Browsing by Author "Nicholas J Kassebaum"

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Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019
(Elsevier B.V., 2022) Kevin S Ikuta; Lucien R Swetschinski; Gisela Robles Aguilar; Fablina Sharara; Tomislav Mestrovic; Authia P Gray; Nicole Davis Weaver; Eve E Wool; Chieh Han; Anna Gershberg Hayoon; Amirali Aali; Semagn Mekonnen Abate; Mohsen Abbasi-Kangevari; Zeinab Abbasi-Kangevari; Sherief Abd-Elsalam; Getachew Abebe; Aidin Abedi; Amir Parsa Abhari; Hassan Abidi; Richard Gyan Aboagye; Abdorrahim Absalan; Hiwa Abubaker Ali; Juan Manuel Acuna; Tigist Demssew Adane; Isaac Yeboah Addo; Oyelola A Adegboye; Mohammad Adnan; Qorinah Estiningtyas Sakilah Adnani; Muhammad Sohail Afzal; Saira Afzal; Zahra Babaei Aghdam; Bright Opoku Ahinkorah; Aqeel Ahmad; Araz Ramazan Ahmad; Rizwan Ahmad; Sajjad Ahmad; Sohail Ahmad; Sepideh Ahmadi; Ali Ahmed; Haroon Ahmed; Jivan Qasim Ahmed; Tarik Ahmed Rashid; Marjan Ajami; Budi Aji; Mostafa Akbarzadeh-Khiavi; Chisom Joyqueenet Akunna; Hanadi Al Hamad; Fares Alahdab; Ziyad Al-Aly; Mamoon A Aldeyab; Alicia V Aleman; Fadwa Alhalaiqa Naji Alhalaiqa; Robert Kaba Alhassan; Beriwan Abdulqadir Ali; Liaqat Ali; Syed Shujait Ali; Yousef Alimohamadi; Vahid Alipour; Atiyeh Alizadeh; Syed Mohamed Aljunid; Kasim Allel; Sami Almustanyir; Edward Kwabena Ameyaw; Arianna Maever L Amit; Nivedita Anandavelane; Robert Ancuceanu; Catalina Liliana Andrei; Tudorel Andrei; Dewi Anggraini; Adnan Ansar; Anayochukwu Edward Anyasodor; Jalal Arabloo; Aleksandr Y Aravkin; Demelash Areda; Timur Aripov; Anton A Artamonov; Judie Arulappan; Raphael Taiwo Aruleba; Muhammad Asaduzzaman; Tahira Ashraf; Seyyed Shamsadin Athari; Daniel Atlaw; Sameh Attia; Marcel Ausloos; Tewachew Awoke; Beatriz Paulina Ayala Quintanilla; Tegegn Mulatu Ayana; Sina Azadnajafabad; Amirhossein Azari Jafari; B. Darshan; Muhammad Badar; Ashish D Badiye; Nayereh Baghcheghi; Sara Bagherieh; Atif Amin Baig; Indrajit Banerjee; Aleksandra Barac; Mainak Bardhan; Francesco Barone-Adesi; Hiba Jawdat Barqawi; Amadou Barrow; Pritish Baskaran; Saurav Basu; Abdul-Monim Mohammad Batiha; Neeraj Bedi; Melaku Ashagrie Belete; Uzma Iqbal Belgaumi; Rose G Bender; Bharti Bhandari; Dinesh Bhandari; Pankaj Bhardwaj; Sonu Bhaskar; Krittika Bhattacharyya; Suraj Bhattarai; Saeid Bitaraf; Danilo Buonsenso; Zahid A Butt; Florentino Luciano Caetano Dos Santos; Jiao Cai; Daniela Calina; Paulo Camargos; Luis Alberto Cámera; Rosario Cárdenas; Muge Cevik; Joshua Chadwick; Jaykaran Charan; Akhilanand Chaurasia; Patrick R Ching; Sonali Gajanan Choudhari; Enayet Karim Chowdhury; Fazle Rabbi Chowdhury; Dinh-Toi Chu; Isaac Sunday Chukwu; Omid Dadras; Fentaw Teshome Dagnaw; Xiaochen Dai; Saswati Das; Anna Dastiridou; Sisay Abebe Debela; Fitsum Wolde Demisse; Solomon Demissie; Diriba Dereje; Msganaw Derese; Hardik Dineshbhai Desai; Fikadu Nugusu Dessalegn; Samuel Abebe A Dessalegni; Belay Desye; Kartik Dhaduk; Meghnath Dhimal; Sameer Dhingra; Nancy Diao; Daniel Diaz; Shirin Djalalinia; Milad Dodangeh; Deepa Dongarwar; Bezabih Terefe Dora; Fariba Dorostkar; Haneil Larson Dsouza; Eleonora Dubljanin; Susanna J Dunachie; Oyewole Christopher Durojaiye; Hisham Atan Edinur; Habtamu Bekele Ejigu; Michael Ekholuenetale; Temitope Cyrus Ekundayo; Hassan El-Abid; Muhammed Elhadi; Mohamed A Elmonem; Amir Emami; Luchuo Engelbert Bain; Daniel Berhanie Enyew; Ryenchindorj Erkhembayar; Babak Eshrati; Farshid Etaee; Adeniyi Francis Fagbamigbe; Shahab Falahi; Aida Fallahzadeh; Emerito Jose A Faraon; Ali Fatehizadeh; Ginenus Fekadu; João C Fernandes; Allegra Ferrari; Getahun Fetensa; Irina Filip; Florian Fischer; Masoud Foroutan; Peter Andras Gaal; Muktar A Gadanya; Abhay Motiramji Gaidhane; Balasankar Ganesan; Mesfin Gebrehiwot; Reza Ghanbari; Mohammad Ghasemi Nour; Ahmad Ghashghaee; Ali Gholamrezanezhad; Abdolmajid Gholizadeh; Mahaveer Golechha; Pouya Goleij; Davide Golinelli; Amador Goodridge; Damitha Asanga Gunawardane; Yuming Guo; Rajat Das Gupta; Sapna Gupta; Veer Bala Gupta; Vivek Kumar Gupta; Alemu Guta; Parham Habibzadeh; Atlas Haddadi Avval; Rabih Halwani; Asif Hanif; Md Abdul Hannan; Harapan Harapan; Shoaib Hassan; Hadi Hassankhani; Khezar Hayat; Behzad Heibati; Golnaz Heidari; Mohammad Heidari; Reza Heidari-Soureshjani; Claudiu Herteliu; Demisu Zenbaba Heyi; Kamal Hezam; Praveen Hoogar; Nobuyuki Horita; Md Mahbub Hossain; Mehdi Hosseinzadeh; Mihaela Hostiuc; Sorin Hostiuc; Soodabeh Hoveidamanesh; Junjie Huang; Salman Hussain; Nawfal R Hussein; Segun Emmanuel Ibitoye; Olayinka Stephen Ilesanmi; Irena M Ilic; Milena D Ilic; Mohammad Tarique Imam; Mustapha Immurana; Leeberk Raja Inbaraj; Arnaud Iradukunda; Nahlah Elkudssiah Ismail; Chidozie C D Iwu; Chinwe Juliana Iwu; Merin J. Linda; Mihajlo Jakovljevic; Elham Jamshidi; Tahereh Javaheri; Fatemeh Javanmardi; Javad Javidnia; Sathish Kumar Jayapal; Umesh Jayarajah; Rime Jebai; Ravi Prakash Jha; Tamas Joo; Nitin Joseph; Farahnaz Joukar; Jacek Jerzy Jozwiak; Salah Eddine Oussama Kacimi; Vidya Kadashetti; Laleh R Kalankesh; Rohollah Kalhor; Vineet Kumar Kamal; Himal Kandel; Neeti Kapoor; Samad Karkhah; Bekalu Getnet Kassa; Nicholas J Kassebaum; Patrick D.M.C. Katoto; Mohammad Keykhaei; Himanshu Khajuria; Abbas Khan; Imteyaz A. Khan; Maseer Khan; Md Nuruzzaman Khan; Moien A.B. Khan; Moawiah Mohammad Khatatbeh; Mona M Khater; Hamid Reza Khayat Kashani; Jagdish Khubchandani; Hanna Kim; Min Seo Kim; Ruth W Kimokoti; Niranjan Kissoon; Sonali Kochhar; Farzad Kompani; Soewarta Kosen; Parvaiz A Koul; Sindhura Lakshmi Koulmane Laxminarayana; Fiorella Krapp Lopez; Kewal Krishan; Vijay Krishnamoorthy; Vishnutheertha Kulkarni; Naveen Kumar; Om P Kurmi; Ambily Kuttikkattu; Hmwe Hmwe Kyu; Dharmesh Kumar Lal; Judit Lám; Iván Landires; Savita Lasrado; Sang-Woong Lee; Jacopo Lenzi; Sonia Lewycka; Shanshan Li; Stephen S Lim; Wei Liu; Rakesh Lodha; Michael J Loftus; Ayush Lohiya; Lászl Lorenzovici; Mojgan Lotfi; Ata Mahmoodpoor; Mansour Adam Mahmoud; Razzagh Mahmoudi; Azeem Majeed; Jamal Majidpoor; Alaa Makki; Galana Ayana Mamo; Yosef Manla; Miquel Martorell; Clara N Matei; Barney Mcmanigal; Entezar Mehrabi Nasab; Ravi Mehrotra; Addisu Melese; Oliver Mendoza-Cano; Ritesh G Menezes; Alexios-Fotios A Mentis; Georgia Micha; Irmina Maria Michalek; Ana Carolina Micheletti Gomide Nogueira Des; Neda Milevska Kostova; Shabir Ahmad Mir; Mojgan Mirghafourvand; Seyyedmohammadsadeq Mirmoeeni; Erkin M Mirrakhimov; Mohammad Mirza-Aghazadeh-attari; Abay Sisay Misganaw; Awoke Misganaw; Sanjeev Misra; Esmaeil Mohammadi; Mokhtar Mohammadi; Abdollah Mohammadian-Hafshejani; Shafiu Mohammed; Syam Mohan; Mohammad Mohseni; Ali H Mokdad; Sara Momtazmanesh; Lorenzo Monasta; Catrin E Moore; Maryam Moradi; Mostafa Moradi Sarabi; Shane Douglas Morrison; Majid Motaghinejad; Haleh Mousavi Isfahani; Amin Mousavi Khaneghah; Seyed Ali Mousavi-Aghdas; Sumaira Mubarik; Francesk Mulita; Getaneh Baye B Mulu; Sandra B Munro; Saravanan Muthupandian; Tapas Sadasivan Nair; Atta Abbas Naqvi; Himanshi Narang; Zuhair S Natto; Muhammad Naveed; Biswa Prakash Nayak; Shumaila Naz; Ionut Negoi; Seyed Aria Nejadghaderi; Sandhya Neupane Kandel; Che Henry Ngwa; Robina Khan Niazi; Antonio Tolentino Nogueira Des; Nafise Noroozi; Hasti Nouraei; Ali Nowroozi; Virginia Nuñez-Samudio; Jerry John Nutor; Chimezie Igwegbe Nzoputam; Ogochukwu Janet Nzoputam; Bogdan Oancea; Rahman Md Obaidur; Vivek Anand Ojha; Akinkunmi Paul Okekunle; Osaretin Christabel Okonji; Andrew T Olagunju; Bolajoko Olubukunola Olusanya; Ahmed Omar Bali; Emad Omer; Nikita Otstavnov; Bilcha Oumer; Jagadish Rao Padubidri; Keyvan Pakshir; Tamás Palicz; Adrian Pana; Shahina Pardhan; Jose L Paredes; Utsav Parekh; Eun-Cheol Park; Seoyeon Park; Ashish Pathak; Rajan Paudel; Uttam Paudel; Shrikant Pawar; Hamidreza Pazoki Toroudi; Minjin Peng; Umberto Pensato; Veincent Christian Filipino Pepito; Marcos Pereira; Mario F P Peres; Norberto Perico; Ionela-Roxana Petcu; Zahra Zahid Piracha; Indrashis Podder; Nayanum Pokhrel; Ramesh Poluru; Maarten J Postma; Naeimeh Pourtaheri; Akila Prashant; Ibrahim Qattea; Mohammad Rabiee; Navid Rabiee; Amir Radfar; Saber Raeghi; Sima Rafiei; Pankaja Raghav Raghav; Leila Rahbarnia; Vafa Rahimi-Movaghar; Mosiur Rahman; Muhammad Aziz Rahman; Amir Masoud Rahmani; Vahid Rahmanian; Pradhum Ram; Muhammad Modassar Ali Nawaz Ranjha; Sowmya J Rao; Mohammad-Mahdi Rashidi; Azad Rasul; Zubair Ahmed Ratan; Salman Rawaf; Reza Rawassizadeh; Mohammad Sadegh Razeghinia; Elrashdy Moustafa Mohamed Redwan; Misganu Teshoma Regasa; Giuseppe Remuzzi; Melese Abate Reta; Nazila Rezaei; Aziz Rezapour; Abanoub Riad; Rezaul Karim Ripon; Kristina E Rudd; Basema Saddik; Saeid Sadeghian; Umar Saeed; Mohsen Safaei; Azam Safary; Sher Zaman Safi; Maryam Sahebazzamani; Amirhossein Sahebkar; Harihar Sahoo; Saina Salahi; Sarvenaz Salahi; Hedayat Salari; Sana Salehi; Hossein Samadi Kafil; Abdallah M Samy; Nima Sanadgol; Senthilkumar Sankararaman; Francesco Sanmarchi; Brijesh Sathian; Monika Sawhney; Ganesh Kumar Saya; Subramanian Senthilkumaran; Allen Seylani; Pritik A Shah; Masood Ali Shaikh; Elaheh Shaker; Murad Ziyaudinovich Shakhmardanov; Mequannent Melaku Sharew; Athena Sharifi-Razavi; Purva Sharma; Rahim Ali Sheikhi; Ali Sheikhy; Pavanchand H Shetty; Mika Shigematsu; Jae Il Shin; Hesamaddin Shirzad-Aski; K.M. Shivakumar; Parnian Shobeiri; Seyed Afshin Shorofi; Sunil Shrestha; Migbar Mekonnen Sibhat; Negussie Boti Sidemo; Mustafa Kamal Sikder; Luís Manuel Lopes Rodrigues Silva; Jasvinder A Singh; Paramdeep Singh; Surjit Singh; Md Shahjahan Siraj; Samarjeet Singh Siwal; Valentin Yurievich Skryabin; Anna Aleksandrovna Skryabina; Bogdan Socea; Damtew Damtew Solomon; Yimeng Song; Chandrashekhar T Sreeramareddy; Muhammad Suleman; Rizwan Suliankatchi Abdulkader; Saima Sultana; Miklós Szócska; Seyed-Amir Tabatabaeizadeh; Mohammad Tabish; Majid Taheri; Elahe Taki; Ker-Kan Tan; Sarmila Tandukar; Nathan Y Tat; Vivian Y Tat; Belay Negash Tefera; Yibekal Manaye Tefera; Gebremaryam Temesgen; Mohamad-Hani Temsah; Samar Tharwat; Arulmani Thiyagarajan; Imad I Tleyjeh; Christopher E Troeger; Krishna Kishore Umapathi; Era Upadhyay; Sahel Valadan Tahbaz; Pascual R Valdez; Jef Van Den Eynde; H Rogier Van Doorn; Siavash Vaziri; Georgios-Ioannis Verras; Harimadhav Viswanathan; Bay Vo; Abdul Waris; Gizachew Tadesse Wassie; Nuwan Darshana Wickramasinghe; Sajad Yaghoubi; Gahin Abdulraheem Tayib Yahya Yahya; Seyed Hossein Yahyazadeh Jabbari; Arzu Yigit; Vahit Yigit; Dong Keon Yon; Naohiro Yonemoto; Mazyar Zahir; Burhan Abdullah Zaman; Sojib Bin Zaman; Moein Zangiabadian; Iman Zare; Mikhail Sergeevich Zastrozhin; Zhi-Jiang Zhang; Peng Zheng; Chenwen Zhong; Mohammad Zoladl; Alimuddin Zumla; Simon I Hay; Christiane Dolecek; Benn Sartorius; Christopher J L Murray; Mohsen Naghavi
Background: Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes. Methods: We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2·5th and 97·5th percentiles across 1000 posterior draws for each quantity of interest. Findings: From an estimated 13·7 million (95% UI 10·9–17·1) infection-related deaths in 2019, there were 7·7 million deaths (5·7–10·2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13·6% (10·2–18·1) of all global deaths and 56·2% (52·1–60·1) of all sepsis-related deaths in 2019. Five leading pathogens—Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa—were responsible for 54·9% (52·9–56·9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185–285) per 100 000 population, and lowest in the high-income super-region, with 52·2 deaths (37·4–71·5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths. Interpretation: The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development. Funding: Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care, using UK aid funding managed by the Fleming Fund. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Global, regional, and national burden of meningitis, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
(Elsevier Ltd, 2018) Joseph Raymond Zunt; Nicholas J Kassebaum; Natacha Blake; Linda Glennie; Claire Wright; Emma Nichols; Foad Abd-Allah; Jemal Abdela; Ahmed Abdelalim; Abdu A Adamu; Mina G Adib; Alireza Ahmadi; Muktar Beshir Ahmed; Amani Nidhal Aichour; Ibtihel Aichour; Miloud Taki Eddine Aichour; Nadia Akseer; Rajaa M Al-Raddadi; Fares Alahdab; Kefyalew Addis Alene; Syed Mohamed Aljunid; Mohammad A AlMazora; Khalid; Nelson Alvis-Guzman; Megbaru Debalkie Animut; Mina Anjomshoa; Mustafa Geleto Ansha; Rana Jawad Asghar; Euripide F G A Avokpaho; Ashish Awasthi; Hamid Badali; Aleksandra Barac; Till Winfried Bärnighausen; Quique Bassat; Neeraj Bedi; Abate Bekele Belachew; Krittika Bhattacharyya; Zulfiqar A Bhutta; Ali Bijani; Zahid A Butt; Félix Carvalho; Carlos A Castañeda-Orjuela; Abdulaal Chitheer; Jee-Young J Choi; Devasahayam J Christopher; Anh Kim Dang; Ahmad Daryani; Gebre Teklemariam Demoz; Shirin Djalalinia; Huyen Phuc Do; Manisha Dubey; Eleonora Dubljanin; Eyasu Ejeta Duken; Maysaa El Sayed Zaki; Iqbal Rf Elyazar; Hamed Fakhim; Eduarda Fernandes; Florian Fischer; Takeshi Fukumoto; Morsaleh Ganji; Abadi Kahsu Gebre; Afewerki Gebremeskel; Bradford D Gessner; Sameer Vali Gopalani; Yuming Guo; Rahul Gupta; Gessessew Bugssa Hailu; Arvin Haj-Mirzaian; Samer Hamidi; Simon I Hay; Andualem Henok; Seyed Sina Naghibi Irvani; Ravi Prakash Jha; Mikk Jürisson; Amaha Kahsay; Manoochehr Karami; André Karch; Amir Kasaeian; Getachew Mullu Kassa; Tesfaye Dessale Kassa; Adane Teshome Kefale; Yousef Saleh Khader; Ibrahim A Khalil; Ejaz Ahmad Khan; Young-Ho Khang; Jagdish Khubchandani; Ruth W Kimokoti; Adnan Kisa; Faris Hasan Lami; Miriam Levi; Shanshan Li; Clement T Loy; Marek Majdan; Azeem Majeed; Lorenzo Giovanni Mantovani; Francisco Rogerlândio Martins-Melo; Colm McAlinden; Varshil Mehta; Addisu Melese; Ziad A Memish; Desalegn Tadese Mengistu; Getnet Mengistu; Tomislav Mestrovic; Haftay Berhane Mezgebe; Bartosz Miazgowski; Branko Milosevic; Ali H Mokdad; Lorenzo Monasta; Ghobad Moradi; Paula Moraga; Seyyed Meysam Mousavi; Ulrich Otto Mueller; Srinivas Murthy; Ghulam Mustafa; Mohsen Naghavi; Aliya Naheed; Gurudatta Naik; Charles Richard James Newton; Yirga Legesse Nirayo; Molly R Nixon; Richard Ofori-Asenso; Felix Akpojene Ogbo; Andrew T Olagunju; Tinuke O Olagunju; Bolajoko Olubukunola Olusanya; Justin R Ortiz; Mayowa Ojo Owolabi; Shanti Patel; Gabriel D Pinilla-Monsalve; Maarten J Postma; Mostafa Qorbani; Alireza Rafiei; Vafa Rahimi-Movaghar; Robert C Reiner; Andre M N Renzaho; Mohammad Sadegh Rezai; Kedir Teji Roba; Luca Ronfani; Gholamreza Roshandel; Ali Rostami; Hosein Safari; Saeed Safari; Saeid Safiri; Rajesh Sagar; Abdallah M Samy; Milena M Santric Milicevic; Benn Sartorius; Shahabeddin Sarvi; Monika Sawhney; Sonia Saxena; Azadeh Shafieesabet; Masood Ali Shaikh; Mehdi Sharif; Mika Shigematsu; Si Si; Eirini Skiadaresi; Mari Smith; Ranjani Somayaji; Mu'Awiyyah Babale Sufiyan; Nega Yimer Tawye; Mohamad-Hani Temsah; Miguel Tortajada-Girbés; Bach Xuan Tran; Khanh Bao Tran; Kingsley Nnanna Ukwaja; Irfan Ullah; Isidora S Vujcic; Fasil Wagnew; Yasir Waheed; Kidu Gidey Weldegwergs; Andrea Sylvia Winkler; Alison B Wiyeh; Charles Shey Wiysonge; Grant M A Wyper; Ebrahim M Yimer; Naohiro Yonemoto; Zoubida Zaidi; Zerihun Menlkalew Zenebe; Valery L Feigin; Theo Vos; Christopher J L Murray
Background: Acute meningitis has a high case-fatality rate and survivors can have severe lifelong disability. We aimed to provide a comprehensive assessment of the levels and trends of global meningitis burden that could help to guide introduction, continuation, and ongoing development of vaccines and treatment programmes. Methods: The Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2016 study estimated meningitis burden due to one of four types of cause: pneumococcal, meningococcal, Haemophilus influenzae type b, and a residual category of other causes. Cause-specific mortality estimates were generated via cause of death ensemble modelling of vital registration and verbal autopsy data that were subject to standardised data processing algorithms. Deaths were multiplied by the GBD standard life expectancy at age of death to estimate years of life lost, the mortality component of disability-adjusted life-years (DALYs). A systematic analysis of relevant publications and hospital and claims data was used to estimate meningitis incidence via a Bayesian meta-regression tool. Meningitis deaths and cases were split between causes with meta-regressions of aetiological proportions of mortality and incidence, respectively. Probabilities of long-term impairment by cause of meningitis were applied to survivors and used to estimate years of life lived with disability (YLDs). We assessed the relationship between burden metrics and Socio-demographic Index (SDI), a composite measure of development based on fertility, income, and education. Findings: Global meningitis deaths decreased by 21·0% from 1990 to 2016, from 403 012 (95% uncertainty interval [UI] 319 426–458 514) to 318 400 (265 218–408 705). Incident cases globally increased from 2·50 million (95% UI 2·19–2·91) in 1990 to 2·82 million (2·46–3·31) in 2016. Meningitis mortality and incidence were closely related to SDI. The highest mortality rates and incidence rates were found in the peri-Sahelian countries that comprise the African meningitis belt, with six of the ten countries with the largest number of cases and deaths being located within this region. Haemophilus influenzae type b was the most common cause of incident meningitis in 1990, at 780 070 cases (95% UI 613 585–978 219) globally, but decreased the most (–49·1%) to become the least common cause in 2016, with 397 297 cases (291 076–533 662). Meningococcus was the leading cause of meningitis mortality in 1990 (192 833 deaths [95% UI 153 358–221 503] globally), whereas other meningitis was the leading cause for both deaths (136 423 [112 682–178 022]) and incident cases (1·25 million [1·06–1·49]) in 2016. Pneumococcus caused the largest number of YLDs (634 458 [444 787–839 749]) in 2016, owing to its more severe long-term effects on survivors. Globally in 2016, 1·48 million (1·04—1·96) YLDs were due to meningitis compared with 21·87 million (18·20—28·28) DALYs, indicating that the contribution of mortality to meningitis burden is far greater than the contribution of disabling outcomes. Interpretation: Meningitis burden remains high and progress lags substantially behind that of other vaccine-preventable diseases. Particular attention should be given to developing vaccines with broader coverage against the causes of meningitis, making these vaccines affordable in the most affected countries, improving vaccine uptake, improving access to low-cost diagnostics and therapeutics, and improving support for disabled survivors. Substantial uncertainty remains around pathogenic causes and risk factors for meningitis. Ongoing, active cause-specific surveillance of meningitis is crucial to continue and to improve monitoring of meningitis burdens and trends throughout the world. Funding: Bill & Melinda Gates Foundation. © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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
(Elsevier B.V., 2021) Joseph L. Ward; Peter S Azzopardi; Kate Louise Francis; John S Santelli; Vegard Skirbekk; Susan M Sawyer; Nicholas J Kassebaum; Ali H Mokdad; Simon I Hay; Foad Abd-Allah; Amir Abdoli; Mohammad Abdollahi; Aidin Abedi; Hassan Abolhassani; Lucas Guimarães Abreu; Michael R M Abrigo; Eman Abu-Gharbieh; Abdelrahman I Abushouk; Oladimeji M Adebayo; Victor Adekanmbi; Davoud Adham; Shailesh M Advani; Khashayar Afshari; Anurag Agrawal; Tauseef Ahmad; Keivan Ahmadi; Anwar E Ahmed; Budi Aji; Blessing Akombi-Inyang; Fares Alahdab; Ziyad Al-Aly; Khurshid Alam; Fahad Mashhour Alanezi; Turki M Alanzi; Jacqueline Elizabeth Alcalde-Rabanal; Biresaw Wassihun Alemu; Samar Al-Hajj; Robert Kaba Alhassan; Saqib Ali; Gianfranco Alicandro; Mehran Alijanzadeh; Syed Mohamed Aljunid; Amir Almasi-Hashiani; Nihad A Almasri; Hesham M Al-Mekhlafi; Jordi Alonso; Rajaa M Al-Raddadi; Khalid A Altirkawi; Nelson Alvis-Guzman; Azmeraw T Amare; Saeed Amini; Arya Aminorroaya; Arianna Maever L Amit; Dickson A Amugsi; Robert Ancuceanu; Deanna Anderlini; Catalina Liliana Andrei; Sofia Androudi; Fereshteh Ansari; Iman Ansari; Carl Abelardo T Antonio; Davood Anvari; Razique Anwer; Seth Christopher Yaw Appiah; Jalal Arabloo; Morteza Arab-Zozani; Johan Ärnlöv; Malke Asaad; Mehran Asadi-Aliabadi; Ali A Asadi-Pooya; Maha Moh'd Wahbi Atout; Marcel Ausloos; Elvis Korku Avenyo; Leticia Avila-Burgos; Beatriz Paulina Ayala Quintanilla; Getinet Ayano; Yared Asmare Aynalem; Samad Azari; Zelalem Nigussie Azene; Mohammad Hossein Bakhshaei; Shankar M Bakkannavar; MacIej Banach; Palash Chandra Banik; Miguel A Barboza; Suzanne Lyn Barker-Collo; Till Winfried Bärnighausen; Sanjay Basu; Bernhard T Baune; Mohsen Bayati; Neeraj Bedi; Ettore Beghi; Tariku Tesfaye Bekuma; Arielle Wilder Bell; Michelle L Bell; Corina Benjet; Isabela M Bensenor; Abadi Kidanemariam Berhe; Kidanemaryam Berhe; Adam E Berman; Akshaya Srikanth Bhagavathula; Nikha Bhardwaj; Pankaj Bhardwaj; Krittika Bhattacharyya; Suraj Bhattarai; Zulfiqar A Bhutta; Ali Bijani; Boris Bikbov; Antonio Biondi; Tesega Tesega Mengistu Birhanu; Raaj Kishore Biswas; Somayeh Bohlouli; Srinivasa Rao Bolla; Archith Boloor; Rohan Borschmann; Soufiane Boufous; Nicola Luigi Bragazzi; Dejana Braithwaite; Nicholas J K Breitborde; Hermann Brenner; Gabrielle B Britton; Richard A Burns; Sharath Burugina Nagaraja; Zahid A Butt; Florentino Luciano Caetano Dos Santos; Luis Alberto Cámera; Ismael R Campos-Nonato; Julio Cesar Campuzano Rincon; Rosario Cárdenas; Giulia Carreras; Juan J Carrero; Felix Carvalho; Joao Mauricio Castaldelli-Maia; Carlos A Castañeda-Orjuela; Giulio Castelpietra; Ferrán Catalá-López; Ester Cerin; Joht Singh Chandan; Hsing-Yi Chang; Jung-Chen Chang; Jaykaran Charan; Vijay Kumar Chattu; Sarika Chaturvedi; Jee-Young Jasmine Choi; Mohiuddin Ahsanul Kabir Chowdhury; Devasahayam J Christopher; Dinh-Toi Chu; Michael T Chung; Sheng-Chia Chung; Flavia M Cicuttini; Traian Vasile Constantin; Vera Marisa Costa; Saad M A Dahlawi; Haijiang Dai; Xiaochen Dai; Giovanni Damiani; Lalit Dandona; Rakhi Dandona; Parnaz Daneshpajouhnejad; Aso Mohammad Darwesh; Claudio Alberto Dávila-Cervantes; Kairat Davletov; Fernando Pio De La Hoz; Diego De Leo; Nikolaos Dervenis; Rupak Desai; Assefa Desalew; Keshab Deuba; Samath Dhamminda Dharmaratne; Govinda Prasad Dhungana; Mostafa Dianatinasab; Diana Dias Da Silva; Daniel Diaz; Alireza Didarloo; Shirin Djalalinia; Fariba Dorostkar; Chirag P Doshi; Leila Doshmangir; Kerrie E Doyle; Andre Rodrigues Duraes; Mohammad Ebrahimi Kalan; Sanam Ebtehaj; David Edvardsson; Maha El Tantawi; Islam Y Elgendy; Shaimaa I El-Jaafary; Aisha Elsharkawy; Babak Eshrati; Sharareh Eskandarieh; Saman Esmaeilnejad; Firooz Esmaeilzadeh; Sadaf Esteghamati; Andre Faro; Farshad Farzadfar; Nazir Fattahi; Valery L Feigin; Tomas Y Ferede; Seyed-Mohammad Fereshtehnejad; Eduarda Fernandes; Pietro Ferrara; Irina Filip; Florian Fischer; James L Fisher; Nataliya A Foigt; Morenike Oluwatoyin Folayan; Artem Alekseevich Fomenkov; Masoud Foroutan; Takeshi Fukumoto; Mohamed M Gad; Abhay Motiramji Gaidhane; Silvano Gallus; Teshome Gebre; Ketema Bizuwork Gebremedhin; Gebreamlak Gebremedhn Gebremeskel; Leake Gebremeskel; Assefa Ayalew Gebreslassie; Hailay Abrha Gesesew; Keyghobad Ghadiri; Mansour Ghafourifard; Farhad Ghamari; Ahmad Ghashghaee; Syed Amir Gilani; Elena V Gnedovskaya; Myron Anthony Godinho; Mahaveer Golechha; Srinivas Goli; Philimon N Gona; Sameer Vali Gopalani; Giuseppe Gorini; Michal Grivna; Mohammed Ibrahim Mohialdeen Gubari; Harish Chander Gugnani; Rafael Alves Guimarães; Yuming Guo; Rajeev Gupta; Juanita A Haagsma; Nima Hafezi-Nejad; Teklehaimanot Gereziher Haile; Arvin Haj-Mirzaian; Arya Haj-Mirzaian; Brian J Hall; Randah R Hamadeh; Kanaan Hamagharib Abdullah; Samer Hamidi; Demelash Woldeyohannes Handiso; Asif Hanif; Graeme J Hankey; Hamidreza Haririan; Josep Maria Haro; Ahmed I Hasaballah; Abdiwahab Hashi; Amr Hassan; Soheil Hassanipour; Hadi Hassankhani; Khezar Hayat; Reza Heidari-Soureshjani; Claudiu Herteliu; Fatemeh Heydarpour; Hung Chak Ho; Michael K Hole; Ramesh Holla; Praveen Hoogar; Mostafa Hosseini; Mehdi Hosseinzadeh; Mihaela Hostiuc; Sorin Hostiuc; Mowafa Househ; Mohamed Hsairi; Tanvir M Huda; Ayesha Humayun; Rabia Hussain; Bing-Fang Hwang; Ivo Iavicoli; Segun Emmanuel Ibitoye; Olayinka Stephen Ilesanmi; Irena M Ilic; Milena D Ilic; Leeberk Raja Inbaraj; Nirun Intarut; Usman Iqbal; Seyed Sina Naghibi Irvani; M Mofizul Islam; Sheikh Mohammed Shariful Islam; Hiroyasu Iso; Rebecca Q Ivers; Mohammad Ali Jahani; Mihajlo Jakovljevic; Amir Jalali; Manthan Dilipkumar Janodia; Tahereh Javaheri; Panniyammakal Jeemon; Ensiyeh Jenabi; Ravi Prakash Jha; Vivekanand Jha; John S Ji; Jost B Jonas; Kelly M Jones; Farahnaz Joukar; Jacek Jerzy Jozwiak; Petur B Juliusson; Mikk Jürisson; Ali Kabir; Zubair Kabir; Leila R Kalankesh; Rohollah Kalhor; Naser Kamyari; Tanuj Kanchan; Andr Karch; Salah Eddin Karimi; Supreet Kaur; Gbenga A Kayode; Peter Njenga Keiyoro; Nauman Khalid; Mohammad Khammarnia; Maseer Khan; Md Nuruzzaman Khan; Khaled Khatab; Mona M Khater; Mahalaqua Nazli Khatib; Maryam Khayamzadeh; Habibolah Khazaie; Abdullah T Khoja; Christian Kieling; Young-Eun Kim; Yun Jin Kim; Ruth W Kimokoti; Adnan Kisa; Sezer Kisa; Mika Kivimäki; Ali Koolivand; Soewarta Kosen; Ai Koyanagi; Kewal Krishan; Nuworza Kugbey; G Anil Kumar; Manasi Kumar; Nithin Kumar; Om P Kurmi; Dian Kusuma; Carlo La Vecchia; Ben Lacey; Dharmesh Kumar Lal; Ratilal Lalloo; Qing Lan; Iván Landires; Van Charles Lansingh; Anders O Larsson; Savita Lasrado; Zohra S Lassi; Paolo Lauriola; Paul H Lee; Shaun Wen Huey Lee; James Leigh; Matilde Leonardi; Janni Leung; Miriam Levi; Sonia Lewycka; Bingyu Li; Ming-Chieh Li; Shanshan Li; Lee-Ling Lim; Stephen S Lim; Xuefeng Liu; Stefan Lorkowski; Paulo A Lotufo; Raimundas Lunevicius; Ralph Maddison; Phetole Walter Mahasha; Mokhtar Mahdavi Mahdavi; Morteza Mahmoudi; Azeem Majeed; Afshin Maleki; Reza Malekzadeh; Deborah Carvalho Malta; Abdullah A Mamun; Borhan Mansouri; Mohammad Ali Mansournia; Gabriel Martinez; Jose Martinez-Raga; Francisco Rogerlândio Martins-Melo; Amanda J Mason-Jones; Seyedeh Zahra Masoumi; Manu Raj Mathur; Pallab K Maulik; John J McGrath; Man Mohan Mehndiratta; Fereshteh Mehri; Peter T N Memiah; Walter Mendoza; Ritesh G Menezes; Endalkachew Worku Mengesha; Atte Meretoja; Tuomo J Meretoja; Tomislav Mestrovic; Bartosz Miazgowski; Tomasz Miazgowski; Irmina Maria Michalek; Ted R Miller; G.K. Mini; Andreea Mirica; Erkin M Mirrakhimov; Hamed Mirzaei; Maryam Mirzaei; Babak Moazen; Dara K Mohammad; Shadieh Mohammadi; Abdollah Mohammadian-Hafshejani; Noushin Mohammadifard; Reza Mohammadpourhodki; Shafiu Mohammed; Lorenzo Monasta; Ghobad Moradi; Maziar Moradi-Lakeh; Rahmatollah Moradzadeh; Paula Moraga; Shane Douglas Morrison; Abbas Mosapour; Amin Mousavi Khaneghah; Ulrich Otto Mueller; Moses K Muriithi; Christopher J L Murray; Saravanan Muthupandian; Mehdi Naderi; Ahamarshan Jayaraman Nagarajan; Mohsen Naghavi; Mukhammad David Naimzada; Vinay Nangia; Vinod C Nayak; Javad Nazari; Rawlance Ndejjo; Ionut Negoi; Ruxandra Irina Negoi; Henok Biresaw Netsere; Georges Nguefack-Tsague; Diep Ngoc Nguyen; Huong Lan Thi Nguyen; Jing Nie; Dina Nur Anggraini Ningrum; Chukwudi A Nnaji; Shuhei Nomura; Jean Jacques Noubiap; Christoph Nowak; Virginia Nuñez-Samudio; Felix Akpojene Ogbo; Onome Bright Oghenetega; In-Hwan Oh; Morteza Oladnabi; Andrew T Olagunju; Bolajoko Olubukunola Olusanya; Jacob Olusegun Olusanya; Ahmed Omar Bali; Muktar Omer Omer; Obinna E Onwujekwe; Alberto Ortiz; Adrian Otoiu; Nikita Otstavnov; Stanislav S Otstavnov; Simon Øverland; Mayowa O Owolabi; Jagadish Rao Padubidri; Keyvan Pakshir; Raffaele Palladino; Adrian Pana; Songhomitra Panda-Jonas; Anamika Pandey; Carlo Irwin Able Panelo; Eun-Kee Park; Scott B Patten; Amy E Peden; Veincent Christian Filipino Pepito; Emmanuel K Peprah; Jeevan Pereira; Konrad Pesudovs; Hai Quang Pham; Michael R Phillips; Michael A Piradov; Meghdad Pirsaheb; Maarten J Postma; Faheem Hyder Pottoo; Hadi Pourjafar; Akram Pourshams; Sergio I Prada; Elisabetta Pupillo; Zahiruddin Quazi Syed; Mohammad Hasan Rabiee; Navid Rabiee; Amir Radfar; Ata Rafiee; Alberto Raggi; Fakher Rahim; Vafa Rahimi-Movaghar; Mohammad Hifz Ur Rahman; Muhammad Aziz Rahman; Kiana Ramezanzadeh; Chhabi Lal Ranabhat; Sowmya J Rao; Vahid Rashedi; Prateek Rastogi; Priya Rathi; David Laith Rawaf; Salman Rawaf; Lal Rawal; Reza Rawassizadeh; Andre M N Renzaho; Negar Rezaei; Nima Rezaei; Mohammad Sadegh Rezai; Seyed Mohammad Riahi; Jennifer Rickard; Leonardo Roever; Luca Ronfani; Gregory A Roth; Enrico Rubagotti; Susan Fred Rumisha; Godfrey M Rwegerera; Siamak Sabour; Perminder S Sachdev; Basema Saddik; Ehsan Sadeghi; Sahar Saeedi Moghaddam; Rajesh Sagar; Amirhossein Sahebkar; Mohammad Ali Sahraian; S Mohammad Sajadi; Marwa Rashad Salem; Hamideh Salimzadeh; Abdallah M Samy; Juan Sanabria; Milena M Santric-Milicevic; Sivan Yegnanarayana Iyer Saraswathy; Nizal Sarrafzadegan; Arash Sarveazad; Thirunavukkarasu Sathish; Davide Sattin; Deepak Saxena; Sonia Saxena; Silvia Schiavolin; David C Schwebel; Falk Schwendicke; Subramanian Senthilkumaran; Sadaf G Sepanlou; Feng Sha; Omid Shafaat; Saeed Shahabi; Amira A Shaheen; Masood Ali Shaikh; Saeed Shakiba; MohammadBagher Shamsi; Mohammed Shannawaz; Kiomars Sharafi; Aziz Sheikh; Sara Sheikhbahaei; B Suresh Kumar Shetty; Peilin Shi; Mika Shigematsu; Jae Il Shin; Rahman Shiri; Kerem Shuval; Soraya Siabani; Inga Dora Sigfusdottir; Rannveig Sigurvinsdottir; Diego Augusto Santos Silva; João Pedro Silva; Biagio Simonetti; Jasvinder A Singh; Virendra Singh; Abiy H Sinke; Valentin Yurievich Skryabin; Helen Slater; Emma U R Smith; Mohammad Reza Sobhiyeh; Eugene Sobngwi; Amin Soheili; Oluwaseyi Dolapo Somefun; Muluken Bekele Sorrie; Ireneous N Soyiri; Chandrashekhar T Sreeramareddy; Dan J Stein; Mark A Stokes; Agus Sudaryanto; Iyad Sultan; Rafael Tabarés-Seisdedos; Takahiro Tabuchi; Santosh Kumar Tadakamadla; Amir Taherkhani; Animut Tagele Tamiru; Md Ismail Tareque; Kavumpurathu Raman Thankappan; Rekha Thapar; Nihal Thomas; Mariya Vladimirovna Titova; Marcello Tonelli; Marcos Roberto Tovani-Palone; Bach Xuan Tran; Ravensara S Travillian; Alexander C Tsai; Aristidis Tsatsakis; Lorainne Tudor Car; Riaz Uddin; Brigid Unim; Bhaskaran Unnikrishnan; Era Upadhyay; Marco Vacante; Sahel Valadan Tahbaz; Pascual R Valdez; Santosh Varughese; Tommi Juhani Vasankari; Narayanaswamy Venketasubramanian; Paul J Villeneuve; Francesco S Violante; Vasily Vlassov; Theo Vos; Giang Thu Vu; Yasir Waheed; Richard G Wamai; Yafeng Wang; Yanzhong Wang; Yuan-Pang Wang; Ronny Westerman; Nuwan Darshana Wickramasinghe; Ai-Min Wu; Chenkai Wu; Seyed Hossein Yahyazadeh Jabbari; Kazumasa Yamagishi; Yuichiro Yano; Sanni Yaya; Vahid Yazdi-Feyzabadi; Yordanos Gizachew Yeshitila; Paul Yip; Naohiro Yonemoto; Seok-Jun Yoon; Mustafa Z Younis; Taraneh Yousefinezhadi; Chuanhua Yu; Yong Yu; Deniz Yuce; Syed Saoud Zaidi; Sojib Bin Zaman; Mohammad Zamani; Maryam Zamanian; Hadi Zarafshan; Ahmad Zarei; Mikhail Sergeevich Zastrozhin; Yunquan Zhang; Zhi-Jiang Zhang; Xiu-Ju George Zhao; Cong Zhu; George C Patton; Russell M Viner
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. © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Measuring routine childhood vaccination coverage in 204 countries and territories, 1980–2019: a systematic analysis for the Global Burden of Disease Study 2020, Release 1
(Elsevier B.V., 2021) Natalie C Galles; Patrick Y Liu; Rachel L Updike; Nancy Fullman; Jason Nguyen; Sam Rolfe; Alyssa N Sbarra; Megan F Schipp; Ashley Marks; Gdiom Gebreheat Abady; Kaja M Abbas; Sumra Wajid Abbasi; Hedayat Abbastabar; Foad Abd-Allah; Amir Abdoli; Hassan Abolhassani; Akine Eshete Abosetugn; Maryam Adabi; Abdu A Adamu; Olatunji O Adetokunboh; Qorinah Estiningtyas Sakilah Adnani; Shailesh M Advani; Saira Afzal; Seyed Mohammad Kazem Aghamir; Bright Opoku Ahinkorah; Sohail Ahmad; Tauseef Ahmad; Sepideh Ahmadi; Haroon Ahmed; Muktar Beshir Ahmed; Tarik Ahmed Rashid; Yusra Ahmed Salih; Yonas Akalu; Addis Aklilu; Chisom Joyqueenet Akunna; Hanadi Al Hamad; Fares Alahdab; Luciana Albano; Yosef Alemayehu; Kefyalew Addis Alene; Ayman Al-Eyadhy; Robert Kaba Alhassan; Liaqat Ali; Syed Mohamed Aljunid; Sami Almustanyir; Khalid A Altirkawi; Nelson Alvis-Guzman; Hubert Amu; Catalina Liliana Andrei; Tudorel Andrei; Adnan Ansar; Alireza Ansari-Moghaddam; Ippazio Cosimo Antonazzo; Benny Antony; Jalal Arabloo; Morteza Arab-Zozani; Kurnia Dwi Artanti; Judie Arulappan; Asma Tahir Awan; Mamaru Ayenew Awoke; Muluken Altaye Ayza; Ghasem Azarian; Ahmed Y Azzam; Darshan B B; Zaheer-Ud-Din Babar; Senthilkumar Balakrishnan; Maciej Banach; Simachew Animen Bante; Till Winfried Bärnighausen; Hiba Jawdat Barqawi; Amadou Barrow; Quique Bassat; Narantuya Bayarmagnai; Diana Fernanda Bejarano Ramirez; Tariku Tesfaye Bekuma; Habtamu Gebrehana Belay; Uzma Iqbal Belgaumi; Akshaya Srikanth Bhagavathula; Dinesh Bhandari; Nikha Bhardwaj; Pankaj Bhardwaj; Sonu Bhaskar; Krittika Bhattacharyya; Sadia Bibi; Ali Bijani; Antonio Biondi; Archith Boloor; Dejana Braithwaite; Danilo Buonsenso; Zahid A Butt; Paulo Camargos; Giulia Carreras; Felix Carvalho; Carlos A Castañeda-Orjuela; Raja Chandra Chakinala; Jaykaran Charan; Souranshu Chatterjee; Soosanna Kumary Chattu; Vijay Kumar Chattu; Fazle Rabbi Chowdhury; Devasahayam J Christopher; Dinh-Toi Chu; Sheng-Chia Chung; Paolo Angelo Cortesi; Vera Marisa Costa; Rosa A S Couto; Omid Dadras; Amare Belachew Dagnew; Baye Dagnew; Xiaochen Dai; Lalit Dandona; Rakhi Dandona; Jan-Walter De Neve; Meseret Derbew Molla; Behailu Tariku Derseh; Rupak Desai; Abebaw Alemayehu Desta; Deepak Dhamnetiya; Mandira Lamichhane Dhimal; Meghnath Dhimal; Mostafa Dianatinasab; Daniel Diaz; Shirin Djalalinia; Fariba Dorostkar; Bassey Edem; Hisham Atan Edinur; Sahar Eftekharzadeh; Iman El Sayed; Maysaa El Sayed Zaki; Muhammed Elhadi; Shaimaa I El-Jaafary; Aisha Elsharkawy; Shymaa Enany; Ryenchindorj Erkhembayar; Christopher Imokhuede Esezobor; Sharareh Eskandarieh; Ifeanyi Jude Ezeonwumelu; Sayeh Ezzikouri; Jawad Fares; Pawan Sirwan Faris; Berhanu Elfu Feleke; Tomas Y Ferede; Eduarda Fernandes; João C Fernandes; Pietro Ferrara; Irina Filip; Florian Fischer; Mark Rohit Francis; Takeshi Fukumoto; Mohamed M Gad; Shilpa Gaidhane; Silvano Gallus; Tushar Garg; Biniyam Sahiledengle Geberemariyam; Teshome Gebre; Birhan Gebresillassie Gebregiorgis; Ketema Bizuwork Gebremedhin; Berhe Gebremichael; Bradford D Gessner; Keyghobad Ghadiri; Mansour Ghafourifard; Ahmad Ghashghaee; Syed Amir Gilani; Ionela-Roxana Glăvan; Ekaterina Vladimirovna Glushkova; Mahaveer Golechha; Kebebe Bekele Gonfa; Sameer Vali Gopalani; Houman Goudarzi; Mohammed Ibrahim Mohialdeen Gubari; Yuming Guo; Veer Bala Gupta; Vivek Kumar Gupta; Reyna Alma Gutiérrez; Emily Haeuser; Rabih Halwani; Samer Hamidi; Asif Hanif; Shafiul Haque; Harapan Harapan; Arief Hargono; Abdiwahab Hashi; Shoaib Hassan; Mohamed H Hassanein; Soheil Hassanipour; Hadi Hassankhani; Simon I Hay; Khezar Hayat; Mohamed I Hegazy; Golnaz Heidari; Kamal Hezam; Ramesh Holla; Mohammad Enamul Hoque; Mostafa Hosseini; Mehdi Hosseinzadeh; Mihaela Hostiuc; Mowafa Househ; Vivian Chia-rong Hsieh; Junjie Huang; Ayesha Humayun; Rabia Hussain; Nawfal R Hussein; Segun Emmanuel Ibitoye; Olayinka Stephen Ilesanmi; Irena M Ilic; Milena D Ilic; Sumant Inamdar; Usman Iqbal; Lalu Muhammad Irham; Seyed Sina Naghibi Irvani; Sheikh Mohammed Shariful Islam; Nahlah Elkudssiah Ismail; Ramaiah Itumalla; Ravi Prakash Jha; Farahnaz Joukar; Ali Kabir; Zubair Kabir; Rohollah Kalhor; Zul Kamal; Stanley M Kamande; Himal Kandel; André Karch; Getinet Kassahun; Nicholas J Kassebaum; Patrick DMC Katoto; Bayew Kelkay; Andre Pascal Kengne; Yousef Saleh Khader; Himanshu Khajuria; Ibrahim A Khalil; Ejaz Ahmad Khan; Gulfaraz Khan; Junaid Khan; Maseer Adnan Khan; Moien AB Khan; Young-Ho Khang; Abdullah T Khoja; Jagdish Khubchandani; Gyu Ri Kim; Min Seo Kim; Yun Jin Kim; Ruth W Kimokoti; Adnan Kisa; Sezer Kisa; Vladimir Andreevich Korshunov; Soewarta Kosen; Barthelemy Kuate Defo; Vaman Kulkarni; Avinash Kumar; G Anil Kumar; Nithin Kumar; Alexander Kwarteng; Carlo La Vecchia; Faris Hasan Lami; Iván Landires; Savita Lasrado; Zohra S Lassi; Hankil Lee; Yeong Yeh Lee; Miriam Levi; Sonia Lewycka; Shanshan Li; Xuefeng Liu; Stany W Lobo; Platon D Lopukhov; Rafael Lozano; Ricardo Lutzky Saute; Muhammed Magdy Abd El Razek; Alaa Makki; Ahmad Azam Malik; Fariborz Mansour-Ghanaei; Mohammad Ali Mansournia; Lorenzo Giovanni Mantovani; Francisco Rogerlândio Martins-Melo; Philippa C Matthews; John Robert Carabeo Medina; Walter Mendoza; Ritesh G Menezes; Endalkachew Worku Mengesha; Tuomo J Meretoja; Amanual Getnet Mersha; Mohamed Kamal Mesregah; Tomislav Mestrovic; Bartosz Miazgowski; George J Milne; Andreea Mirica; Erkin M Mirrakhimov; Hamid Reza Mirzaei; Sanjeev Misra; Prasanna Mithra; Masoud Moghadaszadeh; Teroj Abdulrahman Mohamed; Karzan Abdulmuhsin Mohammad; Yousef Mohammad; Mokhtar Mohammadi; Abdollah Mohammadian-Hafshejani; Arif Mohammed; Shafiu Mohammed; Archisman Mohapatra; Ali H Mokdad; Mariam Molokhia; Lorenzo Monasta; Mohammad Ali Moni; Ahmed Al Montasir; Catrin E Moore; Ghobad Moradi; Rahmatollah Moradzadeh; Paula Moraga; Ulrich Otto Mueller; Sandra B Munro; Mohsen Naghavi; Mukhammad David Naimzada; Muhammad Naveed; Biswa Prakash Nayak; Ionut Negoi; Sandhya Neupane Kandel; Trang Huyen Nguyen; Rajan Nikbakhsh; Dina Nur Anggraini Ningrum; Molly R Nixon; Chukwudi A Nnaji; Jean Jacques Noubiap; Virginia Nuñez-Samudio; Vincent Ebuka Nwatah; Bogdan Oancea; Chimedsuren Ochir; Felix Akpojene Ogbo; Andrew T Olagunju; Babayemi Oluwaseun Olakunde; Obinna E Onwujekwe; Nikita Otstavnov; Stanislav S Otstavnov; Mayowa O Owolabi; Jagadish Rao Padubidri; Keyvan Pakshir; Eun-Cheol Park; Fatemeh Pashazadeh Kan; Mona Pathak; Rajan Paudel; Shrikant Pawar; Jeevan Pereira; Mario F P Peres; Arokiasamy Perianayagam; Marina Pinheiro; Majid Pirestani; Vivek Podder; Roman V Polibin; Richard Charles G Pollok; Maarten J Postma; Faheem Hyder Pottoo; Mohammad Rabiee; Navid Rabiee; Amir Radfar; Alireza Rafiei; Vafa Rahimi-Movaghar; Mosiur Rahman; Amir Masoud Rahmani; Setyaningrum Rahmawaty; Aashish Rajesh; Rebecca E Ramshaw; Priyanga Ranasinghe; Chythra R Rao; Sowmya J Rao; Priya Rathi; David Laith Rawaf; Salman Rawaf; Andre M N Renzaho; Negar Rezaei; Mohammad Sadegh Rezai; Maria Rios-Blancas; Emma L B Rogowski; Luca Ronfani; Godfrey M Rwegerera; Anas M Saad; Siamak Sabour; Basema Saddik; Mohammad Reza Saeb; Umar Saeed; Amirhossein Sahebkar; Mohammad Ali Sahraian; Nasir Salam; Hamideh Salimzadeh; Mehrnoosh Samaei; A.M. Samy; Juan Sanabria; Francesco Sanmarchi; Milena M Santric-Milicevic; Benn Sartorius; Arash Sarveazad; Brijesh Sathian; Monika Sawhney; Deepak Saxena; Sonia Saxena; Abdul-Aziz Seidu; Allen Seylani; Masood Ali Shaikh; Morteza Shamsizadeh; Pavanchand H Shetty; Mika Shigematsu; Jae Il Shin; Negussie Boti Sidemo; Ambrish Singh; Jasvinder A Singh; Smriti Sinha; Valentin Yurievich Skryabin; Anna Aleksandrovna Skryabina; Amin Soheili; Eyayou Girma Tadesse; Animut Tagele Tamiru; Ker-Kan Tan; Yohannes Tekalegn; Mohamad-Hani Temsah; Bhaskar Thakur; Rekha Thapar; Aravind Thavamani; Ruoyan Tobe-Gai; Hamid Reza Tohidinik; Marcos Roberto Tovani-Palone; Eugenio Traini; Bach Xuan Tran; Manjari Tripathi; Berhan Tsegaye; Gebiyaw Wudie Tsegaye; Anayat Ullah; Saif Ullah; Sana Ullah; Brigid Unim; Marco Vacante; Diana Zuleika Velazquez; Bay Vo; Sebastian Vollmer; Giang Thu Vu; Linh Gia Vu; Yasir Waheed; Andrea Sylvia Winkler; Charles Shey Wiysonge; Vahit Yiğit; Birhanu Wubale Yirdaw; Dong Keon Yon; Naohiro Yonemoto; Chuanhua Yu; Deniz Yuce; Ismaeel Yunusa; Mohammad Zamani; Maryam Zamanian; Dejene Tesfaye Zewdie; Zhi-Jiang Zhang; Chenwen Zhong; Alimuddin Zumla; Christopher J L Murray; Stephen S Lim; Jonathan F Mosser; J. Nguyen; A. Marks; C.J.L. Murray; S.S. Lim; R. Dandona; C.J.L. Murray; S.S. Lim; L. Ali; A. Ullah; B.E. Feleke; A. Elsharkawy; H. Abolhassani; S. Ahmad; T. Ahmad; S. Sabour; H. Ahmed; M.B. Ahmed; T. Ahmed Rashid; D. Saxena; B. Dagnew; M. Derbew Molla; A. Aklilu; Y. Alemayehu; L. Albano; A. Al-Eyadhy; M. Temsah; Y. Mohammad; R.K. Alhassan; M. Hostiuc; I. Negoi; I. Glăvan; A. Ansar; I. Antonazzo; P. Ferrara; A. Singh Mtech; J. Arabloo; A. Ghashghaee; A. Ghashghaee; A. Sarveazad; K.D. Artanti; J. Arulappan; M.A. Awoke; P. Rathi; Z. Babar; B. Gebremichael; M. Zamani; A. Barrow; A. Barrow; V. Kulkarni; D. Saxena; J. Shin; S. Misra; K. Bhattacharyya; S. Bibi; S. Ullah; A. Boloor; S. Sinha; D. Braithwaite; D. Braithwaite; D. Buonsenso; D. Buonsenso; G.W. Tsegaye; J. De Neve; P. Camargos; M. Pinheiro; R. Chakinala; S. Chatterjee; V. Chattu; V. Chattu; I. Bill; D. Chu; S. Chung; S. Chung; L. Dandona; R. Dandona; A. Ansar; G. Kumar; R. Desai; M. Dhimal; S. Eftekharzadeh; M. Elhadi; S. Enany; A.T. Olagunju; P.S. Faris; B. Tsegaye; I. Filip; F. Fischer; M.R. Francis; M.R. Francis; T. Fukumoto; X. Liu; A.M. Saad; S. Gaidhane; T. Garg; Y. Tekalegn; S. Mohammed; T. Gebre; K. Ghadiri; K. Ghadiri; M. Ghafourifard; M. Moghadaszadeh; S. Gilani; S. Gilani; P.D. Lopukhov; M. Golechha; S.V. Gopalani; H. Goudarzi; M.B. Ahmed; H. Goudarzi; Y. Guo; S. Li; Y. Guo; V. Gupta; V.K. Gupta; R.A. Gutiérrez; A. Hargono Dr; S. Hassan; S. Hassan; G. Heidari; S. Islam; V. Hsieh; J. Huang; C. Zhong; A. Humayun; R. Hussain; A. Makki; J. Noubiap; U. Iqbal; S.N. Irvani; S. Islam; R. Kalhor; R. Kalhor; Z. Kamal; Z. Kamal; A. Karch; J. Khan; G. Kim; M. Kim; M. Kim; Y. Kim; S. Kosen; A. Kumar; A. Kwarteng; C. La Vecchia; I. Landires; V. Nuñez-Samudio; I. Landires; S. Lasrado; M. Levi; M. Levi; C.E. Moore; X. Liu; J. Sanabria; A. Thavamani; P.C. Matthews; J.C. Medina; J.C. Medina; W. Mendoza; R.G. Menezes; M.K. Mesregah; T. Mestrovic; M. Mohammadi; A. Mohammed; S. Mohammed; A. Mohapatra; M. Molokhia; E. Traini; H. Mirzaei; M. Zamanian; S.B. Munro; N. Otstavnov; M. Naveed; I. Negoi; T.H. Nguyen; T.H. Nguyen; B.O. Olakunde; M. Pathak; S. Pawar; M. Pirestani; M. Rabiee; M. Rahman; S. Rahmawaty; A. Rajesh; S. Rawaf; S. Rawaf; M. Saeb; U. Saeed; U. Saeed; M. Samaei; J. Sanabria; F. Sanmarchi; M. Sawhney; A. Seidu; A. Seidu; M.A. Shaikh; M. Shigematsu; A. Soheili; K. Tan; B. Thakur; A. Thavamani; E. Traini; M. Tripathi; S. Ullah; S. Ullah; B. Vo; G.T. Vu; A.S. Winkler; A.S. Winkler; C. Yu; D. Yuce
Background: Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods: For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dose-specific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in country-reported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. Findings: By 2019, global coverage of third-dose DTP (DTP3; 81·6% [95% uncertainty interval 80·4–82·7]) more than doubled from levels estimated in 1980 (39·9% [37·5–42·1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38·5% [35·4–41·3] in 1980 to 83·6% [82·3–84·8] in 2019). Third-dose polio vaccine (Pol3) coverage also increased, from 42·6% (41·4–44·1) in 1980 to 79·8% (78·4–81·1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56·8 million (52·6–60·9) to 14·5 million (13·4–15·9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. Interpretation: After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines. Funding: Bill & Melinda Gates Foundation. © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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 Publishing Group, 2020) Rafael Lozano; Nancy Fullman; John Everett Mumford; Megan Knight; Celine M Barthelemy; Cristiana Abbafati; Hedayat Abbastabar; Foad Abd-Allah; Mohammad Abdollahi; Aidin Abedi; Hassan Abolhassani; Akine Eshete Abosetugn; Lucas Guimarães Abreu; Michael R M Abrigo; Abdulaziz Khalid Abu Haimed; Abdelrahman I Abushouk; Maryam Adabi; Oladimeji M Adebayo; Victor Adekanmbi; Jaimie Adelson; Olatunji O Adetokunboh; Davoud Adham; Shailesh M Advani; Ashkan Afshin; Gina Agarwal; Pradyumna Agasthi; Seyed Mohammad Kazem Aghamir; Anurag Agrawal; Tauseef Ahmad; Rufus Olusola Akinyemi; Fares Alahdab; Ziyad Al-Aly; Khurshid Alam; Samuel B Albertson; Yihun Mulugeta Alemu; Robert Kaba Alhassan; Muhammad Ali; Saqib Ali; Vahid Alipour; Syed Mohamed Aljunid; François Alla; Majid Abdulrahman Hamad Almadi; Ali Almasi; Amir Almasi-Hashiani; Nihad A Almasri; Hesham M Al-Mekhlafi; Abdulaziz M Almulhim; Jordi Alonso; Rajaa M Al-Raddadi; Khalid A Altirkawi; Nelson Alvis-Guzman; Nelson J Alvis-Zakzuk; Saeed Amini; Mostafa Amini-Rarani; Fatemeh Amiri; Arianna Maever L Amit; Dickson A Amugsi; Robert Ancuceanu; Deanna Anderlini; Catalina Liliana Andrei; Sofia Androudi; Fereshteh Ansari; Alireza Ansari-Moghaddam; Carl Abelardo T Antonio; Catherine M Antony; Ernoiz Antriyandarti; Davood Anvari; Razique Anwer; Jalal Arabloo; Morteza Arab-Zozani; Aleksandr Y Aravkin; Olatunde Aremu; Johan Ärnlöv; Malke Asaad; Mehran Asadi-Aliabadi; Ali A Asadi-Pooya; Seyyed Shamsadin Athari; Maha Moh'd Wahbi Atout; Marcel Ausloos; Leticia Avila-Burgos; Beatriz Paulina Ayala Quintanilla; Getinet Ayano; Martin Amogre Ayanore; Yared Asmare Aynalem; Getie Lake Aynalem; Muluken Altaye Ayza; Samad Azari; Peter S Azzopardi; Darshan B B; Ebrahim Babaee; Ashish D Badiye; Mohammad Amin Bahrami; Atif Amin Baig; Mohammad Hossein Bakhshaei; Ahad Bakhtiari; Shankar M Bakkannavar; Arun Balachandran; Maciej Banach; Srikanta K Banerjee; Palash Chandra Banik; Agegnehu Bante Bante; Simachew Animen Bante; Suzanne Lyn Barker-Collo; Till Winfried Bärnighausen; Lope H Barrero; Quique Bassat; Sanjay Basu; Bernhard T Baune; Mohsen Bayati; Bayisa Abdissa Baye; Neeraj Bedi; Ettore Beghi; Masoud Behzadifar; Tariku Tesfaye Tesfaye Bekuma; Michelle L Bell; Isabela M Bensenor; Adam E Berman; Eduardo Bernabe; Robert S Bernstein; Akshaya Srikanth Bhagavathula; Dinesh Bhandari; Pankaj Bhardwaj; Anusha Ganapati Bhat; Krittika Bhattacharyya; Suraj Bhattarai; Zulfiqar A Bhutta; Ali Bijani; Boris Bikbov; Ver Bilano; Antonio Biondi; Binyam Minuye Birihane; Moses John Bockarie; Somayeh Bohlouli; Hunduma Amensisa Bojia; Srinivasa Rao Rao Bolla; Archith Boloor; Oliver J Brady; Dejana Braithwaite; Andrew M Briggs; Nikolay Ivanovich Briko; Sharath Burugina Nagaraja; Reinhard Busse; Zahid A Butt; Florentino Luciano Caetano dos Santos; Lucero Cahuana-Hurtado; Luis Alberto Cámera; Rosario Cárdenas; Giulia Carreras; Juan J Carrero; Felix Carvalho; Joao Mauricio Castaldelli-Maia; Carlos A Castañeda-Orjuela; Giulio Castelpietra; Franz Castro; Ferrán Catalá-López; Christopher R Cederroth; Ester Cerin; Joht Singh Chandan; Angela Y Chang; Jaykaran Charan; Vijay Kumar Chattu; Sarika Chaturvedi; Ken Lee Chin; Daniel Youngwhan Cho; Jee-Young Jasmine Choi; Hanne Christensen; Dinh-Toi Chu; Michael T Chung; Liliana G Ciobanu; Massimo Cirillo; Kelly Compton; Paolo Angelo Cortesi; Vera Marisa Costa; Ewerton Cousin; Saad M A Dahlawi; Giovanni Damiani; Lalit Dandona; Rakhi Dandona; Jiregna Darega Gela; Aso Mohammad Darwesh; Ahmad Daryani; Aditya Prasad Dash; Gail Davey; Claudio Alberto Dávila-Cervantes; Kairat Davletov; Jan-Walter De Neve; Edgar Denova-Gutiérrez; Kebede Deribe; Nikolaos Dervenis; Rupak Desai; Samath Dhamminda Dharmaratne; Govinda Prasad Dhungana; Mostafa Dianatinasab; Diana Dias da Silva; Daniel Diaz; Ilse N Dippenaar; Hoa Thi Do; Fariba Dorostkar; Leila Doshmangir; Bruce B Duncan; Andre Rodrigues Duraes; Arielle Wilder Eagan; David Edvardsson; Iman El Sayed; Maha El Tantawi; Islam Y Elgendy; Iqbal RF Elyazar; Khalil Eskandari; Sharareh Eskandarieh; Saman Esmaeilnejad; Alireza Esteghamati; Oluchi Ezekannagha; Tamer Farag; Mohammad Farahmand; Emerito Jose A Faraon; Carla Sofia e Sá Farinha; Andrea Farioli; Pawan Sirwan Faris; Andre Faro; Mehdi Fazlzadeh; Valery L Feigin; Eduarda Fernandes; Pietro Ferrara; Garumma Tolu Feyissa; Irina Filip; Florian Fischer; James L Fisher; Luisa Sorio Flor; Nataliya A Foigt; Morenike Oluwatoyin Folayan; Artem Alekseevich Fomenkov; Masoud Foroutan; Joel Msafiri Francis; Weijia Fu; Takeshi Fukumoto; João M Furtado; Mohamed M Gad; Abhay Motiramji Gaidhane; Emmanuela Gakidou; Natalie C Galles; Silvano Gallus; William M Gardner; Biniyam Sahiledengle Geberemariyam; Abiyu Mekonnen Gebrehiwot; Leake G Gebremeskel; Gebreamlak Gebremedhn Gebremeskel; Hailay Abrha Gesesew; Keyghobad Ghadiri; Mansour Ghafourifard; Ahmad Ghashghaee; Nermin Ghith; Asadollah Gholamian; Syed Amir Gilani; Paramjit Singh Gill; Tiffany K Gill; Themba G Ginindza; Mojgan Gitimoghaddam; Giorgia Giussani; Mustefa Glagn; Elena V Gnedovskaya; Myron Anthony Godinho; Salime Goharinezhad; Sameer Vali Gopalani; Amir Hossein Goudarzian; Bárbara Niegia Garcia Goulart; Mohammed Ibrahim Mohialdeen Gubari; Rafael Alves Guimarães; Rashid Abdi Guled; Teklemariam Gultie; Yuming Guo; Rahul Gupta; Nima Hafezi-Nejad; Abdul Hafiz; Teklehaimanot Gereziher Haile; Randah R Hamadeh; Sajid Hameed; Samer Hamidi; Chieh Han; Hannah Han; Demelash Woldeyohannes Handiso; Asif Hanif; Graeme J Hankey; Josep Maria Haro; Ahmed I Hasaballah; Md Mehedi Hasan; Abdiwahab Hashi; Shoaib Hassan; Amr Hassan; Soheil Hassanipour; Hadi Hassankhani; Rasmus J Havmoeller; Simon I Hay; Khezar Hayat; Golnaz Heidari; Reza Heidari-Soureshjani; Delia Hendrie; Claudiu Herteliu; Thomas R Hird; Hung Chak Ho; Michael K Hole; Ramesh Holla; Praveen Hoogar; Kathleen Pillsbury Hopf; Nobuyuki Horita; Naznin Hossain; Mostafa Hosseini; Mehdi Hosseinzadeh; Mihaela Hostiuc; Sorin Hostiuc; Mowafa Househ; Vivian Chia-rong Hsieh; Guoqing Hu; Tanvir M Huda; Ayesha Humayun; Bing-Fang Hwang; Ivo Iavicoli; Segun Emmanuel Ibitoye; Nayu Ikeda; Olayinka Stephen Ilesanmi; Milena D Ilic; Leeberk Raja Inbaraj; Usman Iqbal; Seyed Sina Naghibi Irvani; Caleb Mackay Salpeter Irvine; M Mofizul Islam; Sheikh Mohammed Shariful Islam; Farhad Islami; Hiroyasu Iso; Chinwe Juliana Iwu; Jalil Jaafari; Farhad Jadidi-Niaragh; Morteza Jafarinia; Deepa Jahagirdar; Mohammad Ali Jahani; Nader Jahanmehr; Mihajlo Jakovljevic; Hosna Janjani; Tahereh Javaheri; Achala Upendra Jayatilleke; Ensiyeh Jenabi; Ravi Prakash Jha; Vivekanand Jha; John S Ji; Peng Jia; Yetunde O John-Akinola; Jost B Jonas; Farahnaz Joukar; Jacek Jerzy Jozwiak; Mikk Jürisson; Zubair Kabir; Leila R Kalankesh; Rohollah Kalhor; Aruna M Kamath; Tanuj Kanchan; Neeti Kapoor; Behzad Karami Matin; Marina Karanikolos; Seyed M Karimi; Nicholas J Kassebaum; Srinivasa Vittal Katikireddi; Gbenga A Kayode; Peter Njenga Keiyoro; Yousef Saleh Khader; Mohammad Khammarnia; Maseer Khan; Ejaz Ahmad Khan; Young-Ho Khang; Khaled Khatab; Amir M Khater; Mona M Khater; Mahalaqua Nazli Khatib; Maryam Khayamzadeh; Jagdish Khubchandani; Neda Kianipour; Yun Jin Kim; Ruth W Kimokoti; Yohannes Kinfu; Adnan Kisa; Katarzyna Kissimova-Skarbek; Mika Kivimäki; Cameron J Kneib; Jonathan M Kocarnik; Sonali Kochhar; Stefan Kohler; Jacek A Kopec; Anna V Korotkova; Vladimir Andreevich Korshunov; Soewarta Kosen; Anirudh Kotlo; Parvaiz A Koul; Ai Koyanagi; Kewal Krishan; Kris J Krohn; Nuworza Kugbey; Vaman Kulkarni; G Anil Kumar; Nithin Kumar; Manasi Kumar; Om P Kurmi; Dian Kusuma; Hmwe Hmwe Kyu; Carlo La Vecchia; Ben Lacey; Dharmesh Kumar Lal; Ratilal Lalloo; Iván Landires; Van Charles Lansingh; Anders O Larsson; Savita Lasrado; Kathryn Mei-Ming Lau; Paolo Lauriola; Jeffrey V Lazarus; Jorge R Ledesma; Paul H Lee; Shaun Wen Huey Lee; Andrew T Leever; Kate E LeGrand; James Leigh; Matilde Leonardi; Shanshan Li; Stephen S Lim; Lee-Ling Lim; Xuefeng Liu; Giancarlo Logroscino; Alan D Lopez; Platon D Lopukhov; Paulo A Lotufo; Alton Lu; Jianing Ma; Mohammed Madadin; Phetole Walter Mahasha; Morteza Mahmoudi; Azeem Majeed; Jeadran N Malagón-Rojas; Shokofeh Maleki; Deborah Carvalho Malta; Borhan Mansouri; Mohammad Ali Mansournia; Santi Martini; Francisco Rogerlândio Martins-Melo; Ira Martopullo; Benjamin Ballard Massenburg; Claudia I Mastrogiacomo; Manu Raj Mathur; Colm McAlinden; Martin McKee; Carlo Eduardo Medina-Solís; Birhanu Geta Meharie; Man Mohan Mehndiratta; Entezar Mehrabi Nasab; Fereshteh Mehri; Ravi Mehrotra; Teferi Mekonnen; Addisu Melese; Peter T N Memiah; Walter Mendoza; Ritesh G Menezes; George A Mensah; Tuomo J Meretoja; Atte Meretoja; Tomislav Mestrovic; Bartosz Miazgowski; Irmina Maria Michalek; Erkin M Mirrakhimov; Maryam Mirzaei; Mehdi Mirzaei-Alavijeh; Philip B Mitchell; Babak Moazen; Masoud Moghadaszadeh; Efat Mohamadi; Yousef Mohammad; Dara K Mohammad; Naser Mohammad Gholi Mezerji; Abdollah Mohammadian-Hafshejani; Shafiu Mohammed; Jemal Abdu Mohammed; Ali H Mokdad; Lorenzo Monasta; Stefania Mondello; Masoud Moradi; Maziar Moradi-Lakeh; Rahmatollah Moradzadeh; Paula Moraga; Joana Morgado-da-Costa; Shane Douglas Morrison; Abbas Mosapour; Jonathan F Mosser; Amin Mousavi Khaneghah; Moses K Muriithi; Ghulam Mustafa; Ashraf F Nabhan; Mehdi Naderi; Ahamarshan Jayaraman Nagarajan; Mohsen Naghavi; Behshad Naghshtabrizi; Mukhammad David Naimzada; Vinay Nangia; Jobert Richie Nansseu; Vinod C Nayak; Javad Nazari; Rawlance Ndejjo; Ionut Negoi; Ruxandra Irina Negoi; Subas Neupane; Kiirithio N Ngari; Georges Nguefack-Tsague; Josephine W Ngunjiri; Cuong Tat Nguyen; Diep Ngoc Nguyen; Huong Lan Thi Nguyen; Chukwudi A Nnaji; Shuhei Nomura; Ole F Norheim; Jean Jacques Noubiap; Christoph Nowak; Virginia Nunez-Samudio; Adrian Otoiu; Felix Akpojene Ogbo; Onome Bright Oghenetega; In-Hwan Oh; Emmanuel Wandera Okunga; Morteza Oladnabi; Andrew T Olagunju; Jacob Olusegun Olusanya; Bolajoko Olubukunola Olusanya; Mojisola Morenike Oluwasanu; Ahmed Omar Bali; Muktar Omer Omer; Kanyin L Ong; Obinna E Onwujekwe; Doris V V Ortega-Altamirano; Alberto Ortiz; Sergej M Ostojic; Nikita Otstavnov; Stanislav S Otstavnov; Simon Øverland; Mayowa O Owolabi; Jagadish Rao. Padubidri; Smita Pakhale; Raffaele Palladino; Adrian Pana; Songhomitra Panda-Jonas; Helena Ullyartha Pangaribuan; Mona Pathak; George C Patton; Sagun Paudel; Hamidreza Pazoki Toroudi; Spencer A Pease; Amy E Peden; Alyssa Pennini; Emmanuel K Peprah; Jeevan Pereira; David M Pigott; Thomas Pilgrim; Tessa M Pilz; Marina Pinheiro; Michael A Piradov; Meghdad Pirsaheb; Khem Narayan Pokhrel; Maarten J Postma; Hadi Pourjafar; Farshad Pourmalek; Reza Pourmirza Kalhori; Akram Pourshams; Sergio I Prada; Dimas Ria Angga Pribadi; Elisabetta Pupillo; Zahiruddin Quazi Syed; Amir Radfar; Ata Rafiee; Alireza Rafiei; Alberto Raggi; Fakher Rahim; Muhammad Aziz Rahman; Ali Rajabpour-Sanati; Saleem Muhammad Rana; Chhabi Lal Ranabhat; Sowmya J Rao; Davide Rasella; Vahid Rashedi; Goura Kishor Rath; Priya Rathi; Salman Rawaf; David Laith Rawaf; Lal Rawal; Reza Rawassizadeh; Christian Razo; Vishnu Renjith; Andre M N Renzaho; Bhageerathy Reshmi; Nima Rezaei; Seyed Mohammad Riahi; Daniel Cury Ribeiro; Jennifer Rickard; Nicholas L S Roberts; Leonardo Roever; Michele Romoli; Luca Ronfani; Gholamreza Roshandel; Enrico Rubagotti; Godfrey M Rwegerera; Siamak Sabour; Perminder S Sachdev; Basema Saddik; Masoumeh Sadeghi; Ehsan Sadeghi; Yahya Safari; Rajesh Sagar; Amirhossein Sahebkar; Mohammad Ali Sahraian; S. Mohammad Sajadi; Mohammad Reza Salahshoor; Marwa R Rashad Salem; Hosni Salem; Joshua Salomon; Hossein Samadi Kafil; Abdallah M Samy; Juan Sanabria; Milena M Santric-Milicevic; Sivan Yegnanarayana Iyer Saraswathy; Rodrigo Sarmiento-Suárez; Benn Sartorius; Arash Sarveazad; Brijesh Sathian; Thirunavukkarasu Sathish; Davide Sattin; Miloje Savic; Susan M Sawyer; Deepak Saxena; Alyssa N Sbarra; Lauren E Schaeffer; Silvia Schiavolin; Maria Inês Schmidt; Aletta Elisabeth Schutte; David C Schwebel; Falk Schwendicke; Soraya Seedat; Feng Sha; Saeed Shahabi; Amira A Shaheen; Masood Ali Shaikh; Morteza Shamsizadeh; Mohammed Shannawaz; Kiomars Sharafi; Fablina Sharara; Hamid Sharifi; David H Shaw; Aziz Sheikh; Abbas Sheikhtaheri; B Suresh Kumar Shetty; Kenji Shibuya; Wondimeneh Shibabaw Shiferaw; Mika Shigematsu; Jae Il Shin; Rahman Shiri; Reza Shirkoohi; K.M. Shivakumar; Mark G Shrime; Kerem Shuval; Soraya Siabani; Radoslaw Sierpinski; Inga Dora Sigfusdottir; Rannveig Sigurvinsdottir; Diego Augusto Santos Silva; João Pedro Silva; Biagio Simonetti; Kyle E Simpson; Jasvinder A Singh; Pushpendra Singh; Dhirendra Narain Sinha; Valentin Yurievich Skryabin; Emma U R Smith; Amin Soheili; Shahin Soltani; Moslem Soofi; Reed J.D. Sorensen; Joan B Soriano; Muluken Bekele Sorrie; Ireneous N Soyiri; Emma Elizabeth Spurlock; Chandrashekhar T Sreeramareddy; Jeffrey D Stanaway; Nicholas Steel; Caroline Stein; Mark A Stokes; Mu'awiyyah Babale Sufiyan; Hafiz Ansar Rasul Suleria; Iyad Sultan; Łukasz Szumowski; Rafael Tabarés-Seisdedos; Takahiro Tabuchi; Santosh Kumar Tadakamadla; Biruk Wogayehu Taddele; Degena Bahrey Tadesse; Amir Taherkhani; Animut Tagele Tamiru; Frank C Tanser; Md Ismail Tareque; Ingan Ukur Tarigan; Whitney L Teagle; Fabrizio Tediosi; Yonas Getaye Getaye Tefera; Freweini Gebrearegay Tela; Zemenu Tadesse Tessema; Bhaskar Thakur; Mariya Vladimirovna Titova; Marcello Tonelli; Roman Topor-Madry; Fotis Topouzis; Marcos Roberto Roberto Tovani-Palone; Bach Xuan Tran; Ravensara Travillian; Christopher E Troeger; Lorainne Tudor Car; Riaz Uddin; Irfan Ullah; Chukwuma David Umeokonkwo; Bhaskaran Unnikrishnan; Era Upadhyay; Olalekan A Uthman; Marco Vacante; Pascual R Valdez; Santosh Varughese; Tommi Juhani Vasankari; Yasser Vasseghian; Narayanaswamy Venketasubramanian; Francesco S Violante; Vasily Vlassov; Stein Emil Vollset; Avina Vongpradith; Theo Vos; Yasir Waheed; Magdalene K Walters; Richard G Wamai; Haidong Wang; Yuan-Pang Wang; Robert G Weintraub; Jordan Weiss; Andrea Werdecker; Ronny Westerman; Lauren B Wilner; Gebremariam Woldu; Charles D A Wolfe; Ai-Min Wu; Sarah Wulf Hanson; Yang Xie; Seyed Hossein Yahyazadeh Jabbari; Kazumasa Yamagishi; Yuichiro Yano; Sanni Yaya; Vahid Yazdi-Feyzabadi; Jamal A Yearwood; Yordanos Gizachew Yeshitila; Paul Yip; Naohiro Yonemoto; Mustafa Z Younis; Zabihollah Yousefi; Taraneh Yousefinezhadi; Hasan Yusefzadeh; Siddhesh Zadey; Telma Zahirian Moghadam; Syed Saoud Zaidi; Leila Zaki; Sojib Bin Zaman; Maryam Zamanian; Hamed Zandian; Mikhail Sergeevich Zastrozhin; Kaleab Alemayehu Zewdie; Yunquan Zhang; Xiu-Ju George Zhao; Yingxi Zhao; Peng Zheng; Cong Zhu; Arash Ziapour; Bianca S Zlavog; Sanjay Zodpey; Christopher J L Murray
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. © 2020 Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Quantifying risks and interventions that have affected the burden of diarrhoea among children younger than 5 years: an analysis of the Global Burden of Disease Study 2017
(Elsevier Ltd, 2020) Christopher E Troeger; Ibrahim A Khalil; Brigette F Blacker; Molly H Biehl; Samuel B Albertson; Stephanie R M Zimsen; Puja C Rao; Degu Abate; Alireza Ahmadi; Mohamed Lemine Cheikh Brahim Ahmed; Chalachew Genet Akal; Fares Alahdab; Noore Alam; Kefyalew Addis Alene; Vahid Alipour; Syed Mohamed Aljunid; Rajaa M Al-Raddadi; Nelson Alvis-Guzman; Saeed Amini; Nahla Hamed Anber; Mina Anjomshoa; Carl Abelardo T Antonio; Jalal Arabloo; Olatunde Aremu; Hagos Tasew Atalay; Suleman Atique; Euripide F G A Avokpaho; Samah Awad; Ashish Awasthi; Alaa Badawi; Kalpana Balakrishnan; Joseph Adel Mattar Banoub; Aleksandra Barac; Quique Bassat; Neeraj Bedi; Derrick A Bennett; Krittika Bhattacharyya; Zulfiqar A Bhutta; Ali Bijani; Josip Car; Félix Carvalho; Carlos A Castañeda-Orjuela; Devasahayam J Christopher; Lalit Dandona; Rakhi Dandona; Ahmad Daryani; Feleke Mekonnen Demeke; Aniruddha Deshpande; Shirin Djalalinia; Manisha Dubey; Eleonora Dubljanin; Eyasu Ejeta Duken; Maysaa El Sayed Zaki; Aman Yesuf Endries; Eduarda Fernandes; Florian Fischer; Nancy Fullman; William M Gardner; Birhanu Geta; Keyghobad Ghadiri; Giuseppe Gorini; Alessandra C Goulart; Yuming Guo; Gessessew Bugssa Hailu; Arvin Haj-Mirzaian; Arya Haj-Mirzaian; Samer Hamidi; Hamid Yimam Hassen; Chi Linh Hoang; Mihaela Hostiuc; Zakir Hussain; Seyed Sina Naghibi Irvani; Spencer L James; Ravi Prakash Jha; Jost B Jonas; André Karch; Amir Kasaeian; Tesfaye Dessale Kassa; Nicholas J Kassebaum; Adane Teshome Kefale; Yousef Saleh Khader; Ejaz Ahmad Khan; Md Nuruzzaman Khan; Young-Ho Khang; Abdullah T Khoja; Ruth W Kimokoti; Adnan Kisa; Sezer Kisa; Niranjan Kissoon; Sonali Kochhar; Soewarta Kosen; Ai Koyanagi; Barthelemy Kuate Defo; G Anil Kumar; Dharmesh Kumar Lal; Cheru Tesema Leshargie; Shanshan Li; Rakesh Lodha; Erlyn Rachelle King MacArayan; Marek Majdan; Abdullah A Mamun; H. Manguerra; Addisu Melese; Ziad A Memish; Desalegn Tadese Mengistu; Tuomo J Meretoja; Tomislav Mestrovic; Bartosz Miazgowski; Erkin M Mirrakhimov; Babak Moazen; Karzan Abdulmuhsin Mohammad; Shafiu Mohammed; Lorenzo Monasta; Catrin E Moore; Jonathan F Mosser; Seyyed Meysam Mousavi; Srinivas Murthy; Ghulam Mustafa; Javad Nazari; Cuong Tat Nguyen; Long Hoang Nguyen; Muhammad Imran Nisar; Molly R Nixon; Felix Akpojene Ogbo; Anselm Okoro; Andrew T Olagunju; Tinuke O Olagunju; P.A. Mahesh; Smita Pakhale; Maarten J Postma; Mostafa Qorbani; Reginald Quansah; Alireza Rafiei; Fakher Rahim; Vafa Rahimi-Movaghar; Rajesh Kumar Rai; Mohammad Sadegh Rezai; Aziz Rezapour; Maria Jesus Rios-Blancas; Luca Ronfani; Katherine Rosettie; Dietrich Rothenbacher; Saeed Safari; Zikria Saleem; Evanson Zondani Sambala; Abdallah M Samy; Milena M Santric Milicevic; Benn Sartorius; Monika Sawhney; Seyedmojtaba Seyedmousavi; Masood Ali Shaikh; Aziz Sheikh; Mika Shigematsu; David L Smith; Joan B Soriano; Chandrashekhar T Sreeramareddy; Jeffrey D Stanaway; Mu'Awiyyah Babale Sufiyan; Teklay G E Teklu; Mohamad-Hani Temsah; Belay Tessema; Bach Xuan Tran; Khanh Bao Tran; Irfan Ullah; Rachel L Updike; Tommi Juhani Vasankari; Yousef Veisani; Fiseha Wadilo Wada; Yasir Waheed; Marcia Weaver; Kirsten E Wiens; Charles Shey Wiysonge; Ebrahim M Yimer; Naohiro Yonemoto; Zoubida Zaidi; Heather J Zar; Afshin Zarghi; Stephen S Lim; Theo Vos; Ali H Mokdad; Christopher J L Murray; Hmwe Hmwe Kyu; Simon I Hay; Robert C Reiner
Background: Many countries have shown marked declines in diarrhoeal disease mortality among children younger than 5 years. With this analysis, we provide updated results on diarrhoeal disease mortality among children younger than 5 years from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) and use the study's comparative risk assessment to quantify trends and effects of risk factors, interventions, and broader sociodemographic development on mortality changes in 195 countries and territories from 1990 to 2017. Methods: This analysis for GBD 2017 had three main components. Diarrhoea mortality was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive, Bayesian, ensemble modelling tool; and the attribution of risk factors and interventions for diarrhoea were modelled in a counterfactual framework that combines modelled population-level prevalence of the exposure to each risk or intervention with the relative risk of diarrhoea given exposure to that factor. We assessed the relative and absolute change in diarrhoea mortality rate between 1990 and 2017, and used the change in risk factor exposure and sociodemographic status to explain differences in the trends of diarrhoea mortality among children younger than 5 years. Findings: Diarrhoea was responsible for an estimated 533 768 deaths (95% uncertainty interval 477 162–593 145) among children younger than 5 years globally in 2017, a rate of 78·4 deaths (70·1–87·1) per 100 000 children. The diarrhoea mortality rate ranged between countries by over 685 deaths per 100 000 children. Diarrhoea mortality per 100 000 globally decreased by 69·6% (63·1–74·6) between 1990 and 2017. Among the risk factors considered in this study, those responsible for the largest declines in the diarrhoea mortality rate were reduction in exposure to unsafe sanitation (13·3% decrease, 11·2–15·5), childhood wasting (9·9% decrease, 9·6–10·2), and low use of oral rehydration solution (6·9% decrease, 4·8–8·4). Interpretation: Diarrhoea mortality has declined substantially since 1990, although there are variations by country. Improvements in sociodemographic indicators might explain some of these trends, but changes in exposure to risk factors—particularly unsafe sanitation, childhood growth failure, and low use of oral rehydration solution—appear to be related to the relative and absolute rates of decline in diarrhoea mortality. Although the most effective interventions might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting against diarrhoea that have already reduced diarrhoea mortality could further avert many thousands of deaths due to this illness. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license