Knowledge of School Health Programme among Public Primary School Teachers in Sokoto Metropolis, Northwestern Nigeria

Background: School health program takes care of the health needs of a significant proportion of the population, especially in the third world countries, by ensuring that children of school age remain healthy and benefit maximally from their education. This study aimed to assess the knowledge of School Health Programme (SHP) among primary school teachers in Sokoto metropolis, northwestern, Nigeria.Methods: A cross-sectional study was conducted among 382 public primary school teachers that were selected by multistage sampling technique. Data was collected using a structured, self-administered questionnaire. Proportions and adjusted odds ratios (OR) were calculated with 95% confidence intervals (CI) in a binary logistic regression model. All levels of significance were set at p < 0.05.Results: The mean age of the respondents was 34.8 ± 8.6 years. More than half of the respondents were Nigerian Certificate in Education (NCE) holders 245 (64.1%). Knowledge of SHP was good in 198 (51.8%) of the respondents. The predictors of good knowledge were belonging to other ethnicity (aOR: 3.70; 95% CI=1.11–12.50, p=0.034), having degree or postgraduate qualification in education (aOR: 4.55; 95% CI=2.63–7.69, p<0.001) and having worked for two or more decades (aOR: 4.15; 95% CI=1.34–12.78, p=0.011)Conclusion: Nearly half of the respondents had poor knowledge of SHP and this is likely to deny a large number of school children of being healthy and benefitting from th eir education. Awareness campaigns and trainings on SHP to fill in the knowledge gap is highly recommended

Preparation and characterization of nanocrystalline Ba(Ti0.96SnxZr0.04-x)O3 ceramic

Nanocrystalline powders of Barium titanate (BaTiO3 or BT) and Ba(Ti0.96SnxZr0.04-x)O3 (BTSZ1, BTSZ2, and BTSZ3) [x=0.02, 0.03 and 0.04] have been synthesized by a combination of solid-state reaction and high energy ball- milling technique (HBM). The effect of increasing Sn content on the microstructure and dielectric properties of the ceramics were studied. X-ray diffraction patterns show cubic and tetragonal symmetry without secondary phase. Sn4+ and Zr4+ ions entered the perovskite-type cubic structure and led to an increase in the lattice parameters. The average crystallite size has been calculated using Scherrer formula. Using Scherrer, the crystallite size of the (110) peaks of the pure BT is 31.2 nm and that of BTSZ1, BTSZ2, and BTSZ3 are 42.7, 37.9 and 42.3 nm respectively. The FESEM results indicated a variation of grain size from 144.53, to 89.28 nm for the pure BT, BTSZ1, BTSZ2, and BTSZ3, which show a decrease in grain size as Sn doping increases. Frequency dependence of dielectric permittivity and loss studied in the range temperature and frequency range 30-400oC and 40 Hz–1 MHz, respectively, for BT, BTSZ1, BTSZ2, and BTSZ3 show a normal ferroelectric phase transition behavior. The corresponding dielectric constant and loss at room temperature show that BTSZ2 has the highest dielectric constant and loss of 1671 and 1.6 respectively. The high dielectric constants and relatively lower loss tangent values meet the current demand for device miniaturization in the electronics industry.Keywords: BT-BTSZ ceramics; high energy ball milling; XRD; FESEM; dielectric propertie

Knowledge of Factors Contributing to Child Malnutrition among Mothers of Under-five Children in Sokoto Metropolis, North-West Nigeria

Background: Malnutrition remains a killer of children, especially in Sub-Saharan Africa. In Nigeria, malnutrition is among the top five killers of children under five years of age. This study aimed to assess the knowledge of factors contributing to child malnutrition among mothers of under-fives.Methods: A cross-sectional study was conducted among 347 mothers of under-five children who were selected using a multistage sampling technique from January to March 2018. Data were collected using an interviewer-administered questionnaire. Data were analysed using IBM SPSS® version 20.0. Descriptive statistics, crude and adjusted Odds Ratio (OR) with 95% Confidence Interval (CI) in cross-tabulation and binary logistic regression analysis, respectively, were estimated.Results: More than half, 198 (57.0%) were aged 40 years and below. Most, 324 (93.4%) of the respondents were Hausas, with only 45 (13.0%) having tertiary education. Majority of the respondents, 326 (93.9%) knew that diarrhoea-causing diseases could lead to malnutrition. About two-thirds, 222 (64.0%) knew that deworming could protect a child from malnutrition. Less than half, 169 (48.7%) did not know that overeating starchy food can cause malnutrition. Overall, majority 216 [62.2% (95% CI = 56.9% - 67.4%)] of the respondents had good knowledge of factors associated with malnutrition. There were no statistically significant predictors of knowledge of factors contributing to malnutrition.Conclusion: Mothers of under-five children in Sokoto metropolis had a high level of knowledge of the factors contributing to child malnutrition. However, there is still a need to continue educating mothers of under-five children on the importance of maintaining proper nutrition for their children. Keywords: Awareness; Factors; Knowledge; Malnutrition; Mothers; Under-fiv

Pattern and management of priapism in a tertiary hospital of North-Western Nigeria

Background: Priapism is a persistent penile erection that continues for more than four hours beyond sexual stimulation and orgasm or unrelated to sexual stimulation1. The objective is to document the pattern and management of priapism in our hospital.Methods: This is a retrospective study of patients managed for Priapism by Urology Unit of our hospital, from January 2009 to December 2015.Results: Thirty patients were managed for managed for priapism within the study period. The mean age at presentation was 23.9 ± 12.2 years with a range of 8- 55 years. Fifteen patients (57.7 %) presented beyond 72 hours of the onset of priapism. All the patients had ischaemic priapism. Half of the patients had sickle cell disease, two (7.7 %) had chronic myeloid leukaemia, five (19.2%) used aphrodisiacs and cause was not established in six (23.1%). The most effective forms of treatments were corporal aspiration and glanulocavernosal shunt. Hydroxyurea was used for the patients with leukaemia. Thirteen (50.0%) of the patients were loss to follow-up after their first visits. Three patients (11.5%) developed erectile dysfunction.Conclusion: Sickle cell disease is the commonest cause of ischaemic priapism in our practice. Late presentation is common and is usually associated with the development of erectile dysfunction.Keywords: priapism, sickle cell disease, aphrodisiacs, erectile dysfunction, treatments of ischaemic priapis

Effects of N-Butanol and Aqueous Fractions of Khaya senegalensis, Guiera senegalensis and Tamarindus Indica Leaves Extracts on Eimeria tenella Oocyst Sporulation in Vitro

The in vitro anti coccidial activities of n-butanol and aqueous fractions of Khaya senegalensis, Gueira senegalensis and Tamarindus indica leaves extracts on Eimeria tenella parasite was studied by observing the effects of the plant extracts on the sporulation of the Eimeria tenella oocysts. Drug resistance and consumer demanding decrease in the use of drugs in animals have generated interest in alternative strategies to control the avian disease one of which is herbal intervention studies. Fresh faecal samples were collected from infected birds and their oocysts load determined. Dilutions of the extracts (100mg, 250mg, 400mg, 550mg, 700mg and 850mg per ml) in distilled water were prepared and placed in separate well labelled petri dishes. 100 oocysts were added to each petri dish and the set up was left at ambient temperature on the laboratory table and monitored twice daily (9.00am and 3.00pm) to observe the sporulation of the oocysts over a 72 hours period. Laboratory sporulation medium (2.5% Potassium dichromate) and Amprolium were used for comparison. The phytochemical result implied that the active ingredients were present mainly in the n-butanol and crude extract  fractions with the nbutanol fraction of the Khaya senegalensis extract containing phenols and flavonoids which have antioxidant effects. The in vitro study showed that the n-butanol fraction of K senegalensis (100mg/ml) and the aqueous fraction of Tamarindus indica (100mg/ml) extracts had similar effects to those obtained using Amprolium which was considered as the standard by inhibiting the sporulation of Eimeria tenella oocysts. It is therefore recommended that more work needs to be done to determine the anti  coccidial activities of these extracts in vivo. Key words: Eimeria tenella, sporulation, in vitro, extract

Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980�2015: the Global Burden of Disease Study 2015

Background Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015. Methods For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification. Findings Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95 uncertainty interval UI 3·1�3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5�2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6�40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7�1·9 million) in 2005, to 1·2 million deaths (1·1�1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections. Interpretation Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030. Funding Bill & Melinda Gates Foundation, and National Institute of Mental Health and National Institute on Aging, National Institutes of Health. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY licens

Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980�2015: a systematic analysis for the Global Burden of Disease Study 2015

Background Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time. Methods Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1�4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980�2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age�sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, 5·8 million (95 uncertainty interval UI 5·7�6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7�53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3�43·6) to 2·6 million (2·6�2·7) neonatal deaths and 47·0% (35·1�57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6�3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone. Interpretation Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030. Funding Bill & Melinda Gates Foundation. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license

Global, regional, and national levels of maternal mortality, 1990�2015: a systematic analysis for the Global Burden of Disease Study 2015

Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10�54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68 in 1990 to more than 80 in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91 coverage of one antenatal care visit, 78 of four antenatal care visits, 81 of in-facility delivery, and 87 of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care�including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population. Funding Bill & Melinda Gates Foundation. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY licens

Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990�2015: a systematic analysis for the Global Burden of Disease Study 2015

Background Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. Findings Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95 uncertainty interval 2·9�3·0) for men and 3·5 years (3·4�3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78�0·92) and 1·2 years (1·1�1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. Interpretation Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. Funding Bill & Melinda Gates Foundation. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY licens

Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990�2015: a systematic analysis for the Global Burden of Disease Study 2015

Background Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015. Methods We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, updates to literature reviews for 85 causes, and the identification and inclusion of additional studies published up to November, 2015, to expand the database used for estimation of non-fatal outcomes to 60�900 unique data sources. Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the DisMod-MR Bayesian meta-regression tool first developed for GBD 2010 and GBD 2013. For some causes, we used alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines measures of income per capita, educational attainment, and fertility (the Socio-demographic Index SDI) and used it to compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores. Findings We generated 9·3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17·2 billion, 95% uncertainty interval UI 15·4�19·2 billion) and diarrhoeal diseases (2·39 billion, 2·30�2·50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2·36 billion (2·35�2·37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20�30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo. Interpretation Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available. Funding Bill & Melinda Gates Foundation. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY licens