Impaired lipid levels and inflammatory response in rats exposed to cadmium

To investigate the subchronic effect of cadmium intoxication on lipid metabolism and the inflammatory responses accompanying it, rats were administered 50 and 100 ppm cadmium through their drinking water for 7 weeks. At both concentrations, cadmium exposure resulted in significant elevation (p < 0.05) of total cholesterol and gave rise to hypertriglyceridemia in the plasma of the animals. The proinflammatory cytokines, IL-2, IL-6 and TNF-α, were highly expressed in the animals. At the 50 ppm dose level, plasma IL-2, IL-6 and TNF-α levels were increased by 20 %, 87 % and 336 % respectively, while the 100 ppm dose yielded 32 %, 57 % and 470 % increases, respectively. A drastic build-up of MDA in the liver elicited by the metal led to an 85 % increase in lipid peroxidation at high dose. A 3-fold increase of lipid hydroperoxidation (LOOH) products was obtained on exposure to cadmium at 100 ppm. Cadmium caused more than a 2-fold increase in oxLDL levels at both doses tested. Paraoxonase activity was also significantly repressed, culminating in a 43 % reduction in activity at 100 ppm dose. Disruption of lipid metabolism, increased lipid peroxidation as well as imbalance in proinflammatory cytokine levels may thus, be means by which cadmium induces its toxicity

Perception of Medical Students on the Effect of Covid-19 on Medical Education in Nigeria

Background: The lockdown due to the COVID-19 pandemic disrupted normal activities including undergraduate medical education in Nigeria, similar to the rest of the world. Nigeria as a low- and middle-income country had peculiar challenges in adjusting to the new norm. This study aimed to assess Nigerian medical student’s perception of the effect of COVID-19 on their learning. Methods: A semi-structured, pre-tested online questionnaire was administered to consenting medical students from thirty-three medical schools in Nigeria. Questions assessed the effect of COVID-19 on study and wellbeing, as well as the perception of interventions from institutions and student organizations to reduce the lockdown consequence on learning. Data was analyzed using (SPSS) version 25. Results: A total of 623 students from 33 institutions participated. All private institutions and 25% of public institutions had commenced online lectures/tutorials, 92% of students in private institutions and 21% in public institutions had attended online lectures/tutorials. Of those who did not attend institution-organized classes, 30.5% were opposed to online lectures, the main reasons stated being internet cost/availability and inefficiency. About 65% of the participants were aware of student-organized online tutorials/seminars. Eighty percent did not feel motivated to study and perceived their personal study to be less effective. Conclusion: Nigerian medical student’s perception of the effect of COVID-19 on their medical education was largely negative. Private institutions fared better in coping with the challenges of the pandemic. Proper planning will be needed to curb the effect of COVID-19 on students’ health and wellbeing

Assessment of Training Needs Among Dairy Cattle Farmers in Oyo State, Nigeria

The training needs of dairy cattle farmers in Oyo state, Nigeria were assessed. A well-structured interview schedule was used to obtain information from 123 respondents. Data were collected on socio-economic characteristics of the respondents, their dairy cattle production enterprises and their training needs which were ascertained in six major areas of cattle production: feeding, breeding, healthcare, housing and management, marketing and finance, product preparation and processing. Data were subjected to descriptive statistics and regression analysis using SPPS (V.21). Results revealed that most (30.1%) of the respondents were 24 – 29 years old, married, were male, had no formal education. Results also revealed that more than 90% of dairy cattle farmers perceived the training needs in feeding as most important. The training index in dairy farming indicated that majority (91.8%) of the farmers needed to be trained more on dairy cattle production and management. Based on the result of this study, it was concluded that breeding, feeding and health care were perceived as the “most needed” training by the respondents. Although, training need in marketing and finance, milk preparation and processing, as well as housing and management were also perceived as important. Furthermore age, sex, marital status, religion, education level, source of flock, purpose of production and breeds of cattle had a direct effect on training needs of the respondent while occupation, household, herd size, had an indirect effect on training need of the respondents

In vitro induction of rat liver mitochondrial membrane permeability transition pore opening by solvent extracts of Momordica charantia leaves

Alteration of mitochondrial functions such as permeability transition (PT), a process associated with the uncoupling of oxidative phosphorylation, has been found to play a vital role in the apoptotic process induced by certain anti-cancer agents. When triggered, PT facilitates the release of mitochondrial apoptogenic proteins which in turn activate the caspase cascade of apoptosis. Thus, this study investigated the in vitro effects of varying concentrations (0.2, 0.4, 0.6, 0.8 and 1.0 mg/ml) of different leaf extracts [Crude Water-Soluble Extract (CWSE), Decoction (DE) and Methanol Extract (ME)] of Momordica charantia (M. charantia), a purported anti-cancer plant of the family Cucurbitaceae on normal rat liver mitochondria. Opening of mitochondrial membrane permeability transition pore (MMPTP) was spectrophotometrically assayed under succinate-energized condition. Results obtained showed concentration-dependent and significant (P&lt;0.05) increases in the extents to which MMPTP opening was induced by the three extract types when compared with the control group. Inductions caused by CWSE and DE increased with increasing concentrations while those caused by ME decreased with increasing concentrations, giving the maximum induction at 1.0 mg/ml (8.1-fold increase) of CWSE and the least induction at 1.0 mg/ml (4.3-fold increase) of ME, respectively. Spermine, a reference inhibitor of MMPTP opening, reversed all observed openings. These results indicate that the tested leaf extracts of M. charantia are potent (CWSE being the most potent) MMPTP opening inducers and the pathway by which M. charantia causes apoptosis in cancer cells is probably mitochondrial-mediated (intrinsic)

Indikatori oksidacije koreliraju s dislipidemijom i razinama upalnih citokina u štakora izloženih fluoridu

The aim of this study was to establish the effects of fluoride on lipid metabolism and attendant inflammatory response by exposing rats to 50 mg L-1 and 100 mg L-1 of fluoride through drinking water for seven weeks. Both concentrations led to hypercholesterolemia while the 100 mg L-1 concentration induced hypertriglyceridaemia. High density lipoprotein (HDL) cholesterol levels dropped in the exposed rats while interleukin 2 (IL-2) increased more than 1.5-fold (p<0.05) and IL-6 and plasma TNF-α more than 2.5 fold (p<0.05). Fluoride-exposed rats also had significantly higher levels of liver malondialdehyde (MDA) and plasma lipid hydroperoxide (LOOH) but lower plasma paraoxonase (PON1) activity. Oxidative stress indices correlated with pro-inflammatory cytokines and plasma cholesterol. In contrast, pro-inflammatory cytokines inversely correlated with plasma triglyceride, HDL cholesterol and PON1. Our results suggest that the association between fluoride exposure with cardiovascular diseases may be related to its ability to disturb lipid homeostasis, and trigger pro-inflammatory cytokines and oxidative stress.Svrha je ovog istraživanja bila utvrditi djelovanje fluorida na metabolizam lipida i upalni odgovor tako što smo štakore izložili fluoridu u pitkoj vodi u koncentracijama od 50 mg L-1 i 100 mg L-1 sedam tjedana. Obje su koncentracije dovele do hiperkolesterolemije, a viša je koncentracija inducirala i hipertrigliceridemiju. U odnosu na kontrolnu skupinu, u izloženih su se štakora razine lipoproteina visoke gustoće (HDL-a) smanjile, a interleukin 2 (IL-2) se povećao više od 1,5 put (p<0,05), kao i IL-6 i čimbenik tumorske nekroze alfa (TNF-α) u plazmi, i to više od 2,5 puta (p<0,05). Usto su izloženi štakori iskazali značajno više razine malondialdehida (MDA) u jetrima te lipidnog hidroperoksida (LOOH) u plazmi, odnosno sniženu aktivnost paraoksonaze (PON1) u plazmi. Indikatori oksidacijskog stresa korelirali su s upalnim citokinima i kolesterolom u plazmi, a upalni citokini inverzno su korelirali s trigliceridima, HDL kolesterolom i PON1 u plazmi. Rezultati istraživanja upućuju na to da povezanost između izloženosti fluoridu i bolesti srca i krvožilja možda potječe od toga što fluorid remeti lipidnu homeostazu te pokreće upalne citokine i, posljedično, oksidacijski stres

Morphological, pathological and phylogenetic analyses identify a diverse group of Colletotrichum spp. causing leaf, pod, and flower diseases on the orphan legume African yam bean

African yam bean (AYB; Sphenostylis stenocarpa Hochst. Ex A. Rich.) is an underutilized legume indigenous to Africa. The crop has great potential as it can enhance food security and its chemical composition offers nutritional and medicinal opportunities. However, the low grain yield caused by fungal diseases, including pod blight and leaf tip dieback, deters farmers from large-scale cultivation. The causal agents of pod and leaf tip dieback on AYB are largely uncharacterized. To determine the prevalence of fungal diseases affecting leaves, pods, and flowers of AYB, a survey was conducted in 2018 and 2019 in major AYB-growing areas in Nigeria. Leaf tip dieback, flower bud rot, and pod blight were the most common symptoms. Morphological and molecular assays were conducted to identify the causal agents of the observed diseases. In all the samples examined, fungi from eight genera were isolated from leaves and pods showing disease symptoms. However, Koch’s postulates were fulfilled only for fungi belonging to the Colletotrichum genus. Fungi from the other seven genera did not produce disease symptoms in healthy AYB tissues. Several Colletotrichum isolates were characterized by sequencing the ITS, glyceraldehyde-3-phosphate dehydrogenase, calmodulin, and ApMAT loci. A combined phylogenetic analysis revealed four Colletotrichum species: C. siamense, C. theobromicola, and C. fructicola, which were recovered from the diseased leaves, and C. truncatum, which was recovered from diseased pods and buds. Our results are useful to gear efforts to develop integrated management strategies to control diseases affecting AYB in Nigeria and other parts of Africa. The availability of such strategies may stimulate greater cultivation of AYB to contribute to diet diversification, which has been repeatedly advocated by a range of stakeholders to increase food security and the prosperity of smallholder farmers

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

BACKGROUND: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. METHODS: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING: Bill & Melinda Gates Foundation