Publications
354 results found
Chang AY, Cowling K, Micah AE, et al., 2020, Past, present, and future of global health financing: A review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050, The Lancet, Vol: 393, Pages: 2233-2260, ISSN: 0140-6736
SummaryBackgroundComprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We aimed to characterise the past, present, and predicted future of global health spending, with an emphasis on equity in spending across countries.MethodsWe estimated domestic health spending for 195 countries and territories from 1995 to 2016, split into three categories—government, out-of-pocket, and prepaid private health spending—and estimated development assistance for health (DAH) from 1990 to 2018. We estimated future scenarios of health spending using an ensemble of linear mixed-effects models with time series specifications to project domestic health spending from 2017 through 2050 and DAH from 2019 through 2050. Data were extracted from a broad set of sources tracking health spending and revenue, and were standardised and converted to inflation-adjusted 2018 US dollars. Incomplete or low-quality data were modelled and uncertainty was estimated, leading to a complete data series of total, government, prepaid private, and out-of-pocket health spending, and DAH. Estimates are reported in 2018 US dollars, 2018 purchasing-power parity-adjusted dollars, and as a percentage of gross domestic product. We used demographic decomposition methods to assess a set of factors associated with changes in government health spending between 1995 and 2016 and to examine evidence to support the theory of the health financing transition. We projected two alternative future scenarios based on higher government health spending to assess the potential ability of governments to gene
Soriano JB, Kendrick PJ, Paulson KR, et al., 2020, Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet Respiratory Medicine, Vol: 8, Pages: 585-596, ISSN: 2213-2600
BackgroundPrevious attempts to characterise the burden of chronic respiratory diseases have focused only on specific disease conditions, such as chronic obstructive pulmonary disease (COPD) or asthma. In this study, we aimed to characterise the burden of chronic respiratory diseases globally, providing a comprehensive and up-to-date analysis on geographical and time trends from 1990 to 2017.MethodsUsing data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we estimated the prevalence, morbidity, and mortality attributable to chronic respiratory diseases through an analysis of deaths, disability-adjusted life-years (DALYs), and years of life lost (YLL) by GBD super-region, from 1990 to 2017, stratified by age and sex. Specific diseases analysed included asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, pneumoconiosis, and other chronic respiratory diseases. We also assessed the contribution of risk factors (smoking, second-hand smoke, ambient particulate matter and ozone pollution, household air pollution from solid fuels, and occupational risks) to chronic respiratory disease-attributable DALYs.FindingsIn 2017, 544·9 million people (95% uncertainty interval [UI] 506·9–584·8) worldwide had a chronic respiratory disease, representing an increase of 39·8% compared with 1990. Chronic respiratory disease prevalence showed wide variability across GBD super-regions, with the highest prevalence among both males and females in high-income regions, and the lowest prevalence in sub-Saharan Africa and south Asia. The age-sex-specific prevalence of each chronic respiratory disease in 2017 was also highly variable geographically. Chronic respiratory diseases were the third leading cause of death in 2017 (7·0% [95% UI 6·8–7·2] of all deaths), behind cardiovascular diseases and neoplasms. Deaths due to chronic respiratory diseases numbered 3 914 196 (95% UI 3 790 578–
Yadgir S, Johnson CO, Aboyans V, et al., 2020, Global, regional, and national burden of calcific aortic valve and degenerative mitral valve diseases, 1990-2017, Circulation, Vol: 141, Pages: 1670-1680, ISSN: 0009-7322
Background: Non-rheumatic valvular heart diseases (NRVDs) are common; however, no studies have estimated their global or national burden. As part of the Global Burden of Disease (GBD) 2017 study, mortality, prevalence, and disability-adjusted life years (DALYs) for calcific aortic valve disease (CAVD), degenerative mitral valve disease (DMVD), and other NRVD were estimated for 195 countries and territories from 1990 to 2017.Methods: Vital registration data, epidemiological survey data, and administrative hospital data were used to estimate disease burden using the GBD modeling framework, which ensures comparability across locations. Geospatial statistical methods were used to estimates disease for all countries, as data on NRVD are extremely limited for some regions of the world, such as sub-Saharan Africa and South Asia. Results accounted for estimated level of disease severity as well as the estimated availability of valve repair or replacement procedures. DALYs and other measures of health-related burden were generated for each sex, five-year age group, location, and year from 1990 to 2017.Results: Globally, CAVD and DMVD caused 102,700 (95% uncertainty interval [UI] 82,700 to 107,900) and 35,700 (95% UI 30,500 to 42,500) deaths, and had 12.6 million (95% UI 11.4 million to 13.8 million) and 18.1 million (95% UI 17.6 million to 18.6 million) prevalent cases in 2017, respectively. 1.5 million (95% UI 1.4 million to 1.6 million) DALYs were estimated as due to NRVD, globally, representing 0.26% (95% UI 0.22% to 0.27%) of total lost health from all diseases in 2017. The number of DALYs increased for CAVD and DMVD between 1990 and 2017, by 123% (95% UI 101% to 137%) and 64% (95% UI 50% to 75%), respectively. There is significant geographic variation in the prevalence, mortality rate, and overall burden of these diseases, with highest age-standardized DALY rates of CAVD estimated for high-income countries.Conclusion: These global and national estimates demonstrate that
Rawaf S, Al-Saffar M, Quezada Yamamoto H, et al., 2020, Chloroquine and hydroxychloroquine effectiveness in human subjects during coronavirus: a systematic review, Publisher: medRxiv
In a search to find effective treatments for COVID-19, chloroquine and hydroxychloroquine have gained attention. We aim to provide evidence to support clinical decision-making regarding medication for the treatment of COVID-19 by carrying out a systematic review of the literature. The electronic databases MEDLINE, EMBASE, Global Health, and HMIC were searched up to April 2020. Eligible study outcomes included: extubation or patient recovery. Relevant data were extracted and analysed by narrative synthesis. Our results included six studies in the review of which four studies were of good or fair quality. All eligible studies included were for coronavirus involving the use of either chloroquine or hydroxychloroquine to treat common symptoms such as fever, cough, shortness of breath and fatigue. Outcomes most commonly reported were improved lung function, viral clearance, and hospital discharge. Strong evidence to support the use of chloroquine and hydroxychloroquine in the treatment of COVID-19 is lacking. Fast track trials are riddled with bias and may not conform to rigorous guidelines which may lead to inadequate data being reported. The use of these drugs in combination with other medications may be useful but without knowing which groups they are suited for and when they may cause more harm than good.
Rawaf S, Quezada Yamamoto H, Rawaf D, 2020, Unlocking towns and cities: COVID-19 exit strategy, Eastern Mediterranean Health Journal, Vol: 26, Pages: 499-502, ISSN: 1020-3397
The novel Coronavirus SARS-2 represents a major global challenge since the first cases were diagnosed in China and reported to the World Health Organization (WHO) on 31 December 2019 (1). On 9 January 2020, WHO issued a statement warning of the ‘risk’ of human-to-human transmission, although China did not report such a meth-od of transmission (2). WHO officially declared a Public Health Emergency on 30 January 2020 and the disease was named COVID-19 on 11 February 2020. On 11 March, it was characterized as a pandemic when the number of cases increased 13-fold. At this point, it had spread to over 60 countries across all continents except Antarctica, with an immediate and profound effect on societies and brought social and economic life to a virtual standstill. As of 30 April, 2020, 3 271 892 cases of COVID-19 were report-ed globally with 232 817 deaths (3). More than one-third of the world population was locked down (4), as part of the ‘suppression’ strategy first proposed by Imperial College London, United Kingdom (5). Such a strategy is aimed at reducing the spread of infection, protect health services and save lives. However, it has a major economic impact globally and has had a deep social and psychological im-pact on many people. Therefore, it is not feasible to main-tain the current lockdown indefinitely. This commentary aims to define the public health principles and the meas-ures that must be considered for a science-based political decision to unlock towns and cities.
LBD Double Burden of Malnutrition Collaborators, 2020, Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017, Nature Medicine, Vol: 26, Pages: 750-759, ISSN: 1078-8956
A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic.
Driscoll T, Rushton L, Hutchings SJ, et al., 2020, Global and regional burden of disease and injury in 2016 arising from occupational exposures: a systematic analysis for the Global Burden of Disease Study 2016, Occupational and Environmental Medicine, Vol: 77, Pages: 133-141, ISSN: 1351-0711
Objectives This study provides an overview of the influence of occupational risk factors on the global burden of disease as estimated by the occupational component of the Global Burden of Disease (GBD) 2016 study.Methods The GBD 2016 study estimated the burden in terms of deaths and disability-adjusted life years (DALYs) arising from the effects of occupational risk factors (carcinogens; asthmagens; particulate matter, gases and fumes (PMGF); secondhand smoke (SHS); noise; ergonomic risk factors for low back pain; risk factors for injury). A population attributable fraction (PAF) approach was used for most risk factors.Results In 2016, globally, an estimated 1.53 (95% uncertainty interval 1.39–1.68) million deaths and 76.1 (66.3–86.3) million DALYs were attributable to the included occupational risk factors, accounting for 2.8% of deaths and 3.2% of DALYs from all causes. Most deaths were attributable to PMGF, carcinogens (particularly asbestos), injury risk factors and SHS. Most DALYs were attributable to injury risk factors and ergonomic exposures. Men and persons 55 years or older were most affected. PAFs ranged from 26.8% for low back pain from ergonomic risk factors and 19.6% for hearing loss from noise to 3.4% for carcinogens. DALYs per capita were highest in Oceania, Southeast Asia and Central sub-Saharan Africa. On a per capita basis, between 1990 and 2016 there was an overall decrease of about 31% in deaths and 25% in DALYs.Conclusions Occupational exposures continue to cause an important health burden worldwide, justifying the need for ongoing prevention and control initiatives.
Driscoll T, Steenland K, Pearce N, et al., 2020, Global and regional burden of chronic respiratory disease in 2016 arising from non-infectious airborne occupational exposures: a systematic analysis for the Global Burden of Disease Study 2016, Occupational and Environmental Medicine, Vol: 77, Pages: 142-150, ISSN: 1351-0711
Objectives This paper presents detailed analysis of the global and regional burden of chronic respiratory disease arising from occupational airborne exposures, as estimated in the Global Burden of Disease 2016 study.Methods The burden of chronic obstructive pulmonary disease (COPD) due to occupational exposure to particulate matter, gases and fumes, and secondhand smoke, and the burden of asthma resulting from occupational exposure to asthmagens, was estimated using the population attributable fraction (PAF), calculated using exposure prevalence and relative risks from the literature. PAFs were applied to the number of deaths and disability-adjusted life years (DALYs) for COPD and asthma. Pneumoconioses were estimated directly from cause of death data. Age-standardised rates were based only on persons aged 15 years and above.Results The estimated PAFs (based on DALYs) were 17% (95% uncertainty interval (UI) 14%–20%) for COPD and 10% (95% UI 9%–11%) for asthma. There were estimated to be 519 000 (95% UI 441,000–609,000) deaths from chronic respiratory disease in 2016 due to occupational airborne risk factors (COPD: 460,100 [95% UI 382,000–551,000]; asthma: 37,600 [95% UI 28,400–47,900]; pneumoconioses: 21,500 [95% UI 17,900–25,400]. The equivalent overall burden estimate was 13.6 million (95% UI 11.9–15.5 million); DALYs (COPD: 10.7 [95% UI 9.0–12.5] million; asthma: 2.3 [95% UI 1.9–2.9] million; pneumoconioses: 0.58 [95% UI 0.46–0.67] million). Rates were highest in males; older persons and mainly in Oceania, Asia and sub-Saharan Africa; and decreased from 1990 to 2016.Conclusions Workplace exposures resulting in COPD, asthma and pneumoconiosis continue to be important contributors to the burden of disease in all regions of the world. This should be reducible through improved prevention and control of relevant exposures.
Sepanlou SG, Safiri S, Bisignano C, et al., 2020, The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet Gastroenterology & Hepatology, Vol: 5, Pages: 245-266, ISSN: 2468-1253
BackgroundCirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories.MethodsWe used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries.FindingsIn 2017, cirrhosis caused more than 1·32 million (95% UI 1·27–1·45) deaths (440 000 [416 000–518 000; 33·3%] in females and 883 000 [838 000–967 000; 66·7%] in males) globally, compared with less than 899 000 (829 000–948 000) deaths in 1990. Deaths due to cirrhosis constituted 2·4% (2·3–2·6) of total deaths globally in 2017 compared with 1·9% (1·8–2·0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21·0 (19·2–22·3) per 100 000 population in 1990 to 16&mid
Bikbov B, Purcell CA, Levey AS, et al., 2020, Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 395, Pages: 709-733, ISSN: 0140-6736
BackgroundHealth system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout.MethodsThe main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function.FindingsGlobally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 t
Kinyoki DK, Osgood-Zimmerman AE, Pickering BV, et al., 2020, Mapping child growth failure across low- and middle-income countries, Nature, Vol: 577, Pages: 231-234, ISSN: 0028-0836
Childhood malnutrition is associated with high morbidity and mortality globally1. Undernourished children are more likely to experience cognitive, physical, and metabolic developmental impairments that can lead to later cardiovascular disease, reduced intellectual ability and school attainment, and reduced economic productivity in adulthood2. Child growth failure (CGF), expressed as stunting, wasting, and underweight in children under five years of age (0–59 months), is a specific subset of undernutrition characterized by insufficient height or weight against age-specific growth reference standards3,4,5. The prevalence of stunting, wasting, or underweight in children under five is the proportion of children with a height-for-age, weight-for-height, or weight-for-age z-score, respectively, that is more than two standard deviations below the World Health Organization’s median growth reference standards for a healthy population6. Subnational estimates of CGF report substantial heterogeneity within countries, but are available primarily at the first administrative level (for example, states or provinces)7; the uneven geographical distribution of CGF has motivated further calls for assessments that can match the local scale of many public health programmes8. Building from our previous work mapping CGF in Africa9, here we provide the first, to our knowledge, mapped high-spatial-resolution estimates of CGF indicators from 2000 to 2017 across 105 low- and middle-income countries (LMICs), where 99% of affected children live1, aggregated to policy-relevant first and second (for example, districts or counties) administrative-level units and national levels. Despite remarkable declines over the study period, many LMICs remain far from the ambitious World Health Organization Global Nutrition Targets to reduce stunting by 40% and wasting to less than 5% by 2025. Large disparities in prevalence and progress exist across and within countries; our maps identify high-prev
Alatab S, Sepanlou SG, Ikuta K, et al., 2020, The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet Gastroenterology & Hepatology, Vol: 5, Pages: 17-30, ISSN: 2468-1253
BackgroundThe burden of inflammatory bowel disease (IBD) is rising globally, with substantial variation in levels and trends of disease in different countries and regions. Understanding these geographical differences is crucial for formulating effective strategies for preventing and treating IBD. We report the prevalence, mortality, and overall burden of IBD in 195 countries and territories between 1990 and 2017, based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017.MethodsWe modelled mortality due to IBD using a standard Cause of Death Ensemble model including data mainly from vital registrations. To estimate the non-fatal burden, we used data presented in primary studies, hospital discharges, and claims data, and used DisMod-MR 2.1, a Bayesian meta-regression tool, to ensure consistency between measures. Mortality, prevalence, years of life lost (YLLs) due to premature death, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) were estimated. All of the estimates were reported as numbers and rates per 100 000 population, with 95% uncertainty intervals (UI).FindingsIn 2017, there were 6·8 million (95% UI 6·4–7·3) cases of IBD globally. The age-standardised prevalence rate increased from 79·5 (75·9–83·5) per 100 000 population in 1990 to 84·3 (79·2–89·9) per 100 000 population in 2017. The age-standardised death rate decreased from 0·61 (0·55–0·69) per 100 000 population in 1990 to 0·51 (0·42–0·54) per 100 000 population in 2017. At the GBD regional level, the highest age-standardised prevalence rate in 2017 occurred in high-income North America (422·0 [398·7–446·1] per 100 000) and the lowest age-standardised prevalence rates were observed in the Caribbean (6·7 [6·3–7·2] per 100 000 population). High Socio-demogra
Nashat N, et al, Quezada Yamamoto H, et al., 2020, Primary care healthcare policy implementation in the eastern Mediterranean region; experience of six countries: part ii, European Journal of General Practice, Vol: 26, Pages: 1-6, ISSN: 1381-4788
Background: Primary healthcare (PHC) is the cornerstone of health systems for the rightfulaccess and cost-effective. It is a key factor in the global strategy for universal health coverage(UHC). Implementing PHC requires an understanding of health system under prevailingcircumstances essential to implement PHC, but data are unavailable.Objectives: This paper describes and analyses the health systems of Algeria, Kuwait,Morocco, Saudi Arabia, Jordan and Iraq and PHC status.Methods: Data were collected during a Workshop at 2018 WONCA East MediterraneanRegional Conference in Kuwait. Academic family physicians (FP) and general practitioners(GP) presented their country reports using the WONCA framework of 11 PowerPoint slides.WHO EMRO reflected on how countries’ experiences can contribute to their Frameworks onIntegrated People-Centered Health Services and UHC..Results: The six countries had achieved a great improvement in populations’ health, butcurrently face challenges of health financing, small number of certified family physicians,difficulties to access service and bureaucratic process. Main concerns were the absence of afamily practice model, brain drain and immigration of FPs. Countries differed in building acoherent policy.Conclusion: Priorities should be focused on: developing PHC model in Eastern MediterraneanRegion with advocacy for community-based PHC to policymakers: capacity building forstrengthening PHC-oriented health systems with FP specialty training and restrict practicingto fully trained FPs; engage communities to improve understanding of PHC; adopt quality andaccreditation policies for better services; validation of the referral and follow-up process; and,develop public-private partnership mechanisms to enhance PHC for UHC.
Rawaf S, 2019, Mapping disparities in education across low- and middle-income countries, Nature, Vol: 577, Pages: 1-16, ISSN: 0028-0836
Educational attainment is an important social determinant of maternal, newborn, and child health1,2,3. As a tool for promoting gender equity, it has gained increasing traction in popular media, international aid strategies, and global agenda-setting4,5,6. The global health agenda is increasingly focused on evidence of precision public health, which illustrates the subnational distribution of disease and illness7,8; however, an agenda focused on future equity must integrate comparable evidence on the distribution of social determinants of health9,10,11. Here we expand on the available precision SDG evidence by estimating the subnational distribution of educational attainment, including the proportions of individuals who have completed key levels of schooling, across all low- and middle-income countries from 2000 to 2017. Previous analyses have focused on geographical disparities in average attainment across Africa or for specific countries, but—to our knowledge—no analysis has examined the subnational proportions of individuals who completed specific levels of education across all low- and middle-income countries12,13,14. By geolocating subnational data for more than 184 million person-years across 528 data sources, we precisely identify inequalities across geography as well as within populations.
GBD 2017 Pancreatic Cancer Collaborators, 2019, The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017., Lancet Gastroenterology and Hepatology, Vol: 4, Pages: 934-947, ISSN: 2468-1253
BACKGROUND: Worldwide, both the incidence and death rates of pancreatic cancer are increasing. Evaluation of pancreatic cancer burden and its global, regional, and national patterns is crucial to policy making and better resource allocation for controlling pancreatic cancer risk factors, developing early detection methods, and providing faster and more effective treatments. METHODS: Vital registration, vital registration sample, and cancer registry data were used to generate mortality, incidence, and disability-adjusted life-years (DALYs) estimates. We used the comparative risk assessment framework to estimate the proportion of deaths attributable to risk factors for pancreatic cancer: smoking, high fasting plasma glucose, and high body-mass index. All of the estimates were reported as counts and age-standardised rates per 100 000 person-years. 95% uncertainty intervals (UIs) were reported for all estimates. FINDINGS: In 2017, there were 448 000 (95% UI 439 000-456 000) incident cases of pancreatic cancer globally, of which 232 000 (210 000-221 000; 51·9%) were in males. The age-standardised incidence rate was 5·0 (4·9-5·1) per 100 000 person-years in 1990 and increased to 5·7 (5·6-5·8) per 100 000 person-years in 2017. There was a 2·3 times increase in number of deaths for both sexes from 196 000 (193 000-200 000) in 1990 to 441 000 (433 000-449 000) in 2017. There was a 2·1 times increase in DALYs due to pancreatic cancer, increasing from 4·4 million (4·3-4·5) in 1990 to 9·1 million (8·9-9·3) in 2017. The age-standardised death rate of pancreatic cancer was highest in the high-income super-region across all years from 1990 to 2017. In 2017, the highest age-standardised death rates were observed in Greenland (17·4 [15·8-19·0] per 100 000 person-years) and Uruguay (12·1 [10·9-13·5] per 100 000 person-years). These countri
GBD 2017 Colorectal Cancer Collaborators, 2019, The global, regional, and national burden of colorectal cancer and its attributable risk factors in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017., Lancet Gastroenterology and Hepatology, Vol: 4, Pages: 913-933, ISSN: 2468-1253
BACKGROUND: Data about the global, regional, and country-specific variations in the levels and trends of colorectal cancer are required to understand the impact of this disease and the trends in its burden to help policy makers allocate resources. Here we provide a status report on the incidence, mortality, and disability caused by colorectal cancer in 195 countries and territories between 1990 and 2017. METHODS: Vital registration, sample vital registration, verbal autopsy, and cancer registry data were used to generate incidence, death, and disability-adjusted life-year (DALY) estimates of colorectal cancer at the global, regional, and national levels. We also determined the association between development levels and colorectal cancer age-standardised DALY rates, and calculated DALYs attributable to risk factors that had evidence of causation with colorectal cancer. All of the estimates are reported as counts and age-standardised rates per 100 000 person-years, with some estimates also presented by sex and 5-year age groups. FINDINGS: In 2017, there were 1·8 million (95% UI 1·8-1·9) incident cases of colorectal cancer globally, with an age-standardised incidence rate of 23·2 (22·7-23·7) per 100 000 person-years that increased by 9·5% (4·5-13·5) between 1990 and 2017. Globally, colorectal cancer accounted for 896 000 (876 300-915 700) deaths in 2017, with an age-standardised death rate of 11·5 (11·3-11·8) per 100 000 person-years, which decreased between 1990 and 2017 (-13·5% [-18·4 to -10·0]). Colorectal cancer was also responsible for 19·0 million (18·5-19·5) DALYs globally in 2017, with an age-standardised rate of 235·7 (229·7-242·0) DALYs per 100 000 person-years, which decreased between 1990 and 2017 (-14·5% [-20·4 to -10·3]). Slovakia, the Netherlands, and New Zealand had the highest age-standa
Quezada Yamamoto H, Dubois E, Mastellos N, et al., 2019, Primary care integration of sexual and reproductive health services for chlamydia testing across WHO-Europe: a systematic review, BMJ Open, Vol: 9, ISSN: 2044-6055
Objective To identify current uptake of chlamydia testing (UCT) as a sexual and reproductive health service (SRHS) integrated in primary care settings of the WHO European region, with the aim to shape policy and quality of care.Design Systematic review for studies published from January 2001 to May 2018 in any European language.Data sources OVID Medline, EMBASE, Maternal and Infant Care and Global Health.Eligibility criteria Published studies, which involved women or men, adolescents or adults, reporting a UCT indicator in a primary care within a WHO European region country. Study designs considered were: randomised control trials (RCTs), quasi-experimental, observational (eg, cohort, case–control, cross-sectional) and mixed-methods studies as well as case reports.Data extraction and synthesis Two independent reviewers screened the sources and validated the selection process. The BRIGGS Critical Appraisal Checklist for Analytical Cross-Sectional Studies, the Mixed Methods Appraisal Tool 2011 and Critical Appraisal Skills Programme (CASP) checklists were considered for quality and risk of bias assessment.Results 24 studies were finally included, of which 15 were cross-sectional, 4 cohort, 2 RCTs, 2 case–control studies and 1 mixed-methods study. A majority of the evidence cites the UK model, followed by the Netherlands, Denmark, Norway and Belgium only. Acceptability if offered test in primary healthcare (PHC) ranged from 55% to 81.4% in women and from 9.5% to 70.6% when both genders were reported together. Men may have a lower UCT compared with women. When both genders were reported together, the lowest acceptability was 9.5% in the Netherlands. Denmark presented the highest percentage of eligible people who tested in a PHC setting (87.3%).Conclusions Different health systems may influence UCT in PHC. The regional use of a common testing rate indicator is suggested to homogenise reporting. There is very little evidence on integration of SRHS such as chla
Fitzmaurice C, Abate D, Abbasi N, et al., 2019, Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017, JAMA Oncology, Vol: 5, Pages: 1749-1768, ISSN: 2374-2437
Importance Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.Objective To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning.Evidence Review We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence.Findings In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for m
GBD 2017 Childhood Cancer Collaborators, 2019, The global burden of childhood and adolescent cancer in 2017: an analysis of the Global Burden of Disease Study 2017, Lancet Oncology, Vol: 20, Pages: 1211-1225, ISSN: 1470-2045
BACKGROUND: Accurate childhood cancer burden data are crucial for resource planning and health policy prioritisation. Model-based estimates are necessary because cancer surveillance data are scarce or non-existent in many countries. Although global incidence and mortality estimates are available, there are no previous analyses of the global burden of childhood cancer represented in disability-adjusted life-years (DALYs). METHODS: Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 methodology, childhood (ages 0-19 years) cancer mortality was estimated by use of vital registration system data, verbal autopsy data, and population-based cancer registry incidence data, which were transformed to mortality estimates through modelled mortality-to-incidence ratios (MIRs). Childhood cancer incidence was estimated using the mortality estimates and corresponding MIRs. Prevalence estimates were calculated by using MIR to model survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated by multiplying age-specific cancer deaths by the difference between the age of death and a reference life expectancy. DALYs were calculated as the sum of YLLs and YLDs. Final point estimates are reported with 95% uncertainty intervals. FINDINGS: Globally, in 2017, there were 11·5 million (95% uncertainty interval 10·6-12·3) DALYs due to childhood cancer, 97·3% (97·3-97·3) of which were attributable to YLLs and 2·7% (2·7-2·7) of which were attributable to YLDs. Childhood cancer was the sixth leading cause of total cancer burden globally and the ninth leading cause of childhood disease burden globally. 82·2% (82·1-82·2) of global childhood cancer DALYs occurred in low, low-middle, or middle Socio-demographic Index locations, whereas 50·3% (50·3-50·3) of adult cancer DALYs occurred in these same
Frank TD, Carter A, Jahagirdar D, et al., 2019, Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017, The Lancet HIV, Vol: 6, Pages: e831-e859, ISSN: 2352-3018
BackgroundUnderstanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980–2017 and forecast these estimates to 2030 for 195 countries and territories.MethodsWe determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package—a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce age-sex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections.FindingsGlobal HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87–2·04) and has since decreased to 0·95 million deaths (0·91–1&
Lovell B, Dhillon R, Khader A, et al., 2019, Delivering and evaluating a scalable training model for strengthening family medicine in resource-limited environments: the Gaza experience, BJGP Open, Vol: 3, Pages: 1-9, ISSN: 2398-3795
Background: Since 2007 Gaza Palestine has been subject to blockade affecting over 1.9 million people. This denies health professionals’ access to Continuing Professional Development (CPD). In Gaza, family physicians are scarce, and their level of training does not meet the needs of UNRWA’s Family Health Team model for better population health. Aim: This study sought to develop a postgraduate training programme for Gazan doctors via a Diploma in Family Medicine and evaluate its impact on physicians and patients.Design and setting: A mixed-methods evaluation of a postgraduate Diploma Methods: The programme was delivered over one year, to 15 primary care doctors. The impact was evaluated through focus group discussions and patient feedback questionnaire survey comparing FM PG Diploma graduate doctors and doctors without the FM PG Diploma. Results: All participating doctors graduated successfully and found the experience extremely positive. Trainees felt that the Diploma helped them take more individualised approach to patients; have a better understanding of psychosocial elements affecting patient health; feel more inclined towards team-working and collaborative approaches to healthcare; and more insight into non-verbal communication such as active listening and tactile gestures. Statistical analysis of patients feedback showed significantly improved patient-reported outcomes and satisfaction when treated by course diplomates compared to non-diplomates. Conclusion: Where there are limited training opportunities, investment in a structured Postgraduate Diploma training programme can improve quality of health service delivery. UNRWA’s experience in Gaza demonstrates the value of a scalable model in resource-limited settings.
Jamil HJ, Niasy A, Jamil MH, et al., 2019, Substance abuse among Middle Eastern Immigrants and refugees in Greater Detroit, Michigan, U.S., Advances in Environmental Studies, Vol: 3, Pages: 209-215, ISSN: 0036-3537
BackgroundSubstance usage is a prevailing endemic around the globe. It has a global effect on the economic and social aspects of society, making it crucial to assess risk factors and prevalence. However, a large number of immigrants and refugees who came to the U.S., have come from Middle Eastern countries in conflict with consequent psychiatric disorders like depression and stress. Literature shows that over 9.2% of the U.S. population alone is involved in illicit drugs and 22.7% is involved in alcohol use. Our study's objective was to assess the prevalence and risk factors of substance use (Alcohol and illicit drugs) among immigrants and refugees in Greater Detroit area of state of Michigan, U.S.MethodsA 7.5% random sample from an Iraqi address list of 5555 (n = 350) (immigrants (n = 152), refugees (n =198)) residing in Greater Detroit was studied. We analyzed alcohol, street drugs, amphetamine and sedative usage in this population via binary logistic regression, linear regression, and Chi square analysis.ResultsResults indicate that there was a significant difference in prevalence of substance usage between immigrants and refugees, with the latter having a higher street drug use (p < 0.001). Immigrants have a higher alcohol use (43.4%) (p < 0.001). The predictors for drinking alcohol were: male, smokers and those without health insurance. Depression was a predictor for using any substance drugs. People who use substances have higher incidence of chronic headaches and lumbago (p < 0.001).
Jamil H, Rawaf S, Alsaghayer A, et al., 2019, Health Assessments of Iraqi Scientists Abroad: Chronic Diseases and Legal Status, ACTA SCIENTIFIC MEDICAL SCIENCES
Jamil H, Hamdanm T, Rawaf S, et al., 2019, Pregnancy outcome among Iraqi soldiers & civilians in Iraq and Gulf War 1991, Archives of Epidemiology, Vol: 4, Pages: 1-8, ISSN: 2577-2252
Context: Although Iraqis were exposed to very severe conditions during the 1991 Gulf War, we have very little information on the effect of distance from the war zone on the outcomes of pregnancy and congenital anomalies in children.Aim: To determine if pregnancy outcomes vary by distance from the 1991Gulf War battle zone.Methods: The study sample consisted of men between the ages 18-45 years and residents within 360 kilometres in Iraqi providences of Basra & Messan at time of 1991 Gulf War. During 2002, 720 out of 1150 participant were enrolled in the study because they were married and had at least one child. We divided the population study into two main groups: battle and non-battle zone and studied the effects of war on pregnancy outcomes.Results: Congenital anomalies in the non-battle zones appear to be significantly higher, which implies that the impact of war was not restricted to the war zone.Conclusion: There is no relationship between geographical closeness to Kuwait and adverse pregnancy outcome.
GBD 2017 Risk Factor Collaborators, 2019, Department of error., The Lancet, Vol: 393, Pages: e44-e44, ISSN: 0140-6736
Greenfield G, Majeed B, Hayhoe B, et al., 2019, Rethinking primary care user fees: is charging a fee for appointments a solution to NHS underfunding?, Br J Gen Pract, Vol: 69, Pages: 280-281
GBD 2016 Neurology Collaborators, 2019, Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016, Lancet Neurology, Vol: 18, Pages: 459-480, ISSN: 1474-4422
BACKGROUND: Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders. METHODS: We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach. FINDINGS: Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247-308]) and second leading cause of deaths (9·0 million [8·8-9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34-44] and DALYs by 15% [9-21]) whereas their age-standardised rates decreased (deaths by 28% [26-30] and DALYs by 27% [24-31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs we
Noormal B, Eltayeb E, Al Nsour M, et al., 2019, Innovative Approaches to Improve Public Health Practice in the Eastern Mediterranean Region: Findings From the Sixth Eastern Mediterranean Public Health Network Regional Conference, JMIR PUBLIC HEALTH AND SURVEILLANCE, Vol: 5, Pages: 198-208, ISSN: 2369-2960
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Alnuaimi A, Rawaf S, Hassounah S, et al., 2019, Use of mobile applications in the management of overweight and obesity in primary and secondary care, JRSM Open, Vol: 10, ISSN: 2054-2704
Mobile technology has emerged as a potentially useful application in the process of facilitating weight loss management. While several empirical studies have demonstrated the positive effects of mobile-based interventions, the extent of such effectiveness is still a topic of debate. Thus, the current systematic review involved searching electronic databases for studies on the use of mobile app-based interventions in the management of overweight and obesity among adults over 18 years of age in a primary and secondary care setting. The results of the review revealed that mobile apps are effective tools for weight loss management and sustaining such loss when compared to standard interventions. However, further research is needed to consider the sustained benefits and the applicability of mobile app-based interventions for large-scale population coverage.
Rawaf S, Raheem M, Rawaf D, 2019, Proactive primary car: integrating public health into primary care, BOOK: Family Practice in the Eastern Mediterranean Region
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