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1. Health disparities across the counties of Kenya and implications for policy makers, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

Author

Achoki, T, Miller-Petrie, MK, Glenn, SD, Kalra, N, Lesego, A, Gathecha, GK, Alam, U, Kiarie, HW, Maina, IW, Adetifa, IMO, Barsosio, HC, Degfie, TT, Keiyoro, PN, Kiirithio, DN, Kinfu, Y, Kinyoki, DK, Kisia, JM, Krish, VS, Lagat, AK, Mooney, MD, Moturi, WN, Newton, CRJ, Ngunjiri, JW, Nixon, MR, Soti, DO, Van De Vijver, S, Yonga, G, Hay, SI, Murray, CJL, and Naghavi, M

Subjects
lcsh:Public aspects of medicine, lcsh:RA1-1270
Abstract

Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 provided comprehensive estimates of health loss globally. Decision makers in Kenya can use GBD subnational data to target health interventions and address county-level variation in the burden of disease. Methods We used GBD 2016 estimates of life expectancy at birth, healthy life expectancy, all-cause and cause-specific mortality, years of life lost, years lived with disability, disability-adjusted life-years, and risk factors to analyse health by age and sex at the national and county levels in Kenya from 1990 to 2016. Findings The national all-cause mortality rate decreased from 850·3 (95% uncertainty interval [UI] 829·8–871·1) deaths per 100 000 in 1990 to 579·0 (562·1–596·0) deaths per 100 000 in 2016. Under-5 mortality declined from 95·4 (95% UI 90·1–101·3) deaths per 1000 livebirths in 1990 to 43·4 (36·9–51·2) deaths per 1000 livebirths in 2016, and maternal mortality fell from 315·7 (242·9–399·4) deaths per 100 000 in 1990 to 257·6 (195·1–335·3) deaths per 100 000 in 2016, with steeper declines after 2006 and heterogeneously across counties. Life expectancy at birth increased by 5·4 (95% UI 3·7–7·2) years, with higher gains in females than males in all but ten counties. Unsafe water, sanitation, and handwashing, unsafe sex, and malnutrition were the leading national risk factors in 2016. Interpretation Health outcomes have improved in Kenya since 2006. The burden of communicable diseases decreased but continues to predominate the total disease burden in 2016, whereas the non-communicable disease burden increased. Health gains varied strikingly across counties, indicating targeted approaches for health policy are necessary.

Published
2018

2. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015 : the Global Burden of Disease Study 2015

Author

GBD 2015 HIV Collaborators, Wang, H, Wolock, TM, Carter, A, Nguyen, G, Kyu, HH, Gakidou, E, Hay, SI, Mills, EJ, Trickey, A, Msemburi, W, Coates, MM, Mooney, MD, Fraser, MS, Sligar, A, Salomon, J, Larson, HJ, Friedman, J, Abajobir, AA, Abate, KH, Abbas, KM, Razek, MM, Abd-Allah, F, Abdulle, AM, Abera, SF, Abubakar, I, Abu-Raddad, LJ, Abu-Rmeileh, NM, Abyu, GY, Adebiyi, AO, Adedeji, IA, Adelekan, AL, Adofo, K, Adou, AK, Ajala, ON, Akinyemiju, TF, Akseer, N, Lami, FH, Al-Aly, Z, Alam, K, Alam, NK, Alasfoor, D, Aldhahri, SF, Aldridge, RW, Alegretti, MA, Aleman, AV, Alemu, ZA, Alfonso-Cristancho, R, Ali, R, Alkerwi, A, Alla, F, Mohammad, R, Al-Raddadi, S, Alsharif, U, Alvarez, E, Alvis-Guzman, N, Amare, AT, Amberbir, A, Amegah, AK, Ammar, W, Amrock, SM, Antonio, CA, Anwari, P, Ärnlöv, J, Artaman, A, Asayesh, H, Asghar, RJ, Assadi, R, Atique, S, Atkins, LS, Avokpaho, EF, Awasthi, A, Quintanilla, BP, Bacha, U, Badawi, A, Barac, A, Bärnighausen, T, Basu, A, Bayou, TA, Bayou, YT, Bazargan-Hejazi, S, Beardsley, J, Bedi, N, Bennett, DA, Bensenor, IM, Betsu, BD, Beyene, AS, Bhatia, E, Bhutta, ZA, Biadgilign, S, Bikbov, B, Birlik, SM, Bisanzio, D, Brainin, M, Brazinova, A, Breitborde, NJ, Brown, A, Burch, M, Butt, ZA, Campuzano, JC, Cárdenas, R, Carrero, JJ, Castañeda-Orjuela, CA, Rivas, JC, Catalá-López, F, Chang, HY, Chang, JC, Chavan, L, Chen, W, Chiang, PP, Chibalabala, M, Chisumpa, VH, Choi, JY, Christopher, DJ, Ciobanu, LG, Cooper, C, Dahiru, T, Damtew, SA, Dandona, L, Dandona, R, Das Neves, J, De Jager, P, De Leo, D, Degenhardt, L, Dellavalle, RP, Deribe, K, Deribew, A, Des Jarlais, DC, Dharmaratne, SD, Ding, EL, Doshi, PP, Driscoll, TR, Dubey, M, Elshrek, YM, Elyazar, I, Endries, AY, Ermakov, SP, Eshrati, B, Esteghamati, A, Faghmous, ID, Farinha, CS, Faro, A, Farvid, MS, Farzadfar, F, Fereshtehnejad, SM, Fernandes, JC, Fischer, F, Fitchett, JR, Foigt, N, Fullman, N, Fürst, T, Gankpé, FG, Gebre, T, Gebremedhin, AT, Gebru, AA, Geleijnse, JM, Gessner, BD, Gething, PW, Ghiwot, TT, Giroud, M, Gishu, MD, Glaser, E, Goenka, S, Goodridge, A, Gopalani, SV, Goto, A, Gugnani, HC, Guimaraes, MD, Gupta, R, Gupta, V, Haagsma, J, Hafezi-Nejad, N, Hagan, H, Hailu, GB, Hamadeh, RR, Hamidi, S, Hammami, M, Hankey, GJ, Hao, Y, Harb, HL, Harikrishnan, S, Haro, JM, Harun, KM, Havmoeller, R, Hedayati, MT, Heredia-Pi, IB, Hoek, HW, Horino, M, Horita, N, Hosgood, HD, Hoy, DG, Hsairi, M, Hu, G, Huang, H, Huang, JJ, Iburg, KM, Idrisov, BT, Innos, K, Iyer, VJ, Jacobsen, KH, Jahanmehr, N, Jakovljevic, MB, Javanbakht, M, Jayatilleke, AU, Jeemon, P, Jha, V, Jiang, G, Jiang, Y, Jibat, T, Jonas, JB, Kabir, Z, Kamal, R, Kan, H, Karch, A, Karema, CK, Karletsos, D, Kasaeian, A, Kaul, A, Kawakami, N, Kayibanda, JF, Keiyoro, PN, Kemp, AH, Kengne, AP, Kesavachandran, CN, Khader, YS, Khalil, I, Khan, AR, Khan, EA, Khang, YH, Khubchandani, J, Kim, YJ, Kinfu, Y, Kivipelto, M, Kokubo, Y, Kosen, S, Koul, PA, Koyanagi, A, Defo, BK, Bicer, BK, Kulkarni, VS, Kumar, GA, Lal, DK, Lam, H, Lam, JO, Langan, SM, Lansingh, VC, Larsson, A, Leigh, J, Leung, R, Li, Y, Lim, SS, Lipshultz, SE, Liu, S, Lloyd, BK, Logroscino, G, Lotufo, PA, Lunevicius, R, Razek, HM, Mahdavi, M, Majdan, M, Majeed, A, Makhlouf, C, Malekzadeh, R, Mapoma, CC, Marcenes, W, Martinez-Raga, J, Marzan, MB, Masiye, F, Mason-Jones, AJ, Mayosi, BM, McKee, M, Meaney, PA, Mehndiratta, MM, Mekonnen, AB, Melaku, YA, Memiah, P, Memish, ZA, Mendoza, W, Meretoja, A, Meretoja, TJ, Mhimbira, FA, Miller, TR, Mikesell, J, Mirarefin, M, Mohammad, KA, Mohammed, S, Mokdad, AH, Monasta, L, Moradi-Lakeh, M, Mori, R, Mueller, UO, Murimira, B, Murthy, GV, Naheed, A, Naldi, L, Nangia, V, Nash, D, Nawaz, H, Nejjari, C, Ngalesoni, FN, De Dieu Ngirabega, J, Nguyen, QL, Nisar, MI, Norheim, OF, Norman, RE, Nyakarahuka, L, Ogbo, FA, Oh, IH, Ojelabi, FA, Olusanya, BO, Olusanya, JO, Opio, JN, Oren, E, Ota, E, Padukudru, MA, Park, HY, Park, JH, Patil, ST, Patten, SB, Paul, VK, Pearson, K, Peprah, EK, Pereira, CC, Perico, N, Pesudovs, K, Petzold, M, Phillips, MR, Pillay, JD, Plass, D, Polinder, S, Pourmalek, F, Prokop, DM, Qorbani, M, Rafay, A, Rahimi, K, Rahimi-Movaghar, V, Rahman, M, Rahman, MH, Rahman, SU, Rai, RK, Rajsic, S, Ram, U, Rana, SM, Rao, PV, Remuzzi, G, Rojas-Rueda, D, Ronfani, L, Roshandel, G, Roy, A, Ruhago, GM, Saeedi, MY, Sagar, R, Saleh, MM, Sanabria, JR, Santos, IS, Sarmiento-Suarez, R, Sartorius, B, Sawhney, M, Schutte, AE, Schwebel, DC, Seedat, S, Sepanlou, SG, Servan-Mori, EE, Shaikh, MA, Sharma, R, She, J, Sheikhbahaei, S, Shen, J, Shibuya, K, Shin, HH, Sigfusdottir, ID, Silpakit, N, Silva, DA, Silveira, DG, Simard, EP, Sindi, S, Singh, JA, Singh, OP, Singh, PK, Skirbekk, V, Sliwa, K, Soneji, S, Sorensen, RJ, Soriano, JB, Soti, DO, Sreeramareddy, CT, Stathopoulou, V, Steel, N, Sunguya, BF, Swaminathan, S, Sykes, BL, Tabarés-Seisdedos, R, Talongwa, RT, Tavakkoli, M, Taye, B, Tedla, BA, Tekle, T, Shifa, GT, Temesgen, AM, Terkawi, AS, Tesfay, FH, Tessema, GA, Thapa, K, Thomson, AJ, Thorne-Lyman, AL, Tobe-Gai, R, Topor-Madry, R, Towbin, JA, Tran, BX, Dimbuene, ZT, Tsilimparis, N, Tura, AK, Ukwaja, KN, Uneke, CJ, Uthman, OA, Venketasubramanian, N, Vladimirov, SK, Vlassov, VV, Vollset, SE, Wang, L, Weiderpass, E, Weintraub, RG, Werdecker, A, Westerman, R, Wijeratne, T, Wilkinson, JD, Wiysonge, CS, Wolfe, CD, Won, S, Wong, JQ, Xu, G, Yadav, AK, Yakob, B, Yalew, AZ, Yano, Y, Yaseri, M, Yebyo, HG, Yip, P, Yonemoto, N, Yoon, SJ, Younis, MZ, Yu, C, Yu, S, Zaidi, Z, Zaki, MELS, Zeeb, H, Zhang, H, Zhao, Y, Zodpey, S, Zoeckler, L, Zuhlke, LJ, Lopez, AD, and Murray, CJ

Subjects
GBD 2015 HIV Collaborators
Abstract

BACKGROUND: Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015. METHODS: For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification. FINDINGS: Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1-3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5-2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6-40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7-1·9 million) in 2005, to 1·2 million deaths (1·1-1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections. INTERPRETATION: Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030. Funding: We thank the countless individuals who have contributed to the Global Burden of Disease (GBD) Study 2015 in various capacities. We specifically thank Jeffrey Eaton and John Stover. HW and CJLM received funding for this study from the Bill & Melinda Gates Foundation; the National Institute of Mental Health, National Institutes of Health (NIH; R01MH110163); and the National Institute on Aging, NIH (P30AG047845). LJAR acknowledges the support of Qatar National Research Fund (NPRP 04-924-3-251) who provided the main funding for generating the data provided to the GBD-Institute for Health Metrics and Evaluation effort. BPAQ acknowledges institutional support from PRONABEC (National Program of Scholarship and Educational Loan), provided by the Peruvian government. DB is supported by the Bill & Melinda Gates Foundation (grant number OPP1068048). JDN was supported in his contribution to this work by a Fellowship from Fundacao para a Ciencia e a Tecnologia, Portugal (SFRH/BPD/92934/2013). KD is supported by a Wellcome Trust Fellowship in Public Health and Tropical Medicine (grant number 099876). TF received financial support from the Swiss National Science Foundation (SNSF; project number P300P3-154634). AG acknowledges funding from Sistema Nacional de Investigadores de Panama-SNI. PJ is supported by Wellcome Trust-DBT India Alliance Clinical and Public Health Intermediate Fellowship. MK receives research support from the Academy of Finland, the Swedish Research Council, Alzheimerfonden, Alzheimer's Research & Prevention Foundation, Center for Innovative Medicine (CIMED) at Karolinska Institutet South Campus, AXA Research Fund, Wallenberg Clinical Scholars Award from the Knut och Alice Wallenbergs Foundation, and the Sheika Salama Bint Hamdan Al Nahyan Foundation. AK's work was supported by the Miguel Servet contract financed by the CP13/00150 and PI15/00862 projects, integrated into the National R&D&I and funded by the ISCIII (General Branch Evaluation and Promotion of Health Research), and the European Regional Development Fund (ERDF-FEDER). SML is funded by a National Institute for Health Research (NIHR) Clinician Scientist Fellowship (grant number NIHR/CS/010/014). HJL reports grants from the NIHR, EU Innovative Medicines Initiative, Centre for Strategic & International Studies, and WHO. WM is Program analyst, Population and Development, in the Peru Country Office of the United Nations Population Fund, which does not necessarily endorse this study. For UOM, funding from the German National Cohort Consortium (O1ER1511D) is gratefully acknowledged. KR reports grants from NIHR Oxford Biomedical Research Centre, NIHR Career Development Fellowship, and Oxford Martin School during the conduct of the study. GR acknowledges that work related to this paper has been done on the behalf of the GBD Genitourinary Disease Expert Group supported by the International Society of Nephrology (ISN). ISS reports grants from FAPESP (Brazilian public agency). RSS receives institutional support from Universidad de Ciencias Aplicadas y Ambientales, UDCA, Bogota Colombia. SS receives postdoctoral funding from the Fonds de la recherche en sante du Quebec (FRSQ), including its renewal. RTS was supported in part by grant number PROMETEOII/2015/021 from Generalitat Valenciana and the national grant PI14/00894 from ISCIII-FEDER. PY acknowledges support from Strategic Public Policy Research (HKU7003-SPPR-12).

Published
2016

3. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015

Author

Wang, H, Wolock, TM, Carter, A, Nguyen, G, Kyu, HH, Gakidou, E, Hay, SI, Mills, EJ, Trickey, A, Msemburi, W, Coates, MM, Mooney, MD, Fraser, MS, Sligar, A, Salomon, J, Larson, HJ, Friedman, J, Abajobir, AA, Abate, KH, Abbas, KM, Abd El Razek, MM, Abd-Allah, F, Abdulle, AM, Abera, SF, Abubakar, I, Abu-Raddad, LJ, Abu-Rmeileh, NME, Abyu, GY, Adebiyi, AO, Adedeji, IA, Adelekan, AL, Adofo, K, Adou, AK, Ajala, ON, Akinyemiju, TF, Akseer, N, Al Lami, FH, Al-Aly, Z, Alam, K, Alam, NKM, Alasfoor, D, Aldhahri, SFS, Aldridge, RW, Alegretti, MA, Aleman, AV, Alemu, ZA, Alfonso-Cristancho, R, Ali, R, Alkerwi, A, Alla, F, Al-Raddadi, RMS, Alsharif, U, Alvarez, E, Alvis-Guzman, N, Amare, AT, Amberbir, A, Amegah, AK, Ammar, W, Amrock, SM, Antonio, CAT, Anwari, P, Arnlov, J, Al, A, Asayesh, H, Asghar, RJ, Assadi, R, Atique, S, Atkins, LS, Avokpaho, EFGA, Awasthi, A, Quintanilla, BPA, Bacha, U, Badawi, A, Barac, A, Barnighausen, T, Basu, A, Bayou, TA, Bayou, YT, Bazargan-Hejazi, S, Beardsley, J, Bedi, N, Bennett, DA, Bensenor, IM, Betsu, BD, Beyene, AS, Bhatia, E, Bhutta, ZA, Biadgilign, S, Bikbov, B, Birlik, SM, Bisanzio, D, Brainin, M, Brazinova, A, Breitborde, NJK, Brown, A, Burch, M, Butt, ZA, Campuzano, JC, Cardenas, R, Carrero, JJ, Castaneda-Orjuela, CA, Rivas, JC, Catala-Lopez, F, Chang, H-Y, Chang, J-C, Chavan, L, Chen, W, Chiang, PP-C, Chibalabala, M, Chisumpa, VH, Choi, J-YJ, Christopher, DJ, Ciobanu, LG, Cooper, C, Dahiru, T, Damtew, SA, Dandona, L, Dandona, R, das Neves, J, de Jager, P, De Leo, D, Degenhardt, L, Dellavalle, RP, Deribe, K, Deribew, A, Jarlais, DCD, Dharmaratne, SD, Ding, EL, Doshi, PP, Driscoll, TR, Dubey, M, Elshrek, YM, Elyazar, I, Endries, AY, Ermakov, SP, Eshrati, B, Esteghamati, A, Faghmous, IDA, Sofia e Sa Farinha, C, Faro, A, Farvid, MS, Farzadfar, F, Fereshtehnejad, S-M, Fernandes, JC, Fischer, F, Fitchett, JRA, Foigt, N, Fullman, N, Furst, T, Gankpe, FG, Gebre, T, Gebremedhin, AT, Gebru, AA, Geleijnse, JM, Gessner, BD, Gething, PW, Ghiwot, TT, Giroud, M, Gishu, MD, Glaser, E, Goenka, S, Goodridge, A, Gopalani, SV, Goto, A, Gugnani, HC, Guimaraes, MDC, Gupta, R, Gupta, V, Haagsma, J, Hafezi-Nejad, N, Hagan, H, Hailu, GB, Hamadeh, RR, Hamidi, S, Hammami, M, Hankey, GJ, Hao, Y, Harb, HL, Harikrishnan, S, Haro, JM, Harun, KM, Havmoeller, R, Hedayati, MT, Heredia-Pi, IB, Hoek, HW, Horino, M, Horita, N, Hosgood, HD, Hoy, DG, Hsairi, M, Hu, G, Huang, H, Huang, JJ, Iburg, KM, Idrisov, BT, Innos, K, Iyer, VJ, Jacobsen, KH, Jahanmehr, N, Jakovljevic, MB, Javanbakht, M, Jayatilleke, AU, Jeemon, P, Jha, V, Jiang, G, Jiang, Y, Jibat, T, Jonas, JB, Kabir, Z, Kamal, R, Kan, H, Karch, A, Karema, CK, Karletsos, D, Kasaeian, A, Kaul, A, Kawakami, N, Kayibanda, JF, Keiyoro, PN, Kemp, AH, Kengne, AP, Kesavachandran, CN, Khader, YS, Khalil, I, Khan, AR, Khan, EA, Khang, Y-H, Khubchandani, J, Kim, YJ, Kinfu, Y, Kivipelto, M, Kokubo, Y, Kosen, S, Koul, PA, Koyanagi, A, Defo, BK, Bicer, BK, Kulkarni, VS, Kumar, GA, Lal, DK, Lam, H, Lam, JO, Langan, SM, Lansingh, VC, Larsson, A, Leigh, J, Leung, R, Li, Y, Lim, SS, Lipshultz, SE, Liu, S, Lloyd, BK, Logroscino, G, Lotufo, PA, Lunevicius, R, Abd El Razek, HM, Mahdavi, M, Majdan, M, Majeed, A, Makhlouf, C, Malekzadeh, R, Mapoma, CC, Marcenes, W, Martinez-Raga, J, Marzan, MB, Masiye, F, Mason-Jones, AJ, Mayosi, BM, Mckee, M, Meaney, PA, Mehndiratta, MM, Mekonnen, AB, Melaku, YA, Memiah, P, Memish, ZA, Mendoza, W, Meretoja, A, Meretoja, TJ, Mhimbira, FA, Miller, TR, Mikesell, J, Mirarefin, M, Mohammad, KA, Mohammed, S, Mokdad, AH, Monasta, L, Moradi-Lakeh, M, Mori, R, Mueller, UO, Murimira, B, Murthy, GVS, Naheed, A, Naldi, L, Nangia, V, Nash, D, Nawaz, H, Nejjari, C, Ngalesoni, FN, Ngirabega, JDD, Quyen, LN, Nisar, MI, Norheim, OF, Norman, RE, Nyakarahuka, L, Ogbo, FA, Oh, I-H, Ojelabi, FA, Olusanya, BO, Olusanya, JO, Opio, JN, Oren, E, Ota, E, Padukudru, MA, Park, H-Y, Park, J-H, Patil, ST, Patten, SB, Paul, VK, Pearson, K, Peprah, EK, Pereira, DM, Perico, N, Pesudovs, K, Petzold, M, Phillips, MR, Pillay, JD, Plass, D, Polinder, S, Pourmalek, F, Prokop, DM, Qorbani, M, Rafay, A, Rahimi, K, Rahimi-Movaghar, V, Rahman, M, Rahman, MHU, Rahman, SU, Rai, RK, Rajsic, S, Ram, U, Rana, SM, Rao, PV, Remuzzi, G, Rojas-Rueda, D, Ronfani, L, Roshandel, G, Roy, A, Ruhago, GM, Saeedi, MY, Sagar, R, Saleh, MM, Sanabria, JR, Santos, IS, Sarmiento-Suarez, R, Sartorius, B, Sawhney, M, Schutte, AE, Schwebel, DC, Seedat, S, Sepanlou, SG, Servan-Mori, EE, Shaikh, MA, Sharma, R, She, J, Sheikhbahaei, S, Shen, J, Shibuya, K, Shin, HH, Sigfusdottir, ID, Silpakit, N, Santos Silva, DA, Alves Silveira, DG, Simard, EP, Sindi, S, Singh, JA, Singh, OP, Singh, PK, Skirbekk, V, Sliwa, K, Soneji, S, Sorensen, RJD, Soriano, JB, Soti, DO, Sreeramareddy, CT, Stathopoulou, V, Steel, N, Sunguya, BF, Swaminathan, S, Sykes, BL, Tabares-Seisdedos, R, Talongwa, RT, Tavakkoli, M, Taye, B, Tedla, BA, Tekle, T, Shifa, GT, Temesgen, AM, Terkawi, AS, Tesfay, FH, Tessema, GA, Thapa, K, Thomson, AJ, Thorne-Lyman, AL, Tobe-Gai, R, Topor-Madry, R, Towbin, JA, Bach, XT, Dimbuene, ZT, Tsilimparis, N, Tura, AK, Ukwaja, KN, Uneke, CJ, Uthman, OA, Venketasubramanian, N, Vladimirov, SK, Vlassov, VV, Vollset, SE, Wang, L, Weiderpass, E, Weintraub, RG, Werdecker, A, Westerman, R, Wijeratne, T, Wilkinson, JD, Wiysonge, CS, Wolfe, CDA, Won, S, Wong, JQ, Xu, G, Yadav, AK, Yakob, B, Yalew, AZ, Yano, Y, Yaseri, M, Yebyo, HG, Yip, P, Yonemoto, N, Yoon, S-J, Younis, MZ, Yu, C, Yu, S, Zaidi, Z, Zaki, MES, Zeeb, H, Zhang, H, Zhao, Y, Zodpey, S, Zoeckler, L, Zuhlke, LJ, Lopez, AD, Murray, CJL, Wang, H, Wolock, TM, Carter, A, Nguyen, G, Kyu, HH, Gakidou, E, Hay, SI, Mills, EJ, Trickey, A, Msemburi, W, Coates, MM, Mooney, MD, Fraser, MS, Sligar, A, Salomon, J, Larson, HJ, Friedman, J, Abajobir, AA, Abate, KH, Abbas, KM, Abd El Razek, MM, Abd-Allah, F, Abdulle, AM, Abera, SF, Abubakar, I, Abu-Raddad, LJ, Abu-Rmeileh, NME, Abyu, GY, Adebiyi, AO, Adedeji, IA, Adelekan, AL, Adofo, K, Adou, AK, Ajala, ON, Akinyemiju, TF, 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Yoon, S-J, Younis, MZ, Yu, C, Yu, S, Zaidi, Z, Zaki, MES, Zeeb, H, Zhang, H, Zhao, Y, Zodpey, S, Zoeckler, L, Zuhlke, LJ, Lopez, AD, and Murray, CJL

Abstract

BACKGROUND: Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015. METHODS: For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification. FINDINGS: Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1-3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5-2·8 mi

Published
2016

4. Health disparities across the counties of Kenya and implications for policy makers, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

Author

Achoki T, Miller-Petrie MK, Glenn SD, Kalra N, Lesego A, Gathecha GK, Alam U, Kiarie HW, Maina IW, Adetifa IMO, Barsosio HC, Degfie TT, Keiyoro PN, Kiirithio DN, Kinfu Y, Kinyoki DK, Kisia JM, Krish VS, Lagat AK, Mooney MD, Moturi WN, Newton CRJ, Ngunjiri JW, Nixon MR, Soti DO, Van De Vijver S, Yonga G, Hay SI, Murray CJL, and Naghavi M

Subjects
Humans, Kenya epidemiology, Administrative Personnel, Global Burden of Disease statistics & numerical data, Health Policy, Health Status Disparities
Abstract

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 provided comprehensive estimates of health loss globally. Decision makers in Kenya can use GBD subnational data to target health interventions and address county-level variation in the burden of disease., Methods: We used GBD 2016 estimates of life expectancy at birth, healthy life expectancy, all-cause and cause-specific mortality, years of life lost, years lived with disability, disability-adjusted life-years, and risk factors to analyse health by age and sex at the national and county levels in Kenya from 1990 to 2016., Findings: The national all-cause mortality rate decreased from 850·3 (95% uncertainty interval [UI] 829·8-871·1) deaths per 100 000 in 1990 to 579·0 (562·1-596·0) deaths per 100 000 in 2016. Under-5 mortality declined from 95·4 (95% UI 90·1-101·3) deaths per 1000 livebirths in 1990 to 43·4 (36·9-51·2) deaths per 1000 livebirths in 2016, and maternal mortality fell from 315·7 (242·9-399·4) deaths per 100 000 in 1990 to 257·6 (195·1-335·3) deaths per 100 000 in 2016, with steeper declines after 2006 and heterogeneously across counties. Life expectancy at birth increased by 5·4 (95% UI 3·7-7·2) years, with higher gains in females than males in all but ten counties. Unsafe water, sanitation, and handwashing, unsafe sex, and malnutrition were the leading national risk factors in 2016., Interpretation: Health outcomes have improved in Kenya since 2006. The burden of communicable diseases decreased but continues to predominate the total disease burden in 2016, whereas the non-communicable disease burden increased. Health gains varied strikingly across counties, indicating targeted approaches for health policy are necessary., Funding: Bill & Melinda Gates Foundation., (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Published
2019
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5. Feasibility of an innovative electronic mobile system to assist health workers to collect accurate, complete and timely data in a malaria control programme in a remote setting in Kenya.

Author

Soti DO, Kinoti SN, Omar AH, Logedi J, Mwendwa TK, Hirji Z, and Ferro S

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Electronic Data Processing, Electronic Health Records, Female, Humans, Infant, Infant, Newborn, Kenya, Malaria diagnosis, Male, Middle Aged, Young Adult, Electronics methods, Epidemiological Monitoring, Malaria epidemiology, Malaria prevention & control, Reminder Systems
Abstract

Background: The cornerstone of decision making aimed at improving health services is accurate and timely health information. The Ministry of Public Health and Sanitation in Kenya decided to pilot feasibility of Fionet, an innovation that integrates diagnostics, data capture and cloud services, in its malaria control programme to demonstrate usability and feasibility by primary level workers in a remote setting in Kenya., Methods: Eleven sites comprising one sub-district hospital, ten health centres and dispensaries were selected in three districts of Kisumu County to participate. Two health workers per site were selected, trained over a two-day period in the use of the Deki Reader™ to undertake rapid diagnostic testing (RDT) for malaria and data capture of patients' records. Health managers in the three districts were trained in the use of Fionet™ portal (web portal to cloud based information) to access the data uploaded by the Deki Readers. Field Support was provided by the Fio Corporation representative in Kenya., Results: A total of 5812 malaria RDTs were run and uploaded to the cloud database during this implementation research study. Uploaded data were automatically aggregated into predetermined reports for use by service managers and supervisors. The Deki Reader enhanced the performance of the health workers by not only guiding them through processing of a malaria RDT test, but also by doing the automated analysis of the RDT, capturing the image, determining whether the RDT was processed according to guidelines, and capturing full patient data for each patient encounter. Supervisors were able to perform remote Quality assurance/Quality control (QA/QC) activities almost in real time., Conclusion: Quality, complete and timely data collection by health workers in a remote setting in Kenya is feasible. This paperless innovation brought unprecedented quality control and quality assurance in diagnosis, care and data capture, all in the hands of the health worker at point of care in an integrated way.

Published
2015
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