Knowledge, attitude and practice of mothers/caregivers on infant and young child feeding in Shabelle zone, Somali Region, Eastern Ethiopia: A cross sectional study

Knowledge, attitude and practice (KAP) of mothers/caregivers on infant and young child feeding are key factors for optimal nutritional status, health and growth of the children. Hence, this study aims to assess the knowledge, attitude and practice of the mothers/caregivers on infant and young child feeding. A cross sectional study was carried out among 415 mothers/caregivers from Gode and Adadle Districts in Shabelle Zone of Somali Region, Eastern Ethiopia, by using semi structured interviewer administered questionnaire. The principal component analysis was carried out to generate KAP indices. Multivariable logistic regression analyses were performed to isolate independent predictors for good knowledge, good practice and favourable attitude of the mothers/caregivers related to child feeding. Out of 415 study participants, 87.5%, and 69.4% were illiterate, and from rural residence, respectively. The majority (96.1 %) of the participants knew the importance of colostrums, time initiation, exclusive and duration of the breastfeeding, and, 82% believed that a newborn should be given butter, sugar and water for the first six months. Furthermore, 50% of the mothers started breastfeeding within one hour after delivery, 66% of the participants started additional food items before the age of the six months, and 69.2% continued breastfeeding for 24 months and above. On multivariable logistic regression, after adjusting for other predictors, being in Gode District (P <0.001), and not being housewife (P = 0.014) were significantly associated with having good Knowledge about optimal infant and young child feeding (IYCF), and wealth index (P = 0.001) are positively associated with favourable attitude, and being literate (P = 0.01) is positively associated with good practice. Conversely, good knowledge about optimal IYCF were negatively associated with favourable attitude (P <0.001), and urban and semi urban residence was negatively associated with good knowledge (P <0.001). In conclusion, the findings showed that despite the high knowledge of the participants on IYCF; a large proportion of mothers/caregivers had negative attitude and poor practice on proper IYCF leading to high rate of suboptimal feeding practices. Behavior change communication interventions using strategies appropriate for the pastoralist and agro pastoralist community. That is, targeting on culture, believes and practices related to IYCF, need to be performed using religious leaders, teachers, students, youth associations, female associations, health professionals, frontline health actors, and developmental armies to bridge the gap between knowledge and practice

Undernutrition prevalence and its determinants among children below five years of age in Shabelle zone, Somali region, eastern Ethiopia

Introduction: Malnutrition is a major public health problem worldwide. More than half of under-five child deaths are due to undernutrition, mainly in developing countries. Ethiopia is among the highest in Sub-Saharan Africa. While, Somali region is the worst in Ethiopia. Objection: This study aims to assess the prevalence and determinants of undernutrition among under-five children living in Gode and Adadle districts of Shabelle Zone, Somali region. Methods: A cross sectional study was carried out in August, 2014 among 415 child-mothers/caregivers. Face-to-face interview using a standard questionnaire, scales and stadiometer measurements of children’s weight and height were done. Bivariate analysis to identify candidate variable for multivariable analysis were done. Multivariable linear regression were used to determine predictors for undernutrition. Results: Out 415 children, 30.4% were stunted, 21.0% underweight, and 20.2% wasted, out of which 17.3%, 9.9% and 8.0% were severely stunted, wasted, and underweight, respectively. The prevalence of undernutrition significantly increased with the age of child. Male children were chronically malnourished (P=0.016), compared to females. Early initiation of breastfeeding after delivery (within one hour) decreases the number of chronic malnutrition (P<0.001). Insecticide treated nets (ITNs) users are less stunted and underweight (P=0.010 and P=0.049), respectively. The higher the number of under-five children in the family (β=-0.4, P=0.001) the lower z-score for weight for age, and being urban/semi-urban residence decreases the z-score for height for age and weight for age (β= -1.132, P=0.001, and β=-0.355, P=0.025), respectively. Conclusion: Undernutrition was high in the study area. The main predictors of undernutrition were age and sex of the children, initiation of breastfeeding, and ITNs uses. It is important to focus on awareness creation using behaviour change communication (BCC) on sustainable nutrition education programs for parents, youths, elders, teachers, and school children. Besides that, health workers and health extension workers capacity building are also necessary

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 : A systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000–2018

Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030

Predictors and prevalence of anemia, among children aged 6 to 59 months in shebelle zone, somali region, eastern Ethiopia: A cross sectional study

Introduction: Anemia is one of the major public health problems in the world. Anemia affected 273.2 million under five children in 2011 of which 62.2 % occur to Sub-Saharan Africa. Ethiopia is one of the seriously affected countries in this region. Hence, the aim of the study is to assess the prevalence, and the predictors of preschool children anemia in Shebelle Zone of Somali Region. Methods: A cross sectional study was conducted on 397 children 6 – 59 months and their mothers/caregivers in Gode and Adadle districts. A face-to-face interview for mothers/caregivers was done using a structured questionnaire, blood hemoglobin level of the children were measured using HemoCue 301. Anemia in this age group was diagnosed if hemoglobin level was less than 11g/dl. Bivariate and multivariable analysis was used to isolate independent predictors for under-five anemia. Results: The mean hemoglobin level of preschool children was 9.66 ± 1.75 g/dl, while the anemia prevalence was 72%, out of which 20%, 46%, and 6% were mild, moderate, and severe anemia, respectively. Children ≤ 24 months were nearly twice (AOR = 1.888, 95% CI = 1.092, 3.362) more likely to develop anemia, Male children were more affected by anemia (AOR = 1.66, 95% CI = 1.001, 2.742). Unprotected drinking water were nearly five times (AOR = 4.88, 95% CI = 2.204, 10.820) more likely to develop anemia, and children having sing of diseases for the last two weeks were more than three times (AOR=3.44, 95% CI = 1.869, 6,321) more likely to be anemic. Conclusion and recommendation: The mean hemoglobin level of this studied population was below the cut off for anemia (11g/dl), and the anemia prevalence in this study is very high, and approximately fifty percent of them are moderately anemic. Behavior change communication with early starting breastfeeding, de-worming, drinking clean, and boiled water, proper using of insecticide treated nets, environmental managements and other services are highly required

Effect of Nutrition Education Intervention on Knowledge Attitude and practice of mothers/caregivers on infant and young child feeding in Shabelle (Gode) Zone, Somali Region, Eastern Ethiopia

Optimal Infant and Young Child Feeding is very important for their health, growth and development. The impact of long term nutrition education intervention on child feeding in underprivileged community is not well documented. Therefore, this study was designed to document the effect of nutrition education intervention on knowledge, attitude and practice of mothers/caregivers towards optimal infants and young child feeding in Shabelle Zone of Somali Region. With regards to the materials and the methods, a randomized controlled trial study was conducted in August, 2015. Data were collected from 404 participants, after eight months of nutrition education intervention. SPSS version 20 software were used. A Chi-square and Fishers exact tests for categorical variables, and t-test for continues variables were used. Out of the total 415 participants assessed at baseline study, 404 were secured in the post intervention study. The majority (>80%) of the participants in both groups were illiterate, and housewives. The intervention group had shown statistical significant improvement in knowledge, attitude and practice of the mothers/caregivers (p<0.05) compared to control group in all tests; independent sample t-test mean score difference of the difference (p<0.001), and paired sample t-test mean score in intervention group (p<0.001). At the end, the nutrition education intervention was found effective in improving mothers/caregivers behaviours related to child feeding practices. Therefore, nutrition education intervention should be further scaled up and adapted to other areas in the Region. Makanan bagi bayi optimal dan kanak-kanak sangat penting untuk kesihatan, pertumbuhan dan perkembangan. Impak intervensi pendidikan pemakanan jangka panjang terhadap pemakanan kanak-kanak di komuniti miskin tidak didokumenkan dengan baik. Oleh itu, kajian ini direka bentuk untuk mendokumenkan kesan intervensi pendidikan nutrisi terhadap pengetahuan, sikap dan amalan ibu/penjaga terhadap bayi optimal dan pemakanan kanak-kanak di Shabelle Zone of Somalia Region. Berhubung dengan bahan dan kaedah, kajian percubaan kawal rawak telah dijalankan pada bulan Ogos, 2015. Data dikumpul dari 404 peserta, selepas lapan bulan intervensi pendidikan pemakanan. Perisian SPSS versi 20 telah digunakan. Ujian tepat Chi-square dan Fishers untuk pembolehubah kategori, dan ujian t untuk pemboleh ubah berterusan digunakan. Dari jumlah 415 peserta yang dinilai pada kajian dasar, 404 telah diperolehi dalam kajian intervensi selepas itu. Majoriti (> 80%) peserta dalam kedua-dua kumpulan adalah buta huruf, dan suri rumah. Kumpulan intervensi menunjukkan peningkatan statistik dalam pengetahuan, sikap dan amalan ibu/penjaga (p<0.05) berbanding kumpulan kawalan dalam semua ujian; Ujian t-ujian sampel bebas mempunyai perbezaan (p<0.001), dan skor pasangan ujian t-sampel yang bersamaan dengan kumpulan intervensi (p<0.001). Pada akhirnya, intervensi pendidikan pemakanan adalah berkesan dalam memperbaiki tingkah laku ibu/penjaga yang berkaitan dengan amalan pemakanan kanak-kanak. Oleh itu, intervensi pendidikan nutrisi perlu ditingkatkan dan disesuaikan dengan kawasan di wilayah lain

Age–sex differences in the global burden of lower respiratory infections and risk factors, 1990–2019: results from the Global Burden of Disease Study 2019

Background: The global burden of lower respiratory infections (LRI) and corresponding risk factors in children older than five years and adults has not been studied as comprehensively as in children under five years old. We assessed the burden and trends of LRI and risk factors across all age groups by sex for 204 countries and territories. Methods: We used clinician-diagnosed pneumonia or bronchiolitis as our case definition for lower respiratory infections. We included ICD9 codes 073.0-073.6, 079.82, 466-469, 480-489, 513.0, and 770.0 and ICD10 codes A48.1, J09-J22, J85.1, P23-P23.9, and U04. We used the Cause of Death Ensemble modelling strategy to analyse 23,109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age-sex-specific incidence and prevalence data identified via systematic review, population-based surveys, and claims and inpatient data. Additionally, we estimated age-sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors.Results: Globally, we estimated LRI episodes of 257 million (95% UI 240–275) for males and 232 million (217–248) for females in 2019. In the same year, LRI accounted for 1.3 million (1.2–1.4) deaths among males and 1.2 million (1.1–1.3) deaths among females. Age-standardised incidence and mortality rates were 1.2 times and 1.3 times greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups while an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older experiencing the highest increase in LRI episodes (126.0% [121.4–131.1]) and deaths (100.0% [83.4–115.9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for mortality among males under the age of five (70.7% [61.8–77.3]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths among males and females younger than five years were attributable to child wasting, and more than a quarter of LRI deaths among those aged 5–14 years were attributable to household air pollution in 2019. For males aged 15–49, 50–69, and 70 years and older, 20.4 (15.4-25.2), 30.5% (24.1–36.9), and 21.9% (16.8–27.3), respectively, of estimated LRI deaths were attributable to smoking in the same year. For females aged 15–49 and 50–69 years, 21.1% (14.5–27.9) and 7.9% (5.5–10.5) of estimated LRI deaths were attributable to household air pollution in 2019. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11.7% (8.2–15.8) of LRI deaths in the same year.Interpretation: The patterns and progress in reducing the burden of LRI and key risk factors varied across age groups and sexes.. The progress seen in under five children was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to achieving multiple Sustainable Development Goals targets, including promoting well-being at all ages and reducing inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would mean preventable deaths and millions of lives saved, as well as reduced health disparities