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)

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)

Modelling the present and futurewater level and discharge of the tidal betna river

Climate change, comprising of changes in precipitation patterns, higher temperatures and sea level rises, increases the likelihood of future flooding in the Betna River basin, Bangladesh. Hydrodynamic modellingwas performed to simulate the present and future water level and discharge for different scenarios using bias-corrected, downscaled data from two general circulation models. The modelling results indicated that, compared to the baseline year (2014–2015), the water level is expected to increase by 11–16% by the 2040s and 14–23% by the 2090s, and the monsoon daily maximum discharge is expected to increase by up to 13% by the 2040s and 21% by the 2090s. Sea level rise is mostly responsible for the increase in water level. The duration of water level exceedance of the established danger threshold and extreme discharge events can increase by up to half a month by the 2040s and above one month by the 2090s. The combined influence of the increased water level and discharge has the potential to cause major floods in the Betna River basin. The results of our study increase the knowledge base on climate change influence on water level and discharge at a local scale. This is valuable for water managers in flood-risk mitigation and water management.</p

The impact of socio-economic development and climate change on E. coli loads and concentrations in Kabul River, Pakistan

Microbial pollution is a major problem worldwide. High concentrations of Escherichia coli have been found in Kabul River in Pakistan. E. coli concentrations vary under different socio-economic conditions, such as population and livestock densities, urbanisation, sanitation and treatment of wastewater and manure, and climate-change aspects, such as floods and droughts. In this paper, we assess potential future E. coli loads and concentrations in the Kabul River using the Soil and Water Assessment Tool with scenarios that are based on the most recent Shared Socio-economic Pathways and Representative Concentration Pathways (SSPs and RCPs) developed for the Intergovernmental Panel on Climate Change (IPCC). Scenario_1 considers moderate population and livestock density growth, planned urbanisation and strongly improved wastewater and manure treatment (based on SSP1, “Sustainability”), and moderate climate change (RCP4.5, moderate greenhouse gas (GHG) emissions). Scenario_2 considers strong population and livestock density growth, moderate urbanisation, slightly improved wastewater treatment, no manure treatment (based on SSP3, “Regional rivalry”) and strong climate change (RCP8.5, high GHG emissions). Simulated E. coli responses to Scenario_2 suggest a mid-century increase in loads by 111% and a late century increase of 201% compared to baseline loads. Similarly, simulated E. coli loads are reduced by 60% for the mid-century and 78% for the late century compared to the baseline loads. When additional treatment is simulated in Scenario_1, the loads are reduced even further by 94%, 92% and 99.3% compared to the baseline concentrations when additional tertiary treatment, manure treatment or both have been applied respectively. This study is one of the first to apply combined socio-economic development and climate change scenario analysis with an E. coli concentration model to better understand how these concentrations may change in the future. The scenario analysis shows that reducing E. coli concentrations in Pakistan's rivers is possible, but requires strongly improved waste water treatment and manure management measures.</p

Modelling the impact of future socio-economic and climate change scenarios on river microbial water quality

Microbial surface water quality is important, as it is related to health risk when the population is exposed through drinking, recreation or consumption of irrigated vegetables. The microbial surface water quality is expected to change with socio-economic development and climate change. This study explores the combined impacts of future socio-economic and climate change scenarios on microbial water quality using a coupled hydrodynamic and water quality model (MIKE21FM-ECOLab). The model was applied to simulate the baseline (2014-2015) and future (2040s and 2090s) faecal indicator bacteria (FIB: E. coli and enterococci) concentrations in the Betna river in Bangladesh. The scenarios comprise changes in socio-economic variables (e.g. population, urbanization, land use, sanitation and sewage treatment) and climate variables (temperature, precipitation and sea-level rise). Scenarios have been developed building on the most recent Shared Socio-economic Pathways: SSP1 and SSP3 and Representative Concentration Pathways: RCP4.5 and RCP8.5 in a matrix. An uncontrolled future results in a deterioration of the microbial water quality (+75% by the 2090s) due to socio-economic changes, such as higher population growth, and changes in rainfall patterns. However, microbial water quality improves under a sustainable scenario with improved sewage treatment (-98% by the 2090s). Contaminant loads were more influenced by changes in socio-economic factors than by climatic change. To our knowledge, this is the first study that combines climate change and socio-economic development scenarios to simulate the future microbial water quality of a river. This approach can also be used to assess future consequences for health risks

Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016

Background Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used causespecific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. Findings In 2016, there were 27.08 million (95% uncertainty interval [UI] 24.30-30.30 million) new cases of TBI and 0.93 million (0.78-1.16 million) new cases of SCI, with age-standardised incidence rates of 369 (331-412) per 100 000 population for TBI and 13 (11-16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55.50 million (53.40-57.62 million) and of SCI was 27.04 million (24.98-30.15 million). From 1990 to 2016, the agestandardised prevalence of TBI increased by 8.4% (95% UI 7.7 to 9.2), whereas that of SCI did not change significantly (-0.2% [-2.1 to 2.7]). Age-standardised incidence rates increased by 3.6% (1.8 to 5.5) for TBI, but did not change significantly for SCI (-3.6% [-7.4 to 4.0]). TBI caused 8.1 million (95% UI 6.0-10.4 million) YLDs and SCI caused 9.5 million (6.7-12.4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82-141) per 100 000 for TBI and 130 (90-170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. Interpretation TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments. © 2018 The Author(s)