Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018

Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations.Peer reviewe

Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49\ub74% (95% uncertainty interval [UI] 46\ub74–52\ub70). The TFR decreased from 4\ub77 livebirths (4\ub75–4\ub79) to 2\ub74 livebirths (2\ub72–2\ub75), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83\ub78 million people per year since 1985. The global population increased by 197\ub72% (193\ub73–200\ub78) since 1950, from 2\ub76 billion (2\ub75–2\ub76) to 7\ub76 billion (7\ub74–7\ub79) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2\ub70%; this rate then remained nearly constant until 1970 and then decreased to 1\ub71% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2\ub75% in 1963 to 0\ub77% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2\ub77%. The global average age increased from 26\ub76 years in 1950 to 32\ub71 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59\ub79% to 65\ub73%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1\ub70 livebirths (95% UI 0\ub79–1\ub72) in Cyprus to a high of 7\ub71 livebirths (6\ub78–7\ub74) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0\ub708 livebirths (0\ub707–0\ub709) in South Korea to 2\ub74 livebirths (2\ub72–2\ub76) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0\ub73 livebirths (0\ub73–0\ub74) in Puerto Rico to a high of 3\ub71 livebirths (3\ub70–3\ub72) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2\ub70% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill & Melinda Gates Foundation

The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. METHODS: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. FINDINGS: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]). INTERPRETATION: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden

Dynamic Appearance-Based Recognition

We describe a hierarchical appearance-based method for learning, recognizing, and predicting arbitrary spatiotemporal sequences of images. The method, which implements a robust hierarchical form of the Kalman filter derived from the Minimum Description Length (MDL) principle, includes as a special case several well-known object encoding techniques including eigenspace methods for static recognition. Successive levels of the hierarchical filter implement dynamic models operating over successively larger spatial and temporal scales. Each hierarchical level predicts the recognition state at a lower level and modifies its own recognition state using the residual error between the prediction and the actual lower-level state. Simultaneously, on a longer time scale, the filter learns an internal model of input dynamics by adapting its generative and state transition matrices at each level to minimize prediction errors. The resulting prediction /learning scheme thereby implements an on-line fo..

Robust Kalman Filters for Prediction, Recognition, and Learning

Using results from the field of robust statistics, we derive a class of Kalman filters that are robust to structured and unstructured noise in the input data stream. Each filter from this class maintains robust optimal estimates of the input process's hidden state by allowing the measurement covariance matrix to be a non-linear function of the prediction errors. This endows the filter with the ability to reject outliers in the input stream. Simultaneously, the filter also learns an internal model of input dynamics by adapting its measurement and state transition matrices using two additional Kalman filter-based adaptation rules. We present experimental results demonstrating the efficacy of such filters in mediating appearance-based segmentation and recognition of objects and image sequences in the presence of varying degrees of occlusion, clutter, and noise

Top-Down Gaze Targeting for Space-Variant Active Vision

The simultaneous need for a wide angle of field and high resolution has led to the use of spatially variant sensors in active vision systems. The use of such sensors however necessitates the existence of gaze control mechanisms for guiding the foveal high resolution region of the sensor to points of interest in the visual world. While bottom-up alerting cues such as motion have previously been used for this purpose, tasks such as visual search are better facilitated by top-down guidance mechanisms. In this paper, we describe the use of iconic scene descriptions for top-down foveal targeting. These descriptions take the form of a vector of responses of a bank of steerable filters at multiple scales and orientations. Such a representation has a number of useful properties such as rotation and scale invariance, partial view-insensitivity and tolerance to occlusions. Top-down control of gaze for uniform resolution sensors is achieved by the process of backprojection which matches vectors o..

On P-selectivity and Closeness

P/poly, the class of sets with polynomial size circuits, has been the subject of considerable study in complexity theory. Two important subclasses of P/poly are the class of sparse sets [6] and the class of P-selective sets [31]. A large number of results have been proved about both these classes but it has been observed (for example, [17]) that despite their similarity, proofs about one class generally do not translate easily to proofs regarding the other class. In this note, we propose to resolve this asymmetry by investigating the class PSEL-close of sets that are polynomially close to P-selective sets; by definition, PSEL-close includes both sparse sets and P-selective sets, thereby providing a unifying platform for proving results applicable to both. Intuitively, PSEL-close is the class of sets that can in a certain sense be approximated by P-selective sets. We prove several results separating PSEL-close from known classes within and including P/poly, and establish its location op..

On P-Selectivity and Closeness

P/poly, the class of sets with polynomial size circuits, has been the subject of considerable study in complexity theory. Two important subclasses of P/poly are the class of sparse sets [Berman and Hartmanis, 1977] and the class of P-selective sets [Selman, 1979]. A large number of results have been proved about both these classes but it has been observed (for example, [Hemaspaandra et al., 1993]) that despite their similarity, proofs about one class generally do not translate easily to proofs regarding the other class. In this note, we propose to resolve this asymmetry by investigating the class PSEL-close of sets that are polynomially close to P-selective sets; by definition, PSEL-close includes both sparse sets and P-selective sets, thereby providing a unifying platform for proving results applicable to both. Intuitively, PSEL-close is the class of sets that can in a certain sense be approximated by P-selective sets. We prove several results separating PSEL-close from known classes within and including P/poly, and establish its location optimally in the extended low hierarchy. We illustrate the naturalness and usefulness of the class by examining the question of whether sets hard for NP or E can be PSEL-close; several well-known results are obtained as immediate corollaries