Geomorphic origin and dynamics of deep, peat-filled, valley bottom wetlands dominated by palmiet (Prionium serratum) : a case study based on the Goukou Wetland, Western Cape

The Goukou Wetland is a 700 ha unchannelled valley bottom wetland near the town of Riversdale in the Western Cape of South Africa. The wetland is approximately 16 km long and between 200 and 800 m wide, with peat deposits up to 8 m deep that get progressively shallower downstream. The Goukou Wetland is one of the last remaining intact peatlands of significant size in the Western Cape. However, there is increasing human pressure on these peat wetlands, where the dominant plant is palmiet (Prionium serratum), which is endemic to the Western and Eastern Cape Provinces of South Africa. Palmiet is viewed as a problem plant by farmers as it is believed to block waterways and promote inundation of arable land and infrastructure. Many landowners therefore actively remove palmiet from peatlands, threatening the integrity of these wetlands. Although the hydrogeomorphic origin of large, non-peat floodplain and valley bottom wetlands has been investigated in South Africa, unchannelled valley-bottom wetlands with deep peat accumulations are rare features and have not been well studied. The hydrogeomorphic factors leading to peat accumulation have been documented elsewhere in Southern Africa, where aggradation due to sedimentation along trunk streams may block a tributary stream, elevating the local base level of the tributary, creating the accommodation space for organic sedimentation. Alternatively, sedimentation along a trunk stream at the toe of a tributary stream may similarly block a trunk stream, promoting organic sedimentation along the trunk stream upstream of the tributary. This pattern of peat accumulation is associated with declining peat thickness upstream of the blocked valley. In the case of the Goukou Wetland, however, peat depth and organic content was found to increase consistently upstream from the toe to the head of the wetland. The Goukou Wetland was graded along its length, with gradient increasing consistently upstream in response to longitudinal variation in discharge. There was no clear relationship between peat formation and tributary streams blocking the wetland. Instead, the distribution of peat and the extent of the wetland appeared to be controlled by the plant palmiet, whose clonal nature and robust root, rhizome and stem system allowed it to grow from channel banks and islands into fast-flowing river channels, slowing river flows and ultimately blocking the channel. The promotion of diffuse flows within the dense, monospecific stands of palmiet creates conditions conducive to water retention and peat accumulation. By growing across the full width of the valley floor, the plant is able to constrict the stream, trapping sediment and slowing flows such that the fluvial environment is changed from a fast flowing stream to one with slow, diffuse flow. These processes appear to lead to the formation of organic sediment, accumulating to form a deep peat basin. The sustained input of water from the folded and fractured quartzite lithologies of the Cape Supergroup that make up the Langeberg Mountains, which provide the bulk of the water supply to the wetland, is also important in promoting permanent flooding in the wetland. A feature that characterized the wetland was the fact that bedrock across the valley beneath the peat deposits exhibited a remarkably uniform elevation. This suggests that over long periods of time (tens to hundreds of thousands of years), bedrock has been laterally planed across the valley floor. It is proposed that valley widening associated with lateral planning of Uitenhage Formation rocks has taken place during periods of episodic very high flows. During these episodes, erosion cuts into the peat wetland and valley sides, cutting to bedrock and planing the valley floor to a uniform elevation for a given distance from the head of the wetland. Periods of episodic degradation are followed by periods of renewed peat accumulation associated with palmiet establishment, such that the wetland valley is shaped by repeated cycles of cutting and filling. Palmiet can be considered an “ecosystem engineer” that is integral to the formation of these deep peat basins. Removal of palmiet from these systems is likely to have negative consequences for the wetland and its functions in that water storage will be reduced, erosion will increase dramatically, and the water-purification function of the wetlands will be lost. Management of these wetlands, which are close to the geomorphic threshold slopes for their size, is therefore essential if they are to be preserved for the benefit of human well-being

Geomorphic origin and dynamics of deep, peat-filled, valley bottom wetlands dominated by palmiet (Prionium serratum) : a case study based on the Goukou Wetland, Western Cape

The Goukou Wetland is a 700 ha unchannelled valley bottom wetland near the town of Riversdale in the Western Cape of South Africa. The wetland is approximately 16 km long and between 200 and 800 m wide, with peat deposits up to 8 m deep that get progressively shallower downstream. The Goukou Wetland is one of the last remaining intact peatlands of significant size in the Western Cape. However, there is increasing human pressure on these peat wetlands, where the dominant plant is palmiet (Prionium serratum), which is endemic to the Western and Eastern Cape Provinces of South Africa. Palmiet is viewed as a problem plant by farmers as it is believed to block waterways and promote inundation of arable land and infrastructure. Many landowners therefore actively remove palmiet from peatlands, threatening the integrity of these wetlands. Although the hydrogeomorphic origin of large, non-peat floodplain and valley bottom wetlands has been investigated in South Africa, unchannelled valley-bottom wetlands with deep peat accumulations are rare features and have not been well studied. The hydrogeomorphic factors leading to peat accumulation have been documented elsewhere in Southern Africa, where aggradation due to sedimentation along trunk streams may block a tributary stream, elevating the local base level of the tributary, creating the accommodation space for organic sedimentation. Alternatively, sedimentation along a trunk stream at the toe of a tributary stream may similarly block a trunk stream, promoting organic sedimentation along the trunk stream upstream of the tributary. This pattern of peat accumulation is associated with declining peat thickness upstream of the blocked valley. In the case of the Goukou Wetland, however, peat depth and organic content was found to increase consistently upstream from the toe to the head of the wetland. The Goukou Wetland was graded along its length, with gradient increasing consistently upstream in response to longitudinal variation in discharge. There was no clear relationship between peat formation and tributary streams blocking the wetland. Instead, the distribution of peat and the extent of the wetland appeared to be controlled by the plant palmiet, whose clonal nature and robust root, rhizome and stem system allowed it to grow from channel banks and islands into fast-flowing river channels, slowing river flows and ultimately blocking the channel. The promotion of diffuse flows within the dense, monospecific stands of palmiet creates conditions conducive to water retention and peat accumulation. By growing across the full width of the valley floor, the plant is able to constrict the stream, trapping sediment and slowing flows such that the fluvial environment is changed from a fast flowing stream to one with slow, diffuse flow. These processes appear to lead to the formation of organic sediment, accumulating to form a deep peat basin. The sustained input of water from the folded and fractured quartzite lithologies of the Cape Supergroup that make up the Langeberg Mountains, which provide the bulk of the water supply to the wetland, is also important in promoting permanent flooding in the wetland. A feature that characterized the wetland was the fact that bedrock across the valley beneath the peat deposits exhibited a remarkably uniform elevation. This suggests that over long periods of time (tens to hundreds of thousands of years), bedrock has been laterally planed across the valley floor. It is proposed that valley widening associated with lateral planning of Uitenhage Formation rocks has taken place during periods of episodic very high flows. During these episodes, erosion cuts into the peat wetland and valley sides, cutting to bedrock and planing the valley floor to a uniform elevation for a given distance from the head of the wetland. Periods of episodic degradation are followed by periods of renewed peat accumulation associated with palmiet establishment, such that the wetland valley is shaped by repeated cycles of cutting and filling. Palmiet can be considered an “ecosystem engineer” that is integral to the formation of these deep peat basins. Removal of palmiet from these systems is likely to have negative consequences for the wetland and its functions in that water storage will be reduced, erosion will increase dramatically, and the water-purification function of the wetlands will be lost. Management of these wetlands, which are close to the geomorphic threshold slopes for their size, is therefore essential if they are to be preserved for the benefit of human well-being

Prediction of Wetland Hydrogeomorphic Type Using Morphometrics and Landscape Characteristics

Accurate spatial maps of wetlands are critical for regional conservation and rehabilitation assessments, yet this often remains an elusive target. Such maps ideally provide information on wetland occurrence and extent, hydrogeomorphic (HGM) type, and ecological condition/level of degradation. All three elements are needed to provide ancillary layers to support mapping from remote imagery and ground-truthing. Knowledge of HGM types is particularly important, because different types show different levels of sensitivity to degradation, and modeling accuracy for occurrence. Here, we develop and test a simple approach for predicting the most likely HGM type for mapped yet unattributed wetland polygons. We used a dataset of some 11,500 wetland polygons attributed by HGM types (floodplain, depression, seep, channeled, and un-channeled valley-bottom) from the Western Cape Province in South Africa. Polygons were attributed and described in terms of nine landscape metrics, at a sub-catchment scale. Using a combination of box-and-whisker plots and PCA, we identified four variables (groundwater depth, relief ratio, slope, and elevation) as being the most important variables in differentiating HGM types. We divided the data into equal parts for training and testing of a simple Bayesian network model. Model validation included field assessments. HGM types were most sensitive to elevation. Model predication was good, with error rates of only 32%. We conclude that this is a useful technique that can be widely applied using readily available data, for rapid classification of HGM types at a regional scale. © Copyright © 2020 Rivers-Moore, Kotze, Job and Mohanlal

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

5. The PROTECT Trial: A Cluster Randomized Clinical Trial of Universal Decolonization with Chlorhexidine and Nasal Povidone Iodine Versus Standard of Care for Prevention of Infections and Hospital Readmissions among Nursing Home Residents

Abstract Background Nursing home (NH) residents are at high infection and hospital readmission risk. Colonization with multidrug-resistant organisms (MDROs) is common. In ICU and post-hospital discharge settings, decolonization has reduced infection rates. However, the effectiveness of this strategy in NHs is unclear. Methods We performed a cluster randomized trial of 1:1 universal decolonization (decol) vs standard of care bathing (control) in 28 California NHs. After an 18 month baseline evaluation of hospitalization rates due to infection and MDRO prevalence, NHs were randomized to decol or control. Decol consisted of 1) chlorhexidine bathing; 2) nasal povidone iodine bid on admission x 5d and then M-F biweekly x 18 mo. Primary outcome was the probability that a transfer to a hospital was due to infection. Secondary outcome was the probability that a NH discharge was to a hospital. Results Four of 28 NHs dropped from the trial (3 decol, 1 control). Mean facility baseline of hospital transfers due to infection was 58% and 57% in the control and decol groups. In the intervention period, proportions were 57% and 48% in the control and decol groups. When accounting for clustering within NHs, hospital transfers due to infection had an OR of 0.91 (95% CI: 0.82-1.02) in the control group and an OR of 0.73 (95% CI: 0.56-0.95) in the decol group when comparing intervention to baseline period. For the primary outcome, decol had a 18% greater impact v. control (P=0.005, Fig. A). Baseline proportion of NH discharges due to hospitalization was 37% and 39% in the control and decol groups. In the intervention period, proportions were 36% and 33%. When accounting for clustering within NHs, the proportion of discharges due to hospitalization had an OR of 1.14 (95% CI: 1.06-1.22) in the control group and 0.91 (CI: 0.77-1.07) in the decol group when comparing the intervention period to the baseline period. For the secondary outcome, decol had a 23% greater impact v. control (P< 0.0001, Fig. B). In this figure, each nursing home is represented by a circle. The size of the circle represents the amount of contributed patient days to the trial. The groups represent “as randomized” categories. Panel A) compares the probability that a transfer to a hospital was due to infection; panel B) compares the probability that a nursing home discharge was to a hospital. The y-axis represents the odds ratio of these probabilities comparing the baseline to the intervention period. The p values represent the significance of the difference between groups (the trial effect). Conclusion Universal NH decolonization with chlorhexidine and nasal iodophor significantly reduced the proportion of transfers to hospitals due to infection and discharges due to hospitalization. Our findings suggest that NH decolonization reduces serious infections and can decrease morbidity in this vulnerable population. Disclosures Loren G. Miller, MD, MPH, Medline (Grant/Research Support, Other Financial or Material Support, Contributed product) Stryker (Other Financial or Material Support, Contributed product) Xttrium (Other Financial or Material Support, Contributed product) James A. McKinnell, MD, Medline (Grant/Research Support) Raveena Singh, MA, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Gabrielle Gussin, MS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Ken Kleinman, PhD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic products) Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic products) Raheeb Saavedra, AS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Lauren Heim, MPH, Medline (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Stryker (Sage) (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product) Xttrium (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product) Shruti K. Gohil, MD, MPH, Medline (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Molnycke (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Stryker (Sage) (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Susan S. Huang, MD, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products

How the freshwater biodiversity information system (FBIS) is supporting national freshwater fish conservation decisions in South Africa

DATA AVAILABILITY STATEMENT : The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/Supplementary Material. Alternatively, the dataset can be accessed via the Freshwater Biodiversity Information System (freshwaterbiodiversity.org).In South Africa, anthropogenic pressures such as water over-abstraction, invasive species impacts, land-use change, pollution, and climate change have caused widespread deterioration of the health of river ecosystems. This comes at great cost to both people and biodiversity, with freshwater fishes ranked as the country’s most threatened species group. Effective conservation and management of South Africa’s freshwater ecosystems requires access to reliable and comprehensive biodiversity data. Despite the existence of a wealth of freshwater biodiversity data, access to these data has been limited. The Freshwater Biodiversity Information System (FBIS) was built to address this knowledge gap by developing an intuitive, accessible and reliable platform for freshwater biodiversity data in South Africa. The FBIS hosts high quality, high accuracy biodiversity data that are freely available to a wide range of stakeholders, including researchers, conservation practitioners and policymakers. We describe how the system is being used to provide freshwater fish data to a national conservation decision-support tool—The Department of Forestry, Fisheries, and the Environment (DFFE) National Environmental Screening Tool (NEST). The NEST uses empirical and modelled biodiversity data to guide Environmental Impact Assessment Practitioners in conducting environmental assessments of proposed developments. Occurrence records for 34 threatened freshwater fishes occurring in South Africa were extracted from the FBIS and verified by taxon specialists, resulting in 6 660 records being used to generate modelled and empirical national distribution (or sensitivity) layers. This represents the first inclusion of freshwater biodiversity data in the NEST, and future iterations of the tool will incorporate additional freshwater taxa. This case study demonstrates how the FBIS fills a pivotal role in the data-to-decision pipeline through supporting data-driven conservation and management decisions at a national level.Funding for the development of the Freshwater Biodiversity Information System (FBIS) was provided by the JRS Biodiversity Foundation Funding for the development of the Freshwater Biodiversity Information System (FBIS) was provided by the JRS Biodiversity Foundation. This work is based on the research supported in part by the National Research Foundation (NRF) of South Africa and the NRF-SAIAB DSI/ NRF Research Chair in Inland Fisheries and Freshwater Ecology.http://www.frontiersin.org/Environmental_Scienceam2024Zoology and EntomologySDG-14:Life below wate

Mass Mortality Caused by Highly Pathogenic Influenza A(H5N1) Virus in Sandwich Terns, the Netherlands, 2022

We collected data on mass mortality in Sandwich terns (Thalasseus sandvicensis) during the 2022 breeding season in the Netherlands. Mortality was associated with at least 2 variants of highly pathogenic avian influenza A(H5N1) virus clade 2.3.4.4b. We report on carcass removal efforts relative to survival in colonies. Mitigation strategies urgently require structured research

The database of the PREDICTS (Projecting Responses of Ecological Diversity In Changing Terrestrial Systems) project

© 2016 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd. The PREDICTS project—Projecting Responses of Ecological Diversity In Changing Terrestrial Systems (www.predicts.org.uk)—has collated from published studies a large, reasonably representative database of comparable samples of biodiversity from multiple sites that differ in the nature or intensity of human impacts relating to land use. We have used this evidence base to develop global and regional statistical models of how local biodiversity responds to these measures. We describe and make freely available this 2016 release of the database, containing more than 3.2 million records sampled at over 26,000 locations and representing over 47,000 species. We outline how the database can help in answering a range of questions in ecology and conservation biology. To our knowledge, this is the largest and most geographically and taxonomically representative database of spatial comparisons of biodiversity that has been collated to date; it will be useful to researchers and international efforts wishing to model and understand the global status of biodiversity

Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS: We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS: Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, an

Alcohol use and burden for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2.2% (95% uncertainty interval [UI] 1.5-3.0) of age-standardised female deaths and 6.8% (5.8-8.0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3.8% (95% UI 3.2-4-3) of female deaths and 12.2% (10.8-13-6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2.3% (95% UI 2.0-2.6) and male attributable DALYs were 8.9% (7.8-9.9). The three leading causes of attributable deaths in this age group were tuberculosis (1.4% [95% UI 1. 0-1. 7] of total deaths), road injuries (1.2% [0.7-1.9]), and self-harm (1.1% [0.6-1.5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27.1% (95% UI 21.2-33.3) of total alcohol-attributable female deaths and 18.9% (15.3-22.6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0.0-0.8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.Peer reviewe