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1. COVID-19 vaccine uptake in individuals with functional difficulty, disability, and comorbid conditions: insights from a national survey in Bangladesh

Author

Shimlin Jahan Khanam, Md. Shohel Rana, M. Mofizul Islam, and Md. Nuruzzaman Khan

Subjects
COVID-19 vaccine, Functional difficulty, Disability, Comorbidity, Bangladesh, Public aspects of medicine, RA1-1270
Abstract

Abstract Background COVID-19 vaccine uptake among individuals with disabilities is crucial for safeguarding their health and well-being. However, the extent of vaccine uptake among this group remains largely unknown in low- and middle-income countries. This study aims to assess the COVID-19 vaccine uptake among persons with functional difficulty, disability and/or comorbidity in Bangladesh and their associated factors. Methods Data from 9,370 respondents extracted from the 2021 National Household Survey on Persons with Disability were analysed. The outcome variable was the uptake of at least one dose of the COVID-19 vaccine (yes, no). Key explanatory variables included the presence of disability (yes, no), comorbidity (yes, no), and both comorbidity and disability (yes, no) among persons with functional difficulty. The relationship between the outcome and explanatory variables was determined using mixed-effects multilevel logistic regressions adjusted for covariates. Results The overall uptake of at least one dose of the COVID-19 vaccine among persons with functional difficulty was 57.37%, among persons with functional difficulty and disability was 48.63% and among persons with functional difficulty and single (57.85%) or multi-comorbidity (60.37%). Compared to the respondents with functional difficulty only, the adjusted odds ratio (aOR) of not receiving any dose of the COVID-19 vaccine for individuals with both functional difficulty and disability was 1.37 (95% CI, 1.22–1.53), and for individuals with functional difficulty, disability and one or more comorbid conditions was 1.30 (95% CI, 1.15–1.47). The aOR of receiving at least one dose of the COVID-19 vaccine among individuals with functional difficulty and one or more comorbid conditions was significantly higher than among those with functional difficulty only. Conclusion In Bangladesh, COVID-19 vaccine uptake was relatively low among individuals with disabilities. The existing COVID-19 vaccine rollout programs and similar future programs should prioritise individuals with disabilities and include targeted strategies to reach them.

Published
2024
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2. Effective tobacco control measures in Bangladesh require a whole-of-government approach

Author

M. Mofizul Islam

Subjects
Tobacco control, whole-of-government approach, public health policy, policy, implementation, Bangladesh, Political science, Social Sciences
Abstract

AbstractIn many low- and middle-income countries, the implementation of tobacco control measures is disorganized, and the activities of the various departments involved are often inadequately aligned with policy aims. This paper discusses some fragmented and conflicting approaches to tobacco control measures in Bangladesh, and how these can undermine public health interventions. The paper argues in favor of a whole-of-government approach. The Framework Convention on Tobacco Control (FCTC) created an unprecedented opportunity to reduce the use of tobacco substantially. While tobacco use declined in most countries that had signed the FCTC, including Bangladesh, the fragmented approach of various government departments and organizations in the country is hindering the proper implementation of tobacco control measures. There is tension between groups that focus on economic development, livelihood, and public health. There is also considerable uncertainty among government officials and an inadequate focus on several crucial aspects such as tobacco cessation services. However, in this rapidly developing country, where there are serious concerns around developing the economy and reducing poverty, it is challenging to separate tobacco control efforts from the promises of employment and tax revenues from tobacco industries. Indeed, this may well overshadow the tobacco control measures. It is necessary, then, to consider the complexity of this issue in Bangladesh by looking at the entire system and to adopt a whole-of-government approach to address the opposing forces. As an FCTC signatory, Bangladesh is obligated to implement tobacco control measures. However, it may not be possible to do this properly without a whole-of-government approach.

Published
2024
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3. Spatial pattern and influential factors for early marriage: evidence from Bangladesh Demographic Health Survey 2017-18 data

Author

Md Arif Billah, Md. Mostaured Ali Khan, Syed Manzoor Ahmed Hanifi, M. Mofizul Islam, and Md. Nuruzzaman Khan

Subjects
Early marriage, Spatial analysis, Influential factors, Multi-level modelling, Bangladesh, Gynecology and obstetrics, RG1-991, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Early marriage is highly prevalent in Bangladesh. It is linked with a range of adverse outcomes, including maternal and child mortality. However, research on regional variations and factors associated with early marriage is scarce in Bangladesh. This study aimed to explore the geographical variations and predictors of early marriage in Bangladesh. Methods Data of women aged 20–24 in the Bangladesh Demographic and Health Survey 2017–18 were analysed. The occurrence of early marriage was the outcome variable. Explanatory variables were several individual-, household- and community-level factors. Geographical hot spots and cold spots of early marriage were first determined using Global Moran’s I statistic. Multilevel mixed-effect Poisson regression was used to determine the association of early marriage with individual-, household-, and community-level factors. Results Almost 59% of women aged 20–24 reported they were married before reached 18. The hotspots of early marriage were mainly concentrated in Rajshahi, Rangpur and Barishal, and the cold spots were in Sylhet and Chattogram divisions. The prevalence of early marriage was lower among higher educated (adjusted prevalence ratio (aPR): 0.45; 95% CI: 0.40, 0.52), and non-Muslim women (aPR: 0.89; 95% CI: 0.79, 0.99) than their counterparts. Higher community-level poverty was significantly associated with early marriage (aPR, 1.16; 95% CI: 1.04, 1.29). Conclusion The study concludes that promoting girls’ education, awareness-building programs about the adverse effects of early marriage and proper application of the child marriage restraint act, particularly in disadvantaged communities are recommended.

Published
2023
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4. Child marriage, marital disruption, and marriage thereafter: evidence from a national survey

Author

M. Mofizul Islam

Subjects
Marriage, Divorce, Remarriage, Child marriage, Age at first marriage, Multiple Indicator Cluster Survey, Gynecology and obstetrics, RG1-991, Public aspects of medicine, RA1-1270
Abstract

Abstract Background This study examines the relationship between women’s ages at their first marriages and the marital disruption among those who experienced child marriages and those who did not as well as identifies some compromises that women make in their remarriages after previous marital disruptions. Methods The data of 57,476 women from the 2019 Bangladesh Multiple Indicator Cluster Survey were analysed using multivariable logistic and linear regressions. Women’s compromises in their remarriages were examined by determining the age differences with their current husbands, whether the current husband has another wife and their attitudes toward the justification of intimate partner violence by husbands. Results Almost 65% of women experienced child marriage, and its prevalence is higher in rural (66.5%) than in urban areas (59.2%). The probability of marital disruptions decreases as the ages at the first marriages rise among women who experienced child marriages and increase among women who did not. Women living in rural areas are less likely than those living in urban areas to report marital dissolution (AOR 0.81, 95% CI 0.73–0.90). Also, women who completed relatively more years of education or have greater wealth are less likely to report marital disruptions and those who never gave birth are more likely to report these (AOR 3.54, 95% CI 3.14–3.99). Women who remarried after previous disruptions are more likely to report that their new husbands are, on average, almost 12 years older than they are, and have another wife. Also, those who experienced marital disruptions are more likely than others to believe that husbands are justified in beating their wives in certain circumstances. Conclusion The odd of marital disruption decreases with the ages at first marriage among women who experienced child marriage and increase among women who did not. There is a curvilinear relationship between women’s ages at their first marriages and the probability of marital disruptions. Making compromises in remarriages after disruptions is common. Because marital disruption is increasing, appropriate policies are needed to address the adverse outcomes of divorces that ensue.

Published
2022
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5. Availability and readiness of healthcare facilities and their effects on long-acting modern contraceptive use in Bangladesh: analysis of linked data

Author

Md Nuruzzaman Khan, Shahinoor Akter, and M. Mofizul Islam

Subjects
Modern contraceptives use, contraception, linked data, health facility data, multilevel regression, Bangladesh, Public aspects of medicine, RA1-1270
Abstract

Abstract Aim Increasing access to long-acting modern contraceptives (LMAC) is one of the key factors in preventing unintended pregnancy and protecting women’s health rights. However, the availability and accessibility of health facilities and their impacts on LAMC utilisation (implant, intrauterine devices, sterilisation) in low- and middle-income countries is an understudied topic. This study aimed to examine the association between the availability and readiness of health facilities and the use of LAMC in Bangladesh. Methods In this survey study, we linked the 2017/18 Bangladesh Demographic and Health Survey data with the 2017 Bangladesh Health Facility Survey data using the administrative-boundary linkage method. Mixed-effect multilevel logistic regressions were conducted. The sample comprised 10,938 married women of 15–49 years age range who were fertile but did not desire a child within 2 years of the date of survey. The outcome variable was the current use of LAMC (yes, no), and the explanatory variables were health facility-, individual-, household- and community-level factors. Results Nearly 34% of participants used LAMCs with significant variations across areas in Bangladesh. The average scores of the health facility management and health facility infrastructure were 0.79 and 0.83, respectively. Of the facilities where LAMCs were available, 69% of them were functional and ready to provide LAMCs to the respondents. The increase in scores for the management (adjusted odds ratio (aOR), 1.59; 95% CI, 1.21–2.42) and infrastructure (aOR, 1.44; 95% CI, 1.01–1.69) of health facilities was positively associated with the overall uptake of LAMC. For per unit increase in the availability and readiness scores to provide LAMC at the nearest health facilities, the aORs for women to report using LAMC were 2.16 (95% CI, 1.18–3.21) and 1.74 (95% CI, 1.15–3.20), respectively. A nearly 27% decline in the likelihood of LAMC uptake was observed for every kilometre increase in the average regional-level distance between women’s homes and the nearest health facilities. Conclusion The proximity of health facilities and their improved management, infrastructure, and readiness to provide LAMCs to women significantly increase their uptake. Policies and programs should prioritise improving health facility readiness to increase LAMC uptake.

Published
2022
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6. Women’s experience of unintended pregnancy and changes in contraceptive methods: evidence from a nationally representative survey

Author

Md Nuruzzaman Khan and M. Mofizul Islam

Subjects
Unintended pregnancy, Contraceptive, Mistimed pregnancy, Switching patterns of contraception, Bangladesh, Gynecology and obstetrics, RG1-991
Abstract

Plain Language summary Unintended pregnancy is considered a public health challenge in low- and middle-income countries (LMICs). Around 89% of the global occurrences of unintended pregnancies occur in LMICs. In absolute numbers, this is equivalent to nearly 88 million pregnancies. Adverse pregnancy consequences, including bleeding, haemorrhage and maternal mortality are common in this group. The adverse consequences are even higher among women facing unintended pregnancies more than once, i.e., repeat unintended pregnancies, which represent around half of the total occurrences of unintended pregnancies in LMICs. Ensuring proper access to effective contraceptives following birth is key to reducing repeat unintended pregnancies and associated adverse consequences. It is critical to know the patterns of women’s pre-pregnancy contraceptive methods use and whether experiences of unintended pregnancies affect their contraceptive methods uptake and their types. However, this data is completely lacking in the context of LMICs. Using nationally representative survey data from Bangladesh, we examined women’s contraceptive switching patterns from before to after pregnancy and their association with pregnancy types. We found increased likelihood of no change in contraceptive using pattern or switching to less effective contraceptives among women after they experienced mistimed pregnancy compared to those whose pregnancy was wanted. This pattern increases the risk of repeat unintended pregnancies in Bangladesh and associated adverse consequences, including maternal and child morbidity and mortality.

Published
2022
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7. Pattern of contraceptive use among reproductive-aged women with diabetes and/or hypertension: findings from Bangladesh Demographic and Health Survey

Author

Md Nuruzzaman Khan, M. Mofizul Islam, and Rakibul M. Islam

Subjects
Diabetes, Hypertension, Contraception, Bangladesh, Gynecology and obstetrics, RG1-991, Public aspects of medicine, RA1-1270
Abstract

Abstract Background The prevalence of chronic conditions such as diabetes and hypertension is increasing among reproductive-aged women in Bangladesh. However, the pattern of contraceptive use among this population remains unknown. We, therefore, explored the pattern of contraceptive use among reproductive-aged women with diabetes and/or hypertension in Bangladesh. Methods We extracted and analysed data of 3,947 women from the 2017/18 Bangladesh Demographic and Health Survey. Women’s pattern of contraceptive use was our outcome variable. We first classified the contraceptive using status as no method use, traditional method use (periodic abstinence, withdrawal, other traditional) and modern method use (pill, intra-uterine device, injections, male condom, female sterilization, male sterilization). We later classified these as (i) no contraceptive use vs any contraceptive use, (ii) traditional method or no use vs modern method use, (iii) traditional method vs modern method use. The explanatory variables were diagnosis of diabetes only, hypertension only or both diabetes and hypertension. The multilevel Poisson regression with robust variance was used to explore the associations. Results The overall prevalence of contraceptive use was 68.0% (95% CI 66.3–69.7). The corresponding prevalences were 69.4% (95% CI 61.8–76.1) in women with diabetes only, 67.3% (95% CI 63.5–70.9) with hypertension only, and 62.0% (95% CI 52.8–70.4) in women having both diabetes and hypertension. The prevalence of modern methods of contraceptive use was lower (46.4%, 95% CI 37.4–55.6) and traditional methods use was higher (16.6%, 95% CI 13.8–16.8) in women who had both diabetes and hypertension than in women who did not have these conditions. The fully adjusted regression model showed that the prevalence of traditional method use was 31% (Prevalence ratio: 1.31, 95% CI 1.02–2.01) higher in women having both diabetes and hypertension compared with their counterparts who had none of these conditions. Conclusion In Bangladesh, women with both diabetes and hypertension were more likely to use traditional contraception methods. These women are likely to experience increased risks of unwanted pregnancies and associated adverse maternal and child health outcomes. Targeted policies and programs should be undertaken to promote modern contraceptive use among women living with both chronic conditions.

Published
2022
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9. GP awareness, practice, knowledge and confidence: evaluation of the first nation-wide dementia-focused continuing medical education program in Australia

Author

Anne-Nicole Casey, M. Mofizul Islam, Heike Schütze, Anne Parkinson, Laurann Yen, Allan Shell, Margaret Winbolt, and Henry Brodaty

Subjects
Alzheimer’s disease, Dementia, Dementia care, Applied knowledge translation, Timely diagnosis, Continuing professional development, Medicine (General), R5-920
Abstract

Abstract Background Dementia is under-diagnosed in primary care. Timely diagnosis and care management improve outcomes for patients and caregivers. This research evaluated the effectiveness of a nationwide Continuing Medical Education (CME) program to enhance dementia-related awareness, practice, knowledge and confidence of general practitioners (GPs) in Australia. Methods Data were collected from self-report surveys by GPs who participated in an accredited CME program face-to-face or online; program evaluations from GPs; and process evaluations from workshop facilitators. CME participants completed surveys at one or more time-points (pre-, post-program, six to 9 months follow-up) between 2015 and 2017. Paired samples t-test was used to determine difference in mean outcome scores (self-reported change in awareness, knowledge, confidence, practice) between time-points. Multivariable regression analyses were used to investigate associations between respondent characteristics and key variables. Qualitative feedback was analysed thematically. Results Of 1352 GPs who completed a survey at one or more time-points (pre: 1303; post: 1017; follow-up: 138), mean scores increased between pre-CME and post-program for awareness (M post-pre = 0.9, p 90%) rated the training as relevant to their practice. These participants, and facilitators who completed process evaluations, suggested adding more content addressing patient capacity and legal issues, locality-specific specialist and support services, case studies and videos to illustrate concepts. Conclusions The sustainability of change in key elements relating to health professionals’ dementia awareness, knowledge and confidence indicated that dementia CME programs may contribute to improving capacity to provide timely dementia diagnosis and management in general practice. Low follow-up response rates warrant cautious interpretation of results. Dementia CME should be adopted in other contexts and updated as more research becomes available.

Published
2020
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10. Prevalence and risk factors of short birth interval in Bangladesh: Evidence from the linked data of population and health facility survey

Author

Mohammad Zahidul Islam, M. Mofizul Islam, Md. Mostafizur Rahman, and Md. Nuruzzaman Khan

Subjects
Public aspects of medicine, RA1-1270
Abstract

The Sustainable Development Goals 3 targets significant reductions in maternal and under-five deaths by 2030. The prevalence of these deaths is significantly associated with short birth intervals (SBI). Identification of factors associated with SBI is pivotal for intervening with appropriate programmes to reduce occurrence of SBI and associated adverse consequences. This study aimed to determine the factors associated with SBI in Bangladesh. A total of 5,941 women included in the 2017/18 Bangladesh Demographic and Health Survey 2017/18 and 1,524 healthcare facilities included in the 2017 Bangladesh Health Facility were linked and analysed. The sample was selected based on the availability of the birth interval data between the two most recent subsequent live birth. SBI was defined as an interval between consecutive births of 33 months or less, as recommended by the World Health Organization and was the outcome variable. Several individual-, households-, and community-level factors were considered as exposure variables. We used descriptive statistics to summarise respondents’ characteristics and multilevel Poisson regression to assess the association between the outcome variable with exposure variables. Around 26% of live births occurred in short intervals, with a further higher prevalence among younger, uneducated, or rural women. The likelihoods of SBI were lower among women aged 20–34 years (PR, 0.14; 95% CI, 0.11–0.17) and ≥35 years (PR, 0.03; 95% CI, 0.02–0.05) as compared to the women aged 19 years or less. Women from households with the richest wealth quintile experienced lower odds of SBI (PR, 0.61; 95% CI, 0.45–0.85) compared to those from the poorest wealth quintile. The prevalences of SBI were higher among women whose second most recent child died (PR, 5.23; 95% CI, 4.18–6.55), those who were living in Chattogram (PR, 1.52; 95% CI, 1.12–2.07) or Sylhet (PR, 2.83, 95% CI, 2.08–3.86) divisions. Availability of modern contraceptives at the nearest healthcare facilities was 66% protective to the occurrence of SBI (PR, 0.34; 95% CI, 0.22–0.78). Also, the prevalence of SBI increased around 85% (PR, 1.85; 95% CI, 1.33–2.18) for every kilometer increase in the distance of nearby health facilities from women’s homes. Targeted and tailored regional policies and programmes are needed to increase the awareness of SBI and associated adverse health outcomes and availability of modern contraception in the healthcare facilities.

Published
2022

11. Holistic primary health care for Aboriginal and Torres Strait Islander prisoners: exploring the role of Aboriginal Community Controlled Health Organisations

Author

Simon Pettit, Paul Simpson, Jocelyn Jones, Megan Williams, M. Mofizul Islam, Anne Parkinson, Bianca Calabria, and Tony Butler

Subjects
Indigenous, prisoners, health care, Aboriginal and Torres Strait Islander Community Controlled Health Organisations, Aboriginal Medical Services, Public aspects of medicine, RA1-1270
Abstract

Abstract Objective: Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ACCHOs) have been identified as having an important role in improving the health and wellbeing of individuals in prison; however, a lack of information exists on how to strengthen this role. This paper explores the experiences of ACCHO staff in primary health care to individuals inside or leaving prison. Methods: Nineteen staff from four ACCHOs were interviewed. ACCHO selection was informed by proximity to prisons, town size and/or Local Government Area offending rates. Thematic analysis of the interviews was undertaken. Results: While most ACCHOs had delivered post‐release programs, primary health care delivery to prisoners was limited. Three themes emerged: i) a lack of access to prisoners; ii) limited funding to provide services to prisoners; and iii) the need for a team approach to primary health care delivery. Conclusion: A holistic model of care underpinned by a reliable funding model (including access to certain Medicare items) and consistent access to prisoners could strengthen ACCHOs’ role in primary health care delivery to people inside or leaving prison. Implications for public health: ACCHOs have an important role to play in the delivery of primary health care to prisoners. Existing models of care for prisoners should be examined to explore how this can occur.

Published
2019
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12. Attitudes to and experiences of intimate partner violence among Rohingya women who married before eighteen years of age

Author

M. Mofizul Islam, Md Nuruzzaman Khan, and Md Mashiur Rahman

Subjects
rohingya, child marriage, intimate partner violence, domestic violence, refugee, Public aspects of medicine, RA1-1270
Abstract

Currently, around a million Rohingya refugees live in Cox’s Bazar, Bangladesh. This study examines the attitudes toward physical abuse and experiences of intimate partner violence (IPV) of Rohingya refugee women who experienced child marriage. A cross-sectional survey was conducted in the Rohingya refugee settlement at Cox’s Bazar, Bangladesh. Attitudes towards physical abuse have been assessed by a set of five questions that asked the situation under which ‘hitting or beating’ one’s wife is justifiable. Multivariable logistic regressions are used to examine the associations of exposure to child marriage with (i) attitudes towards the justification of physical abuse by one’s husband and (ii) experiences of IPV in the 12 months prior to the survey. Data are available for 486 participants. Overall, 61.32% of women experienced child marriage (married before 18 years of age) and they were more likely to have strongly justified beatings/hitting one’s wife under certain circumstances (Adjusted Odds Ratio (AOR) = 2.71; 95%CI: 1.78, 4.11), and to have experienced such IPV by their husbands in the 12 months prior to the survey (AOR = 1.72; 95%CI: 1.13, 2.61). These AORs are higher for women married at ages 12–14 than those married at 15–17. Having some formal education among husband and wife is protective of abuse within a marriage. Rohingya women’s attitudes towards and experiences of IPV are associated with their exposure to child marriage. Interventions for stopping child marriage, marriage registration, social support group, and legal interventions are needed. Offering formal education to all children needs to be prioritized.

Published
2021
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13. Social Prescribing—An Effort to Apply a Common Knowledge: Impelling Forces and Challenges

Author

M. Mofizul Islam

Subjects
social prescribing, non-medical care, referral to social services, social determinants of health, link worker, community referral, Public aspects of medicine, RA1-1270
Abstract

In recent times, social prescribing has been introduced in some countries, and substantially in the U.K. The objective of this scheme is to offer non-medical care mainly to primary care patients. Although the idea of this scheme is not new, its formalization is. Using a narrative synthesis of peer-reviewed and gray literature, this article discusses the social prescribing scheme, some of its compelling aspects and challenges in offering non-medical care, particularly regarding referrals being made from primary care settings. The social prescribing scheme has several impelling forces that include its potential to turn primary care to primary healthcare, tackle social determinants of health and social needs, improve wellbeing and physical health, offer person-centered care, strengthen preventive care, and bridge healthcare organizations with the third sector. This scheme also faces several challenges including service standards and boundaries, sustainability, availability of appropriate services, low engagement of clients and insufficient evidence. While this scheme lacks validated evidence, it is theoretically compelling. Given that the demand for non-medical care is growing in most societies and that the usefulness of non-medical care is gaining prominence, social prescribing is likely to continue to proliferate.

Published
2020
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14. Risks of COVID19 outbreaks in Rohingya refugee camps in Bangladesh

Author

Md Nuruzzaman Khan, M. Mofizul Islam, and Md Mashiur Rahman

Subjects
Rohingya refugee in Bangladesh, COVID-19, Public aspects of medicine, RA1-1270
Abstract

The COVID-19 pandemic was confirmed to have started spreading in Bangladesh since March 2020. Since then the new infections grew exponentially and now the rate is highest in Asia along with wider community-level transmission. In Bangladesh, the preventive measures have been found challenging to implement due to a lack of general awareness of COVID-19 and the absence of a social safety net. In this situation, there is a concern about the heightened risk of infection and its aftermath in Rohingya refugee camps in the southwest part of Bangladesh, where the world’s largest refugee population resides. If COVID-19 starts spreading in the camps, there will have a devastating consequence given that almost one million people live in precarious and unhygienic conditions in an area of only five square kilometres. In this paper, the risk for the Rohingya refugee population of getting COVID-19 disease and the preparedness to diagnose new cases and their management by the facilities of government and international organizations are discussed. Several suggestions are also offered to protect the Rohingya refugee population from deadly COVID-19 disease.

Published
2020
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15. Inequalities in Utilization of Maternal Reproductive Health Care Services in Urban Bangladesh: A Population-Based Study

Author

Md. Nuruzzaman Khan, Pushpendra Kumar, Md. Mijanur Rahman, Md. Nazrul Islam Mondal, and M. Mofizul Islam

Subjects
History of scholarship and learning. The humanities, AZ20-999, Social Sciences
Abstract

This study examined inequalities in the utilization of maternal reproductive health care services in urban Bangladesh. Data of 6,617 urban women were extracted from most recent two rounds of Bangladesh Demographic and Health Survey, conducted in the years 2011 and 2014. Inequalities in the utilization of antenatal checkup, receiving care from a skilled birth attendant, delivery in health care facilities, and postnatal care were investigated through concentration index. Contributions of selected predictors to inequalities were estimated by using the regression-based decomposition method. Noticeable inequalities were observed. Concentration index for utilization of at least one antenatal care visit was 0.09, four or more antenatal visits was 0.17, care from skilled birth attendant was 0.16, delivery care in health care facilities was 0.17, and postnatal care within 2 days of delivery was 0.19. Exposure to mass media, educational status of women and their spouses, wealth status, employment, birth order, and age of pregnancy were significant determinants of inequalities. There was a gradient in the utilization of services when examined across wealth status. Those with unfavorable social determinants of health reported low levels of utilization. Alongside providing tailored health care services to urban poor women, efforts should be made to reduce inequalities in social determinants of health.

Published
2020
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16. Standardised alcohol screening in primary health care services targeting Aboriginal and Torres Strait Islander peoples in Australia

Author

M. Mofizul Islam, Helen T. Oni, K. S. Kylie Lee, Noel Hayman, Scott Wilson, Kristie Harrison, Beth Hummerston, Rowena Ivers, and Katherine M. Conigrave

Subjects
Alcohol screening, AUDIT, AUDIT-C, Indigenous, IRIS, Aboriginal and/or Torres Strait Islander, Medicine (General), R5-920, Social pathology. Social and public welfare. Criminology, HV1-9960
Abstract

Abstract Introduction and aims Aboriginal and Torres Strait Islander Community Controlled Health Services (ACCHSs) around Australia have been asked to standardise screening for unhealthy drinking. Accordingly, screening with the 3-item AUDIT-C (Alcohol Use Disorders Identification Test—Consumption) tool has become a national key performance indicator. Here we provide an overview of suitability of AUDIT-C and other brief alcohol screening tools for use in ACCHSs. Methods All peer-reviewed literature providing original data on validity, acceptability or feasibility of alcohol screening tools among Indigenous Australians was reviewed. Narrative synthesis was used to identify themes and integrate results. Results Three screening tools—full AUDIT, AUDIT-3 (third question of AUDIT) and CAGE (Cut-down, Annoyed, Guilty and Eye-opener) have been validated against other consumption measures, and found to correspond well. Short forms of AUDIT have also been found to compare well with full AUDIT, and were preferred by primary care staff. Help was often required with converting consumption into standard drinks. Researchers commented that AUDIT and its short forms prompted reflection on drinking. Another tool, the Indigenous Risk Impact Screen (IRIS), jointly screens for alcohol, drug and mental health risk, but is relatively long (13 items). IRIS has been validated against dependence scales. AUDIT, IRIS and CAGE have a greater focus on dependence than on hazardous or harmful consumption. Discussion and conclusions Detection of unhealthy drinking before harms occur is a goal of screening, so AUDIT-C offers advantages over tools like IRIS or CAGE which focus on dependence. AUDIT-C’s brevity suits integration with general health screening. Further research is needed on facilitating implementation of systematic alcohol screening into Indigenous primary healthcare.

Published
2018
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17. Effect of exclusive breastfeeding on selected adverse health and nutritional outcomes: a nationally representative study

Author

Md. Nuruzzaman Khan and M. Mofizul Islam

Subjects
Exclusive breastfeeding, child health, Under-nutrition, World Health Organization recommendation, Bangladesh, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Despite growing evidence in support of exclusive breastfeeding (EBF) among infants in the first 6 months of birth, the debate over the optimal duration of EBF continues. This study examines the effect of termination of EBF during the first 2, 4 and 6 months of birth on a set of adverse health and nutritional outcomes of infants. Methods Three waves of Bangladesh Demographic and Health Survey data were analysed using multivariate regression. The adverse health outcomes were: an episode of diarrhea, fever or acute respiratory infection (ARI) during the 2 weeks prior to the survey. Nutritional outcomes were assessed by stunting (height-for-age), wasting (weight-for-height) and underweight (weight-for-age). Population attributable fraction was calculated to estimate percentages of these six outcomes that could have been prevented by supplying EBF. Results Fifty-six percent of infants were exclusively breastfed during the first 6 months. Lack of EBF increased the odds of diarrhea, fever and ARI. Among the babies aged 6 months or less 27.37% of diarrhea, 13.24% of fever and 8.94% of ARI could have been prevented if EBF was not discontinued. If EBF was terminated during 0–2 months, 2–4 months the odds of becoming underweight were 2.16 and 2.01 times higher, respectively, than babies for whom EBF was not terminated. Conclusion Children who are not offered EBF up to 6 months of their birth may suffer from a range of infectious diseases and under-nutrition. Health promotion and other public health interventions should be enhanced to encourage EBF at least up to six-month of birth. Trail registration Data of this study were collected following the guidelines of ICF International and Bangladesh Medical Research Council. The registration number of data collection is 132,989.0.000 and the data-request was registered on September 11, 2016.

Published
2017
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18. Household air pollution from cooking and risk of adverse health and birth outcomes in Bangladesh: a nationwide population-based study

Author

Md Nuruzzaman Khan, Cherri Zhang B. Nurs, M. Mofizul Islam, Md Rafiqul Islam, and Md Mizanur Rahman

Subjects
Cooking fuel, Indoor pollution, Solid fuel, Acute respiratory infection, Low birth weight, Stillbirth, Industrial medicine. Industrial hygiene, RC963-969, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Household air pollution (HAP) from cooking with solid fuels has become a leading cause of death and disability in many developing countries including Bangladesh. We assess the association between HAP and risk of selected adverse birth and maternal health outcomes. Methods Data for this study were extracted from Bangladesh Demographic and Health Survey conducted during 2007–2014. Selected adverse birth outcomes were acute respiratory infection (ARI) among children, stillbirth, low birth weight (LBW), under-five mortality, neonatal mortality and infant mortality. Maternal pregnancy complications and cesarean delivery were considered as the adverse maternal health outcomes. Place of cooking, use of solid fuel within the house boundary and in living room were the exposure variables. To examine the association between exposure and outcome variables, we used a series of multiple logistic regression models accounted for complex survey design. Results Around 90% of the respondents used solid fuel within the house boundary, 11% of them used solid fuel within the living room. Results of multiple regression indicated that cooking inside the house increased the risk of neonatal mortality (aOR,1.25; 95% CI, 1.02–1.52), infant mortality (aOR, 1.18; 95% CI, 1.00–1.40), ARI (aOR, 1.18; 95% CI, 1.08–1.33), LBW (aOR, 1.25; 95% CI, 1.10–1.43), and cesarean delivery (aOR,1.18; 95% CI, 1.01–1.29). Use of solid fuel, irrespective of cooking places, increased the risk of pregnancy complications (aOR, 1.36; 95% CI, 1.19–1.55). Compared to participants who reported cooking outside the house, the risk of ARI, LBW were significantly high among those who performed cooking within the house, irrespective of type of cooking fuel. Conclusion Indoor cooking and use of solid fuel in household increase the risk of ARI, LBW, cesarean delivery, and pregnancy complication. These relationships need further investigation using more direct measures of smoke exposure and clinical measures of health outcomes. The use of clean fuels and structural improvement in household design such as provision of stove ventilation should be encouraged to reduce such adverse health consequences. Trail registration Data related to health were collected by following the guidelines of ICF international and Bangladesh Medical Research Council. The registration number of data collection was 132,989.0.000, and the data-request was registered on March 11, 2015.

Published
2017
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20. Time spent on health‐related activities by senior Australians with chronic diseases: what is the role of multimorbidity and comorbidity?

Author

M. Mofizul Islam, Ian S. McRae, Laurann Yen, Tanisha Jowsey, and Jose M. Valderas

Subjects
time, multimorbidity, comorbidity, disease cluster, self‐management, chronic illness, Public aspects of medicine, RA1-1270
Abstract

Abstract Objective: To examine the effect of various morbidity clusters of chronic diseases on health‐related time use and to explore factors associated with heavy time burden (more than 30 hours/month) of health‐related activities. Methods: Using a national survey, data were collected from 2,540 senior Australians. Natural clusters were identified using cluster analysis and clinical clusters using clinical expert opinion. We undertook a set of linear regressions to model people's time use, and logistic regressions to model heavy time burden. Results: Time use increases with the number of chronic diseases. Six of the 12 diseases are significantly associated with higher time use, with the highest effect for diabetes followed by depression; 18% reported a heavy time burden, with diabetes again being the most significant disease. Clusters and dominant comorbid groupings do not contribute to predicting time use or time burden. Conclusions: Total number of diseases and specific diseases are useful determinants of time use and heavy time burden. Dominant groupings and disease clusters do not predict time use. Implications: In considering time demands on patients and the need for care co‐ordination, care providers need to be aware of how many and what specific diseases the patient faces.

Published
2015
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21. Sexually transmitted infections, sexual risk behaviours and perceived barriers to safe sex among drug users

Author

M. Mofizul Islam, Libby Topp, Katherine M. Conigrave, Paul S. Haber, Ann White, and Carolyn A. Day

Subjects
injecting drug users, sexual risk behaviour, unprotected sex, low‐threshold healthcare, Public aspects of medicine, RA1-1270
Abstract

Abstract Objective : Drug users are at elevated risk of HIV and other sexually transmitted infections (STIs). This study examines prevalence of STIs and perceived barriers to safe sex among drug users accessing low‐threshold primary healthcare in inner‐city Sydney. Methods : Data were extracted manually from clients’ medical records and analysed using STATA. Results : Prevalence of HIV, syphilis, chlamydia and gonorrhoea were low (

Published
2013
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22. Healthcare utilisation and disclosure of injecting drug use among clients of Australia's needle and syringe programs

Author

M. Mofizul Islam, Libby Topp, Jenny Iversen, Carolyn Day, Katherine M. Conigrave, and Lisa Maher

Subjects
Injecting drug use, needle syringe program, healthcare, disclosure, emergency department, Public aspects of medicine, RA1-1270
Abstract

Abstract Background : People who inject drugs (PWID) report limited access to healthcare, and may avoid disclosing drug use. Health service utilisation was examined among participants in the Australian Needle and Syringe Program Survey (ANSPS), an annual cross‐sectional sero‐survey of needle syringe program (NSP) attendees. Methods : An anonymous questionnaire was self‐completed by 2,395 NSP clients throughout Australia. Multivariable logistic regressions identified variables independently associated with (i) disclosure of injecting to the most recent healthcare provider; and (ii) recent presentation to emergency departments. Results : Seventy‐eight percent of participants reported accessing healthcare in the preceding 12 months. Reasons for presentation included general health issues (46%); medication seeking (17%); and both (37%). Participants who recently accessed healthcare or had previously visited their most recent provider were more likely to disclose injecting drug use. Participants presenting to a GP or medical centre were less likely than others to disclose injecting. Those accessing emergency departments were more likely to report recent imprisonment. Conclusions : Despite Australia's universal healthcare system and harm reduction policies, NSP‐participants remain reluctant to disclose injecting, potentially hindering appropriate care and highlighting the need for multiple entry points to the healthcare system, including NSPs and opioid substitution therapy clinics.

Published
2013
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23. Needle Syringe Program-Based Primary HealthCare Centers

Author

M. Mofizul Islam MSc

Subjects
Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, RA1-1270
Abstract

Needle syringe programs (NSPs) are now on a strong platform mainly because of their crucial role in controlling/containing blood-borne virus infections. In many parts of the world, NSPs are gradually augmenting their role as a primary health care centers. Health care from NSPs are found to be better accessible by injecting drug users (IDUs). However, these outlets are becoming a separate source of health care for IDUs—mainly because (i) nondrug users very rarely access these and (ii) IDUs do not access other sources of primary care readily. Moreover, offering health care from NSPs is also relatively cost-intensive, therefore, has some disadvantages. The aim of this commentary is to examine and discuss the advantages and disadvantages of NSP-based primary health care outlets. The benefits NSPs can accrue through offering health care services are immense, as an NSP is a critical junction for service providers to offer health care services to IDUs, who traditionally have been hard to reach by conventional health care. Despite some disadvantages, NSP-based health care is very valuable for IDUs until they are duly taken care by the conventional health care centers.

Published
2010
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25. Effects of lower tiers of government healthcare facilities on unmet need for contraception and contraception use in Bangladesh

Author

Md Nuruzzaman Khan, Shimlin Jahan Khanam, Md Mostaured Ali Khan, M Mofizul Islam, and Melissa L. Harris

Abstract

BackgroundIn low- and middle-income countries (LMICs), including Bangladesh, modern contraception use remains lower than desired, resulting in a higher unmet need. A potential factor contributing to lower contraceptive use is reduced access to and use of lower tiers of government healthcare facilities, including home visits by family welfare assistants (FWAs), as well as women’s visits to community and satellite clinics. These relationships, however, are still unexplored in Bangladesh and LMICs more broadly. The aim of this study was to explore effects of lower tiers of government healthcare facilities on unmet need for contraception and contraception use in Bangladesh.MethodsData from 17,585 sexually active married women were analyzed from the 2017 Bangladesh Demographic and Health Survey. The outcome variables were any contraceptive use, modern contraceptive use, unmet need for contraception, and unmet need for modern contraception. The explanatory variables considered were respondent’s home visits by FWAs, respondent’s visits to a community clinic, and respondent’s visits to a satellite clinic. Multilevel mixed-effect Poisson regression with robust variance was used to determine the association between the outcome and explanatory variables, adjusted for individual-, household-, and community-level factors.ResultsApproximately 18% of respondents were visited by FWAs in the three months prior to the survey date and only 3.4% and 3.1% of women attended community and satellite clinics, respectively. Women who reported being visited by FWAs in the three months prior to the survey were approximately 36% less likely to report an unmet need for modern contraception and 42% more likely to report using modern contraception than women who did not report such a visit. A higher likelihood of unmet need for contraception and a lower likelihood of contraception use was found among women who did not visit these community or satellite clinics or visited these clinics for other reasons than collecting contraception as compared to women who visited these clinics to collect contraception.ConclusionFWAs’ visits to respondents’ homes to provide contraception, as well as respondent’s visits to satellite and community clinics play a major role in Bangladesh to ensure contraception use and reduce the unmet need for contraception. However, their coverage is quite low in Bangladesh. The findings suggest an urgent need for greater government initiatives to increase the number of FWAs and engage in proper monitoring them at the field level.

Published
2023

26. Early childhood development and its association with maternal parity

Author

Md Nuruzzaman Khan and M Mofizul Islam

Subjects
Parity, Family Characteristics, Child Development, Literacy, Pregnancy, Child, Preschool, Pediatrics, Perinatology and Child Health, Public Health, Environmental and Occupational Health, Developmental and Educational Psychology, Humans, Mothers, Female
Abstract

Maternal parity, which is usually measured as the number of children born to a mother, has a substantial impact on the social and environmental factors around children and their development. This paper estimates the Early Childhood Development Index (ECDI) of 3- and 4-year-old children in Bangladesh and examines the relationship between maternal parity and early childhood development.The study analysed nationally representative data from the Bangladesh Multiple Indicator Cluster Survey 2019. The dataset had 9453 children aged from 36 to 59 months. The ECDI was computed following the UNICEF's approach involving psychometric computation of four domains of development: physical, literacy-numeracy, learning and social-emotional. Since the dataset has a hierarchical structure, we used multilevel logistic regression.A quarter (25%) of the children were not on track in their early childhood development. Seventy-one percent were not developmentally on track in the literacy-numeracy domain, 27% were not in the social-emotional and smaller percentages were not in learning (9%) and physical (1%) domains. There was a significant negative association between maternal parity and ECDI (adjusted odds ratio [AOR] 0.95; 95% CI: 0.91-0.99). Attendance at early childhood education programmes was significantly associated with early childhood development (AOR 1.73; 95% CI: 1.47-2.03). Also, female children, those who were not stunted, located in rural areas, received parental stimulation activities, lived in relatively wealthy households or had mothers who had received secondary or further education were more likely than others to be on track of early childhood development.Early childhood development is negatively correlated with maternal parity. The literacy-numeracy domain constitutes the major developmental delay. Programmes for parental awareness should be widely expanded.

Published
2022

27. Premarital sex and its association with child marriage among ever-married women: a study of national representative survey

Author

Md Arif Billah, Md. Mostaured Ali Khan, Syed Manzoor Ahmed Hanifi, M Mofizul Islam, and Md. Nuruzzaman Khan

Abstract

BackgroundSexual engagement before marriage (premarital sex) can influence child marriage; however, the evidence is scarce in low- and middle-income countries (LMICs), including Bangladesh. This study aimed to explore the association between premarital sex and child marriage among ever-married women aged 15-24 years.MethodsWe analysed data of ever-married women aged 15-24 years after extracting from the 2017/18 Bangladesh Demographic Health Survey (BDHS). Premarital sex (yes, no) was the primary exposure in this study, and child marriage was the outcome variable. Multilevel mixed-effect logistic regression models were used to determine the extent to which premarital sex influences the occurrence of child marriage.ResultsThe prevalence of premarital sex and child marriage was 27% and 76.6%, respectively. Ever-married women who experienced child marriage had higher odds of reporting that they had engaged in premarital sex (aOR: 2.68; 95% CI: 2.20-3.26). The odds of premarital sex for women who experienced child marriage were higher in both urban (aOR: 2.67; 95% CI: 1.88-3.80) and rural areas (aOR: 2.69; 95% CI: 2.11-3.43). Child marriage was more common among women of relatively poor households who had premarital sex than those from other wealth quintiles.ConclusionPremarital sex significantly impacts girls’ child marriage in Bangladesh, and it varies greatly depending on the household’s socioeconomic status. Expanding existing school and community-based programmes aimed at reducing girls’ child marriage, abstinence from early premarital-sexual intercourse and context-specific multi-component interventions for at-risk young people may reduce these practices.

Published
2023

28. Spatial pattern and influential factors for early marriage: Evidence from Bangladesh Demographic Health Survey Data 2017-18

Author

Md Arif Billah, Md. Mostaured Ali Khan, Syed Manzoor Ahmed Hanifi, M Mofizul Islam, and Md. Nuruzzaman Khan

Abstract

Background Early marriage is highly prevalent in Bangladesh. It is linked with a range of adverse outcomes, including maternal and child mortality. However, research on regional variations and factors associated with early marriage is scarce in Bangladesh. This study aimed to explore the geographical variations and predictors of early marriage in Bangladesh. Methods Data of women aged 20–24 in the 2017-18 Bangladesh Demographic and Health Survey were analysed. The occurrence of early marriage was the outcome variable. Explanatory variables were several individual-, household- and community-level factors. Geographical hot spots and cold spots of early marriage were first determined using Global Moran’s I statistic. Multilevel mixed-effect Poisson regression was used to determine the association of early marriage with individual-, household-, and community-level factors. Results Almost 59% of women aged 20–24 reported they were married before reached18. The hotspots of early marriage were mainly concentrated in Rajshahi, Rangpur and Barishal, and the cold spots were in Sylhet and Chattogram divisions. The prevalence of early marriage was lower among higher educated (adjusted prevalence ratio (aPR): 0.45; 95% CI: 0.40, 0.52), and non-Muslim women (aPR: 0.89; 95% CI: 0.79, 0.99) than their counterparts. Higher community-level poverty was significantly associated with early marriage (aPR, 1.16; 95% CI: 1.04, 1.29). Conclusion Early marriage is highly prevalent in Bangladesh. Promoting girls’ education, awareness-building programs about the adverse effects of early marriage and proper application of the child marriage restraint act, particularly in disadvantaged communities are recommended.

Published
2023

29. Variation in Prescription Opioid Dispensing across Neighborhoods of Diverse Socioeconomic Disadvantages in Victoria, Australia

Author

Dennis Wollersheim and M. Mofizul Islam

Subjects
pain medicine, medicine.medical_specialty, Victoria, prescription opioid, Pharmaceutical Science, lcsh:Medicine, lcsh:RS1-441, 030226 pharmacology & pharmacy, Article, lcsh:Pharmacy and materia medica, 03 medical and health sciences, 0302 clinical medicine, Environmental health, Urbanization, Drug Discovery, medicine, dispensing, 030212 general & internal medicine, Medical prescription, Socioeconomic status, Disadvantage, Uncategorized, business.industry, Public health, lcsh:R, geographical variation, Australia, Disadvantaged, Defined daily dose, Molecular Medicine, Rural area, business
Abstract

The study examined the relationship between dispensing patterns of prescription opioids, neighborhood-disadvantage-index, and standardized doses dispensed. Three-year&rsquo, s dispensing data drawn from 80 local government areas (LGAs) within Victoria, Australia&rsquo, s second most populous state, was analyzed. Quantities dispensed in defined daily dose (DDD)/1000-people/day were computed for LGAs of low, moderate, high, and very high socio-economic disadvantage. LGAs with various levels of dispensing, and neighborhood disadvantage were identified and mapped. A multivariable regression model examined the effect of neighborhood level disadvantage and identified other factors that are associated with standardized doses dispensed. More women were dispensed opioids than men. Dispensing increased with increasing age. Most of the LGAs with relatively high dispensing were socioeconomically disadvantaged and located outside the major cities. Dispensing gradually increased from low disadvantage to very high disadvantage areas. Dispensing of standardized doses were consistently higher in rural areas than in urban areas. Neighborhood level disadvantage, age, sex, and urbanization were significant factors in the standardized doses dispensed. As inappropriate dispensing of opioids is a major public health problem, research should facilitate understanding of utilization in small areas to enable tailored public health programs. Nationwide and consistent introduction of real-time prescription drug-monitoring programs, and structural interventions to reduce the fundamental causes of socioeconomic disadvantage and isolation are recommended.

Published
2023
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30. Hardcore use of smoked and smokeless tobacco products among men and women in Bangladesh: data from two rounds of the global adult tobacco survey

Author

M. Mofizul Islam

Subjects
Health (social science), Medicine (miscellaneous)
Abstract

This study examines the prevalence of and factors associated with "hardcore" use of smoked and smokeless tobacco (SLT) products in Bangladesh and the variation in the ages people started using them daily. Data from the 2009 and 2017 rounds of the Global Adult Tobacco Survey for Bangladesh were analyzed using multilevel logistic regression. The prevalence of "hardcore" use of smoked tobacco among current smokers decreased from 15.5% in 2009 to 13.1% in 2017. Almost all hardcore smokers were male in both rounds. Among the current users of SLT, 7.0% were "hardcore" users in 2009, with a higher proportion of females (8.9%) than males (4.8%) and these percentages remained similar in 2017. The current smokers in the age-group 25-64 and the current SLT users in the age-group 45-65+ were more likely than their counterparts to be "hardcore" users. The earlier the participants started using daily, the more likely they were to become "hardcore" users. There was regional variation in the prevalence of "hardcore" use. Coordinated preventive interventions and comprehensive treatment programmes and their equitable geographical distribution are needed.

Published
2022

31. Negative effects of short birth interval on child mortality in low- and middle-income countries: A systematic review and meta-analysis

Author

Mohammad Zahidul Islam, Arif Billah, M Mofizul Islam, Mostafizur Rahman, and Nuruzzaman Khan

Subjects
Birth Intervals, Pregnancy, Health Policy, Child Mortality, Infant Mortality, Public Health, Environmental and Occupational Health, Infant, Newborn, Humans, Infant, Female, Child, Developing Countries, Perinatal Mortality
Abstract

Eight databases, PubMed, CINAHL, Web of Science, Embase, PsycINFO, Cochrane Library, Popline, and Maternity and Infant Care, were searched, covering the period of January 2000 to January 2022. Studies that had examined the association between SBI and any form of child mortality were included. The findings of the included studies were summarized through fixed-effects or random-effects meta-analysis and the model was selected based on the heterogeneity index.A total of 51 studies were included. Of them, 19 were conducted in Ethiopia, 10 in Nigeria and 7 in Bangladesh. Significant higher likelihoods of stillbirth (odds ratio (OR) = 2.11; 95% confidence interval (CI) = 1.32-3.38), early neonatal mortality (OR = 1.58; 95% CI = 1.04-2.41), perinatal mortality (OR = 1.71; 95% CI = 1.32-2.21), neonatal mortality (OR = 1.85; 95% CI = 1.68-2.04), post-neonatal mortality (OR = 3.01; 95% CI = 1.43-6.33), infant mortality (OR = 1.92; 95% CI = 1.77-2.07), child mortality (OR = 1.67; 95% CI = 1.27-2.19) and under-five mortality (OR = 1.95; 95% CI = 1.56-2.44) were found among babies born in short birth intervals than those who born in normal intervals.SBI significantly increases the risk of child mortality in LMICs. Programmes to reduce pregnancies in short intervals need to be expanded and strengthened. Reproductive health interventions aimed at reducing child mortality should include proper counselling on family planning, distribution of appropriate contraceptives and increased awareness of the adverse effects of SBI on maternal and child health.

Published
2022

32. Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020

Author

Dana Bryazka, Marissa B Reitsma, Max G Griswold, Kalkidan Hassen Abate, Cristiana Abbafati, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Amir Abdoli, Mohammad Abdollahi, Abu Yousuf Md Abdullah, E S Abhilash, Eman Abu-Gharbieh, Juan Manuel Acuna, Giovanni Addolorato, Oladimeji M Adebayo, Victor Adekanmbi, Kishor Adhikari, Sangeet Adhikari, Qorinah Estiningtyas Sakilah Adnani, Saira Afzal, Wubetu Yimam Agegnehu, Manik Aggarwal, Bright Opoku Ahinkorah, Araz Ramazan Ahmad, Sajjad Ahmad, Tauseef Ahmad, Ali Ahmadi, Sepideh Ahmadi, Haroon Ahmed, Tarik Ahmed Rashid, Chisom Joyqueenet Akunna, Hanadi Al Hamad, Md Zakiul Alam, Dejene Tsegaye Alem, Kefyalew Addis Alene, Yousef Alimohamadi, Atiyeh Alizadeh, Kasim Allel, Jordi Alonso, Saba Alvand, Nelson Alvis-Guzman, Firehiwot Amare, Edward Kwabena Ameyaw, Sohrab Amiri, Robert Ancuceanu, Jason A Anderson, Catalina Liliana Andrei, Tudorel Andrei, Jalal Arabloo, Muhammad Arshad, Anton A Artamonov, Zahra Aryan, Malke Asaad, Mulusew A Asemahagn, Thomas Astell-Burt, Seyyed Shamsadin Athari, Desta Debalkie Atnafu, Prince Atorkey, Alok Atreya, Floriane Ausloos, Marcel Ausloos, Getinet Ayano, Martin Amogre ayanore Ayanore, Olatunde O Ayinde, Jose L Ayuso-Mateos, Sina Azadnajafabad, Melkalem Mamuye Azanaw, Mohammadreza Azangou-Khyavy, Amirhossein Azari Jafari, Ahmed Y Azzam, Ashish D Badiye, Nasser Bagheri, Sara Bagherieh, Mohan Bairwa, Shankar M Bakkannavar, Ravleen Kaur Bakshi, Awraris Hailu Balchut/Bilchut, Till Winfried Bärnighausen, Fabio Barra, Amadou Barrow, Pritish Baskaran, Luis Belo, Derrick A Bennett, Isabela M Benseñor, Akshaya Srikanth Bhagavathula, Neeraj Bhala, Ashish Bhalla, Nikha Bhardwaj, Pankaj Bhardwaj, Sonu Bhaskar, Krittika Bhattacharyya, Vijayalakshmi S Bhojaraja, Bagas Suryo Bintoro, Elena A Elena Blokhina, Belay Boda Abule Bodicha, Archith Boloor, Cristina Bosetti, Dejana Braithwaite, Hermann Brenner, Nikolay Ivanovich Briko, Andre R Brunoni, Zahid A Butt, Chao Cao, Yin Cao, Rosario Cárdenas, Andre F Carvalho, Márcia Carvalho, Joao Mauricio Castaldelli-Maia, Giulio Castelpietra, Luis F S Castro-de-Araujo, Maria Sofia Cattaruzza, Promit Ananyo Chakraborty, Jaykaran Charan, Vijay Kumar Chattu, Akhilanand Chaurasia, Nicolas Cherbuin, Dinh-Toi Chu, Nandita Chudal, Sheng-Chia Chung, Chuchu Churko, Liliana G Ciobanu, Massimo Cirillo, Rafael M Claro, Simona Costanzo, Richard G Cowden, Michael H Criqui, Natália Cruz-Martins, Garland T Culbreth, Berihun Assefa Dachew, Omid Dadras, Xiaochen Dai, Giovanni Damiani, Lalit Dandona, Rakhi Dandona, Beniam Darge Daniel, Anna Danielewicz, Jiregna Darega Gela, Kairat Davletov, Jacyra Azevedo Paiva de Araujo, Antonio Reis de Sá-Junior, Sisay Abebe Debela, Azizallah Dehghan, Andreas K Demetriades, Meseret Derbew Molla, Rupak Desai, Abebaw Alemayehu Desta, Diana Dias da Silva, Daniel Diaz, Lankamo Ena Digesa, Mengistie Diress, Milad Dodangeh, Deepa Dongarwar, Fariba Dorostkar, Haneil Larson Dsouza, Bereket Duko, Bruce B Duncan, Kristina Edvardsson, Michael Ekholuenetale, Frank J Elgar, Muhammed Elhadi, Mohamed A Elmonem, Aman Yesuf Endries, Sharareh Eskandarieh, Azin Etemadimanesh, Adeniyi Francis Fagbamigbe, Ildar Ravisovich Fakhradiyev, Fatemeh Farahmand, Carla Sofia e Sá Farinha, Andre Faro, Farshad Farzadfar, Ali Fatehizadeh, Nelsensius Klau Fauk, Valery L Feigin, Rachel Feldman, Xiaoqi Feng, Zinabu Fentaw, Simone Ferrero, Lorenzo Ferro Desideri, Irina Filip, Florian Fischer, Joel Msafiri Francis, Richard Charles Franklin, Peter Andras Gaal, Mohamed M Gad, Silvano Gallus, Fabio Galvano, Balasankar Ganesan, Tushar Garg, Mesfin Gebrehiwot Damtew Gebrehiwot, Teferi Gebru Gebremeskel, Mathewos Alemu Gebremichael, Tadele Regasa Gemechu, Lemma Getacher, Motuma Erena Getachew, Abera Getachew Obsa, Asmare Getie, Amir Ghaderi, Mansour Ghafourifard, Alireza Ghajar, Seyyed-Hadi Ghamari, Lilian A Ghandour, Mohammad Ghasemi Nour, Ahmad Ghashghaee, Sherief Ghozy, Franklin N Glozah, Ekaterina Vladimirovna Glushkova, Justyna Godos, Amit Goel, Salime Goharinezhad, Mahaveer Golechha, Pouya Goleij, Mohamad Golitaleb, Felix Greaves, Michal Grivna, Giuseppe Grosso, Temesgen Worku Gudayu, Bhawna Gupta, Rajeev Gupta, Sapna Gupta, Veer Bala Gupta, Vivek Kumar Gupta, Nima Hafezi-Nejad, Arvin Haj-Mirzaian, Brian J Hall, Rabih Halwani, Tiilahun Beyene Handiso, Graeme J Hankey, Sanam Hariri, Josep Maria Haro, Ahmed I Hasaballah, Hossein Hassanian-Moghaddam, Simon I Hay, Khezar Hayat, Golnaz Heidari, Mohammad Heidari, Delia Hendrie, Claudiu Herteliu, Demisu Zenbaba Heyi, Kamal Hezam, Mbuzeleni Mbuzeleni Hlongwa, Ramesh Holla, Md Mahbub Hossain, Sahadat Hossain, Seyed Kianoosh Hosseini, Mehdi hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Guoqing Hu, Junjie Huang, Salman Hussain, Segun Emmanuel Ibitoye, Irena M Ilic, Milena D Ilic, Mustapha Immurana, Lalu Muhammad Irham, M Mofizul Islam, Rakibul M Islam, Sheikh Mohammed Shariful Islam, Hiroyasu Iso, Ramaiah Itumalla, Masao Iwagami, Roxana Jabbarinejad, Louis Jacob, Mihajlo Jakovljevic, Zahra Jamalpoor, Elham Jamshidi, Sathish Kumar Jayapal, Umesh Umesh Jayarajah, Ranil Jayawardena, Rime Jebai, Seyed Ali Jeddi, Alelign Tasew Jema, Ravi Prakash Jha, Har Ashish Jindal, Jost B Jonas, Tamas Joo, Nitin Joseph, Farahnaz Joukar, Jacek Jerzy Jozwiak, Mikk Jürisson, Ali Kabir, Robel Hussen Kabthymer, Bhushan Dattatray Kamble, Himal Kandel, Girum Gebremeskel Kanno, Neeti Kapoor, Ibraheem M Karaye, Salah Eddin Karimi, Bekalu Getnet Kassa, Rimple Jeet Kaur, Gbenga A Kayode, Mohammad Keykhaei, Himanshu Khajuria, Rovshan Khalilov, Imteyaz A Khan, Moien AB Khan, Hanna Kim, Jihee Kim, Min Seo Kim, Ruth W Kimokoti, Mika Kivimäki, Vitalii Klymchuk, Ann Kristin Skrindo Knudsen, Ali-Asghar Kolahi, Vladimir Andreevich Korshunov, Ai Koyanagi, Kewal Krishan, Yuvaraj Krishnamoorthy, G Anil Kumar, Narinder Kumar, Nithin Kumar, Ben Lacey, Tea Lallukka, Savita Lasrado, Jerrald Lau, Sang-woong Lee, Wei-Chen Lee, Yo Han Lee, Lee-Ling Lim, Stephen S Lim, Stany W Lobo, Platon D Lopukhov, Stefan Lorkowski, Rafael Lozano, Giancarlo Lucchetti, Farzan Madadizadeh, Áurea M Madureira-Carvalho, Soleiman Mahjoub, Ata Mahmoodpoor, Rashidul Alam Mahumud, Alaa Makki, Mohammad-Reza Malekpour, Narayana Manjunatha, Borhan Mansouri, Mohammad Ali Mansournia, Jose Martinez-Raga, Francisco A Martinez-Villa, Richard Matzopoulos, Pallab K Maulik, Mahsa Mayeli, John J McGrath, Jitendra Kumar Meena, Entezar Mehrabi Nasab, Ritesh G Menezes, Gert B M Mensink, Alexios-Fotios A Mentis, Atte Meretoja, Bedasa Taye Merga, Tomislav Mestrovic, Junmei Miao Jonasson, Bartosz Miazgowski, Ana Carolina Micheletti Gomide Nogueira de Sá, Ted R Miller, GK Mini, Andreea Mirica, Antonio Mirijello, Seyyedmohammadsadeq Mirmoeeni, Erkin M Mirrakhimov, Sanjeev Misra, Babak Moazen, Maryam Mobarakabadi, Marcello Moccia, Yousef Mohammad, Esmaeil Mohammadi, Abdollah Mohammadian-Hafshejani, Teroj Abdulrahman Mohammed, Nagabhishek Moka, Ali H Mokdad, Sara Momtazmanesh, Yousef Moradi, Ebrahim Mostafavi, Sumaira Mubarik, Erin C Mullany, Beemnet Tekabe Mulugeta, Efrén Murillo-Zamora, Christopher J L Murray, Julius C Mwita, Mohsen Naghavi, Mukhammad David Naimzada, Vinay Nangia, Biswa Prakash Nayak, Ionut Negoi, Ruxandra Irina Negoi, Seyed Aria Nejadghaderi, Samata Nepal, Sudan Prasad Prasad Neupane, Sandhya Neupane Kandel, Yeshambel T Nigatu, Ali Nowroozi, Khan M Nuruzzaman, Chimezie Igwegbe Nzoputam, Kehinde O Obamiro, Felix Akpojene Ogbo, Ayodipupo Sikiru Oguntade, Hassan Okati-Aliabad, Babayemi Oluwaseun Olakunde, Gláucia Maria Moraes Oliveira, Ahmed Omar Bali, Emad Omer, Doris V Ortega-Altamirano, Adrian Otoiu, Stanislav S Otstavnov, Bilcha Oumer, Mahesh P A, Alicia Padron-Monedero, Raffaele Palladino, Adrian Pana, Songhomitra Panda-Jonas, Anamika Pandey, Ashok Pandey, Shahina Pardhan, Tarang Parekh, Eun-Kee Park, Charles D H Parry, Fatemeh Pashazadeh Kan, Jay Patel, Siddhartha Pati, George C Patton, Uttam Paudel, Shrikant Pawar, Amy E Peden, Ionela-Roxana Petcu, Michael R Phillips, Marina Pinheiro, Evgenii Plotnikov, Pranil Man Singh Pradhan, Akila Prashant, Jianchao Quan, Amir Radfar, Alireza Rafiei, Pankaja Raghav Raghav, Vafa Rahimi-Movaghar, Azizur Rahman, Md Mosfequr Rahman, Mosiur Rahman, Amir Masoud Rahmani, Shayan Rahmani, Chhabi Lal Ranabhat, Priyanga Ranasinghe, Chythra R Rao, Drona Prakash Rasali, Mohammad-Mahdi Rashidi, Zubair Ahmed Ratan, David Laith Rawaf, Salman Rawaf, Lal Rawal, Andre M N Renzaho, Negar Rezaei, Saeid Rezaei, Mohsen Rezaeian, Seyed Mohammad Riahi, Esperanza Romero-Rodríguez, Gregory A Roth, Godfrey M Rwegerera, Basema Saddik, Erfan Sadeghi, Reihaneh Sadeghian, Umar Saeed, Farhad Saeedi, Rajesh Sagar, Amirhossein Sahebkar, Harihar Sahoo, Mohammad Ali Sahraian, KM Saif-Ur-Rahman, Sarvenaz Salahi, Hamideh Salimzadeh, Abdallah M Samy, Francesco Sanmarchi, Milena M Santric-Milicevic, Yaser Sarikhani, Brijesh Sathian, Ganesh Kumar Saya, Mehdi Sayyah, Maria Inês Schmidt, Aletta Elisabeth Schutte, Michaël Schwarzinger, David C Schwebel, Abdul-Aziz Seidu, Nachimuthu Senthil Kumar, SeyedAhmad SeyedAlinaghi, Allen Seylani, Feng Sha, Sarvenaz Shahin, Fariba Shahraki-Sanavi, Shayan Shahrokhi, Masood Ali Shaikh, Elaheh Shaker, Murad Ziyaudinovich Shakhmardanov, Mehran Shams-Beyranvand, Sara Sheikhbahaei, Rahim Ali Sheikhi, Adithi Shetty, Jeevan K Shetty, Damtew Solomon Shiferaw, Mika Shigematsu, Rahman Shiri, Reza Shirkoohi, K M Shivakumar, Velizar Shivarov, Parnian Shobeiri, Roman Shrestha, Negussie Boti Sidemo, Inga Dora Sigfusdottir, Diego Augusto Santos Silva, Natacha Torres da Silva, Jasvinder A Singh, Surjit Singh, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, David A Sleet, Marco Solmi, YONATAN SOLOMON, Suhang Song, Yimeng Song, Reed J D Sorensen, Sergey Soshnikov, Ireneous N Soyiri, Dan J Stein, Sonu Hangma Subba, Miklós Szócska, Rafael Tabarés-Seisdedos, Takahiro Tabuchi, Majid Taheri, Ker-Kan Tan, Minale Tareke, Elvis Enowbeyang Tarkang, Gebremaryam Temesgen, Worku Animaw Temesgen, Mohamad-Hani Temsah, Kavumpurathu Raman Thankappan, Rekha Thapar, Nikhil Kenny Thomas, Chalachew Tiruneh, Jovana Todorovic, Marco Torrado, Mathilde Touvier, Marcos Roberto Tovani-Palone, Mai Thi Ngoc Tran, Sergi Trias-Llimós, Jaya Prasad Tripathy, Alireza Vakilian, Rohollah Valizadeh, Mehdi Varmaghani, Shoban Babu Varthya, Tommi Juhani Vasankari, Theo Vos, Birhanu Wagaye, Yasir Waheed, Mandaras Tariku Walde, Cong Wang, Yanzhong Wang, Yuan-Pang Wang, Ronny Westerman, Nuwan Darshana Wickramasinghe, Abate Dargie Wubetu, Suowen Xu, Kazumasa Yamagishi, Lin Yang, Gesila Endashaw E Yesera, Arzu Yigit, Vahit Yiğit, Ayenew Engida Ayenew Engida Yimaw, Dong Keon Yon, Naohiro Yonemoto, Chuanhua Yu, Siddhesh Zadey, Mazyar Zahir, Iman Zare, Mikhail Sergeevich Zastrozhin, Anasthasia Zastrozhina, Zhi-Jiang Zhang, Chenwen Zhong, Mohammad Zmaili, Yves Miel H Zuniga, Emmanuela Gakidou, University of St Andrews. School of Medicine, University of St Andrews. Population and Behavioural Science Division, Department of Public Health, University of Helsinki, Hjelt Institute (-2014), Helsinki Inequality Initiative (INEQ), Clinicum, Helsinki University Hospital Area, Bill & Melinda Gates Foundation, King Edward Medical University (Pakistán), Alexander von Humboldt Foundation, University of Oxford (Reino Unido), Medical Research Council (Reino Unido), NIH - National Institute of Mental Health (NIMH) (Estados Unidos), Canada Research Chairs, National Health and Medical Research Council (Australia), National Heart Foundation of Australia, Ministry of Education, Science and Technological Development (Serbia), Wellcome Trust, NIH - National Institute on Aging (NIA) (Estados Unidos), Finlands Akademi (Finlandia), Panjab University (India), Federal Ministry of Education & Research (Alemania), National Council for Scientific and Technological Development (Brasil), Danish National Research Foundation, Queensland Centre for Mental Health Research (Australia), South African Medical Research Council, National Natural Science Foundation of China, Charles Sturt University (Australia), Ain Shams University (Egipto), Mizoram University (India), Kasturba Medical College (India), Manipal Academy of Higher Education (India), Coordenação de Aperfeicoamento de Pessoal de Nível Superior (Brasil), Ministerio de Ciencia e Innovación (España), Collaborators, GBD 2020 Alcohol, Bryazka, Dana, Reitsma, Marissa B, Griswold, Max G, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbasi-Kangevari, Mohsen, Abbasi-Kangevari, Zeinab, Abdoli, Amir, Abdollahi, Mohammad, Abdullah, Abu Yousuf Md, Abhilash, E S, Abu-Gharbieh, Eman, Acuna, Juan Manuel, Addolorato, Giovanni, Adebayo, Oladimeji M, Adekanmbi, Victor, Adhikari, Kishor, Adhikari, Sangeet, Adnani, Qorinah Estiningtyas Sakilah, Afzal, Saira, Agegnehu, Wubetu Yimam, Aggarwal, Manik, Ahinkorah, Bright Opoku, Ahmad, Araz Ramazan, Ahmad, Sajjad, Ahmad, Tauseef, Ahmadi, Ali, Ahmadi, Sepideh, Ahmed, Haroon, Ahmed Rashid, Tarik, Akunna, Chisom Joyqueenet, Al Hamad, Hanadi, Alam, Md Zakiul, Alem, Dejene Tsegaye, Alene, Kefyalew Addi, Alimohamadi, Yousef, Alizadeh, Atiyeh, Allel, Kasim, Alonso, Jordi, Alvand, Saba, Alvis-Guzman, Nelson, Amare, Firehiwot, Ameyaw, Edward Kwabena, Amiri, Sohrab, Ancuceanu, Robert, Anderson, Jason A, Andrei, Catalina Liliana, Andrei, Tudorel, Arabloo, Jalal, Arshad, Muhammad, Artamonov, Anton A, Aryan, Zahra, Asaad, Malke, Asemahagn, Mulusew A, Astell-Burt, Thoma, Athari, Seyyed Shamsadin, Atnafu, Desta Debalkie, Atorkey, Prince, Atreya, Alok, Ausloos, Floriane, Ausloos, Marcel, Ayano, Getinet, Ayanore, Martin Amogre ayanore, Ayinde, Olatunde O, Ayuso-Mateos, Jose L, Azadnajafabad, Sina, Azanaw, Melkalem Mamuye, Azangou-Khyavy, Mohammadreza, Azari Jafari, Amirhossein, Azzam, Ahmed Y, Badiye, Ashish D, Bagheri, Nasser, Bagherieh, Sara, Bairwa, Mohan, Bakkannavar, Shankar M, Bakshi, Ravleen Kaur, Balchut/bilchut, Awraris Hailu, Bärnighausen, Till Winfried, Barra, Fabio, Barrow, Amadou, Baskaran, Pritish, Belo, Lui, Bennett, Derrick A, Benseñor, Isabela M, Bhagavathula, Akshaya Srikanth, Bhala, Neeraj, Bhalla, Ashish, Bhardwaj, Nikha, Bhardwaj, Pankaj, Bhaskar, Sonu, Bhattacharyya, Krittika, Bhojaraja, Vijayalakshmi S, Bintoro, Bagas Suryo, Blokhina, Elena A Elena, Bodicha, Belay Boda Abule, Boloor, Archith, Bosetti, Cristina, Braithwaite, Dejana, Brenner, Hermann, Briko, Nikolay Ivanovich, Brunoni, Andre R, Butt, Zahid A, Cao, Chao, Cao, Yin, Cárdenas, Rosario, Carvalho, Andre F, Carvalho, Márcia, Castaldelli-Maia, Joao Mauricio, Castelpietra, Giulio, Castro-de-Araujo, Luis F S, Cattaruzza, Maria Sofia, Chakraborty, Promit Ananyo, Charan, Jaykaran, Chattu, Vijay Kumar, Chaurasia, Akhilanand, Cherbuin, Nicola, Chu, Dinh-Toi, Chudal, Nandita, Chung, Sheng-Chia, Churko, Chuchu, Ciobanu, Liliana G, Cirillo, Massimo, Claro, Rafael M, Costanzo, Simona, Cowden, Richard G, Criqui, Michael H, Cruz-Martins, Natália, Culbreth, Garland T, Dachew, Berihun Assefa, Dadras, Omid, Dai, Xiaochen, Damiani, Giovanni, Dandona, Lalit, Dandona, Rakhi, Daniel, Beniam Darge, Danielewicz, Anna, Darega Gela, Jiregna, Davletov, Kairat, de Araujo, Jacyra Azevedo Paiva, de Sá-Junior, Antonio Rei, Debela, Sisay Abebe, Dehghan, Azizallah, Demetriades, Andreas K, Derbew Molla, Meseret, Desai, Rupak, Desta, Abebaw Alemayehu, Dias da Silva, Diana, Diaz, Daniel, Digesa, Lankamo Ena, Diress, Mengistie, Dodangeh, Milad, Dongarwar, Deepa, Dorostkar, Fariba, Dsouza, Haneil Larson, Duko, Bereket, Duncan, Bruce B, Edvardsson, Kristina, Ekholuenetale, Michael, Elgar, Frank J, Elhadi, Muhammed, Elmonem, Mohamed A, Endries, Aman Yesuf, Eskandarieh, Sharareh, Etemadimanesh, Azin, Fagbamigbe, Adeniyi Franci, Fakhradiyev, Ildar Ravisovich, Farahmand, Fatemeh, Farinha, Carla Sofia e Sá, Faro, Andre, Farzadfar, Farshad, Fatehizadeh, Ali, Fauk, Nelsensius Klau, Feigin, Valery L, Feldman, Rachel, Feng, Xiaoqi, Fentaw, Zinabu, Ferrero, Simone, Ferro Desideri, Lorenzo, Filip, Irina, Fischer, Florian, Francis, Joel Msafiri, Franklin, Richard Charle, Gaal, Peter Andra, Gad, Mohamed M, Gallus, Silvano, Galvano, Fabio, Ganesan, Balasankar, Garg, Tushar, Gebrehiwot, Mesfin Gebrehiwot Damtew, Gebremeskel, Teferi Gebru, Gebremichael, Mathewos Alemu, Gemechu, Tadele Regasa, Getacher, Lemma, Getachew, Motuma Erena, Getachew Obsa, Abera, Getie, Asmare, Ghaderi, Amir, Ghafourifard, Mansour, Ghajar, Alireza, Ghamari, Seyyed-Hadi, Ghandour, Lilian A, Ghasemi Nour, Mohammad, Ghashghaee, Ahmad, Ghozy, Sherief, Glozah, Franklin N, Glushkova, Ekaterina Vladimirovna, Godos, Justyna, Goel, Amit, Goharinezhad, Salime, Golechha, Mahaveer, Goleij, Pouya, Golitaleb, Mohamad, Greaves, Felix, Grivna, Michal, Grosso, Giuseppe, Gudayu, Temesgen Worku, Gupta, Bhawna, Gupta, Rajeev, Gupta, Sapna, Gupta, Veer Bala, Gupta, Vivek Kumar, Hafezi-Nejad, Nima, Haj-Mirzaian, Arvin, Hall, Brian J, Halwani, Rabih, Handiso, Tiilahun Beyene, Hankey, Graeme J, Hariri, Sanam, Haro, Josep Maria, Hasaballah, Ahmed I, Hassanian-Moghaddam, Hossein, Hay, Simon I, Hayat, Khezar, Heidari, Golnaz, Heidari, Mohammad, Hendrie, Delia, Herteliu, Claudiu, Heyi, Demisu Zenbaba, Hezam, Kamal, Hlongwa, Mbuzeleni Mbuzeleni, Holla, Ramesh, Hossain, Md Mahbub, Hossain, Sahadat, Hosseini, Seyed Kianoosh, Hosseinzadeh, Mehdi, Hostiuc, Mihaela, Hostiuc, Sorin, Hu, Guoqing, Huang, Junjie, Hussain, Salman, Ibitoye, Segun Emmanuel, Ilic, Irena M, Ilic, Milena D, Immurana, Mustapha, Irham, Lalu Muhammad, Islam, M Mofizul, Islam, Rakibul M, Islam, Sheikh Mohammed Shariful, Iso, Hiroyasu, Itumalla, Ramaiah, Iwagami, Masao, Jabbarinejad, Roxana, Jacob, Loui, Jakovljevic, Mihajlo, Jamalpoor, Zahra, Jamshidi, Elham, Jayapal, Sathish Kumar, Jayarajah, Umesh Umesh, Jayawardena, Ranil, Jebai, Rime, Jeddi, Seyed Ali, Jema, Alelign Tasew, Jha, Ravi Prakash, Jindal, Har Ashish, Jonas, Jost B, Joo, Tama, Joseph, Nitin, Joukar, Farahnaz, Jozwiak, Jacek Jerzy, Jürisson, Mikk, Kabir, Ali, Kabthymer, Robel Hussen, Kamble, Bhushan Dattatray, Kandel, Himal, Kanno, Girum Gebremeskel, Kapoor, Neeti, Karaye, Ibraheem M, Karimi, Salah Eddin, Kassa, Bekalu Getnet, Kaur, Rimple Jeet, Kayode, Gbenga A, Keykhaei, Mohammad, Khajuria, Himanshu, Khalilov, Rovshan, Khan, Imteyaz A, Khan, Moien AB, Kim, Hanna, Kim, Jihee, Kim, Min Seo, Kimokoti, Ruth W, Kivimäki, Mika, Klymchuk, Vitalii, Knudsen, Ann Kristin Skrindo, Kolahi, Ali-Asghar, Korshunov, Vladimir Andreevich, Koyanagi, Ai, Krishan, Kewal, Krishnamoorthy, Yuvaraj, Kumar, G Anil, Kumar, Narinder, Kumar, Nithin, Lacey, Ben, Lallukka, Tea, Lasrado, Savita, Lau, Jerrald, Lee, Sang-woong, Lee, Wei-Chen, Lee, Yo Han, Lim, Lee-Ling, Lim, Stephen S, Lobo, Stany W, Lopukhov, Platon D, Lorkowski, Stefan, Lozano, Rafael, Lucchetti, Giancarlo, Madadizadeh, Farzan, Madureira-Carvalho, Áurea M, Mahjoub, Soleiman, Mahmoodpoor, Ata, Mahumud, Rashidul Alam, Makki, Alaa, Malekpour, Mohammad-Reza, Manjunatha, Narayana, Mansouri, Borhan, Mansournia, Mohammad Ali, Martinez-Raga, Jose, Martinez-Villa, Francisco A, Matzopoulos, Richard, Maulik, Pallab K, Mayeli, Mahsa, Mcgrath, John J, Meena, Jitendra Kumar, Mehrabi Nasab, Entezar, Menezes, Ritesh G, Mensink, Gert B M, Mentis, Alexios-Fotios A, Meretoja, Atte, Merga, Bedasa Taye, Mestrovic, Tomislav, Miao Jonasson, Junmei, Miazgowski, Bartosz, Micheletti Gomide Nogueira de Sá, Ana Carolina, Miller, Ted R, Mini, Gk, Mirica, Andreea, Mirijello, Antonio, Mirmoeeni, Seyyedmohammadsadeq, Mirrakhimov, Erkin M, Misra, Sanjeev, Moazen, Babak, Mobarakabadi, Maryam, Moccia, Marcello, Mohammad, Yousef, Mohammadi, Esmaeil, Mohammadian-Hafshejani, Abdollah, Mohammed, Teroj Abdulrahman, Moka, Nagabhishek, Mokdad, Ali H, Momtazmanesh, Sara, Moradi, Yousef, Mostafavi, Ebrahim, Mubarik, Sumaira, Mullany, Erin C, Mulugeta, Beemnet Tekabe, Murillo-Zamora, Efrén, Murray, Christopher J L, Mwita, Julius C, Naghavi, Mohsen, Naimzada, Mukhammad David, Nangia, Vinay, Nayak, Biswa Prakash, Negoi, Ionut, Negoi, Ruxandra Irina, Nejadghaderi, Seyed Aria, Nepal, Samata, Neupane, Sudan Prasad Prasad, Neupane Kandel, Sandhya, Nigatu, Yeshambel T, Nowroozi, Ali, Nuruzzaman, Khan M, Nzoputam, Chimezie Igwegbe, Obamiro, Kehinde O, Ogbo, Felix Akpojene, Oguntade, Ayodipupo Sikiru, Okati-Aliabad, Hassan, Olakunde, Babayemi Oluwaseun, Oliveira, Gláucia Maria Morae, Omar Bali, Ahmed, Omer, Emad, Ortega-Altamirano, Doris V, Otoiu, Adrian, Otstavnov, Stanislav S, Oumer, Bilcha, P A, Mahesh, Padron-Monedero, Alicia, Palladino, Raffaele, Pana, Adrian, Panda-Jonas, Songhomitra, Pandey, Anamika, Pandey, Ashok, Pardhan, Shahina, Parekh, Tarang, Park, Eun-Kee, Parry, Charles D H, Pashazadeh Kan, Fatemeh, Patel, Jay, Pati, Siddhartha, Patton, George C, Paudel, Uttam, Pawar, Shrikant, Peden, Amy E, Petcu, Ionela-Roxana, Phillips, Michael R, Pinheiro, Marina, Plotnikov, Evgenii, Pradhan, Pranil Man Singh, Prashant, Akila, Quan, Jianchao, Radfar, Amir, Rafiei, Alireza, Raghav, Pankaja Raghav, Rahimi-Movaghar, Vafa, Rahman, Azizur, Rahman, Md Mosfequr, Rahman, Mosiur, Rahmani, Amir Masoud, Rahmani, Shayan, Ranabhat, Chhabi Lal, Ranasinghe, Priyanga, Rao, Chythra R, Rasali, Drona Prakash, Rashidi, Mohammad-Mahdi, Ratan, Zubair Ahmed, Rawaf, David Laith, Rawaf, Salman, Rawal, Lal, Renzaho, Andre M N, Rezaei, Negar, Rezaei, Saeid, Rezaeian, Mohsen, Riahi, Seyed Mohammad, Romero-Rodríguez, Esperanza, Roth, Gregory A, Rwegerera, Godfrey M, Saddik, Basema, Sadeghi, Erfan, Sadeghian, Reihaneh, Saeed, Umar, Saeedi, Farhad, Sagar, Rajesh, Sahebkar, Amirhossein, Sahoo, Harihar, Sahraian, Mohammad Ali, Saif-Ur-Rahman, Km, Salahi, Sarvenaz, Salimzadeh, Hamideh, Samy, Abdallah M, Sanmarchi, Francesco, Santric-Milicevic, Milena M, Sarikhani, Yaser, Sathian, Brijesh, Saya, Ganesh Kumar, Sayyah, Mehdi, Schmidt, Maria Inê, Schutte, Aletta Elisabeth, Schwarzinger, Michaël, Schwebel, David C, Seidu, Abdul-Aziz, Senthil Kumar, Nachimuthu, Seyedalinaghi, Seyedahmad, Seylani, Allen, Sha, Feng, Shahin, Sarvenaz, Shahraki-Sanavi, Fariba, Shahrokhi, Shayan, Shaikh, Masood Ali, Shaker, Elaheh, Shakhmardanov, Murad Ziyaudinovich, Shams-Beyranvand, Mehran, Sheikhbahaei, Sara, Sheikhi, Rahim Ali, Shetty, Adithi, Shetty, Jeevan K, Shiferaw, Damtew Solomon, Shigematsu, Mika, Shiri, Rahman, Shirkoohi, Reza, Shivakumar, K M, Shivarov, Velizar, Shobeiri, Parnian, Shrestha, Roman, Sidemo, Negussie Boti, Sigfusdottir, Inga Dora, Silva, Diego Augusto Santo, Silva, Natacha Torres da, Singh, Jasvinder A, Singh, Surjit, Skryabin, Valentin Yurievich, Skryabina, Anna Aleksandrovna, Sleet, David A, Solmi, Marco, Solomon, Yonatan, Song, Suhang, Song, Yimeng, Sorensen, Reed J D, Soshnikov, Sergey, Soyiri, Ireneous N, Stein, Dan J, Subba, Sonu Hangma, Szócska, Mikló, Tabarés-Seisdedos, Rafael, Tabuchi, Takahiro, Taheri, Majid, Tan, Ker-Kan, Tareke, Minale, Tarkang, Elvis Enowbeyang, Temesgen, Gebremaryam, Temesgen, Worku Animaw, Temsah, Mohamad-Hani, Thankappan, Kavumpurathu Raman, Thapar, Rekha, Thomas, Nikhil Kenny, Tiruneh, Chalachew, Todorovic, Jovana, Torrado, Marco, Touvier, Mathilde, Tovani-Palone, Marcos Roberto, Tran, Mai Thi Ngoc, Trias-Llimós, Sergi, Tripathy, Jaya Prasad, Vakilian, Alireza, Valizadeh, Rohollah, Varmaghani, Mehdi, Varthya, Shoban Babu, Vasankari, Tommi Juhani, Vos, Theo, Wagaye, Birhanu, Waheed, Yasir, Walde, Mandaras Tariku, Wang, Cong, Wang, Yanzhong, Wang, Yuan-Pang, Westerman, Ronny, Wickramasinghe, Nuwan Darshana, Wubetu, Abate Dargie, Xu, Suowen, Yamagishi, Kazumasa, Yang, Lin, Yesera, Gesila Endashaw E, Yigit, Arzu, Yiğit, Vahit, Yimaw, Ayenew Engida Ayenew Engida, Yon, Dong Keon, Yonemoto, Naohiro, Yu, Chuanhua, Zadey, Siddhesh, Zahir, Mazyar, Zare, Iman, Zastrozhin, Mikhail Sergeevich, Zastrozhina, Anasthasia, Zhang, Zhi-Jiang, Zhong, Chenwen, Zmaili, Mohammad, Zuniga, Yves Miel H, Gakidou, Emmanuela, Bryazka, D, Reitsma, Mb, Griswold, Mg, Abate, Kh, Abbafati, C, Kangevari, Ma, Kangevari, Za, Abdoli, A, Abdollahi, M, Abdullah, Am, Abhilash, E, Abu Gharbieh, E, Acuna, Jm, Addolorato, G, Adebayo, Om, Adekanmbi, V, Adhikari, K, Adhikari, S, Adnani, Qe, Afzal, S, Agegnehu, Wy, Aggarwal, M, Ahinkorah, Bo, Ahmad, Ar, Ahmad, S, Ahmad, T, Ahmadi, A, Ahmadi, S, Ahmed, H, Rashid, Ta, Akunna, Cj, Al Hamad, H, Alam, Mz, Alem, Dt, Alene, Ka, Alimohamadi, Y, Alizadeh, A, Allel, K, Alonso, J, Alvand, S, Guzman, Na, Amare, F, Ameyaw, Ek, Amiri, S, Ancuceanu, R, Anderson, Ja, Andrei, Cl, Andrei, T, Arabloo, J, Arshad, M, Artamonov, Aa, Aryan, Z, Asaad, M, Asemahagn, Ma, Burt, Ta, Athari, S, Atnafu, Dd, Atorkey, P, Atreya, A, Ausloos, F, Ausloos, M, Ayano, G, Ayanore, Ma, Ayinde, Oo, Mateos, Jla, Azadnajafabad, S, Azanaw, Mm, Khyavy, Ma, Jafari, Aa, Azzam, Ay, Badiye, Ad, Bagheri, N, Bagherieh, S, Bairwa, M, Bakkannavar, Sm, Bakshi, Rk, Balchut, Ah, Null, T, Barra, F, Barrow, A, Baskaran, P, Belo, L, Bennett, Da, Bensenor, Im, Bhagavathula, A, Bhala, N, Bhalla, A, Bhardwaj, N, Bhardwaj, P, Bhaskar, S, Bhattacharyya, K, Bhojaraja, V, Bintoro, B, Blokhina, Eae, Bodicha, Bba, Boloor, A, Bosetti, C, Braithwaite, D, Brenner, H, Briko, Ni, Brunoni, Ar, Butt, Za, Cao, C, Cao, Y, Cardenas, R, Carvalho, Af, Carvalho, M, Maia, Jmc, Castelpietra, G, de Araujo, Lfsc, Cattaruzza, M, Chakraborty, Pa, Charan, J, Chattu, Vk, Chaurasia, A, Cherbuin, N, Chu, Dt, Chudal, N, Chung, Sc, Churko, C, Ciobanu, Lg, Cirillo, M, Claro, Rm, Costanzo, S, Cowden, Rg, Criqui, Mh, Martins, Nc, Culbreth, Gt, Dachew, Ba, Dadras, O, Dai, Xc, Damiani, G, Dandona, L, Dandona, R, Daniel, Bd, Danielewicz, A, Gela, Jd, Davletov, K, de Araujo, Jap, de Sa, Ar, Debela, Sa, Dehghan, A, Demetriades, Ak, Molla, Md, Desai, R, Desta, Aa, da Silva, Dd, Diaz, D, Digesa, Le, Diress, M, Dodangeh, M, Dongarwar, D, Dorostkar, F, Dsouza, Hl, Duko, B, Duncan, Bb, Edvardsson, K, Ekholuenetale, M, Elgar, Fj, Elhadi, M, Elmonem, Ma, Endries, Ay, Eskandarieh, S, Etemadimanesh, A, Fagbamigbe, Af, Fakhradiyev, Ir, Farahmand, F, Farinha, Cse, Faro, A, Farzadfar, F, Fatehizadeh, A, Fauk, Nk, Feigin, Vl, Feldman, R, Feng, Xq, Fentaw, Z, Ferrero, S, Desideri, Lf, Filip, I, Fischer, F, Francis, Jm, Franklin, Rc, Gaal, Pa, Gad, Mm, Gallus, S, Galvano, F, Ganesan, B, Garg, T, Gebrehiwot, Mgd, Gebremeskel, Tg, Gebremichael, Ma, Gemechu, Tr, Getacher, L, Getachew, Me, Obsa, Ag, Getie, A, Ghaderi, A, Ghafourifard, M, Ghajar, A, Ghamari, Sh, Ghandour, La, Nour, Mg, Ghashghaee, A, Ghozy, S, Glozah, Fn, Glushkova, Ev, Godos, J, Goel, A, Goharinezhad, S, Golechha, M, Goleij, P, Golitaleb, M, Greaves, F, Grivna, M, Grosso, G, Gudayu, Tw, Gupta, B, Gupta, R, Gupta, S, Gupta, Vb, Gupta, Vk, Nejad, Nh, Mirzaian, Ah, Hall, Bj, Halwani, R, Handiso, Tb, Hankey, Gj, Hariri, S, Haro, Jm, Hasaballah, Ai, Moghaddam, Hh, Hay, Si, Hayat, K, Heidari, G, Heidari, M, Hendrie, D, Herteliu, C, Heyi, Dz, Hezam, K, Hlongwa, Mm, Holla, R, Hossain, Mm, Hossain, S, Hosseini, Sk, Hosseinzadeh, M, Hostiuc, M, Hostiuc, S, Hu, Gq, Huang, Jj, Hussain, S, Ibitoye, Se, Ilic, Im, Ilic, Md, Immurana, M, Irham, Lm, Islam, Mm, Islam, Rm, Islam, Sm, Iso, H, Itumalla, R, Iwagami, M, Jabbarinejad, R, Jacob, L, Jakovljevic, M, Jamalpoor, Z, Jamshidi, E, Jayapal, Sk, Jayarajah, Uu, Jayawardena, R, Jebai, R, Jeddi, Sa, Jema, At, Jha, Rp, Jindal, Ha, Jonas, Jb, Joo, T, Joseph, N, Joukar, F, Jozwiak, Jj, Jurisson, M, Kabir, A, Kabthymer, Rh, Kamble, Bd, Kandel, H, Kanno, Gg, Kapoor, N, Karaye, Im, Karimi, Se, Kassa, Bg, Kaur, Rj, Kayode, Ga, Keykhaei, M, Khajuria, H, Khalilov, R, Khan, Ia, Ab Khan, M, Kim, H, Kim, J, Kim, M, Kimokoti, Rw, Kivimaki, M, Klymchuk, V, Knudsen, Ak, Kolahi, Aa, Korshunov, Va, Koyanagi, A, Krishan, K, Krishnamoorthy, Y, Kumar, Ga, Kumar, N, Ben, Lacey, Lallukka, T, Lasrado, S, Lau, J, Lee, Sw, Lee, Wc, Lee, Yh, Lim, Ll, Lim, S, Lobo, Sw, Lopukhov, Pd, Lorkowski, S, Lozano, R, Lucchetti, G, Madadizadeh, F, Mahjoub, S, Mahmoodpoor, A, Mahumud, Ra, Makki, A, Malekpour, Mr, Manjunatha, N, Mansouri, B, Mansournia, Ma, Raga, Jm, Villa, Fam, Matzopoulos, R, Maulik, Pk, Mayeli, M, Mcgrath, Jj, Meena, Jk, Nasab, Em, Menezes, Rg, Mensink, Gbm, Mentis, Afa, Meretoja, A, Merga, Bt, Mestrovic, T, Jonasson, Jm, Miazgowski, B, de Sa, Acmgn, Miller, Tr, Mini, G, Mirica, A, Mirijello, A, Mirmoeeni, S, Mirrakhimov, Em, Misra, S, Moazen, B, Mobarakabadi, M, Moccia, M, Mohammad, Y, Mohammadi, E, Hafshejani, Am, Mohammed, Ta, Moka, N, Mokdad, Ah, Momtazmanesh, S, Moradi, Y, Mostafavi, E, Mubarik, S, Mullany, Ec, Mulugeta, Bt, Zamora, Em, Murray, Cjl, Mwita, Jc, Naghavi, M, Naimzada, Md, Nangia, V, Nayak, Bp, Negoi, I, Negoi, Ri, Nejadghaderi, Sa, Nepal, S, Neupane, Spp, Kandel, Sn, Nigatu, Yt, Nowroozi, A, Nuruzzaman, Km, Nzoputam, Ci, Obamiro, Ko, Ogbo, Fa, Oguntade, A, Aliabad, Ho, Olakunde, Bo, Oliveira, Gmm, Bali, Ao, Omer, E, Altamirano, Dvo, Otoiu, A, Otstavnov, S, Oumer, B, Mahesh, Pa, Monedero, Ap, Palladino, R, Pana, A, Jonas, Sp, Pandey, A, Pardhan, S, Parekh, T, Park, Ek, Parry, Cdh, Kan, Fp, Patel, J, Pati, S, Patton, Gc, Paudel, U, Pawar, S, Peden, Ae, Petcu, Ir, Phillips, Mr, Pinheiro, M, Plotnikov, E, Pradhan, Pm, Prashant, A, Quan, Jc, Radfar, A, Rafiei, A, Raghav, Pr, Movaghar, Vr, Rahman, A, Rahman, Mm, Rahman, M, Rahmani, Am, Rahmani, S, Ranabhat, Cl, Ranasinghe, P, Rao, Cr, Rasali, Dp, Rashidi, Mm, Ratan, Za, Rawaf, Dl, Rawaf, S, Rawal, L, Renzaho, Amn, Rezaei, N, Rezaei, S, Rezaeian, M, Riahi, Sm, Rodriguez, Er, Roth, Ga, Rwegerera, Gm, Saddik, B, Sadeghi, E, Sadeghian, R, Saeed, U, Saeedi, F, Sagar, R, Sahebkar, A, Sahoo, H, Sahraian, Ma, Rahman, Ksu, Salahi, S, Salimzadeh, H, Samy, Am, Sanmarchi, F, Milicevic, Mm, Sarikhani, Y, Sathian, B, Saya, Gk, Sayyah, M, Schmidt, Mi, Schutte, Ae, Schwarzinger, M, Schwebel, Dc, Seidu, Aa, Seyedalinaghi, S, Seylani, A, Sha, F, Shahin, S, Sanavi, F, Shahrokhi, S, Shaikh, Ma, Shaker, E, Shakhmardanov, Mz, Beyranvand, M, Sheikhbahaei, S, Sheikhi, Ra, Shetty, A, Shetty, Jk, Shiferaw, D, Shigematsu, M, Shiri, R, Shirkoohi, R, Shivakumar, Km, Shivarov, V, Shobeiri, P, Shrestha, R, Sidemo, Nb, Sigfusdottir, Id, Silva, Da, da Silva, Nt, Singh, Ja, Singh, S, Skryabin, Vy, Skryabina, Aa, Sleet, Da, Solmi, M, Solomon, Y, Song, S, Song, Ym, Sorensen, Rjd, Soshnikov, S, Soyiri, In, Stein, Dj, Subba, Sh, Szocska, M, Seisdedos, Rt, Tabuchi, T, Taheri, M, Tan, Kk, Tareke, M, Tarkang, Ee, Temesgen, G, Temesgen, Wa, Temsah, Mh, Thankappan, Kr, Thapar, R, Thomas, Nk, Tiruneh, C, Todorovic, J, Torrado, M, Touvier, M, Palone, Mrt, Tran, Mtn, Llimos, St, Tripathy, Jp, Vakilian, A, Valizadeh, R, Varmaghani, M, Varthya, Sb, Vasankari, Tj, Vos, T, Wagaye, B, Waheed, Y, Walde, Mt, Wang, C, Wang, Yz, Wang, Yp, Westerman, R, Wickramasinghe, Nd, Wubetu, Ad, Xu, S, Yamagishi, K, Yang, L, Yesera, Gee, Yigit, A, Yimaw, Ae, Yon, Dk, Yonemoto, N, Yu, Ch, Zadey, S, Zahir, M, Zare, I, Zastrozhin, M, Zastrozhina, A, Zhang, Zj, Zhong, Cw, Zmaili, M, Zuniga, Ymh, Gakidou, E, Madureira-Carvalho, Am, Ciobanu, LG, Gakidou, Emma, and GBD 2020 Alcohol Collaborators

Subjects
Adult, Male, Alcohol Drinking, CONTROL POLICIES, adult, Child, Preschool, Female, Geography, Global Burden of Disease, Global Health, Humans, Middle Aged, Quality-Adjusted Life Years, Risk Factors, NDAS, ALL-CAUSE, GUIDELINES, GBD 2020 Alcohol Collaborators, COST-EFFECTIVENESS, Medicine, General & Internal, DRINKING, SDG 3 - Good Health and Well-being, RA0421, General & Internal Medicine, Quality-Adjusted Life Year, RA0421 Public health. Hygiene. Preventive Medicine, DRINKERS, Child, Preschool, 11 Medical and Health Sciences, METAANALYSIS, MCC, Science & Technology, global burden of disease, Risk Factor, General Medicine, CANCER, alcohol drinking, AC, 3121 General medicine, internal medicine and other clinical medicine, REDUCED MORTALITY, Life Sciences & Biomedicine, Human
Abstract

Background: The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods: For this analysis, we constructed burden-weighted dose-response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15-95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings: The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15-39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0-0) and 0·603 (0·400-1·00) standard drinks per day, and the NDE varied between 0·002 (0-0) and 1·75 (0·698-4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0-0·403) to 1·87 (0·500-3·30) standard drinks per day and an NDE that ranged between 0·193 (0-0·900) and 6·94 (3·40-8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3-65·4) were aged 15-39 years and 76·9% (73·0-81·3) were male. Interpretation: There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. Research reported in this publication was supported by the Bill & Melinda Gates Foundation. S Afzal acknowledges the support for intellectual contributions to this manuscript by the Department of Community Medicine and Epidemiology at King Edward Medical University, Lahore, Pakistan. T Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. L Belo acknowledges support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. D Bennett is supported by the UK Medical Research Council Population Health Research Unit at the University of Oxford (Oxford, UK). M Carvalho acknowledges support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. L Castro-de-Araujo was funded by the Medical Research Council (UK), Grant no. MR/T03355X/1 and by the National Institute of Mental Health Grant no. R01MH128911. FJ Elgar is supported by the Canada Research Chairs program. F Greaves acknowledges support from the NIHR Applied Research Collaboration for NW London. V K Gupta acknowledges funding support from the National Health and Medical Research Council (NHMRC), Australia. VB Gupta acknowledges funding support from the National Health and Medical Research Council (NHMRC), Australia. C Herteliu is partially supported by a grant from the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. C Herteliu is partially supported by a grant from the Romanian Ministry of Research Innovation and Digitalization, MCID, project number ID-585-CTR-42-PFE-2021. S Hussain was supported by the Operational Programme Research, Development and Education –Project, Postdoc2MUNI “(No. CZ.02.2.69/0.0/0.0/18_053/0016952). S M S Islam is funded by the National Health and Medical Research Council and received funding from the National Heart Foundation of Australia. The Serbian part of this GBD-related contribution has been co-financed through Grant OI 175 014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. M Kivimaki was supported by the Wellcome Trust (221854/Z/20/Z), the UK Medical Research Council (MR/S011676/1), the US National Institute on Aging (R01AG056477), and the Academy of Finland (350426). K Krishan is supported by the UGC Centre of Advanced Study (Phase II), awarded to the Department of Anthropology, Panjab University, Chandigarh, India. B Lacey acknowledges support from the UK Biobank, funded largely by the UK Medical Research Council and Wellcome. S Lorkowski acknowledges institutional support from the Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig (Germany; German Federal Ministry of Education and Research; grant agreement number 01EA1808A). G Lucchetti received a productivity scholarship from the Brazilian National Council for Scientific and Technological Development — CNPq (Level 1D). J McGrath was supported by the Danish National Research Foundation (Niels Bohr Professor). J McGrath is employed by the Queensland Centre for Mental Health Research (Australia), which receives support from the Queensland Health Department. C Parry acknowleges the South African Medical Research Council. A Peden is supported by a National Health and Medical Research Council Emerging Leadership Fellowship (Grant ID: APP2009306). M R Phillips was supported in part by the Global Alliance for Chronic Diseases - National Natural Science Foundation of China (NSFC. No. 81761128031). M Pinheiro acknowledges FCT for funding through program DL 57/2016 – Norma transitória. A Rahman acknowledges the support from the Data Science Research Unit in Charles Sturt University (Bathurst, NSW, Australia). U Saeed would like to acknowledge the International Center of Medical Sciences Research (ICMSR), Islamabad, Pakistan. A M Samy acknowledges support from Ain Shams University (Cairo, Egypt) and the Egyptian Fulbright Mission Program. N Senthil Kumar acknowledges the DBT, New Delhi sponsored Advanced State Level Biotech Hub (BT/NER/143/SP44475/2021), Mizoram University (Aizawl, Mizoram, India) for facilitating this work. F Sha is supported by the Shenzhen Science and Technology Program (Grant No. KQTD20190929172835662). A Shetty acknowledges Kasturba Medical College (Mangalore, India) and Manipal Academy of Higher Education (Manipal, India) for all the academic support. R Shrestha acknowledges a career development award from the National Institutes of Health (K01DA051346). D Silva was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brazil (CAPES)-Finance Code 001 and is supported in part by CNPq - Brazil (309589/2021-5). D Sleet acknowledges partial support from Veritas Management Group, Inc and The Bizzell Group, LLC. S Trias-Llimós acknowledges research funding from the Juan de la Cierva-Formación program of the Spanish Ministry of Science and Innovation (FJC-2019-039314-I). Sí

Published
2022

33. Intimate Partner Abuse Among Rohingya Women and Its Relationship With Their Abilities to Reject Husbands’ Advances to Unwanted Sex

Author

M. Mofizul Islam, Nuruzzaman Khan, and Mashiur Rahman

Subjects
Adult, Bangladesh, Refugees, 030505 public health, Refugee Camps, Intimate partner abuse, Refugee, Coitus, Intimate Partner Violence, Criminology, Displacement (psychology), Young Adult, 03 medical and health sciences, Clinical Psychology, 0302 clinical medicine, Humans, Domestic violence, Female, 030212 general & internal medicine, Spouses, 0305 other medical science, Psychology, Applied Psychology
Abstract

Currently, around a million Rohingya refugees live in Cox’s Bazar, Bangladesh. Displacement from homelands and restrictions on movement in the refugee camps may exacerbate intimate partner abuse (IPA) against refugee women and their abilities to reject husbands’ advances to unwanted sex. This study examines Rohingya refugee women’s attitudes toward and experience of intimate partner abuse (IPA) and their impact on the abilities to reject husbands’ advances to unwanted sex. A survey was conducted among Rohingya refugee women in Cox’s Bazar, Bangladesh. Women’s attitudes toward IPA, and experience of IPA were the exposure variables. Women’s abilities to say “no” to husbands’ advances to unwanted sexual intercourse was the outcome variable. Multivariable logistic regression models were used to examine the relationships. Participants’ median age was 22 years (range: 13-41). Most women perceived hitting/beatings by their husbands in certain situations as justifiable, 72% had experienced such abuse and 56.5% had to engage in unwanted sexual intercourse with their husbands. Women with increasing leniency towards hitting/beatings and those who had experienced such abuse were less likely to be able to say “no” to husbands’ advances to unwanted sexual intercourse. Rohingya women’s attitudes toward and experience of IPA are associated with their abilities to say “no” to husbands’ advances to unwanted sex. Intervention is needed to denormalize the current practice of IPA, create awareness against IPA, and ensure formal education for girls.

Published
2021

34. Access to female contraceptives by Rohingya refugees, Bangladesh

Author

Mostafizur Rahman, Nuruzzaman Khan, M. Mofizul Islam, and Mashiur Rahman

Subjects
Bangladesh, Refugees, Pregnancy, Age at first marriage, business.industry, Research, Refugee, 030231 tropical medicine, Public Health, Environmental and Occupational Health, Odds ratio, medicine.disease, Logistic regression, Confidence interval, Female contraceptives, 03 medical and health sciences, Cross-Sectional Studies, 0302 clinical medicine, Family planning, Contraceptive Agents, Female, Prevalence, medicine, Humans, Female, business, Demography
Abstract

To determine the prevalence of the use of contraceptives among female Rohingya refugees in Bangladesh and its associated factors.We conducted our cross-sectional survey at the Kutupalong refugee facility located in Cox's Bazar in November 2019. We used univariable and multivariable logistic regression models to determine the association between the use of contraceptives and our various predictor variables, including women's age, age at first marriage, education level and employment status. We also considered factors such as whether previous pregnancies were planned or unplanned, and the occurrence of non-consensual sex with husbands.We found that 50.91% (251/493) of the survey participants used contraceptives, and that injection (169/251; 67.33%) and oral contraceptives (75/251; 29.88%) were the predominant modes. Of the women who did not use contraceptives, the main reasons were reported as disapproval by husbands (118/242; 48.76%), actively seeking a pregnancy (42/242; 17.36%) and religious beliefs (37/242; 15.29%). An increased likelihood of using contraceptives was found to be positively associated with women's employment outside their households (odds ratio, OR: 3.11; 95% confidence interval, CI: 1.69-6.11) and the presence of a health-care centre in the camp (OR: 3.92; 95% CI: 2.01-7.67). Women who reported an unplanned pregnancy during the previous 2 years were less likely to use contraceptives (OR: 0.02; 95% CI: 0.01-0.05).To increase the acceptance and use of contraceptives, we recommend programmes targeted at women of reproductive age and their husbands, religious and community leaders, and providers of family planning and child and maternal health-care services.Déterminer la fréquence d'utilisation de contraceptifs chez les femmes Rohingya réfugiées au Bangladesh, ainsi que les facteurs qui y sont associés.Nous avons mené notre enquête transversale au sein du camp de réfugiés de Kutupalong, dans le district de Cox's Bazar, en novembre 2019. Nous avons employé des modèles de régression logistique univariée et multivariée pour identifier le lien entre le recours aux contraceptifs et nos différentes variables prédictives: âge des femmes, âge lors du premier mariage, niveau d'éducation et situation professionnelle. Enfin, nous avons tenu compte de divers facteurs, notamment le fait que les précédentes grossesses aient été planifiées ou pas, et l'existence de rapports sexuels non consentis avec le mari.Nous avons constaté que 50,91% (251/493) des participantes à l'enquête prenaient des contraceptifs, et que les contraceptifs injectables (169/251; 67,33%) et oraux (75/251; 29,88%) étaient les plus répandus. Chez les femmes qui ne prenaient aucun contraceptif, les principales raisons invoquées étaient la désapprobation du mari (118/242; 48,76%), la volonté de concevoir un enfant (42/242; 17,36%) et les croyances religieuses (37/242; 15,29%). La probabilité de recourir à des contraceptifs augmentait lorsque les femmes exerçaient un emploi hors de leur foyer (odds ratio, OR: 3,11; intervalle de confiance de 95%, IC: 1,69–6,11) et lorsqu'un centre médical était présent dans le camp (OR: 3,92; IC de 95%: 2,01-7,67). Les femmes ayant signalé une grossesse non planifiée au cours des deux dernières années étaient moins susceptibles d'utiliser des contraceptifs (OR: 0,02; IC de 95%: 0,01-0,05).Afin que les contraceptifs soient mieux acceptés et employés, nous recommandons d'opter pour des programmes ciblant les femmes en âge de procréer et leur mari, les autorités religieuses et responsables communautaires, ainsi que les prestataires de services de planification familiale, de santé infantile et de santé maternelle.Determinar la prevalencia del uso de anticonceptivos entre las refugiadas rohingya de Bangladesh y sus factores conexos.Realizamos nuestra encuesta transversal en el centro de refugiados de Kutupalong en Cox's Bazar en noviembre de 2019. Utilizamos modelos de regresión logística univariables y multivariables para determinar la asociación entre el uso de anticonceptivos y nuestras diversas variables de predicción, incluyendo la edad de las mujeres, la edad del primer matrimonio, el nivel de educación y la situación laboral. También consideramos factores tales como si los embarazos anteriores fueron planificados o no, y la existencia del acto sexual no consensuado entre el matrimonio.Comprobamos que el 50,91% (251/493) de los participantes en la encuesta utilizaban anticonceptivos, y que la modalidad predominante era los anticonceptivos inyectados (169/251; 67,33%) y orales (75/251; 29,88%). De las mujeres que no utilizaron anticonceptivos, las principales razones fueron la desaprobación de los maridos (118/242; 48,76%), la búsqueda activa de un embarazo (42/242; 17,36%) y las creencias religiosas (37/242; 15,29%). Descubrimos que la mayor probabilidad de utilizar anticonceptivos estaba positivamente asociada con el empleo de las mujeres fuera de sus hogares (proporción de probabilidades, RM: 3,11; intervalo de confianza del 95%, IC: 1,69-6,11) y con la presencia de un centro de salud en el campamento (RM: 3,92; IC del 95%: 2,01-7,67). Las mujeres que informaron de un embarazo no planificado durante los dos años anteriores tenían menos probabilidades de utilizar anticonceptivos (RM: 0,02; IC del 95%: 0,01-0,05).Para aumentar la aceptación y el uso de los anticonceptivos, recomendamos programas dirigidos a las mujeres en edad de procrear y a sus maridos, a los dirigentes religiosos y comunitarios, así como a los proveedores de servicios de planificación familiar y de atención sanitaria maternoinfantil.الغرض تحديد مدى انتشار استخدام موانع الحمل بين لاجئات الروهينجا في بنغلاديش، والعوامل المرتبطة بذلك. الطريقة أجرينا مسحًا متعدد القطاعات في مرفق كوتوبالونغ للاجئين الواقع في كوكس بازار في نوفمبر/تشرين ثان 2019. استخدمنا نماذج التحوف اللوجيستي أحادية المتغير ومتعددة المتغيرات لتحديد الارتباط بين استخدام موانع الحمل ومتغيراتنا التنبؤية المتنوعة، بما في ذلك عمر المرأة، والعمر عند أول زواج، والمستوى التعليمي، والوضع الوظيفي. كما أخذنا في الاعتبار أيضًا عوامل مثل ما إذا كانت حالات الحمل السابقة مخطط لها أم غير مخطط لها، وممارسة الجنس مع الأزواج من غير موافقة. النتائج وجدنا أن 50.91% (251/493) من المشاركين في المسح استخدموا موانع الحمل، وأن الحقن (169/251؛ 67.33%)، ووسائل منع الحمل عن طريق الفم (75/251؛ 29.88%) كانت هي السائدة. وفقًا للنساء اللاتي لم يستخدمن وسائل منع الحمل، كانت الأسباب الرئيسية المبلغ عنها رفض الأزواج (118/242؛ 48.76%)، والسعي بنشاط للحمل (42/242؛ 17.36%)، والمعتقدات الدينية (37/242 ؛ 15.29٪). تم اكتشاف أن الاحتمالية المتزايدة لاستخدام وسائل موانع الحمل مرتبطة بشكل إيجابي بتوظيف النساء خارج أسرهن (نسبة الاحتمالات: 3.11؛ فاصل الثقة 95%: 1.69 إلى 6.11) ووجود مركز للرعاية الصحية في المخيم (نسبة الاحتمالات: 3.92؛ ‏بفاصل ثقة 95%: 2.01–7.67). كانت النساء اللاتي أبلغن عن حمل غير مخطط له خلال العامين الماضيين أقل احتمالية لاستخدام وسائل مانع الحمل (نسبة الاحتمالات: 0.02؛ ‏بفاصل ثقة 95%: 0.01–0.05). الاستنتاج لزيادة قبول واستخدام وسائل موانع الحمل، نحن نوصي بالبرامج التي تستهدف النساء في سن الإنجاب وأزواجهن، والزعماء الدينيين والمجتمعيين، ومقدمي خدمات تنظيم الأسرة وخدمات رعاية صحة الطفل والأم.确定孟加拉国罗兴亚女性难民避孕药具的使用情况及其相关因素。.2019 年 11 月，我们在考克斯巴扎尔的库图帕朗难民机构开展了横向调查。我们使用单变量和多变量逻辑回归模型，来确定避孕药具的使用与各种预测变量之间的关联，包括妇女的年龄、初婚年龄、受教育程度和就业状况。我们还考虑了一些因素，譬如，之前怀孕是有计划的还是无计划的，以及是否与丈夫发生了非自愿的性行为。.我们发现，有 50.91% (251/493) 的调查参与者使用了避孕药具，其中避孕针剂 (169/251; 67.33%) 和口服避孕药 (75/251; 29.88%) 是主要避孕方式。据报告，有些妇女没有使用避孕药具的主要原因是丈夫不赞成 (118/242; 48.76%)、积极寻求怀孕 (42/242; 17.36%) 和受宗教信仰影响 (37/242; 15.29%)。我们发现，使用避孕药具的可能性与妇女在家庭之外的就业情况（优势比，OR: 3.11; 95％ 置信区间，CI: 1.69–6.11）以及营地是否设有保健中心 (OR: 3.92; 95％ CI: 2.01-7.67) 呈正相关。在过去两年中，报告计划外怀孕的妇女使用避孕药具的可能性较小 (OR: 0.02; 95% CI: 0.01–0.05)。.为了提高避孕药具的接受率和使用率，我们建议针对育龄妇女及其丈夫、宗教和社区领袖，以及计划生育和妇幼保健服务提供者制定相关方案。.Определить распространенность применения противозачаточных средств среди беженок рохинджа в Бангладеш и связанные с этим факторы.В ноябре 2019 года авторы провели перекрестно-групповое исследование в центре для беженцев Кутупалонг, расположенном в Кокс-Базаре. Авторы использовали однофакторные и многофакторные модели логистической регрессии, чтобы определить связь между применением противозачаточных средств и различными прогностическими переменными, включая возраст женщин, возраст вступления в первый брак, уровень образования и статус занятости. Мы также рассмотрели такие факторы, как запланированные или незапланированные предыдущие беременности, а также наличие секса с мужьями без обоюдного согласия.Мы установили, что 50,91% (251/493) участников опроса применяли противозачаточные средства и что преобладающим методом были инъекции (169/251; 67,33%) и оральные контрацептивы (75/251; 29,88%). Среди женщин, которые не пользовались противозачаточными средствами, основными причинами были неодобрение со стороны мужей (118/242; 48,76%), активное стремление забеременеть (42/242; 17,36%) и религиозные убеждения (37/242; 15,29%). Было обнаружено, что повышенная вероятность применения противозачаточных средств положительно связана с занятостью женщин за пределами своей семьи (отношение шансов, ОШ: 3,11; 95%-й ДИ: 1,69–6,11) и наличием медицинского учреждения в лагере (ОШ: 3,92; 95%-й ДИ: 2,01–7,67). Женщины, сообщившие о незапланированной беременности в течение предыдущих 2 лет, реже применяли противозачаточные средства (ОШ: 0,02; 95%-й ДИ: 0,01–0,05).С целью повышения уровня принятия и применения противозачаточных средств рекомендуется проведение программ, ориентированных на женщин репродуктивного возраста и их мужей, религиозных и местных общественных деятелей, а также поставщиков услуг по планированию семьи и охране здоровья матери и ребенка.

Published
2021

35. Bacterial resistance to antibiotics: access, excess, and awareness in Bangladesh

Author

M. Mofizul Islam

Subjects
0301 basic medicine, Microbiology (medical), medicine.medical_specialty, medicine.drug_class, 030106 microbiology, Antibiotics, Inappropriate Prescribing, Microbiology, 03 medical and health sciences, 0302 clinical medicine, Antibiotic resistance, Virology, Drug Resistance, Bacterial, medicine, Animals, Humans, 030212 general & internal medicine, Practice Patterns, Physicians', Intensive care medicine, Bangladesh, business.industry, Public health, Bacterial Infections, Anti-Bacterial Agents, Infectious Diseases, business
Abstract

Introduction: Antibiotic resistance is a substantial cause of mortality, morbidity burden in Bangladesh. In this perspective piece, the problem of antibiotic resistance has been analyzed by critica...

Published
2020

36. Trends and Variations in Concurrent Dispensing of Prescription Opioids and Benzodiazepines in Australia: A Retrospective Analysis

Author

Dennis Wollersheim and M. Mofizul Islam

Subjects
medicine.medical_specialty, Benzodiazepine, Health (social science), business.industry, medicine.drug_class, Health Policy, Public Health, Environmental and Occupational Health, Health outcomes, Opioid, Emergency medicine, Retrospective analysis, Medicine, Medical prescription, business, Law, medicine.drug
Abstract

Objective: Concurrent use of opioids and benzodiazepines may cause a range of adverse health outcomes including fatal overdose. However, little is known about levels of concurrent use and its variation across jurisdictions. This study examined the population-level prevalence of concurrent use in Australia. Methods: We analyzed a 10% sample of unit record data of prescription opioids and benzodiazepines dispensed between January 2013 and December 2016. Using dispensing dates and days of supply in terms of defined daily dose (DDD), the concurrent users were identified as those for whom the supply in DDD quantity for one medicine overlapped with the supply day of the other. Multivariable and multilevel regression models were developed. Results: During the 4 years, almost a million (12.41% of 7.96 million) individuals were identified as concurrent users. Significantly more women were concurrent users than men across all age groups. On average, 1,750 per 100,000 people were concurrent users per year. There was substantial variation in the yearly average of concurrent users across jurisdictions, ranging from less than 1 to 5,400 per 100,000 people (standardized). Much of this variation was attributed to individual-level circumstances rather than structural factors. Conclusion: Concurrent use of opioid and benzodiazepine was common in Australia. There was considerable variation across jurisdictions in terms of the number of concurrent users. Women, older people, or those living in socioeconomically disadvantaged areas were dominant groups of concurrent users. Further research is needed to examine the precise reasons for concurrent use.

Published
2020

37. Estimating global injuries morbidity and mortality

Author

Zohreh Arefi, Rasmus Havmoeller, Pietro Ferrara, Vijay Kumar Chattu, Payman Salamati, Agegnehu Bante Getenet, Seyedeh Zahra Masoumi, Alexander C. Tsai, Andrew T Olagunju, Carl Abelardo T. Antonio, Morteza Abdullatif Khafaie, Tim Driscoll, Reza Rawassizadeh, Vishnu Renjith, Taras Kavetskyy, Ejaz Ahmad Khan, Gebreamlak Gebremedhn Gebremeskel, Richard C. Franklin, Naznin Hossain, Bhaskaran Unnikrishnan, Fariborz Mansour-Ghanaei, Arash Tehrani-Banihashemi, Morteza Naserbakht, Sangram Kishor Patel, Vera Marisa Costa, Suzanne Polinder, Ziad El-Khatib, Ashish Pathak, Mika Shigematsu, Bryan L. Sykes, David M. Pigott, Zeleke Aschalew Melketsedik, Hadi Hassankhani, Nuworza Kugbey, Lal B. Rawal, Masoud Foroutan, Dejana Braithwaite, Muluken Bekele Sorrie, Grant M. A. Wyper, Joht Singh Chandan, Akbar Barzegar, Hamid Safarpour, Kate E. LeGrand, Giulio Castelpietra, Dina Nur Anggraini Ningrum, Seth Christopher Yaw Appiah, Amin Soheili, Azeem Majeed, Akshaya Srikanth Bhagavathula, Nikolay Ivanovich Briko, Vahid Yazdi-Feyzabadi, Walter Mendoza, Ghulam Mustafa, Cuong Tat Nguyen, Pengpeng Ye, Mahesh P A, Carlos Miguel Rios González, Ahmad Daryani, Ibrahim Abdollahpour, Masoud Moradi, Haileab Fekadu Wolde, Mohammad Rabiee, Jaya Prasad Tripathy, Jack T Fox, Diep Ngoc Nguyen, Pallab K. Maulik, Ai-Min Wu, Félix Carvalho, Yun Jin Kim, Fatemeh Rajati, Nathaniel J Henry, David C. Schwebel, Ali H. Mokdad, Akine Eshete Abosetugn, Leonardo Roever, Ketema Bizuwork Gebremedhin, Khalid A Altirkawi, Hayimro Edemealem Merie, Farhad Ghamari, Ramesh Holla, Arash Sarveazad, Devasahayam J. Christopher, Kedir Hussein Abegaz, Suresh Jungari, Rohan Borschmann, Irfan Ullah, Nitin Joseph, Catalina Liliana Andrei, Abdallah M. Samy, Roman Topor-Madry, Michal Grivna, Ivo Rakovac, Mohammad Zamani, Antonio Maria Borzì, Atif Amin Baig, Mohsen Bayati, Mohammad Ali Mansournia, Fatemeh Heydarpour, Juanita A. Haagsma, Segun Emmanuel Ibitoye, Mehdi Sayyah, Teshome Abegaz Kamil, Fakher Rahim, Dillon O Sylte, Feng Sha, Palash Chandra Banik, Mohan Bairwa, Mariya Vladimirovna Titova, Yong Yu, Delia Hendrie, Spencer L. James, Anusha Ganapati Bhat, Seok Jun Yoon, Siavash Rahimi, Jost B. Jonas, Michael R. Phillips, Diana Silva, Amir Hossein Goudarzian, Samath D Dharmaratne, Roba Khundkar, Jemal Abdu Mohammed, Joemer C. Maravilla, Eleonora Dubljanin, Arun Balachandran, Arman Latifi, Randah R. Hamadeh, G. K. Mini, Alessandra C. Goulart, Andreea Mirica, Fatemeh Zarei, Habte Belete, Telma Zahirian Moghadam, Maseer Khan, Morenike Oluwatoyin Folayan, Atte Meretoja, Jasvinder A. Singh, Guilherme Borges, Yasir Waheed, Fahad Alanezi, Masoud Moghadaszadeh, Guoqing Hu, Archith Boloor, Luca Ronfani, Olayinka Stephen Ilesanmi, Vahid Rashedi, Mehran Shams-Beyranvand, Trang Huyen Nguyen, Yonatal Mesfin Tefera, Yousef Khader, Adnan Kisa, Simon I. Hay, Takeshi Fukumoto, Shahrzad Bazargan-Hejazi, Yuichiro Yano, Carlos A Castañeda-Orjuela, Suzanne Barker-Collo, Ghasem Azarian, Sezer Kisa, Basema Saddik, Leake Gebremeskel, Yetunde O. John-Akinola, Jennifer Rickard, Ilais Moreno Velásquez, Priya Rathi, Ali Bijani, Smita Pakhale, Francesco Saverio Violante, Neeraj Bedi, Efat Mohamadi, Deborah Carvalho Malta, Marek Majdan, Feleke Mekonnen Demeke, Chukwudi A Nnaji, Richard Ofori-Asenso, Prateek Rastogi, Xuefeng Liu, Monika Sawhney, Ayman Grada, Prasanna Mithra, Shanshan Li, Masood Ali Shaikh, Erin B Hamilton, Hung Chak Ho, Zichen Liu, Irini Chatziralli, Paulo A. Lotufo, Yuming Guo, Daniel N. Kiirithio, Hamidreza Komaki, Aristidis Tsatsakis, Brijesh Sathian, Daniel Kim, Yoosik Youm, Kebreab Paulos, Saqib Ali, Beriwan Abdulqadir Ali, M. Mofizul Islam, Ahad Bakhtiari, Karen M. Tabb, Davood Anvari, Tomislav Mestrovic, Yunquan Zhang, Muhammad Aziz Rahman, Naohiro Yonemoto, Rupak Desai, Peter Njenga Keiyoro, Rajan Nikbakhsh, Zahra Sadat Dibaji Forooshani, Carlo La Vecchia, Amrit Banstola, Niguse Meles Alema, Shivakumar K.M. Kondlahalli, Soraya Seedat, Filippo Ariani, Chi Linh Hoang, Maziar Moradi-Lakeh, Erika Ota, Dimas Ria Angga Pribadi, Van C. Lansingh, Mohammed Madadin, Mostafa Dianati Nasab, Biniyam Sahiledengle Geberemariyam, Amanda J. Mason-Jones, Marcela Agudelo-Botero, Dinh-Toi Chu, Bach Xuan Tran, Till Bärnighausen, Mehdi Mirzaei-Alavijeh, Mohammad Ali Jahani, Bereket Duko Adema, In-Hwan Oh, Paul S. F. Yip, Ionut Negoi, Eduarda Fernandes, Reza Ghanei Gheshlagh, Kelly Jones, Mahdi Safdarian, Josep Maria Haro, Zahiruddin Quazi Syed, Diego De Leo, Khanh Bao Tran, Syed Mohamed Aljunid, Yasser S. Amer, Tommi Vasankari, Vasily Vlassov, Jose C. Adsuar, Zoubida Zaidi, Asadollah Gholamian, Theo Vos, Nauman Khalid, Malke Asaad, André Faro, Rushdia Ahmed, Tuomo J. Meretoja, Ireneous N. Soyiri, Ana Isabel Ribeiro, Hoa Thi Do, Temesgen Gebeyehu Wondmeneh, Vladimir Andreevich Korshunov, Manasi Kumar, Josip Car, Shoaib Hassan, Mukhammad David Naimzada, Gurudatta Naik, Ali Rajabpour-Sanati, Mustafa Z. Younis, Farid Najafi, Ester Cerin, Lorenzo Monasta, Amit Arora, Rizwan Suliankatchi Abdulkader, Huong Lan Thi Nguyen, Javad Nazari, Joel M. Francis, Martin Amogre Ayanore, Farahnaz Joukar, Babak Moazen, Kebede Deribe, Nithin Kumar, Seyed-Mohammad Fereshtehnejad, Getinet Ayano, Serge Resnikoff, Mark A. Stokes, Alaa Badawi, Narinder Kumar, Habibolah Khazaie, Sojib Bin Zaman, Faris Lami, Jens R. Chapman, Onome Bright Oghenetega, Dhirendra N Sinha, Engida Yisma, Aso Mohammad Darwesh, Demelash Abewa Elemineh, Junaid Khan, Shane D. Morrison, Mansour Ghafourifard, Ata Rafiee, Hadush Gebremariam, Oghenowede Eyawo, Amir Hasanzadeh, Ana Laura Manda, Muhammed Magdy Abd El Razek, Morteza Arab-Zozani, Narayana Manjunatha, Navid Manafi, Ritesh G. Menezes, Ferrán Catalá-López, Hossein Poustchi, Ghobad Moradi, Suliman Alghnam, Tinuke O Olagunju, Mohiuddin Ahsanul Kabir Chowdhury, Man Mohan Mehndiratta, Sorin Hostiuc, Jalal Arabloo, Shaun Wen Huey Lee, Chris D Castle, Joan B. Soriano, Syed Amir Gilani, Mariam Molokhia, Gaurav Gupta, Inga Dora Sigfusdottir, Isabela M. Benseñor, Desalegn Getnet Demsie, Atalay Goshu Muluneh, Young Eun Kim, Olatunde Aremu, Leeberk Raja Inbaraj, Jae Il Shin, Berhe Etsay Tesfay, Neha Chaudhary, Juan Sanabria, Soosanna Kumary Chattu, Sanni Yaya, Rekha Thapar, Biruk Wogayehu Taddele, Maciej Banach, Salman Rawaf, Nicholas L S Roberts, Jagadish Rao Padubidri, Manoochehr Karami, Derrick A Bennett, Duduzile Ndwandwe, Soheil Hassanipour, Ashish Badiye, Krittika Bhattacharyya, Obinna Onwujekwe, Kewal Krishan, João Coelho, Ahmed Abdelalim, Kerrie E. Doyle, Tomasz Miazgowski, Rahman Shiri, Demelash Woldeyohannes Handiso, Navid Rabiee, Nikita Otstavnov, Brian J. Hall, Olalekan A. Uthman, Rohollah Kalhor, Swayam Prakash, Beatriz Paulina Ayala Quintanilla, Gebre Teklemariam Demoz, Ted R. Miller, Rebecca Ivers, Chuanhua Yu, Pascual R. Valdez, Martha Híjar, Taweewat Wiangkham, Maysaa El Sayed Zaki, Rafael Tabarés-Seisdedos, Melkamu Merid Mengesha, Seyedmojtaba Seyedmousavi, Ravi Prakash Jha, Songhomitra Panda-Jonas, Aidin Abedi, Savita Lasrado, Veincent Christian Filipino Pepito, Amir Almasi-Hashiani, Burcu Kucuk Bicer, Hagazi Gebremedhin Kassaye, Yousef Veisani, Ayenew Kassie Tesema, Amir Radfar, Pawan Faris, Oladimeji Adebayo, Fares Alahdab, Heather Orpana, Narayan Bahadur Mahotra, Tripti Khanna, Girikumar Kumaresh, Alireza Rafiei, João Mauricio Castaldelli-Maia, Subramanian Senthilkumaran, Cyrus Alinia, Era Upadhyay, Stanislav S. Otstavnov, Ahmed Omar Bali, Farshad Farzadfar, Vivek Kumar, Sanghamitra Pati, Gholamreza Roshandel, Daiane Borges Machado, Yuan-Pang Wang, Rafael Alves Guimarães, Aziz Sheikh, Jeevan Pereira, Ahamarshan Jayaraman Nagarajan, Soraya Siabani, Kamarul Imran Musa, Farshad Pourmalek, Janet L Leasher, Shafiu Mohammed, Shyam Sundar Budhathoki, Mehdi Naderi, Mehdi Hosseinzadeh, Eun-Kee Park, Marwa Rashad Salem, Alireza Ansari-Moghaddam, Achala Upendra Jayatilleke, Paolo Lauriola, Amir Kasaeian, Adam Belay Wondmieneh, Tilahun Belete Mossie, Rovshan Khalilov, Milena M Santric Milicevic, Ai Koyanagi, Shailesh Advani, Felix Akpojene Ogbo, Nihad A. Almasri, Abdur Razzaque Sarker, Salman Khazaei, Narayanaswamy Venketasubramanian, Josephine W. Ngunjiri, Mihajlo Jakovljevic, Matthew Cunningham, Shaimaa I. El-Jaafary, Hosni Salem, Sharareh Eskandarieh, Muktar Beshir Ahmed, Amy E. Peden, Rajaram Yadav, Srikanta Banerjee, Kenean Getaneh Tlaye, Ronan A Lyons, Farzad Jalilian, Jacek Jerzy Jozwiak, Soufiane Boufous, Leila R Kalankesh, Abdelrahman Ibrahim Abushouk, Mikk Jürisson, Hamid Reza Tohidinik, Flavia M. Cicuttini, Zachary V Dingels, Florian Fischer, Saad M.A. Dahlawi, Rahmatollah Moradzadeh, Getnet Gedefaw, Tauseef Ahmad, Faramarz Shaahmadi, Hamed Zandian, Bruno Ramos Nascimento, Gregory J. Bertolacci, Hamid Yimam Hassen, Christian Lycke Ellingsen, Zulfiqar A Bhutta, Pankaj Bhardwaj, Dawit Habte Woldeyes, Robert C. Reiner, Rakhi Dandona, Akram Pourshams, Lorainne Tudor Car, Inbal Salz, Reza Mohammadpourhodki, Farnam Mohebi, A. A. Fomenkov, Abraham Getachew Kelbore, Benjamin B. Massenburg, Yousef Mohammad, Arash Ziapour, Zabihollah Yousefi, Biresaw Wassihun Alemu, Neeti Kapoor, Seyed Sina Naghibi Irvani, Vinod C. Nayak, Yoshan Moodley, Venkatesh Maled, Zhi-Jiang Zhang, Arielle Wilder Eagan, Saif Ullah, Anwar Rafay, Ali Koolivand, Ibrahim A Khalil, Parul Puri, Lidia Sanchez Riera, Vinay Nangia, Tanuj Kanchan, Mu'awiyyah Babale Sufiyan, Lidia Morawska, Saeed Shahabi, Tiffany K. Gill, Traolach S. Brugha, Michael K. Hole, Vahid Alipour, Sowmya J. Rao, Pankaj Singh, Rosario Cárdenas, Abdollah Mohammadian-Hafshejani, Sanjay Zodpey, Birhanu Geta, Amaha Kahsay, Moritz U. G. Kraemer, Claudio Alberto Dávila-Cervantes, Samer Hamidi, Gbenga A. Kayode, Miloud Taki Eddine Aichour, Peter Memiah, Erkin M. Mirrakhimov, Sheikh Mohammed Shariful Islam, Sadia Bibi, Bartosz Miazgowski, Daniel Y. Cho, Keyvan Pakshir, Aziz Rezapour, R V Polibin, Sudha Jayaraman, S. Mohammad Sajadi, Amir Manafi, Berhe Gebremichael, Ali Yadollahpour, Barthelemy Kuate Defo, Alan D. Lopez, Masoud Behzadifar, Mohammad A. Mohseni Bandpei, Ali Kabir, Jee-Young Jasmine Choi, Gebretsadkan Hintsa Tekulu, Kidanemaryam Berhe, Bill & Melinda Gates Foundation, Sanofi, HUS Comprehensive Cancer Center, Clinicum, University of Helsinki, Helsinki University Hospital Area, HUS Neurocenter, James, S. L., Castle, C. D., Dingels, Z. V., Fox, J. T., Hamilton, E. B., Liu, Z., Roberts, N. L. S., Sylte, D. O., Bertolacci, G. J., Cunningham, M., Henry, N. J., Legrand, K. E., Abdelalim, A., Abdollahpour, I., Abdulkader, R. S., Abedi, A., Abegaz, K. H., Abosetugn, A. E., Abushouk, A. I., Adebayo, O. M., Adsuar, J. C., Advani, S. M., Agudelo-Botero, M., Ahmad, T., Ahmed, M. B., Ahmed, R., Aichour, M. T. E., Alahdab, F., Alanezi, F. M., Alema, N. M., Alemu, B. W., Alghnam, S. A., Ali, B. A., Ali, S., Alinia, C., Alipour, V., Aljunid, S. M., Almasi-Hashiani, A., Almasri, N. A., Altirkawi, K., Amer, Y. S. A., Andrei, C. L., Ansari-Moghaddam, A., Antonio, C. A. T., Anvari, D., Appiah, S. C. Y., Arabloo, J., Arab-Zozani, M., Arefi, Z., Aremu, O., Ariani, F., Arora, A., Asaad, M., Quintanilla, B. P. A., Ayano, G., Ayanore, M. A., Azarian, G., Badawi, A., Badiye, A. D., Baig, A. A., Bairwa, M., Bakhtiari, A., Balachandran, A., Banach, M., Banerjee, S. K., Banik, P. C., Banstola, A., Barker-Collo, S. L., Barnighausen, T. W., Barzegar, A., Bayati, M., Bazargan-Hejazi, S., Bedi, N., Behzadifar, M., Belete, H., Bennett, D. A., Bensenor, I. M., Berhe, K., Bhagavathula, A. S., Bhardwaj, P., Bhat, A. G., Bhattacharyya, K., Bhutta, Z. A., Bibi, S., Bijani, A., Boloor, A., Borges, G., Borschmann, R., Borzi, A. M., Boufous, S., Braithwaite, D., Briko, N. I., Brugha, T., Budhathoki, S. S., Car, J., Cardenas, R., Carvalho, F., Castaldelli-Maia, J. M., Castaneda-Orjuela, C. A., Castelpietra, G., Catala-Lopez, F., Cerin, E., Chandan, J. S., Chapman, J. R., Chattu, V. K., Chattu, S. K., Chatziralli, I., Chaudhary, N., Cho, D. Y., Choi, J. -Y. J., Chowdhury, M. A. K., Christopher, D. J., Chu, D. -T., Cicuttini, F. M., Coelho, J. M., Costa, V. M., Dahlawi, S. M. A., Daryani, A., Davila-Cervantes, C. A., De Leo, D., Demeke, F. M., Demoz, G. T., Demsie, D. G., Deribe, K., Desai, R., Nasab, M. D., Da Silva, D. D., Forooshani, Z. S. D., Do, H. T., Doyle, K. E., Driscoll, T. R., Dubljanin, E., Adema, B. D., Eagan, A. W., Elemineh, D. A., El-Jaafary, S. I., El-Khatib, Z., Ellingsen, C. L., El Sayedzaki, M., Eskandarieh, S., Eyawo, O., Faris, P. S., Faro, A., Farzadfar, F., Fereshtehnejad, S. -M., Fernandes, E., Ferrara, P., Fischer, F., Folayan, M. O., Fomenkov, A. A., Foroutan, M., Francis, J. M., Franklin, R. C., Fukumoto, T., Geberemariyam, B. S., Gebremariam, H., Gebremedhin, K. B., Gebremeskel, L. G., Gebremeskel, G. G., Gebremichael, B., Gedefaw, G. A., Geta, B., Getenet, A. B., Ghafourifard, M., Ghamari, F., Gheshlagh, R. G., Gholamian, A., Gilani, S. A., Gill, T. K., Goudarzian, A. H., Goulart, A. C., Grada, A., Grivna, M., Guimaraes, R. A., Guo, Y., Gupta, G., Haagsma, J. A., Hall, B. J., Hamadeh, R. R., Hamidi, S., Handiso, D. W., Haro, J. M., Hasanzadeh, A., Hassan, S., Hassanipour, S., Hassankhani, H., Hassen, H. Y., Havmoeller, R., Hendrie, D., Heydarpour, F., Hijar, M., Ho, H. C., Hoang, C. L., Hole, M. K., Holla, R., Hossain, N., Hosseinzadeh, M., Hostiuc, S., Hu, G., Ibitoye, S. E., Ilesanmi, O. S., Inbaraj, L. R., Irvani, S. S. N., Islam, M. M., Islam, S. M. S., Ivers, R. Q., Jahani, M. A., Jakovljevic, M., Jalilian, F., Jayaraman, S., Jayatilleke, A. U., Jha, R. P., John-Akinola, Y. O., Jonas, J. B., Jones, K. M., Joseph, N., Joukar, F., Jozwiak, J. J., Jungari, S. B., Jurisson, M., Kabir, A., Kahsay, A., Kalankesh, L. R., Kalhor, R., Kamil, T. A., Kanchan, T., Kapoor, N., Karami, M., Kasaeian, A., Kassaye, H. G., Kavetskyy, T., Kayode, G. A., Keiyoro, P. N., Kelbore, A. G., Khader, Y. S., Khafaie, M. A., Khalid, N., Khalil, I. A., Khalilov, R., Khan, M., Khan, E. A., Khan, J., Khanna, T., Khazaei, S., Khazaie, H., Khundkar, R., Kiirithio, D. N., Kim, Y. -E., Kim, Y. J., Kim, D., Kisa, S., Kisa, A., Komaki, H., Kondlahalli, S. K. M., Koolivand, A., Korshunov, V. A., Koyanagi, A., Kraemer, M. U. G., Krishan, K., Defo, B. K., Bicer, B. K., Kugbey, N., Kumar, N., Kumar, M., Kumar, V., Kumaresh, G., Lami, F. H., Lansingh, V. C., Lasrado, S., Latifi, A., Lauriola, P., Vecchia, C. L., Leasher, J. L., Lee, S. W. H., Li, S., Liu, X., Lopez, A. D., Lotufo, P. A., Lyons, R. A., Machado, D. B., Madadin, M., Abd El Razek, M. M., Mahotra, N. B., Majdan, M., Majeed, A., Maled, V., Malta, D. C., Manafi, N., Manafi, A., Manda, A. -L., Manjunatha, N., Mansour-Ghanaei, F., Mansournia, M. A., Maravilla, J. C., Mason-Jones, A. J., Masoumi, S. Z., Massenburg, B. B., Maulik, P. K., Mehndiratta, M. M., Melketsedik, Z. A., Memiah, P. T. N., Mendoza, W., Menezes, R. G., Mengesha, M. M., Meretoja, T. J., Meretoja, A., Merie, H. E., Mestrovic, T., Miazgowski, B., Miazgowski, T., Miller, T. R., Mini, G. K., Mirica, A., Mirrakhimov, E. M., Mirzaei-Alavijeh, M., Mithra, P., Moazen, B., Moghadaszadeh, M., Mohamadi, E., Mohammad, Y., Darwesh, A. M., Mohammadian-Hafshejani, A., Mohammadpourhodki, R., Mohammed, S., Mohammed, J. A., Mohebi, F., Bandpei, M. A. M., Molokhia, M., Monasta, L., Moodley, Y., Moradi, M., Moradi, G., Moradi-Lakeh, M., Moradzadeh, R., Morawska, L., Velasquez, I. M., Morrison, S. D., Mossie, T. B., Muluneh, A. G., Musa, K. I., Mustafa, G., Naderi, M., Nagarajan, A. J., Naik, G., Naimzada, M. D., Najaf, F., Nangia, V., Nascimento, B. R., Naserbakht, M., Nayak, V., Nazari, J., Ndwandwe, D. E., Negoi, I., Ngunjiri, J. W., Nguyen, T. H., Nguyen, C. T., Nguyen, D. N., Nguyen, H. L. T., Nikbakhsh, R., Ningrum, D. N. A., Nnaji, C. A., Ofori-Asenso, R., Ogbo, F. A., Oghenetega, O. B., Oh, I. -H., Olagunju, A. T., Olagunju, T. O., Bali, A. O., Onwujekwe, O. E., Orpana, H. M., Ota, E., Otstavnov, N., Otstavnov, S. S., Mahesh, A. P., Padubidri, J. R., Pakhale, S., Pakshir, K., Panda-Jonas, S., Park, E. -K., Patel, S. K., Pathak, A., Pati, S., Paulos, K., Peden, A. E., Pepito, V. C. F., Pereira, J., Phillips, M. R., Polibin, R. V., Polinder, S., Pourmalek, F., Pourshams, A., Poustchi, H., Prakash, S., Pribadi, D. R. A., Puri, P., Syed, Z. Q., Rabiee, N., Rabiee, M., Radfar, A., Rafay, A., Rafee, A., Rafei, A., Rahim, F., Rahimi, S., Rahman, M. A., Rajabpour-Sanati, A., Rajati, F., Rakovac, I., Rao, S. J., Rashedi, V., Rastogi, P., Rathi, P., Rawaf, S., Rawal, L., Rawassizadeh, R., Renjith, V., Resnikoff, S., Rezapour, A., Ribeiro, A. I., Rickard, J., Gonzalez, C. M. R., Roever, L., Ronfani, L., Roshandel, G., Saddik, B., Safarpour, H., Safdarian, M., Sajadi, S. M., Salamati, P., Salem, M. R. R., Salem, H., Salz, I., Samy, A. M., Sanabria, J., Riera, L. S., Milicevic, M. M. S., Sarker, A. R., Sarveazad, A., Sathian, B., Sawhney, M., Sayyah, M., Schwebel, D. C., Seedat, S., Senthilkumaran, S., Seyedmousavi, S., Sha, F., Shaahmadi, F., Shahabi, S., Shaikh, M. A., Shams-Beyranvand, M., Sheikh, A., Shigematsu, M., Shin, J. I., Shiri, R., Siabani, S., Sigfusdottir, I. D., Singh, J. A., Singh, P. K., Sinha, D. N., Soheili, A., Soriano, J. B., Sorrie, M. B., Soyiri, I. N., Stokes, M. A., Sufiyan, M. B., Sykes, B. L., Tabares-Seisdedos, R., Tabb, K. M., Taddele, B. W., Tefera, Y. M., Tehrani-Banihashemi, A., Tekulu, G. H., Tesema, A. K. T., Tesfay, B. E., Thapar, R., Titova, M. V., Tlaye, K. G., Tohidinik, H. R., Topor-Madry, R., Tran, K. B., Tran, B. X., Tripathy, J. P., Tsai, A. C., Tsatsakis, A., Car, L. T., Ullah, I., Ullah, S., Unnikrishnan, B., Upadhyay, E., Uthman, O. A., Valdez, P. R., Vasankari, T. J., Veisani, Y., Venketasubramanian, N., Violante, F. S., Vlassov, V., Waheed, Y., Wang, Y. -P., Wiangkham, T., Wolde, H. F., Woldeyes, D. H., Wondmeneh, T. G., Wondmieneh, A. B., Wu, A. -M., Wyper, G. M. A., Yadav, R., Yadollahpour, A., Yano, Y., Yaya, S., Yazdi-Feyzabadi, V., Ye, P., Yip, P., Yisma, E., Yonemoto, N., Yoon, S. -J., Youm, Y., Younis, M. Z., Yousef, Z., Yu, C., Yu, Y., Moghadam, T. Z., Zaidi, Z., Zaman, S. B., Zamani, M., Zandian, H., Zarei, F., Zhang, Z. -J., Zhang, Y., Ziapour, A., Zodpey, S., Dandona, R., Dharmaratne, S. D., Hay, S. I., Mokdad, A. H., Pigott, D. M., Reiner, R. C., Vos, T., James, S, Castle, C, Dingels, Z, Fox, J, Hamilton, E, Liu, Z, Roberts, N, Sylte, D, Bertolacci, G, Cunningham, M, Henry, N, Legrand, K, Abdelalim, A, Abdollahpour, I, Abdulkader, R, Abedi, A, Abegaz, K, Abosetugn, A, Abushouk, A, Adebayo, O, Adsuar, J, Advani, S, Agudelo-Botero, M, Ahmad, T, Ahmed, M, Ahmed, R, Eddine Aichour, M, Alahdab, F, Alanezi, F, Alema, N, Alemu, B, Alghnam, S, Ali, B, Ali, S, Alinia, C, Alipour, V, Aljunid, S, Almasi-Hashiani, A, Almasri, N, Altirkawi, K, Abdeldayem Amer, Y, Andrei, C, Ansari-Moghaddam, A, T Antonio, C, Anvari, D, Yaw Appiah, S, Arabloo, J, Arab-Zozani, M, Arefi, Z, Aremu, O, Ariani, F, Arora, A, Asaad, M, Ayala Quintanilla, B, Ayano, G, Ayanore, M, Azarian, G, Badawi, A, Badiye, A, Baig, A, Bairwa, M, Bakhtiari, A, Balachandran, A, Banach, M, Banerjee, S, Banik, P, Banstola, A, Barker-Collo, S, Bärnighausen, T, Barzegar, A, Bayati, M, Bazargan-Hejazi, S, Bedi, N, Behzadifar, M, Belete, H, Bennett, D, Bensenor, I, Berhe, K, Bhagavathula, A, Bhardwaj, P, Bhat, A, Bhattacharyya, K, Bhutta, Z, Bibi, S, Bijani, A, Boloor, A, Borges, G, Borschmann, R, Borzì, A, Boufous, S, Braithwaite, D, Briko, N, Brugha, T, Budhathoki, S, Car, J, Cárdenas, R, Carvalho, F, Castaldelli-Maia, J, Castañeda-Orjuela, C, Castelpietra, G, Catalá-López, F, Cerin, E, Chandan, J, Chapman, J, Chattu, V, Chattu, S, Chatziralli, I, Chaudhary, N, Cho, D, Choi, J, Kabir Chowdhury, M, Christopher, D, Chu, D, Cicuttini, F, Coelho, J, Costa, V, Dahlawi, S, Daryani, A, Dávila-Cervantes, C, Leo, D, Demeke, F, Demoz, G, Demsie, D, Deribe, K, Desai, R, Nasab, M, Silva, D, Dibaji Forooshani, Z, Do, H, Doyle, K, Driscoll, T, Dubljanin, E, Adema, B, Eagan, A, Elemineh, D, El-Jaafary, S, El-Khatib, Z, Ellingsen, C, Zaki, M, Eskandarieh, S, Eyawo, O, Faris, P, Faro, A, Farzadfar, F, Fereshtehnejad, S, Fernandes, E, Ferrara, P, Fischer, F, Folayan, M, Fomenkov, A, Foroutan, M, Francis, J, Franklin, R, Fukumoto, T, Geberemariyam, B, Gebremariam, H, Gebremedhin, K, Gebremeskel, L, Gebremeskel, G, Gebremichael, B, Gedefaw, G, Geta, B, Getenet, A, Ghafourifard, M, Ghamari, F, Gheshlagh, R, Gholamian, A, Gilani, S, Gill, T, Goudarzian, A, Goulart, A, Grada, A, Grivna, M, Guimarães, R, Guo, Y, Gupta, G, Haagsma, J, Hall, B, Hamadeh, R, Hamidi, S, Handiso, D, Haro, J, Hasanzadeh, A, Hassan, S, Hassanipour, S, Hassankhani, H, Hassen, H, Havmoeller, R, Hendrie, D, Heydarpour, F, Híjar, M, Ho, H, Hoang, C, Hole, M, Holla, R, Hossain, N, Hosseinzadeh, M, Hostiuc, S, Hu, G, Ibitoye, S, Ilesanmi, O, Inbaraj, L, Naghibi Irvani, S, Mofizul Islam, M, Shariful Islam, S, Ivers, R, Jahani, M, Jakovljevic, M, Jalilian, F, Jayaraman, S, Jayatilleke, A, Jha, R, John-Akinola, Y, Jonas, J, Jones, K, Joseph, N, Joukar, F, Jozwiak, J, Jungari, S, Jürisson, M, Kabir, A, Kahsay, A, Kalankesh, L, Kalhor, R, Kamil, T, Kanchan, T, Kapoor, N, Karami, M, Kasaeian, A, Kassaye, H, Kavetskyy, T, Kayode, G, Keiyoro, P, Kelbore, A, Khader, Y, Khafaie, M, Khalid, N, Khalil, I, Khalilov, R, Khan, M, Khan, E, Khan, J, Khanna, T, Khazaei, S, Khazaie, H, Khundkar, R, Kiirithio, D, Kim, Y, Kim, D, Kisa, S, Kisa, A, Komaki, H, Kondlahalli, S, Koolivand, A, Korshunov, V, Koyanagi, A, Kraemer, M, Krishan, K, Defo, B, Bicer, B, Kugbey, N, Kumar, N, Kumar, M, Kumar, V, Kumaresh, G, Lami, F, Lansingh, V, Lasrado, S, Latifi, A, Lauriola, P, Vecchia, C, Leasher, J, Huey Lee, S, Li, S, Liu, X, Lopez, A, Lotufo, P, Lyons, R, Machado, D, Madadin, M, Abd El Razek, M, Mahotra, N, Majdan, M, Majeed, A, Maled, V, Malta, D, Manafi, N, Manafi, A, Manda, A, Manjunatha, N, Mansour-Ghanaei, F, Mansournia, M, Maravilla, J, Mason-Jones, A, Masoumi, S, Massenburg, B, Maulik, P, Mehndiratta, M, Melketsedik, Z, Memiah, P, Mendoza, W, Menezes, R, Mengesha, M, Meretoja, T, Meretoja, A, Merie, H, Mestrovic, T, Miazgowski, B, Miazgowski, T, Miller, T, Mini, G, Mirica, A, Mirrakhimov, E, Mirzaei-Alavijeh, M, Mithra, P, Moazen, B, Moghadaszadeh, M, Mohamadi, E, Mohammad, Y, Darwesh, A, Mohammadian-Hafshejani, A, Mohammadpourhodki, R, Mohammed, S, Mohammed, J, Mohebi, F, Mohseni Bandpei, M, Molokhia, M, Monasta, L, Moodley, Y, Moradi, M, Moradi, G, Moradi-Lakeh, M, Moradzadeh, R, Morawska, L, Velásquez, I, Morrison, S, Mossie, T, Muluneh, A, Musa, K, Mustafa, G, Naderi, M, Nagarajan, A, Naik, G, Naimzada, M, Najafi, F, Nangia, V, Nascimento, B, Naserbakht, M, Nayak, V, Nazari, J, Ndwandwe, D, Negoi, I, Ngunjiri, J, Nguyen, T, Nguyen, C, Nguyen, D, Thi Nguyen, H, Nikbakhsh, R, Anggraini Ningrum, D, Nnaji, C, Ofori-Asenso, R, Ogbo, F, Oghenetega, O, Oh, I, Olagunju, A, Olagunju, T, Bali, A, Onwujekwe, O, Orpana, H, Ota, E, Otstavnov, N, Otstavnov, S, P A, M, Padubidri, J, Pakhale, S, Pakshir, K, Panda-Jonas, S, Park, E, Patel, S, Pathak, A, Pati, S, Paulos, K, Peden, A, Filipino Pepito, V, Pereira, J, Phillips, M, Polibin, R, Polinder, S, Pourmalek, F, Pourshams, A, Poustchi, H, Prakash, S, Angga Pribadi, D, Puri, P, Syed, Z, Rabiee, N, Rabiee, M, Radfar, A, Rafay, A, Rafiee, A, Rafiei, A, Rahim, F, Rahimi, S, Rahman, M, Rajabpour-Sanati, A, Rajati, F, Rakovac, I, Rao, S, Rashedi, V, Rastogi, P, Rathi, P, Rawaf, S, Rawal, L, Rawassizadeh, R, Renjith, V, Resnikoff, S, Rezapour, A, Ribeiro, A, Rickard, J, Rios González, C, Roever, L, Ronfani, L, Roshandel, G, Saddik, B, Safarpour, H, Safdarian, M, Mohammad Sajadi, S, Salamati, P, Rashad Salem, M, Salem, H, Salz, I, Samy, A, Sanabria, J, Riera, L, Santric Milicevic, M, Sarker, A, Sarveazad, A, Sathian, B, Sawhney, M, Sayyah, M, Schwebel, D, Seedat, S, Senthilkumaran, S, Seyedmousavi, S, Sha, F, Shaahmadi, F, Shahabi, S, Shaikh, M, Shams-Beyranvand, M, Sheikh, A, Shigematsu, M, Shin, J, Shiri, R, Siabani, S, Sigfusdottir, I, Singh, J, Singh, P, Sinha, D, Soheili, A, Soriano, J, Sorrie, M, Soyiri, I, Stokes, M, Sufiyan, M, Sykes, B, Tabarés-Seisdedos, R, Tabb, K, Taddele, B, Tefera, Y, Tehrani-Banihashemi, A, Tekulu, G, Tesema Tesema, A, Tesfay, B, Thapar, R, Titova, M, Tlaye, K, Tohidinik, H, Topor-Madry, R, Tran, K, Tran, B, Tripathy, J, Tsai, A, Tsatsakis, A, Car, L, Ullah, I, Ullah, S, Unnikrishnan, B, Upadhyay, E, Uthman, O, Valdez, P, Vasankari, T, Veisani, Y, Venketasubramanian, N, Violante, F, Vlassov, V, Waheed, Y, Wang, Y, Wiangkham, T, Wolde, H, Woldeyes, D, Wondmeneh, T, Wondmieneh, A, Wu, A, Wyper, G, Yadav, R, Yadollahpour, A, Yano, Y, Yaya, S, Yazdi-Feyzabadi, V, Ye, P, Yip, P, Yisma, E, Yonemoto, N, Yoon, S, Youm, Y, Younis, M, Yousefi, Z, Yu, C, Yu, Y, Moghadam, T, Zaidi, Z, Zaman, S, Zamani, M, Zandian, H, Zarei, F, Zhang, Z, Zhang, Y, Ziapour, A, Zodpey, S, Dandona, R, Dharmaratne, S, Hay, S, Mokdad, A, Pigott, D, Reiner, R, Vos, T, James, S.L., Castle, C.D., Dingels, Z.V., Fox, J.T., Hamilton, E.B., Liu, Z., Roberts, N.L.S., Sylte, D.O., Bertolacci, G.J., Cunningham, M., Henry, N.J., Legrand, K.E., Abdelalim, A., Abdollahpour, I., Abdulkader, R.S., Abedi, A., Abegaz, K.H., Abosetugn, A.E., Abushouk, A.I., Adebayo, O.M., Adsuar, J.C., Advani, S.M., Agudelo-Botero, M., Ahmad, T., Ahmed, M.B., Ahmed, R., Aichour, M.T.E., Alahdab, F., Alanezi, F.M., Alema, N.M., Alemu, B.W., Alghnam, S.A., Ali, B.A., Ali, S., Alinia, C., Alipour, V., Aljunid, S.M., Almasi-Hashiani, A., Almasri, N.A., Altirkawi, K., Amer, Y.S.A., Andrei, C.L., Ansari-Moghaddam, A., Antonio, C.A.T., Anvari, D., Appiah, S.C.Y., Arabloo, J., Arab-Zozani, M., Arefi, Z., Aremu, O., Ariani, F., Arora, A., Asaad, M., Quintanilla, B.P.A., Ayano, G., Ayanore, M.A., Azarian, G., Badawi, A., Badiye, A.D., Baig, A.A., Bairwa, M., Bakhtiari, A., Balachandran, A., Banach, M., Banerjee, S.K., Banik, P.C., Banstola, A., Barker-Collo, S.L., Bärnighausen, T.W., Barzegar, A., Bayati, M., Bazargan-Hejazi, S., Bedi, N., Behzadifar, M., Belete, H., Bennett, D.A., Bensenor, I.M., Berhe, K., Bhagavathula, A.S., Bhardwaj, P., Bhat, A.G., Bhattacharyya, K., Bhutta, Z.A., Bibi, S., Bijani, A., Boloor, A., Borges, G., Borschmann, R., Borzì, A.M., Boufous, S., Braithwaite, D., Briko, N.I., Brugha, T., Budhathoki, S.S., Car, J., Cárdenas, R., Carvalho, F., Castaldelli-Maia, J.M., Castañeda-Orjuela, C.A., Castelpietra, G., Catalá-López, F., Cerin, E., Chandan, J.S., Chapman, J.R., Chattu, V.K., Chattu, S.K., Chatziralli, I., Chaudhary, N., Cho, D.Y., Choi, J.-Y.J., Chowdhury, M.A.K., Christopher, D.J., Chu, D.-T., Cicuttini, F.M., Coelho, J.M., Costa, V.M., Dahlawi, S.M.A., Daryani, A., Dávila-Cervantes, C.A., De Leo, D., Demeke, F.M., Demoz, G.T., Demsie, D.G., Deribe, K., Desai, R., Nasab, M.D., Da Silva, D.D., Forooshani, Z.S.D., Do, H.T., Doyle, K.E., Driscoll, T.R., Dubljanin, E., Adema, B.D., Eagan, A.W., Elemineh, D.A., El-Jaafary, S.I., El-Khatib, Z., Ellingsen, C.L., El Sayedzaki, M., Eskandarieh, S., Eyawo, O., Faris, P.S., Faro, A., Farzadfar, F., Fereshtehnejad, S.-M., Fernandes, E., Ferrara, P., Fischer, F., Folayan, M.O., Fomenkov, A.A., Foroutan, M., Francis, J.M., Franklin, R.C., Fukumoto, T., Geberemariyam, B.S., Gebremariam, H., Gebremedhin, K.B., Gebremeskel, L.G., Gebremeskel, G.G., Gebremichael, B., Gedefaw, G.A., Geta, B., Getenet, A.B., Ghafourifard, M., Ghamari, F., Gheshlagh, R.G., Gholamian, A., Gilani, S.A., Gill, T.K., Goudarzian, A.H., Goulart, A.C., Grada, A., Grivna, M., Guimarães, R.A., Guo, Y., Gupta, G., Haagsma, J.A., Hall, B.J., Hamadeh, R.R., Hamidi, S., Handiso, D.W., Haro, J.M., Hasanzadeh, A., Hassan, S., Hassanipour, S., Hassankhani, H., Hassen, H.Y., Havmoeller, R., Hendrie, D., Heydarpour, F., Híjar, M., Ho, H.C., Hoang, C.L., Hole, M.K., Holla, R., Hossain, N., Hosseinzadeh, M., Hostiuc, S., Hu, G., Ibitoye, S.E., Ilesanmi, O.S., Inbaraj, L.R., Irvani, S.S.N., Islam, M.M., Islam, S.M.S., Ivers, R.Q., Jahani, M.A., Jakovljevic, M., Jalilian, F., Jayaraman, S., Jayatilleke, A.U., Jha, R.P., John-Akinola, Y.O., Jonas, J.B., Jones, K.M., Joseph, N., Joukar, F., Jozwiak, J.J., Jungari, S.B., Jürisson, M., Kabir, A., Kahsay, A., Kalankesh, L.R., Kalhor, R., Kamil, T.A., Kanchan, T., Kapoor, N., Karami, M., Kasaeian, A., Kassaye, H.G., Kavetskyy, T., Kayode, G.A., Keiyoro, P.N., Kelbore, A.G., Khader, Y.S., Khafaie, M.A., Khalid, N., Khalil, I.A., Khalilov, R., Khan, M., Khan, E.A., Khan, J., Khanna, T., Khazaei, S., Khazaie, H., Khundkar, R., Kiirithio, D.N., Kim, Y.-E., Kim, Y.J., Kim, D., Kisa, S., Kisa, A., Komaki, H., Kondlahalli, S.K.M., Koolivand, A., Korshunov, V.A., Koyanagi, A., Kraemer, M.U.G., Krishan, K., Defo, B.K., Bicer, B.K., Kugbey, N., Kumar, N., Kumar, M., Kumar, V., Kumar, N., Kumaresh, G., Lami, F.H., Lansingh, V.C., Lasrado, S., Latifi, A., Lauriola, P., Vecchia, C.L., Leasher, J.L., Lee, S.W.H., Li, S., Liu, X., Lopez, A.D., Lotufo, P.A., Lyons, R.A., Machado, D.B., Madadin, M., Abd El Razek, M.M., Mahotra, N.B., Majdan, M., Majeed, A., Maled, V., Malta, D.C., Manafi, N., Manafi, A., Manda, A.-L., Manjunatha, N., Mansour-Ghanaei, F., Mansournia, M.A., Maravilla, J.C., Mason-Jones, A.J., Masoumi, S.Z., Massenburg, B.B., Maulik, P.K., Mehndiratta, M.M., Melketsedik, Z.A., Memiah, P.T.N., Mendoza, W., Menezes, R.G., Mengesha, M.M., Meretoja, T.J., Meretoja, A., Merie, H.E., Mestrovic, T., Miazgowski, B., Miazgowski, T., Miller, T.R., Mini, G.K., Mirica, A., Mirrakhimov, E.M., Mirzaei-Alavijeh, M., Mithra, P., Moazen, B., Moghadaszadeh, M., Mohamadi, E., Mohammad, Y., Darwesh, A.M., Mohammadian-Hafshejani, A., Mohammadpourhodki, R., Mohammed, S., Mohammed, J.A., Mohebi, F., Bandpei, M.A.M., Molokhia, M., Monasta, L., Moodley, Y., Moradi, M., Moradi, G., Moradi-Lakeh, M., Moradzadeh, R., Morawska, L., Velásquez, I.M., Morrison, S.D., Mossie, T.B., Muluneh, A.G., Musa, K.I., Mustafa, G., Naderi, M., Nagarajan, A.J., Naik, G., Naimzada, M.D., Najaf, F., Nangia, V., Nascimento, B.R., Naserbakht, M., Nayak, V., Nazari, J., Ndwandwe, D.E., Negoi, I., Ngunjiri, J.W., Nguyen, T.H., Nguyen, C.T., Nguyen, D.N., Nguyen, H.L.T., Nikbakhsh, R., Ningrum, D.N.A., Nnaji, C.A., Ofori-Asenso, R., Ogbo, F.A., Oghenetega, O.B., Oh, I.-H., Olagunju, A.T., Olagunju, T.O., Bali, A.O., Onwujekwe, O.E., Orpana, H.M., Ota, E., Otstavnov, N., Otstavnov, S.S., Mahesh, A.P., Padubidri, J.R., Pakhale, S., Pakshir, K., Panda-Jonas, S., Park, E.-K., Patel, S.K., Pathak, A., Pati, S., Paulos, K., Peden, A.E., Pepito, V.C.F., Pereira, J., Phillips, M.R., Polibin, R.V., Polinder, S., Pourmalek, F., Pourshams, A., Poustchi, H., Prakash, S., Pribadi, D.R.A., Puri, P., Syed, Z.Q., Rabiee, N., Rabiee, M., Radfar, A., Rafay, A., Rafee, A., Rafei, A., Rahim, F., Rahimi, S., Rahman, M.A., Rajabpour-Sanati, A., Rajati, F., Rakovac, I., Rao, S.J., Rashedi, V., Rastogi, P., Rathi, P., Rawaf, S., Rawal, L., Rawassizadeh, R., Renjith, V., Resnikoff, S., Rezapour, A., Ribeiro, A.I., Rickard, J., González, C.M.R., Roever, L., Ronfani, L., Roshandel, G., Saddik, B., Safarpour, H., Safdarian, M., Sajadi, S.M., Salamati, P., Salem, M.R.R., Salem, H., Salz, I., Samy, A.M., Sanabria, J., Riera, L.S., Milicevic, M.M.S., Sarker, A.R., Sarveazad, A., Sathian, B., Sawhney, M., Sayyah, M., Schwebel, D.C., Seedat, S., Senthilkumaran, S., Seyedmousavi, S., Sha, F., Shaahmadi, F., Shahabi, S., Shaikh, M.A., Shams-Beyranvand, M., Sheikh, A., Shigematsu, M., Shin, J.I., Shiri, R., Siabani, S., Sigfusdottir, I.D., Singh, J.A., Singh, P.K., Sinha, D.N., Soheili, A., Soriano, J.B., Sorrie, M.B., Soyiri, I.N., Stokes, M.A., Sufiyan, M.B., Sykes, B.L., Tabarés-Seisdedos, R., Tabb, K.M., Taddele, B.W., Tefera, Y.M., Tehrani-Banihashemi, A., Tekulu, G.H., Tesema, A.K.T., Tesfay, B.E., Thapar, R., Titova, M.V., Tlaye, K.G., Tohidinik, H.R., Topor-Madry, R., Tran, K.B., Tran, B.X., Tripathy, J.P., Tsai, A.C., Tsatsakis, A., Car, L.T., Ullah, I., Ullah, S., Unnikrishnan, B., Upadhyay, E., Uthman, O.A., Valdez, P.R., Vasankari, T.J., Veisani, Y., Venketasubramanian, N., Violante, F.S., Vlassov, V., Waheed, Y., Wang, Y.-P., Wiangkham, T., Wolde, H.F., Woldeyes, D.H., Wondmeneh, T.G., Wondmieneh, A.B., Wu, A.-M., Wyper, G.M.A., Yadav, R., Yadollahpour, A., Yano, Y., Yaya, S., Yazdi-Feyzabadi, V., Ye, P., Yip, P., Yisma, E., Yonemoto, N., Yoon, S.-J., Youm, Y., Younis, M.Z., Yousef, Z., Yu, C., Yu, Y., Moghadam, T.Z., Zaidi, Z., Zaman, S.B., Zamani, M., Zandian, H., Zarei, F., Zhang, Z.-J., Zhang, Y., Ziapour, A., Zodpey, S., Dandona, R., Dharmaratne, S.D., Hay, S.I., Mokdad, A.H., Pigott, D.M., Reiner, R.C., Vos, T., Instituto de Saúde Pública da Universidade do Porto, James, Spencer L, Castle, Chris D, Dingels, Zachary V, Fox, Jack T, Adema, Bereket Duko, Yisma, Engida, Vos, Theo, and Public Health

Subjects
Male, Populations/contexts, 1106 Human Movement and Sports Sciences, Global injuries, population, 030204 cardiovascular system & hematology, Global Health, contexts, context, Global Burden of Disease, 0302 clinical medicine, Quality-Adjusted Life Year, Global health, 030212 general & internal medicine, Original Research, Data, populations/contexts, Incidence (epidemiology), Incidence, methodology, 3142 Public health care science, environmental and occupational health, Female, Public Health, TERRITORIES, Quality-Adjusted Life Years, descriptive epidemiology, Human, Disabilities, 195 COUNTRIES, statistical issue, 1117 Public Health and Health Services, 03 medical and health sciences, AGE, Life Expectancy, Environmental health, Injury prevention, SYSTEMATIC ANALYSIS, statistical issues, Humans, Mortality, Estimation, SEX-SPECIFIC MORTALITY, DISABILITY, Public Health, Environmental and Occupational Health, populations, Morbidity, Wounds and Injuries, 1106 Human Movement and Sports Sciences, 1117 Public Health and Health Services, 1701 Psychology, Quality-adjusted life year, Years of potential life lost, 1701 Psychology, Life expectancy, Estimates, Human medicine, populations/context
Abstract

Background. While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods. In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results. GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions. GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future. Seyed Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. Alaa Badawi acknowledges support by the Public Health Agency of Canada. Till Bärnighausen acknowledges support by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. Traolach Brugha received support from NatCen Social Research (http://natcen.ac.uk/) via NHS Digital and Department of Health and Social Care London, for the Adult Psychiatric Morbidity Survey (APMS) programme. Felix Carvalho received support from UID/MULTI/04378/2019 with funding from FCT/MCTES through national funds. Vera M Costa acknowledges support from grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. Kebede Deribe is supported by a grant from the Wellcome Trust [grant number 201900] as part of his International Intermediate Fellowship. Tim Driscoll acknowledges that work on occupational risk factors was partially supported by funds from the World Health Organization. Eduarda Fernandes acknowledges support from UID/QUI/50006/2019 with funding from FCT/MCTES through national funds. Yuming Guo acknowledges support from Career Development Fellowships of the Australian National Health and Medical Research Council (numbers APP1107107 and APP1163693). Sheikh Mohammed Shariful Islam is funded by a Fellowship from National Heart Foundation of Australia and Institute for Physical Activity and Nutrition, Deakin University. Mihajlo Jakovljevic acknowledges support by the Ministry of Education Science and Technological Development of the Republic of Serbia through the Grant number OI175014; publication of results was not contingent upon Ministry's censorship or approval. Sudha Jayaraman acknowledges support from: NIH R21: 1R21TW010439-01A1 (PI); Rotary Foundation Global Grant #GG1749568 (PI); NIH P20: 1P20CA210284-01A1 (Co-PI) and DOD grant W81XWH-16-2-0040 (Co-I), during the period of this study. Yun Jin Kim acknowledges support from a grant from the Research Management Centre, Xiamen University Malaysia [grant number: XMUMRF/2018-C2/ITCM/0001]. Kewal Krishan is supported by UGC Centre of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Mansai Kumar acknowledges support from FIC/ NIH K43 1K43MH114320-01. Amanda Mason-Jones acknowledges support by the University of York. Mariam Molokhia is supported by the National Institute for Health Research Biomedical Research Center at Guy’s and St Thomas’s National Health Service Foundation Trust and King’s College London. Ilais Moreno Velasquez is supported by the Sistema Nacional de Investigación (SNI, Senacyt, Panama). Mukhammad David Naimzada acknowledges support from Government of the Russian Federation (Agreement No – 075-02-2019-967). Duduzile Ndwandwe acknowledges support from Cochrane South Africa, South African Medical Research Council. Stanislav S. Otstavnov acknowledges the support from the Government of the Russian Federation (Agreement No – 075-02-2019-967). Ashish Pathak acknowledges support from Indian Council of Medical Research (ICMR), New Delhi, India (Grant number 2013-1253). Michael R Phillips acknowledges support in part by a grant from the National Natural Science Foundation of China (No.81761128031). Abdallah M. Samy received a fellowship from the Egyptian Fulbright Mission Program. Milena Santric Milicevic acknowledges the support from the Ministry of Education, Science and Technological Development, Republic of Serbia (Contract No. 175087). Seyedmojtaba Seyedmousavi was supported by the Intramural Research Program of the National Institutes of Health, Clinical Center, Department of Laboratory Medicine, Bethesda, MD, USA. Rafael Tabarés-Seisdedos was supported in part by the national grant PI17/00719 from ISCIII-FEDER. Sojib Bin Zaman acknowledges support from an "Australian Government Research Training Program (RTP) Scholarship.

Published
2020

38. Association Between Contraception Use, Diabetes and Hypertension: Findings from Bangladesh Demographic and Health Survey

Author

Md Nuruzzaman Khan, M Mofizul Islam, and Rakibul M Islam

Abstract

Background: The prevalence of chorionic conditions such as diabetes and hypertension is increasing among reproductive-aged women in Bangladesh. Pregnancy in women with uncontrolled chronic conditions may increase the risks of adverse consequences, including maternal and child morbidity and mortality. Appropriate contraception use can help women to prevent pregnancy until women have controlled chronic conditions and reduce the risks of adverse maternal and child health consequences. We investigate the associations between diabetes and/or hypertension and contraception use among reproductive-aged women in Bangladesh.Methods: We analysed data of 3,947 women, extracted from the 2017/18 Bangladesh Demographic and Health Survey. Women’s contraception using patterns were our outcome variable, which was classified as (i) any contraception method use vs no use, (ii) modern methods vs traditional methods or no use, (iii) modern methods vs traditional methods use. The explanatory variables were diagnosis of diabetes only, hypertension only or both diabetes and hypertension. The multilevel Poisson regression with robust variance was used to explore the associations.Results The overall prevalence of contraception use was 68.0% (95% CI: 66.3-69.7), 69.4% (95% CI: 61.8-76.1) in women with diabetes only, 67.3% (95% CI: 63.5-70.9) with hypertension only, and 62.0% (95% CI: 52.8-70.4) in women having both diabetes and hypertension. The prevalence of modern methods of contraception use was lower (46.4%, 95% CI: 37.4-55.6) and traditional methods use higher (16.6%, 95% CI: 13.8-16.8) in women who had both diabetes and hypertension than women who did not have these conditions. The fully adjusted regression model showed that the prevalence of traditional method use was 31% (95% CI: 1.02-2.01) higher in women having both diabetes and hypertension compared with their counterparts who had none of these conditions. Conclusion: In Bangladesh, women with both diabetes and hypertension were more likely to use traditional contraception methods. These women are likely to experience increased risks of unwanted pregnancies and associated adverse maternal and child health outcomes.

Published
2022

40. Barriers to screening pregnant women for alcohol or other drugs: A narrative synthesis

Author

Mohamed E Abdel-Latif, Melissa Buultjens, M. Mofizul Islam, and Helen T. Oni

Subjects
Drug, medicine.medical_specialty, Referral, Substance-Related Disorders, Health Personnel, media_common.quotation_subject, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Prenatal Diagnosis, Intervention (counseling), Maternity and Midwifery, medicine, Humans, Narrative, Practice Patterns, Physicians', Referral and Consultation, media_common, 030219 obstetrics & reproductive medicine, 030504 nursing, business.industry, Obstetrics and Gynecology, medicine.disease, Alcoholism, Critical appraisal, Family medicine, Anxiety, Female, medicine.symptom, 0305 other medical science, Drugs in pregnancy, business
Abstract

Background Maternal alcohol or other drug use during pregnancy is associated with a range of adverse health outcomes for mothers and their unborn child. The antenatal period presents an opportunity for health professionals to offer routine screening for alcohol or other drugs, to then provide intervention and referral for treatment and/or specialised support services. However, literature indicates that limited screening practices currently exist in maternity care settings. Aim To identify barriers to screening pregnant women for alcohol or other drugs in maternity care settings, from the perspectives of healthcare professionals. Methods A comprehensive literature search was conducted in October 2017 to identify relevant studies. Seven databases that index health and social sciences literature, and google scholar, were searched. Eligible articles were subjected to critical appraisal. Extracted data from the eligible studies were synthesised using narrative synthesis. Findings Nine studies were eligible for this review. The review identified seven key barriers to screening for alcohol or other drugs in pregnancy, namely competing priorities and time constraint; lack of adequate screening skills and clear protocol; relationship between healthcare providers and pregnant women; healthcare providers’ perceptions; under-reporting or none/false disclosure; inconclusive evidence regarding the risk of alcohol or other drug use in pregnancy; and concerns about guilt and anxiety. Conclusions The narrative review revealed a range of barriers to screening for alcohol or other drugs in pregnancy. Further research in minimising the barriers is required to establish women-centred, evidence-base screening practices.

Published
2019

41. Availability and readiness of healthcare facilities and their effects on long-acting modern contraceptive use in Bangladesh: analysis of linked data

Author

M Mofizul Islam, Md Nuruzzaman Khan, and SHAHINOOR AKTER

Subjects
Public health, Bangladesh, Human Rights, Health Policy, Health Services Accessibility, Contraceptive Agents, Pregnancy, Child, Preschool, Health services and systems, Humans, Female, Health Facilities, Child, Semantic Web
Abstract

Aim Increasing access to long-acting modern contraceptives (LMAC) is one of the key factors in preventing unintended pregnancy and protecting women’s health rights. However, the availability and accessibility of health facilities and their impacts on LAMC utilisation (implant, intrauterine devices, sterilisation) in low- and middle-income countries is an understudied topic. This study aimed to examine the association between the availability and readiness of health facilities and the use of LAMC in Bangladesh. Methods In this survey study, we linked the 2017/18 Bangladesh Demographic and Health Survey data with the 2017 Bangladesh Health Facility Survey data using the administrative-boundary linkage method. Mixed-effect multilevel logistic regressions were conducted. The sample comprised 10,938 married women of 15–49 years age range who were fertile but did not desire a child within 2 years of the date of survey. The outcome variable was the current use of LAMC (yes, no), and the explanatory variables were health facility-, individual-, household- and community-level factors. Results Nearly 34% of participants used LAMCs with significant variations across areas in Bangladesh. The average scores of the health facility management and health facility infrastructure were 0.79 and 0.83, respectively. Of the facilities where LAMCs were available, 69% of them were functional and ready to provide LAMCs to the respondents. The increase in scores for the management (adjusted odds ratio (aOR), 1.59; 95% CI, 1.21–2.42) and infrastructure (aOR, 1.44; 95% CI, 1.01–1.69) of health facilities was positively associated with the overall uptake of LAMC. For per unit increase in the availability and readiness scores to provide LAMC at the nearest health facilities, the aORs for women to report using LAMC were 2.16 (95% CI, 1.18–3.21) and 1.74 (95% CI, 1.15–3.20), respectively. A nearly 27% decline in the likelihood of LAMC uptake was observed for every kilometre increase in the average regional-level distance between women’s homes and the nearest health facilities. Conclusion The proximity of health facilities and their improved management, infrastructure, and readiness to provide LAMCs to women significantly increase their uptake. Policies and programs should prioritise improving health facility readiness to increase LAMC uptake.

Published
2021

42. Mortality from snakebite envenomation: an analysis from the Global Burden of Disease Study 2019

Author

Mohsen Naghavi, Ali H. Mokdad, Amin Soheili, Félix Carvalho, Catalina Liliana Andrei, M. Mofizul Islam, Davood Anvari, Ali Bijani, Scott Zeng, Richard C. Franklin, Vahid Alipour, Sowmya J. Rao, Virginia Núñez-Samudio, Marcel Ausloos, Hoa Do, Eduarda Fernandes, Archith Boloor, Simon I. Hay, Bach Xuan Tran, Lalit Dandona, Iván Landires, Erin B Hamilton, Syed Haque, Dinh-Toi Chu, Rakhi Dandona, Neeti Kapoor, Cuong Tat Nguyen, Firooz Esmaeilzadeh, Olayinka Stephen Ilesanmi, Atalel Fentahun Awedew, Ahmad Ghashghaee, Vinod C Nayak, Jagnoor Jagnoor, Masood Ali Shaikh, Mohammed Madadin, Khezar Hayat, Navid Manafi, Ashish Bhalla, Francis Monteiro, Venkatesh Maled, Christopher J L Murray, Theo Vos, Emily Johnson, Zhi-Jiang Zhang, Tuomo J. Meretoja, Huong Thanh Nguyen, Robert Reiner, Nicholas L S Roberts, Nithin Kumar, Jalal Arabloo, Anna Aleksandrovna Skryabina, Jagadish Rao Padubidri, Zahiruddin Quazi Syed, Maryam Moradi, Irina Filip, Navid Rabiee, Mark A. Stokes, Mahaveer Golechha, Stephen S Lim, Salman Rawaf, Prateek Rastogi, David C. Schwebel, Marcos Roberto Tovani-Palone, Rekha Thapar, Kanyin Ong, Ritesh G. Menezes, Samer Hamidi, Ravensara S. Travillian, Robert Ancuceanu, Kewal Krishan, Ted R. Miller, Mahalaqua Nazli Khatib, Amir Radfar, Ashish Badiye, Majid Pirestani, David Laith Rawaf, Claudiu Herteliu, Masoud Foroutan, Birhan Gebresillassie Gebregiorgis, Spencer L. James, Nikha Bhardwaj, Fares Alahdab, Vafa Rahimi-Movaghar, Subramanian Senthilkumaran, Tianji Cai, Pankaj Bhardwaj, Roba Khundkar, Diana Zuleika Velazquez, Abhay Gaidhane, Soumyadeep Bhaumik, Xiaochen Dai, Monika Sawhney, Shankar M Bakkannavar, Berhe Gebremichael, G Anil Kumar, Ejaz Ahmad Khan, Amir Abdoli, Aziz Eftekhari, Rosa A. S. Couto, Hai Pham, Marina Pinheiro, Tanuj Kanchan, Abebaw Alemayehu Desta, Abdollah Mohammadian-Hafshejani, Farshad Farzadfar, Valentin Yurievich Skryabin, Lucas Earl, David M. Pigott, Samuel M. Ostroff, Laurie B. Marczak, Amirhossein Sahebkar, and Abdallah M. Samy

Subjects
Burden of disease, medicine.medical_specialty, business.industry, medicine, Intensive care medicine, Envenomation, business
Abstract

Venomous snakebite is an important cause of preventable death. The World Health Organization (WHO) set a goal to halve snakebite mortality by 2030. We used verbal autopsy and vital registration data to model the proportion of venomous animal deaths due to snakes by location, age, year, and sex, and applied these proportions to venomous animal contact mortality estimates from the Global Burden of Disease 2019 study. In 2019, 63,400 people (95% uncertainty interval 38,900–78,600) died globally from snakebites, which was equal to an age-standardized mortality rate (ASMR) of 0.8 deaths (0.5–1.0) per 100,000 and represents a 36% (2–49) decrease in ASMR since 1990. India had the greatest number of deaths in 2019, equal to an ASMR of 4.0 per 100,000 (2.3-5.0). We forecast mortality will continue to decline, but not sufficiently to meet the WHO’s goals. Improved data collection should be prioritized to help target interventions, improve burden estimation, and monitor progress.

Published
2021

43. HIV transmission knowledge among Rohingya refugee women in Bangladesh: a cross-sectional survey

Author

M. Mofizul Islam, Mostafizur Rahman, Mashiur Rahman, and Nuruzzaman Khan

Subjects
medicine.medical_specialty, Cross-sectional study, Refugee, sexual and gender disorders, HIV Infections, Formal education, Health care, Epidemiology, medicine, Humans, Hiv transmission, Bangladesh, Refugees, Transmission (medicine), business.industry, Refugee Camps, Public health, public health, infectious disease/HIV, General Medicine, Cross-Sectional Studies, Family medicine, HIV/AIDS, Medicine, epidemiology, Female, business
Abstract

Background and objectiveIncreasing numbers of Rohingya refugees have been found to be infected with HIV since they arrived in Bangladesh after being ousted from Myanmar in 2017. This study aimed to examine the knowledge about HIV transmission among Rohingya refugee women and to identify factors that are associated with that knowledge.DesignA cross-sectional survey was conducted using a structured questionnaire that was based on the standard questionnaire of the Demographic and Health Survey programme.SettingRohingya settlements in the Kutupalong refugee camp at Ukhiya, Cox’s Bazar, Bangladesh.ParticipantsInterviews were conducted with 508 women who had married or given birth in the 2 years before the survey was done.Outcome measureThe participants were asked to answer a set of questions to assess their knowledge about HIV transmission.ResultsAround 70% of the women could not accurately answer four of the eight questions, and there were substantial misconceptions about the modes of HIV transmission. Knowledge regarding HIV transmission among participants increases in conjunction with the age at which they were first married. Women who were involved in work outside their households or those whose husbands were employed were more likely than others to demonstrate relatively good knowledge of transmission. Women who had received some formal education were 2.37 times likely to show relatively good knowledge of HIV transmission than those who had not received any education. Availability of healthcare facilities in the blocks where women resided is also associated with better knowledge. However, knowledge of HIV transmission among Rohingya women was significantly lower than among women in Bangladesh and Myanmar.ConclusionMost Rohingya women have inadequate knowledge of HIV transmission. Targeted interventions are needed to provide HIV education and to assist with prevention and behavioural changes.

Published
2021

44. Availability and readiness of healthcare facilities and their effects on long-acting modern contraception use in Bangladesh: Analysis of linked data

Author

Nuruzzaman Khan, Shahinoor Akter, and M. Mofizul Islam

Subjects
Contraception use, Long acting, Health facility, Unit increase, business.industry, Kilometer, Environmental health, Health care, Medicine, Residence, Odds ratio, business
Abstract

AimEvidence on the availability and accessibility of health facilities and their impacts on long-acting modern contraceptives (LAMC) use in low- and middle-Income countries are scarce. This study examined the influence of the availability and readiness of health facilities in determining the use of LAMC in Bangladesh.MethodsWe linked data of the Bangladesh Demographic and Health Survey and the Health Facility Survey using the administrative-boundary linkage method. Mixed effect multilevel logistic regression was conducted. The sample comprised 10,938 married women of 15-49 years of age, who were fertile but did not desire a child within two years of the date of survey. The outcome variable was the current use of LAMC (yes, no) and the explanatory variables were health facility-, individual-, household- and community-level factors.ResultsNearly 34% of participants used LAMC with significant variations across areas in Bangladesh. The average distance between the nearest LAMC-providing health facilities and women’s homes was 6.36 km, higher in the Sylhet division (8.34 km) and lower in the Dhaka division (4.34 km). Increased scores for the management (adjusted odds ratio (AOR) 1.59; 95% CI, 1.21-2.42) and infrastructure (AOR, 1.44; 95% CI, 1.01-1.69) of health facilities were positively associated with the overall uptake of LAMC. AORs for women to report using LMAC were 2.16 (95% CI, 1.18-3.21) and 1.74 (95% CI, 1.15-3.20), respectively, for per unit increase in the availability and readiness scores to provide LAMC at the nearest health facilities. Nearly 27% decline in the likelihood of LAMC uptake was observed for every kilometer increase in the average regional-level distance between women’s homes and the nearest health facilities.ConclusionThe availability of health facilities close to residence and their improved management, infrastructure, and readiness to provide LAMC play a significant role in increasing LAMC uptake among women. Policies and programs should prioritize increasing the availability and accessibility of health facilities that provide LAMC services.

Published
2021

45. Women's experience of unintended pregnancy and changes in contraceptive methods: evidence from a nationally representative survey

Author

Md Nuruzzaman Khan and M. Mofizul Islam

Subjects
Contraception, Reproductive Medicine, Contraceptive Agents, Pregnancy, Obstetrics and Gynecology, Humans, Pregnancy, Unplanned, Female, Contraception Behavior, Pregnancy, Unwanted
Abstract

Ineffective or no use of contraception following an unintended pregnancy contributes to a subsequent unintended pregnancy. This study aimed to determine whether women's experiences of unintended pregnancies affect changing their contraceptive using patterns.We analysed the 2017/2018 Bangladesh Demographic and Health Survey data. The contraceptive switching pattern was computed by comparing women's contraceptives using data before and after pregnancy. Women were categorised into the following three groups, depending on their patterns of contraceptive use before and after pregnancy: no change, if there were no change in contraceptive using pattern; switched to higher effective contraceptives, if changed from pre-pregnancy less effective contraceptives to post-pregnancy more effective contraceptives; switched to less effective contraceptives, if changed from pre-pregnancy more effective contraceptives to post-pregnancy less effective contraceptives. Women's intention in the most recent pregnancy was our primary explanatory variable, classified as wanted, mistimed and unwanted. Multinomial multilevel logistics regression was used to determine the association between women's intention in the most recent pregnancy and women's contraceptive methods switching patterns from before to after pregnancy.Around 20% of the most recent pregnancies that ended with a live birth were unintended at conception. No contraceptive use was reported by 37% of women before their pregnancies which decreased to 24% after pregnancies. Overall, around 54% of women who reported no contraceptive use before pregnancy used modern contraceptives after pregnancy. The rate was higher among women who experienced unwanted pregnancy (73.4%) than mistimed (58.8%) and wanted (53.4%) pregnancy. Experience of mistimed pregnancy was associated with a higher likelihood of no contraceptive change (aOR, 1.84, 95% CI 1.41-2.39) and switching to less effective contraceptives (aOR, 1.58, 95% CI 1.10-2.26) than switching to more effective contraceptives. However, unwanted pregnancy was not associated with any significant change in contraceptives use from before to after pregnancy.Experience of unintended pregnancy did not change women's contraception using patterns, which indicates the risk of repeat unintended pregnancies and associated adverse consequences, including maternal and child morbidity and mortality. Policies to ensure access to and use of modern contraceptives among women facing unwanted or mistimed pregnancies are recommended.Unintended pregnancy is considered a public health challenge in low- and middle-income countries (LMICs). Around 89% of the global occurrences of unintended pregnancies occur in LMICs. In absolute numbers, this is equivalent to nearly 88 million pregnancies. Adverse pregnancy consequences, including bleeding, haemorrhage and maternal mortality are common in this group. The adverse consequences are even higher among women facing unintended pregnancies more than once, i.e., repeat unintended pregnancies, which represent around half of the total occurrences of unintended pregnancies in LMICs. Ensuring proper access to effective contraceptives following birth is key to reducing repeat unintended pregnancies and associated adverse consequences. It is critical to know the patterns of women’s pre-pregnancy contraceptive methods use and whether experiences of unintended pregnancies affect their contraceptive methods uptake and their types. However, this data is completely lacking in the context of LMICs. Using nationally representative survey data from Bangladesh, we examined women’s contraceptive switching patterns from before to after pregnancy and their association with pregnancy types. We found increased likelihood of no change in contraceptive using pattern or switching to less effective contraceptives among women after they experienced mistimed pregnancy compared to those whose pregnancy was wanted. This pattern increases the risk of repeat unintended pregnancies in Bangladesh and associated adverse consequences, including maternal and child morbidity and mortality.

Published
2021

46. Neonatal Outcomes of Infants Born to Pregnant Women With Substance Use Disorders: A Multilevel Analysis of Linked Data

Author

Melissa Buultjens, M. Mofizul Islam, Helen T. Oni, and Abdel-Latif Mohamed

Subjects
medicine.medical_specialty, Health (social science), Neonatal intensive care unit, Substance-Related Disorders, Psychological intervention, Medicine (miscellaneous), Pregnancy, medicine, Humans, Retrospective Studies, Semantic Web, business.industry, Obstetrics, Public Health, Environmental and Occupational Health, Infant, Newborn, Pregnancy Outcome, Infant, Odds ratio, medicine.disease, Substance abuse, Analgesics, Opioid, Psychiatry and Mental health, Polysubstance dependence, Multilevel Analysis, Premature Birth, Apgar score, Female, Diagnosis code, Pregnant Women, business
Abstract

OBJECTIVE This study examines the associations of substance use disorders in pregnancy with a set of neonatal outcomes. METHODS This is a quantitative retrospective study. Three linked datasets of a 10-year period (2007-2016) from New South Wales, Australia, were examined. Pregnant women were identified positive for substance use disorders when at least one hospital admission during pregnancy or delivery had opioid-, or cannabis-, or stimulant-, or alcohol- or two or more of the four substance groups- related ICD-10-AM diagnostic code. As there was a hierarchical structure in the dataset, the adjusted odds ratio (AOR) was estimated using multilevel logistic regression. FINDINGS Of the 622,640 birth records, 1677 (0.27%) women had opioid-related, 1857 (0.30%) had cannabis-related, 552 (0.09%) had stimulant-related, 595 (0.10%) had alcohol-related and 591 (0.09%) had polysubstance-related ICD-10-AM diagnostic codes. There were significant relationships between opioid use in pregnancy and neonatal health outcomes including preterm birth (AOR 3.2; 95% CI 2.8, 3.7) and admission to the neonatal intensive care unit (NICU) (AOR 10.0; 95% CI 8.8, 11.3). Substance use disorders due to cannabis, stimulants, alcohol or polysubstance were significantly associated with preterm birth, low birthweight, low APGAR score and admission to NICU. Also, alcohol and polysubstance use disorders in pregnancy were found to be significantly associated with stillbirth. CONCLUSION Results demonstrate that substance use disorders in pregnancy are associated with an increased risk of adverse neonatal outcomes. Early identification of substance use disorders through screening and adherence to pharmacotherapy and other psychosocial interventions could improve neonatal outcomes.

Published
2021

47. Exploring rise of pregnancy in Bangladesh resulting from contraceptive failure

Author

Md Nuruzzaman Khan and M Mofizul Islam

Subjects
Adult, Male, Bangladesh, Multidisciplinary, Adolescent, Science, Contraceptive Effectiveness, Abortion, Induced, Condoms, Pregnancy Complications, Young Adult, Contraception, Pregnancy, Medicine, Humans, Female, Program Evaluation
Abstract

The objective of this study was to determine how changes in pre-pregnancy contraceptive methods used between 2011 and 2017/18 contributed to the changes in pregnancy resulting from contraceptive methods failure in Bangladesh. We used 2011 and 2017/18 Bangladesh Demographic and Health Survey data. Pre-pregnancy contraceptive methods failure was our outcome of interest, which was determined using women’s response about whether they became pregnant while using contraceptives before the most recent pregnancy. The year of the survey was the main explanatory variable. Descriptive statistics were used to describe the characteristics of the respondents. The difference in contraceptive methods failure across the socio-demographic characteristics was assessed by Chi-squared test. Multilevel poison regressions were used to determine the changes in the prevalence ratio of contraceptive methods failure across the survey years. Contraceptive methods failure rate increased between the surveys, from 22.8% in 2011 to 27.3% in 2017/18. Also, male condom use increased by 2.8%, while withdrawal/periodic abstinence and/or other methods decreased by 2.9%. The failure rates in these two categories of contraceptive methods increased substantially by 4.0% and 9.0%, respectively. Compared to the 2011 survey, the prevalence ratio (PR) of contraceptive methods failure was 20% (PR 1.2, 95% CI 1.1–1.3) high in the 2017/18 survey. This PR declined 13% (PR 1.1, 95% CI 1.04–1.2) once the model was adjusted for women’s and their partner’s characteristics along with the last contraceptives used. This study provides evidence of increasing rates of pregnancy due to contraceptive failure in Bangladesh. Given that this type of pregnancy is known to cause adverse pregnancy outcomes, including abortion, pregnancy complications, maternal and early child morbidity and mortality, policy and programs are needed to reduce its prevalence. Effective coordination between the contraception providers at the healthcare facilities and the households and a proactive role of family planning workers to make couples aware of the effective use of contraceptives are recommended.

Published
2021

48. Prevalence and risk factors of short birth interval in Bangladesh: Evidence from the linked data of population and health facility survey

Author

Mohammad Zahidul Islam, M. Mofizul Islam, Md. Mostafizur Rahman, and Md. Nuruzzaman Khan

Subjects
education.field_of_study, Descriptive statistics, business.industry, Population, Odds, Child mortality, symbols.namesake, Health facility, Kilometer, Health care, symbols, Medicine, Poisson regression, education, business, Demography
Abstract

BackgroundThe Sustainable Development Goals target significant reductions in maternal and under-five deaths by 2030. The prevalence of these deaths is significantly associated with short birth interval (SBI). Identification of factors associated with SBI is pivotal for intervening with appropriate programmes to reduce these adverse consequences. This study aimed to determine the factors associated with SBI in Bangladesh.MethodsThe Bangladesh Demographic and Health Survey 2017/18 and Bangladesh Health Facility Data 2017 were linked and analysed. SBI was defined as an interval between consecutive births of 33 months or less, as recommended by the World Health Organization. We used descriptive statistics to summarise respondents’ characteristics and multilevel Poisson regression to assess the predictors of SBI.ResultsAround 26% of live births occurred in short intervals, with a further higher prevalence among younger, uneducated, or rural women. The likelihoods of SBI were lower among women aged 20-34 years (PR, 0.14; 95% CI, 0.11-0.17) and ≥ 35 years (PR, 0.03; 95% CI, 0.02-0.05) as compared to the women aged 19 years or less. Women from households with the richest wealth quintile experienced lower odds of SBI (PR, 0.61; 95% CI, 0.45-0.85) compared to those from the poorest wealth quintile. The prevalences of SBI were higher among women for whom the children born from the second most pregnancies died (PR, 5.23; 95% CI, 4.18-6.55), those who were living in Chattogram (PR, 1.52; 95% CI, 1.12-2.07) or Sylhet (PR, 2.83, 95% CI, 2.08-3.86) divisions. Availability of modern contraceptives at the nearest healthcare facilities was 66% protective to the occurrence of SBI (PR, 0.34; 95% CI, 0.22-0.78). Also, the prevalence of SBI increased around 85% (PR, 1.85; 95% CI, 1.33-2.18) for every kilometer increase in the distance of nearby health facilities from women’s homes.ConclusionMore than a quarter of live births in Bangladesh occurred in short intervals. This relatively high prevalence is a challenge for Bangladesh in reducing pregnancy-related adverse consequences, including maternal and child mortality. Policies and programmes are needed to increase awareness of SBI and associated adverse health outcomes and expand access to modern contraceptives.

Published
2021

49. Barriers to women's disclosure of and treatment for substance use during pregnancy: A qualitative study

Author

Helen Tosin Oni, James Alfred Drake, Paul Dietze, Peter Higgs, and M Mofizul Islam

Subjects
Pregnancy, Substance-Related Disorders, Maternity and Midwifery, Obstetrics and Gynecology, Humans, Female, Disclosure, Longitudinal Studies, Child, Qualitative Research, Health Services Accessibility
Abstract

The use of alcohol and or illicit drugs during pregnancy is a complex public health issue. There are many adverse short- and long-term health implications of substance use during pregnancy that can potentially affect the mother-foetal dyad. Although prevention and treatment options - such as counselling, pharmacotherapy, rehabilitation, support and case management and withdrawal management - are available, a range of barriers impedes women's ability to disclose their substance use, which limits access and engagement with available services.This research explored barriers women encountered in disclosing substance use and accessing substance use treatment in pregnancy.Participants were recruited from a longitudinal cohort study of people with a history of injecting drug use from metropolitan Melbourne. One-on-one in-depth interviews with 15 participants were conducted using a semi-structured interview guide. To be included in this study, participants must have reported a history of substance use during one or more of their pregnancies.The fear of losing child custody associated with the involvement of the child protection services was one of the main barriers to disclosing substance use during pregnancy and accessing treatment and rehabilitation services. Other barriers including stigma and perceived limited treatment options impacted women in various ways.Pregnancy is an important time for women and offers opportunities for service providers to support women who are using substances. While not all barriers can be removed, careful consideration of individual cases and circumstances may help service providers to tailor interventions that are likely to be more successful.

Published
2021

50. Factors affecting child marriage and contraceptive use among Rohingya girls in refugee camps

Author

M. Mofizul Islam, Nuruzzaman Khan, and Mashiur Rahman

Subjects
Descriptive statistics, Health Policy, Refugee, media_common.quotation_subject, Public Health, Environmental and Occupational Health, Obstetrics and Gynecology, Qualitative property, Psychiatry and Mental health, Infectious Diseases, Pill, Child marriage, Pediatrics, Perinatology and Child Health, Internal Medicine, Childbirth, Girl, Geriatrics and Gerontology, Thematic analysis, Public aspects of medicine, RA1-1270, Psychology, media_common, Demography, Uncategorized, Research Paper
Abstract

Summary Background: Rohingya girls living in the refugee camps in Bangladesh are disproportionately vulnerable to child marriages and teenage pregnancies. This study examines the factors affecting child marriage and contraceptive use among Rohingya girls who have experienced child marriages. Methods: We collected and analysed quantitative and qualitative data from adolescent Rohingya girls (age 10-19 years) who experienced child marriages. The quantitative data (n=96) came from a cross-sectional survey, and the qualitative data (n=18) from in-depth interviews conducted in the world's largest refugee camp located in Cox's Bazar, Bangladesh. We also interviewed service providers (n=9) of reproductive healthcare services to gain their perspectives regarding contraceptive use among these young girls. We used descriptive statistics to characterise the girls’ demographic profiles, ages at their first marriages, and contraceptive use. Thematic analysis was used for the qualitative data to identify key factors influencing child marriage and contraceptive use among these girls. Findings: On average, the adolescent female participants had been 15.7 years old when they were first married. Over 80% had given birth during the two years before the survey or were pregnant during time of the data collection. The main factors that influenced child marriage were found to be perceptions regarding the physical and mental maturity for marriage, social norms, insecurity, family honour, preferences for younger brides and the relaxed enforcement of the minimum legal age for marriage. A third (34%) of the girls said they were using contraceptives on the week when the study was conducted. The desire for children, religious beliefs, misapprehension about contraception and long waiting periods in facility-based health services and current service provision were the main factors influencing contraceptive use. Depo Provera injections and pills were the dominant methods of contraception. Contraceptive use during the period between marriage and the first childbirth is rare. Interpretation: Girl child marriage is common in Rohingya camps. Contraceptive use is rare among newly married girls before they give birth for the first time. The involvement of female and male Rohingya volunteers for outreach services can be catalytic in promoting contraceptive use. Funding: La Trobe Asia, La Trobe University, Melbourne, Australia. Bengali translation of the abstract in Appendix 1

Published
2021

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