Evaluating Potential Impacts of Climate Change on Hydro- meteorological Variables in Upper Blue Nile Basin, Ethiopia

Climate change impacts are the main concern for sustainability of water management, water use activities and agricultural production throughout the world. Climate changes alter regional hydrologic conditions and results in a variety of impacts on water resource systems. The objective of this study is to assess the impact of climate change on the hydro climatology of Finchaa Sub-basin located in upper Blue Nile Basin of Ethiopia. The GCM (General Circulation Model) derived scenarios (HadCM3 A2a & B2a SRES emission scenarios) were used for the climate projection. The statistical Downscaling Model (SDSM) was used to generate future possible local meteorological variables in the study area. The down-scaled data were then used as input to the Soil and Water Assessment Tool (SWAT) model to simulate the corresponding future stream flow in of Finchaa Sub-basin. The time series generated by GCM of HadCM3 A2a and B2a and Statistical Downscaling Model (SDSM) indicate a significant increasing trend in maximum and minimum temperature values and a slight decreasing trend in precipitation for both A2a1 and B2a2 emission scenarios in sub-basin for all three bench mark periods. The hydrologic impact analysis made with the downscaled temperature and precipitation time series as input to the SWAT model suggested an overall decreasing trend in annual and monthly stream flow in the study area, in three benchmark periods in the future. Potential evapotranspiration in the watershed also will increase annually on average 3 to 16 % for the 2020s and 4 to 19 % for the 2050s and 2080s for both A2a and B2a emissions scenarios. As a result, at the ut let of the watershed the projected on average annual flow decrease by 5.59 %,9.03 %,11% and 2.16 %,4.15 and 3.46 % for the 2020s,2050s and 2080s for both A2a and B2a emissions scenarios. The paper also includes potential strategy recommendations to communities, policy and decision makers for measuring and enhancing effective adaptation option for future climate change impacts on hydrology. Keywords: A2a, B2a, climate change; Finchaa sub-basin, GCM, SDSM, stream flow; SWA

Studies on Temporal Relationship between Normalized Difference Vegetation Index and Rainfall in the Southern Part of Ethiopia

Nowadays remote sensing has become a powerful tool for many aspects of global monitoring for its convenience and high efficiency. This study analyzed temporal distribution of normalized differences vegetation index (NDVI) on the southern Ethiopia and their correlation with rainfall factors from 1995 to 2004. Monthly and annual data of NDVI and rainfall are examined to determine the consequence of rainfall variability on the NDVI of vegetation cover. Normalized Difference Vegetation Index (NDVI) data from  the National Oceanic and Atmospheric Administration (NOAA) satellites and rainfall data from National Meteorology Agency (NMA) were used to investigate the temporal pattern of rainfall and  the response  of vegetation to rainfall in Southern part of Ethiopia. Thus, NDVI is an important variable for climate applications and agricultural productions. It is also important to study the NDVI for different seasons and at different agro-ecological areas to investigate its effects. The temporal pattern of NDVI and rainfall revealed that vegetation responded directly to rainfall. The temporal patterns showed that there was between 0 to 1 months lag between rainfall and vegetation. However it was not possible to draw conclusion regarding the annual and monthly relationship between rainfall and NDVI because, it is not solely explained by rainfall parameter. Determining time series relationship between rainfall and vegetation (NDVI) will improve the prediction of local level rainfall distribution. Effective dissemination of this information to stakeholders will enhance the suffering of communities from vulnerability to climate related risk by improving their management. Keywords: NDVI, Rainfall, Correlation, Variability, Southern Ethiopi

The Eucalyptus Dilemma: The Pursuit for Socio-economic Benefit versus Environmental Impacts of Eucalyptus in Ethiopia

Eucalyptus is one of the most planted types of trees in the world, has been grown in Africa and elsewhere for over a century. The Ethiopia population is growing rapidly. The natural forest coverage and native forest tree species are decreasing in an alarming rate. There are many dilemmas among users, growers, environmentalists, researchers and policy makers on the ecological, socio-economic benefit and environmental impacts Eucalyptus. Ethiopia Farmers commonly plant eucalypts tree on their farmlands. Currently, growing eucalypt trees is becoming a great concern due to its socio-economic benefit and environmental impacts.In Ethiopia, where there are huge gaps between demand and supply of wood as a result of increasing deforestation, the use of fast growing plantation species such as eucalypts is unavoidable as they are preferred to other species, because of their peculiar features; these  include they require minimum care, fast growth and good quality of wood and fibres, easy reproduction  through  seeds, coppice  after  harvested, grow in wide ecological zones and poor environments;  resistant  to environmental  diseases and  stress and generates substantial  income to rural and urban households.On the other hand, Some of Eucalyptus impacts on the environment are: adverse effects of their leaf litter on soil humus, removal of too much water from farmlands, stream banks, catchments areas and underground water, heavy consumption of soil nutrients (deplete soil nutrients), failure to provide food supplies or adequate habitat for wildlife, inability to prevent soil erosion and inhibition of growth of other plants. Numerous study reports appeared that the benefits of Eucalyptus trees are far more than its negative impacts.Consequently, instead of complain whether to avoid plantation of Eucalyptus trees; emphasis should be given by the environmentalists, researchers and policy makers to support users and growers of Eucalyptus in selecting the appropriate place of plantation and species selection for the adequate uses and management on Eucalyptus planting, so that the environmental impacts are minimized and the socio- economic benefits of Eucalyptus were optimized. Therefore, this review paper briefly summarizes the socio-economic benefit and environmental Impacts of Eucalyptus trees. Keywords: Eucalyptus Dilemma; Socio-economic benefit; Environmental Impacts; Ecological effect

Effects of Climate Change on Soil and Water Resources: A Review

This review paper presents an overview of global impacts on soil and water resources as consequence of change in climate and summarizes the measures/adaptation options to minimize the risk. There is a strong scientific consensus that the earth’s climate has changed and will continue to change as human activities increase the concentrations of greenhouse gases in the atmosphere. World population is increasing day by day and at the same time soil and water resources is threatened due to natural resource degradation and climate change. The recent IPCC report has clearly stated that warming of the climate system is unequivocal and it is very likely” caused by natural and human activities. Numerous scholars reported that climate change affects hydrological cycle or water cycle components, especially precipitation, evapotranspiration, temperature, stream flow, ground water and surface runoff. A change in climate can alter the spatial and temporal availability of soil and water resources. These changes will result in increased floods and drought, which will have significant impacts on the soil and water resource availability. Soils are complicatedly linked to the climate system through nitrogen, the carbon, and hydrologic cycles. Because of change in climate soil processes and properties will affected. Along with changes in temperature, climate change will bring changes in global rainfall amounts and distribution patterns. And since temperature and water are two factors that have a large influence on the processes that take place in soils, climate change will therefore cause changes in the world’s soils. Water resources management can help to counter balance effects of climate change on stream flow and water availability until a certain level. This review paper starts with highlighting the studies on the impacts of climate changes on soil and water resource mainly due to change in temperature and rainfall. The impacts of climate change on soil and water resources are highlighted, and respective studies on hydrological responses to climate change are examined. Finally the paper concludes by outlining possible adaptation options in the realm of climate change impacts on soil and water resources. Keywords: Climate change, Soil and water resources, hydrological Cycle, soil processes and Propertie

Work-related Stress and Associated Factors among Academic Staffs at the University of Gondar, Northwest Ethiopia: An Institutionbased Cross-sectional Study

BACKGROUND: Work-related stress is described as a physiological and psychological reaction to the harmful aspects of workplace content. Current evidence indicates that the world of education is a highly stressful occupation. However, in academicians in sub-Saharan African countries, such as Ethiopia,the prevalence and contributing factors are not well studied. This study was, therefore, aimed at filling this gap.METHODS: A cross-sectional study was conducted from March to April 2018. Stratified sampling technique was used to select 535 study participants. To measure work-related stress, we used the pre-tested and structured self-administered University and College Union stress questionnaire. Finally, a significant association was established at p< 0.05 and adjusted odds ratio (AOR) with 95% confidence intervals (CI) in the multivariable model.RESULTS: The overall prevalence of work-related stress in 12 months was 60.4% [95% CI (57.4, 63.5%)].The multivariable logistic regression analysis showed that smoking cigarette (AOR:2.84, 95% CI (1.25, 6.50), high job demand (AOR: 3.27, 95% CI(2.05, 5.21), low job control (AOR:2.25, 95% CI (1.21, 4.20) and age < 28 (AOR:0.25, 95% CI (0.10, 0.63) were the factors associated with work-related stress.CONCLUSION: The prevalence of work-related stress was high. Furthermore, higher emphasis required on job demand, job control, and cigarette smoking to ease the burden of work-related stress factors. This research, therefore, recommended that other causes of WRS, such as working conditions and further large-scale study, be considered for future research

Global, regional, and national burden of tuberculosis, 1990–2016: results from the Global Burden of Diseases, Injuries, and Risk Factors 2016 Study

Background Although a preventable and treatable disease, tuberculosis causes more than a million deaths each year. As countries work towards achieving the Sustainable Development Goal (SDG) target to end the tuberculosis epidemic by 2030, robust assessments of the levels and trends of the burden of tuberculosis are crucial to inform policy and programme decision making. We assessed the levels and trends in the fatal and non-fatal burden of tuberculosis by drug resistance and HIV status for 195 countries and territories from 1990 to 2016. Methods We analysed 15 943 site-years of vital registration data, 1710 site-years of verbal autopsy data, 764 site-years of sample-based vital registration data, and 361 site-years of mortality surveillance data to estimate mortality due to tuberculosis using the Cause of Death Ensemble model. We analysed all available data sources, including annual case notifications, prevalence surveys, population-based tuberculin surveys, and estimated tuberculosis cause-specific mortality to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how the burden of tuberculosis differed from the burden predicted by the Socio-demographic Index (SDI), a composite indicator of income per capita, average years of schooling, and total fertility rate. Findings Globally in 2016, among HIV-negative individuals, the number of incident cases of tuberculosis was 9·02 million (95% uncertainty interval [UI] 8·05–10·16) and the number of tuberculosis deaths was 1·21 million (1·16–1·27). Among HIV-positive individuals, the number of incident cases was 1·40 million (1·01–1·89) and the number of tuberculosis deaths was 0·24 million (0·16–0·31). Globally, among HIV-negative individuals the age-standardised incidence of tuberculosis decreased annually at a slower rate (–1·3% [–1·5 to −1·2]) than mortality did (–4·5% [–5·0 to −4·1]) from 2006 to 2016. Among HIV-positive individuals during the same period, the rate of change in annualised age-standardised incidence was −4·0% (–4·5 to −3·7) and mortality was −8·9% (–9·5 to −8·4). Several regions had higher rates of age-standardised incidence and mortality than expected on the basis of their SDI levels in 2016. For drug-susceptible tuberculosis, the highest observed-to-expected ratios were in southern sub-Saharan Africa (13·7 for incidence and 14·9 for mortality), and the lowest ratios were in high-income North America (0·4 for incidence) and Oceania (0·3 for mortality). For multidrug-resistant tuberculosis, eastern Europe had the highest observed-to-expected ratios (67·3 for incidence and 73·0 for mortality), and high-income North America had the lowest ratios (0·4 for incidence and 0·5 for mortality). Interpretation If current trends in tuberculosis incidence continue, few countries are likely to meet the SDG target to end the tuberculosis epidemic by 2030. Progress needs to be accelerated by improving the quality of and access to tuberculosis diagnosis and care, by developing new tools, scaling up interventions to prevent risk factors for tuberculosis, and integrating control programmes for tuberculosis and HIV

Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000-17

Background Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000-17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2 center dot 5th and 97 center dot 5th percentiles of those 250 draws. Findings While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62 center dot 6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000-7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910-68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. Copyright (c) 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks 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 (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. Methods The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODErn), to generate cause fractions and cause specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. Findings At the broadest grouping of causes of death (Level 1), non-communicable diseases (NC Ds) comprised the greatest fraction of deaths, contributing to 73.4% (95% uncertainty interval [UI] 72.5-74.1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 186% (17.9-19.6), and injuries 8.0% (7.7-8.2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22.7% (21.5-23.9), representing an additional 7.61 million (7. 20-8.01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7.9% (7.08.8). The number of deaths for CMNN causes decreased by 222% (20.0-24.0) and the death rate by 31.8% (30.1-33.3). Total deaths from injuries increased by 2.3% (0-5-4-0) between 2007 and 2017, and the death rate from injuries decreased by 13.7% (12.2-15.1) to 57.9 deaths (55.9-59.2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118.0% (88.8-148.6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36.4% (32.2-40.6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33.6% (31.2-36.1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respirator}, infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990 neonatal disorders, lower respiratory infections, and diarrhoeal diseases were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. Interpretation Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.Peer reviewe