Current and former smokers among adolescents aged 12-17 years in Iran: A systematic review and meta-analysis

Background: Smoking, especially among adolescents, is considered a serious public health concern worldwide being associated with increased mortality. The present study was designed as the first systematic review and meta-analysis of the prevalence of current and former smoking behavior among adolescents in Iran. Methods: Seven international scholarly databases, namely Scopus, Embase, Pubmed/Medline, ISI/Web of Science (WOS), the Cochrane Library, Psyc Info and Cinahl, were extensively searched from January 2000 to September 18, 2019. Google Scholar was also mined. Iranian databases were searched as well (namely, MagIran, Scientific Information Database (SID), and Barakatkns). The DerSimonian-Laird's approach, via the Freeman-Tukey double arcsine method, was used to synthesize the prevalence estimates. Results: The prevalence of current smokers among Iranian adolescents was estimated to be 9 (95 CI: 7 to 10). Stratifying based on gender, the prevalence was 12 among boys (95 CI: 10 to 14) and 6 among girls (95 CI: 5 to 8). The prevalence of former smokers among Iranian adolescents using the random-effect model was computed to be 24 (95 CI: 21 to 27). Conclusion: The findings of this study showed that the prevalence of current and former smoking behavior among Iranian adolescents is a relevant public health concern. The country's young population should be given more attention by health policy- A nd decision-makers and implementation of ad hoc prevention and control policies should be on their agenda. © 2020 The Author(s)

The challenges of implementation of clinical governance in Iran: A meta-synthesis of qualitative studies

Background: Policy- and decision-makers seek to improve the quality of care in the health sector and therefore aim to improve quality through appropriate policies. Higher quality of care will satisfy service providers and the public, reduce costs, increase productivity, and lead to better organisational performance. Clinical governance is a method through which management can be improved and made more accountable, and leads to the provision of better quality of care. In November 2009, the Iranian Ministry of Health and Medical Education implemented new clinical guidelines to standardise and improve clinical services as well as to increase efficiency and reduce costs. The purpose of this study was to assess the challenges of implementing clinical governance through a meta-synthesis of qualitative studies published in Iran. Methods: Ten databases, including ISI/Web of Sciences, PubMed/MEDLINE, Embase, PsycINFO, the Cochrane Library, CINAHL, Scopus, Barakatns, MagIran and the Scientific Information Database, were searched between January 2009 and May 2018. The quality of the included studies was assessed using the Critical Appraisal Skills Programme tool. This study was reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines. Thematic synthesis was used to analyse the data. Results: Ten studies were selected and included based on the inclusion/exclusion criteria. In the first stage, 75 items emerged and were coded, and, following comparison and combination of the codes, 32 codes and 8 themes were finally extracted. These themes included health system structure, management, person-power, cultural factors, information and data, resources, education and evaluation. Conclusion: The findings of the study showed that there exist a variety of challenges for the implementation of clinical governance in Iran. To successfully implement a health policy, its infrastructure needs to be created. Using the views and support of stakeholders can ensure that a policy is well implemented. Trial registration: CRD42017079077. Dated October 10, 2017. © 2019 The Author(s)

Prevalence rate of hepatitis B virus in pregnancy: Implications from a systematic review and meta-analysis of studies published from 2000 to 2016

Background: Hepatitis B Virus (HBV) is one of the most serious infectious diseases and represents a major global health issue worldwide. It can be transmitted vertically and horizontally through contact with infected blood or body fluids. More attention to HBV infection in pregnancy is needed due to high risk of chronicity when transmitted to infants during delivery. Objectives: A comprehensive review of the HBV prevalence rate in pregnant females taking into account different geographical areas and socio-economic status is still lacking. This would be of crucial importance for HBV prevention and control programs. As such, this systematic review and meta-analysis was conducted focusing on HBV prevalence rate in pregnant females from different parts of the world. Methods: Different electronic databases, including Embase, PubMed/MEDLINE, Scopus, and ISI/Web of Science were searched from January 1st 2000 to July 31st 2016, using relevant keywords, such as �prevalence� or �seroprevalence� or �epidemiology� and �pregnancy� or �pregnant� or �antenatal� in combination with �hepatitis B virus� or �HBV� with no language restrictions. The study protocol of this systematic review was deposited at the �International Prospective Register of Systematic Reviews� and registered as CRD42016041985. Results: After scrutinizing all the extant scholarly literature from 2000 to 2016, this study found 222 relevant articles. The overall HBV prevalence rate in pregnant females worldwide was estimated using a random-effect model, giving a value of 3 (95 confidence interval or CI 2 - 4). Heterogeneity between studies was significantly high (I2 = 99.9, P < 0.0001). The clinical and epidemiological burden was higher in developing countries. Conclusions: This suggests that despite the recent scientific advancements and the clinical progress that has occurred in anti-viral therapy, HBV still represents a major issue worldwide, especially in underdeveloped countries. The key strategies for preventing transmission from pregnant females to their fetuses are through early birth dose and infant vaccination, as well as by the use of hepatitis B immunoglobulin (HBIG) and the screening and diagnosis of mothers at high risk and the subsequent use of anti-viral agents during pregnancy in order to reduce maternal DNA concentrations down to undetectable concentrations. Health authorities should effectively implement these approaches to better control HBV in pregnancy. © 2018, Hepatitis Monthly

Prevalence rate of hepatitis B virus in pregnancy: Implications from a systematic review and meta-analysis of studies published from 2000 to 2016

Background: Hepatitis B Virus (HBV) is one of the most serious infectious diseases and represents a major global health issue worldwide. It can be transmitted vertically and horizontally through contact with infected blood or body fluids. More attention to HBV infection in pregnancy is needed due to high risk of chronicity when transmitted to infants during delivery. Objectives: A comprehensive review of the HBV prevalence rate in pregnant females taking into account different geographical areas and socio-economic status is still lacking. This would be of crucial importance for HBV prevention and control programs. As such, this systematic review and meta-analysis was conducted focusing on HBV prevalence rate in pregnant females from different parts of the world. Methods: Different electronic databases, including Embase, PubMed/MEDLINE, Scopus, and ISI/Web of Science were searched from January 1st 2000 to July 31st 2016, using relevant keywords, such as �prevalence� or �seroprevalence� or �epidemiology� and �pregnancy� or �pregnant� or �antenatal� in combination with �hepatitis B virus� or �HBV� with no language restrictions. The study protocol of this systematic review was deposited at the �International Prospective Register of Systematic Reviews� and registered as CRD42016041985. Results: After scrutinizing all the extant scholarly literature from 2000 to 2016, this study found 222 relevant articles. The overall HBV prevalence rate in pregnant females worldwide was estimated using a random-effect model, giving a value of 3 (95 confidence interval or CI 2 - 4). Heterogeneity between studies was significantly high (I2 = 99.9, P < 0.0001). The clinical and epidemiological burden was higher in developing countries. Conclusions: This suggests that despite the recent scientific advancements and the clinical progress that has occurred in anti-viral therapy, HBV still represents a major issue worldwide, especially in underdeveloped countries. The key strategies for preventing transmission from pregnant females to their fetuses are through early birth dose and infant vaccination, as well as by the use of hepatitis B immunoglobulin (HBIG) and the screening and diagnosis of mothers at high risk and the subsequent use of anti-viral agents during pregnancy in order to reduce maternal DNA concentrations down to undetectable concentrations. Health authorities should effectively implement these approaches to better control HBV in pregnancy. © 2018, Hepatitis Monthly

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

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. © 2020, The Author(s)

Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. METHODS: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. FINDINGS: Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. INTERPRETATION: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing

Author Correction: Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017 (Nature Medicine, (2020), 26, 5, (750-759), 10.1038/s41591-020-0807-6)

An amendment to this paper has been published and can be accessed via a link at the top of the paper. © 2020, The Author(s)

Author Correction: Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017 (Nature Medicine, (2020), 26, 5, (750-759), 10.1038/s41591-020-0807-6)

An amendment to this paper has been published and can be accessed via a link at the top of the paper. © 2020, The Author(s)