15 research outputs found

    Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

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    As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016

    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

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    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

    Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

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    BACKGROUND: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 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 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. FINDINGS: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. INTERPRETATION: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. FUNDING: Bill & Melinda Gates Foundation

    The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

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    INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

    Analysis of conceptual understanding of solutions and titration among Rwandan secondary school students

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    AbstractThis study aimed to examine the effect of three teaching approaches: The traditional teaching method, Teacher based demonstration experiment (TBDE), and the Student hands-on experiment (SHE), on students’ conceptual understanding of solutions and titration. The data were collected using a chemistry achievement test (CAT) comprising of 30 multiple-choice questions, prepared according to four levels of Bloom’s taxonomy, including remembering, understanding, applying, and analyzing. The results reveal that TTM alone could help students attain conceptual understanding in the lower-level knowledge domain and showed a slight improvement in the application and analysis level. At the same time, a great misconception was observed in the level of understanding. On the other hand, the combination of TTM with laboratory experiments either by TBDE or SHE improved students’ conceptual understanding of the first three learning domains better than TTM alone. Supplementation of laboratory experiments also improved students’ percentage scores for questions that looked difficult before intervention. The current study recommends that chemistry teachers should combine TTM with a laboratory experiment to bridge the gap between theory and practice. However, despite the positive impact of laboratory experiments in the first three learning domains, their effectiveness seemed to be reduced at the level of analysis. This finding is because the level of inquiry was low. After all, students had to follow the experiment protocol prepared by the teacher. Therefore, we recommend further studies to explore the effect of inquiry-based learning laboratories on students’ conceptual understanding of solutions and titration

    Characteristics and Distribution of Landslides in the Populated Hillslopes of Bujumbura, Burundi

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    Accurate and detailed multitemporal inventories of landslides and their process characterization are crucial for the evaluation of landslide hazards and the implementation of disaster risk reduction strategies in densely-populated mountainous regions. Such investigations are, however, rare in many regions of the tropical African highlands, where landslide research is often in its infancy and not adapted to the local needs. Here, we have produced a comprehensive multitemporal investigation of the landslide processes in the hillslopes of Bujumbura, situated in the landslide-prone East African Rift. We inventoried more than 1200 landslides by combining careful field investigation and visual analysis of satellite images, very-high-resolution topographic data, and historical aerial photographs. More than 20% of the hillslopes of the city are affected by landslides. Recent landslides (post-1950s) are mostly shallow, triggered by rainfall, and located on the steepest slopes. The presence of roads and river quarrying can also control their occurrence. Deep-seated landslides typically concentrate in landscapes that have been rejuvenated through knickpoint retreat. The difference in size distributions between old and recent deep-seated landslides suggests the long-term influence of potentially changing slope-failure drivers. Of the deep-seated landslides, 66% are currently active, those being mostly earthflows connected to the river system. Gully systems causing landslides are commonly associated with the urbanization of the hillslopes. Our results provide a much more accurate record of landslide processes and their impacts in the region than was previously available. These insights will be useful for land management and disaster risk reduction strategies

    Landslide inventory for hazard assessment in a data- poor context: a regional-scale approach in a tropical African environment

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    Landslide hazard remains poorly characterized on regional and global scales. In the tropics in particular, the lack of knowledge on landslide hazard is in sharp contrast with the high landslide susceptibility of the region. Moreover, landslide hazard in the tropics is expected to increase in the future in response to growing demographic pressure and climate and land use changes. With precipitation as the primary trigger for landslides in the tropics, there is a need for an accurate determination of rainfall thresholds for landslide triggering based on regional rainfall information as well as reliable data on landslide occurrences. Here, we present the landslide inventory for the central section of the western branch of the East African Rift (LIWEAR). Specific attention is given to the spatial and temporal accuracy, reliability, and geomorphological meaning of the data. The LIWEAR comprises 143 landslide events with known location and date over a span of 48years from 1968 to 2016. Reported landslides are found to be dominantly related to the annual precipitation patterns and increasing demographic pressure. Field observations in combination with local collaborations revealed substantial biases in the LIWEAR related to landslide processes, landslide impact, and the remote context of the study area. In order to optimize data collection and minimize biases and uncertainties, we propose a three-phase, Search-Store-Validate, workflow as a framework for data collection in a data-poor context. The validated results indicate that the proposed methodology can lead to a reliable landslide inventory in a data-poor context, valuable for regional landslide hazard assessment at the considered temporal and spatial resolutions

    Landslide inventory for hazard assessment in a data-poor context: a regional-scale approach in a tropical African environment

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    © 2018, Springer-Verlag GmbH Germany, part of Springer Nature. Landslide hazard remains poorly characterized on regional and global scales. In the tropics in particular, the lack of knowledge on landslide hazard is in sharp contrast with the high landslide susceptibility of the region. Moreover, landslide hazard in the tropics is expected to increase in the future in response to growing demographic pressure and climate and land use changes. With precipitation as the primary trigger for landslides in the tropics, there is a need for an accurate determination of rainfall thresholds for landslide triggering based on regional rainfall information as well as reliable data on landslide occurrences. Here, we present the landslide inventory for the central section of the western branch of the East African Rift (LIWEAR). Specific attention is given to the spatial and temporal accuracy, reliability, and geomorphological meaning of the data. The LIWEAR comprises 143 landslide events with known location and date over a span of 48 years from 1968 to 2016. Reported landslides are found to be dominantly related to the annual precipitation patterns and increasing demographic pressure. Field observations in combination with local collaborations revealed substantial biases in the LIWEAR related to landslide processes, landslide impact, and the remote context of the study area. In order to optimize data collection and minimize biases and uncertainties, we propose a three-phase, Search-Store-Validate, workflow as a framework for data collection in a data-poor context. The validated results indicate that the proposed methodology can lead to a reliable landslide inventory in a data-poor context, valuable for regional landslide hazard assessment at the considered temporal and spatial resolutions.status: publishe
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