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1. The HIV Epidemic in the Middle East and North Africa: Key Lessons

Author: Mumtaz, Ghina R., Chemaitelly, Hiam, Abu-Raddad, Laith J., Saad-Hussein, Amal, Section editor, and Laher, Ismail, editor
Published: 2021
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2. Epidemiology of gonorrhea in countries of the Middle East and North Africa: systematic review, meta analyses, and meta regressions.

Author: Chemaitelly, Hiam, Harfouche, Manale, Smolak, Alex, Ageeb, Rwedah, Mohamoud, Yousra A., Alaama, Ahmed S., Hermez, Joumana G., and Abu-Raddad, Laith J.
Subjects: GONORRHEA, NEISSERIA gonorrhoeae, FERTILITY clinics, ECTOPIC pregnancy, EPIDEMIOLOGY
Abstract: Background: The epidemiology of Neisseria gonorrhoeae (NG) infection in the Middle East and North Africa (MENA) region remains poorly understood, despite the global recognition of its disease burden and the growing concern regarding antimicrobial resistance. This study aimed to systematically review the evidence on NG prevalence in MENA, estimate the pooled mean prevalence across different populations, and explore population-level associations with prevalence as well as sources of between-study heterogeneity. Methods: The study conducted a systematic review, risk of bias assessment, meta-analyses, and meta-regressions, utilizing both published and unpublished evidence sourced from international, regional, and national databases, in adherence to PRISMA guidelines. Random-effects meta-analyses and meta-regressions were employed to analyze the data. Results: The study identified 341 NG prevalence measures from 21 countries in MENA. The pooled mean prevalence of current urogenital infection was 1.9% (95% confidence interval (CI) 1.1–2.8%) in the general population, with a higher pooled prevalence in studies with sample sizes < 200 (3.1%; 95% CI 1.5–5.0%) compared to those with sample sizes ≥ 200 (1.1%; 95% CI 0.5–1.9%). Among specific populations, the pooled prevalence was 6.5% (95% CI 4.4–9.0%) in female sex workers, 7.5% (95% CI 2.8–14.0%) in attendees of infertility clinics, 3.0% (95% CI 0.4–7.0%) in women with miscarriage or ectopic pregnancy, 3.9% (95% CI 2.7–5.3%) in symptomatic women, and 41.4% (95% CI 34.9–48.1%) in symptomatic men. For male sex workers and men who have sex with men, the pooled prevalence of current urogenital infection was 1.6% (95% CI 0.4–3.4%), while the prevalence of current anorectal infection was 10.4% (95% CI 4.6–18.0%). Through multivariable meta-regressions, 64% of the prevalence variation was explained, revealing a hierarchical pattern in prevalence by population type and sex, and a prevalence decline at a rate of 1% per year. Conclusions: NG prevalence in MENA is comparable to the global prevalence, underscoring a neglected and underrecognized disease burden, with social and economic consequences. Persistent transmission of NG among key populations and other populations at risk increases the potential for the emergence of new drug-resistant strains. MENA is far from achieving the World Health Organization's target of reducing NG incidence by 90% by 2030. [ABSTRACT FROM AUTHOR]
Published: 2024
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3. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author: Collaborators, GBD 2016 Risk Factors, Gakidou, Emmanuela, Afshin, Ashkan, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulle, Abdishakur M, Abera, Semaw Ferede, Aboyans, Victor, Abu-Raddad, Laith J, Abu-Rmeileh, Niveen ME, Abyu, Gebre Yitayih, Adedeji, Isaac Akinkunmi, Adetokunboh, Olatunji, Afarideh, Mohsen, Agrawal, Anurag, Agrawal, Sutapa, Ahmadieh, Hamid, Ahmed, Muktar Beshir, Aichour, Miloud Taki Eddine, Aichour, Amani Nidhal, Aichour, Ibtihel, Akinyemi, Rufus Olusola, Akseer, Nadia, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alam, Tahiya, Alasfoor, Deena, Alene, Kefyalew Addis, Ali, Komal, Alizadeh-Navaei, Reza, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampem, Ansari, Hossein, Antó, Josep M, Antonio, Carl Abelardo T, Anwari, Palwasha, Arian, Nicholas, Ärnlöv, Johan, Artaman, Al, Aryal, Krishna Kumar, Asayesh, Hamid, Asgedom, Solomon Weldegebreal, Atey, Tesfay Mehari, Avila-Burgos, Leticia, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Azzopardi, Peter, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Ballew, Shoshana H, Barac, Aleksandra, Barber, Ryan M, Barker-Collo, Suzanne L, Bärnighausen, Till, Barquera, Simon, Barregard, Lars, Barrero, Lope H, Batis, Carolina, Battle, Katherine E, Baumgarner, Blair R, Baune, Bernhard T, Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Bell, Michelle L, Bennett, Derrick A, Bennett, James R, Bensenor, Isabela M, Berhane, Adugnaw, Berhe, Derbew Fikadu, Bernabé, Eduardo, Betsu, Balem Demtsu, Beuran, Mircea, Beyene, Addisu Shunu, Bhansali, Anil, Bhutta, Zulfiqar A, Bicer, Burcu Kucuk, Bikbov, Boris, Birungi, Charles, Biryukov, Stan, Blosser, Christopher D, Boneya, Dube Jara, Bou-Orm, Ibrahim R, Brauer, Michael, and Breitborde, Nicholas JK
Subjects: Epidemiology, Health Sciences, Prevention, Aetiology, 2.2 Factors relating to the physical environment, Good Health and Well Being, Adolescent, Adult, Aged, Aged, 80 and over, Air Pollution, Body Mass Index, Cause of Death, Child, Child, Preschool, Communicable Diseases, Disabled Persons, Environmental Health, Female, Global Burden of Disease, Humans, Infant, Infant, Newborn, Life Expectancy, Male, Metabolic Diseases, Middle Aged, Noncommunicable Diseases, Occupational Diseases, Quality-Adjusted Life Years, Risk Assessment, Sex Distribution, Smoking, Water Supply, Young Adult, GBD 2016 Risk Factors Collaborators, Medical and Health Sciences, General & Internal Medicine, Biomedical and clinical sciences, Health sciences
Abstract: BackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context.MethodsWe used the comparative risk assessment 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 clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. 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. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined.FindingsSince 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs [95% UI 111·2 million to 137·0 million]), high systolic blood pressure (122·2 million DALYs [110·3 million to 133·3 million], and low birthweight and short gestation (83·0 million DALYs [78·3 million to 87·7 million]), and for women, were high systolic blood pressure (89·9 million DALYs [80·9 million to 98·2 million]), high body-mass index (64·8 million DALYs [44·4 million to 87·6 million]), and high fasting plasma glucose (63·8 million DALYs [53·2 million to 76·3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9-11·6) decline in deaths and a 10·8% (8·3-13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7-17·5) of deaths and 6·2% (3·9-8·7) of DALYs, and population growth for 12·4% (10·1-14·9) of deaths and 12·4% (10·1-14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9-29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks.InterpretationIncreasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade.FundingThe Bill & Melinda Gates Foundation, Bloomberg Philanthropies.
Published: 2017

4. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author: Collaborators, GBD 2016 DALYs and HALE, Hay, Simon I, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulkader, Rizwan Suliankatchi, Abdulle, Abdishakur M, Abebo, Teshome Abuka, Abera, Semaw Ferede, Aboyans, Victor, Abu-Raddad, Laith J, Ackerman, Ilana N, Adedeji, Isaac A, Adetokunboh, Olatunji, Afshin, Ashkan, Aggarwal, Rakesh, Agrawal, Sutapa, Agrawal, Anurag, Ahmed, Muktar Beshir, Aichour, Miloud Taki Eddine, Aichour, Amani Nidhal, Aichour, Ibtihel, Aiyar, Sneha, Akinyemiju, Tomi F, Akseer, Nadia, Al Lami, Faris Hasan, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alam, Tahiya, Alasfoor, Deena, Alene, Kefyalew Addis, Ali, Raghib, Alizadeh-Navaei, Reza, Alkaabi, Juma M, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Allen, Christine, Al-Maskari, Fatma, AlMazroa, Mohammad AbdulAziz, Al-Raddadi, Rajaa, Alsharif, Ubai, Alsowaidi, Shirina, Althouse, Benjamin M, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampem, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T, Anwari, Palwasha, Ärnlöv, Johan, Arora, Megha, Artaman, Al, Aryal, Krishna Kumar, Asgedom, Solomon W, Atey, Tesfay Mehari, Atnafu, Niguse Tadele, Avila-Burgos, Leticia, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Awasthi, Shally, Azarpazhooh, Mahmoud Reza, Azzopardi, Peter, Babalola, Tesleem Kayode, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Bannick, Marlena S, Barac, Aleksandra, Barker-Collo, Suzanne L, Bärnighausen, Till, Barquera, Simon, Barrero, Lope H, Basu, Sanjay, Battista, Robert, Battle, Katherine E, Baune, Bernhard T, Bazargan-Hejazi, Shahrzad, Beardsley, Justin, Bedi, Neeraj, Béjot, Yannick, Bekele, Bayu Begashaw, Bell, Michelle L, Bennett, Derrick A, Bennett, James R, Bensenor, Isabela M, Benson, Jennifer, Berhane, Adugnaw, Berhe, Derbew Fikadu, Bernabé, Eduardo, Betsu, Balem Demtsu, Beuran, Mircea, and Beyene, Addisu Shunu
Subjects: Epidemiology, Public Health, Health Sciences, Social Determinants of Health, Clinical Research, Burden of Illness, Prevention, Behavioral and Social Science, 2.4 Surveillance and distribution, Good Health and Well Being, Adult, Age Distribution, Aged, Aged, 80 and over, Cause of Death, Communicable Diseases, Disabled Persons, Female, Global Burden of Disease, Global Health, Humans, Life Expectancy, Male, Middle Aged, Noncommunicable Diseases, Quality-Adjusted Life Years, Residence Characteristics, Sex Distribution, Wounds and Injuries, GBD 2016 DALYs and HALE Collaborators, Medical and Health Sciences, General & Internal Medicine, Biomedical and clinical sciences, Health sciences
Abstract: BackgroundMeasurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI).MethodsWe used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate.FindingsThe highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally.InterpretationAt a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support.FundingBill & Melinda Gates Foundation.
Published: 2017

5. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author: Collaborators, GBD 2016 Disease and Injury Incidence and Prevalence, Vos, Theo, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulkader, Rizwan Suliankatchi, Abdulle, Abdishakur M, Abebo, Teshome Abuka, Abera, Semaw Ferede, Aboyans, Victor, Abu-Raddad, Laith J, Ackerman, Ilana N, Adamu, Abdu Abdullahi, Adetokunboh, Olatunji, Afarideh, Mohsen, Afshin, Ashkan, Agarwal, Sanjay Kumar, Aggarwal, Rakesh, Agrawal, Anurag, Agrawal, Sutapa, Ahmadieh, Hamid, Ahmed, Muktar Beshir, Aichour, Miloud Taki Eddine, Aichour, Amani Nidhal, Aichour, Ibtihel, Aiyar, Sneha, Akinyemi, Rufus Olusola, Akseer, Nadia, Al Lami, Faris Hasan, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alam, Tahiya, Alasfoor, Deena, Alene, Kefyalew Addis, Ali, Raghib, Alizadeh-Navaei, Reza, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Allen, Christine, Al-Maskari, Fatma, Al-Raddadi, Rajaa, Alsharif, Ubai, Alsowaidi, Shirina, Altirkawi, Khalid A, Amare, Azmeraw T, Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampem, Andersen, Hjalte H, Antonio, Carl Abelardo T, Anwari, Palwasha, Ärnlöv, Johan, Artaman, Al, Aryal, Krishna Kumar, Asayesh, Hamid, Asgedom, Solomon W, Assadi, Reza, Atey, Tesfay Mehari, Atnafu, Niguse Tadele, Atre, Sachin R, Avila-Burgos, Leticia, Avokphako, Euripide Frinel G Arthur, Awasthi, Ashish, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Banerjee, Amitava, Bannick, Marlena S, Barac, Aleksandra, Barber, Ryan M, Barker-Collo, Suzanne L, Bärnighausen, Till, Barquera, Simon, Barregard, Lars, Barrero, Lope H, Basu, Sanjay, Battista, Bob, Battle, Katherine E, Baune, Bernhard T, Bazargan-Hejazi, Shahrzad, Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Béjot, Yannick, Bekele, Bayu Begashaw, Bell, Michelle L, Bennett, Derrick A, Bensenor, Isabela M, Benson, Jennifer, Berhane, Adugnaw, Berhe, Derbew Fikadu, Bernabé, Eduardo, Betsu, Balem Demtsu, Beuran, Mircea, and Beyene, Addisu Shunu
Subjects: Biomedical and Clinical Sciences, Epidemiology, Public Health, Clinical Sciences, Health Sciences, Brain Disorders, Neurosciences, Women's Health, Aging, Mental Health, Burden of Illness, Behavioral and Social Science, 2.4 Surveillance and distribution, Good Health and Well Being, Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Cause of Death, Child, Child, Preschool, Communicable Diseases, Disabled Persons, Female, Global Burden of Disease, Global Health, Humans, Incidence, Infant, Infant, Newborn, Male, Middle Aged, Noncommunicable Diseases, Prevalence, Sex Distribution, Wounds and Injuries, Young Adult, GBD 2016 Disease and Injury Incidence and Prevalence Collaborators, Medical and Health Sciences, General & Internal Medicine, Biomedical and clinical sciences, Health sciences
Abstract: BackgroundAs mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016.MethodsWe estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).FindingsGlobally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8-75·9 million [7·2%, 6·0-8·3]), 45·1 million (29·0-62·8 million [5·6%, 4·0-7·2]), 36·3 million (25·3-50·9 million [4·5%, 3·8-5·3]), 34·7 million (23·0-49·6 million [4·3%, 3·5-5·2]), and 34·1 million (23·5-46·0 million [4·2%, 3·2-5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3-3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0-11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer's disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862-11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018-19 228).InterpretationThe decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response.FundingBill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.
Published: 2017

6. Sexually transmitted infections among pregnant Syrian refugee women seeking antenatal care in Lebanon.

Author: Fahme, Sasha A, Fakih, Iman, Ghassani, Ali, El-Nakib, Mostafa, Abu-Raddad, Laith J, Klausner, Jeffrey D, and Mumtaz, Ghina R
Subjects: SEXUALLY transmitted diseases, SYRIAN refugees, WOMEN refugees, PRENATAL care, SYPHILIS, TRICHOMONIASIS, WOMEN'S hospitals, NUCLEIC acid amplification techniques
Abstract: This article discusses a study that examined the prevalence of sexually transmitted infections (STIs) among pregnant Syrian refugee women seeking antenatal care in Lebanon. The study found that there were significant sociodemographic differences between urban and rural settings, with women in rural areas having a higher risk of residing in a refugee camp, never being enrolled in school, and being in a polygamous marriage. The research found a low prevalence of STIs, with only two cases of chlamydia and one case of trichomoniasis detected. The findings suggest that pregnant Syrian refugee women in Lebanon have a lower prevalence of STIs compared to women in other Middle Eastern and North African countries, but further research is needed to understand the burden of other STIs among this population. [Extracted from the article]
Published: 2024
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7. Incorporating Interventions to an Extended SEIRD Model with Vaccination: Application to COVID-19 in Qatar.

Author: AMONA, ELIZABETH B., GHANAM, RYAD A., BOONE, EDWARD L., SAHOO, INDRANIL, and ABU-RADDAD, LAITH J.
Subjects: COVID-19 vaccines, COVID-19 pandemic, VIRAL transmission, PARAMETER estimation, INTERVENTION (Federal government)
Abstract: The COVID-19 outbreak of 2020 has required many governments to develop and adopt mathematical-statistical models of the pandemic for policy and planning purposes. To this end, this work provides a tutorial on building a compartmental model using Susceptible, Exposed, Infected, Recovered, Deaths and Vaccinated (SEIRDV) status through time. The proposed model uses interventions to quantify the impact of various government attempts made to slow the spread of the virus. Furthermore, a vaccination parameter is also incorporated in the model, which is inactive until the time the vaccine is deployed. A Bayesian framework is utilized to perform both parameter estimation and prediction. Predictions are made to determine when the peak Active Infections occur. We provide inferential frameworks for assessing the effects of government interventions on the dynamic progression of the pandemic, including the impact of vaccination. The proposed model also allows for quantification of number of excess deaths averted over the study period due to vaccination. [ABSTRACT FROM AUTHOR]
Published: 2024
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8. The Impact of Cross-Immunity, Mutation and Stochastic Extinction on Pathogen Diversity

Author: Abu-Raddad, Laith J. and Ferguson, Neil M.
Published: 2004

9. Transmission Dynamics of the Etiological Agent of SARS in Hong Kong: Impact of Public Health Interventions

Author: Riley, Steven, Fraser, Christophe, Donnelly, Christl A., Ghani, Azra C., Abu-Raddad, Laith J., Hedley, Anthony J., Leung, Gabriel M., Ho, Lai-Ming, Lam, Tai-Hing, Thach, Thuan Q., Chau, Patsy, Chan, King-Pan, Lo, Su-Vui, Leung, Pak-Yin, Tsang, Thomas, Ho, William, Lee, Koon-Hung, Ferguson, Neil M., and Anderson, Roy M.
Published: 2003

10. Epidemiology of herpes simplex virus type 2 in the Middle East and North Africa: Systematic review, meta‐analyses, and meta‐regressions.

Author: Harfouche, Manale, Alareeki, Asalah, Osman, Aisha M. M., Alaama, Ahmed S., Hermez, Joumana G., and Abu‐Raddad, Laith J.
Subjects: HERPES simplex virus, HERPES genitalis, SEXUALLY transmitted diseases, EPIDEMIOLOGY, SEROPREVALENCE
Abstract: Herpes simplex virus type 2 (HSV‐2) infection is a prevalent, sexually transmitted infection with poorly characterized prevalence in the Middle East and North Africa (MENA) region. This study characterized HSV‐2 epidemiology in MENA. HSV‐2 reports were systematically reviewed as guided by the Cochrane Collaboration Handbook and findings were reported following PRISMA guidelines. Random‐effects meta‐analyses and meta‐regressions were performed to estimate pooled mean outcome measures and to assess predictors of HSV‐2 antibody prevalence (seroprevalence), trends in seroprevalence, and between‐study heterogeneity. In total, sixty‐one overall (133 stratified) HSV‐2 seroprevalence measures and two overall (four stratified) proportion measures of HSV‐2 detection in laboratory‐confirmed genital herpes were extracted from 37 relevant publications. Pooled mean seroprevalence was 5.1% (95% confidence interval [CI]: 3.6%–6.8%) among general populations, 13.3% (95% CI: 8.6%–18.7%) among intermediate‐risk populations, 20.6% (95% CI: 5.3%–42.3%) among female sex workers, and 18.3% (95% CI: 3.9%–39.4%) among male sex workers. Compared to Fertile Crescent countries, seroprevalence was 3.39‐fold (95% CI: 1.86–6.20) and 3.90‐fold (95% CI: 1.78–8.57) higher in Maghreb and Horn of Africa countries, respectively. Compared to studies published before 2010, seroprevalence was 1.73‐fold (95% CI: 1.00–2.99) higher in studies published after 2015. Pooled mean proportion of HSV‐2 detection in genital herpes was 73.8% (95% CI: 42.2%–95.9%). In conclusion, MENA has a lower HSV‐2 seroprevalence than other world regions. Yet, 1 in 20 adults is chronically infected, despite conservative prevailing sexual norms. Seroprevalence may also be increasing, unlike other world regions. Findings support the need for expansion of surveillance and monitoring of HSV‐2 infection in MENA. [ABSTRACT FROM AUTHOR]
Published: 2023
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11. Effectiveness of influenza vaccination against SARS-CoV-2 infection among healthcare workers in Qatar.

Author: Tayar, Elias, Abdeen, Sami, Abed Alah, Muna, Chemaitelly, Hiam, Bougmiza, Iheb, Ayoub, Houssein H., Kaleeckal, Anvar Hassan, Latif, Ali Nizar, Shaik, Riyazuddin Mohammad, Al-Romaihi, Hamad Eid, Al-Thani, Mohamed H., Bertollini, Roberto, Abu-Raddad, Laith J., and Al-Khal, Abdullatif
Abstract: Some studies have reported that influenza vaccination is associated with lower risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and/or coronavirus disease 2019 (COVID-19) morbidity and mortality. This study aims to estimate effectiveness of influenza vaccination, using Abbott's quadrivalent Influvac Tetra vaccine, against SARS-CoV-2 infection and against severe COVID-19. This matched, test-negative, case-control study was implemented on a population of 30,774 healthcare workers (HCWs) in Qatar during the 2020 annual influenza vaccination campaign, September 17, 2020-December 31, 2020, before introduction of COVID-19 vaccination. Of 30,774 HCWs, 576 with PCR-positive tests and 10,033 with exclusively PCR-negative tests were eligible for inclusion in the study. Matching by sex, age, nationality, reason for PCR testing, and PCR test date yielded 518 cases matched to 2058 controls. Median duration between influenza vaccination and the PCR test was 43 days (IQR, 29–62). Estimated effectiveness of influenza vaccination against SARS-CoV-2 infection> 14 days after receiving the vaccine was 29.7% (95% CI: 5.5–47.7%). Estimated effectiveness of influenza vaccination against severe, critical, or fatal COVID-19 was 88.9% (95% CI: 4.1–98.7%). Sensitivity analyses confirmed the main analysis results. Recent influenza vaccination is associated with a significant reduction in the risk of SARS-CoV-2 infection and COVID-19 severity. [ABSTRACT FROM AUTHOR]
Published: 2023
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12. Severity, criticality, and fatality of the SARS-CoV-2 Beta variant

Author: Abu-Raddad, Laith J, Chemaitelly, Hiam, Ayoub, Houssein H, Yassine, Hadi M, Benslimane, Fatiha M, Al Khatib, Hebah A, Tang, Patrick, Hasan, Mohammad R, Coyle, Peter, AlMukdad, Sawsan, Al Kanaani, Zaina, Al Kuwari, Einas, Jeremijenko, Andrew, Kaleeckal, Anvar Hassan, Latif, Ali Nizar, Shaik, Riyazuddin Mohammad, Abdul Rahim, Hanan F, Nasrallah, Gheyath K, Al Kuwari, Mohamed Ghaith, Butt, Adeel A, Al Romaihi, Hamad Eid, Al-Thani, Mohamed H, Al Khal, Abdullatif, and Bertollini, Roberto
Subjects: severe disease, variant, SARS-CoV-2, epidemiology, infection, case-control
Abstract: Beta (B.1.351) variant COVID-19 disease was investigated in Qatar. Compared to Alpha (B.1.1.7) variant, odds of progressing to severe disease were 1.24-fold (95% CI: 1.11-1.39) higher for Beta. Odds of progressing to critical disease were 1.49-fold (95% CI: 1.13-1.97) higher. Odds of COVID-19 death were 1.57-fold (95% CI: 1.03-2.43) higher.
Published: 2021

13. Epidemiological Benefits of More-Effective Tuberculosis Vaccines, Drugs, and Diagnostics

Author: Abu-Raddad, Laith J., Sabatelli, Lorenzo, Achterberg, Jerusha T., Sugimoto, Jonathan D., Longini,, Ira M., Dye, Christopher, Halloran, M. Elizabeth, and A. Levin, Simon
Published: 2009
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14. Dual Infection with HIV and Malaria Fuels the Spread of Both Diseases in Sub-Saharan Africa

Author: Abu-Raddad, Laith J., Patnaik, Padmaja, and Kublin, James G.
Published: 2006
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15. Two prolonged viremic SARS-CoV-2 infections with conserved viral genome for two months

Author: Abu-Raddad, Laith J, Chemaitelly, Hiam, Malek, Joel A, Ahmed, Ayeda A, Mohamoud, Yasmin A, Younuskunju, Shameem, Al Kanaani, Zaina, Al Khal, Abdullatif, Al Kuwari, Einas, Butt, Adeel A, Coyle, Peter, Jeremijenko, Andrew, Kaleeckal, Anvar Hassan, Latif, Ali Nizar, Shaik, Riyazuddin Mohammad, Abdul Rahim, Hanan F, Yassine, Hadi M, Al Kuwari, Mohamed G, Al Romaihi, Hamad Eid, Al-Thani, Mohamed H, and Bertollini, Roberto
Subjects: Microbiology (medical), Adult, Male, Time Factors, Epidemiology, Short Communication, Enzyme-Linked Immunosorbent Assay, Genome, Viral, Antibodies, Viral, Microbiology, Infectious Disease Incubation Period, COVID-19 Testing, Genetics, Humans, Viremia, Molecular Biology, Ecology, Evolution, Behavior and Systematics, Genome, Reverse Transcriptase Polymerase Chain Reaction, SARS-CoV-2, COVID-19, Infectious Diseases, Asymptomatic Diseases, RNA, Viral, Female, Infection, Infectious period
Abstract: We document two cases of viremic and prolonged active infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) where the viral genome was conserved for two months, but infection was with little or no symptoms. The first infection persisted for 80 days and the second for 62 days. Clearance of infection occurred 40 and 41 days, respectively, after development of detectable antibodies. Both cases were identified incidentally in an investigation of reinfection in a cohort of 133,266 laboratory-confirmed infected persons., Highlights • Two cases had substantial viral RNA concentration and conserved viral genome for ~2 months. • Infection clearance occurred >60 days after first positive swab. • Infection clearance occurred ~40 days after development of detectable antibodies. • Prolonged active infection was not associated with severity.
Published: 2021

16. Severity, Criticality, and Fatality of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Beta Variant.

Author: Abu-Raddad, Laith J, Chemaitelly, Hiam, Ayoub, Houssein H, Yassine, Hadi M, Benslimane, Fatiha M, Khatib, Hebah A Al, Tang, Patrick, Hasan, Mohammad R, Coyle, Peter, AlMukdad, Sawsan, Kanaani, Zaina Al, Kuwari, Einas Al, Jeremijenko, Andrew, Kaleeckal, Anvar Hassan, Latif, Ali Nizar, Shaik, Riyazuddin Mohammad, Rahim, Hanan F Abdul, Nasrallah, Gheyath K, Kuwari, Mohamed Ghaith Al, and Butt, Adeel A
Subjects: *SARS-CoV-2, *COVID-19, *CONFIDENCE intervals, *SEVERITY of illness index, *DESCRIPTIVE statistics, *DATA analysis software, *ODDS ratio, *SENSITIVITY & specificity (Statistics), *DEMOGRAPHY
Abstract: Beta (B.1.351)–variant coronavirus disease 2019 (COVID-19) disease was investigated in Qatar. Compared with the Alpha (B.1.1.7) variant, odds (95% confidence interval) of progressing to severe disease, critical disease, and COVID-19–related death were 1.24-fold (1.11–1.39), 1.49-fold (1.13–1.97), and 1.57-fold (1.03–2.43) higher, respectively, for the Beta variant. [ABSTRACT FROM AUTHOR]
Published: 2022
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17. Epidemiology of herpes simplex virus type 2 in Latin America and the Caribbean: systematic review, meta-analyses and metaregressions.

Author: Harfouche, Manale, Maalmi, Haifa, and Abu-Raddad, Laith J.
Subjects: HERPES genitalis, META-analysis, HUMAN sexuality, SYSTEMATIC reviews, REGRESSION analysis, HOMOSEXUALITY, HERPESVIRUSES, ODDS ratio, EPIDEMIOLOGICAL research
Abstract: Objective: To characterise epidemiology of herpes simplex virus type 2 (HSV-2) in Latin America and the Caribbean.Methods: HSV-2 reports were systematically reviewed and synthesised, and findings were reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analyses and metaregressions were conducted.Finding: 102 relevant reports were identified including 13 overall incidence measures, 163 overall (and 402 stratified) seroprevalence measures, and 7 and 10 proportions of virus detection in genital ulcer disease and in genital herpes, respectively. Pooled mean seroprevalence was 20.6% (95% CI 18.7% to 22.5%) in general populations, 33.3% (95% CI 26.0% to 41.0%) in intermediate-risk populations, 74.8% (95% CI 70.6% to 78.8%) in female sex workers, and 54.6% (95% CI 47.4% to 61.7%) in male sex workers, men who have sex with men and transgender people. In general populations, seroprevalence increased from 9.6% (95% CI 7.1% to 12.4%) in those aged <20 years to 17.9% (95% CI 13.6% to 22.5%) in those aged 20-30, 27.6% (95% CI 21.4% to 34.2%) in those aged 30-40 and 38.4% (95% CI 32.8% to 44.2%) in those aged >40. Compared with women, men had lower seroprevalence with an adjusted risk ratio (ARR) of 0.68 (95% CI 0.60 to 0.76). Seroprevalence declined by 2% per year over the last three decades (ARR of 0.98, 95% CI 0.97 to 0.99). Pooled mean proportions of HSV-2 detection in GUD and genital herpes were 41.4% (95% CI 18.9% to 67.0%) and 91.1% (95% CI 82.7% to 97.2%), respectively.Conclusions: One in five adults is HSV-2 infected, a higher level than other world regions, but seroprevalence is declining. Despite this decline, HSV-2 persists as the aetiological cause of nearly half of GUD cases and almost all of genital herpes cases. [ABSTRACT FROM AUTHOR]
Published: 2021
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18. Characterizing epidemiology of prediabetes, diabetes, and hypertension in Qataris: A cross-sectional study.

Author: Al-Thani, Mohammed H., Al-Mutawa, Kholood A., Alyafei, Salah A., Ijaz, Muhammad A., Khalifa, Shamseldin A. H., Kokku, Suresh B., Mishra, Amit C. M., Poovelil, Benjamin V., Soussi, Mounir B., Toumi, Amine A., Dargham, Soha R., Awad, Susanne F., and Abu-Raddad, Laith J.
Subjects: DIABETES, HYPERTENSION, EPIDEMIOLOGY, DISEASE complications, PREDIABETIC state
Abstract: Objectives: To characterize the epidemiologic profiles of prediabetes mellitus (preDM), diabetes mellitus (DM), and hypertension (HTN) in Qataris using the nationally representative 2012 Qatar STEPwise Survey. Methods: A secondary data analysis of a cross-sectional survey that included 2,497 Qatari nationals aged 18–64 years. Descriptive and analytical statistical analyses were conducted. Results: Prevalence of preDM, DM, and HTN in Qataris aged 18–64 years was 11.9% (95% confidence interval [CI] 9.6%-14.7%), 10.4% (95% CI 8.4%-12.9%), and 32.9% (95% CI 30.4%-35.6%), respectively. Age was the common factor associated with the three conditions. Adjusted analyses showed that unhealthy diet (adjusted odds ratio (aOR) = 1.84, 95% CI 1.01–3.36) was significantly associated with preDM; that physical inactivity (aOR = 1.66, 95% CI 1.12–2.46), central obesity (aOR = 2.08, 95% CI 1.02–4.26), and HTN (aOR = 2.18, 95% CI 1.40–3.38) were significantly associated with DM; and that DM (aOR = 2.07, 95% CI 1.34–3.22) was significantly associated with HTN. Population attributable fraction of preDM associated with unhealthy diet was 7.7%; of DM associated with physical inactivity, central obesity, and HTN, respectively, was 14.9%, 39.8%, and 17.5%; and of HTN associated with DM was 3.0%. Conclusions: One in five Qataris is living with either preDM or DM, and one in three is living with HTN, conditions that were found to be primarily driven by lifestyle factors. Prevention, control, and management of these conditions should be a national priority to reduce their disease burden and associated disease sequelae. [ABSTRACT FROM AUTHOR]
Published: 2021
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19. Assessment of the Risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Reinfection in an Intense Reexposure Setting.

Author: Abu-Raddad, Laith J, Chemaitelly, Hiam, Malek, Joel A, Ahmed, Ayeda A, Mohamoud, Yasmin A, Younuskunju, Shameem, Ayoub, Houssein H, Kanaani, Zaina Al, Khal, Abdullatif Al, Kuwari, Einas Al, Butt, Adeel A, Coyle, Peter, Jeremijenko, Andrew, Kaleeckal, Anvar Hassan, Latif, Ali Nizar, Shaik, Riyazuddin Mohammad, Rahim, Hanan F Abdul, Yassine, Hadi M, Kuwari, Mohamed G Al, and Romaihi, Hamad Eid Al
Subjects: *CLINICAL pathology, *COVID-19, *CONFIDENCE intervals, *REINFECTION, *DISEASE incidence, *RISK assessment, *GENOMES, *DESCRIPTIVE statistics, *IMMUNITY, *POLYMERASE chain reaction, *COVID-19 testing, *LONGITUDINAL method, *DISEASE risk factors
Abstract: Background Risk of reinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unknown. We assessed the risk and incidence rate of documented SARS-CoV-2 reinfection in a cohort of laboratory-confirmed cases in Qatar. Methods All SARS-CoV-2 laboratory-confirmed cases with at least 1 polymerase chain reaction–positive swab that was ≥45 days after a first positive swab were individually investigated for evidence of reinfection. Viral genome sequencing of the paired first positive and reinfection viral specimens was conducted to confirm reinfection. Results Out of 133 266 laboratory-confirmed SARS-CoV-2 cases, 243 persons (0.18%) had at least 1 subsequent positive swab ≥45 days after the first positive swab. Of these, 54 cases (22.2%) had strong or good evidence for reinfection. Median time between the first swab and reinfection swab was 64.5 days (range, 45–129). Twenty-three of the 54 cases (42.6%) were diagnosed at a health facility, suggesting presence of symptoms, while 31 (57.4%) were identified incidentally through random testing campaigns/surveys or contact tracing. Only 1 person was hospitalized at the time of reinfection but was discharged the next day. No deaths were recorded. Viral genome sequencing confirmed 4 reinfections of 12 cases with available genetic evidence. Reinfection risk was estimated at 0.02% (95% confidence interval [CI],.01%–.02%), and reinfection incidence rate was 0.36 (95% CI,.28–.47) per 10 000 person-weeks. Conclusions SARS-CoV-2 reinfection can occur but is a rare phenomenon suggestive of protective immunity against reinfection that lasts for at least a few months post primary infection. [ABSTRACT FROM AUTHOR]
Published: 2021
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20. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author: Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulkader, Rizwan Suliankatchi, Abdulle, Abdishakur M, Abebo, Teshome Abuka, Abera, Semaw Ferede, Aboyans, Victor, Abu-Raddad, Laith J, Ackerman, Ilana N, Adedeji, Isaac A, Adetokunboh, Olatunji, Afshin, Ashkan, Aggarwal, Rakesh, Agrawal, Sutapa, Agrawal, Anurag, Ahmed, Muktar Beshir, Aichour, Miloud Taki Eddine, Aichour, Amani Nidhal, Aichour, Ibtihel, Aiyar, Sneha, Akinyemiju, Tomi F, Akseer, Nadia, Al Lami, Faris Hasan, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alam, Tahiya, Alasfoor, Deena, Alene, Kefyalew Addis, Ali, Raghib, Alizadeh-Navaei, Reza, Alkaabi, Juma M, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Allen, Christine, Al-Maskari, Fatma, AlMazroa, Mohammad AbdulAziz, Al-Raddadi, Rajaa, Alsharif, Ubai, Alsowaidi, Shirina, Althouse, Benjamin M, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampem, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T, Anwari, Palwasha, Ärnlöv, Johan, Arora, Megha, Artaman, Al, Aryal, Krishna Kumar, Asgedom, Solomon W, Atey, Tesfay Mehari, Atnafu, Niguse Tadele, Avila-Burgos, Leticia, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Awasthi, Shally, Azarpazhooh, Mahmoud Reza, Azzopardi, Peter, Babalola, Tesleem Kayode, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Bannick, Marlena S, Barac, Aleksandra, Barker-Collo, Suzanne L, Bärnighausen, Till, Barquera, Simon, Barrero, Lope H, Basu, Sanjay, Battista, Robert, Battle, Katherine E, Baune, Bernhard T, Bazargan-Hejazi, Shahrzad, Beardsley, Justin, Bedi, Neeraj, Béjot, Yannick, Bekele, Bayu Begashaw, Bell, Michelle L, Bennett, Derrick A, Bennett, James R, Bensenor, Isabela M, Benson, Jennifer, Berhane, Adugnaw, Berhe, Derbew Fikadu, Bernabé, Eduardo, Betsu, Balem Demtsu, Beuran, Mircea, Beyene, Addisu Shunu, Bhansali, Anil, Bhatt, Samir, Bhutta, Zulfiqar A, Biadgilign, Sibhatu, Bicer, Burcu Kucuk, Bienhoff, Kelly, Bikbov, Boris, Birungi, Charles, Biryukov, Stan, Bisanzio, Donal, Bizuayehu, Habtamu Mellie, Blyth, Fiona M, Boneya, Dube Jara, Bose, Dipan, Bou-Orm, Ibrahim R, Bourne, Rupert R A, Brainin, Michael, Brayne, Carol, Brazinova, Alexandra, Breitborde, Nicholas J K, Briant, Paul S, Britton, Gabrielle, Brugha, Traolach S, Buchbinder, Rachelle, Bulto, Lemma Negesa Bulto, Bumgarner, Blair R, Butt, Zahid A, Cahuana-Hurtado, Lucero, Cameron, Ewan, Campos-Nonato, Ismael Ricardo, Carabin, Hélène, Cárdenas, Rosario, Carpenter, David O, Carrero, Juan Jesus, Carter, Austin, Carvalho, Felix, Casey, Daniel, Castañeda-Orjuela, Carlos A, Castle, Chris D, Catalá-López, Ferrán, Chang, Jung-Chen, Charlson, Fiona J, Chaturvedi, Pankaj, Chen, Honglei, Chibalabala, Mirriam, Chibueze, Chioma Ezinne, Chisumpa, Vesper Hichilombwe, Chitheer, Abdulaal A, Chowdhury, Rajiv, Christopher, Devasahayam Jesudas, Ciobanu, Liliana G, Cirillo, Massimo, Colombara, Danny, Cooper, Leslie Trumbull, Cooper, Cyrus, Cortesi, Paolo Angelo, Cortinovis, Monica, Criqui, Michael H, Cromwell, Elizabeth A, Cross, Marita, Crump, John A, Dadi, Abel Fekadu, Dalal, Koustuv, Damasceno, Albertino, Dandona, Lalit, Dandona, Rakhi, das Neves, José, Davitoiu, Dragos V, Davletov, Kairat, de Courten, Barbora, De Leo, Diego, De Steur, Hans, Defo, Barthelemy Kuate, Degenhardt, Louisa, Deiparine, Selina, Dellavalle, Robert P, Deribe, Kebede, Deribew, Amare, Des Jarlais, Don C, Dey, Subhojit, Dharmaratne, Samath D, Dhillon, Preet K, Dicker, Daniel, Djalainia, Shirin, Do, Huyen Phuc, Dokova, Klara, Doku, David Teye, Dorsey, E Ray, dos Santos, Kadine Priscila Bender, Driscoll, Tim R, Dubey, Manisha, Duncan, Bruce Bartholow, Ebel, Beth E, Echko, Michelle, El-Khatib, Ziad Ziad, Enayati, Ahmadali, Endries, Aman Yesuf, Ermakov, Sergey Petrovich, Erskine, Holly E, Eshetie, Setegn, Eshrati, Babak, Esteghamati, Alireza, Estep, Kara, Fanuel, Fanuel Belayneh Bekele, Farag, Tamer, Farinha, Carla Sofia e Sa, Faro, André, Farzadfar, Farshad, Fazeli, Mir Sohail, Feigin, Valery L, Feigl, Andrea B, Fereshtehnejad, Seyed-Mohammad, Fernandes, João C, Ferrari, Alize J, Feyissa, Tesfaye Regassa, Filip, Irina, Fischer, Florian, Fitzmaurice, Christina, Flaxman, Abraham D, Foigt, Nataliya, Foreman, Kyle J, Franklin, Richard C, Frostad, Joseph J, Fullman, Nancy, Fürst, Thomas, Furtado, Joao M, Futran, Neal D, Gakidou, Emmanuela, Garcia-Basteiro, Alberto L, Gebre, Teshome, Gebregergs, Gebremedhin Berhe, Gebrehiwot, Tsegaye Tewelde, Geleijnse, Johanna M, Geleto, Ayele, Gemechu, Bikila Lencha, Gesesew, Hailay Abrha, Gething, Peter W, Ghajar, Alireza, Gibney, Katherine B, Gillum, Richard F, Ginawi, Ibrahim Abdelmageem Mohamed, Gishu, Melkamu Dedefo, Giussani, Giorgia, Godwin, William W, Goel, Kashish, Goenka, Shifalika, Goldberg, Ellen M, Gona, Philimon N, Goodridge, Amador, Gopalani, Sameer Vali, Gosselin, Richard A, Gotay, Carolyn C, Goto, Atsushi, Goulart, Alessandra Carvalho, Graetz, Nicholas, Gugnani, Harish Chander, Gupta, Prakash C, Gupta, Rajeev, Gupta, Tanush, Gupta, Vipin, Gupta, Rahul, Gutiérrez, Reyna A, Hachinski, Vladimir, Hafezi-Nejad, Nima, Hailu, Alemayehu Desalegne, Hailu, Gessessew Bugssa, Hamadeh, Randah Ribhi, Hamidi, Samer, Hammami, Mouhanad, Handal, Alexis J, Hankey, Graeme J, Hao, Yuantao, Harb, Hilda L, Hareri, Habtamu Abera, Haro, Josep Maria, Harun, Kimani M, Harvey, James, Hassanvand, Mohammad Sadegh, Havmoeller, Rasmus, Hay, Simon I, Hay, Roderick J, Hedayati, Mohammad T, Hendrie, Delia, Henry, Nathaniel J, Heredia-Pi, Ileana Beatriz, Heydarpour, Pouria, Hoek, Hans W, Hoffman, Howard J, Horino, Masako, Horita, Nobuyuki, Hosgood, H Dean, Hostiuc, Sorin, Hotez, Peter J, Hoy, Damian G, Htet, Aung Soe, Hu, Guoqing, Huang, John J, Huynh, Chantal, Iburg, Kim Moesgaard, Igumbor, Ehimario Uche, Ikeda, Chad, Irvine, Caleb Mackay Salpeter, Islam, Sheikh Mohammed Shariful, Jacobsen, Kathryn H, Jahanmehr, Nader, Jakovljevic, Mihajlo B, James, Peter, Jassal, Simerjot K, Javanbakht, Mehdi, Jayaraman, Sudha P, Jeemon, Panniyammakal, Jensen, Paul N, Jha, Vivekanand, Jiang, Guohong, John, Denny, Johnson, Catherine O, Johnson, Sarah Charlotte, Jonas, Jost B, Jürisson, Mikk, Kabir, Zubair, Kadel, Rajendra, Kahsay, Amaha, Kamal, Ritul, Kar, Chittaranjan, Karam, Nadim E, Karch, André, Karema, Corine Kakizi, Karimi, Seyed M, Karimkhani, Chante, Kasaeian, Amir, Kassa, Getachew Mullu, Kassaw, Nigussie Assefa, Kassebaum, Nicholas J, Kastor, Anshul, Katikireddi, Srinivasa Vittal, Kaul, Anil, Kawakami, Norito, Keiyoro, Peter Njenga, Kemmer, Laura, Kengne, Andre Pascal, Keren, Andre, Kesavachandran, Chandrasekharan Nair, Khader, Yousef Saleh, Khalil, Ibrahim A, Khan, Ejaz Ahmad, Khang, Young-Ho, Khoja, Abdullah T, Khosravi, Ardeshir, Khubchandani, Jagdish, Kiadaliri, Aliasghar Ahmad, Kieling, Christian, Kim, Yun Jin, Kim, Daniel, Kimokoti, Ruth W, Kinfu, Yohannes, Kisa, Adnan, Kissimova-Skarbek, Katarzyna A, Kissoon, Niranjan, Kivimaki, Mika, Knudsen, Ann Kristin, Kokubo, Yoshihiro, Kolte, Dhaval, Kopec, Jacek A, Kosen, Soewarta, Kotsakis, Georgios A, Koul, Parvaiz A, Koyanagi, Ai, Kravchenko, Michael, Krohn, Kristopher J, Kumar, G Anil, Kumar, Pushpendra, Kyu, Hmwe H, Lager, Anton Carl Jonas, Lal, Dharmesh Kumar, Lalloo, Ratilal, Lallukka, Tea, Lambert, Nkurunziza, Lan, Qing, Lansingh, Van C, Larsson, Anders, Leasher, Janet L, Lee, Paul H, Leigh, James, Leshargie, Cheru Tesema, Leung, Janni, Leung, Ricky, Levi, Miriam, Li, Yichong, Li, Yongmei, Liang, Xiaofeng, Liben, Misgan Legesse, Lim, Stephen S, Linn, Shai, Liu, Patrick Y, Liu, Angela, Liu, Shiwei, Liu, Yang, Lodha, Rakesh, Logroscino, Giancarlo, Looker, Katharine J, Lopez, Alan D, Lorkowski, Stefan, Lotufo, Paulo A, Lozano, Rafael, Lucas, Timothy C D, Lunevicius, Raimundas, Lyons, Ronan A, Macarayan, Erlyn Rachelle King, Maddison, Emilie R, Magdy Abd El Razek, Hassan Magdy Abd, Magdy Abd El Razek, Mohammed, Magis-Rodriguez, Carlos, Mahdavi, Mahdi, Majdan, Marek, Majdzadeh, Reza, Majeed, Azeem, Malekzadeh, Reza, Malhotra, Rajesh, Malta, Deborah Carvalho, Mamun, Abdullah A, Manguerra, Helena, Manhertz, Treh, Mantovani, Lorenzo G, Mapoma, Chabila C, March, Lyn M, Marczak, Laurie B, Martinez-Raga, Jose, Martins, Paulo Henrique Viegas, Martins-Melo, Francisco Rogerlândio, Martopullo, Ira, März, Winfried, Mathur, Manu Raj, Mazidi, Mohsen, McAlinden, Colm, McGaughey, Madeline, McGrath, John J, McKee, Martin, Mehata, Suresh, Meier, Toni, Meles, Kidanu Gebremariam, Memiah, Peter, Memish, Ziad A, Mendoza, Walter, Mengesha, Melkamu Merid, Mengistie, Mubarek Abera, Mengistu, Desalegn Tadese, Mensah, George A, Meretoja, Tuomo J, Meretoja, Atte, Mezgebe, Haftay Berhane, Micha, Renata, Millear, Anoushka, Miller, Ted R, Minnig, Shawn, Mirarefin, Mojde, Mirrakhimov, Erkin M, Misganaw, Awoke, Mishra, Shiva Raj, Mitchell, Philip B, Mohammad, Karzan Abdulmuhsin, Mohammadi, Alireza, Mohammed, Muktar Sano Kedir, Mohammed, Kedir Endris, Mohammed, Shafiu, Mohan, Murali B V, Mokdad, Ali H, 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Uthman, O, Uzochukwu, B, van Boven, J, Varughese, S, Vasankari, T, Veerman, L, Venkatesh, S, Venketasubramanian, N, Vidavalur, R, Vijayakumar, L, Violante, F, Vishnu, A, Vladimirov, S, Vlassov, V, Vollset, S, Vos, T, Wadilo, F, Wakayo, T, Wallin, M, Wang, Y, Weichenthal, S, Weiderpass, E, Weintraub, R, Weiss, D, Werdecker, A, Westerman, R, Whiteford, H, Wijeratne, T, Williams, H, Wiysonge, C, Woldeyes, B, Wolfe, C, Woodbrook, R, Woolf, A, Workicho, A, Xavier, D, Xu, G, Yadgir, S, Yaghoubi, M, Yakob, B, Yan, L, Yano, Y, Ye, P, Yihdego, M, Yimam, H, Yip, P, Yonemoto, N, Yoon, S, Yotebieng, M, Younis, M, Yu, C, Zaidi, Z, Zaki, M, Zegeye, E, Zenebe, Z, Zhang, X, Zheng, Y, Zhou, M, Zipkin, B, Zodpey, S, Zoeckler, L, Zuhlke, L, Brayne, Carol [0000-0001-5307-663X], Chowdhury, Rajiv [0000-0003-4881-5690], and Apollo - University of Cambridge Repository
Subjects: Male, Dánarmein, AUSTRALIA, GBD, disability-adjusted life-years (DALYs), Heilsufar, Lífslíkur, Epidemiology, Life expectancy, Diseases, Global Health, THERAPY, Global Burden of Disease, Residence Characteristics, Fullorðnir, Cause of Death, Medicine and Health Sciences, Psychology, Konur, Aged, 80 and over, Tölfræði, PLASMODIUM-FALCIPARUM, Aldraðir, Sjúkdómar, Medicine (all), Fatlaðir, Men, Þjóðir, 11 Medical And Health Sciences, ASSOCIATION, Middle Aged, Health policy, PREVALENCE, Sálfræði, disability-adjusted life-years (DALYs), Female, Lýðheilsa, Quality-Adjusted Life Years, Life Sciences & Biomedicine, Global Health Metrics, Adult, AFRICA, Quality of life, People with disabilities, GBD, WEIGHTS, Social ecology, Lífsgæði, Communicable Diseases, World health/statistics, Age Distribution, Life Expectancy, Medicine, General & Internal, SDG 3 - Good Health and Well-being, General & Internal Medicine, Heilbrigðisstefna, Humans, Adults, Disabled Persons, Women, Sex Distribution, Mortality, Noncommunicable Diseases, Aged, Science & Technology, Faraldsfræði, MORTALITY, Wounds and injuries, EPIDEMIOLOGIC TRANSITION, HIV, Áverkar, Karlar, Wounds and Injuries, Félagshagfræði, Older people
Abstract: Correction in: LANCET Volume: 390 Issue: 10106 Pages: E38-E38 Published: OCT 28 2017, Background Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. Findings The highest globally observed HALE at birth for both women and men was in Singapore, at 75.2 years (95% uncertainty interval 71.9-78.6) for females and 72.0 years (68.8-75.1) for males. The lowest for females was in the Central African Republic (45.6 years [42.0-49.5]) and for males was in Lesotho (41.5 years [39.0-44.0]). From 1990 to 2016, global HALE increased by an average of 6.24 years (5.97-6.48) for both sexes combined. Global HALE increased by 6.04 years (5.74-6.27) for males and 6.49 years (6.08-6.77) for females, whereas HALE at age 65 years increased by 1.78 years (1.61-1.93) for males and 1.96 years (1.69-2.13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2.3% [-5.9 to 0.9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16.1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. Interpretation At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support., Bill & Melinda Gates Foundation
Published: 2017

21. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author: Gakidou, Emmanuela, Afshin, Ashkan, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M., Abd-Allah, Foad, Abdulle, Abdishakur M., Abera, Semaw Ferede, Aboyans, Victor, Abu-Raddad, Laith J., Abu-Rmeileh, Niveen M. E., Abyu, Gebre Yitayih, Adedeji, Isaac Akinkunmi, Adetokunboh, Olatunji, Afarideh, Mohsen, Agrawal, Anurag, Agrawal, Sutapa, Kiadaliri, Aliasghar Ahmad, Ahmadieh, Hamid, Ahmed, Muktar Beshir, Aichour, Amani Nidhal, Aichour, Ibtihel, Aichour, Miloud Taki Eddine, Akinyemi, Rufus Olusola, Akseer, Nadia, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alam, Tahiya, Alasfoor, Deena, Alene, Kefyalew Addis, Ali, Komal, Alizadeh-Navaei, Reza, Alkerwi, Ala'a, Alla, Francois, Allebeck, Peter, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A., Alvis-Guzman, Nelson, Amare, Azmeraw T., Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampem, Ansari, Hossein, Anto, Josep M., Antonio, Carl Abelardo T., Anwari, Palwasha, Arian, Nicholas, Arnlov, Johan, Artaman, A., Aryal, Krishna Kumar, Asayesh, Hamid, Asgedom, Solomon Weldegebreal, Atey, Tesfay Mehari, Avila-Burgos, Leticia, Avokpaho, Euripide Frinel G. Arthur, Awasthi, Ashish, Azzopardi, Peter, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Ballew, Shoshana H., Barac, Aleksandra, Barber, Ryan M., Barker-Collo, Suzanne L., Barnighausen, Till, Barquera, Simon, Barregard, Lars, Barrero, Lope H., Batis, Carolina, Battle, Katherine E., Baune, Bernhard T., Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Bell, Michelle L., Bennett, Derrick A., Bennett, James R., Bensenor, Isabela M., Berhane, Adugnaw, Berhe, Derbew Fikadu, Bernabe, Eduardo, Betsu, Balem Demtsu, Beuran, Mircea, Beyene, Addisu Shunu, Bhansali, Anil, Bhutta, Zulfiqar A., Bikbov, Boris, Birungi, Charles, Biryukov, Stan, Blosser, Christopher D., Boneya, Dube Jara, Bou-Orm, Ibrahim R., Brauer, Michael, Breitborde, Nicholas J. K., Brenner, Hermann, Brugha, Traolach S., Bulto, Lemma Negesa Bulto, Baumgarner, Blair R., Butt, Zahid A., Cahuana-Hurtado, Lucero, Cardenas, Rosario, Carrero, Juan Jesus, Castaneda-Orjuela, Carlos A., Catala-Lopez, Ferran, Cercy, Kelly, Chang, Hsing-Yi, Charlson, Fiona J., Chimed-Ochir, Odgerel, Chisumpa, Vesper Hichilombwe, Chitheer, Abdulaal A., Christensen, Hanne, Christopher, Devasahayam Jesudas, Cirillo, Massimo, Cohen, Aaron J., Comfort, Haley, Cooper, Cyrus, Coresh, Josef, Cornaby, Leslie, Cortesi, Paolo Angelo, Criqui, Michael H., Crump, John A., Dandona, Lalit, Dandona, Rakhi, das Neves, Jose, Davey, Gail, Davitoiu, Dragos V., Davletov, Kairat, de Courten, Barbora, Degenhardt, Louisa, Deiparine, Selina, Dellavalle, Robert P., Deribe, Kebede, Deshpande, Aniruddha, Dharmaratne, Samath D., Ding, Eric L., Djalalinia, Shirin, Huyen Phuc Do, Huyen Phuc Do, Dokova, Klara, Doku, David Teye, Dorsey, E. 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K., Johnson, Catherine O., Jonas, Jost B., Jurisson, Mikk, Kabir, Zubair, Kadel, Rajendra, Kahsay, Amaha, Kamal, Ritul, Karch, Andre, Karema, Corine Kakizi, Kasaeian, Amir, Kassebaum, Nicholas J., Kastor, Anshul, Katikireddi, Srinivasa Vittal, Kawakami, Norito, Keiyoro, Peter Njenga, Kelbore, Sefonias Getachew, Kemmer, Laura, Kengne, Andre Pascal, Kesavachandran, Chandrasekharan Nair, Khader, Yousef Saleh, Khalil, Ibrahim A., Khan, Ejaz Ahmad, Khang, Young-Ho, Khosravi, Ardeshir, Khubchandani, Jagdish, Kieling, Christian, Kim, Daniel, Kim, Jun Y., Kim, Yun Jin, Kimokoti, Ruth W., Kinfu, Yohannes, Kisa, Adnan, Kissimova-Skarbek, Katarzyna A., Kivimaki, Mika, Knibbs, Luke D., Knudsen, Ann Kristin, Kopec, Jacek A., Kosen, Soewarta, Koul, Parvaiz A., Koyanagi, Ai, Kravchenko, Michael, Krohn, Kristopher J., Kromhout, Hans, Defo, Barthelemy Kuate, Bicer, Burcu Kucuk, Kumar, G. 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M., Mereta, Seid Tiku, Meretoja, Atte, Meretoja, Tuomo J., Mezgebe, Haftay Berhane, Micha, Renata, Millear, Anoushka, Miller, Ted R., Minnig, Shawn, Mirarefin, Mojde, Mirrakhimov, Erkin M., Misganaw, Awoke, Mishra, Shiva Raj, Mohammad, Karzan Abdulmuhsin, Mohammed, Kedir Endris, Mohammed, Shafiu, Ibrahim, Norlinah Mohamed, Mohan, Murali B. V., Mokdad, Ali H., Monasta, Lorenzo, Montanez Hernandez, Julio Cesar, Montico, Marcella, Moradi-Lakeh, Maziar, Moraga, Paula, Morawska, Lidia, Morrison, Shane D., Mountjoy-Venning, Cliff, Mueller, Ulrich O., Mullany, Erin C., Muller, Kate, Murthy, Gudlavalleti Venkata Satyanarayana, Musa, Kamarul Imran, Naghavi, Mohsen, Naheed, Aliya, Nangia, Vinay, Natarajan, Gopalakrishnan, Negoi, Ionut, Negoi, Ruxandra Irina, Cuong Tat Nguyen, Cuong Tat Nguyen, Grant Nguyen, Grant Nguyen, Minh Nguyen, Minh Nguyen, Quyen Le Nguyen, Quyen Le Nguyen, Trang Huyen Nguyen, Trang Huyen Nguyen, Nichols, Emma, Ningrum, Dina Nur Anggraini, Nomura, Marika, Vuong Minh Nong, Vuong Minh Nong, Norheim, Ole F., Norrving, Bo, Noubiap, Jean Jacques N., Obermeyer, Carla Makhlouf, Ogbo, Felix Akpojene, Oh, Hwan, Oladimeji, Olanrewaju, Olagunju, Andrew Toyin, Olagunju, Tinuke Oluwasefunmi, Olivares, Pedro R., Olsen, Helen E., Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Opio, John Nelson, Oren, Eyal, Ortiz, Alberto, Ota, Erika, Owolabi, Mayowa O., Pa, Mahesh, Pacella, Rosana E., Pana, Adrian, Panda, Basant Kumar, Panda-Jonas, Songhomitra, Pandian, Jeyaraj D., Papachristou, Christina, Park, Eun-Kee, Parry, Charles D., Patten, Scott B., Patton, George C., Pereira, David M., Perico, Norberto, Pesudovs, Konrad, Petzold, Max, Phillips, Michael Robert, Pillay, Julian David, Piradov, Michael A., Pishgar, Farhad, Plass, Dietrich, Pletcher, Martin A., Polinder, Suzanne, Popova, Svetlana, Poulton, Richie G., Pourmalek, Farshad, Prasad, Narayan, Purcell, Carrie, Qorbani, Mostafa, Radfar, Amir, Rafay, Anwar, Rahimi-Movaghar, Afarin, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahman, Muhammad Aziz, Rai, Rajesh Kumar, Rajsic, Sasa, Ram, Usha, Rawaf, Salman, Rehm, Colin D., Rehm, Jurgen, Reiner, Robert C., Reitsma, Marissa B., Myriam Reynales-Shigematsu, Luz, Remuzzi, Giuseppe, Renzaho, Andre M. 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S., Thamsuwan, Ornwipa, Thankappan, Kavumpurathu Raman, Theis, Andrew M., Thomas, Matthew Lloyd, Thomson, Alan J., Thrift, Amanda G., Tillmann, Taavi, Tobe-Gai, Ruoyan, Tobollik, Myriam, Tollanes, Mette C., Tonelli, Marcello, Topor-Madry, Roman, Torre, Anna, Tortajada, Miguel, Touvier, Mathilde, Tran, Bach Xuan, Truelsen, Thomas, Tuem, Kald Beshir, Tuzcu, Emin Murat, Tyrovolas, Stefanos, Ukwaja, Kingsley Nnanna, Uneke, Chigozie Jesse, Updike, Rachel, Uthman, Olalekan A., van Boven, Job F. M., van Donkelaar, Aaron, Varughese, Santosh, Vasankari, Tommi, Veerman, Lennert J., Venkateswaran, Vidhya, Venketasubramanian, Narayanaswamy, Violante, Francesco S., Vladimirov, Sergey K., Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Vos, Theo, Wadilo, Fiseha, Wakayo, Tolassa, Wallin, Mitchell T., Wang, Yuan-Pang, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G., Weiss, Daniel J., Werdecker, Andrea, Westerman, Ronny, Whiteford, Harvey A., Wiysonge, Charles Shey, Woldeyes, Belete Getahun, Wolfe, Charles D. A., Woodbrook, Rachel, Workicho, Abdulhalik, Hanson, Sarah Wulf, Xavier, Denis, Xu, Gelin, Yadgir, Simon, Yakob, Bereket, Yan, Lijing L., Yaseri, Mehdi, Yimam, Hassen Hamid, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Yotebieng, Marcel, Younis, Mustafa Z., Zaidi, Zoubida, Zaki, Maysaa El Sayed, Zavala-Arciniega, Luis, Zhang, Xueying, Zimsen, Stephanie Raman M., Zipkin, Ben, Zodpey, Sanjay, Lim, Stephen S., Murray, Christopher J. 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Nomura, Marika, Nong, Vuong Minh, Norheim, Ole F., Norrving, Bo, Noubiap, Jean Jacques N., Obermeyer, Carla Makhlouf, Ogbo, Felix Akpojene, Oh, In-Hwan, Oladimeji, Olanrewaju, Olagunju, Andrew Toyin, Olagunju, Tinuke Oluwasefunmi, Olivares, Pedro R., Olsen, Helen E., Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Opio, John Nelson, Oren, Eyal, Ortiz, Alberto, Ota, Erika, Owolabi, Mayowa O., Pa, Mahesh, Pacella, Rosana E., Pana, Adrian, Panda, Basant Kumar, Panda-Jonas, Songhomitra, Pandian, Jeyaraj D., Papachristou, Christina, Park, Eun-Kee, Parry, Charles D., Patten, Scott B., Patton, George C., Pereira, David M., Perico, Norberto, Pesudovs, Konrad, Petzold, Max, Phillips, Michael Robert, Pillay, Julian David, Piradov, Michael A., Pishgar, Farhad, Plass, Dietrich, Pletcher, Martin A., Polinder, Suzanne, Popova, Svetlana, Poulton, Richie G., Pourmalek, Farshad, Prasad, Narayan, Purcell, Carrie, Qorbani, Mostafa, Radfar, Amir, Rafay, Anwar, Rahimi-Movaghar, Afarin, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahman, Muhammad Aziz, Rai, Rajesh Kumar, Rajsic, Sasa, Ram, Usha, Rawaf, Salman, Rehm, Colin D., Rehm, Jürgen, Reiner, Robert C., Reitsma, Marissa B., Reynales-Shigematsu, Luz Myriam, Remuzzi, Giuseppe, Renzaho, Andre M.N., Resnikoff, Serge, Rezaei, Satar, Ribeiro, Antonio L., Rivera, Juan A., Roba, Kedir Teji, Rojas-Rueda, David, Roman, Yesenia, Room, Robin, Roshandel, Gholamreza, Roth, Gregory A., Rothenbacher, Dietrich, Rubagotti, Enrico, Rushton, Lesley, Sadat, Nafi, Safdarian, Mahdi, Safi, Sare, Safiri, Saeid, Sahathevan, Ramesh, Salama, Joseph, Salomon, Joshua A., Samy, Abdallah M., Sanabria, Juan Ramon, Sanchez-Niño, Maria Dolore, Sánchez-Pimienta, Tania G., Santomauro, Damian, Santos, Itamar S., Santric Milicevic, Milena M., Sartorius, Benn, Satpathy, Maheswar, Sawhney, Monika, Saxena, Sonia, Schaeffner, Elke, Schmidt, Maria Inê, Schneider, Ione J.C., Schutte, Aletta E., Schwebel, David C., Schwendicke, Falk, Seedat, Soraya, Sepanlou, Sadaf G., Serdar, Berrin, Servan-Mori, Edson E., Shaddick, Gavin, Shaheen, Amira, Shahraz, Saeid, Shaikh, Masood Ali, Shamah Levy, Teresa, Shamsipour, Mansour, Shamsizadeh, Morteza, Shariful Islam, Sheikh Mohammed, Sharma, Jayendra, Sharma, Rajesh, She, Jun, Shen, Jiabin, Shi, Peilin, Shibuya, Kenji, Shields, Chloe, Shiferaw, Mekonnen Sisay, Shigematsu, Mika, Shin, Min-Jeong, Shiri, Rahman, Shirkoohi, Reza, Shishani, Kawkab, Shoman, Haitham, Shrime, Mark G., Sigfusdottir, Inga Dora, Silva, Diego Augusto Santo, Silva, João Pedro, Silveira, Dayane Gabriele Alve, Singh, Jasvinder A., Singh, Virendra, Sinha, Dhirendra Narain, Skiadaresi, Eirini, Slepak, Erica Leigh, Smith, David L., Smith, Mari, Sobaih, Badr H.A., Sobngwi, Eugene, Soneji, Samir, Sorensen, Reed J.D., Sposato, Luciano A., Sreeramareddy, Chandrashekhar T., Srinivasan, Vinay, Steel, Nichola, Stein, Dan J., Steiner, Caitlyn, Steinke, Sabine, Stokes, Mark Andrew, Strub, Bryan, Subart, Michelle, Sufiyan, Muawiyyah Babale, Suliankatchi, Rizwan Abdulkader, Sur, Patrick J., Swaminathan, Soumya, Sykes, Bryan L., Szoeke, Cassandra E.I., Tabarés-Seisdedos, Rafael, Tadakamadla, Santosh Kumar, Takahashi, Ken, Takala, Jukka S., Tandon, Nikhil, Tanner, Marcel, Tarekegn, Yihunie L., Tavakkoli, Mohammad, Tegegne, Teketo Kassaw, Tehrani-Banihashemi, Arash, Terkawi, Abdullah Sulieman, Tesssema, Belay, Thakur, J.S., Thamsuwan, Ornwipa, Thankappan, Kavumpurathu Raman, Theis, Andrew M., Thomas, Matthew Lloyd, Thomson, Alan J., Thrift, Amanda G., Tillmann, Taavi, Tobe-Gai, Ruoyan, Tobollik, Myriam, Tollanes, Mette C., Tonelli, Marcello, Topor-Madry, Roman, Torre, Anna, Tortajada, Miguel, Touvier, Mathilde, Tran, Bach Xuan, Truelsen, Thoma, Tuem, Kald Beshir, Tuzcu, Emin Murat, Tyrovolas, Stefano, Ukwaja, Kingsley Nnanna, Uneke, Chigozie Jesse, Updike, Rachel, Uthman, Olalekan A., Van Boven, Job F.M., Van Donkelaar, Aaron, Varughese, Santosh, Vasankari, Tommi, Veerman, Lennert J., Venkateswaran, Vidhya, Venketasubramanian, Narayanaswamy, Violante, Francesco S., Vladimirov, Sergey K., Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Vos, Theo, Wadilo, Fiseha, Wakayo, Tolassa, Wallin, Mitchell T., Wang, Yuan-Pang, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G., Weiss, Daniel J., Werdecker, Andrea, Westerman, Ronny, Whiteford, Harvey A., Wiysonge, Charles Shey, Woldeyes, Belete Getahun, Wolfe, Charles D.A., Woodbrook, Rachel, Workicho, Abdulhalik, Wulf Hanson, Sarah, Xavier, Deni, Xu, Gelin, Yadgir, Simon, Yakob, Bereket, Yan, Lijing L., Yaseri, Mehdi, Yimam, Hassen Hamid, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Yotebieng, Marcel, Younis, Mustafa Z., Zaidi, Zoubida, El Sayed Zaki, Maysaa, Zavala-Arciniega, Lui, Zhang, Xueying, Zimsen, Stephanie Raman M., Zipkin, Ben, Zodpey, Sanjay, Lim, Stephen S., and Murray, Christopher J.L.
Subjects: Líkamsþyngdarstuðull, Dánarmein, Heilsufar, Dánartíðni, Birthweight, Fæðingarþyngd, Börn, HEALTH-RISKS, Pregnancy, EPIDEMIOLOGY, Psychology, Meðganga, Children, Konur, Body mass index, PRECAUTIONARY PRINCIPLE, Public health, Global burden of disease/statistics and numerical data, Medicine (all), Smoking, COST, Men, 11 Medical And Health Sciences, Health policy, Háþrýstingur, Sálfræði, World health, Hypertension, Lýðheilsa, Reykingar, Life Sciences & Biomedicine, COUNTRIES, Quality of life, DEATHS, Lífsgæði, Health risk assessment, Medicine, General & Internal, Heilbrigðisvísindi, General & Internal Medicine, Heilbrigðisstefna, Women, Mortality, Áhættugreining, CHINESE POPULATION, OBESITY PREVENTION, Science & Technology, HYPERTENSION, MORTALITY, Malnutrition, Næringarskortur, Karlar, Cause of death/trends, RA
Abstract: Correction in: LANCET Volume: 390 Issue: 10104 Pages: 1736-1736 Published: OCT 14 2017 ; LANCET Volume: 390 Issue: 10106 Pages: E38-E38 Published: OCT 28 2017., Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context. Methods We used the comparative risk assessment 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 clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. 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. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined. Findings Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124.1 million DALYs [95% UI 111.2 million to 137.0 million]), high systolic blood pressure (122.2 million DALYs [110.3 million to 133.3 million], and low birthweight and short gestation (83.0 million DALYs [78.3 million to 87.7 million]), and for women, were high systolic blood pressure (89.9 million DALYs [80.9 million to 98.2 million]), high body-mass index (64.8 million DALYs [44.4 million to 87.6 million]), and high fasting plasma glucose (63.8 million DALYs [53.2 million to 76.3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9.3% (6.9-11.6) decline in deaths and a 10.8% (8.3-13.1) decrease in DALYs at the global level, while population ageing accounts for 14.9% (12.7-17.5) of deaths and 6.2% (3.9-8.7) of DALYs, and population growth for 12.4% (10.1-14.9) of deaths and 12.4% (10.1-14.9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27.3% (24.9-29.7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks. Interpretation Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade., The Bill & Melinda Gates Foundation, Bloomberg Philanthropies.
Published: 2017

22. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author: Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M., Abd-Allah, Foad, Abera, Semaw Ferede, Abraha, Haftom Niguse, Abu-Raddad, Laith J., Abu-Rmeileh, Niveen M. E., Adedeji, Isaac Akinkunmi, Adedoyin, Rufus Adesoji, Adetifa, Ifedayo Morayo O., Adetokunboh, Olatunji, Afshin, Ashkan, Aggarwal, Rakesh, Agrawal, Anurag, Agrawal, Sutapa, Ahmad Kiadaliri, Aliasghar, Ahmed, Muktar Beshir, Aichour, Miloud Taki Eddine, Aichour, Amani Nidhal, Aichour, Ibthiel, Aiyar, Sneha, Akanda, Ali Shafqat, Akinyemiju, Tomi F., Akseer, Nadia, Al Lami, Faris Hasan, Alabed, Samer, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alasfoor, Deena, Aldridge, Robert William, Alene, Kefyalew Addis, Al-Eyadhy, Ayman, Alhabib, Samia, Ali, Raghib, Alizadeh-Navaei, Reza, Aljunid, Syed M., Alkaabi, Juma M., Alkerwi, Ala'a, Alla, François, Allam, Shalini D., Allebeck, Peter, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A., Alvis-Guzman, Nelson, Amare, Azmeraw T., Ameh, Emmanuel A., Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampem, Anber, Nahla, Andrei, Catalina Liliana, Androudi, Sofia, Ansari, Hossein, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T., Anwari, Palwasha, Ärnlöv, Johan, Arora, Megha, Artaman, Al, Aryal, Krishna Kumar, Asayesh, Hamid, Asgedom, Solomon Weldegebreal, Asghar, Rana Jawad, Assadi, Reza, Assaye, Ashagre Molla, Atey, Tesfay Mehari, Atre, Sachin R., Avila-Burgos, Leticia, Avokpaho, Euripide Frinel G. Arthur, Awasthi, Ashish, Babalola, Tesleem Kayode, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Balalla, Shivanthi, Barac, Aleksandra, Barber, Ryan M., Barboza, Miguel A., Barker-Collo, Suzanne L., Bärnighausen, Till, Barquera, Simon, Barregard, Lars, Barrero, Lope H., Baune, Bernhard T., Bazargan-Hejazi, Shahrzad, Bedi, Neeraj, Beghi, Ettore, Béjot, Yannick, Bekele, Bayu Begashaw, Bell, Michelle L., Bello, Aminu K., Bennett, Derrick A., Bennett, James R., Bensenor, Isabela M., Benson, Jennifer, Berhane, Adugnaw, Berhe, Derbew Fikadu, Bernabé, Eduardo, Beuran, Mircea, Beyene, Addisu Shunu, Bhala, Neeraj, Bhansali, Anil, Bhaumik, Soumyadeep, Bhutta, Zulfiqar A., Bicer, Burcu Kucuk, Bidgoli, Hassan Haghparast, Bikbov, Boris, Birungi, Charles, Biryukov, Stan, Bisanzio, Donal, Bizuayehu, Habtamu Mellie, Bjerregaard, Peter, Blosser, Christopher D., Boneya, Dube Jara, Boufous, Soufiane, Bourne, Rupert R. A., Brazinova, Alexandra, Breitborde, Nicholas J. 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S., Radfar, Amir, Rafay, Anwar, Rahimi-Movaghar, Afarin, Rahimi-Movaghar, Vafa, Rahman, Mohammad Hifz Ur, Rahman, Sajjad Ur, Rahman, Mahfuzar, Rai, Rajesh Kumar, Rajsic, Sasa, Ram, Usha, Rana, Saleem M., Ranabhat, Chhabi Lal, Rao, Paturi Vishnupriya, Rawaf, Salman, Ray, Sarah E., Rego, Maria Albertina Santiago, Rehm, Jürgen, Reiner, Robert C., Remuzzi, Giuseppe, Renzaho, Andre M. N., Resnikoff, Serge, Rezaei, Satar, Rezai, Mohammad Sadegh, Ribeiro, Antonio L., Rivas, Jacqueline Castillo, Rokni, Mohammad Bagher, Ronfani, Luca, Roshandel, Gholamreza, Roth, Gregory A., Rothenbacher, Dietrich, Roy, Ambuj, Rubagotti, Enrico, Ruhago, George Mugambage, Saadat, Soheil, Sabde, Yogesh Damodar, Sachdev, Perminder S., Sadat, Nafis, Safdarian, Mahdi, Safi, Sare, Safiri, Saeid, Sagar, Rajesh, Sahathevan, Ramesh, Sahebkar, Amirhossein, Sahraian, Mohammad Ali, Salama, Joseph, Salamati, Payman, Salomon, Joshua A., Salvi, Sundeep Santosh, Samy, Abdallah M., Sanabria, Juan Ramon, Sanchez-Niño, Maria Dolores, Santos, Itamar S., Santric Milicevic, Milena M., Sarmiento-Suarez, Rodrigo, Sartorius, Benn, Satpathy, Maheswar, Sawhney, Monika, Saxena, Sonia, Saylan, Mete I., Schmidt, Maria Inês, Schneider, Ione J. 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Patrick J., Swaminathan, Soumya, Sykes, Bryan L., Szoeke, Cassandra E.I., Tabarés-Seisdedos, Rafael, Tadakamadla, Santosh Kumar, Tadese, Fentaw, Tandon, Nikhil, Tanne, David, Tarajia, Musharaf, Tavakkoli, Mohammad, Taveira, Nuno, Tehrani-Banihashemi, Arash, Tekelab, Tesfalidet, Tekle, Dejen Yemane, Temam Shifa, Girma, Temsah, Mohamad-Hani, Terkawi, Abdullah Sulieman, Tesema, Cheru Leshargie, Tesssema, Belay, Theis, Andrew, Thomas, Nihal, Thompson, Alex H., Thomson, Alan J., Thrift, Amanda G., Tiruye, Tenaw Yimer, Tobe-Gai, Ruoyan, Tonelli, Marcello, Topor-Madry, Roman, Topouzis, Foti, Tortajada, Miguel, Tran, Bach Xuan, Truelsen, Thoma, Trujillo, Ulise, Tsilimparis, Nikolao, Tuem, Kald Beshir, Tuzcu, Emin Murat, Tyrovolas, Stefano, Ukwaja, Kingsley Nnanna, Undurraga, Eduardo A., Uthman, Olalekan A., Uzochukwu, Benjamin S. Chudi, Van Boven, Job F.M., Varakin, Yuri Y., Varughese, Santosh, Vasankari, Tommi, Vasconcelos, Ana Maria Nogale, Venketasubramanian, Narayanaswamy, Vidavalur, Ramesh, Violante, Francesco S., Vishnu, Abhishek, Vladimirov, Sergey K., Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Vos, Theo, Waid, Jillian L., Wakayo, Tolassa, Wang, Yuan-Pang, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G., Werdecker, Andrea, Wesana, Joshua, Wijeratne, Tissa, Wilkinson, James D., Wiysonge, Charles Shey, Woldeyes, Belete Getahun, Wolfe, Charles D.A., Workicho, Abdulhalik, Workie, Shimelash Bitew, Xavier, Deni, Xu, Gelin, Yaghoubi, Mohsen, Yakob, Bereket, Yalew, Ayalnesh Zemene, Yan, Lijing L., Yano, Yuichiro, Yaseri, Mehdi, Ye, Pengpeng, Yimam, Hassen Hamid, Yip, Paul, Yirsaw, Biruck Desalegn, Yonemoto, Naohiro, Yoon, Seok-Jun, Yotebieng, Marcel, Younis, Mustafa Z., Zaidi, Zoubida, El Sayed Zaki, Maysaa, Zeeb, Hajo, Zenebe, Zerihun Menlkalew, Zerfu, Taddese Alemu, Zhang, Anthony Lin, Zhang, Xueying, Zodpey, Sanjay, Zuhlke, Liesl Joanna, Lopez, Alan D., Murray, Christopher J.L., Wang, H, Abajobir, A, Abate, K, Abbafati, C, Abbas, K, Abd-Allah, F, Abera, S, Abraha, H, Abu-Raddad, L, Abu-Rmeileh, N, Adedeji, I, Adedoyin, R, Adetifa, I, Adetokunboh, O, Afshin, A, Aggarwal, R, Agrawal, A, Agrawal, S, Ahmad Kiadaliri, A, Ahmed, M, Aichour, A, Aichour, I, Aichour, M, Aiyar, S, Akanda, A, Akinyemiju, T, Akseer, N, Al-Eyadhy, A, Al Lami, F, Alabed, S, Alahdab, F, Al-Aly, Z, Alam, K, Alam, N, Alasfoor, D, Aldridge, R, Alene, K, Alhabib, S, Ali, R, Alizadeh-Navaei, R, Aljunid, S, Alkaabi, J, Alkerwi, A, Alla, F, Allam, S, Allebeck, P, Al-Raddadi, R, Alsharif, U, Altirkawi, K, Martin, E, Alvis-Guzman, N, Amare, A, Ameh, E, Amini, E, Ammar, W, Amoako, Y, Anber, N, Andrei, C, Androudi, S, Ansari, H, Ansha, M, Antonio, C, Anwari, P, Ärnlöv, J, Arora, M, Artaman, A, Aryal, K, Asayesh, H, Asgedom, S, Asghar, R, Assadi, R, Atey, T, Atre, S, Avila-Burgos, L, Avokpaho, E, Awasthi, A, Ayala Quintanilla, B, Babalola, T, Bacha, U, Badawi, A, Balakrishnan, K, Balalla, S, Barac, A, Barber, R, Barboza, M, Barker-Collo, S, Bärnighausen, T, Barquera, S, Barregard, L, Barrero, L, Baune, B, Bazargan-Hejazi, S, Bedi, N, Beghi, E, Béjot, Y, Bekele, B, Bell, M, Bello, A, Bennett, D, Bennett, J, Bensenor, I, Benson, J, Berhane, A, Berhe, D, Bernabé, E, Beuran, M, Beyene, A, Bhala, N, Bhansali, A, Bhaumik, S, Bhutta, Z, Bikbov, B, Birungi, C, Biryukov, S, Bisanzio, D, Bizuayehu, H, Bjerregaard, P, Blosser, C, Boneya, D, Boufous, S, Bourne, R, Brazinova, A, Breitborde, N, Brenner, H, Brugha, T, Bukhman, G, Bulto, L, Bumgarner, B, Burch, M, Butt, Z, Cahill, L, Cahuana-Hurtado, L, Campos-Nonato, I, Car, J, Car, M, Cárdenas, R, Carpenter, D, Carrero, J, Carter, A, Castañeda-Orjuela, C, Castillo Rivas, J, Castro, F, Castro, R, Catalá-López, F, Chen, H, Chiang, P, Chibalabala, M, Chisumpa, V, Chitheer, A, Choi, J, Christensen, H, Christopher, D, Ciobanu, L, Cirillo, M, Cohen, A, 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A, Karema, C, Karimi, S, Karthikeyan, G, Kasaeian, A, Kassaw, N, Kassebaum, N, Kastor, A, Katikireddi, S, Kaul, A, Kawakami, N, Kazanjan, K, Keiyoro, P, Kelbore, S, Kemp, A, Kengne, A, Keren, A, Kereselidze, M, Kesavachandran, C, Ketema, E, Khader, Y, Khalil, I, Khan, E, Khan, G, Khang, Y, Khera, S, Khoja, A, Khosravi, M, Kibret, G, Kieling, C, Kim, C, Kim, D, Kim, P, Kim, S, Kim, Y, Kimokoti, R, Kinfu, Y, Kishawi, S, Kissimova-Skarbek, K, Kissoon, N, Kivimaki, M, Knudsen, A, Kokubo, Y, Kopec, J, Kosen, S, Koul, P, Koyanagi, A, Kravchenko, M, Krohn, K, Kuate Defo, B, Kucuk Bicer, B, Kuipers, E, Kulikoff, X, Kulkarni, V, Kumar, G, Kumar, P, Kumsa, F, Kutz, M, Lachat, C, Lagat, A, Lager, A, Lal, D, Lalloo, R, Lambert, N, Lan, Q, Van Lansingh, C, Larson, H, Larsson, A, Laryea, D, Lavados, P, Laxmaiah, A, Lee, P, Leigh, J, Leung, J, Leung, R, Levi, M, Li, Y, Liao, Y, Liben, M, Lim, S, Linn, S, Lipshultz, S, Liu, S, Lodha, R, Logroscino, G, Lorch, S, Lorkowski, S, Lotufo, P, Lozano, R, Lunevicius, R, Lyons, R, Ma, S, Macarayan, E, Machado, I, Mackay, M, Magdy Abd El Razek, M, Magis-Rodriguez, C, Mahdavi, M, Majdan, M, Majdzadeh, R, Majeed, A, Malekzadeh, R, Malhotra, R, Malta, D, Mantovani, L, Manyazewal, T, Mapoma, C, Marczak, L, Marks, G, Martinez-Raga, J, Martins-Melo, F, Massano, J, Maulik, P, Mayosi, B, Mazidi, M, Mcalinden, C, Mcgarvey, S, Mcgrath, J, Mckee, M, Mehata, S, Mehndiratta, M, Mehta, K, Meier, T, Mekonnen, T, Meles, K, Memiah, P, Memish, Z, Mendoza, W, Mengesha, M, Mengistie, M, Mengistu, D, Menon, G, Menota, B, Mensah, G, Meretoja, A, Meretoja, T, Mezgebe, H, Micha, R, Mikesell, J, Miller, T, Mills, E, Minnig, S, Mirarefin, M, Mirrakhimov, E, Misganaw, A, Mishra, S, Mohammad, K, Mohammadi, A, Mohammed, K, Mohammed, S, Mohan, M, Mohanty, S, Mokdad, A, Molla Assaye, A, Mollenkopf, S, Molokhia, M, Monasta, L, Montañez Hernandez, J, Montico, M, Mooney, M, Moore, A, Moradi-Lakeh, M, Moraga, P, Morawska, L, Moreno Velasquez, I, Mori, R, Morrison, S, Mruts, K, Mueller, U, Mullany, E, Muller, K, Murthy, G, Murthy, S, Musa, K, Nachega, J, Nagata, C, Nagel, G, Naghavi, M, Naidoo, K, Nanda, L, Nangia, V, Nascimento, B, Natarajan, G, Negoi, I, Nguyen, C, Nguyen, G, Nguyen, Q, Nguyen, T, Ningrum, D, Nisar, M, Nomura, M, Nong, V, Norheim, O, Norrving, B, Noubiap, J, Nyakarahuka, L, Obermeyer, C, O'Donnell, M, Ogbo, F, Oh, I, Okoro, A, Oladimeji, O, Olagunju, A, Olusanya, B, Olusanya, J, Oren, E, Ortiz, A, Osgood-Zimmerman, A, Ota, E, Owolabi, M, Oyekale, A, Mahesh, P, Pacella, R, Pakhale, S, Pana, A, Panda, B, Panda-Jonas, S, Park, E, Parsaeian, M, Patel, T, Patten, S, Patton, G, Paudel, D, Pereira, D, Perez-Padilla, R, Perez-Ruiz, F, Perico, N, Pervaiz, A, Pesudovs, K, Peterson, C, Petri, W, Petzold, M, Phillips, M, Piel, F, Pigott, D, Pishgar, F, Plass, D, Polinder, S, Popova, S, Postma, M, Poulton, R, Pourmalek, F, Prasad, N, Purwar, M, Qorbani, M, Rabiee, R, Radfar, A, Rafay, A, Rahimi-Movaghar, A, Rahimi-Movaghar, V, Rahman, M, Rahman, S, Rai, R, Rajsic, S, Ram, U, Rana, S, Ranabhat, C, Rao, P, Rawaf, S, Ray, S, Rego, M, Rehm, J, Reiner, R, Remuzzi, G, Renzaho, A, Resnikoff, S, Rezaei, S, Rezai, M, Ribeiro, A, Rokni, M, Ronfani, L, Roshandel, G, Roth, G, Rothenbacher, D, Roy, A, Rubagotti, E, Ruhago, G, Saadat, S, Sabde, Y, Sachdev, P, Sadat, N, Safdarian, M, Safi, S, Safiri, S, Sagar, R, Sahathevan, R, Sahebkar, A, Sahraian, M, Salama, J, Salamati, P, Salomon, J, Salvi, S, Samy, A, Sanabria, J, Sanchez-Niño, M, Santos, I, Santric Milicevic, M, Sarmiento-Suarez, R, Sartorius, B, Satpathy, M, Sawhney, M, Saxena, S, Saylan, M, Schmidt, M, Schneider, I, Schutte, A, Schwebel, D, Schwendicke, F, Seedat, S, Seid, A, Sepanlou, S, Servan-Mori, E, Shackelford, K, Shaheen, A, Shahraz, S, Shaikh, M, Shamsipour, M, Shamsizadeh, M, Islam, S, Sharma, J, Sharma, R, She, J, Shen, J, Shetty, B, Shi, P, Shibuya, K, Shigematsu, M, Shiri, R, Shiue, I, Shrime, M, Sigfusdottir, I, Silberberg, D, Silpakit, N, Silva, D, Silva, J, Silveira, D, Sindi, S, Singh, A, Singh, J, Singh, P, Singh, V, Sinha, D, Skiadaresi, E, Sligar, A, Smith, D, Sobaih, B, Sobngwi, E, Soneji, S, Soriano, J, Sreeramareddy, C, Srinivasan, V, Stathopoulou, V, Steel, N, Stein, D, Steiner, C, Stöckl, H, Stokes, M, Strong, M, Sufiyan, M, Suliankatchi, R, Sunguya, B, Sur, P, Swaminathan, S, Sykes, B, Szoeke, C, Tabarés-Seisdedos, R, Tadakamadla, S, Tadese, F, Tandon, N, Tanne, D, Tarajia, M, Tavakkoli, M, Taveira, N, Tehrani-Banihashemi, A, Tekelab, T, Tekle, D, Temam Shifa, G, Temsah, M, Terkawi, A, Tesema, C, Tesssema, B, Theis, A, Thomas, N, Thompson, A, Thomson, A, Thrift, A, Tiruye, T, Tobe-Gai, R, Tonelli, M, Topor-Madry, R, Topouzis, F, Tortajada, M, Tran, B, Truelsen, T, Trujillo, U, Tsilimparis, N, Tuem, K, Tuzcu, E, Tyrovolas, S, Ukwaja, K, Undurraga, E, Uthman, O, Uzochukwu, B, Van Boven, J, Varakin, Y, Varughese, S, Vasankari, T, Vasconcelos, A, Venketasubramanian, N, Vidavalur, R, Violante, F, Vishnu, A, Vladimirov, S, Vlassov, V, Vollset, S, Vos, T, Waid, J, Wakayo, T, Wang, Y, Weichenthal, S, Weiderpass, E, Weintraub, R, Werdecker, A, Wesana, J, Wijeratne, T, Wilkinson, J, Wiysonge, C, Woldeyes, B, Wolfe, C, Workicho, A, Workie, S, Xavier, D, Xu, G, Yaghoubi, M, Yakob, B, Yalew, A, Yan, L, Yano, Y, Yaseri, M, Ye, P, Yimam, H, Yip, P, Yirsaw, B, Yonemoto, N, Yoon, S, Yotebieng, M, Younis, M, Zaidi, Z, El Sayed Zaki, M, Zeeb, H, Zenebe, Z, Zerfu, T, Zhang, A, Zhang, X, Zodpey, S, Zuhlke, L, Lopez, A, Murray, C, Erasmus MC other, Emergency Medicine, Rehabilitation Medicine, Gastroenterology & Hepatology, Public Health, and Neurology
Subjects: Dánarmein, Heilsufar, Dánartíðni, Lífslíkur, Epidemiology, Aldurshópar, ALCOHOL, Börn, Medicine and Health Sciences, Psychology, DEVELOPING-COUNTRIES, Children, Konur, Ungbörn, Tölfræði, Educational status, Aldraðir, Medicine (all), Global burden of disease/statistics and numerical data, DEATH, Men, Þjóðir, Staðtölur, Stillbirth, Sálfræði, World health, SURVIVAL, Income, CHILD-MORTALITY, HEALTH, Burðarmálsdauði, Infants, Age distribution, HIV infections, Child mortality, Alnæmi, Menntun, GBD, Fæðingartíðni, RUSSIAN MORTALITY, Birth rate, Life Expectancy, SDG 3 - Good Health and Well-being, Women, Mortality, METAANALYSIS, Faraldsfræði, HIV, Frjósemi, Fertility, Socioeconomic Factors, Karlar, Barnadauði, Félagshagfræði, Tekjur, Older people, Cause of death/trends, RA
Abstract: Correction in: Group Author(s): GBD 2016 Mortality Collaborators LANCET Volume: 390 Issue: 10106 Pages: E38-E38 Published: OCT 28 2017, Background Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. Methods We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0.5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Sociodemographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. Findings Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86.9 years (95% UI 86.7-87.2), and for men in Singapore, at 81.3 years (78.8-83.7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016. Interpretation Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled., Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.
Published: 2017

23. The status of hepatitis C virus infection among people who inject drugs in the Middle East and North Africa.

Author: Mahmud, Sarwat, Mumtaz, Ghina R., Chemaitelly, Hiam, Al Kanaani, Zaina, Kouyoumjian, Silva P., Hermez, Joumana G., and Abu‐Raddad, Laith J.
Subjects: HEPATITIS C virus, INTRAVENOUS drug abuse, GENOTYPES, HEPATITIS C risk factors
Abstract: Background and aims: People who inject drugs (PWID) are a key population at high risk of hepatitis C virus (HCV) infection. The aim of this study was to delineate the epidemiology of HCV in PWID in the Middle East and North Africa (MENA). Methods: Syntheses of data were conducted on the standardized and systematically assembled databases of the MENA HCV Epidemiology Synthesis Project, 1989–2018. Random‐effects meta‐analyses and meta‐regressions were performed. Meta‐regression variables included country, study site, year of data collection and year of publication [to assess trends in HCV antibody prevalence over time], sample size and sampling methodology. Numbers of chronically infected PWID across MENA were estimated. The Shannon Diversity Index was calculated to assess genotype diversity. Results: Based on 118 HCV antibody prevalence measures, the pooled mean prevalence in PWID for all MENA was 49.3% [95% confidence interval (CI) = 44.4–54.1%]. The country‐specific pooled mean ranged from 21.7% (95% CI = 4.9–38.6%) in Tunisia to 94.2% (95% CI = 90.8–96.7%) in Libya. An estimated 221 704 PWID were chronically infected, with the largest numbers found in Iran at 68 526 and in Pakistan at 46 554. There was no statistically significant evidence for a decline in HCV antibody prevalence over time. Genotype diversity was moderate (Shannon Diversity Index of 1.01 out of 1.95; 52.1%). The pooled mean percentage for each HCV genotype was highest in genotype 3 (42.7%) and in genotype 1 (35.9%). Conclusion: Half of people who inject drugs in the Middle East and North Africa appear to have ever been infected with hepatitis C virus, but there are large variations in antibody prevalence among countries. In addition to > 200 000 chronically infected current people who inject drugs, there is an unknown number of people who no longer inject drugs who may have acquired hepatitis C virus during past injecting drug use. Harm reduction services must be expanded, and innovative strategies need to be employed to ensure accessibility to hepatitis C virus testing and treatment. [ABSTRACT FROM AUTHOR]
Published: 2020
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24. Characterising HIV/AIDS knowledge and attitudes in the Middle East and North Africa: Systematic review and data synthesis.

Author: Mumtaz, Ghina R., Hilmi, Nahla, Majed, El Zahraa, and Abu-Raddad, Laith J.
Subjects: HIV prevention, HIV infection transmission, HIV infection epidemiology, AIDS, ATTITUDE (Psychology), GREY literature, HEALTH attitudes, PSYCHOLOGY of HIV-positive persons, MEDLINE, MINORITIES, ONLINE information services, SEX work, REFUGEES, RESEARCH funding, RISK perception, RURAL population, SYSTEMATIC reviews, SOCIAL attitudes, DISEASE prevalence, HEALTH literacy, MEN who have sex with men, DESCRIPTIVE statistics
Abstract: This article reviews HIV/AIDS knowledge and attitudes in various population groups in the Middle East and North Africa (MENA), and highlights their relevance to HIV epidemiology and the design and implementation of preventions and treatment efforts. PubMed and the MENA HIV/AIDS Epidemiology Synthesis Project database of grey/unpublished literature were searched. Levels of knowledge were categorised based on presence of basic knowledge, comprehensive knowledge, and misconceptions and misinformation. Attitudes towards people living with HIV/AIDS (PLHIV) were classified into positive or negative. Basic knowledge was overall high among key populations at higher risk of infection (KPAR), and bridging and general population groups, but still a few population pockets had low basic knowledge. Level of comprehensive knowledge was overall low, and misinformation and misconceptions were prevalent. Some KPAR, including people who inject drugs, men who have sex with men, and female sex workers, were unaware of some modes of HIV transmission. Perception of risk of infection was low even among KPAR. We found differentials in knowledge putting women, rural populations, refugees, and other marginalised minorities at a disadvantage. Attitudes towards PLHIV tended to be negative. These findings are of concern, particularly for KPAR currently experiencing emerging HIV epidemics. [ABSTRACT FROM AUTHOR]
Published: 2020
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25. Epidemiology of , , , , and herpes simplex virus type 2 among female sex workers in the Middle East and North Africa: systematic review and meta-analytics.

Author: Chemaitelly, Hiam, Weiss, Helen A ., Smolak, Alex, Majed, Elzahraa, and Abu-Raddad, Laith J .
Subjects: TREPONEMA pallidum, CHLAMYDIA trachomatis, EPIDEMIOLOGY
Abstract: Background: The epidemiology of sexually transmitted infections (STIs) and the role of commercial heterosexual sex networks in driving STI transmission in the Middle East and North Africa (MENA) region remain largely unknown.Objective: To characterize the epidemiology of Treponema pallidum (syphilis), Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and herpes simplex virus type 2 (HSV-2) among female sex workers (FSWs) in MENA using an in-depth quantitative assessment.Methods: A systematic review on ten international, regional, and country-level databases was conducted, and reported following PRISMA guidelines. Pooled prevalences of current and/or ever infection for each STI were estimated using random-effects meta-analyses. Sources of between-study heterogeneity were investigated through random-effects meta-regressions.Results: One T. pallidum incidence study and 144 STI prevalence studies were identified for 45 812 FSWs in 13 MENA countries. The pooled prevalence of current infection was 12.7% (95% confidence interval (CI) = 8.5%-17.7%) for T. pallidum, 14.4% (95% CI = 8.2%-22.0%) for C. trachomatis, 5.7% (95% CI = 3.5%-8.4%) for N. gonorrhoeae, and 7.1% (95% CI = 4.3%-10.5%) for T. vaginalis. The pooled prevalence of ever infection (seropositivity using antibody testing) was 12.8% (95% CI = 9.4%-16.6%) for T. pallidum, 80.3% (95% CI = 53.2%-97.6%) for C. trachomatis, and 23.7% (95% CI = 10.2%-40.4%) for HSV-2. The multivariable meta-regression for T. pallidum infection demonstrated strong subregional differences, with the Horn of Africa and North Africa showing, respectively 6-fold (adjusted odds ratio (AOR): 6.4; 95% CI = 2.5-16.7) and 5-fold (AOR = 5.0; 95% CI = 2.5-10.6) higher odds of infection than Eastern MENA. There was also strong evidence for declining T. pallidum odds of infection at 7% per year (AOR = 0.93; 95% CI = 0.88-0.98). Study-specific factors including diagnostic method, sample size, sampling methodology, and response rate, were not associated with syphilis infection. The multivariable model explained 48.5% of the variation in T. pallidum prevalence.Conclusions: STI infection levels among FSWs in MENA are considerable, supporting a key role for commercial heterosexual sex networks in transmission dynamics, and highlighting the health needs of this neglected and vulnerable population. Syphilis prevalence in FSWs appears to have been declining for at least three decades. Gaps in evidence persist for multiple countries. [ABSTRACT FROM AUTHOR]
Published: 2019
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26. Characterizing herpes simplex virus type 1 and type 2 seroprevalence declines and epidemiological association in the United States.

Author: Chemaitelly, Hiam, Nagelkerke, Nico, Omori, Ryosuke, and Abu-Raddad, Laith J.
Subjects: HUMAN herpesvirus 1, SEROPREVALENCE, HEALTH & Nutrition Examination Survey, HUMAN sexuality
Abstract: Objective: Assessing the epidemiological association between herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) infections in the United States, and characterizing the trends in the standardized HSV-1 and HSV-2 antibody prevalences (seroprevalences), 1999–2016. Methods: Source of data was the cross-sectional and nationally-representative biennial surveys of the National Health and Nutrition Examination Survey (NHANES). All nine NHANES rounds for 1999–2016 were included in analysis. Datasets of these rounds were combined and analyzed accounting for survey design and applying weighting procedures. Logistic regressions were used to identify associations with seropositivity. Sensitivity analyses were conducted. Results: Odds of HSV-1 infection declined by 2.84% (95% CI: 1.70%-4.00%) annually among men, and by 2.22% (95% CI: 1.23%-3.21%) among women. Declines were highest at younger ages. Odds of HSV-2 infection declined by 2.23% (95% CI: 0.71%-3.82%) annually among men, and by 2.89% (95% CI: 1.57%-4.28%) among women. Odds ratio of the association between HSV-2 and HSV-1 seropositivity was 0.71 (95% CI: 0.60–0.84) for men and 0.81 (95% CI: 0.72–0.91) for women, after adjustment for age, ethnicity, and year. Conclusion: HSV-1 and HSV-2 seroprevalences showed a strong declining trend for at least two decades, for both sexes and for the different ethnicities, possibly reflecting improvements in hygiene and living conditions (for HSV-1), and safer sexual behavior (for HSV-2). HSV-1 seroprevalence declines are most pronounced among young individuals. There is evidence for cross protection between the two infections, suggestive of HSV-1 seropositivity being partially protective against HSV-2 infection. [ABSTRACT FROM AUTHOR]
Published: 2019
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27. Herpes simplex virus type 1 epidemiology in Latin America and the Caribbean: Systematic review and meta-analytics.

Author: Sukik, Layan, Alyafei, Maryam, Harfouche, Manale, and Abu-Raddad, Laith J.
Subjects: HUMAN herpesvirus 1, SEROPREVALENCE, META-analysis, HERPES genitalis, EPIDEMIOLOGY, VIRUS isolation
Abstract: Objectives: To investigate the epidemiology of herpes simplex virus type 1 (HSV-1) in Latin America and the Caribbean. Methods: Systematic review and meta-analytics guided by the Cochrane Collaboration Handbook and reported following the PRISMA guidelines. Results: Thirty-three relevant reports were identified including 35 overall (and 95 stratified) seroprevalence measures, and five and nine proportions of virus isolation in genital ulcer disease (GUD) and in genital herpes, respectively. Pooled mean seroprevalence was 57.2% (95% CI: 49.7–64.6%) among children and 88.4% (95% CI: 85.2–91.2%) among adults. Pooled mean seroprevalence was lowest at 49.7% (95% CI: 42.8–56.6%) in those aged ≤10, followed by 77.8% (95% CI: 67.9–84.8%) in those aged 10–20, 82.8% (95% CI: 73.1–90.8%) in those aged 20–30, 92.5% (95% CI: 89.4–95.1%) in those aged 30–40, and 94.2% (95% CI: 92.7–95.5%) in those aged ≥40. Age was the strongest source of heterogeneity in seroprevalence, explaining 54% of variation. Evidence was found for seroprevalence decline over time. Pooled mean proportion of HSV-1 isolation was 0.9% (95% CI: 0.0–3.6%) in GUD and 10.9% (95% CI: 4.4–19.4%) in genital herpes. Conclusions: HSV-1 is a widely prevalent infection in this region, but its epidemiology may be slowly transitioning, with still limited contribution for HSV-1 in genital herpes. [ABSTRACT FROM AUTHOR]
Published: 2019
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28. Temporal evolution of HIV sero-discordancy patterns among stable couples in sub-Saharan Africa.

Author: Awad, Susanne F., Chemaitelly, Hiam, and Abu-Raddad, Laith J.
Subjects: HIV infection transmission, HIV infections, THERAPEUTICS, ANTIRETROVIRAL agents, DISEASE prevalence, DEMOGRAPHIC surveys
Abstract: Introduction: Objective was to examine the temporal variation of HIV sero-discordancy in select representative countries (Kenya, Lesotho, Mali, Niger, Tanzania, and Zimbabwe) in sub-Saharan Africa at different HIV epidemic scales. A sero-discordant couple is defined as a stable couple (SC) in which one partner is HIV-positive while the other is HIV-negative. Methods: A deterministic compartmental mathematical model was constructed to describe HIV transmission dynamics. The model was pair-based, that is explicitly modeling formation of SCs and infection dynamics in both SCs and in single individuals. The model accommodated for different forms of infection statuses in SCs. Using population-based nationally-representative epidemiologic and demographic input data, historical (1980–2014) and future (2015–2030) trends of sero-discordancy and other demographic and epidemiologic indicators were projected throughout HIV epidemic phases. Results: As the epidemics emerged, about 90% of SCs affected by HIV were sero-discordant. This proportion declined to 45%-88% at epidemic peak and stabilized as the epidemics started their natural decline. The largest reductions in sero-discordancy were in high HIV-prevalence countries. As the epidemics further declined with antiretroviral therapy (ART) scale-up, the proportion of sero-discordant couples among HIV-affected couples was projected to increase to 70%-92% by 2030. The proportion of sero-discordant couples among all SCs increased as the epidemics emerged and evolved, then peaked at 2%-20% as the epidemics peaked, and then declined as the epidemics declined to reach 0.3%-16% by 2030. Conclusions: Sero-discordancy patterns varied with the evolution of the epidemics, and were affected by both epidemic phase and scale. The largest variations were found in high HIV-prevalence countries. The fraction of stable couples that are sero-discordant, as opposed to being sero-concordant positive, was projected to increase with ART scale-up and further HIV incidence decline over the coming two decades. These findings inform strategic planning and resource allocation for interventions among sero-discordant couples. [ABSTRACT FROM AUTHOR]
Published: 2018
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29. Hepatitis C virus genotypes in the Middle East and North Africa: Distribution, diversity, and patterns.

Author: Mahmud, Sarwat, Al‐Kanaani, Zaina, Chemaitelly, Hiam, Chaabna, Karima, Kouyoumjian, Silva P., and Abu‐Raddad, Laith J.
Abstract: Our objective was to characterize the distribution, diversity and patterns of hepatitis C virus (HCV) genotypes in the Middle East and North Africa (MENA). Source of data was a database of HCV genotype studies in MENA populated using a series of systematic literature searches. Pooled mean proportions were estimated for each genotype and by country using DerSimonian-Laird random-effects meta-analyses. Genotype diversity within countries was assessed using Shannon Diversity Index. Number of chronic infections by genotype and country was calculated using the pooled proportions and country-specific numbers of chronic infection. Analyses were conducted on 338 genotype studies including 82 257 genotyped individuals. Genotype 1 was dominant (≥50%) in Algeria, Iran, Morocco, Oman, Tunisia, and UAE, and was overall ubiquitous across the region. Genotype 2 was common (10-50%) in Algeria, Bahrain, Libya, and Morocco. Genotype 3 was dominant in Afghanistan and Pakistan. Genotype 4 was dominant in Egypt, Iraq, Jordan, Palestine, Qatar, Saudi Arabia, and Syria. Genotypes 5, 6, and 7 had limited or no presence across countries. Genotype diversity varied immensely throughout MENA. Weighted by population size, MENA's chronic infections were highest among genotype 3, followed by genotype 4, genotype 1, genotype 2, genotype 5, and genotype 6. Despite ubiquitous presence of genotype 1, the vast majority of chronic infections were of genotypes 3 or 4, because of the sizable epidemics in Pakistan and Egypt. Three sub-regional patterns were identified: genotype 3 pattern centered in Pakistan, genotype 4 pattern centered in Egypt, and genotype 1 pattern ubiquitous in most MENA countries. [ABSTRACT FROM AUTHOR]
Published: 2018
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30. Hepatitis C virus viremic rate in the Middle East and North Africa: Systematic synthesis, meta-analyses, and meta-regressions.

Author: Harfouche, Manale, Chemaitelly, Hiam, Kouyoumjian, Silva P., Mahmud, Sarwat, Chaabna, Karima, Al-Kanaani, Zaina, and Abu-Raddad, Laith J.
Subjects: HEPATITIS C treatment, EPIDEMIOLOGY, META-analysis, MEDICAL databases, REGRESSION analysis
Abstract: Objectives: To estimate hepatitis C virus (HCV) viremic rate, defined as the proportion of HCV chronically infected individuals out of all ever infected individuals, in the Middle East and North Africa (MENA). Methods: Sources of data were systematically-gathered and standardized databases of the MENA HCV Epidemiology Synthesis Project. Meta-analyses were conducted using DerSimonian-Laird random-effects models to determine pooled HCV viremic rate by risk population or subpopulation, country/subregion, sex, and study sampling method. Random-effects meta-regressions were conducted to identify predictors of higher viremic rate. Results: Analyses were conducted on 178 measures for HCV viremic rate among 19,593 HCV antibody positive individuals. In the MENA region, the overall pooled mean viremic rate was 67.6% (95% CI: 64.9–70.3%). Across risk populations, the pooled mean rate ranged between 57.4% (95% CI: 49.4–65.2%) in people who inject drugs, and 75.5% (95% CI: 61.0–87.6%) in populations with liver-related conditions. Across countries/subregions, the pooled mean rate ranged between 62.1% (95% CI: 50.0–72.7%) and 70.4% (95% CI: 65.5–75.1%). Similar pooled estimates were further observed by risk subpopulation, sex, and sampling method. None of the hypothesized population-level predictors of higher viremic rate were statistically significant. Conclusions: Two-thirds of HCV antibody positive individuals in MENA are chronically infected. Though there is extensive variation in study-specific measures of HCV viremic rate, pooled mean estimates are similar regardless of risk population or subpopulation, country/subregion, HCV antibody prevalence in the background population, or sex. HCV viremic rate is a useful indicator to track the progress in (and coverage of) HCV treatment programs towards the set target of HCV elimination by 2030. [ABSTRACT FROM AUTHOR]
Published: 2017
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31. Hepatitis C infection epidemiology in Mongolia: protocol of a systematic review and meta-analysis.

Author: Chaabna, Karima and Abu-Raddad, Laith J.
Subjects: *HEPATITIS C risk factors, *DISEASES, *RNA, *THERAPEUTICS
Abstract: Background: Hepatitis C virus (HCV) morbidity appears to be high in Mongolia. Yet, the scale and nature of the infection burden is not well-understood. Our study's objective is to systematically review and synthetize all available epidemiological data on HCV antibody (Ab) prevalence, ribonucleic acid (RNA) prevalence, incidence, risk factors to HCV exposure, and circulating HCV genotypes/subtypes among different at-risk populations. Additionally, we aim to estimate national population-level HCV-Ab prevalence and the number of HCV chronically infected individuals in the population of Mongolia. Methods: Our systematic review will be reported based on the items outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2009) statement. All reports with primary data collected from surveillance or observational studies on Mongolian populations will be eligible for inclusion if the study sample size is greater than 25. Included reports need to present studies that use biological assay for HCV-Ab ascertainment. We will consider three primary outcomes of interest: HCV-Ab incidence, HCV-Ab prevalence, and HCV genotypes/subtypes among different at-risk populations. In addition, two secondary outcomes of interests will be also collected: HCV RNA prevalence, and unadjusted and/or adjusted statistically significant risk factors for HCV exposure (p value =0.05). In order to identify relevant reports, we will search PubMed, Embase, and Index Medicus for the Southeast Asian region. Additionally, we will search Mongolian scientific and medical journals not indexed in PubMed or Embase and the archives of Mongolian local conferences. Lastly, the literature search will be supplemented by checking references of the included reports and identified reviews. We will use broad search criteria with no language or time restrictions. Meta-analyses will estimate pooled HCV-Ab prevalence (by at-risk population, sex, age group, and period), and pooled RNA prevalence among HCV-Ab positive individuals in the general population. Age-adjustment of estimates will be conducted. Discussion: The proposed systematic review and meta-analysis will produce a comprehensive synthesis of HCV epidemiology in Mongolia. The study will provide empirical evidence to inform health policy decision-making, resource allocation, and planning and implementation of relevant public health interventions. [ABSTRACT FROM AUTHOR]
Published: 2017
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32. Urban Chikungunya in the Middle East and North Africa: A systematic review.

Author: Humphrey, John M., Glesby, Marshall J., Reusken, Chantal B. E. M., Cleton, Natalie B., Koopmans, Marion P. G., and Abu-Raddad, Laith J.
Subjects: CHIKUNGUNYA virus, CHIKUNGUNYA, EPIDEMIOLOGY, INFECTIOUS disease transmission
Abstract: Background: The epidemiology of Chikungunya virus (CHIKV) in the Middle East and North Africa (MENA) is not well characterized despite increasing recognition of its expanding infection and disease burden in recent years. Methodology / Principal findings: Following Cochrane Collaboration guidelines and reporting our findings following PRISMA guidelines, we systematically reviewed records describing the human prevalence and incidence, CHIKV prevalence/infection rates in vectors, outbreaks, and reported cases for CHIKV across the MENA region. We identified 29 human seroprevalence measures, one human incidence study, one study reporting CHIKV infection rates in Aedes, and nine outbreaks and case reports/series reported in the MENA from 1970–2015. Overall, anti-CHIKV antibody or reports of autochthonous transmission were identified from 10 of 23 countries in the MENA region (Djibouti, Egypt, Iraq, Iran, Kuwait, Pakistan, Saudi Arabia, Somalia, Sudan, and Yemen), with seroprevalence measures among general populations (median 1.0%, range 0–43%) and acute febrile illness populations (median 9.8%, range 0–30%). Sudan reported the highest number of studies (n = 11) and the highest seroprevalence among general populations (median 12%, range 0–43%) and undifferentiated acute febrile illness populations (median 18%, range 10–23%). CHIKV outbreaks were reported from Djibouti, Pakistan, Sudan, and Yemen. Conclusions / Significance: Seroprevalence studies and outbreak reports suggest endemic transmission of urban cycle CHIKV in at least the Red Sea region and Pakistan. However, indications of seroprevalence despite a low quantity of CHIKV epidemiologic research from the region suggests that CHIKV transmission is currently underrecognized. [ABSTRACT FROM AUTHOR]
Published: 2017
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33. Could Circumcision of HIV-Positive Males Benefit Voluntary Medical Male Circumcision Programs in Africa? Mathematical Modeling Analysis.

Author: Awad, Susanne F., Sgaier, Sema K., Lau, Fiona K., Mohamoud, Yousra A., Tambatamba, Bushimbwa C., Kripke, Katharine E., Thomas, Anne G., Bock, Naomi, Reed, Jason B., Njeuhmeli, Emmanuel, and Abu-Raddad, Laith J.
Subjects: HIV-positive men, CIRCUMCISION, EPIDEMIOLOGY, DISEASE prevalence, MATHEMATICAL models
Abstract: Background: The epidemiological and programmatic implications of inclusivity of HIV-positive males in voluntary medical male circumcision (VMMC) programs are uncertain. We modeled these implications using Zambia as an illustrative example. Methods and Findings: We used the Age-Structured Mathematical (ASM) model to evaluate, over an intermediate horizon (2010–2025), the effectiveness (number of VMMCs needed to avert one HIV infection) of VMMC scale-up scenarios with varying proportions of HIV-positive males. The model was calibrated by fitting to HIV prevalence time trend data from 1990 to 2014. We assumed that inclusivity of HIV positive males may benefit VMMC programs by increasing VMMC uptake among higher risk males, or by circumcision reducing HIV male-to-female transmission risk. All analyses were generated assuming no further antiretroviral therapy (ART) scale-up. The number of VMMCs needed to avert one HIV infection was projected to increase from 12.2 VMMCs per HIV infection averted, in a program that circumcises only HIV-negative males, to 14.0, in a program that includes HIV-positive males. The proportion of HIV-positive males was based on their representation in the population (e.g. 12.6% of those circumcised in 2010 would be HIV-positive based on HIV prevalence among males of 12.6% in 2010). However, if a program that only reaches out to HIV-negative males is associated with 20% lower uptake among higher-risk males, the effectiveness would be 13.2 VMMCs per infection averted. If improved inclusivity of HIV-positive males is associated with 20% higher uptake among higher-risk males, the effectiveness would be 12.4. As the assumed VMMC efficacy against male-to-female HIV transmission was increased from 0% to 20% and 46%, the effectiveness of circumcising regardless of HIV status improved from 14.0 to 11.5 and 9.1, respectively. The reduction in the HIV incidence rate among females increased accordingly, from 24.7% to 34.8% and 50.4%, respectively. Conclusion: Improving inclusivity of males in VMMC programs regardless of HIV status increases VMMC effectiveness, if there is moderate increase in VMMC uptake among higher-risk males and/or if there is moderate efficacy for VMMC against male-to-female transmission. In these circumstances, VMMC programs can reduce the HIV incidence rate in males by nearly as much as expected by some ART programs, and additionally, females can benefit from the intervention nearly as much as males. [ABSTRACT FROM AUTHOR]
Published: 2017
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34. Dengue in the Middle East and North Africa: A Systematic Review.

Author: Humphrey, John M., Cleton, Natalie B., Reusken, Chantal B. E. M., Glesby, Marshall J., Koopmans, Marion P. G., and Abu-Raddad, Laith J.
Subjects: DENGUE, DIAGNOSIS of fever, SEROPREVALENCE, DENGUE viruses, PUBLIC health, META-analysis, INFECTIOUS disease transmission
Abstract: Background: Dengue virus (DENV) infection is widespread and its disease burden has increased in past decades. However, little is known about the epidemiology of dengue in the Middle East and North Africa (MENA). Methodology / Principal Findings: Following Cochrane Collaboration guidelines and reporting our findings following PRISMA guidelines, we systematically reviewed available records across MENA describing dengue occurrence in humans (prevalence studies, incidence studies, and outbreak reports), occurrence of suitable vectors (Aedes aegypti and Aedes albopictus), and DENV vector infection rates. We identified 105 human prevalence measures in 13 of 24 MENA countries; 81 outbreaks reported from 9 countries from 1941–2015; and reports of Ae. aegypti and/or Ae. albopictus occurrence in 15 countries. The majority of seroprevalence studies were reported from the Red Sea region and Pakistan, with multiple studies indicating >20% DENV seroprevalence in general populations (median 25%, range 0–62%) in these subregions. Fifty percent of these studies were conducted prior to 1990. Multiple studies utilized assays susceptible to serologic cross-reactions and 5% of seroprevalence studies utilized viral neutralization testing. There was considerable heterogeneity in study design and outbreak reporting, as well as variability in subregional study coverage, study populations, and laboratory methods used for diagnosis. Conclusions / Significance: DENV seroprevalence in the MENA is high among some populations in the Red Sea region and Pakistan, while recent outbreaks in these subregions suggest increasing incidence of DENV which may be driven by a variety of ecologic and social factors. However, there is insufficient study coverage to draw conclusions about Aedes or DENV presence in multiple MENA countries. These findings illustrate the epidemiology of DENV in the MENA while revealing priorities for DENV surveillance and Aedes control. [ABSTRACT FROM AUTHOR]
Published: 2016
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35. Hepatitis C Virus Epidemiology in Djibouti, Somalia, Sudan, and Yemen: Systematic Review and Meta-Analysis.

Author: Chaabna, Karima, Kouyoumjian, Silva P., and Abu-Raddad, Laith J.
Subjects: HEPATITIS C virus, EPIDEMIOLOGY, VIRAL antibodies, SYSTEMATIC reviews
Abstract: Objectives: To characterize hepatitis C virus (HCV) epidemiology and assess country-specific population-level HCV prevalence in four countries in the Middle East and North Africa (MENA) region: Djibouti, Somalia, Sudan, and Yemen. Methods: Reports of HCV prevalence were systematically reviewed as per PRISMA guidelines. Pooled HCV prevalence estimates in different risk populations were conducted when the number of measures per risk category was at least five. Results: We identified 101 prevalence estimates. Pooled HCV antibody prevalence in the general population in Somalia, Sudan and Yemen was 0.9% (95% confidence interval [95%CI]: 0.3%–1.9%), 1.0% (95%CI: 0.3%–1.9%) and 1.9% (95%CI: 1.4%–2.6%), respectively. The only general population study from Djibouti reported a prevalence of 0.3% (CI: 0.2%–0.4%) in blood donors. In high-risk populations (e.g., haemodialysis and haemophilia patients), pooled HCV prevalence was 17.3% (95%CI: 8.6%–28.2%) in Sudan. In Yemen, three studies of haemodialysis patients reported HCV prevalence between 40.0%-62.7%. In intermediate-risk populations (e.g.. healthcare workers, in patients and men who have sex with men), pooled HCV prevalence was 1.7% (95%CI: 0.0%–4.9%) in Somalia and 0.6% (95%CI: 0.4%–0.8%) in Sudan. Conclusion: National HCV prevalence in Yemen appears to be higher than in Djibouti, Somalia, and Sudan as well as most other MENA countries; but otherwise prevalence levels in this subregion are comparable to global levels. The high HCV prevalence in patients who have undergone clinical care appears to reflect ongoing transmission in clinical settings. HCV prevalence in people who inject drugs remains unknown. [ABSTRACT FROM AUTHOR]
Published: 2016
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36. The Epidemiology of Hepatitis C Virus in the Fertile Crescent: Systematic Review and Meta-Analysis.

Author: Chemaitelly, Hiam, Chaabna, Karima, and Abu-Raddad, Laith J.
Subjects: EPIDEMIOLOGY, HEPATITIS C, SYSTEMATIC reviews, META-analysis, DISEASE prevalence, SEROCONVERSION, PATIENTS
Abstract: Objective: To characterize hepatitis C virus (HCV) epidemiology in countries of the Fertile Crescent region of the Middle East and North Africa (MENA), namely Iraq, Jordan, Lebanon, Palestine, and Syria. Methods: We systematically reviewed and synthesized available records of HCV incidence and prevalence following PRISMA guidelines. Meta-analyses were implemented using a DerSimonian-Laird random effects model with inverse weighting to estimate the country-specific HCV prevalence among the various at risk population groups. Results: We identified eight HCV incidence and 240 HCV prevalence measures in the Fertile Crescent. HCV sero-conversion risk among hemodialysis patients was 9.2% in Jordan and 40.3% in Iraq, and ranged between 0% and 3.5% among other populations in Iraq over different follow-up times. Our meta-analyses estimated HCV prevalence among the general population at 0.2% in Iraq (range: 0–7.2%; 95% CI: 0.1–0.3%), 0.3% in Jordan (range: 0–2.0%; 95% CI: 0.1–0.5%), 0.2% in Lebanon (range: 0–3.4%; 95% CI: 0.1–0.3%), 0.2% in Palestine (range: 0–9.0%; 95% CI: 0.2–0.3%), and 0.4% in Syria (range: 0.3–0.9%; 95% CI: 0.4–0.5%). Among populations at high risk, HCV prevalence was estimated at 19.5% in Iraq (range: 0–67.3%; 95% CI: 14.9–24.5%), 37.0% in Jordan (range: 21–59.5%; 95% CI: 29.3–45.0%), 14.5% in Lebanon (range: 0–52.8%; 95% CI: 5.6–26.5%), and 47.4% in Syria (range: 21.0–75.0%; 95% CI: 32.5–62.5%). Genotypes 4 and 1 appear to be the dominant circulating strains. Conclusions: HCV prevalence in the population at large appears to be below 1%, lower than that in other MENA sub-regions, and tending towards the lower end of the global range. However, there is evidence for ongoing HCV transmission within medical facilities and among people who inject drugs (PWID). Migration dynamics appear to have played a role in determining the circulating genotypes. HCV prevention efforts should be targeted, and focus on infection control in clinical settings and harm reduction among PWID. [ABSTRACT FROM AUTHOR]
Published: 2015
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37. The Epidemiology of Hepatitis C Virus in the Maghreb Region: Systematic Review and Meta-Analyses.

Author: Fadlalla, Fatima A., Mohamoud, Yousra A., Mumtaz, Ghina R., and Abu-Raddad, Laith J.
Subjects: HEPATITIS C virus, EPIDEMIOLOGY, SYSTEMATIC reviews, DISEASE prevalence, HEMOPHILIACS
Abstract: Objective: To systematically review and synthesize available epidemiological data on hepatitis C virus (HCV) prevalence and incidence in the Maghreb region and to estimate the country-specific population-level HCV prevalence. Methods: We conducted a systematic review of HCV antibody prevalence and incidence in the Maghreb countries as outlined by the PRISMA guidelines. Meta-analyses were conducted using DerSimonian-Laird random-effect models with inverse variance weighting to pool HCV prevalence estimates among general population groups. Results: We identified 133 HCV prevalence measures and two HCV incidence measures. Among high risk groups, HCV prevalence ranged between 22% and 94% among people who inject drugs, 20% and 76% among dialysis patients, and 2% and 51% among hemophiliacs. Among intermediate-risk groups, considerable but widely variable HCV prevalence was found. Most common risk factors cited across studies were the duration of dialysis, number of transfusions, and having a history of surgery or dental work. The national HCV prevalence in Algeria was estimated at 0.3% (95%CI: 0.1–0.5), Libya 1.2% (95%CI: 1.1–1.3), Mauritania 1.1% (95%CI: 0–2.3), Morocco 0.8% (95%CI: 0.5–1.2), and Tunisia 0.6% (95%CI: 0.5–0.8). Conclusions: HCV prevalence in the Maghreb region of the Middle East and North Africa is comparable to that in developed countries of about 1%. HCV exposures appear often to be linked to medical care and are suggestive of ongoing transmission in such settings. Injecting drug use appears also to be a major, though not dominant, contributor to HCV transmission. Further research is needed to draw a more thorough understanding of HCV epidemiology, especially in the countries with limited number of studies. HCV prevention policy and programming in these countries should focus on the settings of exposure. [ABSTRACT FROM AUTHOR]
Published: 2015
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38. Prevention of type II diabetes mellitus in Qatar: Who is at risk?

Author: Christos, Paul J., Chemaitelly, Hiam, Abu-Raddad, Laith J., Zirie, Mahmoud Ali, Deleu, Dirk, and Mushlin, Alvin I.
Subjects: TYPE 2 diabetes prevention, TYPE 2 diabetes risk factors, OUTPATIENT services in hospitals, MEDICAL statistics
Abstract: Background: Type II diabetes mellitus (DM) is one of the leading chronic diseases in Qatar as well as worldwide. However, the risk factors for DM in Qatar and their prevalence are not well understood. We conducted a case-control study with the specific aim of estimating, based on data from outpatients with DM in Qatar (cases) and outpatient/inpatient controls, the association between demographic/ lifestyle factors and DM. Methods: A total of 459 patients with DM from Hamad General Hospital (HGH) outpatient adult diabetes clinics, and 342 control patients from various outpatient clinics and inpatient departments within Hamad Medical Corporation (HMC) (years 2006-2008), were recruited. The association between risk factors and DM was evaluated using bivariate and multivariable logistic regression analyses. In addition to odds ratios (OR) and 95% confidence intervals (95% CI), we estimated the population attributable risk fractions for the DM demographic/lifestyle risk factors. Results: Qatari nationality was the strongest risk factor for DM (adjusted OR = 5.5; 95% CI = 3.5-8.6; p, 0.0001), followed by higher monthly income (defined as $3000 Qatari Riyals, adjusted OR = 5.1; 95% CI = 3.0-8.7; p,0.0001), age .65 years (adjusted OR = 3.3; 95% CI = 0.9-11.4; p = 0.06), male gender (adjusted OR = 2.9; 95% CI = 1.8-4.8; p, 0.0001), obesity (BMI $30, adjusted OR = 2.2; 95% CI = 1.5-3.2; p,0.0001), no college education (adjusted OR = 1.7; 95% CI = 1.2-2.6; p = 0.009), and no daily vigorous/moderate activity (adjusted OR = 1.5; 95% CI = 0.9-2.3; p = 0.12). Among Qatari nationals, obesity was found to be the main risk factor for DM (unadjusted OR = 3.0; 95% CI = 1.6-5.6;p,0.0001), followed by no college education (unadjusted OR = 2.7; 95% CI = 1.5-5.1; p = 0.001), while consanguinity did not appear to play a major role in predicting DM (unadjusted OR = 1.5; 95% CI = 0.8-2.8; p = 0.21). Our findings further suggested that eliminating obesity and improving access to education may reduce DM cases by up to one third for the population at large (31.7% and 26.8%, respectively) and up to half (46.9% and 49.3%, respectively) for Qatari nationals. Promoting physical activity may reduce the burden of DM by up to 9.4% for the population at large and up to 17.3% for Qatari nationals. Conclusions: Demographic/lifestyle factors appear to be the main risk factors for the high DM levels observed in Qatar, with a contribution that outweighs that of genetic risk factors. While further evaluation of DM risk factors among the Qatari population (as opposed to the resident population) is important and of interest, these findings highlight the need to focus short-term DM interventions on addressing demographic/lifestyle risk factors to achieve substantial and timely declines in DM levels. [ABSTRACT FROM AUTHOR]
Published: 2014
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39. HIV among People Who Inject Drugs in the Middle East and North Africa: Systematic Review and Data Synthesis.

Author: Mumtaz, Ghina R., Weiss, Helen A., Thomas, Sara L., Riome, Suzanne, Setayesh, Hamidreza, Riedner, Gabriele, Semini, Iris, Tawil, Oussama, Akala, Francisca Ayodeji, Wilson, David, and Abu-Raddad, Laith J.
Subjects: THERAPEUTICS, HIV infections, INJECTIONS, EPIDEMICS, INTERNATIONAL organization
Abstract: Laith Abu-Raddad and colleagues assess the current state of knowledge of the HIV epidemic among people who inject drugs in the Middle East and North Africa. Please see later in the article for the Editors' Summary [ABSTRACT FROM AUTHOR]
Published: 2014
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40. The epidemiology of hepatitis C virus in Egypt: a systematic review and data synthesis.

Author: Mohamoud, Yousra A., Mumtaz, Ghina R., Riome, Suzanne, Miller, DeWolfe, and Abu-Raddad, Laith J.
Subjects: HEPATITIS C treatment, DISEASE prevalence, MULTIVARIATE analysis, BLOOD donors, OPERATIVE surgery, VIRUS disease transmission
Abstract: Background: Egypt has the highest prevalence of hepatitis C virus (HCV) in the world, estimated nationally at 14.7%. Our study's objective was to delineate the evidence on the epidemiology of HCV infection among the different population groups in Egypt, and to draw analytical inferences about the nature of HCV transmission in this country. Methods: We conducted a systematic review of all data on HCV prevalence and incidence in Egypt following PRISMA guidelines. The main sources of data included PubMed and Embase databases. We also used a multivariate regression model to infer the temporal trend of HCV prevalence among the general population and high risk population in Egypt. Results: We identified 150 relevant records, four of which were incidence studies. HCV incidence ranged from 0.8 to 6.8 per 1,000 person-years. Overall, HCV prevalence among pregnant women ranged between 5-15%, among blood donors between 5-25%, and among other general population groups between 0-40%. HCV prevalence among multi-transfused patients ranged between 10-55%, among dialysis patients between 50-90%, and among other high risk populations between 10% and 85%. HCV prevalence varied widely among other clinical populations and populations at intermediate risk. Risk factors appear to be parenteral anti-schistosomal therapy, injections, transfusions, and surgical procedures, among others. Results of our time trend analysis suggest that there is no evidence of a statistically significant decline in HCV prevalence over time in both the general population (p-value: 0.215) and high risk population (p-value: 0.426). Conclusions: Egypt is confronted with an HCV disease burden of historical proportions that distinguishes this nation from others. A massive HCV epidemic at the national level must have occurred with substantial transmission still ongoing today. HCV prevention in Egypt must become a national priority. Policymakers, and public health and medical care stakeholders need to introduce and implement further prevention measures targeting the routes of HCV transmission. [ABSTRACT FROM AUTHOR]
Published: 2013
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41. An Apparent Lack of Epidemiologic Association between Hepatitis C Virus Knowledge and the Prevalence of Hepatitis C Infection in a National Survey in Egypt.

Author: Chemaitelly, Hiam, Abu-Raddad, Laith J., and Miller, F. DeWolfe
Subjects: *EPIDEMIOLOGY, *HEPATITIS C virus, *HEPATITIS C, *DISEASE prevalence, *VIRAL antibodies, *SURVEYS
Abstract: Background: Egypt has by far the largest hepatitis C virus (HCV) prevalence in the world with 14.7% of the population being antibody positive for HCV. The aim of this study was to examine the association between knowledge of HCV and HCV antibody positivity among the Egyptian population. Methods: We characterized different measures of HCV knowledge and examined their associations with HCV prevalence, by analyzing a nationally representative database using standard epidemiologic methods. The database, the 2008 Egyptian Demographic and Health Survey, included demographic, health, and HCV biomarker information for a sample of over 12,000 individuals. Results: Basic knowledge of HCV was found to be high, but multiple gaps were identified in the specific knowledge of HCV and its modes of transmission. There was no statistically significant difference in HCV prevalence between those who have heard of HCV infection and those who have not (14.4% vs. 15.9%, p>.05). Similar results were found for the other HCV knowledge measures including those specific to HCV modes of transmission and to the sources of information for HCV awareness. Logistic regression analyses did not demonstrate an association between HCV knowledge and HCV prevalence. Conclusions: Our results do not provide support for an effect of awareness on reducing the risk of HCV infection in Egypt. Public health messages directed at the lay public may not provide sufficient empowerment for individuals to avoid HCV infection, and should be complemented with prevention programs to promote and strengthen infection control in the settings of exposure, particularly in health care facilities. [ABSTRACT FROM AUTHOR]
Published: 2013
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42. HIV-1 molecular epidemiology evidence and transmission patterns in the Middle East and North Africa.

Author: Mumtaz, Ghina, Hilmi, Nahla, Akala, Francisca Ayodeji, Semini, Iris, Riedner, Gabriele, Wilson, David, and Abu-Raddad, Laith J
Abstract: The distribution of HIV-1 subtypes in a population tracks the spread and evolution of the epidemic. This study is a systematic review of all available evidence on HIV-1 molecular epidemiology and subtype distribution in the Middle East and North Africa. Sources of data included Medline and various institutional documents and databases. In several countries, a diverse distribution of HIV-1 subtypes was observed principally reflecting travel-related exogenous exposures. A trend for a dominant HIV-1 subtype was observed in a few other settings and was often linked to HIV transmission within specific high-risk groups such as subtype A and CRF35_AD among injecting drug users and subtype C among commercial sex networks. Multiple exogenous introductions of HIV-1 variants seemed common to all countries, as observed from the high diversity in subtypes, or the high genetic divergence among any specific subtype even if predominant. In several countries though, epidemic-type clustering of specific subtypes suggests established or nascent HIV epidemics among classic core risk groups for HIV infection. HIV prevention efforts in MENA must be prioritized for these high-risk groups. [ABSTRACT FROM PUBLISHER]
Published: 2011
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43. HSV-2 serology can be predictive of HIV epidemic potential and hidden sexual risk behavior in the Middle East and North Africa.

Author: Abu-Raddad, Laith J., Schiffer, Joshua T., Ashley, Rhoda, Mumtaz, Ghina, Alsallaq, Ramzi A., Akala, Francisca Ayodeji, Semini, Iris, Riedner, Gabriele, and Wilson, David
Abstract: Abstract: Background: HIV prevalence is low in the Middle East and North Africa (MENA) region, though the risk or potential for further spread in the future is not well understood. Behavioral surveys are limited in this region and when available have serious limitations in assessing the risk of HIV acquisition. We demonstrate the potential use of herpes simplex virus-2 (HSV-2) seroprevalence as a marker for HIV risk within MENA. Methods: We designed a mathematical model to assess whether HSV-2 prevalence can be predictive of future HIV spread. We also conducted a systematic literature review of HSV-2 seroprevalence studies within MENA. Results: We found that HSV-2 prevalence data are rather limited in this region. Prevalence is typically low among the general population but high in established core groups prone to sexually transmitted infections such as men who have sex with men and female sex workers. Our model predicts that if HSV-2 prevalence is low and stable, then the risk of future HIV epidemics is low. However, expanding or high HSV-2 prevalence (greater than about 20%), implies a risk for a considerable HIV epidemic. Based on available HSV-2 prevalence data, it is not likely that the general population in MENA is experiencing or will experience such a considerable HIV epidemic. Nevertheless, the risk for concentrated HIV epidemics among several high-risk core groups is present. Conclusions: HSV-2 prevalence surveys provide a useful mechanism for identifying and corroborating populations at risk for HIV within MENA. HSV-2 serology offers an effective tool for probing hidden sexual risk behaviors in a region where quality behavioral data are limited. [ABSTRACT FROM AUTHOR]
Published: 2010
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44. Genital Herpes Has Played a More Important Role than Any Other Sexually Transmitted Infection in Driving HIV Prevalence in Africa.

Author: Abu-Raddad, Laith J., Magaret, Amalia S., Celum, Connie, Wald, Anna, Longini Jr., Ira M., Self, Steven G., and Corey, Lawrence
Subjects: *HERPES genitalis, *SEXUALLY transmitted diseases, *HERPESVIRUS vaccines, *HIV infections, *ACYCLOVIR, *GONORRHEA, *SYPHILIS, *EPIDEMIOLOGY
Abstract: Background: Extensive evidence from observational studies suggests a role for genital herpes in the HIV epidemic. A number of herpes vaccines are under development and several trials of the efficacy of HSV-2 treatment with acyclovir in reducing HIV acquisition, transmission, and disease progression have just reported their results or will report their results in the next year. The potential impact of these interventions requires a quantitative assessment of the magnitude of the synergy between HIV and HSV-2 at the population level. Methods and Findings: A deterministic compartmental model of HIV and HSV-2 dynamics and interactions was constructed. The nature of the epidemiologic synergy was explored qualitatively and quantitatively and compared to other sexually transmitted infections (STIs). The results suggest a more substantial role for HSV-2 in fueling HIV spread in sub- Saharan Africa than other STIs. We estimate that in settings of high HSV-2 prevalence, such as Kisumu, Kenya, more than a quarter of incident HIV infections may have been attributed directly to HSV-2. HSV-2 has also contributed considerably to the onward transmission of HIV by increasing the pool of HIV positive persons in the population and may explain one-third of the differential HIV prevalence among the cities of the Four City study. Conversely, we estimate that HIV had only a small net impact on HSV-2 prevalence. Conclusions: HSV-2 role as a biological cofactor in HIV acquisition and transmission may have contributed substantially to HIV particularly by facilitating HIV spread among the low-risk population with stable long-term sexual partnerships. This finding suggests that prevention of HSV-2 infection through a prophylactic vaccine may be an effective intervention both in nascent epidemics with high HIV incidence in the high risk groups, and in established epidemics where a large portion of HIV transmission occurs in stable partnerships. [ABSTRACT FROM AUTHOR]
Published: 2008
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45. Modeling the Impact of COVID-19 Vaccination in Lebanon: A Call to Speed-Up Vaccine Roll Out.

Author: Mumtaz, Ghina R., El-Jardali, Fadi, Jabbour, Mathilda, Harb, Aya, Abu-Raddad, Laith J., and Makhoul, Monia
Subjects: COVID-19 vaccines, SOCIAL distancing, HERD immunity, VACCINES, SARS-CoV-2
Abstract: Four months into the SARS-CoV-2 vaccination campaign, only 10.7% of the Lebanese population have received at least one dose, raising serious concerns over the speed of vaccine roll-out and its impact in the event of a future surge. Using mathematical modeling, we assessed the short-term impact of various vaccine roll-out scenarios on SARS-CoV-2 epidemic course in Lebanon. At current population immunity levels, estimated by the model at 40% on 15 April 2021, a large epidemic wave is predicted if all social distancing restrictions are gradually eased and variants of concern are introduced. Reaching 80% vaccine coverage by the end of 2021 will flatten the epidemic curve and will result in a 37% and 34% decrease in the peak daily numbers of severe/critical disease cases and deaths, respectively; while reaching intermediate coverage of 40% will result in only a 10–11% decrease in each. Reaching 80% vaccine coverage by August would prevent twice as many severe/critical disease cases and deaths than if it were reached by December. Easing restrictions over a longer duration resulted in more favorable vaccination impact. In conclusion, for vaccination to have impact in the short-term, scale-up has to be rapid and reach high coverage (at least 70%), while sustaining social distancing measures during roll-out. At current vaccination pace, this is unlikely to be achieved. Concerted efforts need to be made to overcome local challenges and substantially scale up vaccination to avoid a surge that the country, with its multiple crises and limited health-care capacity, is largely unprepared for. [ABSTRACT FROM AUTHOR]
Published: 2021
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46. Epidemiological Differences in the Impact of COVID-19 Vaccination in the United States and China.

Author: Makhoul, Monia, Chemaitelly, Hiam, Ayoub, Houssein H., Seedat, Shaheen, Abu-Raddad, Laith J., Tafuri, Silvio, and Bradfute, Steven B.
Subjects: COVID-19 vaccines, COVID-19, CHINA-United States relations
Abstract: This study forecasts Coronavirus Disease 2019 (COVID-19) vaccination impact in two countries at different epidemic phases, the United States (US) and China. We assessed the impact of both a vaccine that prevents infection (VES of 95%) and a vaccine that prevents only disease (VEP of 95%) through mathematical modeling. For VES of 95% and gradual easing of restrictions, vaccination in the US reduced the peak incidence of infection, disease, and death by >55% and cumulative incidence by >32% and in China by >77% and >65%, respectively. Nearly three vaccinations were needed to avert one infection in the US, but only one was needed in China. For VEP of 95%, vaccination benefits were half those for VES of 95%. In both countries, impact of vaccination was substantially enhanced with rapid scale-up, vaccine coverage >50%, and slower or no easing of restrictions, particularly in the US. COVID-19 vaccination can flatten, delay, and/or prevent future epidemic waves. However, vaccine impact is destined to be heterogeneous across countries because of an underlying "epidemiologic inequity" that reduces benefits for countries already at high incidence, such as the US. Despite 95% efficacy, actual vaccine impact could be meager in such countries if vaccine scale-up is slow, acceptance is poor, or restrictions are eased prematurely. [ABSTRACT FROM AUTHOR]
Published: 2021
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47. Epidemiological Impact of SARS-CoV-2 Vaccination: Mathematical Modeling Analyses.

Author: Makhoul, Monia, Ayoub, Houssein H., Chemaitelly, Hiam, Seedat, Shaheen, Mumtaz, Ghina R., Al-Omari, Sarah, and Abu-Raddad, Laith J.
Subjects: SARS-CoV-2, MATHEMATICAL analysis, MATHEMATICAL models, VACCINATION, VACCINE effectiveness
Abstract: This study aims to inform SARS-CoV-2 vaccine development/licensure/decision-making/implementation, using mathematical modeling, by determining key preferred vaccine product characteristics and associated population-level impacts of a vaccine eliciting long-term protection. A prophylactic vaccine with efficacy against acquisition (VES) ≥70% can eliminate the infection. A vaccine with VES <70% may still control the infection if it reduces infectiousness or infection duration among those vaccinated who acquire the infection, if it is supplemented with <20% reduction in contact rate, or if it is complemented with herd-immunity. At VES of 50%, the number of vaccinated persons needed to avert one infection is 2.4, and the number is 25.5 to avert one severe disease case, 33.2 to avert one critical disease case, and 65.1 to avert one death. The probability of a major outbreak is zero at VES ≥70% regardless of the number of virus introductions. However, an increase in social contact rate among those vaccinated (behavior compensation) can undermine vaccine impact. In addition to the reduction in infection acquisition, developers should assess the natural history and disease progression outcomes when evaluating vaccine impact. [ABSTRACT FROM AUTHOR]
Published: 2020
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48. HIV epidemiology among female sex workers and their clients in the Middle East and North Africa: systematic review, meta-analyses, and meta-regressions.

Author: Chemaitelly, Hiam, Weiss, Helen A., Calvert, Clara, Harfouche, Manale, and Abu-Raddad, Laith J.
Subjects: META-analysis, SEX workers, EPIDEMIOLOGY, HIV, DISEASE prevalence
Abstract: Background: HIV epidemiology among female sex workers (FSWs) and their clients in the Middle East and North Africa (MENA) region is poorly understood. We addressed this gap through a comprehensive epidemiological assessment.Methods: A systematic review of population size estimation and HIV prevalence studies was conducted and reported following PRISMA guidelines. Risk of bias (ROB) assessments were conducted for all included studies using various quality domains, as informed by Cochrane Collaboration guidelines. The pooled mean HIV prevalence was estimated using random-effects meta-analyses. Sources of heterogeneity and temporal trends were identified through meta-regressions.Results: We identified 270 size estimation studies in FSWs and 42 in clients, and 485 HIV prevalence studies in 287,719 FSWs and 69 in 29,531 clients/proxy populations. Most studies had low ROB in multiple quality domains. The median proportion of reproductive-age women reporting current/recent sex work was 0.6% (range = 0.2-2.4%) and of men reporting currently/recently buying sex was 5.7% (range = 0.3-13.8%). HIV prevalence ranged from 0 to 70% in FSWs (median = 0.1%) and 0-34.6% in clients (median = 0.4%). The regional pooled mean HIV prevalence was 1.4% (95% CI = 1.1-1.8%) in FSWs and 0.4% (95% CI = 0.1-0.7%) in clients. Country-specific pooled prevalence was < 1% in most countries, 1-5% in North Africa and Somalia, 17.3% in South Sudan, and 17.9% in Djibouti. Meta-regressions identified strong subregional variations in prevalence. Compared to Eastern MENA, the adjusted odds ratios (AORs) ranged from 0.2 (95% CI = 0.1-0.4) in the Fertile Crescent to 45.4 (95% CI = 24.7-83.7) in the Horn of Africa. There was strong evidence for increasing prevalence post-2003; the odds increased by 15% per year (AOR = 1.15, 95% CI = 1.09-1.21). There was also a large variability in sexual and injecting risk behaviors among FSWs within and across countries. Levels of HIV testing among FSWs were generally low. The median fraction of FSWs that tested for HIV in the past 12 months was 12.1% (range = 0.9-38.0%).Conclusions: HIV epidemics among FSWs are emerging in MENA, and some have reached stable endemic levels, although still some countries have limited epidemic dynamics. The epidemic has been growing for over a decade, with strong regionalization and heterogeneity. HIV testing levels were far below the service coverage target of "UNAIDS 2016-2021 Strategy." [ABSTRACT FROM AUTHOR]
Published: 2019
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49. Effectiveness of the neutralizing antibody sotrovimab among high-risk patients with mild-to-moderate SARS-CoV-2 in Qatar.

Author: Zaqout, Ahmed, Almaslamani, Muna A., Chemaitelly, Hiam, Hashim, Samar A., Ittaman, Ajithkumar, Alimam, Abeir, Rustom, Fatma, Daghfal, Joanne, Abukhattab, Mohammed, AlMukdad, Sawsan, Kaleeckal, Anvar Hassan, Latif, Ali Nizar, Butt, Adeel A., Bertollini, Roberto, Al-Khal, Abdullatif, Omrani, Ali S., and Abu-Raddad, Laith J.
Subjects: *SARS-CoV-2 Omicron variant, *SARS-CoV-2, *COVID-19 treatment, *ODDS ratio, *COVID-19
Abstract: • Sotrovimab's effectiveness against COVID-19 Omicron variant disease severity was assessed. • Sotrovimab showed no protective effect in reducing COVID-19 severity. • The lack of protective effect may be explained by the dominance of Omicron BA.2 subvariant. To estimate the real-world effectiveness of sotrovimab against severe, critical, or fatal COVID-19 in Qatar at a time in which most SARS-CoV-2 incidences occurred due to the BA.2 Omicron subvariant. We conducted a matched case-control study among all individuals eligible for sotrovimab treatment per United States Food and Drug Administration guidelines in the resident population of Qatar. The odds of progression to severe forms of COVID-19 were compared in cases (treatment group) versus controls (eligible patients who opted not to receive the treatment). Subgroup analyses were conducted. A total of 3364 individuals were eligible for sotrovimab treatment during the study period, of whom 519 individuals received the treatment, whereas the remaining 2845 constituted the controls. The adjusted odds ratio of disease progression to severe, critical, or fatal COVID-19 comparing the treatment group to the control group was 2.67 (95% confidence interval 0.60-11.91). In the analysis including only the subgroup of patients at higher risk of severe forms of COVID-19, the adjusted odds ratio was 0.65 (95% confidence interval 0.17-2.48). There was no evidence for a protective effect of sotrovimab in reducing COVID-19 severity in a setting dominated by the BA.2 subvariant. [ABSTRACT FROM AUTHOR]
Published: 2022
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50. Epidemiology of hepatitis C virus in the Arabian Gulf countries: Systematic review and meta-analysis of prevalence.

Author: Mohamoud, Yousra A., Riome, Suzanne, and Abu-Raddad, Laith J.
Subjects: *EPIDEMIOLOGY, *HEPATITIS C virus, *DISEASE prevalence, *META-analysis, *RANDOM effects model, *PATIENTS
Abstract: Summary Objective The aims of this study were to perform a systematic review and synthesize epidemiological data on hepatitis C virus (HCV) in the Arabian Gulf countries, and to assess the country-specific prevalence among nationals and expatriate populations. Methods A systematic review of HCV antibody prevalence and incidence in the Arabian Gulf countries was conducted, based on the items outlined in the PRISMA statement. Meta-analyses were performed incorporating inverse variance weighting and using a random-effects model to pool summary estimates of HCV prevalence among general population groups, for nationals and the entire resident population. Results A total of 557 prevalence measures and one incidence measure were identified for the Arabian Gulf countries. HCV prevalence among nationals was 0.24% (95% confidence interval (CI) 0.02–0.63) in the United Arab Emirates (UAE), 0.44% (95% CI 0.29–0.62) in Kuwait, 0.51% (95% CI 0.43–0.59) in Qatar, and 1.65% (95% CI 1.40–1.91) in Saudi Arabia. No data were available for Bahrain or Oman. Among the entire resident populations, HCV prevalence was 0.30% (95% CI 0.23–0.38) in Bahrain, 0.41% (95% CI 0.35–0.46) in Oman, 1.06% (95% CI 0.51–1.81) in Qatar, 1.45% (95% CI 0.75–2.34) in Kuwait, 1.63% (95% CI 1.42–1.84) in Saudi Arabia, and 1.64% (95% CI 0.96–2.49) in UAE. A higher prevalence was observed among expatriate populations such as Egyptians. Among the high-risk populations, HCV prevalence was as high as 78.6% in the multi-transfused and 74.6% in people who inject drugs. Conclusions National-level HCV prevalence in the Arabian Gulf region is comparable to global levels. A higher prevalence is found in specific expatriate populations, reflecting the prevalence in their countries of origin. Most exposures appear to occur in high-risk groups and these are often linked to medical care. [ABSTRACT FROM AUTHOR]
Published: 2016
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