| 1. |
- Lozano, Rafael, et al.
(författare)
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Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017
- 2018
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Ingår i: The Lancet. - : Elsevier. - 1474-547X .- 0140-6736. ; 392:10159, s. 2091-2138
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Tidskriftsartikel (refereegranskat)abstract
- Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030.
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| 2. |
- Afshin, Ashkan, et al.
(författare)
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Health Effects of Overweight and Obesity in 195 Countries over 25 Years
- 2017
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Ingår i: New England Journal of Medicine. - : MASSACHUSETTS MEDICAL SOC. - 0028-4793 .- 1533-4406. ; 377:1, s. 13-27
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Although the rising pandemic of obesity has received major attention in many countries, the effects of this attention on trends and the disease burden of obesity remain uncertain. METHODS We analyzed data from 68.5 million persons to assess the trends in the prevalence of overweight and obesity among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body-mass index (BMI), according to age, sex, cause, and BMI in 195 countries between 1990 and 2015. RESULTS In 2015, a total of 107.7 million children and 603.7 million adults were obese. Since 1980, the prevalence of obesity has doubled in more than 70 countries and has continuously increased in most other countries. Although the prevalence of obesity among children has been lower than that among adults, the rate of increase in childhood obesity in many countries has been greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million deaths globally, nearly 40% of which occurred in persons who were not obese. More than two thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden related to high BMI has increased since 1990; however, the rate of this increase has been attenuated owing to decreases in underlying rates of death from cardiovascular disease. CONCLUSIONS The rapid increase in the prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem.
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| 3. |
- Ahrens, Lutz, et al.
(författare)
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Poly- and perfluoroalkylated substances (PFASs) in water, sediment and fish muscle tissue from Lake Tana, Ethiopia and implications for human exposure
- 2016
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Ingår i: Chemosphere. - : Elsevier BV. - 0045-6535 .- 1879-1298. ; 165, s. 352-357
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Tidskriftsartikel (refereegranskat)abstract
- Lake Tana is Ethiopia's largest lake and there are plans to increase the harvest of fish from the lake. The objective of this study was to assess the levels of poly- and perfluoroalkyl substances (PFASs) in different compartments of the lake (water, sediment, and fish muscle tissue), and its implications for human exposure. The results showed higher PFAS concentrations in piscivorous fish species (Labeobarbus mega-stoma and Labeobarbus gorguari) than non-piscivorous species (Labeobarbus intermedius, Oreochromis niloticus and Clarias gariepinus) and also spatial distribution similarities. The Sigma PFAS concentrations ranged from 0.073 to 5.6 ng L-1 (on average, 2.9 ng L-1) in surface water, 0.22-0.55 ng g(-1) dry weight (dw) (on average, 0.30 ng g(-1) dw) in surface sediment, and non-detected to 5.8 ng g(-1) wet weight (ww) (on average, 1.2 ng g(-1) ww) in all fish species. The relative risk (RR) indicates that the consumption of fish contaminated with perfiuorooctane sulfonate (PFOS) will likely not cause any harmful effects for the Ethiopian fish eating population. However, mixture toxicity of the sum of PFASs, individual fish consumption patterns and increasing fish consumption are important factors to consider in future risk assessments.
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| 4. |
- Alarcon Ferrari, Cristian, et al.
(författare)
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Citizen Science as Democratic Innovation That Renews Environmental Monitoring and Assessment for the Sustainable Development Goals in Rural Areas
- 2021
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Ingår i: Sustainability. - : MDPI. - 2071-1050. ; 13:5
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Tidskriftsartikel (refereegranskat)abstract
- This commentary focuses on analyzing the potential of citizen science to address legitimacy issues in the knowledge base used to guide transformative governance in the context of the United Nation’s Sustainable Development Goals (henceforth SDGs). The commentary develops two interrelated arguments for better understanding the limits of what we term “traditional” Environmental Monitoring and Assessment (EMA) as well as the potential of citizen science (CS) for strengthening the legitimacy of EMA in the local implementation of SDGs. We start by arguing that there is an urgent need for a profound renewal of traditional EMA to better implement the SDGs. Then, we present CS as a democratic innovation that provides a path to EMA renewal that incorporates, develops, and extends the role of CS in data production and use by EMA. The commentary substantiates such arguments based on current approaches to CS and traditional EMA. From this starting point, we theorize the potential of CS as a democratic innovation that can repurpose EMA as a tool for the implementation of the SDGs. With a focus on the implementation of SDG15 (Life on Land) in local contexts, the commentary presents CS as a democratic innovation for legitimate transformative governance that can affect socio-ecological transitions. We see this approach as especially appropriate to analyze the implementation of SDGs in rural settings where a specific resource nexus can create conflict-laden contexts with much potential for a renewed EMA to support transformative governance towards Agenda 2030.
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| 5. |
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| 6. |
- Bishop, Kevin, 1960-, et al.
(författare)
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Forest Cover and Stream Flow in a Headwater of the Blue Nile : Complementing Observational Data Analysis with Community Perception
- 2010
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Ingår i: Ambio. - : Springer Science and Business Media LLC. - 0044-7447 .- 1654-7209. ; 39:4, s. 284-294
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Tidskriftsartikel (refereegranskat)abstract
- This study analyses the relation of forest cover and stream flow on the 266 km2 Koga watershed in the headwaters of Blue Nile Basin using both observed hydrological data and community perception. The watershed went from 16% forest cover in 1957 to 1% by 1986. The hydrological record did not reveal changes in the flow regime between 1960 and 2002 despite the reduction in forest area. This agrees with the perception of the downstream community living near the gauging station. The upstream community, however, reported both decreases in low flows and increases in high flows shortly after the forest cover was reduced. The upstream deforestation effect appeared to have been buffered by a wetland lower in the watershed. This study concludes that community perception can be a complement to observational data for better understanding how forest cover influences the flow regime.
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| 7. |
- Bryazka, D., et al.
(författare)
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Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020
- 2022
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Ingår i: Lancet. - 0140-6736. ; 400:10347, s. 185-235
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Tidskriftsartikel (refereegranskat)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% (7.0-81.3) 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. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.
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| 8. |
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| 9. |
- Ellison, David, et al.
(författare)
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Trees, forests and water : Cool insights for a hot world
- 2017
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Ingår i: Global Environmental Change. - : Elsevier BV. - 0959-3780 .- 1872-9495. ; 43, s. 51-61
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Tidskriftsartikel (refereegranskat)abstract
- Forest-driven water and energy cycles are poorly integrated into regional, national, continental and global decision-making on climate change adaptation, mitigation, land use and water management. This constrains humanity's ability to protect our planet's climate and life-sustaining functions. The substantial body of research we review reveals that forest, water and energy interactions provide the foundations for carbon storage, for cooling terrestrial surfaces and for distributing water resources. Forests and trees must be recognized as prime regulators within the water, energy and carbon cycles. If these functions are ignored, planners will be unable to assess, adapt to or mitigate the impacts of changing land cover and climate. Our call to action targets a reversal of paradigms, from a carbon-centric model to one that treats the hydrologic and climate-cooling effects of trees and forests as the first order of priority. For reasons of sustainability, carbon storage must remain a secondary, though valuable, by-product. The effects of tree cover on climate at local, regional and continental scales offer benefits that demand wider recognition. The forest- and tree-centered research insights we review and analyze provide a knowledge-base for improving plans, policies and actions. Our understanding of how trees and forests influence water, energy and carbon cycles has important implications, both for the structure of planning, management and governance institutions, as well as for how trees and forests might be used to improve sustainability, adaptation and mitigation efforts.
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| 10. |
- Feigin, Valery L, et al.
(författare)
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Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016.
- 2018
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Ingår i: The New England journal of medicine. - 1533-4406 .- 0028-4793. ; 379:25, s. 2429-2437
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Tidskriftsartikel (refereegranskat)abstract
- The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases.We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate.The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation.In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe. (Funded by the Bill and Melinda Gates Foundation.).
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| 11. |
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| 12. |
- Gebrehiwot, Solomon Gebreyohannis, 1974-, et al.
(författare)
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Community perceptions of forest–water relationships in the Blue Nile Basin of Ethiopia
- 2014
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Ingår i: GeoJournal. - : Springer Science and Business Media LLC. - 0343-2521 .- 1572-9893. ; 79:5, s. 605-618
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Tidskriftsartikel (refereegranskat)abstract
- Community perception of forest–water relationship was gathered using participatory rural appraisal tools in four watersheds of the Blue Nile River Basin in Ethiopia. These were compared and contrasted with the observational records of forest cover and water flow. Upstream and downstream communities were assessed separately to check for differences in perception based on location within a watershed. The key result of the study was that people in the study watersheds had a range of perceptions about the forest–water relationship which were watershed specific. The perceptions were generally consistent with observational evidence from the same watersheds. This study highlighted the need for locale-specific approaches to land and water management in the Basin, as well as the potential value of using community perceptions to complement the observational records which can have spatial and temporal limitations.
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| 13. |
- Gebrehiwot, Solomon Gebreyohannis, et al.
(författare)
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Forest cover change over four decades in the Blue Nile Basin, Ethiopia : comparison of three watersheds
- 2014
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Ingår i: Regional Environmental Change. - : Springer Science and Business Media LLC. - 1436-3798 .- 1436-378X. ; 14:1, s. 253-266
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to quantify forest cover changes in three watersheds (Gilgel Abbay (1,646 km(2)), Birr (980 km(2)), and Upper-Didesa (1,980 km(2)) of the Blue Nile Basin between 1957 and 2001. Four land cover maps were produced for each watershed for 1957/1958, 1975, 1986, and 2000/2001. Nine different types of land cover were identified, five of which were forest cover classes. Between 1957 and 2001, the total forest cover increased in Gilgel Abbay (from 10 to 22 % cover) and decreased in Birr (from 29 to 22 % cover) as well as in Upper-Didesa (from 89 to 45 % cover). The increase in Gilgel Abbay was primarily due to the expansion of eucalyptus plantations. Natural forest cover decreased in all three watersheds. Wooded grassland decreased by two-thirds, dry/moist mixed forests decreased by half, and riverine forests had disappeared by 1975 in Gilgel Abbay and Birr. Major deforestation had already taken place in the northern watersheds, Gilgel Abbay and Birr, before the 1960s and 1970s, while in the southern watershed, Upper-Didesa, much of the deforestation occurred after 1975. The southern watershed still remained by far the most forested watershed in 2001 despite the strong ongoing deforestation. The changes in forest cover could affect natural resource management, greenhouse gas emissions, water resources, and agricultural production including coffee production. The patterns of change are different in the three watersheds. We therefore recommend further studies of the local conditions and drivers of change as the basis for designing effective policy to halt further loss of natural forest, which offers a wealth of ecosystem services.
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| 14. |
- Gebrehiwot, Solomon Gebreyohannis
(författare)
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Forests, water and food security in the northwestern highlands of Ethiopia : Knowledge synthesis
- 2015
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Ingår i: Environmental Science and Policy. - : Elsevier BV. - 1462-9011 .- 1873-6416. ; 48, s. 128-136
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Forskningsöversikt (refereegranskat)abstract
- This paper synthesizes the spatial and temporal relationship between forest cover and water, as well as its implications for food security in the northwestern highlands of Ethiopia. Different studies addressing the topic of land cover and hydrology have been reviewed. Analyses of 20-40 year long time series showed little and inconsistent relationships between forest cover change and hydrology on meso-scale (100-1000 km(2)) watersheds. Spatial studies, however, showed stronger relationships between land cover and low flow features such as grasslands and woodlands. Interviews with local communities suggested land cover change impacts are more pronounced at smaller scale (<100 km(2)) watersheds; which is consistent with observational studies on small scale watersheds and farm level plots. The stronger relationships between forests and hydrology at smaller scales suggests land management policies should be oriented to farm level conditions, where water is vital for the food security of subsistence farmers who comprise 86% of the population in the highlands.
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| 15. |
- Gebrehiwot, Solomon Gebreyohannis, et al.
(författare)
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Is observation uncertainty masking the signal of land use change impacts on hydrology?
- 2019
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Ingår i: Journal of Hydrology. - : Elsevier. - 0022-1694 .- 1879-2707. ; 570, s. 393-400
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Tidskriftsartikel (refereegranskat)abstract
- Analysis of hydrological impacts of land use change raises questions about whether, and how much, such impacts are misrepresented because of errors in river flow observations. In this paper, land use change impacts (represented by changes in watershed storage) and different ranges of discharge measurement error are compared to assess how errors in discharge measurement can potentially mask a land use change impact. Using a watershed from the Ethiopian highlands to exemplify this, we simulated five different levels of land use change impacts with five levels of watershed storage reductions (from 10% to 50% change) and the associated time series of runoff. Different levels of observation error were then introduced into these artificial time series. Comparison was made between every pair, i.e. a time series derived from a certain level of land use change (storage reduction) versus a time series corresponding to a given level of observation error, using a step-change t-test. Significant step-changes between pairs define the detectability of land use change impact. The analysis was made for the entire 30-year time series as well as for the most extreme annual weather conditions. The results showed that for the average year and wettest year, 75% or more error in observed discharge masks the maximum simulated land use change impact on hydrology. In dry years, a 50% error in discharge is enough to mask the same impact. Knowing (and improving) the level of data quality contributes to a better understanding of hydrological uncertainties and improves the precision in assessing land use change impacts. Both of these are essential elements in water resources development planning.
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| 16. |
- Gebrehiwot, Solomon Gebreyohannis, et al.
(författare)
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The long-term hydrology of East Africa's water tower : statistical change detection in the watersheds of the Abbay Basin
- 2014
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Ingår i: Regional Environmental Change. - : Springer Science and Business Media LLC. - 1436-3798 .- 1436-378X. ; 14:1, s. 321-331
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Tidskriftsartikel (refereegranskat)abstract
- Forty-five years (1960-2004) of hydrological data from 12 watersheds in the Abbay Basin, Ethiopia, were tested for possible trends over the entire time series and differences in medians (step-wise changes) between three sub-periods. The classification of the sub-periods was based on the major political changes in 1975 and 1991. Variables investigated were rainfall (P), total flow (Q(t)), high flow (Q(h)), low flow (Q(1)), low flow index (LFI) and run-off coefficient (C). Data were checked for outliers, errors and homogeneity. Trend was tested after serial and cross-correlation tests. The data for each variable were serially uncorrelated from 1 to 10 lag years. There were five globally significant trends out of 50 test cases and 36 significant step-wise changes out of 180 tests. The majority of the significant changes were watershed specific. Run-off coefficient was the single variable showing a consistently increasing trend and stood for ca. 25 % of the total significant trends and step-wise changes. Half of these changes occurred after 1991. We concluded that despite the land use policy changes in 1975 and 1991, as well as the long-term soil degradation, the hydrological regime was quite stable over the 45-year period, with the exception of an increase in the run-off coefficient in the latter part of the run-off record in some watersheds.
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| 17. |
- Gebrehiwot, Solomon Gebreyohannis, 1974-, et al.
(författare)
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The Nile Basin waters and the West African rainforest : Rethinking the boundaries
- 2019
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Ingår i: WIREs Water. - : WILEY. - 2049-1948. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- This focus article presents the state of the West African rainforest (WARF), its role in atmospheric moisture transport to the Nile Basin, and the potential impact of its deforestation on the Nile Basin's water regime, as well as options for improving transboundary water governance. The Nile is the longest river in the world, but delivers less water per unit area than other major rivers. Pressures from the Basin's rapidly growing population and agricultural demand risk exacerbating transboundary water conflicts. About 85% of the surface water reaching Aswan in Egypt originates from the Ethiopian Highlands which comprise less than 10% of the Nile Basin's total area (3.3 million km(2)). Some of the atmospheric moisture reaching the Highlands crosses over the WARF; other moisture source areas include the Mediterranean Sea, the Indian Ocean, and the Atlantic Ocean. The WARF adds atmospheric moisture and modifies the regional climate system. Deforestation in the WARF has the potential to alter rainfall patterns over the Ethiopian Highlands and thus flows in the Nile River, with reductions a likely outcome. Transregional governance that looks beyond basin boundaries to the sources and routes of moisture transport (the precipitationshed) has yet to be integrated into land-atmosphere and water management negotiations. To better achieve sustainable land management and water resource development in the Nile Basin, scientific and governance frameworks need to be established that include the WARF region states in the ongoing negotiations between the Nile riparian states. This article is categorized under: Engineering Water > Planning Water Human Water > Water Governance Science of Water > Methods
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| 18. |
- Gebrehiwot, Solomon, et al.
(författare)
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Hydrological change detection using modeling : Half a century of runoff from four rivers in the Blue Nile Basin
- 2013
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Ingår i: Water resources research. - : American Geophysical Union (AGU). - 0043-1397 .- 1944-7973. ; 49:6, s. 3842-3851
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Tidskriftsartikel (refereegranskat)abstract
- Land cover changes can have significant impacts on hydrological regime. The objective of this study was to detect possible hydrological changes of four watersheds in the Blue Nile Basin using a model-based method for hydrological change detection. The four watersheds, Birr, Upper-Didesa, Gilgel Abbay, and Koga range in size from 260 to 1800 km(2). The changes were assessed based on model parameters, model residuals, and in the overall function of the watersheds in transferring rainfall into runoff. The entire time series (1960-2004) was divided into three periods based on political and land management policy changes. A conceptual rainfall-runoff model, the HBV (Hydrologiska Byrans Vattenbalansavdelning) model, was used for the analysis, and suitable parameter sets for each period were found based on a Monte Carlo approach. The values of six out of nine parameters changed significantly between the periods. Model residuals also showed significant changes between the three periods in three of the four watersheds. On the other hand, the overall functioning of the watersheds in processing rainfall to runoff changed little. So even though the individual parameters and model residuals were changing, the integrated functioning of the watersheds showed minimal changes. This study demonstrated the value of using different approaches for detecting hydrological change and highlighted the sensitivity of the outcome to the applied modeling and statistical methods.
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| 19. |
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| 20. |
- Gebrehiwot, Solomon, et al.
(författare)
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Hydrological characterization of watersheds in the Blue Nile Basin, Ethiopia
- 2011
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Ingår i: Hydrology and Earth System Sciences. - : Copernicus GmbH. - 1027-5606 .- 1607-7938. ; 15:1, s. 11-20
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Tidskriftsartikel (refereegranskat)abstract
- Thirty-two watersheds (31-4350 km(2)), in the Blue Nile Basin, Ethiopia, were hydrologically characterized with data from a study of water and land resources by the US Department of Interior, Bureau of Reclamation (USBR) published in 1964. The USBR document contains data on flow, topography, geology, soil type, and land use for the period 1959 to 1963. The aim of the study was to identify watershed variables best explaining the variation in the hydrological regime, with a special focus on low flows. Moreover, this study aimed to identify variables that may be susceptible to management policies for developing and securing water resources in dry periods. Principal Component Analysis (PCA) and Partial Least Square (PLS) were used to analyze the relationship between five hydrologic response variables (total flow, high flow, low flow, runoff coefficient, low flow index) and 30 potential explanatory watershed variables. The explanatory watershed variables were classified into three groups: land use, climate and topography as well as geology and soil type. Each of the three groups had almost equal influence on the variation in hydrologic variables (R-2 values ranging from 0.3 to 0.4). Specific variables from within each of the three groups of explanatory variables were better in explaining the variation. Low flow and low flow index were positively correlated to land use types woodland, dense wet forest and savannah grassland, whereas grazing land and bush land were negatively correlated. We concluded that extra care for preserving low flow should be taken on tuffs/basalts which comprise 52% of the Blue Nile Basin. Land use management plans should recognize that woodland, dense wet forest and savannah grassland can promote higher low flows, while grazing land diminishes low flows.
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| 21. |
- Gebrehiwot, Solomon
(författare)
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Hydrology and forests in the Blue Nile basin : what can be learned from half a century of observations and community perception for water management?
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Forest cover change is considered a major cause of water scarcity during the dry season in the Blue Nile River Basin of Ethiopia, which is part of the Nile River system. However, this is an over-simplification of the complex reality of forest and flow relationships, especially in the tropics. The objectives of this study were to explore the spatial relationship of land use and flow regime, detect temporal changes in the hydrological regime, determine changes in the forest cover, and summarize the results to define the relationship between forest cover and hydrological regime. Two broad approaches were used to address these aims: observational data analysis and community perception. Thirty-two watersheds were covered in the spatial study, and 45 years of data for a dozen of these watersheds were analyzed in the temporal study. Statistical methods were used to explore the spatial relationship of land use and flow, and both statistical and modeling methods were used to detect hydrological change over time. Remote sensing analysis was used to document forest cover changes. Natural grassland and woodland had a positive, while grazing land and open bush land had a negative correlation with low flow regimes at the spatial scale. There were no major temporal changes in the flow regime, or clear results to attribute land degradation or land use change to hydrological changes and specific changes within each watershed. The change related to forest cover were watershed specific, although there were general differences between southern and northern watersheds regarding the time of deforestation. The community perception indicated the relationship of forest cover change and flow regime was more complex than just deforestation causing loss of dry season flow. According to the elders, forest and flow relationships were watershed specific, even sub-watershed specific. The lack of a clear relationship between forest cover change and flow regime in the temporal dimension could be attributed to the scale of watersheds, uncertainty about the measurement of flow extremes, and the impact of variability in rainfall within the region. The watershed-specific nature of the relationship between forest and flow within the Basin, confirmed by the community perception, indicates forest hydrology studies should be tailored to watershed scale, or even sub-watershed scale i. e. hill-slope scale, and address the relevance of water availability at farm and river scale.
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| 22. |
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| 23. |
- Ikuta, K. S., et al.
(författare)
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Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019
- 2022
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Ingår i: Lancet. - : Elsevier BV. - 0140-6736. ; 400:10369, s. 2221-2248
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Tidskriftsartikel (refereegranskat)abstract
- Background Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes. Methods We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2.5th and 97.5th percentiles across 1000 posterior draws for each quantity of interest. Findings From an estimated 13.7 million (95% UI 10.9-17.1) infection-related deaths in 2019, there were 7.7 million deaths (5.7-10.2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13.6% (10.2-18.1) of all global deaths and 56.2% (52.1-60.1) of all sepsis-related deaths in 2019. Five leading pathogens-Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa-were responsible for 54.9% (52.9-56.9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185-285) per 100 000 population, and lowest in the high-income super-region, with 52.2 deaths (37.4-71.5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths. Interpretation The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development. Copyright (c) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
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| 24. |
- Kassebaum, Nicholas J., et al.
(författare)
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Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015 : a systematic analysis for the Global Burden of Disease Study 2015
- 2016
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Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 388:10053, s. 1603-1658
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Tidskriftsartikel (refereegranskat)abstract
- Background Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. Findings Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs off set by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2.9 years (95% uncertainty interval 2.9-3.0) for men and 3.5 years (3.4-3.7) for women, while HALE at age 65 years improved by 0.85 years (0.78-0.92) and 1.2 years (1.1-1.3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. Interpretation Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum.
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| 25. |
- Mellander, Per-Erik, et al.
(författare)
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Summer Rains and Dry Seasons in the Upper Blue Nile Basin : The Predictability of Half a Century of Past and Future Spatiotemporal Patterns
- 2013
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:7, s. e68461-
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Tidskriftsartikel (refereegranskat)abstract
- During the last 100 years the Ethiopian upper Blue Nile Basin (BNB) has undergone major changes in land use, and is now potentially facing changes in climate. Rainfall over BNB supplies over two-thirds of the water to the Nile and supports a large local population living mainly on subsistence agriculture. Regional food security is sensitive to both the amount and timing of rain and is already an important political challenge that will be further complicated if scenarios of climate change are realized. In this study a simple spatial model of the timing and duration of summer rains (Kiremt) and dry season (Bega), and annual rain over the upper BNB was established from observed data between 1952 and 2004. The model was used to explore potential impacts of climate change on these rains, using a down-scaled ECHAM5/MP1-OM scenario between 2050 and 2100. Over the observed period the amount, onset and duration of Kiremt rains and rain-free Bega days have exhibited a consistent spatial pattern. The spatially averaged annual rainfall was 1490 mm of which 93% was Kiremt rain. The average Kiremt rain and number of rainy days was higher in the southwest (322 days) and decreased towards the north (136 days). Under the 2050-2100 scenario, the annual mean rainfall is predicted to increase by 6% and maintain the same spatial pattern as in the past. A larger change in annual rainfall is expected in the southwest (ca. +130 mm) with a gradually smaller change towards the north (ca. +70 mm). Results highlight the need to account for the characteristic spatiotemporal zonation when planning water management and climate adaptation within the upper BNB. The presented simple spatial resolved models of the presence of Kiremt and annual total rainfall could be used as a baseline for such long-term planning.
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| 26. |
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| 27. |
- Mokdad, Ali H., et al.
(författare)
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Diabetes mellitus and chronic kidney disease in the Eastern Mediterranean Region : findings from the Global Burden of Disease 2015 study
- 2018
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Ingår i: International Journal of Public Health. - : SPRINGER BASEL AG. - 1661-8556 .- 1661-8564. ; 63, s. 177-186
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Tidskriftsartikel (refereegranskat)abstract
- We used findings from the Global Burden of Disease 2015 study to update our previous publication on the burden of diabetes and chronic kidney disease due to diabetes (CKD-DM) during 1990-2015. We extracted GBD 2015 estimates for prevalence, mortality, and disability-adjusted life years (DALYs) of diabetes (including burden of low vision due to diabetes, neuropathy, and amputations and CKD-DM for 22 countries of the EMR from the GBD visualization tools. In 2015, 135,230 (95% UI 123,034-148,184) individuals died from diabetes and 16,470 (95% UI 13,977-18,961) from CKD-DM, 216 and 179% increases, respectively, compared to 1990. The total number of people with diabetes was 42.3 million (95% UI 38.6-46.4 million) in 2015. DALY rates of diabetes in 2015 were significantly higher than the expected rates based on Socio-demographic Index (SDI). Our study showed a large and increasing burden of diabetes in the region. There is an urgency in dealing with diabetes and its consequences, and these efforts should be at the forefront of health prevention and promotion.
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| 28. |
- Murray, Christopher J. L., et al.
(författare)
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Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017
- 2018
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Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1995-2051
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Tidskriftsartikel (refereegranskat)abstract
- Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4–52·0). The TFR decreased from 4·7 livebirths (4·5–4·9) to 2·4 livebirths (2·2–2·5), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3–200·8) since 1950, from 2·6 billion (2·5–2·6) to 7·6 billion (7·4–7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9–1·2) in Cyprus to a high of 7·1 livebirths (6·8–7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07–0·09) in South Korea to 2·4 livebirths (2·2–2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3–0·4) in Puerto Rico to a high of 3·1 livebirths (3·0–3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill & Melinda Gates Foundation.
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| 29. |
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| 30. |
- Wang, Haidong, et al.
(författare)
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Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015 : a systematic analysis for the Global Burden of Disease Study 2015
- 2016
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Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 388:10053, s. 1459-1544
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.METHODS: We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).FINDINGS: Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death.INTERPRETATION: At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems.
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