Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. METHODS: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. FINDINGS: Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. INTERPRETATION: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing

Global, regional, and national burden of suicide mortality 1990 to 2016: Systematic analysis for the Global Burden of Disease Study 2016

Objectives To use the estimates from the Global Burden of Disease Study 2016 to describe patterns of suicide mortality globally, regionally, and for 195 countries and territories by age, sex, and Socio-demographic index, and to describe temporal trends between 1990 and 2016. Design Systematic analysis. Main outcome measures Crude and age standardised rates from suicide mortality and years of life lost were compared across regions and countries, and by age, sex, and Socio-demographic index (a composite measure of fertility, income, and education). Results The total number of deaths from suicide increased by 6.7 (95 uncertainty interval 0.4 to 15.6) globally over the 27 year study period to 817 000 (762 000 to 884 000) deaths in 2016. However, the age standardised mortality rate for suicide decreased by 32.7 (27.2 to 36.6) worldwide between 1990 and 2016, similar to the decline in the global age standardised mortality rate of 30.6. Suicide was the leading cause of age standardised years of life lost in the Global Burden of Disease region of high income Asia Pacific and was among the top 10 leading causes in eastern Europe, central Europe, western Europe, central Asia, Australasia, southern Latin America, and high income North America. Rates for men were higher than for women across regions, countries, and age groups, except for the 15 to 19 age group. There was variation in the female to male ratio, with higher ratios at lower levels of Socio-demographic index. Women experienced greater decreases in mortality rates (49.0, 95 uncertainty interval 42.6 to 54.6) than men (23.8, 15.6 to 32.7). Conclusions Age standardised mortality rates for suicide have greatly reduced since 1990, but suicide remains an important contributor to mortality worldwide. Suicide mortality was variable across locations, between sexes, and between age groups. Suicide prevention strategies can be targeted towards vulnerable populations if they are informed by variations in mortality rates. © Published by the BMJ Publishing Group Limited

Village poultry in Ethiopia socio-technical analysis and learning with farmers

In developing countries village poultry keeping is regarded an important livelihood opportunity for the poor. To improve poultry systems, it is necessary to keep in mind a large number of local complexities. This study aimed to integrate participatory-, survey- and model-based approaches to socio-technical analysis and mutual farmer-researcher learning about constraints to and opportunities for village poultry development in Ethiopia. The study applied a combined technography and systems approach as an input in analyzing possibilities for poultry development in terms of context-mechanism-outcome. To this end it used as data collection methods individual and open-group interviews, a cross-sectional stratified random survey, farm-recording, a market survey, and village-poultry modelling. Feed-back workshops were organised to share between farmers and researchers the data collected through farm-recording and to learn about outcomes of simulation scenarios for identifying improvement options of village poultry systems. Village poultry significantly contributed to the livelihoods of poor households: economically as starter capital, as a means to recover from disasters, as an accessible protein source and for income and exchange purposes, and socio-culturally for mystical functions, hospitality and exchange of gifts to strengthen social relationships. Poor households used sharing arrangements to have access to poultry. Distance to markets influenced flock sizes and poultry marketing organization. Religious festival days were associated with increased poultry consumption and sales, and fasting periods with decreased consumption. Farm-recording was as a first entry point to learn about how farmers participate in research. It transpired that researchers needed to understand the religious and customary norms of the community and adjust the data collection tools and procedures to fit these norms. As a second entry point, farm recording information was presented back to farmers to validate the data and to discuss with farmers the reasons of variation between households. A third entry point for sharing between researchers and farmers was modelling and simulation. Information from literature was used for development of a village-poultry model. The study documented experiences of how the modelling process was used to engage farmers and researchers in joint learning about village poultry keeping. The present study has indicated that through the combination of multiple approaches and methods researchers can arrive at better understanding of constraints affecting farmers’ reality. This implies more relevant problem definition and therefore a potentially more effective technology development process. The study confirms that village poultry research and development are not only about finding technical solutions but also involve addressing household livelihoods, and institutional and policy issues from a social science perspective

Village poultry in Ethiopia : socio-technical analysis and learning with farmers

In developing countries village poultry keeping is regarded an important livelihood opportunity for the poor. To improve poultry systems, it is necessary to keep in mind a large number of local complexities. This study aimed to integrate participatory-, survey- and model-based approaches to socio-technical analysis and mutual farmer-researcher learning about constraints to and opportunities for village poultry development in Ethiopia. The study applied a combined technography and systems approach as an input in analyzing possibilities for poultry development in terms of context-mechanism-outcome. To this end it used as data collection methods individual and open-group interviews, a cross-sectional stratified random survey, farm-recording, a market survey, and village-poultry modelling. Feed-back workshops were organised to share between farmers and researchers the data collected through farm-recording and to learn about outcomes of simulation scenarios for identifying improvement options of village poultry systems. Village poultry significantly contributed to the livelihoods of poor households: economically as starter capital, as a means to recover from disasters, as an accessible protein source and for income and exchange purposes, and socio-culturally for mystical functions, hospitality and exchange of gifts to strengthen social relationships. Poor households used sharing arrangements to have access to poultry. Distance to markets influenced flock sizes and poultry marketing organization. Religious festival days were associated with increased poultry consumption and sales, and fasting periods with decreased consumption. Farm-recording was as a first entry point to learn about how farmers participate in research. It transpired that researchers needed to understand the religious and customary norms of the community and adjust the data collection tools and procedures to fit these norms. As a second entry point, farm recording information was presented back to farmers to validate the data and to discuss with farmers the reasons of variation between households. A third entry point for sharing between researchers and farmers was modelling and simulation. Information from literature was used for development of a village-poultry model. The study documented experiences of how the modelling process was used to engage farmers and researchers in joint learning about village poultry keeping. The present study has indicated that through the combination of multiple approaches and methods researchers can arrive at better understanding of constraints affecting farmers’ reality. This implies more relevant problem definition and therefore a potentially more effective technology development process. The study confirms that village poultry research and development are not only about finding technical solutions but also involve addressing household livelihoods, and institutional and policy issues from a social science perspective

Modelling the impact of interventions on the dynamics in village poultry systems

There are many technical possibilities to improve free-range and backyard poultry keeping. Rural households, however, are not adopting these technologies widely. This paper presents a model approach for ex ante evaluation of interventions in village poultry systems. The dynamic deterministic computer model considers mortality, egg production, reproduction, offtake, and their interrelationships. In the base situation, the model reflects the behaviour of a relatively stable village poultry flock. The model was used to explore how interventions influence the dynamics of a village poultry flock. Over the simulated period of three years, NCD (Newcastle Disease) vaccination, daytime housing, supplementary feeding, and control of broodiness each had a positive effect on bird offtake, egg production, egg offtake, and flock size. Crossbreeding had a highly negative effect on these key variables. The impact of interventions is also related to the use of the available resources. Cost¿benefit calculations for the Tigray region in Ethiopia and village poultry research sites in Kenya indicated that NCD vaccinations were economically most effective. Housing and crossbreeding had a highly negative impact on net returns. When applied with situation-specific input data, the model can be used in the first stages of research and development approaches to support decisions on priorities of projects in village poultry production

Modelling the impact of interventions on the dynamics in village poultry systems

There are many technical possibilities to improve free-range and backyard poultry keeping. Rural households, however, are not adopting these technologies widely. This paper presents a model approach for ex ante evaluation of interventions in village poultry systems. The dynamic deterministic computer model considers mortality, egg production, reproduction, offtake, and their interrelationships. In the base situation, the model reflects the behaviour of a relatively stable village poultry flock. The model was used to explore how interventions influence the dynamics of a village poultry flock. Over the simulated period of three years, NCD (Newcastle Disease) vaccination, daytime housing, supplementary feeding, and control of broodiness each had a positive effect on bird offtake, egg production, egg offtake, and flock size. Crossbreeding had a highly negative effect on these key variables. The impact of interventions is also related to the use of the available resources. Cost¿benefit calculations for the Tigray region in Ethiopia and village poultry research sites in Kenya indicated that NCD vaccinations were economically most effective. Housing and crossbreeding had a highly negative impact on net returns. When applied with situation-specific input data, the model can be used in the first stages of research and development approaches to support decisions on priorities of projects in village poultry production