15 research outputs found

    Global and national Burden of diseases and injuries among children and adolescents between 1990 and 2013

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    Importance The literature focuses on mortality among children younger than 5 years. Comparable information on nonfatal health outcomes among these children and the fatal and nonfatal burden of diseases and injuries among older children and adolescents is scarce. Objective To determine levels and trends in the fatal and nonfatal burden of diseases and injuries among younger children (aged <5 years), older children (aged 5-9 years), and adolescents (aged 10-19 years) between 1990 and 2013 in 188 countries from the Global Burden of Disease (GBD) 2013 study. Evidence Review Data from vital registration, verbal autopsy studies, maternal and child death surveillance, and other sources covering 14 244 site-years (ie, years of cause of death data by geography) from 1980 through 2013 were used to estimate cause-specific mortality. Data from 35 620 epidemiological sources were used to estimate the prevalence of the diseases and sequelae in the GBD 2013 study. Cause-specific mortality for most causes was estimated using the Cause of Death Ensemble Model strategy. For some infectious diseases (eg, HIV infection/AIDS, measles, hepatitis B) where the disease process is complex or the cause of death data were insufficient or unavailable, we used natural history models. For most nonfatal health outcomes, DisMod-MR 2.0, a Bayesian metaregression tool, was used to meta-analyze the epidemiological data to generate prevalence estimates. Findings Of the 7.7 (95% uncertainty interval [UI], 7.4-8.1) million deaths among children and adolescents globally in 2013, 6.28 million occurred among younger children, 0.48 million among older children, and 0.97 million among adolescents. In 2013, the leading causes of death were lower respiratory tract infections among younger children (905 059 deaths; 95% UI, 810 304-998 125), diarrheal diseases among older children (38 325 deaths; 95% UI, 30 365-47 678), and road injuries among adolescents (115 186 deaths; 95% UI, 105 185-124 870). Iron deficiency anemia was the leading cause of years lived with disability among children and adolescents, affecting 619 (95% UI, 618-621) million in 2013. Large between-country variations exist in mortality from leading causes among children and adolescents. Countries with rapid declines in all-cause mortality between 1990 and 2013 also experienced large declines in most leading causes of death, whereas countries with the slowest declines had stagnant or increasing trends in the leading causes of death. In 2013, Nigeria had a 12% global share of deaths from lower respiratory tract infections and a 38% global share of deaths from malaria. India had 33% of the world’s deaths from neonatal encephalopathy. Half of the world’s diarrheal deaths among children and adolescents occurred in just 5 countries: India, Democratic Republic of the Congo, Pakistan, Nigeria, and Ethiopia. Conclusions and Relevance Understanding the levels and trends of the leading causes of death and disability among children and adolescents is critical to guide investment and inform policies. Monitoring these trends over time is also key to understanding where interventions are having an impact. Proven interventions exist to prevent or treat the leading causes of unnecessary death and disability among children and adolescents. The findings presented here show that these are underused and give guidance to policy makers in countries where more attention is needed

    Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: Quantifying the epidemiological transition

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    Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition - in which increasing sociodemographic status brings structured change in disease burden - is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions

    Orienting Asean Towards Its People: Enabling Engagement With Local NGOs

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    Non-governmental organisations (NGOs), civil-society organisations and grassroots groups are a growing phenomenon across Southeast Asia. Many of these organisations fill in gaps and provide services that are not otherwise met by local authorities and governments; others purport to be the voice of the marginalised, disempowered or discriminated. There is a broad spectrum of these organisations present in Southeast Asia – from the home-grown entity that scavenges funds from myriad sources and volunteers; to large, international establishments with substantial regular funding, full-time staff and transnational networks and influence. ASEAN’s history in dealing with NGOs is chequered. Most affiliated organisations are government-owned or government-influenced organisations (GONGOs) who support ASEAN’s goals and legitimise its policies. This paper proposes that ASEAN should be more supportive of local ground-up organisations so that the regional body can act upon its goal of nurturing caring, equitable and inclusive communities with an empowered civil society, as well as fulfil its commitment to achieving the UN’s Sustainable Development Goals. An NGO Matrix that can be used as a tool to plot organisation types could help identify groups that should get the most support. As a demonstrative example, the tool has been applied to several environmental organisations currently active in South Malaysia

    Combatting Climate Change: Involving Indigenous Communities

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    Climate change combat is often in the hands of policy-makers, researchers and governments. However it is the marginalised and indigenous communities that feel the full force of climate change effects. To be effective the campaign needs to include the wisdom and traditional practices of these communities to better protect those who need it the most

    UN Development Goals: Sustaining the Southeast Asian Fisherman

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    The UN Sustainable Development Goals highlight the need to protect the oceans, coastlines and small-scale fishermen. However, this may be in conflict with ASEAN’s bid to reach the targets set out in the ASEAN Economic Community Blueprint. Serious political will and effective on-the-ground effort will be vital in preserving Southeast Asia’s highly endangered fishing heritage

    Sustainable Highland Development through Stakeholders’ Perceptions on Agro EcoTourism in Cameron Highlands: A Preliminary Finding

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    Cameron Highlands was discovered in 1885 and was developed as a hill station. It first served as a quaint retreat destination for the British residence where the urban morphology of its little town centres were strongly characterised by colonial architecture such as bungalows, institutional buildings and government offices, shophouses and market stalls. Eventually due to economic pressure and location potentials, more land was opened for tea plantations and vegetable and flower industries. Conversely, recent rapid uncontrolled developments in the built environment and agricultural sectors have tarnished its natural environment, old-world charm and historical values. If this trend persists, the popularity of Cameron Highlands as a vacation destination for local and foreign visitors may be badly affected. This research paper seeks to determine the perception of local stakeholders and tourists of the development in Cameron Highlands and whether they agree that agro-ecotourism can be used as a tool to achieve sustainability in the area. This paper is an assessment of a pilot test to determine initial perceptions toward Cameron Highlands development. The pilot test sample size was 41 respondents, comprising local authorities, local communities and NGOs, as well as local and international tourists. The results showed that the majority agreed that agro-ecotourism can generate a sustainable income and preserve the environment while ensuring sustainability through fair trade

    Sustainable Highland Development through Stakeholders’ Perceptions on Agro EcoTourism in Cameron Highlands: A Preliminary Finding

    No full text
    Cameron Highlands was discovered in 1885 and was developed as a hill station. It first served as a quaint retreat destination for the British residence where the urban morphology of its little town centres were strongly characterised by colonial architecture such as bungalows, institutional buildings and government offices, shophouses and market stalls. Eventually due to economic pressure and location potentials, more land was opened for tea plantations and vegetable and flower industries. Conversely, recent rapid uncontrolled developments in the built environment and agricultural sectors have tarnished its natural environment, old-world charm and historical values. If this trend persists, the popularity of Cameron Highlands as a vacation destination for local and foreign visitors may be badly affected. This research paper seeks to determine the perception of local stakeholders and tourists of the development in Cameron Highlands and whether they agree that agro-ecotourism can be used as a tool to achieve sustainability in the area. This paper is an assessment of a pilot test to determine initial perceptions toward Cameron Highlands development. The pilot test sample size was 41 respondents, comprising local authorities, local communities and NGOs, as well as local and international tourists. The results showed that the majority agreed that agro-ecotourism can generate a sustainable income and preserve the environment while ensuring sustainability through fair trade

    Sustainable Highland Development through Stakeholders’ Perceptions on Agro EcoTourism in Cameron Highlands: A Preliminary Finding

    No full text
    Cameron Highlands was discovered in 1885 and was developed as a hill station. It first served as a quaint retreat destination for the British residence where the urban morphology of its little town centres were strongly characterised by colonial architecture such as bungalows, institutional buildings and government offices, shophouses and market stalls. Eventually due to economic pressure and location potentials, more land was opened for tea plantations and vegetable and flower industries. Conversely, recent rapid uncontrolled developments in the built environment and agricultural sectors have tarnished its natural environment, old-world charm and historical values. If this trend persists, the popularity of Cameron Highlands as a vacation destination for local and foreign visitors may be badly affected. This research paper seeks to determine the perception of local stakeholders and tourists of the development in Cameron Highlands and whether they agree that agro-ecotourism can be used as a tool to achieve sustainability in the area. This paper is an assessment of a pilot test to determine initial perceptions toward Cameron Highlands development. The pilot test sample size was 41 respondents, comprising local authorities, local communities and NGOs, as well as local and international tourists. The results showed that the majority agreed that agro-ecotourism can generate a sustainable income and preserve the environment while ensuring sustainability through fair trade
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