| 1. |
- Ademuyiwa, Adesoji O., et al.
(author)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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In: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Journal article (peer-reviewed)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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| 2. |
- Lozano, Rafael, et al.
(author)
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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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In: The Lancet. - : Elsevier. - 1474-547X .- 0140-6736. ; 392:10159, s. 2091-2138
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Journal article (peer-reviewed)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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| 3. |
- Murray, Christopher J. L., et al.
(author)
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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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In: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1995-2051
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Journal article (peer-reviewed)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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| 4. |
- Stanaway, Jeffrey D., et al.
(author)
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Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017
- 2018
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In: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1923-1994
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Journal article (peer-reviewed)abstract
- Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk- outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017.
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| 5. |
- Naqvi, Salman Raza, et al.
(author)
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Agro-industrial residue gasification feasibility in captive power plants : A South-Asian case study
- 2021
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In: Energy. - : Elsevier. - 0360-5442 .- 1873-6785. ; 214
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Journal article (peer-reviewed)abstract
- The objective of this study is to build knowledge on the potential of agro-industrial residue gasification (AIRG) for use in captive power generation through a comprehensive case study. In order to evaluate the economic viability, key performance indicators, such as net present value (NPV), levelized cost of electricity (LCOE), and operating costs etc. are studied. The major textile industry located in the Raiwind area of Punjab province of Pakistan has been selected. The effect and variations of the capacity factor has also been studied coupled with the levelized cost of electricity. The agricultural residue as feedstock to the gasifier is rice husk that is the abundantly available in South Asia. Furthermore, the impact of government subsidies on natural gas is also under the scope of the study. The agro-industrial residue gasification system is found to be a potential alternative to furnace oil (FO) or gas-based captive power plants (CPPs). The results of residue-based gasification system imply a large potential when comparing the cost of electricity with national grid electricity during the peak hours. Therefore, the proposed gasification system offers economic incentives when the textile industry potentially utilizes gasification-based electricity during peak hours and national grid electricity during off-peak hours. (C) 2020 Elsevier Ltd. All rights reserved.
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| 6. |
- Ullah, Hameed, et al.
(author)
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Polyoxometalate based ionic liquids reinforced on magnetic nanoparticles: A sustainable solution for microplastics and heavy metal ions elimination from water
- 2024
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In: Microchemical journal (Print). - : Elsevier. - 0026-265X .- 1095-9149. ; 204
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Journal article (peer-reviewed)abstract
- To purify water from contaminents is essential for life on universe. Here, in this manuscript we introduces an innovative approach to overcome the intricate challenge of eliminating heavy metal ions and microplastics from water. We designed a mesoporous composite materials by synergistically integrating polyoxometalates (POMs) based ionic liquids with silica coated magnetic nanoparticles. The synthesis process initiates with the utilization of highly reduced molybdenum aggregates in polyoxometalate-ionic liquids, reinforced onto magnetic nanoparticles (POM–IL–MNPs). Crafted composites, including Q8[Mo64Ni8La6]@SiO2@Fe3O4, Q10[Mo64Ni8La6]@SiO2@Fe3O4, Q8[Mo176/Mo248]@SiO2@Fe3O4, and Q10[Mo176/Mo248]@SiO2@Fe3O4, are meticulously designed by substituting POM counter cations with long-chain alkyl-based quaternary ammonium salts. The ionic liquids and composites exhibit remarkable hydrophobicity and thermal stability due to large anions and long-chain organic counter cations. Comprehensive characterization, including FT–IR, UV–vis spectroscopy, TGA, DSC, CV, rheological study, elemental analysis, and ICP-AES, ensures a thorough investigation. Additional analyses, such as Powder X-ray diffraction (PXRD), SEM, EDX, DLS, N2 adsorption, and VSM, reveal amorphous crystallinity, distinctive surface morphology, and substantial specific surface area. Core shell structure of POM-IL-MNPs was determined by Transmision electron microscope (TEM), ICP-AES analysis demonstrates metal ion removal efficiencies from 87.35% to 99.98%, with DLS confirming 100% efficiency in PVC beads elimination. This research not only advances water decontamination but also provides valuable insights into designing and characterizing novel materials with promising environmental applications.
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| 7. |
- Baharin, Shamsul Ammar Shamsul, et al.
(author)
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Microwave and Very High Frequency Radiations of The First Narrow Initial Breakdown
- 2021
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In: 2021 35TH INTERNATIONAL CONFERENCE ON LIGHTNING PROTECTION (ICLP) AND XVI INTERNATIONAL SYMPOSIUM ON LIGHTNING PROTECTION (SIPDA). - : Institute of Electrical and Electronics Engineers (IEEE). - 9781665423465
-
Conference paper (peer-reviewed)abstract
- This paper reports the observation of microwave and very high frequency (VHF) radiation pulses associated with the first narrow (<10us) initial breakdown (IB) pulses of ten negative cloud-to-ground (-CG) flashes. The centre frequency of microwave and VHF sensors was 0.97 GHz and 60 MHz, respectively. We found that all microwave pulses were the initiation event led the first VHF pulses ranging between 0.03187 and 2.57968 mu s and led the first narrow IB pulses ranging between 0.02382 and 2.70202 mu s. Half of the VHF pulses were observed to lead the first narrow IB pulses ranging between 0.03453 and 0.128 mu s. Moreover, polarity of microwave radiation pulses was always positive while the polarity of the first narrow IB pulses always negative. On the other hand, half of VHF radiation pulses had the same polarity as microwave radiation pulses.
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| 8. |
- Baharin, Shamsul Ammar Shamsul, et al.
(author)
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Microwave radiation associated with positive narrow bipolar events
- 2023
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In: Journal of Atmospheric and Solar-Terrestrial Physics. - : Elsevier. - 1364-6826 .- 1879-1824. ; 242
-
Journal article (peer-reviewed)abstract
- In this paper, we examined seven isolated positive Narrow Bipolar Events (NBEs), one positive NBE that initiated an IC flash progressed to a single-stroke Cloud-to-Ground (CG) flash, and one positive NBE that initiated an IC flash. Seven NBEs have been accompanied by significant Very-High Frequency (VHF) and microwave radiation pulses. We recorded all NBEs from two measurement stations (ST1 and ST2) separated at 13.3 km apart which consisted of fast antenna (FA) and slow antenna (SA) sensors, a magnetic field (B-field) sensor, a VHF sensor (60 MHz), and a microwave sensor (0.97 GHz). The waveforms were sampled at 2.5 GHz (400 ps). The key finding is that all microwave radiation pulses have been found to precede both the VHF radiation pulses and NBEs with average lead time of 63 +/- 39 ns and 122 +/- 143 ns, respectively. In comparison to stepped leader pulses or SLPs (conventional breakdown), the average lead time of microwave to VHF for NBEs (fast breakdown) was 88% faster compared to the average lead time of microwave to VHF for SLPs. Moreover, the average lead time of VHF to NBEs was 56% faster when compared to the average lead time of VHF to SLPs. The VHF interferometer map for an isolated NBE (NBE6) showed upward propagation of VHF radiation sources (fast negative breakdown) with initiation altitude, total length of the VHF radiation sources propagation, and estimated velocity were 10.2 +/- 0.3 km, 2.9 +/- 0.6 km, and 1.8 x 108 and 2.8 x 108 ms-1, respectively. On the other hand, interferometer map for an NBE that initiated a single-stroke CG (NBE3) showed bidirectional fast streamers propagation with initiation altitude, total length of the VHF radiation sources propagation, and estimated velocity were 14.0 +/- 0.4 km, 2.9 +/- 0.82 km, and 1.6 x 108 and 2.8 x 108 ms-1, respectively. Clearly, the microwave and VHF radiation pulses associated with positive NBEs have been emitted by different processes of fast breakdown mechanism. Therefore, it can be suggested that the microwave radiation is emitted by electron avalanches/corona while the VHF ra-diation is emitted by fast propagating streamers.
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| 9. |
- Baharin, Shamsul Ammar Shamsul, et al.
(author)
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Microwave radiation associated with stepped leaders of negative cloud-to-ground flashes
- 2022
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In: Atmospheric research. - : Elsevier. - 0169-8095 .- 1873-2895. ; 270
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Journal article (peer-reviewed)abstract
- In this paper, Very-High Frequency (VHF) and microwave radiation pulses associated with stepped leader pulses (conventional breakdown) are examined. A total of 100 stepped leader pulses (SLPs) with the associated 100 quiet periods (QPs) from ten negative cloud-to-ground (CG) flashes within the reversal distance (<8 km) have been analyzed. The QP is defined as the period between two SLPs when no electrical activity within the fast antenna sensor bandwidth was detected. The measurement system is made up of fast antenna (FA) and slow antenna (SA) sensors, a VHF sensor (60 MHz center frequency with 40 MHz bandwidth), and a microwave sensor (0.97 GHz center frequency with 20 MHz bandwidth). The waveforms were sampled at 2.5 GHz (400 ps). The total durations of the SLPs and QPs were 2.648 +/- 1.152 mu s and 2.708 +/- 1.670 mu s, respectively. All microwave and VHF radiation waveforms have been detected as clear individual oscillating pulses. The key finding is that the microwave radiation can be classified into three categories based on the total number of detected individual oscillating pulses during the QP. Two microwave pulses detected during the QP (Category 1) are suggested to be associated with the electron avalanche/corona process at the tip of an existing negative leader and a space stem. The VHF pulses associated with the microwave pulses are suggested to be emitted by propagating streamers. On the other hand, a single microwave pulse detected during the QP (Category 2) is suggested to be emitted by the electron avalanche/corona process of a space stem. The VHF pulses associated with the microwave pulse are suggested to be emitted by propagating streamers. In both categories, 70% of the microwave radiation pulses have been observed to precede VHF radiation pulses with an average lead time of 0.848 +/- 1.336 mu s. The head-on collision of a downward propagating negative streamer and an upward propagating positive streamer (from space stem) emitted significant microwave radiation. A new negative leader was formed when the head-on collision took place. The microwave radiation pulses emitted by the head-on collision process were observed to precede SLPs with an average lead time of 0.423 +/- 0.378 mu s. Around 80% of the microwave radiation pulses preceded VHF radiation pulses with average lead time of 0.540 +/- 0.596 mu s. Therefore, microwave and VHF radiation pulses are suggested to be emitted by different processes of the electrical breakdown mechanism. The microwave radiation is emitted by electron avalanche/corona/head-on collision while the VHF radiation is emitted by propagating streamers.
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| 10. |
- Khalil, Ibrahim, et al.
(author)
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Burden of Diarrhea in the Eastern Mediterranean Region, 1990-2013 : Findings from the Global Burden of Disease Study 2013
- 2016
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In: American Journal of Tropical Medicine and Hygiene. - : American Society of Tropical Medicine and Hygiene. - 1476-1645 .- 0002-9637. ; 95:6, s. 1319-1329
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Journal article (peer-reviewed)abstract
- Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden.
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