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. Funding: Bill & Melinda Gates Foundation

Gastro-protective effect of methanol extract of Ficus asperifolia bark on indomethacin-induced gastric ulcer in rats

The gastro-protective and antioxidant effects of methanol extract of Ficus asperifolia bark on indomethacin induced gastric ulcer were investigated in male rats. Thirty two male rats divided into 4 equal groups and were treated as follows: group1 (control), 0.5ml of 5% tween 80 (vehicle for the extract), groups 2 and 3, 100 and 500mg/kg of Ficus asperifolia extract respectively and group 4, cimetidine (100mg/kg). After two weeks of daily oral administration of vehicle, extract or cimetidine, gastric ulcer was induced in all rats with indomethacin (40 mg/kg, p.o). Gastric juice pH, gastric acid concentration, gastric ulcer score, percentage gastric ulcer inhibition, activity levels of superoxide dismutase (SOD), catalase and malondiadehyde (MDA) were determined. Ficus asperifolia extract significantly increased gastric pH (p<0.05) but decreased (p<0.01) gastric acid secretion in dose dependent manner when compared with the control. Inhibition of gastric ulcer in extract and cimetidine treated rats was similar. Activities of SOD and catalase were significantly increased (p<0.05) while MDA was significantly decreased (p< 0.05) in extract treated rats when compared with the control. The results suggest that Ficus asperifolia possesses gastro-protective and antioxidant properties against gastric ulcer induced by indomethacin

Protective role of methanol extract of Carpolobia lutea root against cadmium-induced changes in biochemical and antioxidant indices in liver of male Wistar rats

Oxidative stress and impaired antioxidant system have been implicated in the pathophysiology of various disease conditions associated with Cadmium (Cd) toxicity. Carpolobia lutea (C. lutea), has been shown to possess antioxidant properties. Carpolobia lutea root was obtained in Ijare via Akure, authenticated at Forestry Research Institute of Nigeria. Methanolic extract of Carpolobia lutea (MCL) was obtained by Soxhlet extraction and subjected to Gas Chromatography-Mass Spectrometry (GC-MS) to identify chemical compounds in the extract. Thirty male Wistar rats (150-170 g) were used in this study and treated as follows: Control (1 mL/kg body weight (bw) distilled water), Cd (2 mg/kg bw), Cd+MCL (2 mg/kg+100 mg/kg bw), Cd+MCL (2 mg/kg+200 mg/kg bw), MCL (100 mg/kg bw), MCL (200 mg/kg bw). The administration of C. lutea was done orally for eight weeks, and a single dose of 2 mg/kg Cd was administered intraperitoneally. Liver levels of alkaline phosphatase (ALP), alanine aminotransferase (ALT) and aspartate aminotransferase (AST), superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA) and histology were assessed. The GC-MS result showed the presence of 21 compounds. The C. lutea extract significantly reduced (P&lt;0.05) ALP, AST and MDA while a significant increase was observed in SOD and CAT activities which were initially altered by administration of cadmium. The C. lutea extract also significantly attenuated the histopathological alterations of the liver rats. C. lutea root extract attenuated cadmium-induced toxicity which are indications of its antioxidant potential and may be responsible for its protecting effect against coadmium-induced liver damage.&nbsp

Fake COVID-19 vaccinations in Africa

Deliveries of vaccine supplies by the COVAX programme under the WHO commenced in February 2021.1 COVAX has proposed to distribute 520 million doses to Africa by the end of 2021.1 On 28 March 2021, African Union member states endorsed purchasing 220 million doses of the Johnson & Johnson single shot of the COVID-19 vaccine. However, priority was given to the Johnson & Johnson vaccine to the central-most pooled procurement due to being a single-shot vaccine, being cheap and easy to administer, having good storage conditions and production of doses being within Africa, with fill–finish activities taking place in South Africa

Data on the thermal properties of soil and its moisture content

The dataset contains thermal properties of soil such as thermal conductivity, thermal diffusivity, temperature and specific heat capacity in an agricultural farm within the University of Ibadan, Ibadan, Nigeria. The data were acquired in forty (40) sampling points using thermal analyzer called KD-2 Pro. Soil samples taken at these sampling points were analyzed in the laboratory for their moisture content following the standard reference of American Association of State Highway and Transport Officials (AASHTO) T265. The data were acquired within the first and second weeks in the month of April, 2012. Statistical analyses were performed on the data set to understand the data. The data is made available publicly because thermal properties of soils have significant role in understanding the water retention capacity of soil and could be helpful for proper irrigation water management