Forecasting the effects of smoking prevalence scenarios on years of life lost and life expectancy from 2022 to 2050 : a systematic analysis for the Global Burden of Disease Study 2021
- Bryazka, Dana, Reitsma, Marissa, Abate, Yohannes, Abd Al Magied, Abdallah, Abdelkader, Atef, Abdollahi, Arash, Abdoun, Meriem, Abdulkader, Rizwan, Abeldaño Zuñiga, Roberto, Abhilash, E., Abiodun, Olugbenga, Abiodun, Olumide, Aboagye, Richard, Abreu, Lucas, Abtahi, Dariush, Abualruz, Hasan, Abubakar, Bilyaminu, Abu-Rmeileh, Niveen, Aburuz, Salahdein, Abu-Zaid, Ahmed, Adane, Mesafint, Adebiyi, Akindele, Adegboye, Oyelola, Adekanmbi, Victor, Adewuyi, Habeeb, Adnani, Qorinah, Adzigbli, Leticia, Ganesan, Balasankar, Rahman, Muhammad Aziz, Alif, Sheikh
- Authors: Bryazka, Dana , Reitsma, Marissa , Abate, Yohannes , Abd Al Magied, Abdallah , Abdelkader, Atef , Abdollahi, Arash , Abdoun, Meriem , Abdulkader, Rizwan , Abeldaño Zuñiga, Roberto , Abhilash, E. , Abiodun, Olugbenga , Abiodun, Olumide , Aboagye, Richard , Abreu, Lucas , Abtahi, Dariush , Abualruz, Hasan , Abubakar, Bilyaminu , Abu-Rmeileh, Niveen , Aburuz, Salahdein , Abu-Zaid, Ahmed , Adane, Mesafint , Adebiyi, Akindele , Adegboye, Oyelola , Adekanmbi, Victor , Adewuyi, Habeeb , Adnani, Qorinah , Adzigbli, Leticia , Ganesan, Balasankar , Rahman, Muhammad Aziz , Alif, Sheikh
- Date: 2024
- Type: Text , Journal article
- Relation: The Lancet Public Health Vol. 9, no. 10 (2024), p. e729-e744
- Full Text:
- Reviewed:
- Description: Background: Smoking is the leading behavioural risk factor for mortality globally, accounting for more than 175 million deaths and nearly 4·30 billion years of life lost (YLLs) from 1990 to 2021. The pace of decline in smoking prevalence has slowed in recent years for many countries, and although strategies have recently been proposed to achieve tobacco-free generations, none have been implemented to date. Assessing what could happen if current trends in smoking prevalence persist, and what could happen if additional smoking prevalence reductions occur, is important for communicating the effect of potential smoking policies. Methods: In this analysis, we use the Institute for Health Metrics and Evaluation's Future Health Scenarios platform to forecast the effects of three smoking prevalence scenarios on all-cause and cause-specific YLLs and life expectancy at birth until 2050. YLLs were computed for each scenario using the Global Burden of Disease Study 2021 reference life table and forecasts of cause-specific mortality under each scenario. The reference scenario forecasts what could occur if past smoking prevalence and other risk factor trends continue, the Tobacco Smoking Elimination as of 2023 (Elimination-2023) scenario quantifies the maximum potential future health benefits from assuming zero percent smoking prevalence from 2023 onwards, whereas the Tobacco Smoking Elimination by 2050 (Elimination-2050) scenario provides estimates for countries considering policies to steadily reduce smoking prevalence to 5%. Together, these scenarios underscore the magnitude of health benefits that could be reached by 2050 if countries take decisive action to eliminate smoking. The 95% uncertainty interval (UI) of estimates is based on the 2·5th and 97·5th percentile of draws that were carried through the multistage computational framework. Findings: Global age-standardised smoking prevalence was estimated to be 28·5% (95% UI 27·9–29·1) among males and 5·96% (5·76–6·21) among females in 2022. In the reference scenario, smoking prevalence declined by 25·9% (25·2–26·6) among males, and 30·0% (26·1–32·1) among females from 2022 to 2050. Under this scenario, we forecast a cumulative 29·3 billion (95% UI 26·8–32·4) overall YLLs among males and 22·2 billion (20·1–24·6) YLLs among females over this period. Life expectancy at birth under this scenario would increase from 73·6 years (95% UI 72·8–74·4) in 2022 to 78·3 years (75·9–80·3) in 2050. Under our Elimination-2023 scenario, we forecast 2·04 billion (95% UI 1·90–2·21) fewer cumulative YLLs by 2050 compared with the reference scenario, and life expectancy at birth would increase to 77·6 years (95% UI 75·1–79·6) among males and 81·0 years (78·5–83·1) among females. Under our Elimination-2050 scenario, we forecast 735 million (675–808) and 141 million (131–154) cumulative YLLs would be avoided among males and females, respectively. Life expectancy in 2050 would increase to 77·1 years (95% UI 74·6–79·0) among males and 80·8 years (78·3–82·9) among females. Interpretation: Existing tobacco policies must be maintained if smoking prevalence is to continue to decline as forecast by the reference scenario. In addition, substantial smoking-attributable burden can be avoided by accelerating the pace of smoking elimination. Implementation of new tobacco control policies are crucial in avoiding additional smoking-attributable burden in the coming decades and to ensure that the gains won over the past three decades are not lost. Funding: Bloomberg Philanthropies and the Bill & Melinda Gates Foundation. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliates “Balasankar Ganesan, Muhammad Aziz Rahman and Sheikh Alif” is provided in this record**
- Authors: Bryazka, Dana , Reitsma, Marissa , Abate, Yohannes , Abd Al Magied, Abdallah , Abdelkader, Atef , Abdollahi, Arash , Abdoun, Meriem , Abdulkader, Rizwan , Abeldaño Zuñiga, Roberto , Abhilash, E. , Abiodun, Olugbenga , Abiodun, Olumide , Aboagye, Richard , Abreu, Lucas , Abtahi, Dariush , Abualruz, Hasan , Abubakar, Bilyaminu , Abu-Rmeileh, Niveen , Aburuz, Salahdein , Abu-Zaid, Ahmed , Adane, Mesafint , Adebiyi, Akindele , Adegboye, Oyelola , Adekanmbi, Victor , Adewuyi, Habeeb , Adnani, Qorinah , Adzigbli, Leticia , Ganesan, Balasankar , Rahman, Muhammad Aziz , Alif, Sheikh
- Date: 2024
- Type: Text , Journal article
- Relation: The Lancet Public Health Vol. 9, no. 10 (2024), p. e729-e744
- Full Text:
- Reviewed:
- Description: Background: Smoking is the leading behavioural risk factor for mortality globally, accounting for more than 175 million deaths and nearly 4·30 billion years of life lost (YLLs) from 1990 to 2021. The pace of decline in smoking prevalence has slowed in recent years for many countries, and although strategies have recently been proposed to achieve tobacco-free generations, none have been implemented to date. Assessing what could happen if current trends in smoking prevalence persist, and what could happen if additional smoking prevalence reductions occur, is important for communicating the effect of potential smoking policies. Methods: In this analysis, we use the Institute for Health Metrics and Evaluation's Future Health Scenarios platform to forecast the effects of three smoking prevalence scenarios on all-cause and cause-specific YLLs and life expectancy at birth until 2050. YLLs were computed for each scenario using the Global Burden of Disease Study 2021 reference life table and forecasts of cause-specific mortality under each scenario. The reference scenario forecasts what could occur if past smoking prevalence and other risk factor trends continue, the Tobacco Smoking Elimination as of 2023 (Elimination-2023) scenario quantifies the maximum potential future health benefits from assuming zero percent smoking prevalence from 2023 onwards, whereas the Tobacco Smoking Elimination by 2050 (Elimination-2050) scenario provides estimates for countries considering policies to steadily reduce smoking prevalence to 5%. Together, these scenarios underscore the magnitude of health benefits that could be reached by 2050 if countries take decisive action to eliminate smoking. The 95% uncertainty interval (UI) of estimates is based on the 2·5th and 97·5th percentile of draws that were carried through the multistage computational framework. Findings: Global age-standardised smoking prevalence was estimated to be 28·5% (95% UI 27·9–29·1) among males and 5·96% (5·76–6·21) among females in 2022. In the reference scenario, smoking prevalence declined by 25·9% (25·2–26·6) among males, and 30·0% (26·1–32·1) among females from 2022 to 2050. Under this scenario, we forecast a cumulative 29·3 billion (95% UI 26·8–32·4) overall YLLs among males and 22·2 billion (20·1–24·6) YLLs among females over this period. Life expectancy at birth under this scenario would increase from 73·6 years (95% UI 72·8–74·4) in 2022 to 78·3 years (75·9–80·3) in 2050. Under our Elimination-2023 scenario, we forecast 2·04 billion (95% UI 1·90–2·21) fewer cumulative YLLs by 2050 compared with the reference scenario, and life expectancy at birth would increase to 77·6 years (95% UI 75·1–79·6) among males and 81·0 years (78·5–83·1) among females. Under our Elimination-2050 scenario, we forecast 735 million (675–808) and 141 million (131–154) cumulative YLLs would be avoided among males and females, respectively. Life expectancy in 2050 would increase to 77·1 years (95% UI 74·6–79·0) among males and 80·8 years (78·3–82·9) among females. Interpretation: Existing tobacco policies must be maintained if smoking prevalence is to continue to decline as forecast by the reference scenario. In addition, substantial smoking-attributable burden can be avoided by accelerating the pace of smoking elimination. Implementation of new tobacco control policies are crucial in avoiding additional smoking-attributable burden in the coming decades and to ensure that the gains won over the past three decades are not lost. Funding: Bloomberg Philanthropies and the Bill & Melinda Gates Foundation. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliates “Balasankar Ganesan, Muhammad Aziz Rahman and Sheikh Alif” is provided in this record**
Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2·5 air pollution, 1990–2019 : an analysis of data from the Global Burden of Disease Study 2019
- Burkart, Katrin, Causey, Kate, Cohen, Aaron, Wozniak, Sarah, Salvi, Devashri, Abbafati, Cristiana, Adekanmbi, Victor, Adsuar, Jose, Ahmadi, Keivan, Alahdab, Fares, Al-Aly, Ziyad, Alipour, Vahid, Alvis-Guzman, Nelson, Amegah, Adeladza, Andrei, Catalina, Andrei, Tudorel, Ansari, Fereshteh, Arabloo, Jalal, Aremu, Olatunde, Aripov, Timur, Babaee, Ebrahim, Banach, Maciej, Barnett, Anthony, Bärnighausen, Till, Bedi, Neeraj, Behzadifar, Masoud, Béjot, Yannick, Bennett, Derrick, Rahman, Muhammad Aziz
- Authors: Burkart, Katrin , Causey, Kate , Cohen, Aaron , Wozniak, Sarah , Salvi, Devashri , Abbafati, Cristiana , Adekanmbi, Victor , Adsuar, Jose , Ahmadi, Keivan , Alahdab, Fares , Al-Aly, Ziyad , Alipour, Vahid , Alvis-Guzman, Nelson , Amegah, Adeladza , Andrei, Catalina , Andrei, Tudorel , Ansari, Fereshteh , Arabloo, Jalal , Aremu, Olatunde , Aripov, Timur , Babaee, Ebrahim , Banach, Maciej , Barnett, Anthony , Bärnighausen, Till , Bedi, Neeraj , Behzadifar, Masoud , Béjot, Yannick , Bennett, Derrick , Rahman, Muhammad Aziz
- Date: 2022
- Type: Text , Journal article
- Relation: The Lancet Planetary Health Vol. 6, no. 7 (2022), p. e586-e600
- Full Text:
- Reviewed:
- Description: Background: Experimental and epidemiological studies indicate an association between exposure to particulate matter (PM) air pollution and increased risk of type 2 diabetes. In view of the high and increasing prevalence of diabetes, we aimed to quantify the burden of type 2 diabetes attributable to PM2·5 originating from ambient and household air pollution. Methods: We systematically compiled all relevant cohort and case-control studies assessing the effect of exposure to household and ambient fine particulate matter (PM2·5) air pollution on type 2 diabetes incidence and mortality. We derived an exposure–response curve from the extracted relative risk estimates using the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. The estimated curve was linked to ambient and household PM2·5 exposures from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, and estimates of the attributable burden (population attributable fractions and rates per 100 000 population of deaths and disability-adjusted life-years) for 204 countries from 1990 to 2019 were calculated. We also assessed the role of changes in exposure, population size, age, and type 2 diabetes incidence in the observed trend in PM2·5-attributable type 2 diabetes burden. All estimates are presented with 95% uncertainty intervals. Findings: In 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM2·5 exposure, with an estimated 3·78 (95% uncertainty interval 2·68–4·83) deaths per 100 000 population and 167 (117–223) disability-adjusted life-years (DALYs) per 100 000 population. Approximately 13·4% (9·49–17·5) of deaths and 13·6% (9·73–17·9) of DALYs due to type 2 diabetes were contributed by ambient PM2·5, and 6·50% (4·22–9·53) of deaths and 5·92% (3·81–8·64) of DALYs by household air pollution. High burdens, in terms of numbers as well as rates, were estimated in Asia, sub-Saharan Africa, and South America. Since 1990, the attributable burden has increased by 50%, driven largely by population growth and ageing. Globally, the impact of reductions in household air pollution was largely offset by increased ambient PM2·5. Interpretation: Air pollution is a major risk factor for diabetes. We estimated that about a fifth of the global burden of type 2 diabetes is attributable PM2·5 pollution. Air pollution mitigation therefore might have an essential role in reducing the global disease burden resulting from type 2 diabetes. Funding: Bill & Melinda Gates Foundation. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliate “Muhammad Aziz Rahman” is provided in this record**
- Authors: Burkart, Katrin , Causey, Kate , Cohen, Aaron , Wozniak, Sarah , Salvi, Devashri , Abbafati, Cristiana , Adekanmbi, Victor , Adsuar, Jose , Ahmadi, Keivan , Alahdab, Fares , Al-Aly, Ziyad , Alipour, Vahid , Alvis-Guzman, Nelson , Amegah, Adeladza , Andrei, Catalina , Andrei, Tudorel , Ansari, Fereshteh , Arabloo, Jalal , Aremu, Olatunde , Aripov, Timur , Babaee, Ebrahim , Banach, Maciej , Barnett, Anthony , Bärnighausen, Till , Bedi, Neeraj , Behzadifar, Masoud , Béjot, Yannick , Bennett, Derrick , Rahman, Muhammad Aziz
- Date: 2022
- Type: Text , Journal article
- Relation: The Lancet Planetary Health Vol. 6, no. 7 (2022), p. e586-e600
- Full Text:
- Reviewed:
- Description: Background: Experimental and epidemiological studies indicate an association between exposure to particulate matter (PM) air pollution and increased risk of type 2 diabetes. In view of the high and increasing prevalence of diabetes, we aimed to quantify the burden of type 2 diabetes attributable to PM2·5 originating from ambient and household air pollution. Methods: We systematically compiled all relevant cohort and case-control studies assessing the effect of exposure to household and ambient fine particulate matter (PM2·5) air pollution on type 2 diabetes incidence and mortality. We derived an exposure–response curve from the extracted relative risk estimates using the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. The estimated curve was linked to ambient and household PM2·5 exposures from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, and estimates of the attributable burden (population attributable fractions and rates per 100 000 population of deaths and disability-adjusted life-years) for 204 countries from 1990 to 2019 were calculated. We also assessed the role of changes in exposure, population size, age, and type 2 diabetes incidence in the observed trend in PM2·5-attributable type 2 diabetes burden. All estimates are presented with 95% uncertainty intervals. Findings: In 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM2·5 exposure, with an estimated 3·78 (95% uncertainty interval 2·68–4·83) deaths per 100 000 population and 167 (117–223) disability-adjusted life-years (DALYs) per 100 000 population. Approximately 13·4% (9·49–17·5) of deaths and 13·6% (9·73–17·9) of DALYs due to type 2 diabetes were contributed by ambient PM2·5, and 6·50% (4·22–9·53) of deaths and 5·92% (3·81–8·64) of DALYs by household air pollution. High burdens, in terms of numbers as well as rates, were estimated in Asia, sub-Saharan Africa, and South America. Since 1990, the attributable burden has increased by 50%, driven largely by population growth and ageing. Globally, the impact of reductions in household air pollution was largely offset by increased ambient PM2·5. Interpretation: Air pollution is a major risk factor for diabetes. We estimated that about a fifth of the global burden of type 2 diabetes is attributable PM2·5 pollution. Air pollution mitigation therefore might have an essential role in reducing the global disease burden resulting from type 2 diabetes. Funding: Bill & Melinda Gates Foundation. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliate “Muhammad Aziz Rahman” is provided in this record**
Mapping development and health effects of cooking with solid fuels in low-income and middle-income countries, 2000–18 : a geospatial modelling study
- Frostad, Joseph, Nguyen, QuynhAnh, Baumann, Mathew, Blacker, Brigette, Marczak, Laurie, Deshpande, Aniruddha, Wiens, Kirsten, LeGrand, Kate, Johnson, Kimberly, Abbasi-Kangevari, Mohsen, Abdoli, Amir, Abolhassani, Hassan, Abreu, Lucas, Abrigo, Michael, Abu-Rmeileh, Niveen, Adekanmbi, Victor, Agrawal, Anurag, Ahmed, Muktar, Al-Aly, Ziyad, Alanezi, Fahad, Alcalde-Rabanal, Jacqueline, Alipour, Vahid, Altirkawi, Khalid, Alvis-Guzman, Nelson, Alvis-Zakzuk, Nelson, Amegah, Adeladza, Amini, Saeed, Amiri, Fatemeh, Amugsi, Dickson, Rahman, Muhammad Aziz
- Authors: Frostad, Joseph , Nguyen, QuynhAnh , Baumann, Mathew , Blacker, Brigette , Marczak, Laurie , Deshpande, Aniruddha , Wiens, Kirsten , LeGrand, Kate , Johnson, Kimberly , Abbasi-Kangevari, Mohsen , Abdoli, Amir , Abolhassani, Hassan , Abreu, Lucas , Abrigo, Michael , Abu-Rmeileh, Niveen , Adekanmbi, Victor , Agrawal, Anurag , Ahmed, Muktar , Al-Aly, Ziyad , Alanezi, Fahad , Alcalde-Rabanal, Jacqueline , Alipour, Vahid , Altirkawi, Khalid , Alvis-Guzman, Nelson , Alvis-Zakzuk, Nelson , Amegah, Adeladza , Amini, Saeed , Amiri, Fatemeh , Amugsi, Dickson , Rahman, Muhammad Aziz
- Date: 2022
- Type: Text , Journal article
- Relation: The Lancet Global Health Vol. 10, no. 10 (2022), p. e1395-e1411
- Full Text:
- Reviewed:
- Description: Background: More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehensively analysed. We estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels. Methods: We did a geospatial modelling study to map the prevalence of solid-fuel use for cooking at a 5 km × 5 km resolution in 98 LMICs based on 2·1 million household observations of the primary cooking fuel used from 663 population-based household surveys over the years 2000 to 2018. We use observed temporal patterns to forecast household air pollution in 2030 and to assess the probability of attaining the Sustainable Development Goal (SDG) target indicator for clean cooking. We aligned our estimates of household air pollution to geospatial estimates of ambient air pollution to establish the risk transition occurring in LMICs. Finally, we quantified the effect of residual primary solid-fuel use for cooking on child health by doing a counterfactual risk assessment to estimate the proportion of deaths from lower respiratory tract infections in children younger than 5 years that could be associated with household air pollution. Findings: Although primary reliance on solid-fuel use for cooking has declined globally, it remains widespread. 593 million people live in districts where the prevalence of solid-fuel use for cooking exceeds 95%. 66% of people in LMICs live in districts that are not on track to meet the SDG target for universal access to clean energy by 2030. Household air pollution continues to be a major contributor to particulate exposure in LMICs, and rising ambient air pollution is undermining potential gains from reductions in the prevalence of solid-fuel use for cooking in many countries. We estimated that, in 2018, 205 000 (95% uncertainty interval 147 000–257 000) children younger than 5 years died from lower respiratory tract infections that could be attributed to household air pollution. Interpretation: Efforts to accelerate the adoption of clean cooking fuels need to be substantially increased and recalibrated to account for subnational inequalities, because there are substantial opportunities to improve air quality and avert child mortality associated with household air pollution. Funding: Bill & Melinda Gates Foundation. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliate “Muhammad Aziz Rahman” is provided in this record**
- Authors: Frostad, Joseph , Nguyen, QuynhAnh , Baumann, Mathew , Blacker, Brigette , Marczak, Laurie , Deshpande, Aniruddha , Wiens, Kirsten , LeGrand, Kate , Johnson, Kimberly , Abbasi-Kangevari, Mohsen , Abdoli, Amir , Abolhassani, Hassan , Abreu, Lucas , Abrigo, Michael , Abu-Rmeileh, Niveen , Adekanmbi, Victor , Agrawal, Anurag , Ahmed, Muktar , Al-Aly, Ziyad , Alanezi, Fahad , Alcalde-Rabanal, Jacqueline , Alipour, Vahid , Altirkawi, Khalid , Alvis-Guzman, Nelson , Alvis-Zakzuk, Nelson , Amegah, Adeladza , Amini, Saeed , Amiri, Fatemeh , Amugsi, Dickson , Rahman, Muhammad Aziz
- Date: 2022
- Type: Text , Journal article
- Relation: The Lancet Global Health Vol. 10, no. 10 (2022), p. e1395-e1411
- Full Text:
- Reviewed:
- Description: Background: More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehensively analysed. We estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels. Methods: We did a geospatial modelling study to map the prevalence of solid-fuel use for cooking at a 5 km × 5 km resolution in 98 LMICs based on 2·1 million household observations of the primary cooking fuel used from 663 population-based household surveys over the years 2000 to 2018. We use observed temporal patterns to forecast household air pollution in 2030 and to assess the probability of attaining the Sustainable Development Goal (SDG) target indicator for clean cooking. We aligned our estimates of household air pollution to geospatial estimates of ambient air pollution to establish the risk transition occurring in LMICs. Finally, we quantified the effect of residual primary solid-fuel use for cooking on child health by doing a counterfactual risk assessment to estimate the proportion of deaths from lower respiratory tract infections in children younger than 5 years that could be associated with household air pollution. Findings: Although primary reliance on solid-fuel use for cooking has declined globally, it remains widespread. 593 million people live in districts where the prevalence of solid-fuel use for cooking exceeds 95%. 66% of people in LMICs live in districts that are not on track to meet the SDG target for universal access to clean energy by 2030. Household air pollution continues to be a major contributor to particulate exposure in LMICs, and rising ambient air pollution is undermining potential gains from reductions in the prevalence of solid-fuel use for cooking in many countries. We estimated that, in 2018, 205 000 (95% uncertainty interval 147 000–257 000) children younger than 5 years died from lower respiratory tract infections that could be attributed to household air pollution. Interpretation: Efforts to accelerate the adoption of clean cooking fuels need to be substantially increased and recalibrated to account for subnational inequalities, because there are substantial opportunities to improve air quality and avert child mortality associated with household air pollution. Funding: Bill & Melinda Gates Foundation. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliate “Muhammad Aziz Rahman” is provided in this record**
Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000-17
- Wiens, Kirsten, Lindstedt, Paulina, Blacker, Brigette, Johnson, Kimberly, Baumann, Mathew, Schaeffer, Lauren, Abbastabar, Hedayat, Abd-Allah, Foad, Abdelalim, Ahmed, Abdollahpour, Ibrahim, Abegaz, Kedir, Abejie, Ayenew, Abreu, Lucas, Abrigo, Michael, Abualhasan, Ahmed, Accrombessi, Manfred, Acharya, Dilaram, Adabi, Maryam, Adamu, Abdu, Adebayo, Oladimeji, Adedoyin, Rufus, Adekanmbi, Victor, Adetokunboh, Olatunji, Adhena, Beyene, Afarideh, Mohsen, Ahmad, Sohail, Ahmadi, Keivan, Ahmed, Anwar, Ahmed, Muktar, Rahman, Muhammad Aziz
- Authors: Wiens, Kirsten , Lindstedt, Paulina , Blacker, Brigette , Johnson, Kimberly , Baumann, Mathew , Schaeffer, Lauren , Abbastabar, Hedayat , Abd-Allah, Foad , Abdelalim, Ahmed , Abdollahpour, Ibrahim , Abegaz, Kedir , Abejie, Ayenew , Abreu, Lucas , Abrigo, Michael , Abualhasan, Ahmed , Accrombessi, Manfred , Acharya, Dilaram , Adabi, Maryam , Adamu, Abdu , Adebayo, Oladimeji , Adedoyin, Rufus , Adekanmbi, Victor , Adetokunboh, Olatunji , Adhena, Beyene , Afarideh, Mohsen , Ahmad, Sohail , Ahmadi, Keivan , Ahmed, Anwar , Ahmed, Muktar , Rahman, Muhammad Aziz
- Date: 2020
- Type: Text , Journal article
- Relation: The Lancet Global Health Vol. 8, no. 8 (2020), p. e1038-e1060
- Full Text:
- Reviewed:
- Description: Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000–17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000–7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910–68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliate “Muhammad Aziz Rahman” is provided in this record**
- Authors: Wiens, Kirsten , Lindstedt, Paulina , Blacker, Brigette , Johnson, Kimberly , Baumann, Mathew , Schaeffer, Lauren , Abbastabar, Hedayat , Abd-Allah, Foad , Abdelalim, Ahmed , Abdollahpour, Ibrahim , Abegaz, Kedir , Abejie, Ayenew , Abreu, Lucas , Abrigo, Michael , Abualhasan, Ahmed , Accrombessi, Manfred , Acharya, Dilaram , Adabi, Maryam , Adamu, Abdu , Adebayo, Oladimeji , Adedoyin, Rufus , Adekanmbi, Victor , Adetokunboh, Olatunji , Adhena, Beyene , Afarideh, Mohsen , Ahmad, Sohail , Ahmadi, Keivan , Ahmed, Anwar , Ahmed, Muktar , Rahman, Muhammad Aziz
- Date: 2020
- Type: Text , Journal article
- Relation: The Lancet Global Health Vol. 8, no. 8 (2020), p. e1038-e1060
- Full Text:
- Reviewed:
- Description: Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000–17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000–7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910–68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliate “Muhammad Aziz Rahman” is provided in this record**
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