Explaining technical inefficiency and the variation in income from apple adoption in highland Ethiopia: The role of unequal endowments and knowledge asymmetries

This paper considers the performance and quality of apple fruits and seedlings production in Chencha district of southern Ethiopia. The estimated, three-factor (labour, land and capital) production frontier reveals that the technical inefficiency is 60% and 48% for fruits and seedlings production, respectively. Endowments in land, apple plantation and manure are important production factors for both fruits and seedlings, while labour is significant only for seedlings production. We could not reject constant returns to scale, neither for apple fruits nor for seedlings. Apart from capital and labour endowments, producer knowledge on apple cultivation is a positive and significant determinant of the level of output, product quality, and income generated from apples. The insignificance of the education variable for fruits and seedlings production suggests that what matters in the apple business is specific knowledge of apple-growing technology rather than formal education, at least beyond primary education

Explaining technical inefficiency and the variation in income from apple adoption in highland Ethiopia : The role of unequal endowments and knowledge asymmetries

This paper considers the performance and quality of apple fruits and seedlings production in Chencha district of southern Ethiopia. The estimated, three-factor (labour, land and capital) production frontier reveals that the technical inefficiency is 60% and 48% for fruits and seedlings production, respectively. Endowments in land, apple plantation and manure are important production factors for both fruits and seedlings, while labour is significant only for seedlings production. We could not reject constant returns to scale, neither for apple fruits nor for seedlings. Apart from capital and labour endowments, producer knowledge on apple cultivation is a positive and significant determinant of the level of output, product quality, and income generated from apples. The insignificance of the education variable for fruits and seedlings production suggests that what matters in the apple business is specific knowledge of apple-growing technology rather than formal education, at least beyond primary education.</p

Factors Affecting the Profitability of Smallholder Common Bean Producers in Central Rift Valley of Ethiopia

አህፅሮት ቦሎቄ ከዋና ዋናዎቹ የጥራጥሬ ሰብሎች የሚመደብ ሰብል ሲሆን ለሀገሪቱ ኢኮኖሚ እንዲሁም ለአርሶ አደሩ የምግብና የገቢ ምንጭ በመሆን ከፍተኛ አስተዋፅዖ ያደርጋል፡፡ በምስራቅና ደቡብ አፍሪካ ውስጥ ኢትዮጵያ በቦሎቄ ምርት የሦስተኛ ደረጃን ትይዛለች፡፡ በ2010 ዓ.ም. ሀገሪቱ 40 በመቶ የሚሆነውን የቦሎቄ ምርት ወደ አለም አቀፍ ገበያ ልካለች፡፡ ቦሎቄ ከፍተኛ የኢኮኖሚ ጠቀሜታ ያለው ሰብል ቢሆንም ሰፊ የሆነ የተሸሻሉ የቦሎቄ ዝርያዎች ስርጭት በተለያዩ ጊዜያት ቢከናወኑም በቅርብ ጊዜ በተለይም በመካከለኛው ስምጥ ሸለቆ ያሉ አርሶ አደሮች ወደሌሎች ሰብሎች ሲያዘነብሉ ይታያል፡፡ ከዚህ ችግር ጋር በተያያዘ ሁኔታ የቦሎቄ ምርት የትርፋማነት ጥናት አለመኖር የመረጃ ጉድለት ፈጥሯል፡፡ አብዛኞቹ ከዚህ በፊት የተደረጉ ጥናቶች የሰብሉን የትርፋማነትና አዋጭነት ጥናት ያላደረጉ ሲሆን ጥናቱ ይህንን ጉደለት ለመሙላት ታስቦ የተተገበረ ነው፡፡ የአርሶ አደሩ ትርፋማነት ለማጥናት ይረዳ ዘንድ የቦለቄ አምራች በሆኑ አካባባዎች አርሶ አደሮች በተለየ የመምረቻ ዘዴ ተለይተው የቅኝት ተሳታፊ ሆነዋል፡፡ የተሰበሰበውም መረጃ ቀለል ያሉ የመረጃ ቀመሮችና እና ለአዋጭነት አስተዋጽኦ ያለቸው ምክንያቶች ትንተና ተደርጎበታል፡፡ የጥናቱ ውጤት እንደሚያሳየው ከሆነ የአርሶ አደሩ ያልተጣራ ጠቅላላ ትርፍ በአማካይ 13486 ብር በሄክታር&nbsp; ሲሆን ጠቅላላ የተጣራ ገቢ ደግሞ 8127 ብር በሄክታር ይሆናል፡፡ ለቦሎቄ ምርት ትርፋማነት አስተዋዕኦ ከሚያደርጉ አበይት ምክንቶች ውስጥ አርሶ አደሩ ከዋና ገበያ ያለው ርቀት፣ የአርሶ አደሩ የእድሜ ሁኔታ፣ የቤተሰቡ ቁጥር፤ ከግብርና ስራ ውጭ ያሉ ገቢዎች እና የማዳበሪያ ማግኛ ምንጮች አስፈላጊ ሆነው ተገኝተዋል፡፡ በአንጻራዊ መልኩ ሲታይ የወንድ አባወራ አርሶ አደሮች የተሻለ ትርፋማ ሲሆኑ፤ በግብርና ስራ ያለ ልምድ፤ በገበሬ ቡድን አባል መሆንና ምርቱ የተሸጠበት የገበያ ሰንሰለት ዓይነቶች አዎንታዊ በሆነ መልኩ ተጽዕኖ የሚሳድሩ ምክንያቶች ናቸው፡፡ ስለዚህም የቦለቄ አምራች አርሶ አደሮችን ትርፋማነት ለመጨመር፤ አዎንታዊ ምክንያቶችን ከፍ ማድረግና አሉታዊ ምክንያቶችን በመቀነስ የፖሊሲ እርምጃዎችን ማቀናጀት ያስፈልጋል፡፡ &nbsp; Abstract Common bean is one of the major pulse crops which played an important role in the Ethiopian national economy and to farmers as food and cash income. Ethiopia ranked third in common bean production in Eastern and Southern Africa. The country exported 40 percent of its total common bean production in 2010. Despite the wide dissemination of improved common bean varieties and its economic importance, there is a dearth of information on the profitability of smallholder farmers from common bean production. Most of the previous studies on common bean did little on the profitability of smallholder bean producers. This study is designed with the aim of assessing the profitability status of smallholder common bean producers and factors correlated with it. Sample bean producers were selected randomly using simple random sampling. The cross-sectional data collected from sampled households are analyzed using descriptive statistics and Ordinary Least Square (OLS). The result of the study shows that the mean common bean gross margin and net farm income was 13486 and 8127 Birr/ha respectively. Distance from the nearest market, Age, Family size, off farm income and fertilizer source are the factors influencing the profitability of smallholder common bean producers negatively. However, Gender, farm experience, group membership and target market channel had a positive significant influence on smallholder based common bean production profitability. Therefore, in order to enhance the profitability of smallholder households, among others, it is important to improve access to input and output market and collective actions by farmers. There is also a need to minimize the gender gap in the profitability through affirmative action such as the provision of special credit and access to modern technologies by female farmers.&nbsp; &nbsp

Gender inequality and the sexual and reproductive health status of young and older women in the Afar Region of Ethiopia

The main purpose of this research was to analyze gender context in the Afar region of Ethiopia and propose a set of strategies or actions to improve adolescent and youth health. Using a pre-established gender analysis framework, an explorative qualitative study was conducted in five districts. Sixteen key informants and eight focus group discussions were conducted among adult women and men of young adolescents and youth. The study revealed that younger and older women are the most disadvantaged groups of the society. This is due to the high workload on women and girls (housekeeping, building a house and taking care of cattle and children), they also are less valued, have no control over resources and have no part in decision making, including their personal life choices. As a result, they rarely access school and health facilities. They are forced get married according to arranged marriage called “absuma.” As such, they suffer from multiple reproductive health problems. Women have poor decision-making autonomy, lack control over resources, have limited participation in socio-economic practices, and experience child and early forced marriage, and this poor service utilization has exposed them to the worst sexual and reproductive health outcomes

Cultural malpractice during pregnancy, childbirth, and the postnatal period and its associated factors among women who gave birth once in Dire Dawa city administration, Eastern Ethiopia, in 2021

BackgroundCultural practices are any experiences or beliefs that are socially shared views and behaviors practiced in a certain society at a certain time. Cultural malpractices are defined as socially shared views and traditionally accepted behaviors experienced in a certain society that harm maternal health. Worldwide, the period of pregnancy, labor, and delivery is embedded with different beliefs, customs, and rituals in different societies that contribute a lot to maternal death. They are responsible for the annual deaths of 303,000 mothers and 2.7 million newborns globally. In developing countries, it accounts for approximately 5%–15% of maternal deaths. In Ethiopia, approximately 18% of infant deaths occur due to cultural malpractice, and 52% of pregnant mothers give birth at home following cultural customs in Dire Dawa city. The objective of this study was to assess cultural malpractices during pregnancy, childbirth, and the postnatal period and its associated factors among women who gave birth once in Dire Dawa City in 2021.MethodsCommunity-based mixed study was conducted. A total of 624 study participants were selected through a systematic random sampling technique, and a purposive sampling method was used for qualitative data. The study was conducted in the randomly selected Kebeles of Dire Dawa City, Eastern Ethiopia, from November 1 to December 30, 2021. Data were entered into Epi Data version 4.1 and exported to SPSS version 24 for analysis. Bivariate and multivariate analyses were done, and the degree of association was measured by using the odds ratio with 95% CI and significance was declared at a p-value of &lt;0.05. The qualitative data were analyzed thematically using ATLAS-ti version 7.ResultsThe overall prevalence of cultural malpractice during pregnancy, childbirth, and the postnatal period was 74.6% [95% CI: 70.59%, 77.49%]. Women over the age of 35 were two times more likely [AOR 2.61, 95% CI, 1.45–4.72] to commit cultural malpractice than women aged 15–24 and 25–34. Those with no antenatal care (ANC) follow-up were three times more likely to commit cultural malpractice [AOR 3.57, 95% CI, 1.72–7.40], those who were absent from health education were nearly two times more likely to commit cultural malpractice [AOR 1.83, 95%CI, 1.25–2.67], and women whose culture allows harmful traditional practices were nearly two times more likely to commit cultural malpractices than their counterparts [AOR 1.69, 95%CI, 1.29–2.54].ConclusionIn this study, nearly three-fourths of participants were involved in cultural malpractices. Therefore, strengthening community education and behavioral change messages on the importance of ANC and avoiding unhealthy care during pregnancy, childbirth, postnatal and neonatal periods, especially with pregnancy at old age (age &gt; 35), may help to reduce cultural malpractices

Zoonotic tuberculosis in a high bovine tuberculosis burden area of Ethiopia

BackgroundTuberculosis (TB) is a major cause of ill health and one of the leading causes of death worldwide, caused by species of the Mycobacterium tuberculosis complex (MTBC), with Mycobacterium tuberculosis being the dominant pathogen in humans and Mycobacterium bovis in cattle. Zoonotic transmission of TB (zTB) to humans is frequent particularly where TB prevalence is high in cattle. In this study, we explored the prevalence of zTB in central Ethiopia, an area highly affected by bovine TB (bTB) in cattle.MethodA convenient sample of 385 patients with pulmonary tuberculosis (PTB, N = 287) and tuberculous lymphadenitis (TBLN, N = 98) were included in this cross-sectional study in central Ethiopia. Sputum and fine needle aspirate (FNA) samples were obtained from patients with PTB and TBLN, respectively, and cultures were performed using BACTEC™ MGIT™ 960. All culture positive samples were subjected to quantitative PCR (qPCR) assays, targeting IS1081, RD9 and RD4 genomic regions for detection of MTBC, M. tuberculosis and M. bovis, respectively.ResultsTwo hundred and fifty-five out of 385 sampled patients were culture positive and all were isolates identified as MTBC by being positive for the IS1081 assay. Among them, 249 (97.6%) samples had also a positive RD9 result (intact RD9 locus) and were consequently classified as M. tuberculosis. The remaining six (2.4%) isolates were RD4 deficient and thereby classified as M. bovis. Five out of these six M. bovis strains originated from PTB patients whereas one was isolated from a TBLN patient. Occupational risk and the widespread consumption of raw animal products were identified as potential sources of M. bovis infection in humans, and the isolation of M. bovis from PTB patients suggests the possibility of human-to-human transmission, particularly in patients with no known contact history with animals.ConclusionThe detected proportion of culture positive cases of 2.4% being M. bovis from this region was higher zTB rate than previously reported for the general population of Ethiopia. Patients with M. bovis infection are more likely to get less efficient TB treatment because M. bovis is inherently resistant to pyrazinamide. MTBC species identification should be performed where M. bovis is common in cattle, especially in patients who have a history of recurrence or treatment failure

The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15–39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods: Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15–39 years to define adolescents and young adults. Findings: There were 1·19 million (95% UI 1·11–1·28) incident cancer cases and 396 000 (370 000–425 000) deaths due to cancer among people aged 15–39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59·6 [54·5–65·7] per 100 000 person-years) and high-middle SDI countries (53·2 [48·8–57·9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14·2 [12·9–15·6] per 100 000 person-years) and middle SDI (13·6 [12·6–14·8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23·5 million (21·9–25·2) DALYs to the global burden of disease, of which 2·7% (1·9–3·6) came from YLDs and 97·3% (96·4–98·1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation: Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Funding: Bill &amp; Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St Baldrick's Foundation, and the National Cancer Institute

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs 1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). Interpretation: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury

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