Zuniga YMH, Hay SI, Reiner RC. Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17. Lancet Glob Health 2020; 8:e1162-e1185. [PMID: 32827479 PMCID: PMC7443708 DOI: 10.1016/s2214-109x(20)30278-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/01/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. METHODS We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. FINDINGS Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4-40·7) to 50·3% (50·0-50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1-46·5) in 2017, compared with 28·7% (28·5-29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2-89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664-711) of the 1830 (1797-1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6-80·7) of countries from 2000 to 2017, and in 53·9% (50·6-59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. INTERPRETATION Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation. FUNDING Bill & Melinda Gates Foundation.
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Niyongombwa I, Sibomana I, Karenzi ID, Kiswezi A, Rickard J. Kigali Surgical Sepsis (KiSS) Score: A New Tool to Predict Outcomes in Surgical Patients with Sepsis in Low- and Middle-Income Settings. World J Surg 2020; 44:3651-3657. [PMID: 32700110 DOI: 10.1007/s00268-020-05708-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sepsis is common in surgical patients, and its presence influences the outcomes in those to undergo surgery. Factors such as advanced age, presence of comorbidities and many other conditions increase mortality in surgical patients with sepsis. The sequential organ failure assessment (SOFA) score simplified into qSOFA helps to define sepsis and to identify patients who are likely to die from it. Sepsis in surgery is under investigated in low- and middle-income countries and so are the factors for mortality in that specific surgical population. Our aim was to develop a prognostic tool accurate in predicting outcomes in surgical patients with sepsis who present at University Teaching Hospitals of Kigali (CHUK) and Butare (CHUB) and in other centers with limited resources METHODS: This was a prospective cohort study conducted over a period of 1 year from February 2018 to January 2019. The surgical patients with sepsis recruited in the first 6 months at CHUK served as the derivation cohort and those recruited in the next 6 months from both CHUK and CHUB served as the validation cohort. The Kigali surgical sepsis (KiSS) score was derived, and to determine its accuracy in predicting mortality, we measured sensitivity, specificity and area under receiver operator characteristic (AUROC) curve. We then compared this with qSOFA score. RESULTS A total of 288 patients were recruited with 144 in each cohort. The mean age was 36.5, and median age was 32.6. The mean length of hospital stay (LoHS) was 22.9 days. The overall intensive care unit (ICU) admission rate was 51.4%, and the surgical sepsis-related hospital mortality rate was 21.7%. Factors associated with surgical sepsis-related hospital mortality were age above 55 years (p = 0.034), presence of comorbidities (p = 0.069), hypotension (p = 0.014), tachycardia (p = 0.061), tachypnea (p = 0.028), decreased level of consciousness (p = 0.021), presence of GIT perforation (p = 0.026) and number of impaired organ function (p = 0.035). A predictive score (KiSS score) consisting of six parameters was derived from these factors and compared to qSOFA score. The sensitivity of KiSS score in predicting mortality was 73% (vs 52% for qSOFA), and the specificity was 97% (vs 87% for qSOFA). The predictive validity for hospital mortality was assessed by AUROC curve, and it was 0.939 (95% CI, p < 0.001) for KiSS and 0.684 (95% CI, p < 0.001) for qSOFA. CONCLUSION The KiSS score was effective in predicting surgical sepsis-related hospital mortality in low-resource setting. The KiSS score showed an added advantage of stratifying septic surgical patients to be operated on into those with good, variable and poor prognosis.
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Affiliation(s)
- Irénée Niyongombwa
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda.
- Department of Surgery, Bushenge Provincial Hospital, Nyamasheke, Rwanda.
| | - Isaie Sibomana
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
- Department of Surgery, Kibuye Referral Hospital, Karongi, Rwanda
| | - Irénée D Karenzi
- Department of Surgery, Ruhengeri Referral Hospital, Musanze, Rwanda
| | - Ahmed Kiswezi
- Mater Misericordiae Teaching Hospital, Nairobi, Kenya
| | - Jennifer Rickard
- Department of Surgery and Critical Care, University of Minnesota Medical Center, Minneapolis, MN, USA
- Rwanda Human Resources for Health Program, Kigali, Rwanda
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Reiner RC, Wiens KE, Deshpande A, Baumann MM, Lindstedt PA, Blacker BF, Troeger CE, Earl L, Munro SB, Abate D, Abbastabar H, Abd-Allah F, Abdelalim A, Abdollahpour I, Abdulkader RS, Abebe G, Abegaz KH, Abreu LG, Abrigo MRM, Accrombessi MMK, Acharya D, Adabi M, Adebayo OM, Adedoyin RA, Adekanmbi V, Adetokunboh OO, Adhena BM, Afarideh M, Ahmadi K, Ahmadi M, Ahmed AE, Ahmed MB, Ahmed R, Ajumobi O, Akal CG, Akalu TY, Akanda AS, Alamene GM, Alanzi TM, Albright JR, Alcalde Rabanal JE, Alemnew BT, Alemu ZA, Ali BA, Ali M, Alijanzadeh M, Alipour V, Aljunid SM, Almasi A, Almasi-Hashiani A, Al-Mekhlafi HM, Altirkawi K, Alvis-Guzman N, Alvis-Zakzuk NJ, Amare AT, Amini S, Amit AML, Andrei CL, Anegago MT, Anjomshoa M, Ansari F, Antonio CAT, Antriyandarti E, Appiah SCY, Arabloo J, Aremu O, Armoon B, Aryal KK, Arzani A, Asadi-Lari M, Ashagre AF, Atalay HT, Atique S, Atre SR, Ausloos M, Avila-Burgos L, Awasthi A, Awoke N, Ayala Quintanilla BP, Ayano G, Ayanore MA, Ayele AA, Aynalem YAA, Azari S, Babaee E, Badawi A, Bakkannavar SM, Balakrishnan S, Bali AG, Banach M, Barac A, Bärnighausen TW, Basaleem H, Bassat Q, Bayati M, Bedi N, Behzadifar M, Behzadifar M, Bekele YA, Bell ML, Bennett DA, Berbada DA, Beyranvand T, Bhat AG, Bhattacharyya K, Bhattarai S, Bhaumik S, Bijani A, Bikbov B, Biswas RK, Bogale KA, Bohlouli S, Brady OJ, Bragazzi NL, Briko NI, Briko AN, Burugina Nagaraja S, Butt ZA, Campos-Nonato IR, Campuzano Rincon JC, Cárdenas R, Carvalho F, Castro F, Chansa C, Chatterjee P, Chattu VK, Chauhan BG, Chin KL, Christopher DJ, Chu DT, Claro RM, Cormier NM, Costa VM, Damiani G, Daoud F, Dandona L, Dandona R, Darwish AH, Daryani A, Das JK, Das Gupta R, Dasa TT, Davila CA, Davis Weaver N, Davitoiu DV, De Neve JW, Demeke FM, Demis AB, Demoz GT, Denova-Gutiérrez E, Deribe K, Desalew A, Dessie GA, Dharmaratne SD, Dhillon P, Dhimal M, Dhungana GP, Diaz D, Ding EL, Diro HD, Djalalinia S, Do HP, Doku DT, Dolecek C, Dubey M, Dubljanin E, Duko Adema B, Dunachie SJ, Durães AR, Duraisamy S, Effiong A, Eftekhari A, El Sayed I, El Sayed Zaki M, El Tantawi M, Elemineh DA, El-Jaafary SI, Elkout H, Elsharkawy A, Enany S, Endalamfaw A, Endalew DA, Eskandarieh S, Esteghamati A, Etemadi A, Farag TH, Faraon EJA, Fareed M, Faridnia R, Farioli A, Faro A, Farzam H, Fazaeli AA, Fazlzadeh M, Fentahun N, Fereshtehnejad SM, Fernandes E, Filip I, Fischer F, Foroutan M, Francis JM, Franklin RC, Frostad JJ, Fukumoto T, Gayesa RT, Gebremariam KT, Gebremedhin KBB, Gebremeskel GG, Gedefaw GA, Geramo YCD, Geta B, Gezae KE, Ghashghaee A, Ghassemi F, Gill PS, Ginawi IA, Goli S, Gomes NGM, Gopalani SV, Goulart BNG, Grada A, Gugnani HC, Guido D, Guimares RA, Guo Y, Gupta R, Gupta R, Hafezi-Nejad N, Haile MT, Hailu GB, Haj-Mirzaian A, Haj-Mirzaian A, Hall BJ, Handiso DW, Haririan H, Hariyani N, Hasaballah AI, Hasan MM, Hasanzadeh A, Hassankhani H, Hassen HY, Hayelom DH, Heidari B, Henry NJ, Herteliu C, Heydarpour F, Hidru HDD, Hoang CL, Hoogar P, Hoseini-Ghahfarokhi M, Hossain N, Hosseini M, Hosseinzadeh M, Househ M, Hu G, Humayun A, Hussain SA, Ibitoye SE, Ilesanmi OS, Ilic MD, Inbaraj LR, Irvani SSN, Islam SMS, Iwu CJ, Jaca A, Jafari Balalami N, Jahanmehr N, Jakovljevic M, Jalali A, Jayatilleke AU, Jenabi E, Jha RP, Jha V, Ji JS, Jia P, Johnson KB, Jonas JB, Jozwiak JJ, Kabir A, Kabir Z, Kahsay A, Kalani H, Kanchan T, Karami Matin B, Karch A, Karki S, Kasaeian A, Kasahun GG, Kayode GA, Kazemi Karyani A, Keiyoro PN, Ketema DB, Khader YS, Khafaie MA, Khalid N, Khalil AT, Khalil I, Khalilov R, Khan MN, Khan EA, Khan G, Khan J, Khatab K, Khater A, Khater MM, Khatony A, Khayamzadeh M, Khazaei M, Khazaei S, Khodamoradi E, Khosravi MH, Khubchandani J, Kiadaliri AA, Kim YJ, Kimokoti RW, Kisa S, Kisa A, Kissoon N, Kondlahalli SKMKMM, Kosek MN, Koyanagi A, Kraemer MUG, Krishan K, Kugbey N, Kumar GA, Kumar M, Kumar P, Kusuma D, La Vecchia C, Lacey B, Lal A, Lal DK, Lami FH, Lansingh VC, Lasrado S, Lee PH, Leili M, Lenjebo TTLL, Levine AJ, Lewycka S, Li S, Linn S, Lodha R, Longbottom J, Lopukhov PD, Magdeldin S, Mahasha PW, Mahotra NB, Malta DC, Mamun AA, Manafi N, Manafi F, Manda AL, Mansournia MA, Mapoma CC, Marami D, Marczak LB, Martins-Melo FR, März W, Masaka A, Mathur MR, Maulik PK, Mayala BK, McAlinden C, Mehndiratta MM, Mehrotra R, Mehta KM, Meles GG, Melese A, Memish ZA, Mena AT, Menezes RG, Mengesha MM, Mengistu DT, Mengistu G, Meretoja TJ, Miazgowski B, Mihretie KMM, Miller-Petrie MK, Mills EJ, Mir SM, Mirabi P, Mirrakhimov EM, Mohamadi-Bolbanabad A, Mohammad KA, Mohammad Y, Mohammad DK, Mohammad Darwesh A, Mohammad Gholi Mezerji N, Mohammadifard N, Mohammed AS, Mohammed S, Mohammed JA, Mohebi F, Mokdad AH, Monasta L, Moodley Y, Moradi M, Moradi G, Moradi-Joo M, Moradi-Lakeh M, Moraga P, Mosapour A, Mouodi S, Mousavi SM, Mozaffor MMM, Muluneh AG, Muriithi MK, Murray CJL, Murthy GVS, Musa KI, Mustafa G, Muthupandian S, Naderi M, Nagarajan AJ, Naghavi M, Najafi F, Nangia V, Nazari J, Ndwandwe DE, Negoi I, Ngunjiri JW, Nguyen QP, Nguyen TH, Nguyen CT, Nigatu D, Ningrum DNA, Nnaji CA, Nojomi M, Noubiap JJ, Oh IH, Okpala O, Olagunju AT, Omar Bali A, Onwujekwe OE, Ortega-Altamirano DDV, Osarenotor O, Osei FB, Owolabi MO, P A M, Padubidri JR, Pana A, Pashaei T, Pati S, Patle A, Patton GC, Paulos K, Pepito VCF, Pereira A, Perico N, Pesudovs K, Pigott DM, Piroozi B, Platts-Mills JA, Poljak M, Postma MJ, Pourjafar H, Pourmalek F, Pourshams A, Poustchi H, Prada SI, Preotescu L, Quintana H, Rabiee N, Rabiee M, Radfar A, Rafiei A, Rahim F, Rahimi-Movaghar V, Rahman MA, Rajati F, Ramezanzadeh K, Rana SM, Ranabhat CL, Rasella D, Rawaf S, Rawaf DL, Rawal L, Remuzzi G, Renjith V, Renzaho AMN, Reta MA, Rezaei S, Ribeiro AI, Rickard J, Rios González CM, Rios-Blancas MJ, Roever L, Ronfani L, Roro EM, Rostami A, Rothenbacher D, Rubagotti E, Rubino S, Saad AM, Sabour S, Sadeghi E, Safari S, Safdarian M, Sagar R, Sahraian MA, Sajadi SM, Salahshoor MR, Salam N, Salehi F, Salehi Zahabi S, Salem MRR, Salem H, Salimi Y, Salimzadeh H, Sambala EZ, Samy AM, Sanabria J, Santos IS, Saraswathy SYI, Sarker AR, Sartorius B, Sathian B, Satpathy M, Sbarra AN, Schaeffer LE, Schwebel DC, Senbeta AM, Senthilkumaran S, Shabaninejad H, Shaheen AA, Shaikh MA, Shalash AS, Shallo SA, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Sharif M, Shey MS, Shibuya K, Shiferaw WSS, Shigematsu M, Shil A, Shin JI, Shiri R, Shirkoohi R, Si S, Siabani S, Singh JA, Singh NP, Sinha DN, Sisay MM, Skiadaresi E, Smith DL, Sobhiyeh MR, Sokhan A, Soofi M, Soriano JB, Sorrie MB, Soyiri IN, Sreeramareddy CT, Sudaryanto A, Sufiyan MB, Suleria HAR, Sykes BL, Tamirat KS, Tassew AA, Taveira N, Taye B, Tehrani-Banihashemi A, Temsah MH, Tesfay BE, Tesfay FH, Tessema ZT, Thankappan KR, Thirunavukkarasu S, Thomas N, Tlaye KG, Tlou B, Tovani-Palone MR, Traini E, Tran KB, Trihandini I, Ullah I, Unnikrishnan B, Valadan Tahbaz S, Valdez PR, Varughese S, Veisani Y, Violante FS, Vollmer S, Vos T, Wada FW, Waheed Y, Wang Y, Wang YP, Weldesamuel GT, Welgan CA, Westerman R, Wiangkham T, Wijeratne T, Wiysonge CSS, Wolde HF, Wondafrash DZ, Wonde TE, Wu AM, Xu G, Yadollahpour A, Yahyazadeh Jabbari SH, Yamada T, Yaseri M, Yenesew MA, Yeshaneh A, Yilma MT, Yimer EM, Yip P, Yirsaw BD, Yisma E, Yonemoto N, Younis MZ, Yousof HASA, Yu C, Yusefzadeh H, Zamani M, Zambrana-Torrelio C, Zandian H, Zeleke AJ, Zepro NB, Zewale TA, Zhang D, Zhang Y, Zhao XJ, Ziapour A, Zodpey S, Hay SI. Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000-17: analysis for the Global Burden of Disease Study 2017. Lancet 2020; 395:1779-1801. [PMID: 32513411 PMCID: PMC7314599 DOI: 10.1016/s0140-6736(20)30114-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [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: 06/29/2019] [Revised: 10/24/2019] [Accepted: 01/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. METHODS We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. FINDINGS The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1-65·8), 17·4% (7·7-28·4), and 59·5% (34·2-86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. INTERPRETATION By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health. FUNDING Bill & Melinda Gates Foundation.
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Dworkin M, Cyuzuzo T, Hategekimana JDD, Katabogama J, Ntirenganya F, Rickard J. Barriers to Surgical Care at a Tertiary Hospital in Kigali, Rwanda. J Surg Res 2020; 250:148-155. [DOI: 10.1016/j.jss.2019.12.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/02/2019] [Accepted: 12/29/2019] [Indexed: 10/25/2022]
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Forrester JD, Berndtson AE, Santorelli J, Raschke E, Weiser TG, Coombs AV, Sawyer RG, Chou J, Knight HP, Valenzuela JY, Rickard J. Survey of National Surgical Site Infection Surveillance Programs in Low- and Middle-Income Countries. Surg Infect (Larchmt) 2020; 21:621-625. [PMID: 32397833 DOI: 10.1089/sur.2020.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Surgical site infection (SSI) surveillance programs are strongly recommended as a core component of effective national infection prevention and control (IPC) programs. Participation in national SSI surveillance (nSSIS) programs has been shown to decrease reported SSIs among high-income countries (HICs), and it is expected that the same is possible among low- and middle-income countries (LMICs). We sought to determine what, if any nSSIS programs exist among LMICs. Methods: A cross-sectional survey was performed to evaluate existence of nSSIS of World Bank-defined LMICs. A digital survey assessment for presence of national IPC and nSSIS programs was delivered to persons capable of identifying the presence of such a program. Statistical analysis was performed using STATA. Institutional Review Board approval was obtained for this study. Results: Of the 137 countries identified, 55 (40%) were upper middle income (UMI), 47 (34%) were lower middle income (LMI), and 34 (25%) were low income. Representatives from 39 (28%) LMICs completed the survey. Of these respondent countries, 13 (33%) reported the presence of a national IPC program. There was no difference between countries with IPC programs and those without with respect to country income designation, population size, World Health Organization region, or conflict status. Only five (13% of all respondents) reported presence of a nSSIS program. Conclusions: National surgical site infection surveillance programs are an integral component of a country's ability to provide safe surgical procedures. Presence of nSSIS was reported infrequently in LMICs. International governing bodies should be encouraged to guide LMIC leadership in establishing a nSSIS infrastructure that will help enable safe surgical procedures.
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Affiliation(s)
- Joseph D Forrester
- Section of Acute Care Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Allison E Berndtson
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California, San Diego, La Jolla, California, USA
| | - Jarrett Santorelli
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California, San Diego, La Jolla, California, USA
| | - Eric Raschke
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California, San Diego, La Jolla, California, USA
| | - Thomas G Weiser
- Section of Acute Care Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Andre V Coombs
- Section of Acute Care Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Robert G Sawyer
- Department of Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Jesse Chou
- Department of Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Hunter P Knight
- Department of Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Julie Y Valenzuela
- Division of Trauma Critical Care, Southside Hospital/Northwell Health, Glen Cove, New York, USA
| | - Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Rickard J. Bacterial Resistance in Surgical Infections in Low-Resource Settings. Surg Infect (Larchmt) 2020; 21:509-515. [PMID: 32380936 DOI: 10.1089/sur.2020.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: There is an alarming increase in antimicrobial resistance (AMR) globally, complicating management of surgical infections, especially in low-resource settings. Of particular concern for surgeons are third generation cephalosporin-resistant and carbapenem-resistant Enterobacteriaceae. Methods: The published literature was searched to identify the scope and causative factors of emerging bacterial resistance in low- and middle-income countries (LMICs). Results: Antimicrobial resistance impacts economics, human development, health equity, health security, and food production. Factors that contribute to AMR include use of antibiotic agents in livestock, antibiotic agents in wastewater and sewage, poor sanitation, and overprescribing or unregulated use of antibiotic agents. Because the factors influencing AMR globally are multi-factorial, solutions must be addressed at multiple levels. In LMICs, these can occur through national initiatives, at the facility level, or at the community level with coordination engaging government agencies, the private sector, civil service, and professional groups. Conclusions: There is a growing recognition of the need for national AMR prevention programs. Meanwhile, infection prevention and control programs and antimicrobial stewardship remain cornerstones of management at the facility level.
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Affiliation(s)
- Jennifer Rickard
- Department of Surgery, University of Minnesota Minneapolis, Minnesota, USA
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Affiliation(s)
- Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gregory Beilman
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Franklin RC, Peden AE, Hamilton EB, Bisignano C, Castle CD, Dingels ZV, Hay SI, Liu Z, Mokdad AH, Roberts NLS, Sylte DO, Vos T, Abady GG, Abosetugn AE, Ahmed R, Alahdab F, Andrei CL, Antonio CAT, Arabloo J, Arba AAK, Badiye AD, Bakkannavar SM, Banach M, Banik PC, Banstola A, Barker-Collo SL, Barzegar A, Bayati M, Bhardwaj P, Bhaumik S, Bhutta ZA, Bijani A, Boloor A, Carvalho F, Chowdhury MAK, Chu DT, Colquhoun SM, Dagne H, Dagnew B, Dandona L, Dandona R, Daryani A, Dharmaratne SD, Dibaji Forooshani ZS, Do HT, Driscoll TR, Eagan AW, El-Khatib Z, Fernandes E, Filip I, Fischer F, Gebremichael B, Gupta G, Haagsma JA, Hassan S, Hendrie D, Hoang CL, Hole MK, Holla R, Hostiuc S, Househ M, Ilesanmi OS, Inbaraj LR, Irvani SSN, Islam MM, Ivers RQ, Jayatilleke AU, Joukar F, Kalhor R, Kanchan T, Kapoor N, Kasaeian A, Khan M, Khan EA, Khubchandani J, Krishan K, Kumar GA, Lauriola P, Lopez AD, Madadin M, Majdan M, Maled V, Manafi N, Manafi A, McKee M, Meles HG, Menezes RG, Meretoja TJ, Miller TR, Mithra P, Mohammadian-Hafshejani A, Mohammadpourhodki R, Mohebi F, Molokhia M, Mustafa G, Negoi I, Nguyen CT, Nguyen HLT, Olagunju AT, Olagunju TO, Padubidri JR, Pakshir K, Pathak A, Polinder S, Pribadi DRA, Rabiee N, Radfar A, Rana SM, Rickard J, Safari S, Salamati P, Samy AM, Sarker AR, Schwebel DC, Senthilkumaran S, Shaahmadi F, Shaikh MA, Shin JI, Singh PK, Soheili A, Stokes MA, Suleria HAR, Tarigan IU, Temsah MH, Tesfay BE, Valdez PR, Veisani Y, Ye P, Yonemoto N, Yu C, Yusefzadeh H, Zaman SB, Zhang ZJ, James SL. The burden of unintentional drowning: global, regional and national estimates of mortality from the Global Burden of Disease 2017 Study. Inj Prev 2020; 26:i83-i95. [PMID: 32079663 PMCID: PMC7571364 DOI: 10.1136/injuryprev-2019-043484] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [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] [Received: 09/19/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 12/21/2022]
Abstract
Background Drowning is a leading cause of injury-related mortality globally. Unintentional drowning (International Classification of Diseases (ICD) 10 codes W65-74 and ICD9 E910) is one of the 30 mutually exclusive and collectively exhaustive causes of injury-related mortality in the Global Burden of Disease (GBD) study. This study’s objective is to describe unintentional drowning using GBD estimates from 1990 to 2017. Methods Unintentional drowning from GBD 2017 was estimated for cause-specific mortality and years of life lost (YLLs), age, sex, country, region, Socio-demographic Index (SDI) quintile, and trends from 1990 to 2017. GBD 2017 used standard GBD methods for estimating mortality from drowning. Results Globally, unintentional drowning mortality decreased by 44.5% between 1990 and 2017, from 531 956 (uncertainty interval (UI): 484 107 to 572 854) to 295 210 (284 493 to 306 187) deaths. Global age-standardised mortality rates decreased 57.4%, from 9.3 (8.5 to 10.0) in 1990 to 4.0 (3.8 to 4.1) per 100 000 per annum in 2017. Unintentional drowning-associated mortality was generally higher in children, males and in low-SDI to middle-SDI countries. China, India, Pakistan and Bangladesh accounted for 51.2% of all drowning deaths in 2017. Oceania was the region with the highest rate of age-standardised YLLs in 2017, with 45 434 (40 850 to 50 539) YLLs per 100 000 across both sexes. Conclusions There has been a decline in global drowning rates. This study shows that the decline was not consistent across countries. The results reinforce the need for continued and improved policy, prevention and research efforts, with a focus on low- and middle-income countries.
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Affiliation(s)
- Richard Charles Franklin
- College of Public Health, Medical and Veterinary Science, James Cook University, Douglas, Queensland, Australia.,Royal Life Saving Society, Sydney, New South Wales, Australia
| | - Amy E Peden
- Royal Life Saving Society, Sydney, New South Wales, Australia.,School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Erin B Hamilton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Catherine Bisignano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Chris D Castle
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Zachary V Dingels
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Zichen Liu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Nicholas L S Roberts
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Dillon O Sylte
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Gdiom Gebreheat Abady
- College of Medicine and Health Sciences, Department of Nursing, Adigrat University, Adigrat, Ethiopia
| | | | - 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, Dhaka, Bangladesh
| | - Fares Alahdab
- Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, Minnesota, USA
| | | | - Carl Abelardo T Antonio
- Department of Health Policy and Administration, University of the Philippines Manila, Manila, 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
| | | | - Ashish D Badiye
- Department of Forensic Science, Government Institute of Forensic Science, Nagpur, India
| | - Shankar M Bakkannavar
- Department of Forensic Medicine and Toxicology, Manipal Academy of Higher Education, Manipal, India
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland.,Polish Mothers' Memorial Hospital Research Institute, Lodz, Poland
| | - Palash Chandra Banik
- Department of Non-Communicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
| | - Amrit Banstola
- Department of Research, Public Health Perspective Nepal, Pokhara-Lekhnath Metropolitan City, Nepal
| | | | - Akbar Barzegar
- Occupational Health Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Bayati
- Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pankaj Bhardwaj
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India.,Department of Community Medicine, Datta Meghe Institute of Medical Sciences, Deemed University, Wardha, India
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, University of Toronto, Toronto, Ontario, Canada.,Centre 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
| | - Archith Boloor
- Department of Internal Medicine, Manipal Academy of Higher Education, Mangalore, India
| | - Félix Carvalho
- Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
| | - Mohiuddin Ahsanul Kabir Chowdhury
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.,Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
| | - Dinh-Toi Chu
- Faculty of Biology, Hanoi National University of Education, Hanoi, Vietnam
| | - Samantha M Colquhoun
- Research School of Population Health, Australian National University, Action, Australian Capital Territory, Australia
| | - Henok Dagne
- Environmental and Occupational Health and Safety, University of Gondar, Gondar, Ethiopia
| | - Baye Dagnew
- Department of Human Physiology, University of Gondar, Gondar, Ethiopia
| | - Lalit Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA.,Public Health Foundation of India, Gurugram, India
| | - Rakhi Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Public Health Foundation of India, Gurugram, India
| | - Ahmad Daryani
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Samath Dhamminda Dharmaratne
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Hoa Thi Do
- Center of Excellence in Public Health Nutrition, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Tim Robert Driscoll
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Arielle Wilder Eagan
- Department of Global Health and Social Medicine, Harvard University, Boston, Massachusetts, USA.,Department of Social Services, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ziad El-Khatib
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,World Health Programme, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Québec, Canada
| | | | - Irina Filip
- Psychiatry Department, Kaiser Permanente, Fontana, California, USA.,School of Health Sciences, A.T. Still University, Arizona, Missouri, USA
| | - Florian Fischer
- Department of Population Medicine and Health Services Research, Bielefeld University, Bielefeld, Germany
| | | | - Gaurav Gupta
- Non-Communicable Diseases (NCD), World Health Organization (WHO), New Delhi, India
| | - Juanita A Haagsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Shoaib Hassan
- Centre for International Health and Section for Ethics and Health Economics, University of Bergen, Bergen, Norway
| | - Delia Hendrie
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Chi Linh Hoang
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Michael K Hole
- Department of Pediatrics, Dell Medical School, University of Texas Austin, Austin, Texas, USA
| | - Ramesh Holla
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Clinical Legal Medicine Department, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
| | - Mowafa Househ
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar.,Qatar Foundation for Education, Science, and Community Development, Doha, Qatar
| | | | | | - Seyed Sina Naghibi Irvani
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Mofizul Islam
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Rebecca Q Ivers
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Achala Upendra Jayatilleke
- Institute of Medicine, University of Colombo, Colombo, Sri Lanka.,Faculty of Graduate Studies, University of Colombo, Colombo, Sri Lanka
| | - Farahnaz Joukar
- Gastrointestinal and Liver Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Rohollah Kalhor
- Social Determinants of Health Research Center, Qazvin, Iran.,Health Services Management Department, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Tanuj Kanchan
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India
| | - Neeti Kapoor
- Department of Forensic Science, Government Institute of Forensic Science, Nagpur, India
| | - Amir Kasaeian
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maseer Khan
- Epidemiology Department, Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
| | - Ejaz Ahmad Khan
- Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
| | - Jagdish Khubchandani
- Department of Nutrition and Health Science, Ball State University, Muncie, Indiana, USA
| | - Kewal Krishan
- Department of Anthropology, Panjab University, Chandigarh, India
| | - G Anil Kumar
- Public Health Foundation of India, Gurugram, India
| | - Paolo Lauriola
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Alan D Lopez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,University of Melbourne, Melbourne, Victoria, Australia
| | - Mohammed Madadin
- Pathology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Marek Majdan
- Department of Public Health, Trnava University, Trnava, Slovakia
| | - Venkatesh Maled
- Health Education and Research Department, SDM College of Medical Sciences & Hospital, Dharwad, India.,Health University, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Navid Manafi
- Ophthalmology Department, Iran University of Medical Sciences, Tehran, Iran.,Ophthalmology Department, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ali Manafi
- Plastic Surgery Department, Iran University of Medical Sciences, Tehran, Iran
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ritesh G Menezes
- Forensic Medicine Division, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Tuomo J Meretoja
- Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland.,University of Helsinki, Helsinki, Finland
| | - Ted R Miller
- School of Public Health, Curtin University, Perth, Western Australia, Australia.,Pacific Institute for Research & Evaluation, Calverton, Maryland, USA
| | - Prasanna Mithra
- Community Medicine, Manipal Academy of Higher Education, Mangalore, India
| | | | | | - Farnam Mohebi
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Iran National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mariam Molokhia
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Ghulam Mustafa
- Department of Pediatric Medicine, Nishtar Medical University, Multan, Pakistan.,Department of Pediatrics & Pediatric Pulmonology, Institute of Mother & Child Care, Multan, Pakistan
| | - Ionut Negoi
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,General Surgery Department, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam
| | | | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Department of Psychiatry, University of Lagos, Lagos, Nigeria
| | - Tinuke O Olagunju
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jagadish Rao Padubidri
- Department of Forensic Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Keyvan Pakshir
- Parasitology and Mycology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ashish Pathak
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, RD Gardi Medical College, Ujjain, India
| | - Suzanne Polinder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Navid Rabiee
- Department of Chemistry, Sharif University of Technology, Tehran, Iran
| | - Amir Radfar
- College of Medicine, University of Central Florida, Orlando, Florida, USA.,College of Graduate Health Sciences, A.T. Still University, Mesa, Arizona, USA
| | - Saleem Muhammad Rana
- University Institute of Public Health, University of Lahore, Lahore, Pakistan.,Public Health Department, University of Health Sciences, Lahore, Pakistan
| | - Jennifer Rickard
- Surgery Department, University of Minnesota, Minneapolis, Minnesota, USA.,Surgery Department, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Saeed Safari
- Emergency Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdallah M Samy
- Department of Entomology, Ain Shams University, Cairo, Egypt
| | - Abdur Razzaque Sarker
- Health Economics, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Faramarz Shaahmadi
- Department of Health Promotion and Education, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Jae Il Shin
- College of Medicine, Yonsei University, Seodaemun-gu, South Korea.,Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | | | - Amin Soheili
- Medical Surgical Nursing Department, Urmia University of Medical Science, Urmia, Iran.,Emergency Nursing Department, Semnan University of Medical Sciences, Semnan, Iran
| | - Mark A Stokes
- Department of Psychology, Deakin University, Burwood, Victoria, Australia
| | | | - Ingan Ukur Tarigan
- Center for Health Resource and Services Research and Development, National Institute of Health Research & Development, Jakarta, Indonesia
| | - Mohamad-Hani Temsah
- Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Pascual R Valdez
- Argentine Society of Medicine, Buenos Aires, Argentina.,Velez Sarsfield Hospital, Buenos Aires, Argentina
| | - Yousef Veisani
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Pengpeng Ye
- Division of Injury Prevention and Mental Health Improvement, National Center for Chronic and Non-Communicable Disease Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Naohiro Yonemoto
- Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China.,Global Health Institute, Wuhan University, Wuhan, China
| | - Hasan Yusefzadeh
- Department of Health Economics and Management, Urmia University of Medical Science, Urmia, Iran
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Zhi-Jiang Zhang
- Department of Preventive Medicine, Wuhan University, Wuhan, China
| | - Spencer L James
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Bunogerane GJ, Rickard J. A cross sectional survey of factors influencing mortality in Rwandan surgical patients in the intensive care unit. Surgery 2019; 166:193-197. [PMID: 31151680 DOI: 10.1016/j.surg.2019.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/22/2019] [Accepted: 04/17/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Management of critically ill patients is a challenge in low resource settings where there is a paucity of trained staff, infrastructure, resources, and drugs. We aimed to study the characteristics of surgical patients admitted in intensive care unit in a limited resource setting and determine factors associated with mortality. METHODS This was a cross-sectional observational study of all surgical patients admitted to the intensive care unit of a tertiary referral hospital in Rwanda. Data included demographics, diagnosis, management, and outcomes. Logistic regression was used to determine factors associated with mortality. RESULTS Over a 7-month period, there were 126 surgical patients admitted to the intensive care unit. Common diagnoses included head injury (n = 55, 44%), peritonitis (n = 33, 26%), brain tumor (n = 15, 12%), and trauma (n = 15, 12%). The overall mortality was 47% with the highest mortality seen in patients with peritonitis (76%). Factors associated with mortality on intensive care unit admission included hypotension (odds ratio, 12.50; 95% confidence interval, 3.04, 51.32) and having any comorbidity (odds ratio 5.69, 95% confidence interval, 1.58, 20.50). CONCLUSION Surgical patients admitted to the intensive care unit bear a significant mortality. Common surgical intensive care unit diagnoses include head injury and peritonitis. We recommend a review of the admission policy to optimize utility of the intensive care unit.
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Affiliation(s)
- Gisele Juru Bunogerane
- Department of Surgery, University of Rwanda, Kigali, Rwanda; University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Jennifer Rickard
- University Teaching Hospital of Kigali, Kigali, Rwanda; Department of Surgery, University of Minnesota, Minneapolis, MN.
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47
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Rickard J, Beilman G, Forrester J, Sawyer R, Stephen A, Weiser TG, Valenzuela J. Surgical Infections in Low- and Middle-Income Countries: A Global Assessment of the Burden and Management Needs. Surg Infect (Larchmt) 2019; 21:478-494. [PMID: 31816263 DOI: 10.1089/sur.2019.142] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: The burden of surgical infections in low- and middle-income countries (LMICs) remains poorly defined compared with high-income countries. Although there are common infections necessitating surgery prevalent across the world, such as appendicitis and peptic ulcer disease, other conditions are more localized geographically. To date, comprehensive assessment of the burden of surgically treatable infections or sequelae of surgical infections in LMICs is lacking. Methods: We reviewed the literature to define the burden of surgical infections in LMICs and characterize the needs and challenges of addressing this issue. Results: Surgical infections comprise a broad range of diseases including intra-abdominal, skin and soft tissue, and healthcare-associated infections and other infectious processes. Treatment of surgical infections requires a functional surgical ecosystem, microbiology services, and appropriate and effective antimicrobial therapy. Systems must be developed and maintained to evaluate screening, prevention, and treatment strategies. Solutions and interventions are proposed focusing on reducing the burden of disease, improving surveillance, strengthening antibiotic stewardship, and enhancing the management of surgical infections. Conclusions: Surgical infections constitute a large burden of disease globally. Challenges to management in LMICs include a shortage of trained personnel and material resources. The increasing rate of antimicrobial drug resistance, likely related to antibiotic misuse, adds to the challenges. Development of surveillance, infection prevention, and antimicrobial stewardship programs are initial steps forward. Education is critical and should begin early in training, be an active process, and be sustained through regular programs.
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Affiliation(s)
- Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gregory Beilman
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joseph Forrester
- Department of Surgery, Stanford University, Stanford, California, USA
| | - Robert Sawyer
- Department of Surgery, Homer Stryker MD School of Medicine, Western Michigan University, Kalamazoo, Michigan, USA
| | - Andrew Stephen
- Department of Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Thomas G Weiser
- Department of Surgery, Stanford University, Stanford, California, USA
| | - Julie Valenzuela
- Department of Surgery, Northwell Health, New Hyde Park, New York, USA
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48
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Munyaneza M, Jayaraman S, Ntirenganya F, Rickard J. Factors Influencing Seeking and Reaching Care in Patients With Peritonitis in Rwanda. J Surg Res 2019; 246:236-242. [PMID: 31610351 DOI: 10.1016/j.jss.2019.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/29/2019] [Accepted: 09/13/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Peritonitis is an emergency which frequently requires surgical intervention. The aim of this study was to describe factors influencing seeking and reaching care for patients with peritonitis presenting to a tertiary referral hospital in Rwanda. METHODS This was a cross-sectional study of patients with peritonitis admitted to University Teaching Hospital of Kigali. Data were collected on demographics, prehospital course, and in-hospital management. Delays were classified according to the Three Delays Model as delays in seeking or reaching care. Chi square test and logistic regression were used to determine associations between delayed presentation and various factors. RESULTS Over a 9-month period, 54 patients with peritonitis were admitted. Twenty (37%) patients attended only primary school and 15 (28%) never went to school. A large number (n = 26, 48%) of patients were unemployed and most (n = 45, 83%) used a community-based health insurance. For most patients (n = 44, 81%), the monthly income was less than 10,000 Rwandan francs (RWF) (11.90 U.S. Dollars [USD]). Most (n = 51, 94%) patients presented to the referral hospital with more than 24 h of symptoms. More than half (n = 31, 60%) of patients had more than 4 d of symptoms on presentation. Most (n = 37, 69%) patients consulted a traditional healer before presentation at the health care system. Consultation with a traditional healer was associated with delayed presentation at the referral hospital (P < 0.001). Most (n = 29, 53%) patients traveled more than 2 h to reach a health facility and this was associated with delayed presentation (P = 0.019). The cost of transportation ranged between 5000 and 1000 RWF (5.95-11.90 USD) for most patients and was not associated with delayed presentation (P = 0.449). CONCLUSIONS In this study, most patients with peritonitis present in a delayed fashion to the referral hospital. Factors associated with seeking and reaching care included sociodemographic characteristics, health-seeking behaviors, cost of care, and travel time. These findings highlight factors associated with delays in seeking and reaching care for patients with peritonitis.
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Affiliation(s)
- Martin Munyaneza
- Department of Surgery, University of Rwanda, Kigali, Rwanda; Department of Surgery, University Teaching Hospital of Butare, Butare, Rwanda
| | - Sudha Jayaraman
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Faustin Ntirenganya
- Department of Surgery, University of Rwanda, Kigali, Rwanda; Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Jennifer Rickard
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda; Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
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49
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Sutherland T, Mpirimbanyi C, Nziyomaze E, Niyomugabo JP, Niyonsenga Z, Muvunyi CM, Mueller A, Bebell LM, Nkubana T, Musoni E, Talmor D, Rickard J, Riviello ED. Widespread antimicrobial resistance among bacterial infections in a Rwandan referral hospital. PLoS One 2019; 14:e0221121. [PMID: 31443107 PMCID: PMC6707788 DOI: 10.1371/journal.pone.0221121] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 05/03/2019] [Accepted: 07/30/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Resistance among bacterial infections is increasingly well-documented in high-income countries; however, relatively little is known about bacterial antimicrobial resistance in low-income countries, where the burden of infections is high. METHODS We prospectively screened all adult inpatients at a referral hospital in Rwanda for suspected infection for seven months. Blood, urine, wound and sputum samples were cultured and tested for antibiotic susceptibility. We examined factors associated with resistance and compared hospital outcomes for participants with and without resistant isolates. RESULTS We screened 19,178 patient-days, and enrolled 647 unique participants with suspected infection. We obtained 942 culture specimens, of which 357 were culture-positive specimens. Of these positive specimens, 155 (43.4%) were wound, 83 (23.2%) urine, 64 (17.9%) blood, and 55 (15.4%) sputum. Gram-negative bacteria comprised 323 (88.7%) of all isolates. Of 241 Gram-negative isolates tested for ceftriaxone, 183 (75.9%) were resistant. Of 92 Gram-negative isolates tested for the extended spectrum beta-lactamase (ESBL) positive phenotype, 66 (71.7%) were ESBL positive phenotype. Transfer from another facility, recent surgery or antibiotic exposure, and hospital-acquired infection were each associated with resistance. Mortality was 19.6% for all enrolled participants. CONCLUSIONS This is the first published prospective hospital-wide antibiogram of multiple specimen types from East Africa with ESBL testing. Our study suggests that low-resource settings with limited and inconsistent access to the full range of antibiotic classes may bear the highest burden of resistant infections. Hospital-acquired infections and recent antibiotic exposure are associated with a high proportion of resistant infections. Efforts to slow the development of resistance and supply effective antibiotics are urgently needed.
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Affiliation(s)
- Tori Sutherland
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, United States of America
| | - Christophe Mpirimbanyi
- Department of Surgery, Kigali University Teaching Hospital, University of Rwanda, College of Medicine and Health Sciences, School of Medicine and Pharmacy, Kigali, Rwanda
| | - Elie Nziyomaze
- Department of Surgery, Kigali University Teaching Hospital, University of Rwanda, College of Medicine and Health Sciences, School of Medicine and Pharmacy, Kigali, Rwanda
| | - Jean-Paul Niyomugabo
- Department of Surgery, Kigali University Teaching Hospital, University of Rwanda, College of Medicine and Health Sciences, School of Medicine and Pharmacy, Kigali, Rwanda
| | - Zack Niyonsenga
- Department of Surgery, Kigali University Teaching Hospital, University of Rwanda, College of Medicine and Health Sciences, School of Medicine and Pharmacy, Kigali, Rwanda
| | - Claude Mambo Muvunyi
- Department of Clinical Biology, Kigali University Teaching Hospital, University of Rwanda, College of Medicine and Health Sciences, School of Medicine and Pharmacy, Kigali, Rwanda
| | - Ariel Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, United States of America
| | - Lisa M. Bebell
- Division of Infectious Diseases, Massachusetts General Hospital, MGH Global Health, and Harvard Medical School, Boston, United States of America
| | - Theoneste Nkubana
- Department of Pathology, Kigali University Teaching Hospital, Kigali, Rwanda
| | - Emile Musoni
- Department of Clinical Biology, Kigali University Teaching Hospital, University of Rwanda, College of Medicine and Health Sciences, School of Medicine and Pharmacy, Kigali, Rwanda
| | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, United States of America
| | - Jennifer Rickard
- Department of Surgery, Kigali University Teaching Hospital, University of Rwanda, College of Medicine and Health Sciences, School of Medicine and Pharmacy, Kigali, Rwanda
- Department of Surgery, University of Minnesota, Minneapolis, United States of America
| | - Elisabeth D. Riviello
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, United States of America
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50
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Abahuje E, Sibomana I, Rwagahirima E, Urimubabo C, Munyaneza R, Rickard J. Development of an acute care surgery service in Rwanda. Trauma Surg Acute Care Open 2019; 4:e000332. [PMID: 31423464 PMCID: PMC6688707 DOI: 10.1136/tsaco-2019-000332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/23/2019] [Accepted: 06/27/2019] [Indexed: 11/04/2022] Open
Abstract
Background Acute care surgery (ACS) encompasses trauma, critical care, and emergency general surgery. Due to high volumes of emergency surgery, an ACS service was developed at a referral hospital in Rwanda. The aim of this study was to evaluate the epidemiology of ACS and understand the impact of an ACS service on patient outcomes. Methods This is a retrospective observational study of ACS patients before and after introduction of an ACS service. χ2 test and Wilcoxon rank-sum test were used to describe the epidemiology and compare outcomes before (pre-ACS)) and after (post-ACS) implementation of the ACS service. Results Data were available for 120 patients before ACS and 102 patients after ACS. Diagnoses included: intestinal obstruction (n=80, 36%), trauma (n=38, 17%), appendicitis (n=31, 14%), and soft tissue infection (n=17, 8%) with no difference between groups. The most common operation was midline laparotomy (n=138, 62%) with no difference between groups (p=0.910). High American Society of Anesthesiologists (ASA) score (ASA ≥3) (11% vs. 40%, p<0.001) was more common after ACS. There was no difference in intensive care unit admission (8% vs. 8%, p=0.894), unplanned reoperation (22% vs. 13%, p=0.082), or mortality (10% vs. 11%, p=0.848). The median length of hospital stay was longer (11 days vs. 7 days, p<0.001) before ACS. Conclusions An ACS service can be implemented in a low-resource setting. In Rwanda, ACS patients are young with few comorbidities, but high rates of mortality and morbidity. In spite of more patients who are critically ill in the post-ACS period, implementation of an ACS service resulted in decreased length of hospital stay with no difference in morbidity and mortality. Level of evidence Prognostic and epidemiologic study type, level III.
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Affiliation(s)
- Egide Abahuje
- Department of Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Isaie Sibomana
- Department of Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Elisee Rwagahirima
- Department of Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Christian Urimubabo
- Department of Surgery, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - Robert Munyaneza
- Department of Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Jennifer Rickard
- Department of Surgery, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda.,Department of Surgery, University of Minnesota System, Minneapolis, Minnesota, USA
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