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2. Racial disparity in mortality from tuberculosis in the US between states with and without a history of Jim-Crow laws: an analysis of the Global Burden of Disease (GBD) and risk factors study, 1990 to 2019

Author

Philimon N. Gona, Lorena M. Estrada-Martinez, Lingling Zhang, Clara M. Gona, Aaloke Mody, Sowmya R. Rao, Joseph Cooper, Kibibi Mack-Shelton, Ping Chen, Suzanne G. Leveille, Ali H. Mokdad, and G. B. D. 2019 T. B. Racial Disparity

Subjects
Tuberculosis-related mortality in US States, Tuberculosis Epidemiology in US States, Changes in Tuberculosis mortality, Jim-Crow states, Public aspects of medicine, RA1-1270
Abstract

Abstract Background While TB-related mortality in the US declined four-fold from 1990 to 2019, country-level estimates of TB burden obscure within-state racial heterogeneity and changes in TB burden over time. In sixteen US Southern States and Washington DC, the effects of health inequities engendered by Jim-Crow laws enacted from the late 1800s to the 1960s have not been evaluated for TB-related mortality. We, therefore, sought to compare TB mortality rates and annualized rate of change (AROC) between 1990 and 2019 in former Jim-Crow vs. non-Jim-Crow states to help guide response efforts and inform resource prioritization to improve racial equity. Methods We evaluated whether TB-related mortality varied over time, from 1990 to 2019, between states that have a history of enacting Jim-Crow laws vs. states with no such history using estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). TB mortality per 100,000 population and bootstrap 95% uncertainty intervals (UIs) were modeled using the Cause of Death Ensemble model (CODEm) framework with varying combinations of predictive covariates. For changes over time, we present age-standardized AROC as the percent difference in the natural logarithm of the rate in 1990 and 2019 divided by 30 (i.e., 100*[ln(2019 Rate/1990 Rate)/(30)) and the corresponding 95% UIs. Results TB-related mortality in all US states declined between 1990 and 2019. From 1990 to 2019, most former Jim-Crow states had higher mortality rates than states that did not enact Jim-Crow laws. The most significant decline in TB mortality was in Washington DC, with a six-fold decline from 2.69 (2.46–2.96) per 100,000 population in 1990 to 0.45(0.37–0.55) in 2019, corresponding to an AROC of -0.83% (-0.86;-0.79). The lowest decline was in Iowa, from 0.30 (0.27–0.33) to 0.09 (0.07–0.11) (AROC: -0.70% (-0.76; -0.63)). Eleven of the 16 states and Washington DC in the third tertile of TB mortality rate in 1990 (range 0.81–2.69) had a history of Jim-Crow laws, whereas none of the 17 states in the first tertile (range 0.30–0.51) had such history. Conversely, mortality decreased relatively slowly in former Jim-Crow states than in non-Jim-Crow states. Conclusions Even though the 1964 Civil Rights Act dismantled Jim-Crow statutes, racial inequities in TB burden experienced by past generations may still be felt in subsequent generations. Understanding the role of structural racism at the intersection of science and medicine shows the complex ways historical laws, such as Jim-Crow laws, continue to negatively impact health outcomes and warn of future dangers, such as COVID-19, to avoid.

Published
2024
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3. The association of physical activity duration and intensity on emotional intelligence in 10–13 year-old Children

Author

Marie C. Gabour, Tongjian You, Richard Fleming, Paul D. McNicholas, and Philimon N. Gona

Subjects
Physical activity, Duration, Intensity, Emotional Intelligence, Adolescents, Medicine (General), R5-920
Abstract

Previous studies have shown that Physical Activity (PA) has a positive association with emotional health and intelligence in adolescents but none have focused on the relationship of PA duration and intensity on Emotional Intelligence (EI). The purpose of this study was to cross-sectionally assess the association of PA measures on overall EI and its domains in a cohort of 2 029 adolescents aged 10–13 years of age in the National Longitudinal Survey for Children and Youth (NLSCY) from Canada. Multivariable linear regression analysis of EI was adjusted for age, sex, annual household income, and health status. One-way analysis of variance (ANOVA) was used to relate PA duration measured in minutes, frequency, and intensity categories with continuous GEI scores and also the corresponding scores for domains of GEI. The mean GEI scores were (28.3 ​± ​6.6) for 0–30 ​minute (min) PA duration, (30.0 ​± ​6.5) for 30 to ​

Published
2024
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6. Epigenetic variation impacts individual differences in the transcriptional response to influenza infection

Author

Aracena, Katherine A., Lin, Yen-Lung, Luo, Kaixuan, Pacis, Alain, Gona, Saideep, Mu, Zepeng, Yotova, Vania, Sindeaux, Renata, Pramatarova, Albena, Simon, Marie-Michelle, Chen, Xun, Groza, Cristian, Lougheed, David, Gregoire, Romain, Brownlee, David, Boye, Carly, Pique-Regi, Roger, Li, Yang, He, Xin, Bujold, David, Pastinen, Tomi, Bourque, Guillaume, and Barreiro, Luis B.

Published
2024
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8. Safety of cholecystectomy performed by surgeons who prefer fundus first versus surgeons who prefer a standard laparoscopic approach

Author

Åsa Edergren, Gabriel Sandblom, Mikael Franko, Thorhallur Agustsson, Yucel Cengiz, and Gona Jaafar

Subjects
Gallbladder surgery, Intraoperative complications, Cholecystectomy/adverse effects, Bile duct injury, Cohort studies, Surgery, RD1-811
Abstract

Background: An alternative method to standard laparoscopic cholecystectomy (SLC) is the “fundus first” method (FFLC). Concerns have been raised that FFLC can lead to misinterpretation of important anatomical structures, thus causing complications of a more serious kind than SLC. Comparisons between the methods are complicated by the fact that FFLC is often used as a rescue procedure in complicated cases. To avoid confounding related to this we conducted a population-based study with comparisons on the surgeon level. Method: In GallRiks, the Swedish registry for Gallbladder surgery, we stratified all cholecystectomies performed 2006–2020 in three groups: surgeries carried out by surgeons that uses FFLC in 80% group” and the operative time was shorter (OR 0.76 [0.69–0.83]). Conclusion: In this study including >160,000 cholecystectomies, both methods was found to be equally safe. Key message: During laparoscopic cholecystectomy, the standard method of dissection and fundus first dissection are equally safe surgical techniques. Surgeons need to learn both methods to be able to use the one most appropriate for each individual case.

Published
2024
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9. Topologies, Posets and Finite Quandles

Author

Elhamdadi, Mohamed, Gona, Tushar, and Lahrani, Hitakshi

Subjects
Mathematics - General Topology, 54E99, 57K12
Abstract

An Alexandroff space is a topological space in which every intersection of open sets is open. There is one to one correspondence between Alexandroff $T_0$-spaces and partially ordered sets (posets). We investigate Alexandroff $T_0$-topologies on finite quandles. We prove that there is a non-trivial topology on a finite quandle making right multiplications continuous functions if and only if the quandle has more than one orbit. Furthermore, we show that right continuous posets on quandles with $n$ orbits are $n$-partite. We also find, for the even dihedral quandles, the number of all possible topologies making the right multiplications continuous. Some explicit computations for quandles of cardinality up to five are given.

Published
2022

10. Aberrant T-cell exhaustion in severe combined immunodeficiency survivors with poor T-cell reconstitution after transplantation.

Author

Labrosse, Roxane, Boufaied, Ines, Bourdin, Benoîte, Gona, Saideep, Randolph, Haley, Logan, Brent, Bourbonnais, Sara, Berthe, Chloé, Chan, Wendy, Buckley, Rebecca, Parrott, Roberta, Cuvelier, Geoffrey, Kapoor, Neena, Chandra, Sharat, Dávila Saldaña, Blachy, Eissa, Hesham, Goldman, Fred, Heimall, Jennifer, OReilly, Richard, Chaudhury, Sonali, Kolb, Edward, Shenoy, Shalini, Griffith, Linda, Pulsipher, Michael, Notarangelo, Luigi, Pai, Sung-Yun, Haddad, Élie, Barreiro, Luis, Decaluwe, Hélène, Dvorak, Christopher, Puck, Jennifer, Cowan, Morton, and Kohn, Donald

Subjects
Conditioning chemotherapy, T-cell exhaustion, hematopoietic cell transplantation (HCT), immune reconstitution, severe combined immunodeficiency (SCID), Humans, Severe Combined Immunodeficiency, CD8-Positive T-Lymphocytes, T-Cell Exhaustion, Hematopoietic Stem Cell Transplantation, Receptors, Antigen, T-Cell, Lymphopenia
Abstract

BACKGROUND: Severe combined immunodeficiency (SCID) comprises rare inherited disorders of immunity that require definitive treatment through hematopoietic cell transplantation (HCT) or gene therapy for survival. Despite successes of allogeneic HCT, many SCID patients experience incomplete immune reconstitution, persistent T-cell lymphopenia, and poor long-term outcomes. OBJECTIVE: We hypothesized that CD4+ T-cell lymphopenia could be associated with a state of T-cell exhaustion in previously transplanted SCID patients. METHODS: We analyzed markers of exhaustion in blood samples from 61 SCID patients at a median of 10.4 years after HCT. RESULTS: Compared to post-HCT SCID patients with normal CD4+ T-cell counts, those with poor T-cell reconstitution showed lower frequency of naive CD45RA+/CCR7+ T cells, recent thymic emigrants, and TCR excision circles. They also had a restricted TCR repertoire, increased expression of inhibitory receptors (PD-1, 2B4, CD160, BTLA, CTLA-4), and increased activation markers (HLA-DR, perforin) on their total and naive CD8+ T cells, suggesting T-cell exhaustion and aberrant activation, respectively. The exhaustion score of CD8+ T cells was inversely correlated with CD4+ T-cell count, recent thymic emigrants, TCR excision circles, and TCR diversity. Exhaustion scores were higher among recipients of unconditioned HCT, especially when further in time from HCT. Patients with fewer CD4+ T cells showed a transcriptional signature of exhaustion. CONCLUSIONS: Recipients of unconditioned HCT for SCID may develop late post-HCT T-cell exhaustion as a result of diminished production of T-lineage cells. Elevated expression of inhibitory receptors on their T cells may be a biomarker of poor long-term T-cell reconstitution.

Published
2023

12. Trends in the burden of most common obesity‐related cancers in 16 Southern Africa development community countries, 1990–2019. Findings from the global burden of disease study

Author

Philimon Gona, Clara Gona, Suha Ballout, Chabila Mapoma, Sowmya Rao, Ali Mokdad, and (GBD 2019 SADC BMI)

Subjects
annual rate of change, global burden of disease, obesity‐related cancers, prevalence and mortality rates, Southern Africa development community, Internal medicine, RC31-1245
Abstract

Abstract Background Obesity‐related cancers in the 16 Southern African Development Community (SADC) countries is quite prominent. The changes and time trends of the burden of obesity‐related cancers in developing countries like SADC remain largely unknown. A descriptive epidemiological analysis was conducted to assess the burden of obesity‐related cancers, (liver, esophageal, breast, prostate, colon/rectal, leukemia, ovarian, uterine, pancreatic, kidney, gallbladder/biliary tract, and thyroid cancers) in SADC countries. Methods Data from the 2019 Global Burden of Diseases Study was used. Deaths extracted from vital registration, verbal autopsies and ICD codes. Cancer‐type, mortality and prevalence per 100,000 population and 95% uncertainty intervals (UIs) were calculated using the Cause of Death Ensemble model and Spatio‐Temporal Gaussian process with mixed effects regression models. Annual rates of change (AROCs) between 1990 and 2019 and the corresponding UIs were calculated. Results The top age‐standardized mortality rates per 100,000 in 2019 for males were leukemia, 20.1(14.4–26.4), esophageal cancer, 15.1 (11.2–19.1), and colon and rectal cancer, 10.3 (8.6–12.6). For females, breast cancer, 20.6 (16.6–25.0), leukemia, 17.1 (11.4–23.7), and esophageal cancer, 8.3 (5.5–10.7), had the leading mortality rates. For males, AROC substantial (p

Published
2024
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13. A host-directed oxadiazole compound potentiates antituberculosis treatment via zinc poisoning in human macrophages and in a mouse model of infection.

Author

Alexandra Maure, Emeline Lawarée, Francesco Fiorentino, Alexandre Pawlik, Saideep Gona, Alexandre Giraud-Gatineau, Matthew J G Eldridge, Anne Danckaert, David Hardy, Wafa Frigui, Camille Keck, Claude Gutierrez, Olivier Neyrolles, Nathalie Aulner, Antonello Mai, Mélanie Hamon, Luis B Barreiro, Priscille Brodin, Roland Brosch, Dante Rotili, and Ludovic Tailleux

Subjects
Biology (General), QH301-705.5
Abstract

Antituberculosis drugs, mostly developed over 60 years ago, combined with a poorly effective vaccine, have failed to eradicate tuberculosis. More worryingly, multiresistant strains of Mycobacterium tuberculosis (MTB) are constantly emerging. Innovative strategies are thus urgently needed to improve tuberculosis treatment. Recently, host-directed therapy has emerged as a promising strategy to be used in adjunct with existing or future antibiotics, by improving innate immunity or limiting immunopathology. Here, using high-content imaging, we identified novel 1,2,4-oxadiazole-based compounds, which allow human macrophages to control MTB replication. Genome-wide gene expression analysis revealed that these molecules induced zinc remobilization inside cells, resulting in bacterial zinc intoxication. More importantly, we also demonstrated that, upon treatment with these novel compounds, MTB became even more sensitive to antituberculosis drugs, in vitro and in vivo, in a mouse model of tuberculosis. Manipulation of heavy metal homeostasis holds thus great promise to be exploited to develop host-directed therapeutic interventions.

Published
2024
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14. Rapid transformation in aquatic food value chains in three Nigerian states

Author

Lenis Saweda O. Liverpool-Tasie, Ayala Wineman, Mark Umunna Amadi, Ayuba Gona, Chukwuemeka Chinonso Emenekwe, Ming Fang, Olawale Olunuga, Robert Ugochukwu Onyeneke, Sunday Norbert, Taiwo Mayomi Adenike, Thomas Reardon, and Ben Belton

Subjects
Nigeria, value chain, aquaculture, capture fisheries, micro, small and medium enterprises (MSMEs), Aquaculture. Fisheries. Angling, SH1-691
Abstract

IntroductionNigeria is Africa’s most populous country, third largest fish producer, and second largest aquaculture producer. There have been numerous studies of aquaculture and fisheries in Nigeria, but no study to date has analyzed aquaculture and capture fisheries value chains together, while giving equal weight to all value chain segments and systematically capturing information on temporal trends in value chain structure, conduct, and performance. This paper does so.MethodsWe conducted a structured, qualitative, rapid reconnaissance survey of 180 actors from eight segments of the aquatic food value chain in three Nigerian states with contrasting geographies, Ebonyi, Kebbi, and Oyo.ResultsResults particularly important for future research and policy are as follows. (1) Partial vertical integration is a common feature of the organization of firms in all value chain segments, as a risk reduction strategy to overcome market imperfections and frictions. Scarcity and high cost of imported intermediate inputs is stimulating local innovation and import substitution manufacturing of feeds and fabricated items. (2) Inter-sectoral spillovers from the poultry industry have hastened the development of fish value chains, while improvements in power supply have enabled the expansion of cold storage capacity, facilitating the geographical lengthening of frozen fish value chains. (3) Rapid technological and/or institutional change is occurring in all value chain segments, including those usually viewed as traditional, such as processing and fishing. Logistics services are becoming more specialized and sophisticated, and digital communications technologies including social media play an increasingly important role in value chain coordination and marketing. (4) Increasing opportunity costs of time drive demand for convenience foods such as smoked and fried fish, which require little further preparation and can be stored at room temperature. Demand for farmed catfish is linked to growing consumption of food away from home at bars and restaurants. (5) Significant opportunities exist to improve the performance of value chains in terms of gender equity, environmental impacts, and food safety.

Published
2024
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15. Intelligent Motion Planning for a Cost-effective Object Follower Mobile Robotic System with Obstacle Avoidance

Author

Gona, Sai Nikhil and Bandhakavi, Prithvi Raj

Subjects
Computer Science - Robotics, Computer Science - Computer Vision and Pattern Recognition, 68T40, I.2.9
Abstract

There are few industries which use manually controlled robots for carrying material and this cannot be used all the time in all the places. So, it is very tranquil to have robots which can follow a specific human by following the unique coloured object held by that person. So, we propose a robotic system which uses robot vision and deep learning to get the required linear and angular velocities which are {\nu} and {\omega}, respectively. Which in turn makes the robot to avoid obstacles when following the unique coloured object held by the human. The novel methodology that we are proposing is accurate in detecting the position of the unique coloured object in any kind of lighting and tells us the horizontal pixel value where the robot is present and also tells if the object is close to or far from the robot. Moreover, the artificial neural networks that we have used in this problem gave us a meagre error in linear and angular velocity prediction and the PI controller which was used to control the linear and angular velocities, which in turn controls the position of the robot gave us impressive results and this methodology outperforms all other methodologies., Comment: 24 pages, 27 figures

Published
2021

16. CO2 emissions, economic growth and energy consumption nexus: the case of India

Author

Gona Babu RAO

Subjects
energy consumption, economic growth, co2 emissions, ardl, vecm, Business, HF5001-6182, Economic theory. Demography, HB1-3840, Economics as a science, HB71-74
Abstract

In the present global world environmental sustainability has become an important element in achieving a long-term development policy. Nowadays, developing countries like India struggling to deal with these concerns, which all requires a specific treatment. On this basis, this study is to investigate the causal relationship between CO2 emissions, economic growth and energy consumption for India over the time period of 1990-2019. The study is applied Autoregressive Distributed Lag (ARDL) model to look at the long-run dynamics, while the Vector Error Correction (VECM) model is applied to identify causal direction. The ARDL test confirms that there is a longrun relationship exists between the variables. The VECM results reveal that there is a long-run causality in CO2 emissions, GDP and EC. A range of diagnostic tests were also used to confirm the validity and reliability of the results. The results also point out to a unidirectional causality running from CO2 emissions to economic growth to energy consumption, from energy consumption to CO2 emissions. This study reveals new findings that contribute the existing literature and may be of particular interest to the country’s policymakers in light of the economic system and role of in environmental issues.

Published
2023

17. Antigen-driven colonic inflammation is associated with development of dysplasia in primary sclerosing cholangitis

Author

Shaw, Dustin G., Aguirre-Gamboa, Raúl, Vieira, Marcos C., Gona, Saideep, DiNardi, Nicholas, Wang, Anni, Dumaine, Anne, Gelderloos-Arends, Jody, Earley, Zachary M., Meckel, Katherine R., Ciszewski, Cezary, Castillo, Anabella, Monroe, Kelly, Torres, Joana, Shah, Shailja C., Colombel, Jean-Frédéric, Itzkowitz, Steven, Newberry, Rodney, Cohen, Russell D., Rubin, David T., Quince, Christopher, Cobey, Sarah, Jonkers, Iris H., Weber, Christopher R., Pekow, Joel, Wilson, Patrick C., Barreiro, Luis B., and Jabri, Bana

Published
2023
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18. Morphological and Molecular Identification of Adoretus hirsutus (Ohaus, 1914) (Coleoptera:Scarabaeidae:Rutelinae) from Erbil Governorate Kurdistan Region- Iraq

Author

Gona Sharif, Abbas Farage, and nabeel mawlood

Subjects
molecular identification, morphological study, mt coi gene, adoretus hirsutus, sequencing, Agriculture
Abstract

This study provides a detailed description of Adoretus hirsutus (Ohaus, 1914) (Coleoptera:Scarabaeidae: Rutelinae), as a first record in Iraq. Between March and July 2022, we collected specimens from various weed flowers in different locations within the Erbil Governorate, Kurdistan Region, Iraq. According to molecular analysis, Adoretus hirsutus was used as a source of samples for PCR amplification of the fragments (710 bp) of the mtCOI gene for phylogenetic analysis. To compare the nucleotide sequence with those of other insect species, a section of the mtCOI gene from the collected insect was aligned with the NCBI GenBank database using the BLAST tool. The BLAST results showed that the second record in the NCBI GenBank identity of insects. The COI sequence of Adoretus hirsutus was submitted to GenBank with accession numbers OQ4288117, OQ428818, and OQ428819. The morphological diagnostic characteristics of the species are; Labrum nearly cup shaped, lateral margins moderately concave with a row of small spines, median apical projection overhanging the mentum. Mandibles irregular shaped, apically with single oval shaped tooth. Terminal maxillary palpomere 1.5 times as long as the 2nd. Antenna brown, consisting of 10 antennomeres ending in a unilateral three lamellated club, equal in length. Outer margin of fore tibia with three acute teeth. Aedagaeus moderately curved, parameres elongated oval, apical part is very acute. Some important parts such as labrum, mandible, antenna, fore legs, elytra, pygidium and male genitalia have been photographed.

Published
2023
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19. Utility of the 3Di short version in the identification and diagnosis of autism in children at the Kenyan coast

Author

Patricia Kipkemoi, Symon M. Kariuki, Joseph Gona, Felicita Wangeci Mwangi, Martha Kombe, Collins Kipkoech, Paul Murimi, William Mandy, Richard Warrington, David Skuse, Charles R.J.C. Newton, and Amina Abubakar

Subjects
autism, diagnosis, Africa, 3Di, psychometrics, reliability, Psychiatry, RC435-571
Abstract

IntroductionThe precise epidemiological burden of autism is unknown because of the limited capacity to identify and diagnose the disorder in resource-constrained settings, related in part to a lack of appropriate standardised assessment tools and health care experts. We assessed the reliability, validity, and diagnostic accuracy of the Developmental Diagnostic Dimensional Interview (3Di) in a rural setting on the Kenyan coast.MethodsUsing a large community survey of neurodevelopmental disorders (NDDs), we administered the 3Di to 2,110 children aged between 6 years and 9 years who screened positive or negative for any NDD and selected 242 who had specific symptoms suggestive of autism based on parental report and the screening tools for review by a child and adolescent psychiatrist. On the basis of recorded video, a multi-disciplinary team applied the Autism Diagnostic Observation Schedule to establish an autism diagnosis. Internal consistency was used to examine the reliability of the Swahili version of the 3Di, tetrachoric correlations to determine criterion validity, structural equation modelling to evaluate factorial structure and receiver operating characteristic analysis to calculate diagnostic accuracy against Diagnostic Statistical Manual of Mental Disorders (DSM) diagnosis.ResultsThe reliability coefficients for 3Di were excellent for the entire scale {McDonald’s omega (ω) = 0.83 [95% confidence interval (CI) 0.79–0.91]}. A higher-order three-factor DSM-IV-TR model showed an adequate fit with the model, improving greatly after retaining high-loading items and correlated items. A higher-order two-factor DSM-5 model also showed an adequate fit. There were weak to satisfactory criterion validity scores [tetrachoric rho = 0.38 (p = 0.049) and 0.59 (p = 0.014)] and good diagnostic accuracy metrics [area under the curve = 0.75 (95% CI: 0.54–0.96) and 0.61 (95% CI: 0.49–0.73] for 3Di against the DSM criteria. The 3Di had a moderate sensitivity [66.7% (95% CI: 0.22–0.96)] and a good specificity [82.5% (95% CI: 0.74–0.89)], when compared with the DSM-5. However, we observed poor sensitivity [38.9% (95% CI: 0.17–0.64)] and good specificity [83.5% (95% CI: 0.74–0.91)] against DSM-IV-TR.ConclusionThe Swahili version of the 3Di provides information on autism traits, which may be helpful for descriptive research of endophenotypes, for instance. However, for accuracy in newly diagnosed autism, it should be complemented by other tools, e.g., observational clinical judgment using the DSM criteria or assessments such as the Autism Diagnostic Observation Schedule. The construct validity of the Swahili 3Di for some domains, e.g., communication, should be explored in future studies.

Published
2024
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22. Disrupting Bias without Trainings: The Effect of Equity Advocates on Faculty Search Committees

Author

Cahn, Peter S., Gona, Clara M., Naidoo, Keshrie, and Truong, Kimberly A.

Abstract

Many institutions of higher education have implemented workshops for hiring committee members to familiarize them with the pernicious effects of implicit bias and how to counteract them. Unfortunately, the enthusiasm for implicit bias trainings is not matched by the evidence for their effectiveness. Recognizing the difficulty of removing entrenched biases and the potential for trainings to backfire, we introduced the role of equity advocate (EA) at one institution. EAs are trained volunteer faculty and staff members who serve on search committees outside their home departments to identify behaviors and judgments that might have a disparate racial effect in hiring. We conducted focus groups to document the perspectives of both EAs and non-EA search committee members who completed a cycle of academic hiring. Search committee members credited EAs with helping to mitigate bias by questioning their assumptions and introducing standardized tools for evaluating candidates. By contrast, EAs reported a more contentious relationship with the rest of the search committee and expressed less confidence that the process was free from bias. Both groups agreed that the EAs added valuable race-conscious equitable practices, and untrained committee members identified ways they could apply the lessons of bias reduction in other parts of their professional roles. Our study provides evidence for how to engage all faculty and staff members in sustainable, equity-minded efforts.

Published
2022
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23. Evaluation of peripheral cannulation technique among nurses in maternity and Dr. Jamal Ahmad Rashid pediatric teaching hospitals in Sulaimaniyah, Iraq

Author

Gona Othman Faris, Awayi Ghazy Abdulkareem, Niyan Hakim Ismael, and Delan Jamal Qader

Subjects
Peripheral cannulation, Technique evaluation, Nursing practice, Descriptive-analytical study, Nursing, RT1-120
Abstract

Abstract Background Obedience to the excellent standards of nursing practice is the ultimate attitude to develop patient outcomes and avoid nursing process related-infections. Inserting the peripheral intravenous cannula is the utmost mutual aggressive technique achieved in nursing care for patients. Therefore, nurses must have adequate knowledge and practice to ensure the procedure’s success. Objectives To determine the peripheral cannulation technique evaluation among nurses working in the emergency departments. Methods This descriptive-analytical study was conducted at Maternity and Pediatric Teaching Hospitals in Sulaimaniyah, Iraq on 101 randomly selected nurses, from 14th December 2021 to 16th March 2022. Data collection was carried out through a structured interview questionnaire aimed to gather the nurses’ general characteristics and an observational checklist to assess the nurses’ pre, during and post practices regarding peripheral cannulation technique. Results According to general practice, 43.6% of nurses had an average level, 29.7% had a good level, and 26.7% had a poor level of practice in the evaluation of the peripheral cannulation technique. Our study also showed a positive association between socio-demographic characteristics of the studied samples with the overall level of practice regarding peripheral cannulation technique. Conclusions Nurses were not practised peripheral cannulation technique appropriately; however, half of the nurses’ had an average level of practice, although their practices were not followed the standard protocols.

Published
2023
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24. Neonatal imprinting of alveolar macrophages via neutrophil-derived 12-HETE

Author

Pernet, Erwan, Sun, Sarah, Sarden, Nicole, Gona, Saideep, Nguyen, Angela, Khan, Nargis, Mawhinney, Martin, Tran, Kim A., Chronopoulos, Julia, Amberkar, Dnyandeo, Sadeghi, Mina, Grant, Alexandre, Wali, Shradha, Prevel, Renaud, Ding, Jun, Martin, James G., Thanabalasuriar, Ajitha, Yipp, Bryan G., Barreiro, Luis B., and Divangahi, Maziar

Published
2023
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25. Partial skeletal muscle-specific Drp1 knockout enhances insulin sensitivity in diet-induced obese mice, but not in lean mice

Author

Benjamin A. Kugler, Jared Lourie, Nicolas Berger, Nana Lin, Paul Nguyen, Edzana DosSantos, Abir Ali, Amira Sesay, H. Grace Rosen, Baby Kalemba, Gregory M. Hendricks, Joseph A. Houmard, Hiromi Sesaki, Philimon Gona, Tongjian You, Zhen Yan, and Kai Zou

Subjects
Mitochondrial fission, Mitochondrial dynamics, Insulin sensitivity, Mitochondrial H 2O2, Internal medicine, RC31-1245
Abstract

Objective: Dynamin-related protein 1 (Drp1) is the key regulator of mitochondrial fission. We and others have reported a strong correlation between enhanced Drp1 activity and impaired skeletal muscle insulin sensitivity. This study aimed to determine whether Drp1 directly regulates skeletal muscle insulin sensitivity and whole-body glucose homeostasis. Methods: We employed tamoxifen-inducible skeletal muscle-specific heterozygous Drp1 knockout mice (mDrp1+/−). Male mDrp1+/− and wildtype (WT) mice were fed with either a high-fat diet (HFD) or low-fat diet (LFD) for four weeks, followed by tamoxifen injections for five consecutive days, and remained on their respective diet for another four weeks. In addition, we used primary human skeletal muscle cells (HSkMC) from lean, insulin-sensitive, and severely obese, insulin-resistant humans and transfected the cells with either a Drp1 shRNA (shDrp1) or scramble shRNA construct. Skeletal muscle and whole-body insulin sensitivity, skeletal muscle insulin signaling, mitochondrial network morphology, respiration, and H2O2 production were measured. Results: Partial deletion of the Drp1 gene in skeletal muscle led to improved whole-body glucose tolerance and insulin sensitivity (P

Published
2023
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26. Mapping disparities in education across low- and middle-income countries

Author

Graetz, Nicholas, Woyczynski, Lauren, Wilson, Katherine F, Hall, Jason B, Abate, Kalkidan Hassen, Abd-Allah, Foad, Adebayo, Oladimeji M, Adekanmbi, Victor, Afshari, Mahdi, Ajumobi, Olufemi, Akinyemiju, Tomi, Alahdab, Fares, Al-Aly, Ziyad, Alcalde Rabanal, Jacqueline Elizabeth, Alijanzadeh, Mehran, Alipour, Vahid, Altirkawi, Khalid, Amiresmaili, Mohammadreza, Anber, Nahla Hamed, Andrei, Catalina Liliana, Anjomshoa, Mina, Antonio, Carl Abelardo T, Arabloo, Jalal, Aremu, Olatunde, Aryal, Krishna K, Asadi-Aliabadi, Mehran, Atique, Suleman, Ausloos, Marcel, Awasthi, Ashish, Ayala Quintanilla, Beatriz Paulina, Azari, Samad, Badawi, Alaa, Banoub, Joseph Adel Mattar, Barker-Collo, Suzanne Lyn, Barnett, Anthony, Bedi, Neeraj, Bennett, Derrick A, Bhattacharjee, Natalia V, Bhattacharyya, Krittika, Bhattarai, Suraj, Bhutta, Zulfiqar A, Bijani, Ali, Bikbov, Boris, Britton, Gabrielle, Burstein, Roy, Butt, Zahid A, Cardenas, Rosario, Carvalho, Felix, Castaneda-Orjuela, Carlos A, Castro, Franz, Cerin, Ester, Chang, Jung-Chen, Collison, Michael L, Cooper, Cyrus, Cork, Michael A, Daoud, Farah, Das Gupta, Rajat, Weaver, Nicole Davis, De Neve, Jan-Walter, Deribe, Kebede, Desalegn, Beruk Berhanu, Deshpande, Aniruddha, Desta, Melaku, Dhimal, Meghnath, Diaz, Daniel, Dinberu, Mesfin Tadese, Djalalinia, Shirin, Dubey, Manisha, Dubljanin, Eleonora, Duraes, Andre R, Dwyer-Lindgren, Laura, Earl, Lucas, Kalan, Mohammad Ebrahimi, El-Khatib, Ziad, Eshrati, Babak, Faramarzi, Mahbobeh, Fareed, Mohammad, Faro, Andre, Fereshtehnejad, Seyed-Mohammad, Fernandes, Eduarda, Filip, Irina, Fischer, Florian, Fukumoto, Takeshi, Garcia, Jose A, Gill, Paramjit Singh, Gill, Tiffany K, Gona, Philimon N, Gopalani, Sameer Vali, Grada, Ayman, Guo, Yuming, Gupta, Rajeev, Gupta, Vipin, Haj-Mirzaian, Arvin, Haj-Mirzaian, Arya, Hamadeh, Randah R, Hamidi, Samer, Hasan, Mehedi, Hassen, Hamid Yimam, Hendrie, Delia, and Henok, Andualem

Subjects
Pediatric, Aetiology, 2.3 Psychological, social and economic factors, Good Health and Well Being, Bayes Theorem, Developing Countries, Education, Female, Health Status, Humans, Male, Socioeconomic Factors, Local Burden of Disease Educational Attainment Collaborators, General Science & Technology
Abstract

Educational attainment is an important social determinant of maternal, newborn, and child health1-3. As a tool for promoting gender equity, it has gained increasing traction in popular media, international aid strategies, and global agenda-setting4-6. The global health agenda is increasingly focused on evidence of precision public health, which illustrates the subnational distribution of disease and illness7,8; however, an agenda focused on future equity must integrate comparable evidence on the distribution of social determinants of health9-11. Here we expand on the available precision SDG evidence by estimating the subnational distribution of educational attainment, including the proportions of individuals who have completed key levels of schooling, across all low- and middle-income countries from 2000 to 2017. Previous analyses have focused on geographical disparities in average attainment across Africa or for specific countries, but-to our knowledge-no analysis has examined the subnational proportions of individuals who completed specific levels of education across all low- and middle-income countries12-14. By geolocating subnational data for more than 184 million person-years across 528 data sources, we precisely identify inequalities across geography as well as within populations.

Published
2020

28. Review: Failure of current digoxin monitoring for toxicity: new monitoring recommendations to maintain therapeutic levels for efficacy

Author

Sridhar Rao Gona, Joel Rosenberg, Ria C. Fyffe-Freil, Janet M. Kozakiewicz, and Mary E. Money

Subjects
digoxin, digoxin toxicity, therapeutic level, narrow therapeutic index and critical dose drugs, rapid atrial fibrillation/flutter, digoxin morbidity, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

The current recommendations for monitoring digoxin, a narrow therapeutic index drug, are limited to confirming medication use or investigating suspicion of toxicity and fail our oath to do no harm. Numerous meta-analyses evaluating digoxin use consistently recommend frequent monitoring to maintain the level of 0.5 to ≤1.0 ng/ml because higher levels lead to increased morbidity and mortality without benefit. Data from the United States National Poison Control Center (2012–2020) show annual deaths due to digoxin of 18–36 compared to lithium's 1–7, and warfarin's 0–2 respectively. The latter drugs also have narrow therapeutic indexes like digoxin yet are more carefully monitored. Recognition of digoxin toxicity is impaired as levels are not being routinely checked after medications are added to a patient's regimen. In addition, providers may be using ranges to guide treatment that are no longer appropriate. It is imperative that monitoring guidelines and laboratory therapeutic levels are revised to reduce morbidity and mortality due to digoxin. In this review, we provide a comprehensive literature review of digoxin monitoring guidelines, digoxin toxicity, and evidence to support revising the ranges for serum digoxin monitoring.

Published
2023
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29. Duration and stability of metabolically healthy obesity over 30 years

Author

Camhi, Sarah M, Must, Aviva, Gona, Philimon N, Hankinson, Arlene, Odegaard, Andrew, Reis, Jared, Gunderson, Erica P, Jacobs, David R, and Carnethon, Mercedes R

Subjects
Public Health, Biomedical and Clinical Sciences, Nutrition and Dietetics, Health Sciences, Prevention, Nutrition, Clinical Research, Obesity, Adult, Black or African American, Blood Glucose, Blood Pressure, Cohort Studies, Female, Humans, Male, Middle Aged, Obesity, Metabolically Benign, Risk Factors, Sex Distribution, United States, White People, Young Adult, Medical and Health Sciences, Education, Endocrinology & Metabolism, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundObese adults who are free from metabolic risk factors may develop risk factors over time. Our objective was to characterize development of obesity and duration of metabolically healthy obese (MHO) over 30 years.MethodsParticipants in CARDIA who developed obesity (BMI ≥ 30 kg/m2) at follow-up exams during years 7, 10, 15, 20, 25, and 30 were analyzed. MHO was defined as obese and having 0 or 1 risk factor: ≥SBP/DBP 130/85 mmHg; fasting glucose ≥100 mg/dL/5.55 mmol/L; fasting triglycerides (≥150 mg/dL/1.69 mmol/L); and HDL-C (men

Published
2019

30. Impact of climate change on groundwater potential and recharge in the drought prone Runde catchment of Zimbabwe

Author

Liberty S. Gona, Webster Gumindoga, Donald T. Rwasoka, and Richard J. Stuart Owen

Subjects
gis, precipitation, simulated rainfall, validation, wetness index, Water supply for domestic and industrial purposes, TD201-500, River, lake, and water-supply engineering (General), TC401-506
Abstract

Groundwater provides critical freshwater supplies for most rural communities living in drought-prone areas. Such is the case for Runde catchment in Zimbabwe, whose rural communities depend on groundwater. Climate change and increased variability pose a threat to water availability by affecting groundwater potential and recharge, but the full extent of the threat is not well understood. Thus, the main objective of this study was to assess the impact of climate change on groundwater potential and recharge in the catchment. The groundwater potential mapping was performed using a spatially weighted overlay method with inputs: soil type, geology, land use, observed precipitation, topographic wetness index and elevation. This mapping produced a groundwater potential index, classified into groundwater potential zones and cross-validated with borehole yield data, r=0.63 and n=62. The groundwater potential validation showed 1.6 and 4.8% of the total boreholes were in the high (>7 L/s) to very high (4–7 L/s) while 43.5 and 50.1% moderate (1–4 L/s), and low (

Published
2022
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31. Changes in body mass index, obesity, and overweight in Southern Africa development countries, 1990 to 2019: Findings from the Global Burden of Disease, Injuries, and Risk Factors Study

Author

Philimon N. Gona, Ruth W. Kimokoti, Clara M. Gona, Suha Ballout, Sowmya R. Rao, Chabila C. Mapoma, Justin Lo, and Ali H. Mokdad

Subjects
high body mass index, ischemic heart disease, mortality, overweight & obesity, prevalence, SADC countries, Internal medicine, RC31-1245
Abstract

Abstract Background High body mass index (BMI) is associated with stroke, ischemic heart disease (IHD), and type 2 diabetes mellitus (T2DM). An epidemiological analysis of the prevalence of high BMI, stroke, IHD, and T2DM was conducted for 16 Southern Africa Development Community (SADC) using Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study data. Methods GBD obtained data from vital registration, verbal autopsy, and ICD codes. Prevalence of high BMI (≥25 kg/m2), stroke, IHD, and T2DM attributed to high BMI were calculated. Cause of Death Ensemble Model and Spatiotemporal Gaussian regression was used to estimate mortality due to stroke, IHD, and T2DM attributable to high BMI. Results Obesity in adult females increased 1.54‐fold from 12.0% (uncertainty interval [UI]: 11.5–12.4) to 18.5% (17.9–19.0), whereas in adult males, obesity nearly doubled from 4.5 (4.3–4.8) to 8.8 (8.5–9.2). In children, obesity more than doubled in both sexes, and overweight increased by 27.4% in girls and by 37.4% in boys. Mean BMI increased by 0.7 from 22.4 (21.6–23.1) to 23.1 (22.3–24.0) in adult males, and by 1.0 from 23.8 (22.9–24.7) to 24.8 (23.8–25.8) in adult females. South Africa 44.7 (42.5–46.8), Swaziland 33.9 (31.7–36.0) and Lesotho 31.6 (29.8–33.5) had the highest prevalence of obesity in 2019. The corresponding prevalence in males for the three countries were 19.1 (17.5–20.7), 19.3 (17.7–20.8), and 9.2 (8.4–10.1), respectively. The DRC and Madagascar had the least prevalence of adult obesity, from 5.6 (4.8–6.4) and 7.0 (6.1–7.9), respectively in females in 2019, and in males from 4.9 (4.3–5.4) in the DRC to 3.9 (3.4–4.4) in Madagascar. Conclusions The prevalence of high BMI is high in SADC. Obesity more than doubled in adults and nearly doubled in children. The 2019 mean BMI for adult females in seven countries exceeded 25 kg/m2. SADC countries are unlikely to meet UN2030 SDG targets. Prevalence of high BMI should be studied locally to help reduce morbidity.

Published
2021
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32. Detection of NDM-1/5 and OXA-48 co-producing extensively drug-resistant hypervirulent Klebsiella pneumoniae in Northern Italy

Author

Giovanni Lorenzin, Floriana Gona, Simone Battaglia, Andrea Spitaleri, Francesca Saluzzo, Alberto Trovato, Federico di Marco, Paola Cichero, Anna Biancardi, Paola Nizzero, Barbara Castiglione, Paolo Scarpellini, Matteo Moro, and Daniela Maria Cirillo

Subjects
Hypervirulent Klebsiella pneumoniae, NDM-5, NDM-1, OXA-48, Multiple plasmids, Carbapenem-resistant Klebsiella pneumoniae, Microbiology, QR1-502
Abstract

ABSTRACT: Objectives: Using a hybrid long-read sequencing approach, we aimed to fully characterise four extensively-drug resistant (XDR) hypervirulent Klebsiella pneumoniae isolates, one of which represented the first strain isolated in Italy co-expressing NDM-1/5 and OXA-48 carbapenemases. Methods: Whole-genome sequencing was performed using Illumina and Oxford Nanopore Technology platforms. An assembly pipeline was used to recover the structures both of the chromosome and plasmids. Results: Multilocus sequence typing (MLST) showed that these strains belonged to high-risk sequence types (STs) not commonly circulating in Italy (ST383, ST147 and ST15). The hybrid sequencing approach allowed to characterise three multidrug resistance plasmids, which demonstrated high homology with previously sequenced plasmids, that were simultaneously detected in one ST383 strain carrying, respectively, blaNDM-1, blaNDM-5 and blaOXA-48. Conclusion: This is the first report in Italy of new hypervirulent XDR K. pneumoniae clones characterised by co-production of OXA-48, NDM-1 and NDM-5. The discovery of new high-risk clones harbouring multiple mobile elements is a growing problem that poses a great challenge for public health.

Published
2022
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33. Distribution, determinants and normal reference values of aortic arch width: Thoracic aortic geometry in the Framingham Heart Study

Author

Saadia Qazi, Philimon N. Gona, Rebecca M. Musgrave, Caroline S. Fox, Joseph M. Massaro, Udo Hoffmann, Michael L. Chuang, and Christopher J. O'Donnell

Subjects
Computed tomography, Epidemiology, Risk factors, Aortic geometry, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Study objective: Aortic arch geometry changes with age, including an increase in aortic arch width (AAW). High AAW is a predictor of incident adverse cardiovascular disease (CVD) events, but its distribution and determinants are unknown. We hypothesized that traditional CVD risk factors, in addition to age, are associated with increased AAW in community-dwelling adults. Study design: Framingham Offspring and Third Generation cohort participants (N = 3026, 52 % men) underwent thoracic multidetector computed tomography (MDCT). A referent group (733M, 738W) free of clinical CVD, hypertension, dyslipidemia, smoking, and diabetes was used to generate sex and 10-year age-group specific upper 90th percentile (P90) cut-points for AAW. AAW was measured as the distance between the cross-sectional centroids of the ascending and descending thoracic aorta. Multivariable logistic regression models were used to identify clinical correlates of high AAW (≥referent P90) in the overall study group. Results: Among referent participants, AAW increased with greater age-group, p for trend

Published
2023
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34. Intersection of HIV and Anemia in women of reproductive age: a 10-year analysis of three Zimbabwe demographic health surveys, 2005–2015

Author

Philimon N. Gona, Clara M. Gona, Vasco Chikwasha, Clara Haruzivishe, Chabila C. Mapoma, and Sowmya R. Rao

Subjects
Anemia in women 15–49 years, Intersection of Anemia and HIV, Zimbabwe demographic health surveys, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Women of reproductive age 15–49 are at a high risk of iron-deficiency anemia, which in turn may contribute to maternal morbidity and mortality. Common causes of anemia include poor nutrition, infections, malaria, HIV, and treatments for HIV. We conducted a secondary analysis to study the prevalence of and associated risk factors for anemia in women to elucidate the intersection of HIV and anemia using data from 3 cycles of Zimbabwe Demographic and Health Survey (ZDHS) conducted in 2005, 2010, and 2015. Methods DHS design comprises of a two-stage cluster-sampling to monitor and evaluate indicators for population health. A field hemoglobin test was conducted in eligible women. Anemia was defined as hemoglobin

Published
2021
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35. The political economy of Somali piracy: Unravelling the actors, their motivations and activities, 2005-2011

Author

Justus Ondigi, George Gona, and Kenneth Ombongi

Subjects
somali economy, somali piracy, somali coast, combat economy, shadow economy, coping economy, Auxiliary sciences of history
Abstract

Understanding piracy as a criminal business enterprise only presents a partial portrait of what is otherwise a complex phenomenon. Somali piracy could be better understood if it were framed as a multi-layered engagement whose various actors’ participation is driven by varied motivations beyond commentators, scholars and analysts’ explanations of the phenomenon as a struggle for control, domination and fierce competition among actors. This article seeks to illustrate the facets of Somali piracy through the lens of a political economy approach to provide a nuanced consideration of the various actors who participated in the piracy economy, what motivated them to participate in this economy and suggests the functions of the economies which emerge. Such an endeavour, unlike the past, will not glorify a few people or groups but will attempt to reveal the many other actors and their activities. Through the mining of secondary sources and newspaper articles, the authors demonstrate how the collapsed economy of Somalia after the Siad Barre regime opened many economic opportunities for a variety of people in Somalia and beyond. This provides not only a different but also a disaggregated explanation of piratical activities in the Horn of Africa and a foundation of targeted interventions to end the scourge.

Published
2022
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36. Topologies, posets and finite quandles

Author

M. Elhamdadi, H. Lahrani, and T. Gona

Subjects
quandles, topology, poset, Mathematics, QA1-939
Abstract

An Alexandroff space is a topological space in which every intersection of open sets is open. There is one to one correspondence between Alexandroff T0 -spaces and partially ordered sets (posets). We investigate Alexandroff T0 -topologies on finite quandles. We prove that there is a non-trivial topology on a finite quandle making right multiplications continuous functions if and only if the quandle has more than one orbit. Furthermore, we show that right continuous posets on quandles with n orbits are n-partite. We also find, for the even dihedral quandles, the number of all possible topologies making the right multiplications continuous. Some explicit computations for quandles of cardinality up to five are given.

Published
2022

37. New Antimicrobials for Gram-Positive Sustained Infections: A Comprehensive Guide for Clinicians

Author

Davide Carcione, Jari Intra, Lilia Andriani, Floriana Campanile, Floriana Gona, Silvia Carletti, Nicasio Mancini, Gioconda Brigante, Dario Cattaneo, Sara Baldelli, Mattia Chisari, Alessandra Piccirilli, Stefano Di Bella, and Luigi Principe

Subjects
Gram-positive pathogens, novel anti-MRSA β-lactams, lipoglycopeptides, omadacycline, delafloxacin, tedizolid, Medicine, Pharmacy and materia medica, RS1-441
Abstract

Antibiotic resistance is a public health problem with increasingly alarming data being reported. Gram-positive bacteria are among the protagonists of severe nosocomial and community infections. The objective of this review is to conduct an extensive examination of emerging treatments for Gram-positive infections including ceftobiprole, ceftaroline, dalbavancin, oritavancin, omadacycline, tedizolid, and delafloxacin. From a methodological standpoint, a comprehensive analysis on clinical trials, molecular structure, mechanism of action, microbiological targeting, clinical use, pharmacokinetic/pharmacodynamic features, and potential for therapeutic drug monitoring will be addressed. Each antibiotic paragraph is divided into specialized microbiological, clinical, and pharmacological sections, including detailed and appropriate tables. A better understanding of the latest promising advances in the field of therapeutic options could lead to the development of a better approach in managing antimicrobial therapy for multidrug-resistant Gram-positive pathogens, which increasingly needs to be better stratified and targeted.

Published
2023
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38. Oral rehydration solution coverage in under 5 children with diarrhea: a tri-country, subnational, cross-sectional comparative analysis of two demographic health surveys cycles

Author

Philimon N. Gona, Clara M. Gona, Vasco Chikwasha, Clara Haruzivishe, Sowmya R. Rao, and Chabila C. Mapoma

Subjects
Oral rehydration solution, Under 5 children, Diarrhea, Demographic health surveys, Public aspects of medicine, RA1-1270
Abstract

Abstract Background More than 3 million children under 5 years in developing countries die from dehydration due to diarrhea, a preventable and treatable disease. We conducted a comparative analysis of two Demographic Health Survey (DHS) cycles to examine changes in ORS coverage in Zimbabwe, Zambia and Malawi. These surveys are cross-sectional conducted on a representative sample of the non-institutionalized individuals. Methods The sample is drawn using a stratified two-stage cluster sampling design with census enumeration areas, typically, selected first as primary sampling units (PSUs) and then a fixed number of households from each PSU. We examined national and sub-regional prevalence of ORS use during a recent episode of diarrhea (within 2 weeks of survey) using DHSs for 2007–2010 (1st Period), and 2013–2016 (2nd Period). Weighted proportions of ORS were obtained and multivariable- design-adjusted logistic regression analysis was used to obtain Odds Ratios (aORs) and 95% confidence intervals (CIs) and weighted proportions of ORS coverage. Results Crude ORS coverage increased from 21.0% (95% CI: 17.4–24.9) in 1st Period to 40.5% (36.5–44.6) in 2nd Period in Zimbabwe; increased from 60.8% (56.1–65.3) to 64.7% (61.8–67.5) in Zambia; and decreased from 72.3% (68.4–75.9) to 64.6% (60.9–68.1) in Malawi. The rates of change in coverage among provinces in Zimbabwe ranged from 10.3% over the three cycles (approximately 10 years) in Midlands to 44.2% in Matabeleland South; in Zambia from − 9.5% in Eastern Province to 24.4% in Luapula; and in Malawi from − 16.5% in the Northern Province to − 3.2% in Southern Province. The aORs for ORS use was 3.95(2.66–5.86) for Zimbabwe, 2.83 (2.35–3.40) for Zambia, and, 0.71(0.59–0.87) for Malawi. Conclusion ORS coverage increased in Zimbabwe, stagnated in Zambia, but declined in Malawi. Monitoring national and province-level trends of ORS use illuminates geographic inequalities and helps identify priority areas for targeting resource allocation.. Provision of safe drinking-water, adequate sanitation and hygiene will help reduce the causes and the incidence of diarrhea. Health policies to strengthen access to appropriate treatments such as vaccines for rotavirus and cholera and promoting use of ORS to reduce the burden of diarrhea should be developed and implemented.

Published
2020
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39. Burden and changes in HIV/AIDS morbidity and mortality in Southern Africa Development Community Countries, 1990–2017

Author

Philimon N. Gona, Clara M. Gona, Suha Ballout, Sowmya R. Rao, Ruth Kimokoti, Chabila C. Mapoma, and Ali H. Mokdad

Subjects
HIV/AIDS, mortality, Morbidity, DALYs, Trends, SADC countries, Public aspects of medicine, RA1-1270
Abstract

Abstract Background The 16 Southern Africa Development Community (SADC) countries remain the epicentre of the HIV/AIDS epidemic with the largest number of people living with HIV/AIDS. Anti-retroviral treatment (ART) has improved survival and prevention of mother-to-child transmission (PMTCT) of HIV, but the disease remains a serious cause of mortality. We conducted a descriptive epidemiological analysis of HIV/AIDS burden for the 16 SADC countries using secondary data from the Global Burden of Diseases, Injuries and Risk Factor (GBD) Study. Methods The GBD study is a systematic, scientific effort by the Institute for Health Metrics and Evaluation (IHME) to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors by age, sex, and geographies for specific points in time. We analyzed the following outcomes: mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to HIV/AIDS for SADC. Input data for GBD was extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service utilisation, disease notifications, and other sources. Country- and cause-specific HIV/AIDS-related death rates were calculated using the Cause of Death Ensemble model (CODEm) and spatiotemporal Gaussian process regression (ST-GPR). Deaths were multiplied by standard life expectancy at each age-group to calculate YLLs. Cause-specific mortality was estimated using a Bayesian meta-regression modelling tool, DisMod-MR. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases to calculate YLDs. Crude and age-adjusted rates per 100,000 population and changes between 1990 and 2017 were determined for each country. Results In 2017, HIV/AIDS caused 336,175 deaths overall in SADC countries, and more than 20 million DALYs. This corresponds to a 3-fold increase from 113,631 deaths (6,915,170 DALYs) in 1990. The five leading countries with the proportion of deaths attributable to HIV/AIDS in 2017 were Botswana at the top with 28.7% (95% UI; 23.7–35.2), followed by South Africa 28.5% (25.8–31.6), Lesotho, 25.1% (21.2–30.4), eSwatini 24.8% (21.3–28.6), and Mozambique 24.2% (20.6–29.3). The five countries had relative attributable deaths that were at least 14 times greater than the global burden of 1.7% (1.6–1.8). Similar patterns were observed with YLDs, YLLs, and DALYs. Comoros, Seychelles and Mauritius were on the lower end, with attributable proportions less than 1%, below the global proportion. Conclusions Great progress in reducing HIV/AIDS burden has been achieved since the peak but more needs to be done. The post-2005 decline is attributed to PMTCT of HIV, resources provided through the US President’s Emergency Plan For AIDS Relief (PEPFAR), and behavioural change. The five countries with the highest burden of HIV/AIDS as measured by proportion of death attributed to HIV/AIDS and age-standardized mortaility rate were Botswana, South Africa, Lesotho, eSwatini, and Mozambique. SADC countries should cooperate, work with donors, and embrace the UN Fast-Track approach, which calls for frontloading investment from domestic or other sources to prevent and treat HIV/AIDS. Robust tracking, testing, and early treatment are required, as well as refinement of individual treatment strategies for transient individuals in the region.

Published
2020
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40. Gastrointestinal Stromal Tumor Associated with Neurofibromatosis Type 1 Simulating a Neurofibrosarcoma in a Black African Adult Patient

Author

Gnangoran Marcellin Koffi, Alassan Mahassadi, Sylvanus Koui, and Kountele Gona Soro

Subjects
intestinal bleeding, gastrointestinal stromal tumor, neurofibromatosis, africa, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Gastrointestinal stromal tumor (GIST) is the most prevalent mesenchymal tumor encountered in patients with neurofibromatosis type I (NF1). This association is rarely reported in black African adult patients. Clinical signs such as abdominal pain, intestinal bleeding, and palpable abdominal nodules may contribute to the diagnosis of GIST. However, these clinical signs may also indicate the presence of other solid intestinal tumors such as a neurofibrosarcoma which is an intestinal complication of NF1. The immunohistochemistry staining of the resected tissue is mandatory that allows establishing a correct diagnostic of GIST. The immunohistochemistry is also a challenging method in African countries with limited resources. Herein, we report a case of multiple intestinal involvement of GIST associated with NF1 revealed by a recurrent intestinal bleeding in a black African adult patient. The GIST diagnosis was suspected on a computed tomography scan images and laparotomy findings, which were confirmed by histopathological and immunochemistry examinations of the resected nodules. The immunohistochemistry staining of the tissue was positive for CD34 and CD117 indicating the presence of GIST in black African patient with NF1. The surgical treatment was consisted of a double intestinal resection with anastomosis that removed all palpable nodules located on the intestinal antimesenteric wall. No additional chemotherapy was administered to the patient who is so far under follow-up. The patient has not presented any episode of intestinal bleeding since the surgical treatment. We emphasize in this case report the importance of a recurrent intestinal bleeding in patient with NF1 that may indicate the presence of GIST and, the need of performing a large intestinal resection, as the most valuable treatment in limited resource countries.

Published
2021
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41. Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015

Author

Roth, Gregory A, Johnson, Catherine, Abajobir, Amanuel, Abd-Allah, Foad, Abera, Semaw Ferede, Abyu, Gebre, Ahmed, Muktar, Aksut, Baran, Alam, Tahiya, Alam, Khurshid, Alla, François, Alvis-Guzman, Nelson, Amrock, Stephen, Ansari, Hossein, Ärnlöv, Johan, Asayesh, Hamid, Atey, Tesfay Mehari, Avila-Burgos, Leticia, Awasthi, Ashish, Banerjee, Amitava, Barac, Aleksandra, Bärnighausen, Till, Barregard, Lars, Bedi, Neeraj, Ketema, Ezra Belay, Bennett, Derrick, Berhe, Gebremedhin, Bhutta, Zulfiqar, Bitew, Shimelash, Carapetis, Jonathan, Carrero, Juan Jesus, Malta, Deborah Carvalho, Castañeda-Orjuela, Carlos Andres, Castillo-Rivas, Jacqueline, Catalá-López, Ferrán, Choi, Jee-Young, Christensen, Hanne, Cirillo, Massimo, Cooper, Leslie, Criqui, Michael, Cundiff, David, Damasceno, Albertino, Dandona, Lalit, Dandona, Rakhi, Davletov, Kairat, Dharmaratne, Samath, Dorairaj, Prabhakaran, Dubey, Manisha, Ehrenkranz, Rebecca, Zaki, Maysaa El Sayed, Faraon, Emerito Jose A, Esteghamati, Alireza, Farid, Talha, Farvid, Maryam, Feigin, Valery, Ding, Eric L, Fowkes, Gerry, Gebrehiwot, Tsegaye, Gillum, Richard, Gold, Audra, Gona, Philimon, Gupta, Rajeev, Habtewold, Tesfa Dejenie, Hafezi-Nejad, Nima, Hailu, Tesfaye, Hailu, Gessessew Bugssa, Hankey, Graeme, Hassen, Hamid Yimam, Abate, Kalkidan Hassen, Havmoeller, Rasmus, Hay, Simon I, Horino, Masako, Hotez, Peter J, Jacobsen, Kathryn, James, Spencer, Javanbakht, Mehdi, Jeemon, Panniyammakal, John, Denny, Jonas, Jost, Kalkonde, Yogeshwar, Karimkhani, Chante, Kasaeian, Amir, Khader, Yousef, Khan, Abdur, Khang, Young-Ho, Khera, Sahil, Khoja, Abdullah T, Khubchandani, Jagdish, Kim, Daniel, Kolte, Dhaval, Kosen, Soewarta, Krohn, Kristopher J, Kumar, G Anil, Kwan, Gene F, Lal, Dharmesh Kumar, Larsson, Anders, Linn, Shai, Lopez, Alan, Lotufo, Paulo A, and Razek, Hassan Magdy Abd El

Subjects
Prevention, Cardiovascular, Burden of Illness, Heart Disease, Aging, Aetiology, 2.4 Surveillance and distribution, Good Health and Well Being, Adult, Aged, Cardiovascular Diseases, Cause of Death, Female, Global Health, Humans, Life Expectancy, Male, Middle Aged, Morbidity, Prevalence, Prospective Studies, Retrospective Studies, Risk Assessment, Risk Factors, Sex Distribution, Survival Rate, Young Adult, cause of death, epidemiology, global health, Cardiorespiratory Medicine and Haematology, Public Health and Health Services, Cardiovascular System & Hematology
Abstract

BackgroundThe burden of cardiovascular diseases (CVDs) remains unclear in many regions of the world.ObjectivesThe GBD (Global Burden of Disease) 2015 study integrated data on disease incidence, prevalence, and mortality to produce consistent, up-to-date estimates for cardiovascular burden.MethodsCVD mortality was estimated from vital registration and verbal autopsy data. CVD prevalence was estimated using modeling software and data from health surveys, prospective cohorts, health system administrative data, and registries. Years lived with disability (YLD) were estimated by multiplying prevalence by disability weights. Years of life lost (YLL) were estimated by multiplying age-specific CVD deaths by a reference life expectancy. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility.ResultsIn 2015, there were an estimated 422.7 million cases of CVD (95% uncertainty interval: 415.53 to 427.87 million cases) and 17.92 million CVD deaths (95% uncertainty interval: 17.59 to 18.28 million CVD deaths). Declines in the age-standardized CVD death rate occurred between 1990 and 2015 in all high-income and some middle-income countries. Ischemic heart disease was the leading cause of CVD health lost globally, as well as in each world region, followed by stroke. As SDI increased beyond 0.25, the highest CVD mortality shifted from women to men. CVD mortality decreased sharply for both sexes in countries with an SDI >0.75.ConclusionsCVDs remain a major cause of health loss for all regions of the world. Sociodemographic change over the past 25 years has been associated with dramatic declines in CVD in regions with very high SDI, but only a gradual decrease or no change in most regions. Future updates of the GBD study can be used to guide policymakers who are focused on reducing the overall burden of noncommunicable disease and achieving specific global health targets for CVD.

Published
2017

42. Association of Traditional Cardiovascular Risk Factors With Venous Thromboembolism

Author

Mahmoodi, Bakhtawar K, Cushman, Mary, Anne Næss, Inger, Allison, Matthew A, Bos, Willem J, Brækkan, Sigrid K, Cannegieter, Suzanne C, Gansevoort, Ron T, Gona, Philimon N, Hammerstrøm, Jens, Hansen, John-Bjarne, Heckbert, Susan, Holst, Anders G, Lakoski, Susan G, Lutsey, Pamela L, Manson, JoAnn E, Martin, Lisa W, Matsushita, Kunihiro, Meijer, Karina, Overvad, Kim, Prescott, Eva, Puurunen, Marja, Rossouw, Jacques E, Sang, Yingying, Severinsen, Marianne T, Ten Berg, Jur, Folsom, Aaron R, and Zakai, Neil A

Subjects
Epidemiology, Biomedical and Clinical Sciences, Health Sciences, Tobacco, Hematology, Prevention, Cardiovascular, Clinical Research, Tobacco Smoke and Health, Good Health and Well Being, Age Factors, Blood Pressure, Body Mass Index, Diabetes Complications, Humans, Hyperlipidemias, Hypertension, Lipids, Proportional Hazards Models, Prospective Studies, Pulmonary Embolism, Risk Factors, Sex Factors, Smoking, Venous Thromboembolism, Venous Thrombosis, cardiovascular disease, diabetes mellitus, hyperlipidemia, hypertension, risk factors, smoking, venous thromboembolism, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Public Health and Health Services, Cardiovascular System & Hematology, Cardiovascular medicine and haematology, Clinical sciences, Sports science and exercise
Abstract

BackgroundMuch controversy surrounds the association of traditional cardiovascular disease risk factors with venous thromboembolism (VTE).MethodsWe performed an individual level random-effect meta-analysis including 9 prospective studies with measured baseline cardiovascular disease risk factors and validated VTE events. Definitions were harmonized across studies. Traditional cardiovascular disease risk factors were modeled categorically and continuously using restricted cubic splines. Estimates were obtained for overall VTE, provoked VTE (ie, VTE occurring in the presence of 1 or more established VTE risk factors), and unprovoked VTE, pulmonary embolism, and deep-vein thrombosis.ResultsThe studies included 244 865 participants with 4910 VTE events occurring during a mean follow-up of 4.7 to 19.7 years per study. Age, sex, and body mass index-adjusted hazard ratios for overall VTE were 0.98 (95% confidence interval [CI]: 0.89-1.07) for hypertension, 0.97 (95% CI: 0.88-1.08) for hyperlipidemia, 1.01 (95% CI: 0.89-1.15) for diabetes mellitus, and 1.19 (95% CI: 1.08-1.32) for current smoking. After full adjustment, these estimates were numerically similar. When modeled continuously, an inverse association was observed for systolic blood pressure (hazard ratio=0.79 [95% CI: 0.68-0.92] at systolic blood pressure 160 vs 110 mm Hg) but not for diastolic blood pressure or lipid measures with VTE. An important finding from VTE subtype analyses was that cigarette smoking was associated with provoked but not unprovoked VTE. Fully adjusted hazard ratios for the associations of current smoking with provoked and unprovoked VTE were 1.36 (95% CI: 1.22-1.52) and 1.08 (95% CI: 0.90-1.29), respectively.ConclusionsExcept for the association between cigarette smoking and provoked VTE, which is potentially mediated through comorbid conditions such as cancer, the modifiable traditional cardiovascular disease risk factors are not associated with increased VTE risk. Higher systolic blood pressure showed an inverse association with VTE.

Published
2017

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

Author

Schumacher, A. E., Kyu, H. H., Antony, C. M., Aravkin, A. Y., Azhar, G. S., Bisignano, C., Burkart, K., Cercy, K. M., Chung, E., Coberly, K., Comfort, H., Cousin, E., Culbreth, G. T., Cunningham, M., Weaver, N. D., Degenhardt, L., Deitesfeld, L., Dirac, M. A., Estep, K., Feigin, V. L., Flaxman, A. D., Flor, L. S., Force, L. M., Fuller, J. E., Gakidou, E., Hay, S. I., Ikuta, K. S., Jones, D. P., Kassebaum, N. J., Kassel, M. B., Keller, C., Kinzel, K. E., Krohn, K. J., Lozano, R., May, E. A., McKowen, A. W., McLaughlin, S. A., Mehlman, M. L., Mestrovic, T., Mokdad, A. H., Mosser, J. F., Mougin, V., Naghavi, M., Nesbit, O. D., Novotney, A., Ozten, Y., Pease, S. A., Pigott, D. M., Reiner, R. C., Robinson-Oden, H. E., Shaw, D. H., Slepak, E. L. N., Sorensen, R. J. D., Verghese, N. A., Vollset, S., Vongpradith, A., Vos, T., Wang, D., Watson, S., Weaver, M. R., Wells, K. M., Wilson, S., Wool, E. E., Zheng, P., Lim, S. S., Murray, C. J. L., Boyko, E. J., Chahine, Y., Kalani, R., Krishnamoorthy, V., Khalil, I. A., Minja, N. W., Morrison, S. D., Nafukho, F. M., Olivas-Martinez, A., Orellana, E., Tram, K., Aali, A., Rahnavard, N., Ahmadzade, A., Mohammad-Pour, S., Morovatdar, N., Pourali, G., Zafari, N., Abbafati, C., Cattaruzza, M. S., Abbas, J., Phillips, M. R., Abbasgholizadeh, R., Emamverdi, M., Friedman, J., Abbasi, M. A., Daneshvar, S., Dashti, M., Ghasemzadeh, A., Mirza-Aghazadeh-Attari, M., Doshmangir, L., Ghafourifard, M., Lotfi, M., Hosseini, M., Jadidi-Niaragh, F., Kalankesh, L. R., Karimi, S., Mohammad-Alizadeh-Charandabi, S., Khalafi, M., Mirghafourvand, M., Mirinezhad, S., Heris, R. M., Mousavi, S., Kafil, H. S., Abbasian, M., Momenzadeh, K., Santos, F. C. D., Carr, S., Chi, G., Elgendy, I. Y., Feroze, A. H., Kempen, J. H., Kubeisy, C. M., Li, Z., Rohloff, P., Liu, X., Natto, Z. S., Olanipekun, T. O., Pigeolet, M., Pradhan, P. M. S., Zweck, E., Sharfaei, S., Sheikh, A., Abtahi, D., Salimi, S., Shakeri, A., Tajbakhsh, A., Aghamiri, S., Ahmadzade, M., Hashemi, M. B., Ajami, M., Asgary, S., Ghasemi, M., Hassanian-Moghaddam, H., Kolahi, A., Nikoobar, A., Heidari-Foroozan, M., Montazeri, F., Nejadghaderi, S., Rahmani, S., Ziaeefar, P., Hesami, H., Zahir, M., Jahankhani, K., Rasouli-Saravani, A., Jahanmehr, N., Kashani, H. K., Nasiri, M., Raee, P., Rezaee, M., Safi, S., Shool, S., Tabatabai, S., ElHafeez, S. A., Tantawi, M. E., Elmeligy, O. A. A., Ghazy, R. M., Talaat, I. M., Abdelmasseh, M., Sanabria, J., Abd-Elsalam, S., Abdelwahab, A., Abdollahi, M., Abolhassani, H., Rezaei, N., Saghazadeh, A., Ala, M., Noroozi, N., Bahri, R. A., Khatami, F., Ayyoubzadeh, S., Azadnajafabad, S., Keykhaei, M., Momtazmanesh, S., Mousavi, P., Behnoush, A., Farrokhpour, H., Karimi, H., Khalaji, A., Khanmohammadi, S., Mayeli, M., Mohammadi, S., Eskandarieh, S., Sahraian, M., Fahimi, S., Malekzadeh, R., Mansouri, V., Sepanlou, S. G., Ghassemi, F., Haddadi, M., Kazemian, S., Khadembashiri, M., Khamesipour, F., Khavandegar, A., Khormali, M., Salamati, P., Kompani, F., Larijani, B., Mirdamadi, N., Seyedi, S., Malazy, O. T., Mahmoudi, E., Rashedi, S., Rad, E. M., Mansournia, M., Nasab, E. M., Mohammadshahi, M., Mostafavi, H., SeyedAlinaghi, S., Shafie, M., Shahbandi, A., Vahdani, A. M., Sharifan, A., Shirkoohi, R., Sohrabi, H., Tavangar, S., Heidari-Soureshjani, R., Abdoun, M., Abdullahi, A., Awotidebe, A. W., Borodo, S. B., Gadanya, M. A., Ladan, M., Ali, M. U., Tyrovolas, S., Abdurehman, A. M., Debele, A. T., Getachew, T., Gudeta, M. D., Misgana, T., Sertsu, A., Abebe, M., Ayele, G. M., Afework, A., Lerango, T. L., Tebeje, T. M., Sibhat, M. M., Tesfaye, S. H., Abedi, A., Gholamrezanezhad, A., Salehi, S., Athari, S., Hanifi, N., Abegaz, T. M., Kifle, Z. D., Zuñiga, R. A. A., Abhilash, E. S., Abiodun, O. O., Aboagye, R. G., Amu, H., Ayanore, M. A., Dowou, R. K., Immurana, M., Klu, D., Orish, V. N., Carrero, J. J., Cederroth, C. R., Deuba, K., Laflamme, L., Fereshtehnejad, S., Kauppila, J. H., Abouzid, M., Abreu, L. G., Malta, D. C., Prates, E. J. S., Nascimento, B. R., Abrha, W. A., Weldemariam, A. H., Girmay, A., Abrigo, M. R. M., Rumeileh, S. A., Abu-Rmeileh, N. M., Aburuz, S., Ahmed, L. A., Alam, Z., Elbarazi, I., Grivna, M., Nauman, J., Khan, G., Khan, M. A., Zaki, N., Ahmad, M. M., Abu-Zaid, A., Temsah, R. M. H., Zand, R., Acuna, J. M., Gautam, P., Chowdhury, R., Adair, T., Jiang, H., Babu, A. S., Borschmann, R., Meretoja, A., Wijeratne, T., Addo, I. Y., Okeke, S. R., Dai, Z., Xu, X., Huda, M., Mitchell, P. B., Peden, A. E., Resnikoff, S., Sharma, S., Si, Y., Sitas, F., Ye, P., Adebayo, O. M., Aladelusi, T. O., Salami, A. A., Ilesanmi, O. S., Owolabi, M. O., Adegboye, O. A., Adekanmbi, V., AlBataineh, M. T., Almahmeed, W., Aden, B., Adepoju, A. V., Adetunji, C. O., Adeyeoluwa, T. E., Oyeyemi, I. T., Oyeyemi, O. T., Udoakang, A. J., Adeyomoye, O. I., Anuoluwa, I. A., Bello, O. O., Oluwafemi, Y. D., Ekundayo, T. C., Idowu, O. O., Oluwatunase, G. O., Afolabi, A. A., Ekholuenetale, M., Fagbamigbe, A. F., Olufadewa, I. I., Ibitoye, S. E., Okekunle, A. P., Adha, R., Adikusuma, W., Adibi, A., Chen, M., Hossain, M., Rasali, D. P., Pashaei, A., Adnani, Q. E. S., Postma, M. J., Adra, S., Barqawi, H. J., Dash, N. R., Halwani, R., Maghazachi, A. A., Saber-Ayad, M. M., Sharif-Askari, N. S., Ahmad, F., Saddik, B., Saleh, M. A., Alzoubi, K. H., Omar, H. A., Arumugam, A., Bustanji, Y., Elemam, N. M., Faris, M. E. M., Karim, A., Qaisar, R., Semreen, M. H., Soliman, S. S. M., Altirkawi, K. A., Afraz, A., Ilaghi, M., Nematollahi, M., Afyouni, S., Amindarolzarbi, A., Zandieh, G. G. Z., Columbus, A., Kamireddy, A., Shafaat, O., Kazemi, F., Vervoort, D., Zhang, H., Jamshidi, E., Afzal, S., Agasthi, P., Agodi, A., Barchitta, M., D'Amico, E., Maugeri, A., Veroux, M., Biondi, A., Isola, G., Vacante, M., Falzone, L., Libra, M., Agyemang-Duah, W., Nikpoor, A., Ahinkorah, B. O., Demant, D., Ahmad, A., Mustafa, G., Pathan, A. R., Tabish, M., Ahmad, D., Bagheri, N., Burns, R. A., Cherbuin, N., Ahmad, T., Ahmadi, K., Saxena, S., Beaney, T., Palladino, R., Rawaf, S., Mossialos, E., Rawaf, D. L., Ahmed, A., Siddig, E. E., Ahmed, H., Ahmed, M. B., Shiferaw, D., Ashemo, M. Y., Gerema, U., Getachew, M. E., Bayileyegn, N. S., Mohamed, A. I., Eshetie, T. C., Tiruye, T. Y., Ahmed, S., Ali, H., Bodunrin, A. O., Tumurkhuu, M., Tung, K., Ubah, C. S., Aruleba, R. T., Aji, B., Ajumobi, O., Akalu, G. T., Beyene, H. B., Deribe, K., Ijo, D., Kassaw, N. A., Akara, E., Akinosoglou, K., Akkala, S., Asaad, M., Hassan, A. M., Bleyer, A., Akyirem, S., Bell, M. L., Song, Y., Etaee, F., Goldust, M., Li, W., Pawar, S., Hamad, H. A., Sathian, B., Hasan, S. A., Homsi, A. A., Almidani, O., Göbölös, L., Qadire, M. A., AL-Ahdal, T. M. A., Chen, S., Moazen, B., Alalalmeh, S. O., Hegazi, O. E., Shahwan, M. J., Shamsi, M. A., Zyoud, S. H., Al-Aly, Z., Wang, C., Alam, K., Alam, M., Al-Amer, R. M., Naik, G. R., Alanzi, T. M., Bah, S., Menezes, R. G., Alanezi, F. M., Albashtawy, M., Aldridge, R. W., Chung, S., Hossain, S., Kim, J., Kivimäki, M., Sunkersing, D., Umar, T., Zumla, A., Alemi, S., Al-Eyadhy, A., Temsah, M., Alhabib, K. F., ElGohary, G. M. T., Meo, S. A., Al-Gheethi, A. A. S., Kiross, G. T., Alhalaiqa, F. A. N., Al-Maweri, S. A. A., Alomari, M. A., Mohammed, M., Al-Hanawi, M. K., Binmadi, N., Malik, A. A., Samargandy, S., Ali, A., Khan, I., Sawyer, S. M., Ali, B. A., Ali, R., Ali, S. S., Ali, Z., Samakkhah, S. A., Alicandro, G., Alif, S. M., Maharjan, P., Rai, P., Hasan, M., Thapa, R., Thrift, A. G., Aligol, M., Alimi, R., Aliyi, A. A., Jema, A., Al-Jumaily, A., Hankey, G. J., Kujan, O., Mansour, A., Aljunid, S. M., Al-Sabah, S. K., Al-Marwani, S., Almazan, J. U., Poddighe, D., Al-Mekhlafi, H. M., Ariffin, H., Lim, L., Bandyopadhyay, S., Basnyat, B., Maude, R. J., Bennett, D. A., Browne, A. J., Dolecek, C., Dunachie, S. J., Newton, C. R. J., Rodriguez, J. A. B., Kheirallah, K. A., Alonso, N., Bensenor, I. M., Brunoni, A. R., Castaldelli-Maia, J., Peres, M. F. P., Wang, Y., Alqahtani, J. S., Alqutaibi, A., Altaf, A., Alvi, F. J., Nargus, S., Arooj, M., Latif, M., Shahid, S., Shahid, W., Ashraf, M., Riaz, M. A., Al-Tawfiq, J. A., Alwafi, H., Rehman, F., Al-Worafi, Y. M., Aly, H., Ali, A. H., Amare, A., Gill, T. K., Yadav, L., Noubiap, J., Opio, J., Mengesha, E. W., Ameyaw, E. K., Amhare, A., Lin, S., Amin, T. T., Elhabashy, H. R., Hassan, A., Dehkordi, J. A., Kabir, H., Amiri, S., Amugsi, D. A., Wado, Y. D., Amzat, J., Bello, M. B., Shittu, A., Aruleba, I. T., Ancuceanu, R., Andrei, C., Florin, B. T., Negoi, I., Serban, D., Hostiuc, M., Hostiuc, S., Matei, C. N., Negoi, R. I., Anderlini, D., Begum, T., Kanmiki, E., Maravilla, J. C., Khan, A., Moni, M., Lalloo, R., McGrath, J. J., Veerman, L. J., Andrade, P. P., Busse, R., Mohammed, S., Andrei, T., Herteliu, C., Mirica, A., Otoiu, A., Petcu, I., Dima, A., Stefan, S., Angappan, D., Anil, A., Charan, J., Shamim, M., Singh, S., Varthya, S. B., Baskaran, P., Bhardwaj, P., Bhardwaj, N., Dixit, S. G., Krishna, H., Nayyar, A. K., Choudhary, R., Dixit, A., Misra, S., Mittal, M., Saravanan, A., Singh, M., Ram, P., Anjum, A., Antriyandarti, E., Anwar, S., Anyasodor, A. E., Appiah, S., Boampong, M. S., Aqeel, M., Arabloo, J., Eghdami, S., Panahi, P., Kabir, A., Salahi, S., Behnagh, A. K., Kasraei, H., Khodadoust, E., Latifinaibin, K., Moradi-Lakeh, M., Toroudi, H. P., Sarveazad, A., Zahedi, M., Moradi, M., Arab-Zozani, M., Ghalibaf, A. M., Rajabpour-Sanati, A., Arafat, M., Araújo, A. M., Belo, L., Carvalho, F., Costa, V. M., da Silva, D. D., Silva, J. P., Carvalho, M., Cruz-Martins, N., Freitas, A., Vieira, R. J., Pinheiro, M., Ribeiro, A., Aremu, A., Odetokun, I. A., Aripov, T., Armocida, B., Unim, B., Sabbatucci, M., Artamonov, A. A., Artanti, K. D., Efendi, F., Purnobasuki, H., Wulandari, R. D., Arulappan, J., Chavula, M. P., Edvardsson, D., Orru, H., Fattahi, H., Asika, M. O., Onwujekwe, O. E., Atout, M. M. W., Atreya, A., Attia, S., Aujayeb, A., Avan, A., Hachinski, V., Stranges, S., Bolarinwa, O. A., Ginindza, T. G., Ogunsakin, R. E., Quintanilla, B. A., Rahman, M., Ayuso-Mateos, J. L., Ortiz, A., Soriano, J. B., Catalá-López, F., Aziz, S., Azzam, A. Y., Babashahi, M., Bayati, M., Kouhanjani, M. F., Fazeli, P., Karajizadeh, M., Ghahramani, S., Sarikhani, Y., Shahabi, S., Iravanpour, F., Jafarinia, M., Oliaee, R. T., Ravangard, R., Razeghian-Jahromi, I., Roshanzamir, S., Mansoori, Y., Bakkannavar, S. M., Nayak, V. C., Holla, R., Kamath, A., Rao, M., Ligade, V. S., Rao, C. R., Shetty, R. S., Rao, I., Reshmi, B., Badar, M., Badawi, A., Bhutta, Z. A., Chattu, V., Malhotra, A. K., Mostofinejad, A., Shakil, H., Badiye, A. D., Bansal, H., Kapoor, N., Baghdadi, S., Bagherieh, S., Fatehizadeh, A., Mehrabani-Zeinabad, K., Sadeghi, M., Mirmosayyeb, O., Saber, K., Shafaat, A., Bahadorikhalili, S., Bai, J., Yu, C., Bai, R., Baker, J. L., Bako, A. T., Makram, O. M., Balakrishnan, S., Balogun, S. A., Singh, A., Tian, J., Jatau, A., Baltatu, O. C., Baltatu, O., Campos, L. A., Bam, K., Olaiya, M. T., Bhandari, D., Dalli, L. L., Banach, M., Banik, B., Banik, P. C., Barati, S., Saeedi, M., Bardhan, M., Barker-Collo, S. L., Beyene, K. A., Barone-Adesi, F., Barr, R. D., Kurmi, O. P., Mannan, F., Olagunju, A. T., Barrero, L. H., Basharat, Z., Bashir, A. I. J., Bashiru, H. A., Folayan, M. O., Bassat, Q., Basso, J. D., Silva, S., Rodrigues, M., Basu, S., Batra, K., Batra, R., Sharma, M., Baune, B. T., Bedi, N., Ghailan, K. Y., Khan, M., Halboub, E. S., Shanawaz, M., Sayeed, A., Siraj, M., Behboudi, E., Soleimani, H., Beiranvand, M., Ramirez, D. F. B., Malagón-Rojas, J. N., Belgaumi, U. I., Bello, A. K., Ebenezer, O., Eboreime, E., Umair, M., Beloukas, A., Lunevicius, R., Bendak, S., Benzian, H., Friedman, S. D., Peprah, E. K., Berezvai, Z., Berman, A. E., Bermudez, A. C., Loreche, A., Liu, S., Mohamed, M. F. H., Bettencourt, P. J. G., Bhagat, D. S., Bhagavathula, A. S., Bhala, N., Dehbandi, R., Glasbey, J. C., Bhalla, A., Marasini, B. P., Paudel, U., Poudel, L., Bhardwaj, P. V., Bhargava, A., Kahe, F., Bhaskar, S., Bhat, V., Bhatti, G. K., Kalra, S., Bhatti, J. S., Senapati, S., Bhatti, M. S., Bhatti, R., Das, J. K., Bikbov, B., Bintoro, B., Bisulli, F., Golinelli, D., Guicciardi, S., Lenzi, J., Mazzotti, A., Muccioli, L., Sanmarchi, F., Violante, F. S., Biswas, A., Dhali, A., Biswas, R., Chen, L., Driscoll, T. R., Tang, H. K., Islam, S., Kandel, H., You, Y., Leigh, J., Singh, B. B., Visontay, R., Bitaraf, S., Kaydi, N., Eini, E., Khafaie, M. A., Sadeghian, S., Bjørge, T., Dadras, O., Wojewodzic, M. W., Bodolica, V., Bonny, A., Bora, K., Basara, B. B., Francis, K. L., Kerr, J. A., Carvajal, A. B., Bouaoud, S., Ouyahia, A., Boudalia, S., Lanfranchi, F., Bragazzi, N. L., Braithwaite, D., Ding, D. D., Karanth, S. D., Naghavi, P., Brenner, H., Britton, G., Bulamu, N. B., Bulto, L. N., Foley, K. M., Jemere, D., Kaambwa, B., Mpundu-Kaambwa, C., Buonsenso, D., Villani, L., Nagaraja, S. B., Butt, Z. A., Cai, T., Calina, D., Cámera, L. A., Campos-Nonato, I. R., Denova-Gutiérrez, E., Ortega-Altamirano, D. V., Rios-Blancas, M., Pando-Robles, V., Cao, C., Cardenas, C. A., Cárdenas, R., Carreras, G., Carugno, A., Castañeda-Orjuela, C. A., Castelpietra, G., Catapano, A. L., Damiani, G., Vecchia, C. L., Caye, A., Duncan, B. B., Schmidt, M. I., Hugo, F. N., Cembranel, F., Cenderadewi, M., Emeto, T. I., Obamiro, K. O., Cerin, E., Poudel, G. R., Guo, C., Sarkar, C., Yip, P., Cevik, M., Chacón-Uscamaita, P. R., Chirinos-Caceres, J. L., Chakraborty, C., Chan, J., Chang, C., Douiri, A., Wafa, H. 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Abstract

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, ant

Published
2024
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44. Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Author

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Yiğit, Vahit, Yip, Paul, Yon, Dong Keon, Yonemoto, Naohiro, You, Yuyi, Younis, Mustafa Z, Yu, Chuanhua, Zadey, Siddhesh, Zadnik, Vesna, Zafari, Nima, Zahedi, Mohammad, Zahid, Muhammad Nauman, Zahir, Mazyar, Zakham, Fathiah, Zaki, Nazar, Zakzuk, Josefina, Zamagni, Giulia, Zaman, Burhan Abdullah, Zaman, Sojib Bin, Zamora, Nelson, Zand, Ramin, Zandi, Milad, Zandieh, Ghazal G Z, Zanghì, Aurora, Zare, Iman, Zastrozhin, Mikhail Sergeevich, Zeariya, Mohammed G M, Zeng, Youjie, Zhai, Chunxia, Zhang, Chen, Zhang, Haijun, Zhang, Hongwei, Zhang, Yunquan, Zhang, Zhaofeng, Zhang, Zhenyu, Zhao, Hanqing, Zhao, Yang, Zhao, Yong, Zheng, Peng, Zhong, Chenwen, Zhou, Juexiao, Zhu, Bin, Zhu, Zhaohua, Ziaeefar, Pardis, Zielińska, Magdalena, Zou, Zhiyong, Zumla, Alimuddin, Zweck, Elric, Zyoud, Samer H, Lim, Stephen S, and Murray, Christopher J L

Published
2024

45. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Author

Naghavi, M, Ong, K, Aali, A, Ababneh, H, Abate, Y, Abbafati, C, Abbasgholizadeh, R, Abbasian, M, Abbasi-Kangevari, M, Abbastabar, H, Abd ElHafeez, S, Abdelmasseh, M, Abd-Elsalam, S, Abdelwahab, A, Abdollahi, M, Abdollahifar, M, Abdoun, M, Abdulah, D, Abdullahi, A, Abebe, M, Abebe, S, Abedi, A, Abegaz, K, Abhilash, E, Abidi, H, Abiodun, O, Aboagye, R, Abolhassani, H, Abolmaali, M, Abouzid, M, Aboye, G, Abreu, L, Abrha, W, Abtahi, D, Abu Rumeileh, S, Abualruz, H, Abubakar, B, Abu-Gharbieh, E, Abu-Rmeileh, N, Aburuz, S, Abu-Zaid, A, Accrombessi, M, Adal, T, Adamu, A, Addo, I, Addolorato, G, Adebiyi, A, Adekanmbi, V, Adepoju, A, Adetunji, C, Adetunji, J, Adeyeoluwa, T, Adeyinka, D, Adeyomoye, O, Admass, B, Adnani, Q, Adra, S, Afolabi, A, Afzal, M, Afzal, S, Agampodi, S, Agasthi, P, Aggarwal, M, Aghamiri, S, Agide, F, Agodi, A, Agrawal, A, Agyemang-Duah, W, Ahinkorah, B, Ahmad, A, Ahmad, D, Ahmad, F, Ahmad, M, Ahmad, S, Ahmad, T, Ahmadi, K, Ahmadzade, A, Ahmed, A, Ahmed, H, Ahmed, L, Ahmed, M, Ahmed, S, Ajami, M, Aji, B, Akara, E, Akbarialiabad, H, Akinosoglou, K, Akinyemiju, T, Akkaif, M, Akyirem, S, Al Hamad, H, Al Hasan, S, Alahdab, F, Alalalmeh, S, Alalwan, T, Al-Aly, Z, Alam, K, Alam, M, Alam, N, Al-amer, R, Alanezi, F, Alanzi, T, Al-Azzam, S, Albakri, A, Albashtawy, M, Albataineh, M, Alcalde-Rabanal, J, Aldawsari, K, Aldhaleei, W, Aldridge, R, Alema, H, Alemayohu, M, Alemi, S, Alemu, Y, Al-Gheethi, A, Alhabib, K, Alhalaiqa, F, Al-Hanawi, M, Ali, A, Ali, L, Ali, M, Ali, R, Ali, S, Alicandro, G, Alif, S, Alikhani, R, Alimohamadi, Y, Aliyi, A, Aljasir, M, Aljunid, S, Alla, F, Allebeck, P, Al-Marwani, S, Al-Maweri, S, Almazan, J, Al-Mekhlafi, H, Almidani, L, Almidani, O, Alomari, M, Al-Omari, B, Alonso, J, Alqahtani, J, Alqalyoobi, S, Alqutaibi, A, Al-Sabah, S, Altaany, Z, Altaf, A, Al-Tawfiq, J, Altirkawi, K, Aluh, D, Alvis-Guzman, N, Alwafi, H, Al-Worafi, Y, Aly, H, Aly, S, Alzoubi, K, Amani, R, Amare, A, Amegbor, P, Ameyaw, E, Amin, T, Amindarolzarbi, A, Amiri, S, 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Zhi-Jiang, Zhao, Hanqing, Zhong, Chenwen, Zhou, Juexiao, Zhu, Bin, Zhu, Lei, Ziafati, Makan, Zielińska, Magdalena, Zitoun, Osama A, Zoladl, Mohammad, Zou, Zhiyong, Zuhlke, Liesl J, Zumla, Alimuddin, Zweck, Elric, Zyoud, Samer H, Wool, Eve E, and Murray, Christopher J L

Published
2024

46. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Author

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M, Claassens, M, Cogen, R, Columbus, A, Conde, J, Cortesi, P, Cousin, E, Criqui, M, Cruz-Martins, N, Dadras, O, Dai, S, Dai, X, Dai, Z, Dalaba, M, Damiani, G, Das, J, Das, S, Dashti, M, Dávila-Cervantes, C, Davletov, K, De Leo, D, Debele, A, Debopadhaya, S, Decleene, N, Deeba, F, Degenhardt, L, Del Bo', C, Delgado-Enciso, I, Demetriades, A, Denova-Gutiérrez, E, Dervenis, N, Desai, H, Desai, R, Deuba, K, Dhama, K, Dharmaratne, S, Dhingra, S, Dias da Silva, D, Diaz, D, Diaz, L, Diaz, M, Dima, A, Ding, D, Dirac, M, Do, T, do Prado, C, Dohare, S, Dominguez, R, Dong, W, Dongarwar, D, D'Oria, M, Dorsey, E, Doshmangir, L, Dowou, R, Driscoll, T, Dsouza, H, Dsouza, V, Dube, J, Dumith, S, Duncan, B, Duraes, A, Duraisamy, S, Durojaiye, O, Dzianach, P, Dziedzic, A, Eboreime, E, Ebrahimi, A, Edinur, H, Edvardsson, D, Eikemo, T, Eini, E, Ekholuenetale, M, Ekundayo, T, El Sayed, I, El Tantawi, M, Elbarazi, I, Elemam, N, Elgohary, G, Elhadi, M, Elmeligy, O, Elnahas, G, Elshaer, M, Elsohaby, I, 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Tuo, Landires, Iván, Lanfranchi, Francesco, Langguth, Berthold, Laplante-Lévesque, Ariane, Larijani, Bagher, Larsson, Anders O, Lasrado, Savita, Lauriola, Paolo, Le, Huu-Hoai, Le, Long Khanh Dao, Le, Nhi Huu Hanh, Le, Trang Diep Thanh, Leasher, Janet L, Ledda, Caterina, Lee, Munjae, Lee, Paul H, Lee, Sang-woong, Lee, Seung Won, Lee, Wei-Chen, Lee, Yo Han, LeGrand, Kate E, Lenzi, Jacopo, Leong, Elvynna, Leung, Janni, Li, Ming-Chieh, Li, Wei, Li, Xiaopan, Li, Yichong, Li, Yongze, Lim, Lee-Ling, Lim, Stephen S, Lindstrom, Megan, Linn, Shai, Liu, Gang, Liu, Runben, Liu, Shiwei, Liu, Wei, Liu, Xiaofeng, Liu, Xuefeng, Llanaj, Erand, Lo, Chun-Han, López-Bueno, Rubén, Loreche, Arianna Maever, Lorenzovici, László, Lozano, Rafael, Lubinda, Jailos, Lucchetti, Giancarlo, Lunevicius, Raimundas, Lusk, Jay B, lv, hengliang, Ma, Zheng Feei, Machairas, Nikolaos, Madureira-Carvalho, Áurea M, Magaña Gómez, Javier A, Maghazachi, Azzam A, Maharjan, Preeti, Mahasha, Phetole Walter, Maheri, Mina, Mahjoub, Soleiman, Mahmoud, Mansour Adam, Mahmoudi, Elham, Majeed, Azeem, Makris, Konstantinos Christos, Malakan Rad, Elaheh, Malhotra, Kashish, Malik, Ahmad Azam, Malik, Iram, Malta, Deborah Carvalho, Manla, Yosef, Mansour, Ali, Mansouri, Pejman, Mansournia, Mohammad Ali, Mantilla Herrera, Ana M, Mantovani, Lorenzo Giovanni, Manu, Emmanuel, Marateb, Hamid Reza, Mardi, Parham, Martinez, Gabriel, Martinez-Piedra, Ramon, Martini, Daniela, Martins-Melo, Francisco Rogerlândio, Martorell, Miquel, Marx, Wolfgang, Maryam, Sharmeen, Marzo, Roy Rillera, Mathangasinghe, Yasith, Mathieson, Stephanie, Mathioudakis, Alexander G, Mattumpuram, Jishanth, Maugeri, Andrea, Mayeli, Mahsa, Mazidi, Mohsen, Mazzotti, Antonio, McGrath, John J, McKee, Martin, McKowen, Anna Laura W, McPhail, Michael A, Mehrabani-Zeinabad, Kamran, Mehrabi Nasab, Entezar, Mekene Meto, Tesfahun, Mendoza, Walter, Menezes, Ritesh G, Mensah, George A, Mentis, Alexios-Fotios A, Meo, Sultan Ayoub, Meresa, Haftu Asmerom, Meretoja, Atte, 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Mouodi, Simin, Mrejen, Matías, Msherghi, Ahmed, Mubarik, Sumaira, Mueller, Ulrich Otto, Mulita, Francesk, Munjal, Kavita, Murillo-Zamora, Efrén, Murlimanju, BV, Mustafa, Ghulam, Muthu, Sathish, Muzaffar, Muhammad, Myung, Woojae, Nagarajan, Ahamarshan Jayaraman, Naghavi, Pirouz, Naik, Ganesh R, Nainu, Firzan, Nair, Sanjeev, Najmuldeen, Hastyar Hama Rashid, Nangia, Vinay, Naqvi, Atta Abbas, Narayana, Aparna Ichalangod, Nargus, Shumaila, Nascimento, Gustavo G, Nashwan, Abdulqadir J, Nasrollahizadeh, Ali, Nasrollahizadeh, Amir, Natto, Zuhair S, Nayak, Biswa Prakash, Nayak, Vinod C, Nduaguba, Sabina Onyinye, Negash, Hadush, Negoi, Ionut, Negoi, Ruxandra Irina, Nejadghaderi, Seyed Aria, Nesbit, Olivia D, Netsere, Henok Biresaw, Ng, Marie, Nguefack-Tsague, Georges, Ngunjiri, Josephine W, Nguyen, Dang H, Nguyen, Hien Quang, Niazi, Robina Khan, Nikolouzakis, Taxiarchis Konstantinos, Nikoobar, Ali, Nikoomanesh, Fatemeh, Nikpoor, Amin Reza, Nnaji, Chukwudi A, Nnyanzi, Lawrence Achilles, Noman, Efaq Ali, Nomura, Shuhei, Norrving, Bo, Nri-Ezedi, Chisom Adaobi, Ntaios, George, Ntsekhe, Mpiko, Nurrika, Dieta, Nzoputam, Chimezie Igwegbe, Nzoputam, Ogochukwu Janet, Oancea, Bogdan, Odetokun, Ismail A, O'Donnell, Martin James, Oguntade, Ayodipupo Sikiru, Oguta, James Odhiambo, Okati-Aliabad, Hassan, Okeke, Sylvester Reuben, Okekunle, Akinkunmi Paul, Okonji, Osaretin Christabel, Olagunju, Andrew T, Olasupo, Omotola O, Olatubi, Matthew Idowu, Oliveira, Gláucia Maria Moraes, Olufadewa, Isaac Iyinoluwa, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Omar, Hany A, Omer, Goran Latif, Omonisi, Abidemi E Emmanuel, Onie, Sandersan, Onwujekwe, Obinna E, Ordak, Michal, Orish, Verner N, Ortega-Altamirano, Doris V, Ortiz, Alberto, Ortiz-Brizuela, Edgar, Osman, Wael M S, Ostroff, Samuel M, Osuagwu, Uchechukwu Levi, Otoiu, Adrian, Otstavnov, Nikita, Otstavnov, Stanislav S, Ouyahia, Amel, Ouyang, Guoqing, Owolabi, Mayowa O, P A, Mahesh Padukudru, Padron-Monedero, Alicia, Padubidri, Jagadish Rao, Palicz, Tamás, Palladino, Claudia, Pan, Feng, Pandi-Perumal, Seithikurippu R, Pangaribuan, Helena Ullyartha, Panos, Georgios D, Panos, Leonidas D, Pantea Stoian, Anca Mihaela, Pardhan, Shahina, Parikh, Romil R, Pashaei, Ava, Pasovic, Maja, Passera, Roberto, Patel, Jay, Patel, Sangram Kishor, Patil, Shankargouda, Patoulias, Dimitrios, Patthipati, Venkata Suresh, Pawar, Shrikant, Pazoki Toroudi, Hamidreza, Pease, Spencer A, Peden, Amy E, Pedersini, Paolo, Peng, Minjin, Pensato, Umberto, Pepito, Veincent Christian Filipino, Peprah, Emmanuel K, Peprah, Prince, Perdigão, João, Pereira, Maria Odete, Perianayagam, Arokiasamy, Perico, Norberto, Pesudovs, Konrad, Petermann-Rocha, Fanny Emily, Petri, William A, Pham, Hoang Tran, Philip, Anil K, Phillips, Michael R, Pigeolet, Manon, Pigott, David M, Pillay, Julian David, Piracha, Zahra Zahid, Pirouzpanah, Saeed, Plass, Dietrich, Plotnikov, Evgenii, Poddighe, Dimitri, Polinder, Suzanne, Postma, Maarten J, Pourtaheri, Naeimeh, Prada, Sergio I, Pradhan, Pranil Man Singh, Prasad, Manya, Prates, Elton Junio Sady, Priscilla, Tina, Pritchett, Natalie, Puri, Pooja, Puvvula, Jagadeesh, Qasim, Nameer Hashim, Qattea, Ibrahim, Qazi, Asma Saleem, Qian, Gangzhen, Rabiee Rad, Mehrdad, Radhakrishnan, Raghu Anekal, Radhakrishnan, Venkatraman, Raeisi Shahraki, Hadi, Rafferty, Quinn, Raggi, Alberto, Raghav, Pankaja Raghav, Rahim, Md Jillur, Rahman, Md Mosfequr, Rahman, Mohammad Hifz Ur, Rahman, Mosiur, Rahman, Muhammad Aziz, Rahmani, Shayan, Rahmanian, Mohammad, Rahmawaty, Setyaningrum, Rajaa, Sathish, Ramadan, Mahmoud Mohammed, Ramasamy, Shakthi Kumaran, Ramasubramani, Premkumar, Ramazanu, Sheena, Rana, Kritika, Ranabhat, Chhabi Lal, Rancic, Nemanja, Rane, Amey, Rao, Chythra R, Rao, Kumuda, Rao, Mithun, Rao, Sowmya J, Rashidi, Mohammad-Mahdi, Rathnaiah Babu, Giridhara, Rauniyar, Santosh Kumar, Rawaf, David Laith, Rawaf, Salman, Razo, Christian, Reddy, Murali Mohan Rama Krishna, Redwan, Elrashdy Moustafa Mohamed, Reifels, Lennart, Reiner Jr, Robert C, Remuzzi, Giuseppe, Renzaho, Andre M N, Reshmi, Bhageerathy, Reyes, Luis Felipe, Rezaei, Nazila, Rezaei, Negar, Rezaei, Nima, Rezaei Hachesu, Peyman, Rezaeian, Mohsen, Rickard, Jennifer, Rodrigues, Célia Fortuna, Rodriguez, Jefferson Antonio Buendia, Roever, Leonardo, Ronfani, Luca, Roshandel, Gholamreza, Rotimi, Kunle, Rout, Himanshu Sekhar, Roy, Bedanta, Roy, Nitai, Roy, Priyanka, Rubagotti, Enrico, S N, Chandan, Saad, Aly M A, Saber-Ayad, Maha Mohamed, Sabour, Siamak, Sacco, Simona, Sachdev, Perminder S, Saddik, Basema, Saddler, Adam, Sadee, Bashdar Abuzed, Sadeghi, Erfan, Sadeghi, Masoumeh, Saeb, Mohammad Reza, Saeed, Umar, Safi, Sher Zaman, Sagar, Rajesh, Sagoe, Dominic, Saif, Zahra, Sajid, Mirza Rizwan, Sakshaug, Joseph W, Salam, Nasir, Salami, Afeez Abolarinwa, Salaroli, Luciane B, Saleh, Mohamed A, Salem, Marwa Rashad, Salem, Mohammed Z Y, Sallam, Malik, Samadzadeh, Sara, Samargandy, Saad, Samodra, Yoseph Leonardo, Samy, Abdallah M, Sanabria, Juan, Sanna, Francesca, Santos, Itamar S, Santric-Milicevic, Milena M, Sarasmita, Made Ary, Sarikhani, Yaser, Sarmiento-Suárez, Rodrigo, Sarode, Gargi Sachin, Sarode, Sachin C, Sarveazad, Arash, Sathian, Brijesh, Sathyanarayan, Anudeep, Satpathy, Maheswar, Sawhney, Monika, Scarmeas, Nikolaos, Schaarschmidt, Benedikt Michael, Schmidt, Maria Inês, Schneider, Ione Jayce Ceola, Schumacher, Austin E, Schwebel, David C, Schwendicke, Falk, Sedighi, Mansour, Senapati, Sabyasachi, Senthilkumaran, Subramanian, Sepanlou, Sadaf G, Sethi, Yashendra, Setoguchi, Soko, Seylani, Allen, Shadid, Jamileh, Shafie, Mahan, Shah, Humaira, Shah, Nilay S, Shah, Pritik A, Shahbandi, Ataollah, Shahid, Samiah, Shahid, Wajeehah, Shahwan, Moyad Jamal, Shaikh, Masood Ali, Shakeri, Alireza, Shalash, Ali S, Sham, Sunder, Shamim, Muhammad Aaqib, Shamshirgaran, Mohammad Ali, Shamsi, Mohammad Anas, Shanawaz, Mohd, Shankar, Abhishek, Shannawaz, Mohammed, Sharath, Medha, Sharifan, Amin, Sharifi-Rad, Javad, Sharma, Manoj, Sharma, Rajesh, Sharma, Saurab, Sharma, Ujjawal, Sharma, Vishal, Shastry, Rajesh P, Shavandi, Amin, Shayan, Amir Mehdi, Shayan, Maryam, Shehabeldine, Amr Mohamed Elsayed, Shetty, Pavanchand H, Shibuya, Kenji, Shifa, Jemal Ebrahim, Shiferaw, Desalegn, Shiferaw, Wondimeneh Shibabaw, Shigematsu, Mika, Shiri, Rahman, Shitaye, Nebiyu Aniley, Shittu, Aminu, Shivakumar, K M, Shivarov, Velizar, Shokati Eshkiki, Zahra, Shool, Sina, Shrestha, Sunil, Shuval, Kerem, Sibhat, Migbar Mekonnen, Siddig, Emmanuel Edwar, Sigfusdottir, Inga Dora, Silva, Diego Augusto Santos, Silva, João Pedro, Silva, Luís Manuel Lopes Rodrigues, Silva, Soraia, Simpson, Colin R, Singal, Anjali, Singh, Abhinav, Singh, Balbir Bagicha, Singh, Harmanjit, Singh, Jasvinder A, Singh, Mahendra, Singh, Paramdeep, Skou, Søren T, Sleet, David A, Slepak, Erica Leigh N, Solanki, Ranjan, Soliman, Sameh S M, Song, Suhang, Song, Yimeng, Sorensen, Reed J D, Soriano, Joan B, Soyiri, Ireneous N, Spartalis, Michael, Sreeramareddy, Chandrashekhar T, Stark, Benjamin A, Starodubova, Antonina V, Stein, Caroline, Stein, Dan J, Steiner, Caitlyn, Steiner, Timothy J, Steinmetz, Jaimie D, Steiropoulos, Paschalis, Stockfelt, Leo, Stokes, Mark A, Subedi, Narayan Subedi, Subramaniyan, Vetriselvan, Suemoto, Claudia Kimie, Suleman, Muhammad, Suliankatchi Abdulkader, Rizwan, Sultana, Abida, Sundström, Johan, Swain, Chandan Kumar, Szarpak, Lukasz, Tabaee Damavandi, Payam, Tabarés-Seisdedos, Rafael, Tabatabaei Malazy, Ozra, Tabatabaeizadeh, Seyed-Amir, Tabatabai, Shima, Tabche, Celine, Tabish, Mohammad, Tadakamadla, Santosh Kumar, Taheri Abkenar, Yasaman, Taheri Soodejani, Moslem, Taherkhani, Amir, Taiba, Jabeen, Talaat, Iman M, Talukder, Ashis, Tampa, Mircea, Tamuzi, Jacques Lukenze, Tan, Ker-Kan, Tandukar, Sarmila, Tang, Haosu, Tavakoli Oliaee, Razieh, Tavangar, Seyed Mohammad, Teimoori, Mojtaba, Temsah, Mohamad-Hani, Teramoto, Masayuki, Thangaraju, Pugazhenthan, Thankappan, Kavumpurathu Raman, Thapar, Rekha, Thayakaran, Rasiah, Thirunavukkarasu, Sathish, Thomas, Nihal, Thomas, Nikhil Kenny, Thum, Chern Choong Chern, Tichopad, Ales, Ticoalu, Jansje Henny Vera, Tillawi, Tala, Tiruye, Tenaw Yimer, Tobe-Gai, Ruoyan, Tonelli, Marcello, Topor-Madry, Roman, Torre, Anna E, Touvier, Mathilde, Tovani-Palone, Marcos Roberto, Tran, Jasmine T, Tran, Mai Thi Ngoc, Tran, Nghia Minh, Tran, Ngoc-Ha, Trico, Domenico, Tromans, Samuel Joseph, Truyen, Thien Tan Tri Tai, Tsatsakis, Aristidis, Tsegay, Guesh Mebrahtom, Tsermpini, Evangelia Eirini, Tumurkhuu, Munkhtuya, Tyrovolas, Stefanos, Udoh, Arit, Umair, Muhammad, Umakanthan, Srikanth, Umar, Tungki Pratama, Undurraga, Eduardo A, Unim, Brigid, Unnikrishnan, Bhaskaran, Unsworth, Carolyn Anne, Upadhyay, Era, Urso, Daniele, Usman, Jibrin Sammani, Vahabi, Seyed Mohammad, Vaithinathan, Asokan Govindaraj, Van den Eynde, Jef, Varga, Orsolya, Varma, Ravi Prasad, Vart, Priya, Vasankari, Tommi Juhani, Vasic, Milena, Vaziri, Siavash, Vellingiri, Balachandar, Venketasubramanian, Narayanaswamy, Veroux, Massimiliano, Verras, Georgios-Ioannis, Vervoort, Dominique, Villafañe, Jorge Hugo, Violante, Francesco S, Vlassov, Vasily, Vollset, Stein Emil, Volovat, Simona Ruxandra, Vongpradith, Avina, Waheed, Yasir, Wang, Cong, Wang, Fang, Wang, Ning, Wang, Shu, Wang, Yanzhong, Wang, Yuan-Pang, Ward, Paul, Wassie, Emebet Gashaw, Weaver, Marcia R, Weerakoon, Kosala Gayan, Weintraub, Robert G, Weiss, Daniel J, Weldemariam, Abrha Hailay, Wells, Katherine M, Wen, Yi Feng, Whisnant, Joanna L, Whiteford, Harvey A, Wiangkham, Taweewat, Wickramasinghe, Dakshitha Praneeth, Wickramasinghe, Nuwan Darshana, Wilandika, Angga, Wilkerson, Caroline, Willeit, Peter, Wimo, Anders, Woldegebreal, Demewoz H, Wolf, Axel Walter, Wong, Yen Jun, Woolf, Anthony D, Wu, Chenkai, Wu, Felicia, Wu, Xinsheng, Wu, Zenghong, Wulf Hanson, Sarah, Xia, Yanjie, Xiao, Hong, Xu, Xiaoyue, Xu, Yvonne Yiru, Yadav, Lalit, Yadollahpour, Ali, Yaghoubi, Sajad, Yamagishi, Kazumasa, Yang, Lin, Yano, Yuichiro, Yao, Yao, Yaribeygi, Habib, Yazdanpanah, Mohammad Hosein, Ye, Pengpeng, Yehualashet, Sisay Shewasinad, Yesuf, Subah Abderehim, Yezli, Saber, Yiğit, Arzu, Yiğit, Vahit, Yigzaw, Zeamanuel Anteneh, Yismaw, Yazachew, Yon, Dong Keon, Yonemoto, Naohiro, Younis, Mustafa Z, Yu, Chuanhua, Yu, Yong, Yusuf, Hadiza, Zahid, Mondal Hasan, Zakham, Fathiah, Zaki, Leila, Zaki, Nazar, Zaman, Burhan Abdullah, Zamora, Nelson, Zand, Ramin, Zandieh, Ghazal G Z, Zar, Heather J, Zarrintan, Armin, Zastrozhin, Mikhail Sergeevich, Zhang, Haijun, Zhang, Ning, Zhang, Yunquan, Zhao, Hanqing, Zhong, Chenwen, Zhong, Panliang, Zhou, Juexiao, Zhu, Zhaohua, Ziafati, Makan, Zielińska, Magdalena, Zimsen, Stephanie R M, Zoladl, Mohammad, Zumla, Alimuddin, Zyoud, Samer H, Vos, Theo, and Murray, Christopher J L

Abstract

Background: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. Methods: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause.

Published
2024

47. Maternal mortality decline in Zimbabwe, 2007/2008 to 2018/2019: findings from mortality surveys using civil registration, vital statistics and health system data

Author

Jenny Cresswell, Robert Pattinson, Gwendoline Kandawasvika, Aveneni Mangombe, Bernard Madzima, Thulani Magwali, Stephen Munjanja, Gwendoline Chimhini, Lennarth Nyström, Agnes Mahomva, Reuben Musarandega, Davidzoyashe Makosa, Rhoderick Machekano, Solwayo Ngwenya, Maxwell Chirehwa, Eunice Tahuringana, Margaret Nyandoro, Esther Ngaru, Tsitsi Magure, Nhamo Gona, Vongai Dondo, Ronald Mataya, Bothwell Guzha, Jonathan Kasule, Taurai Gunguwo, Sarah Manyame, Julius Chirengwa, Velda Mushangwe, Michael Nyakura, Gerald Madziyire, Sunhurai Mukwambo, McMillan Parirenyatwa, Lucia Gondongwe, Chipo Chimamise, Winston Chirombe, Grace Chaora, Enesia Ziki, Mercy Gaza, Chipo Gwanzura, Admire Chikutiro, Rumbidzai Makoni, and Grant Murewanhema

Subjects
Medicine (General), R5-920, Infectious and parasitic diseases, RC109-216
Abstract

Background Sustainable Development Goal (SDG) 3.1 target is to reduce the global maternal mortality ratio (MMR) to less than 70 maternal deaths per 100 000 live births by 2030. In the Ending Preventable Maternal Mortality strategy, a supplementary target was added, that no country has an MMR above 140 by 2030. We conducted two cross-sectional reproductive age mortality surveys to analyse changes in Zimbabwe’s MMR between 2007–2008 and 2018–2019 towards the SDG target.Methods We collected data from civil registration, vital statistics and medical records on deaths of women of reproductive ages (WRAs), including maternal deaths from 11 districts, randomly selected from each province (n=10) using cluster sampling. We calculated weighted mortality rates and MMRs using negative binomial models, with 95% CIs, performed a one-way analysis of variance of the MMRs and calculated the annual average reduction rate (ARR) for the MMR.Results In 2007–2008 we identified 6188 deaths of WRAs, 325 pregnancy-related deaths and 296 maternal deaths, and in 2018–2019, 1856, 137 and 130, respectively. The reproductive age mortality rate, weighted by district, declined from 11 to 3 deaths per 1000 women. The MMR (95% CI) declined from 657 (485 to 829) to 217 (164 to 269) deaths per 100 000 live births at an annual ARR of 10.1%.Conclusions Zimbabwe’s MMR declined by an annual ARR of 10.1%, against a target of 10.2%, alongside declining reproductive age mortality. Zimbabwe should continue scaling up interventions against direct maternal mortality causes to achieve the SDG 3.1 target by 2030.

Published
2022
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48. Hypervariable-Locus Melting Typing: a Novel Approach for More Effective High-Resolution Melting-Based Typing, Suitable for Large Microbiological Surveillance Programs

Author

Matteo Perini, Aurora Piazza, Simona Panelli, Stella Papaleo, Alessandro Alvaro, Francesca Vailati, Marta Corbella, Francesca Saluzzo, Floriana Gona, Daniele Castelli, Claudio Farina, Piero Marone, Daniela Maria Cirillo, Annalisa Cavallero, Gian Vincenzo Zuccotti, and Francesco Comandatore

Subjects
microbiological surveillance, high-resolution melting, outbreak reconstruction, low- and middle-income countries, real-time surveillance, Microbiology, QR1-502
Abstract

ABSTRACT Pathogen typing is pivotal to detecting the emergence of high-risk clones in hospital settings and to limit their spread. Unfortunately, the most commonly used typing methods (i.e., pulsed-field gel electrophoresis [PFGE], multilocus sequence typing [MLST], and whole-genome sequencing [WGS]) are expensive or time-consuming, limiting their application to real-time surveillance. High-resolution melting (HRM) can be applied to perform cost-effective and fast pathogen typing, but developing highly discriminatory protocols is challenging. Here, we present hypervariable-locus melting typing (HLMT), a novel approach to HRM-based typing that enables the development of more effective and portable typing protocols. HLMT types the strains by assigning them to melting types (MTs) on the basis of a reference data set (HLMT-assignment) and/or by clustering them using melting temperatures (HLMT-clustering). We applied the HLMT protocol developed on the capsular gene wzi for Klebsiella pneumoniae on 134 strains collected during surveillance programs in four hospitals. Then, we compared the HLMT results to those obtained using wzi, MLST, WGS, and PFGE typing. HLMT distinguished most of the K. pneumoniae high-risk clones with a sensitivity comparable to that of PFGE and MLST+wzi. It also drew surveillance epidemiological curves comparable to those obtained using MLST+wzi, PFGE, and WGS typing. Furthermore, the results obtained using HLMT-assignment were consistent with those of wzi typing for 95% of the typed strains, with a Jaccard index value of 0.9. HLMT is a fast and scalable approach for pathogen typing, suitable for real-time hospital microbiological surveillance. HLMT is also inexpensive, and thus, it is applicable for infection control programs in low- and middle-income countries. IMPORTANCE In this work, we describe hypervariable-locus melting typing (HLMT), a novel fast approach to pathogen typing using the high-resolution melting (HRM) assay. The method includes a novel approach for gene target selection, primer design, and HRM data analysis. We successfully applied this method to distinguish the high-risk clones of Klebsiella pneumoniae, one of the most important nosocomial pathogens worldwide. We also compared HLMT to typing using WGS, the capsular gene wzi, MLST, and PFGE. Our results show that HLMT is a typing method suitable for real-time epidemiological investigation. The application of HLMT to hospital microbiology surveillance can help to rapidly detect outbreak emergence, improving the effectiveness of infection control strategies.

Published
2022
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50. Characteristics and Clinical Implications of Carbapenemase-Producing Klebsiella pneumoniae Colonization and Infection, Italy

Author

Marianna Rossi, Liliane Chatenoud, Floriana Gona, Isabella Sala, Giovanni Nattino, Alessia D'Antonio, Daniele Castelli, Teresa Itri, Paola Morelli, Sara Bigoni, Chiara Aldieri, Roberto Martegani, Paolo A. Grossi, Cecilia Del Curto, Stefania Piconi, Sara G. Rimoldi, Paola Brambilla, Paolo Bonfanti, Evelyn Van Hauwermeiren, Massimo Puoti, Gianni Gattuso, Chiara Cerri, Mario C. Raviglione, Daniela M. Cirillo, Alessandra Bandera, and Andrea Gori

Subjects
Klebsiella pneumoniae, Carbapenem resistance, KPC-Kp, Enterobacteriaceae, CRE, antimicrobial resistance, Medicine, Infectious and parasitic diseases, RC109-216
Abstract

Klebsiella pneumoniae carbapenemase–producing K. pneumoniae (KPC-Kp) has been endemic in Italy since 2013. In a multicenter cohort study, we investigated various aspects of KPC-Kp among patients, including 15-day mortality rates and delays in adequate therapy. Most (77%) KPC-Kp strains were sequence type (ST) ST512 or ST307. During 2017, KPC-Kp prevalence was 3.26 cases/1,000 hospitalized patients. Cumulative incidence of KPC-Kp acquired >48 hours after hospital admission was 0.68% but varied widely between centers. Among patients with mild infections and noninfected colonized patients, 15-day mortality rates were comparable, but rates were much higher among patients with severe infections. Delays of >4 days in receiving adequate therapy more frequently occurred among patients with mild infections than those with severe infections, and delays were less common for patients with known previous KPC-Kp colonization. Italy urgently needs a concerted surveillance system to control the spread of KPC-Kp.

Published
2021
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