| 1. |
- 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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| 2. |
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| 3. |
- Glasbey, JC, et al.
(author)
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- 2021
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swepub:Mat__t
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| 4. |
- 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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| 5. |
- Bravo, L, et al.
(author)
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- 2021
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swepub:Mat__t
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| 6. |
- Tabiri, S, et al.
(author)
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- 2021
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swepub:Mat__t
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| 7. |
- Forouzanfar, Mohammad H, et al.
(author)
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Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013 : a systematic analysis for the Global Burden of Disease Study 2013.
- 2015
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In: The Lancet. - 0140-6736 .- 1474-547X. ; 386:10010, s. 2287-2323
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Journal article (peer-reviewed)abstract
- BACKGROUND: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.METHODS: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.FINDINGS: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.INTERPRETATION: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.FUNDING: Bill & Melinda Gates Foundation.
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| 8. |
- Karim, K.M. Rabiul, et al.
(author)
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Differences in the acceptance of wife abuse among ethnic minority Garo and Santal and mainstream Bengali communities in rural Bangladesh
- 2020
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In: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 15:7, s. 1-19
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Journal article (peer-reviewed)abstract
- Studies on wife abuse in Bangladesh predominantly include the mainstreamBengalipopulation, although there are at least 27 ethnic minority communities including a few 'female-centered' matrilineal groups living in the country. This study explored ethnic differences in the attitudinal acceptance of wife abuse among matrilineal ethnic minorityGaro, patrilineal ethnic minoritySantal, and mainstream patriarchalBengalicommunities in rural Bangladesh. Adopting a cross-sectional design, the study included 1,929 women and men randomly selected from 24Garo,Santal, andBengalivillages. Multivariate Poisson regression was performed to predict the number of contextual events, where the respondents attitudinally endorsed wife abuse. Of the sample, 33.2% were fromGaro, 33.2% fromSantal, and 33.6% from theBengalicommunities. The acceptance of wife abuse was high in the sample; specifically, 34.1% of the respondents accepted physical wife abuse, 67.5% accepted emotional abuse, and 71.6% accepted any abuse (either physical or emotional) at least on one contextual reason provided in a 10-item scale. The mean for accepting any abuse was 3.0 (SD= 2.8), emotional abuse 2.3 (SD= 2.2), and physical abuse 0.8 (SD= 1.4). The study showed that the rates of accepting any abuse and physical abuse were respectively 16% and 56% lower amongGaroas well as 14% and 33% lower amongSantalthan that of theBengalicommunity. Data also revealed that individual level factors like younger age, higher education, prestigious occupation as well as family level factors such as higher income, female mobility, and female family authority were inversely associated with the acceptance of wife abuse in the sample. It appears that the gender regime of a society has a great influence on the attitudes toward wife abuse. We argue that a comprehensive socio-cultural transformation of the patriarchal societies into a gender equal order is imperative for the prevention of widespread wife abuse in the country.
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| 9. |
- Karim, K.M. Rabiul, et al.
(author)
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Does Childhood Experience of Family Victimization influence Adulthood Refusal of Wife Abuse? Evidence from Rural Bangladesh.
- 2021
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In: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 16:6
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Journal article (peer-reviewed)abstract
- This study examined how different forms of childhood family victimization are associated with the attitudinal (not actual action) refusal of wife abuse among women and men in rural Bangladesh. It included 1,929 randomly selected married women and men. Of the sample, 31.3% (Men = 49.3%, Women = 13.5%) attitudinally refused overall wife abuse, 38.5% (Men = 53.2%, Women = 23.8%) refused emotional abuse, 67.0% (Men = 82.5%, Women = 51.6%) refused physical abuse, 78.0% (Men = 88.6%, Women = 67.4%) refused abuse on wife’s disobeying family obligations, and 32.3% (Men = 50.3%, Women = 14.6%) refused abuse on challenging male authority. Multivariate logistic regression revealed that the odds ratio (ORs) of the attitudinal refusal of overall wife abuse were 1.75 (p = .041) for the childhood non-victims of emotional abuse and 2.31 (p < .001) for the victims of mild emotional abuse, compared to the victims of severe emotional abuse. On the other hand, the ORs of the overall refusal of abuse were 1.84 (p = .031) for the non-victims of physical abuse and 1.29 (p = .465) for the victims of mild physical abuse, compared to the childhood victims of severe physical abuse. Data further revealed that the childhood non-victimization of physical abuse increased all types of attitudinal refusal of wife abuse, e.g., emotional abuse, physical abuse, abuse on disobeying family obligations, and abuse on challenging male authority. Compared to the childhood experiences of severe emotional abuse, data also indicated that childhood exposure to mild emotional abuse might increase the attitudinal refusal of wife abuse on a few issues, e.g., abuse on disobeying family obligations, abuse on challenging male authority, and physical abuse. It appeared that childhood experiences of family victimization greatly influence different types of attitudinal refusal of wife abuse. We argue that the issue of childhood victimization should be brought to the forefront in the discourse. We recommend that state machinery and social welfare agencies should expend significant efforts to stop child abuse within the family and in other areas of society in rural Bangladesh.
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| 10. |
- Karim, K.M. Rabiul, et al.
(author)
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Gender differences in marital violence : a cross-ethnic study among Bengali, Garo, and Santal communities in rural Bangladesh
- 2021
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In: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 16:5
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Journal article (peer-reviewed)abstract
- Studies on marital violence (MV) in Bangladesh have primarily focused on the women of the mainstream Bengali people, although half of the population is men, and there are also ethnic minority communities with diverse gender constructions. The current study examined the gender differences in MV among the matrilineal ethnic minority Garo, patrilineal ethnic minority Santal, and the patrilineal mainstream Bengali communities in rural Bangladesh. Adopting a cross-sectional design, we randomly included 1,929 currently married men and women from 24 villages. We used cross-tabulations as well as multivariate logistic regressions to estimate the ethnic and gender differences in MV. Data revealed that women were widely exposed to different types of MV, while only a few men experienced such abuses. It showed that 95.6% of the women experienced emotional abuse, 63.5% physical abuse, 71.4% sexual abuse, and 50.6% poly-victimization, whereas these rates were quite low among the men (emotional = 9.7%, physical = 0.7%, sexual = 0.1%). No men reported poly-victimization. The odds ratio (OR) for emotional, physical, and sexual MV were respectively, 184.44 (95% CI = 93.65−363.24, p<0.001), 449.23 (95% CI = 181.59−1111.35, p<0.001), and 2789.71(95% CI = 381.36−20407.08, p<0.001) for women compared to men. Data further revealed that matrilineal Garo women experienced less MV (emotional = 90.7%, physical = 53.4%, sexual = 64.0%, poly = 38.8%) than the patrilineal Santal (emotional = 99.4%, physical = 67.3%, sexual = 71.3%, poly = 53.9%) and Bengali women (emotional = 96.6%, physical = 69.6%, sexual = 78.8%, poly = 58.9%). Multivariate regressions also showed that the Bengali society perpetrated more physical (OR = 1.90, 95% CI = 1.27−2.85, p = 0.002) and sexual (OR = 2.04, 95% CI = 1.34−3.10, p = 0.001) MV than the Garo society. It appears that MV is largely a gendered issue in the country. Though both women and men can be the victims of MV, the nature/extent of victimization noticeably differs according to the social organization. Matrilineal society appears to be less abusive than the patrilineal one. Interventions aimed to prevent domestic violence in rural Bangladesh should take these findings into account.
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