Kayode R . Fowobaje, PhD | University Of Ibadan,Ibadan Oyo State Nigeria (original) (raw)

Papers by Kayode R . Fowobaje, PhD

African Journal of Biomedical Research, 2024

Background: The occurrence of stroke is higher among Africans than African Americans and European... more Background: The occurrence of stroke is higher among Africans than African Americans and European Americans. Unfortunately, there is a paucity of data on African-wide pooled estimates of stroke risk factors. This study explores the risk factors of stroke among Africans. Methods: A systematic search of all articles on the risk factors of stroke in the African population was conducted in six electronic databases: PubMed, African Journal Online, Web of Science, Google Scholar, Cochrane Library, and Scopus. The data were pooled, and a random effect meta-analysis approach was used to determine the overall magnitude of stroke risk factors. Subgroup analyses were also carried out to investigate the extent of stroke risk factors across study designs. All statistical analyses were performed using R. Results: We found 15 prominent risk factors in 27 eligible articles. Twelve (12) of 15 risk factors were significantly related to stroke among Africans. The overall pooled estimated magnitude of stroke risk factors among African are 11.81 (95%CI: 7.32-19.05; I 2 = 92%) for hypertension, 3.17 (95%CI: 2.46-4.07; I 2 = 75%) for Diabetes Mellitus, 3.01 (95%CI: 1.61-5.62; I 2 = 92%) for Cardiac Disease, 1.69 (95%CI: 1.41-2.04; I 2 = 15%) for salt consumption, 1.68 (95%CI: 1.51-1.87; I 2 = 0.0%) for stress, and 1.47 (95%CI: 1.25-1.74; I 2 = 71%) for elevated waist-hip ratio. Conclusion: Prominent risk factors of stroke among indigenous Africans are primarily modifiable, and context-specific intervention targeted at these risk factors might be promising in managing the already high burden of stroke among indigenous Africans.

Purpose: To determine the frequency at which patients newly diagnosed with glaucoma in subSaharan... more Purpose: To determine the frequency at which patients newly diagnosed with glaucoma in subSaharan Africa (SSA) decline recommended therapy and to characterize the reasons for declining therapy. Methods: This was a multicenter, cross-sectional study conducted on adult patients at the time of glaucoma diagnosis at 27 centers in 10 countries in SSA. Data collected from the diagnostic encounter included demographics, clinical glaucoma characteristics, treatment recommendations, patient acceptance of therapy, and reasons for declining therapy. Results: Among 2,282 eyes of 1,198 patients offered treatment for glaucoma, initially recommended treatment was accepted in 2,126 eyes (93.2%). Acceptance of therapy varied with the nature of treatment offered, with medical therapy accepted in 99.2% of eyes, laser therapy in 88.3%, and surgical therapy in 69.3%. The most common reasons cited for declining therapy were fear (42.9%) and cost (41.7%); cost was the primary reason for declining medical and laser therapy, while fear was the most common reason for declining surgical therapy. Most patients declining laser or surgical therapy accepted medical therapy as an alternate therapy (98.1%). Conclusions: Patients’ acceptance of glaucoma therapy was high overall, but lower for surgery than for laser or medical therapy. Most patients who declined laser or surgical therapy accepted medical therapy as an alternate therapy when offered. Educational interventions, sustainable incentives, and other approaches are needed to enhance patient acceptance of glaucoma therapy in this setting, particularly surgery when needed.

eye, 2024

BACKGROUND: We aimed to update estimates of global vision loss due to age-related macular degener... more BACKGROUND: We aimed to update estimates of global vision loss due to age-related macular degeneration (AMD). METHODS: We did a systematic review and meta-analysis of population-based surveys of eye diseases from January, 1980, to October, 2018. We fitted hierarchical models to estimate the prevalence of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness (< 3/60) caused by AMD, stratified by age, region, and year. RESULTS: In 2020, 1.85 million (95%UI: 1.35 to 2.43 million) people were estimated to be blind due to AMD, and another 6.23 million (95%UI: 5.04 to 7.58) with MSVI globally. High-income countries had the highest number of individuals with AMD-related blindness (0.60 million people; 0.46 to 0.77). The crude prevalence of AMD-related blindness in 2020 (among those aged ≥ 50 years) was 0.10% (0.07 to 0.12) globally, and the region with the highest prevalence of AMD-related blindness was North Africa/ Middle East (0.22%; 0.16 to 0.30). Age-standardized prevalence (using the GBD 2019 data) of AMD-related MSVI in people aged ≥ 50 years in 2020 was 0.34% (0.27 to 0.41) globally, and the region with the highest prevalence of AMD-related MSVI was also North Africa/Middle East (0.55%; 0.44 to 0.68). From 2000 to 2020, the estimated crude prevalence of AMD-related blindness decreased globally by 19.29%, while the prevalence of MSVI increased by 10.08%. CONCLUSIONS: The estimated increase in the number of individuals with AMD-related blindness and MSVI globally urges the creation of novel treatment modalities and the expansion of rehabilitation services.

The Plant Genome, 2024

Regular measurement of realized genetic gain allows plant breeders to assess and review the effec... more Regular measurement of realized genetic gain allows plant breeders to assess and review the effectiveness of their strategies, allocate resources efficiently, and make informed decisions throughout the breeding process. Realized genetic gain estimation requires separating genetic trends from nongenetic trends using the linear mixed model (LMM) on historical multi-environment trial data. The LMM, accounting for the year effect, experimental designs, and heterogeneous residual variances, estimates best linear unbiased estimators of genotypes and regresses them on their years of origin. An illustrative example of estimating realized genetic gain was provided by analyzing historical data on fresh cassava (Manihot esculenta Crantz) yield in West Africa (https://github.com/Biometrics-IITA/Estimating-Realized-Genetic-Gain). This approach can serve as a model applicable to other crops and regions. Modernization of breeding programs is necessary to maximize the rate of genetic gain. This can be achieved by adopting genomics to enable faster breeding, accurate selection, and improved traits through genomic selection and gene editing. Tracking operational costs, establishing robust, digitalized data management and analytics systems, and developing effective varietal selection processes based on customer insights are also crucial for success. Capacity building and collaboration of breeding programs and institutions also play a significant role in accelerating genetic gains.

J Pediatr Infect Dis, 2023

Objective Community-acquired pneumonia (CAP) is the commonest cause of death in under-5 children ... more Objective Community-acquired pneumonia (CAP) is the commonest cause of death in under-5 children worldwide. Although the mortality from CAP has decreased over the last decade, it is still unacceptably high in lower-middle-income countries (LMICs). We aimed to determine the case fatality rate (CFR), and factors associated with treatment failure and outcome, using recommended antimicrobials. Methods A 5-year retrospective review of severe pediatric pneumonia admissions between August 1st, 2014 and July 31st, 2019 at the University College Hospital, Ibadan, Nigeria was conducted. Relevant clinical information including antibiotics use and outcome was analyzed using descriptive statistics, test of association, and logistic regression. Results There were 588 children aged 2 to 59 months, male:female ratio was 1.5:1. About two-thirds were aged 12 months. The majority were fully immunized for age (87.2%), about 34% were malnourished and 68% were hypoxemic at presentation. Only 71% of children were commenced on the recommended first-line antibiotics following the Pediatric Association of Nigeria (PAN) antibiotic guidelines. Initial antibiotics were changed in 22.3% of the patients. The need to change intravenous (iv) amoxicillin plus iv gentamicin was necessary in 23.80% compared with 18.1% for iv cefuroxime plus iv gentamicin. Severe acute malnutrition (odds ratio [OR]: 2.8 [95% confidence interval [CI]: 1.1-7.3]) and hypoxemia (OR:2.3 [95%CI: 1.0-5.6]) were independently associated with antibiotics change. The CFR was 1.36%. Conclusion The low CFR suggests a better outcome compared with other previous studies in LMICs. However, the high rate of antibiotics changes (22.3%) was possibly due to failure of first line antibiotics; especially among malnourished and hypoxemic children. Randomized controlled trial of iv cefuroxime plus gentamicin versus iv amoxicillin plus gentamicin is recommended.

The Lancet, 2024

Background Regular, detailed reporting on population health by underlying cause of death is funda... more Background Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. Methods The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimateswith alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sexlocation-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2•5th and 97•5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration causeof-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds.

Global estimates on the number of people blind or visually impaired by glaucoma: A meta-analysis from 2000 to 2020, 2024

OBJECTIVES: To estimate global and regional trends from 2000 to 2020 of the number of persons vis... more OBJECTIVES: To estimate global and regional trends from 2000 to 2020 of the number of persons visually impaired by glaucoma and their proportion of the total number of vision-impaired individuals. METHODS: A systematic review and meta-analysis of published population studies and grey literature from 2000 to 2020 was carried out to estimate global and regional trends in number of people with vision loss due to glaucoma. Moderate or severe vision loss (MSVI) was defined as visual acuity of 6/60 or better but <6/18 (moderate) and visual acuity of 3/60 or better but <6/60 (severe vision loss). Blindness was defined as presenting visual acuity <3/60. RESULTS: Globally, in 2020, 3.61 million people were blind and nearly 4.14 million were visually impaired by glaucoma. Glaucoma accounted for 8.39% (95% uncertainty intervals [UIs]: 6.54, 10.29) of all blindness and 1.41% (95% UI: 1.10, 1.75) of all MSVI. Regionally, the highest proportion of blindness relating to glaucoma was found in high-income countries (26.12% [95% UI: 20.72, 32.09]), while the region with the highest age-standardized prevalence of glaucoma-related blindness and MSVI was Sub-Saharan Africa. Between 2000 and 2020, global age-standardized prevalence of glaucoma-related blindness among adults ≥50 years decreased by 26.06% among males (95% UI: 25.87, 26.24), and by 21.75% among females (95% UI: 21.54, 21.96), while MSVI due to glaucoma increased by 3.7% among males (95% UI: 3.42, 3.98), and by 7.3% in females (95% UI: 7.01, 7.59). CONCLUSIONS: Within the last two decades, glaucoma has remained a major cause of blindness globally and regionally.

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021 , 2024

Background Regular, detailed reporting on population health by underlying cause of death is funda... more Background Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. Methods The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates— with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sexlocation-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration causeof-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. Findings The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading f ive causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles.

Eye, 2024

OBJECTIVES: To estimate global and regional trends from 2000 to 2020 of the number of persons vis... more OBJECTIVES: To estimate global and regional trends from 2000 to 2020 of the number of persons visually impaired by glaucoma and their proportion of the total number of vision-impaired individuals. METHODS: A systematic review and meta-analysis of published population studies and grey literature from 2000 to 2020 was carried out to estimate global and regional trends in number of people with vision loss due to glaucoma. Moderate or severe vision loss (MSVI) was defined as visual acuity of 6/60 or better but <6/18 (moderate) and visual acuity of 3/60 or better but <6/60 (severe vision loss). Blindness was defined as presenting visual acuity <3/60. RESULTS: Globally, in 2020, 3.61 million people were blind and nearly 4.14 million were visually impaired by glaucoma. Glaucoma accounted for 8.39% (95% uncertainty intervals [UIs]: 6.54, 10.29) of all blindness and 1.41% (95% UI: 1.10, 1.75) of all MSVI. Regionally, the highest proportion of blindness relating to glaucoma was found in high-income countries (26.12% [95% UI: 20.72, 32.09]), while the region with the highest age-standardized prevalence of glaucoma-related blindness and MSVI was Sub-Saharan Africa. Between 2000 and 2020, global age-standardized prevalence of glaucoma-related blindness among adults ≥50 years decreased by 26.06% among males (95% UI: 25.87, 26.24), and by 21.75% among females (95% UI: 21.54, 21.96), while MSVI due to glaucoma increased by 3.7% among males (95% UI: 3.42, 3.98), and by 7.3% in females (95% UI: 7.01, 7.59). CONCLUSIONS: Within the last two decades, glaucoma has remained a major cause of blindness globally and regionally.

Global estimates on the number of people blind or visually impaired by cataract: a meta-analysis from 2000 to 2020, 2024

BACKGROUND: To estimate global and regional trends from 2000 to 2020 of the number of persons vis... more BACKGROUND: To estimate global and regional trends from 2000 to 2020 of the number of persons visually impaired by cataract and their proportion of the total number of vision-impaired individuals. METHODS: A systematic review and meta-analysis of published population studies and gray literature from 2000 to 2020 was carried out to estimate global and regional trends. We developed prevalence estimates based on modeled distance visual impairment and blindness due to cataract, producing location-, year-, age-, and sex-specific estimates of moderate to severe vision impairment (MSVI presenting visual acuity <6/18, ≥3/60) and blindness (presenting visual acuity <3/60). Estimates are agestandardized using the GBD standard population. RESULTS: In 2020, among overall (all ages) 43.3 million blind and 295 million with MSVI, 17.0 million (39.6%) people were blind and 83.5 million (28.3%) had MSVI due to cataract blind 60% female, MSVI 59% female. From 1990 to 2020, the count of persons blind (MSVI) due to cataract increased by 29.7%(93.1%) whereas the age-standardized global prevalence of cataract-related blindness improved by −27.5% and MSVI increased by 7.2%. The contribution of cataract to the age-standardized prevalence of blindness exceeded the global figure only in South Asia (62.9%) and Southeast Asia and Oceania (47.9%). CONCLUSIONS: The number of people blind and with MSVI due to cataract has risen over the past 30 years, despite a decrease in the age-standardized prevalence of cataract. This indicates that cataract treatment programs have been beneficial, but population growth and aging have outpaced their impact. Growing numbers of cataract blind indicate that more, better-directed, resources are needed to increase global capacity for cataract surgery.

Background Anaemia is a major health problem worldwide. Global estimates of anaemia burden are cr... more Background Anaemia is a major health problem worldwide. Global estimates of anaemia burden are crucial for developing appropriate interventions to meet current international targets for disease mitigation. We describe the prevalence, years lived with disability, and trends of anaemia and its underlying causes in 204 countries and territories. Methods We estimated population-level distributions of haemoglobin concentration by age and sex for each location from 1990 to 2021. We then calculated anaemia burden by severity and associated years lived with disability (YLDs). With data on prevalence of the causes of anaemia and associated cause-specific shifts in haemoglobin concentrations, we modelled the proportion of anaemia attributed to 37 underlying causes for all locations, years, and demographics in the Global Burden of Disease Study 2021. Findings In 2021, the global prevalence of anaemia across all ages was 24•3% (95% uncertainty interval [UI] 23•9-24•7), corresponding to 1•92 billion (1•89-1•95) prevalent cases, compared with a prevalence of 28•2% (27•8-28•5) and 1•50 billion (1•48-1•52) prevalent cases in 1990. Large variations were observed in anaemia burden by age, sex, and geography, with children younger than 5 years, women, and countries in sub-Saharan Africa and south Asia being particularly affected. Anaemia caused 52•0 million (35•1-75•1) YLDs in 2021, and the YLD rate due to anaemia declined with increasing Socio-demographic Index. The most common causes of anaemia YLDs in 2021 were dietary iron deficiency (cause-specific anaemia YLD rate per 100 000 population: 422•4 [95% UI 286•1-612•9]), haemoglobinopathies and haemolytic anaemias (89•0 [58•2-123•7]), and other neglected tropical diseases (36•3 [24•4-52•8]), collectively accounting for 84•7% (84•1-85•2) of anaemia YLDs. Interpretation Anaemia remains a substantial global health challenge, with persistent disparities according to age, sex, and geography. Estimates of cause-specific anaemia burden can be used to design locally relevant health interventions aimed at improving anaemia management and prevention. Funding Bill & Melinda Gates Foundation.

Purpose To test an online training course for nonophthalmic diabetic retinopathy (DR) graders for... more Purpose To test an online training course for nonophthalmic diabetic retinopathy (DR) graders for recognition of glaucomatous optic nerves in Vietnam. Methods This was an uncontrolled, experimental, before-and-after study in which 43 non-ophthalmic DR graders underwent baseline testing on a standard image set, completed a self-paced, online training course and were retested using the same photographs presented randomly. Twenty-nine local ophthalmologists completed the same test without the training course. DR graders then underwent additional one-to-one training by a glaucoma specialist and were retested. Test performance (% correct, compared with consensus grades from four fellowshiptrained glaucoma experts), sensitivity, specificity, positive and negative predictive value, and area under the receiver operating (AUC) curve, were computed. Results Mean age of DR graders (32.6±5.5 years) did not differ from ophthalmologists (32.3±7.3 years, p=0.13). Online training required a mean of 297.9 (SD 144.6) minutes. Graders' mean baseline score (33.3%±14.3%) improved significantly after training (55.8%±12.6%, p<0.001), and post-training score did not differ from ophthalmologists (58.7±15.4%, p=0.384). Although grader sensitivity reduced before [85.5% (95% CI 83.5% to 87.3%)] versus after [80.4% (78.3% to 82.4%)] training, specificity improved significantly [47.8 (44.9 to 50.7) vs 79.8 (77.3 to 82.0), p<0.001]. Grader AUC also improved after training [66.6 (64.9 to 68.3)] to [80.1 (78.5 to 81.6), p<0.001]. Additional one-to-one grader training by a glaucoma specialist did not further improve grader scores. Conclusion Non-ophthalmic DR graders can be trained to recognise glaucoma using a short online course in this setting, with no additional benefit from more expensive one-to-one training. After 5-hour online training in recognising glaucomatous optic nerve head, scores of non-ophthalmic DR graders doubled, and did not differ from local ophthalmologists. Intensive one-to-one training did not further improve performance

The Lancent Haematology

Background Anaemia is a major health problem worldwide. Global estimates of anaemia burden are cr... more Background Anaemia is a major health problem worldwide. Global estimates of anaemia burden are crucial for developing appropriate interventions to meet current international targets for disease mitigation. We describe the prevalence, years lived with disability, and trends of anaemia and its underlying causes in 204 countries and territories. Methods We estimated population-level distributions of haemoglobin concentration by age and sex for each location from 1990 to 2021. We then calculated anaemia burden by severity and associated years lived with disability (YLDs). With data on prevalence of the causes of anaemia and associated cause-specific shifts in haemoglobin concentrations, we modelled the proportion of anaemia attributed to 37 underlying causes for all locations, years, and demographics in the Global Burden of Disease Study 2021. Findings In 2021, the global prevalence of anaemia across all ages was 24•3% (95% uncertainty interval [UI] 23•9-24•7), corresponding to 1•92 billion (1•89-1•95) prevalent cases, compared with a prevalence of 28•2% (27•8-28•5) and 1•50 billion (1•48-1•52) prevalent cases in 1990. Large variations were observed in anaemia burden by age, sex, and geography, with children younger than 5 years, women, and countries in sub-Saharan Africa and south Asia being particularly affected. Anaemia caused 52•0 million (35•1-75•1) YLDs in 2021, and the YLD rate due to anaemia declined with increasing Socio-demographic Index. The most common causes of anaemia YLDs in 2021 were dietary iron deficiency (cause-specific anaemia YLD rate per 100 000 population: 422•4 [95% UI 286•1-612•9]), haemoglobinopathies and haemolytic anaemias (89•0 [58•2-123•7]), and other neglected tropical diseases (36•3 [24•4-52•8]), collectively accounting for 84•7% (84•1-85•2) of anaemia YLDs. Interpretation Anaemia remains a substantial global health challenge, with persistent disparities according to age, sex, and geography. Estimates of cause-specific anaemia burden can be used to design locally relevant health interventions aimed at improving anaemia management and prevention. Funding Bill & Melinda Gates Foundation.

Scientific Reports , 2023

Reliable estimates of subnational vaccination coverage are critical to track progress towards glo... more Reliable estimates of subnational vaccination coverage are critical to track progress towards global immunisation targets and ensure equitable health outcomes for all children. However, conflict can limit the reliability of coverage estimates from traditional household-based surveys due to an inability to sample in unsafe and insecure areas and increased uncertainty in underlying population estimates. In these situations, model-based geostatistical (MBG) approaches offer alternative coverage estimates for administrative units affected by conflict. We estimated first-and third-dose

Journal of Glaucoma, 2023

Abstract Purpose: To characterize treatment patterns for newly-diagnosed glaucoma in sub-Saharan... more Abstract
Purpose:
To characterize treatment patterns for newly-diagnosed glaucoma in sub-Saharan Africa (SSA).

Methods:
This was a multicenter cross-sectional study of adults newly diagnosed with glaucoma at 27 eye care centers in 10 African countries. In addition to demographic and clinical data, physician treatment recommendations (medication, laser, surgery, or no treatment) were recorded. Statistical analyses were performed using STATA version 14.0

Results:
Data from 1201 patients were analyzed. Physicians were most likely to recommend primary medical therapy upon diagnosis of glaucoma (69.4%), with laser (13.2%), surgery (14.9%), and no treatment (2.5%) recommended to the remaining patients. All sites had medical therapy available and most (25/27, 92.6%) could provide surgical treatment; only 16/27 (59.3%) sites offered laser, and at these sites, 30.8% of eyes were recommended to undergo primary laser procedures. As glaucoma severity increased, laser was recommended less, surgery more, and medications unchanged. Patient acceptance of medical therapy was 99.1%, laser 88.3%, and surgery 69.3%.

Conclusions:
Medical therapy for first-line glaucoma management is preferred by most physicians in SSA (69%). Laser therapy may be underutilized at centers where it is available. These findings underscore the need for comparative studies of glaucoma treatments in SSA to inform the development of evidence-based treatment guidelines and of programs to reduce glaucoma blindness in SSA. Strategic approaches to glaucoma therapy in SSA must address the question of whether medical therapy is the most optimal first line approach in this setting.

s: This paper examines the approximation of Hypergeometric population by binomial distribution. T... more s: This paper examines the approximation of Hypergeometric population by binomial distribution. The influence of the sample size k without replacement under various values of the parameters m and n such that m+n< ∞ of the Hypergeometric distribution was considered. Simulation studies using RGui software was used to generate Hypergeometric random variate for various values of the parameters m, n, k starting from m=2, n=2, k=2 in 100 replicates. The goodness-of-fit of the binomial distribution as an approximation to the Hypergeometric distribution simulated data was examined using Pearson chi-square goodness-of-fit test and Likelihood Ratio Test (LRT) were used to test the approximation of the discrete (count) data. Results from this study revealed that the Hypergeometric random variate could asymptotically approach the binomial distribution at m+n≥10 and the absolute difference between m and n is not large i.e. |m-n|= δ for a bounded δ≥0 which changes as m and n changes such that ...

Journal of Pediatric Infection Disease

Objective Community-acquired pneumonia (CAP) is the commonest cause of death in under-5 children ... more Objective Community-acquired pneumonia (CAP) is the commonest cause of death in under-5 children worldwide. Although the mortality from CAP has decreased over the last decade, it is still unacceptably high in lower-middle-income countries (LMICs). We aimed to determine the case fatality rate (CFR), and factors associated with treatment failure and outcome, using recommended antimicrobials. Methods A 5-year retrospective review of severe pediatric pneumonia admissions between August 1st, 2014 and July 31st, 2019 at the University College Hospital, Ibadan, Nigeria was conducted. Relevant clinical information including antibiotics use and outcome was analyzed using descriptive statistics, test of association, and logistic regression. Results There were 588 children aged 2 to 59 months, male:female ratio was 1.5:1. About two-thirds were aged 12 months. The majority were fully immunized for age (87.2%), about 34% were malnourished and 68% were hypoxemic at presentation. Only 71% of children were commenced on the recommended first-line antibiotics following the Pediatric Association of Nigeria (PAN) antibiotic guidelines. Initial antibiotics were changed in 22.3% of the patients. The need to change intravenous (iv) amoxicillin plus iv gentamicin was necessary in 23.80% compared with 18.1% for iv cefuroxime plus iv gentamicin. Severe acute malnutrition (odds ratio [OR]: 2.8 [95% confidence interval [CI]: 1.1-7.3]) and hypoxemia (OR:2.3 [95%CI: 1.0-5.6]) were independently associated with antibiotics change. The CFR was 1.36%. Conclusion The low CFR suggests a better outcome compared with other previous studies in LMICs. However, the high rate of antibiotics changes (22.3%) was possibly due to failure of first line antibiotics; especially among malnourished and hypoxemic children. Randomized controlled trial of iv cefuroxime plus gentamicin versus iv amoxicillin plus gentamicin is recommended.

The Lancet Public Health , 2022

Background Globally, transport and unintentional injuries persist as leading preventable causes o... more Background Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10-24 years during the past three decades. Methods Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10-14, 15-19, and 20-24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31•1 million DALYs (of which 16•2 million [52%] were transport related) among adolescents aged 10-24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34•4% (from 17•5 to 11•5 per 100 000) for transport injuries, and by 47•7% (from 15•9 to 8•3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80•5% to 42 774 for transport injuries and by 39•4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010-19, the rate per 100 000 of transport injury DALYs was reduced by 16•7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48•5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0•2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010-19. Interpretation As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low-middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury. Funding Bill & Melinda Gates Foundation.

The Lancet Global Health, 2023

Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevent... more Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-ofpocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Cooperation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings In 2019, at the onset of the COVID-19 pandemic, US$9•2 trillion (95% uncertainty interval [UI] 9•1-9•3) was spent on health worldwide. We found great disparities in the amount of resources devoted to health, with high-income countries spending 7•3trillion(957•3 trillion (95% UI 7•2-7•4) in 2019; 293•7 times the 7•3trillion(9524•8 billion (95% UI 24•3-25•3) spent by low-income countries in 2019. That same year, 43•1billionindevelopmentassistancewasprovidedtomaintainorimprovehealth.Thepandemicledtoanunprecedentedincreaseindevelopmentassistancetargetedtowardshealth;in2020and2021,43•1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, 43•1billionindevelopmentassistancewasprovidedtomaintainorimprovehealth.Thepandemicledtoanunprecedentedincreaseindevelopmentassistancetargetedtowardshealth;in2020and2021,1•8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and $37•8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12•2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the healthrelated COVID-19 response is 252•2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11-21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained. Funding Bill & Melinda Gates Foundation.

SN Social Sciences

Political speech acts are critical for politicians launching a regime because they can provide in... more Political speech acts are critical for politicians launching a regime because they can provide information that can be used to control people's thoughts and opinions. The purpose of this study was to conduct a qualitative content analysis of the inaugural and ascension addresses of Nigerian heads of state and presidents. The textual data used in this analysis were the ascension and inaugural addresses of Nigerian Heads of State and Presidents from 1960 to 2019. They were extracted and analysed using text-mining techniques. Textual data were clustered about their topical content using Latent Dirichlet Allocation (LDA), and speech cohesion between these addresses was examined using a similarity matrix and heatmap. Furthermore, term frequency and association analyses were performed to examine the high-frequency terms (tokens) and the terms (tokens) that are strongly correlated within each of the ascension/inaugural addresses (corpus). The summarization of characters and words in the ascension and inaugural addresses reveals that the Civilian Presidents used more characters and words than the Military Heads of State. There was an increase in the number of characters and words in the ascension and inaugural addresses among those who had served the nation multiple times. The total sentiment score in the ascension/inaugural addresses from 1960 to 2019 by Civilian Presidents and Military Heads of State revealed that the Civilian Presidents expressed more trust, surprise, sadness, joy, fear, disgust and anticipation in their addresses than the Military Heads of State. The most occurring term (token) in the ascension/inaugural addresses was the word government which appeared 221 times. The most token in the corpus government was found to be moderately correlated with the following tokens: loss, existing and majority. Similarly, economic was found to be moderately correlated with these tokens: inflation, building, education, exchange, loan, workers and technical. In this study, all the ascension/inaugural addresses share similar topic distribution: as seen in Abacha's and Muritala's addresses; and Shonekan's inaugural address was very similar to Balewa, Azikwe and Babangida's addresses; Babangida's ascension, Abdulsalam's 1998 ascension, Jonathan's 2010 inaugural Extended author information available on the last page of the article SN Soc Sci (2022) 2:279 279 Page 2 of 21 and Buhari's 2015 inaugural addresses discussed similar topics to Obasanjo's 1976 ascension address. The highest average sentiment score was observed in Obasanjo's 2003 inaugural address and the lowest score was in Buhari's 1983 ascension address. The sentiment score for the ascension/inaugural addresses showed that Civilian Presidents inaugural addresses expressed more positive, joy, trust and anticipation than Military Heads of State. These emotions showed that the Civilian President's inaugural addresses are better when compared to Military Heads of State in terms of the sentiment scores.

African Journal of Biomedical Research, 2024

Background: The occurrence of stroke is higher among Africans than African Americans and European... more Background: The occurrence of stroke is higher among Africans than African Americans and European Americans. Unfortunately, there is a paucity of data on African-wide pooled estimates of stroke risk factors. This study explores the risk factors of stroke among Africans. Methods: A systematic search of all articles on the risk factors of stroke in the African population was conducted in six electronic databases: PubMed, African Journal Online, Web of Science, Google Scholar, Cochrane Library, and Scopus. The data were pooled, and a random effect meta-analysis approach was used to determine the overall magnitude of stroke risk factors. Subgroup analyses were also carried out to investigate the extent of stroke risk factors across study designs. All statistical analyses were performed using R. Results: We found 15 prominent risk factors in 27 eligible articles. Twelve (12) of 15 risk factors were significantly related to stroke among Africans. The overall pooled estimated magnitude of stroke risk factors among African are 11.81 (95%CI: 7.32-19.05; I 2 = 92%) for hypertension, 3.17 (95%CI: 2.46-4.07; I 2 = 75%) for Diabetes Mellitus, 3.01 (95%CI: 1.61-5.62; I 2 = 92%) for Cardiac Disease, 1.69 (95%CI: 1.41-2.04; I 2 = 15%) for salt consumption, 1.68 (95%CI: 1.51-1.87; I 2 = 0.0%) for stress, and 1.47 (95%CI: 1.25-1.74; I 2 = 71%) for elevated waist-hip ratio. Conclusion: Prominent risk factors of stroke among indigenous Africans are primarily modifiable, and context-specific intervention targeted at these risk factors might be promising in managing the already high burden of stroke among indigenous Africans.

Purpose: To determine the frequency at which patients newly diagnosed with glaucoma in subSaharan... more Purpose: To determine the frequency at which patients newly diagnosed with glaucoma in subSaharan Africa (SSA) decline recommended therapy and to characterize the reasons for declining therapy. Methods: This was a multicenter, cross-sectional study conducted on adult patients at the time of glaucoma diagnosis at 27 centers in 10 countries in SSA. Data collected from the diagnostic encounter included demographics, clinical glaucoma characteristics, treatment recommendations, patient acceptance of therapy, and reasons for declining therapy. Results: Among 2,282 eyes of 1,198 patients offered treatment for glaucoma, initially recommended treatment was accepted in 2,126 eyes (93.2%). Acceptance of therapy varied with the nature of treatment offered, with medical therapy accepted in 99.2% of eyes, laser therapy in 88.3%, and surgical therapy in 69.3%. The most common reasons cited for declining therapy were fear (42.9%) and cost (41.7%); cost was the primary reason for declining medical and laser therapy, while fear was the most common reason for declining surgical therapy. Most patients declining laser or surgical therapy accepted medical therapy as an alternate therapy (98.1%). Conclusions: Patients’ acceptance of glaucoma therapy was high overall, but lower for surgery than for laser or medical therapy. Most patients who declined laser or surgical therapy accepted medical therapy as an alternate therapy when offered. Educational interventions, sustainable incentives, and other approaches are needed to enhance patient acceptance of glaucoma therapy in this setting, particularly surgery when needed.

eye, 2024

BACKGROUND: We aimed to update estimates of global vision loss due to age-related macular degener... more BACKGROUND: We aimed to update estimates of global vision loss due to age-related macular degeneration (AMD). METHODS: We did a systematic review and meta-analysis of population-based surveys of eye diseases from January, 1980, to October, 2018. We fitted hierarchical models to estimate the prevalence of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness (< 3/60) caused by AMD, stratified by age, region, and year. RESULTS: In 2020, 1.85 million (95%UI: 1.35 to 2.43 million) people were estimated to be blind due to AMD, and another 6.23 million (95%UI: 5.04 to 7.58) with MSVI globally. High-income countries had the highest number of individuals with AMD-related blindness (0.60 million people; 0.46 to 0.77). The crude prevalence of AMD-related blindness in 2020 (among those aged ≥ 50 years) was 0.10% (0.07 to 0.12) globally, and the region with the highest prevalence of AMD-related blindness was North Africa/ Middle East (0.22%; 0.16 to 0.30). Age-standardized prevalence (using the GBD 2019 data) of AMD-related MSVI in people aged ≥ 50 years in 2020 was 0.34% (0.27 to 0.41) globally, and the region with the highest prevalence of AMD-related MSVI was also North Africa/Middle East (0.55%; 0.44 to 0.68). From 2000 to 2020, the estimated crude prevalence of AMD-related blindness decreased globally by 19.29%, while the prevalence of MSVI increased by 10.08%. CONCLUSIONS: The estimated increase in the number of individuals with AMD-related blindness and MSVI globally urges the creation of novel treatment modalities and the expansion of rehabilitation services.

The Plant Genome, 2024

Regular measurement of realized genetic gain allows plant breeders to assess and review the effec... more Regular measurement of realized genetic gain allows plant breeders to assess and review the effectiveness of their strategies, allocate resources efficiently, and make informed decisions throughout the breeding process. Realized genetic gain estimation requires separating genetic trends from nongenetic trends using the linear mixed model (LMM) on historical multi-environment trial data. The LMM, accounting for the year effect, experimental designs, and heterogeneous residual variances, estimates best linear unbiased estimators of genotypes and regresses them on their years of origin. An illustrative example of estimating realized genetic gain was provided by analyzing historical data on fresh cassava (Manihot esculenta Crantz) yield in West Africa (https://github.com/Biometrics-IITA/Estimating-Realized-Genetic-Gain). This approach can serve as a model applicable to other crops and regions. Modernization of breeding programs is necessary to maximize the rate of genetic gain. This can be achieved by adopting genomics to enable faster breeding, accurate selection, and improved traits through genomic selection and gene editing. Tracking operational costs, establishing robust, digitalized data management and analytics systems, and developing effective varietal selection processes based on customer insights are also crucial for success. Capacity building and collaboration of breeding programs and institutions also play a significant role in accelerating genetic gains.

J Pediatr Infect Dis, 2023

Objective Community-acquired pneumonia (CAP) is the commonest cause of death in under-5 children ... more Objective Community-acquired pneumonia (CAP) is the commonest cause of death in under-5 children worldwide. Although the mortality from CAP has decreased over the last decade, it is still unacceptably high in lower-middle-income countries (LMICs). We aimed to determine the case fatality rate (CFR), and factors associated with treatment failure and outcome, using recommended antimicrobials. Methods A 5-year retrospective review of severe pediatric pneumonia admissions between August 1st, 2014 and July 31st, 2019 at the University College Hospital, Ibadan, Nigeria was conducted. Relevant clinical information including antibiotics use and outcome was analyzed using descriptive statistics, test of association, and logistic regression. Results There were 588 children aged 2 to 59 months, male:female ratio was 1.5:1. About two-thirds were aged 12 months. The majority were fully immunized for age (87.2%), about 34% were malnourished and 68% were hypoxemic at presentation. Only 71% of children were commenced on the recommended first-line antibiotics following the Pediatric Association of Nigeria (PAN) antibiotic guidelines. Initial antibiotics were changed in 22.3% of the patients. The need to change intravenous (iv) amoxicillin plus iv gentamicin was necessary in 23.80% compared with 18.1% for iv cefuroxime plus iv gentamicin. Severe acute malnutrition (odds ratio [OR]: 2.8 [95% confidence interval [CI]: 1.1-7.3]) and hypoxemia (OR:2.3 [95%CI: 1.0-5.6]) were independently associated with antibiotics change. The CFR was 1.36%. Conclusion The low CFR suggests a better outcome compared with other previous studies in LMICs. However, the high rate of antibiotics changes (22.3%) was possibly due to failure of first line antibiotics; especially among malnourished and hypoxemic children. Randomized controlled trial of iv cefuroxime plus gentamicin versus iv amoxicillin plus gentamicin is recommended.

The Lancet, 2024

Background Regular, detailed reporting on population health by underlying cause of death is funda... more Background Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. Methods The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimateswith alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sexlocation-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2•5th and 97•5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration causeof-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds.

Global estimates on the number of people blind or visually impaired by glaucoma: A meta-analysis from 2000 to 2020, 2024

OBJECTIVES: To estimate global and regional trends from 2000 to 2020 of the number of persons vis... more OBJECTIVES: To estimate global and regional trends from 2000 to 2020 of the number of persons visually impaired by glaucoma and their proportion of the total number of vision-impaired individuals. METHODS: A systematic review and meta-analysis of published population studies and grey literature from 2000 to 2020 was carried out to estimate global and regional trends in number of people with vision loss due to glaucoma. Moderate or severe vision loss (MSVI) was defined as visual acuity of 6/60 or better but <6/18 (moderate) and visual acuity of 3/60 or better but <6/60 (severe vision loss). Blindness was defined as presenting visual acuity <3/60. RESULTS: Globally, in 2020, 3.61 million people were blind and nearly 4.14 million were visually impaired by glaucoma. Glaucoma accounted for 8.39% (95% uncertainty intervals [UIs]: 6.54, 10.29) of all blindness and 1.41% (95% UI: 1.10, 1.75) of all MSVI. Regionally, the highest proportion of blindness relating to glaucoma was found in high-income countries (26.12% [95% UI: 20.72, 32.09]), while the region with the highest age-standardized prevalence of glaucoma-related blindness and MSVI was Sub-Saharan Africa. Between 2000 and 2020, global age-standardized prevalence of glaucoma-related blindness among adults ≥50 years decreased by 26.06% among males (95% UI: 25.87, 26.24), and by 21.75% among females (95% UI: 21.54, 21.96), while MSVI due to glaucoma increased by 3.7% among males (95% UI: 3.42, 3.98), and by 7.3% in females (95% UI: 7.01, 7.59). CONCLUSIONS: Within the last two decades, glaucoma has remained a major cause of blindness globally and regionally.

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021 , 2024

Background Regular, detailed reporting on population health by underlying cause of death is funda... more Background Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. Methods The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates— with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sexlocation-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration causeof-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. Findings The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading f ive causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles.

Eye, 2024

OBJECTIVES: To estimate global and regional trends from 2000 to 2020 of the number of persons vis... more OBJECTIVES: To estimate global and regional trends from 2000 to 2020 of the number of persons visually impaired by glaucoma and their proportion of the total number of vision-impaired individuals. METHODS: A systematic review and meta-analysis of published population studies and grey literature from 2000 to 2020 was carried out to estimate global and regional trends in number of people with vision loss due to glaucoma. Moderate or severe vision loss (MSVI) was defined as visual acuity of 6/60 or better but <6/18 (moderate) and visual acuity of 3/60 or better but <6/60 (severe vision loss). Blindness was defined as presenting visual acuity <3/60. RESULTS: Globally, in 2020, 3.61 million people were blind and nearly 4.14 million were visually impaired by glaucoma. Glaucoma accounted for 8.39% (95% uncertainty intervals [UIs]: 6.54, 10.29) of all blindness and 1.41% (95% UI: 1.10, 1.75) of all MSVI. Regionally, the highest proportion of blindness relating to glaucoma was found in high-income countries (26.12% [95% UI: 20.72, 32.09]), while the region with the highest age-standardized prevalence of glaucoma-related blindness and MSVI was Sub-Saharan Africa. Between 2000 and 2020, global age-standardized prevalence of glaucoma-related blindness among adults ≥50 years decreased by 26.06% among males (95% UI: 25.87, 26.24), and by 21.75% among females (95% UI: 21.54, 21.96), while MSVI due to glaucoma increased by 3.7% among males (95% UI: 3.42, 3.98), and by 7.3% in females (95% UI: 7.01, 7.59). CONCLUSIONS: Within the last two decades, glaucoma has remained a major cause of blindness globally and regionally.

Global estimates on the number of people blind or visually impaired by cataract: a meta-analysis from 2000 to 2020, 2024

BACKGROUND: To estimate global and regional trends from 2000 to 2020 of the number of persons vis... more BACKGROUND: To estimate global and regional trends from 2000 to 2020 of the number of persons visually impaired by cataract and their proportion of the total number of vision-impaired individuals. METHODS: A systematic review and meta-analysis of published population studies and gray literature from 2000 to 2020 was carried out to estimate global and regional trends. We developed prevalence estimates based on modeled distance visual impairment and blindness due to cataract, producing location-, year-, age-, and sex-specific estimates of moderate to severe vision impairment (MSVI presenting visual acuity <6/18, ≥3/60) and blindness (presenting visual acuity <3/60). Estimates are agestandardized using the GBD standard population. RESULTS: In 2020, among overall (all ages) 43.3 million blind and 295 million with MSVI, 17.0 million (39.6%) people were blind and 83.5 million (28.3%) had MSVI due to cataract blind 60% female, MSVI 59% female. From 1990 to 2020, the count of persons blind (MSVI) due to cataract increased by 29.7%(93.1%) whereas the age-standardized global prevalence of cataract-related blindness improved by −27.5% and MSVI increased by 7.2%. The contribution of cataract to the age-standardized prevalence of blindness exceeded the global figure only in South Asia (62.9%) and Southeast Asia and Oceania (47.9%). CONCLUSIONS: The number of people blind and with MSVI due to cataract has risen over the past 30 years, despite a decrease in the age-standardized prevalence of cataract. This indicates that cataract treatment programs have been beneficial, but population growth and aging have outpaced their impact. Growing numbers of cataract blind indicate that more, better-directed, resources are needed to increase global capacity for cataract surgery.

Background Anaemia is a major health problem worldwide. Global estimates of anaemia burden are cr... more Background Anaemia is a major health problem worldwide. Global estimates of anaemia burden are crucial for developing appropriate interventions to meet current international targets for disease mitigation. We describe the prevalence, years lived with disability, and trends of anaemia and its underlying causes in 204 countries and territories. Methods We estimated population-level distributions of haemoglobin concentration by age and sex for each location from 1990 to 2021. We then calculated anaemia burden by severity and associated years lived with disability (YLDs). With data on prevalence of the causes of anaemia and associated cause-specific shifts in haemoglobin concentrations, we modelled the proportion of anaemia attributed to 37 underlying causes for all locations, years, and demographics in the Global Burden of Disease Study 2021. Findings In 2021, the global prevalence of anaemia across all ages was 24•3% (95% uncertainty interval [UI] 23•9-24•7), corresponding to 1•92 billion (1•89-1•95) prevalent cases, compared with a prevalence of 28•2% (27•8-28•5) and 1•50 billion (1•48-1•52) prevalent cases in 1990. Large variations were observed in anaemia burden by age, sex, and geography, with children younger than 5 years, women, and countries in sub-Saharan Africa and south Asia being particularly affected. Anaemia caused 52•0 million (35•1-75•1) YLDs in 2021, and the YLD rate due to anaemia declined with increasing Socio-demographic Index. The most common causes of anaemia YLDs in 2021 were dietary iron deficiency (cause-specific anaemia YLD rate per 100 000 population: 422•4 [95% UI 286•1-612•9]), haemoglobinopathies and haemolytic anaemias (89•0 [58•2-123•7]), and other neglected tropical diseases (36•3 [24•4-52•8]), collectively accounting for 84•7% (84•1-85•2) of anaemia YLDs. Interpretation Anaemia remains a substantial global health challenge, with persistent disparities according to age, sex, and geography. Estimates of cause-specific anaemia burden can be used to design locally relevant health interventions aimed at improving anaemia management and prevention. Funding Bill & Melinda Gates Foundation.

Purpose To test an online training course for nonophthalmic diabetic retinopathy (DR) graders for... more Purpose To test an online training course for nonophthalmic diabetic retinopathy (DR) graders for recognition of glaucomatous optic nerves in Vietnam. Methods This was an uncontrolled, experimental, before-and-after study in which 43 non-ophthalmic DR graders underwent baseline testing on a standard image set, completed a self-paced, online training course and were retested using the same photographs presented randomly. Twenty-nine local ophthalmologists completed the same test without the training course. DR graders then underwent additional one-to-one training by a glaucoma specialist and were retested. Test performance (% correct, compared with consensus grades from four fellowshiptrained glaucoma experts), sensitivity, specificity, positive and negative predictive value, and area under the receiver operating (AUC) curve, were computed. Results Mean age of DR graders (32.6±5.5 years) did not differ from ophthalmologists (32.3±7.3 years, p=0.13). Online training required a mean of 297.9 (SD 144.6) minutes. Graders' mean baseline score (33.3%±14.3%) improved significantly after training (55.8%±12.6%, p<0.001), and post-training score did not differ from ophthalmologists (58.7±15.4%, p=0.384). Although grader sensitivity reduced before [85.5% (95% CI 83.5% to 87.3%)] versus after [80.4% (78.3% to 82.4%)] training, specificity improved significantly [47.8 (44.9 to 50.7) vs 79.8 (77.3 to 82.0), p<0.001]. Grader AUC also improved after training [66.6 (64.9 to 68.3)] to [80.1 (78.5 to 81.6), p<0.001]. Additional one-to-one grader training by a glaucoma specialist did not further improve grader scores. Conclusion Non-ophthalmic DR graders can be trained to recognise glaucoma using a short online course in this setting, with no additional benefit from more expensive one-to-one training. After 5-hour online training in recognising glaucomatous optic nerve head, scores of non-ophthalmic DR graders doubled, and did not differ from local ophthalmologists. Intensive one-to-one training did not further improve performance

The Lancent Haematology

Background Anaemia is a major health problem worldwide. Global estimates of anaemia burden are cr... more Background Anaemia is a major health problem worldwide. Global estimates of anaemia burden are crucial for developing appropriate interventions to meet current international targets for disease mitigation. We describe the prevalence, years lived with disability, and trends of anaemia and its underlying causes in 204 countries and territories. Methods We estimated population-level distributions of haemoglobin concentration by age and sex for each location from 1990 to 2021. We then calculated anaemia burden by severity and associated years lived with disability (YLDs). With data on prevalence of the causes of anaemia and associated cause-specific shifts in haemoglobin concentrations, we modelled the proportion of anaemia attributed to 37 underlying causes for all locations, years, and demographics in the Global Burden of Disease Study 2021. Findings In 2021, the global prevalence of anaemia across all ages was 24•3% (95% uncertainty interval [UI] 23•9-24•7), corresponding to 1•92 billion (1•89-1•95) prevalent cases, compared with a prevalence of 28•2% (27•8-28•5) and 1•50 billion (1•48-1•52) prevalent cases in 1990. Large variations were observed in anaemia burden by age, sex, and geography, with children younger than 5 years, women, and countries in sub-Saharan Africa and south Asia being particularly affected. Anaemia caused 52•0 million (35•1-75•1) YLDs in 2021, and the YLD rate due to anaemia declined with increasing Socio-demographic Index. The most common causes of anaemia YLDs in 2021 were dietary iron deficiency (cause-specific anaemia YLD rate per 100 000 population: 422•4 [95% UI 286•1-612•9]), haemoglobinopathies and haemolytic anaemias (89•0 [58•2-123•7]), and other neglected tropical diseases (36•3 [24•4-52•8]), collectively accounting for 84•7% (84•1-85•2) of anaemia YLDs. Interpretation Anaemia remains a substantial global health challenge, with persistent disparities according to age, sex, and geography. Estimates of cause-specific anaemia burden can be used to design locally relevant health interventions aimed at improving anaemia management and prevention. Funding Bill & Melinda Gates Foundation.

Scientific Reports , 2023

Reliable estimates of subnational vaccination coverage are critical to track progress towards glo... more Reliable estimates of subnational vaccination coverage are critical to track progress towards global immunisation targets and ensure equitable health outcomes for all children. However, conflict can limit the reliability of coverage estimates from traditional household-based surveys due to an inability to sample in unsafe and insecure areas and increased uncertainty in underlying population estimates. In these situations, model-based geostatistical (MBG) approaches offer alternative coverage estimates for administrative units affected by conflict. We estimated first-and third-dose

Journal of Glaucoma, 2023

Abstract Purpose: To characterize treatment patterns for newly-diagnosed glaucoma in sub-Saharan... more Abstract
Purpose:
To characterize treatment patterns for newly-diagnosed glaucoma in sub-Saharan Africa (SSA).

Methods:
This was a multicenter cross-sectional study of adults newly diagnosed with glaucoma at 27 eye care centers in 10 African countries. In addition to demographic and clinical data, physician treatment recommendations (medication, laser, surgery, or no treatment) were recorded. Statistical analyses were performed using STATA version 14.0

Results:
Data from 1201 patients were analyzed. Physicians were most likely to recommend primary medical therapy upon diagnosis of glaucoma (69.4%), with laser (13.2%), surgery (14.9%), and no treatment (2.5%) recommended to the remaining patients. All sites had medical therapy available and most (25/27, 92.6%) could provide surgical treatment; only 16/27 (59.3%) sites offered laser, and at these sites, 30.8% of eyes were recommended to undergo primary laser procedures. As glaucoma severity increased, laser was recommended less, surgery more, and medications unchanged. Patient acceptance of medical therapy was 99.1%, laser 88.3%, and surgery 69.3%.

Conclusions:
Medical therapy for first-line glaucoma management is preferred by most physicians in SSA (69%). Laser therapy may be underutilized at centers where it is available. These findings underscore the need for comparative studies of glaucoma treatments in SSA to inform the development of evidence-based treatment guidelines and of programs to reduce glaucoma blindness in SSA. Strategic approaches to glaucoma therapy in SSA must address the question of whether medical therapy is the most optimal first line approach in this setting.

s: This paper examines the approximation of Hypergeometric population by binomial distribution. T... more s: This paper examines the approximation of Hypergeometric population by binomial distribution. The influence of the sample size k without replacement under various values of the parameters m and n such that m+n< ∞ of the Hypergeometric distribution was considered. Simulation studies using RGui software was used to generate Hypergeometric random variate for various values of the parameters m, n, k starting from m=2, n=2, k=2 in 100 replicates. The goodness-of-fit of the binomial distribution as an approximation to the Hypergeometric distribution simulated data was examined using Pearson chi-square goodness-of-fit test and Likelihood Ratio Test (LRT) were used to test the approximation of the discrete (count) data. Results from this study revealed that the Hypergeometric random variate could asymptotically approach the binomial distribution at m+n≥10 and the absolute difference between m and n is not large i.e. |m-n|= δ for a bounded δ≥0 which changes as m and n changes such that ...

Journal of Pediatric Infection Disease

Objective Community-acquired pneumonia (CAP) is the commonest cause of death in under-5 children ... more Objective Community-acquired pneumonia (CAP) is the commonest cause of death in under-5 children worldwide. Although the mortality from CAP has decreased over the last decade, it is still unacceptably high in lower-middle-income countries (LMICs). We aimed to determine the case fatality rate (CFR), and factors associated with treatment failure and outcome, using recommended antimicrobials. Methods A 5-year retrospective review of severe pediatric pneumonia admissions between August 1st, 2014 and July 31st, 2019 at the University College Hospital, Ibadan, Nigeria was conducted. Relevant clinical information including antibiotics use and outcome was analyzed using descriptive statistics, test of association, and logistic regression. Results There were 588 children aged 2 to 59 months, male:female ratio was 1.5:1. About two-thirds were aged 12 months. The majority were fully immunized for age (87.2%), about 34% were malnourished and 68% were hypoxemic at presentation. Only 71% of children were commenced on the recommended first-line antibiotics following the Pediatric Association of Nigeria (PAN) antibiotic guidelines. Initial antibiotics were changed in 22.3% of the patients. The need to change intravenous (iv) amoxicillin plus iv gentamicin was necessary in 23.80% compared with 18.1% for iv cefuroxime plus iv gentamicin. Severe acute malnutrition (odds ratio [OR]: 2.8 [95% confidence interval [CI]: 1.1-7.3]) and hypoxemia (OR:2.3 [95%CI: 1.0-5.6]) were independently associated with antibiotics change. The CFR was 1.36%. Conclusion The low CFR suggests a better outcome compared with other previous studies in LMICs. However, the high rate of antibiotics changes (22.3%) was possibly due to failure of first line antibiotics; especially among malnourished and hypoxemic children. Randomized controlled trial of iv cefuroxime plus gentamicin versus iv amoxicillin plus gentamicin is recommended.

The Lancet Public Health , 2022

Background Globally, transport and unintentional injuries persist as leading preventable causes o... more Background Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10-24 years during the past three decades. Methods Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10-14, 15-19, and 20-24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31•1 million DALYs (of which 16•2 million [52%] were transport related) among adolescents aged 10-24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34•4% (from 17•5 to 11•5 per 100 000) for transport injuries, and by 47•7% (from 15•9 to 8•3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80•5% to 42 774 for transport injuries and by 39•4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010-19, the rate per 100 000 of transport injury DALYs was reduced by 16•7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48•5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0•2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010-19. Interpretation As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low-middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury. Funding Bill & Melinda Gates Foundation.

The Lancet Global Health, 2023

Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevent... more Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-ofpocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Cooperation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings In 2019, at the onset of the COVID-19 pandemic, US$9•2 trillion (95% uncertainty interval [UI] 9•1-9•3) was spent on health worldwide. We found great disparities in the amount of resources devoted to health, with high-income countries spending 7•3trillion(957•3 trillion (95% UI 7•2-7•4) in 2019; 293•7 times the 7•3trillion(9524•8 billion (95% UI 24•3-25•3) spent by low-income countries in 2019. That same year, 43•1billionindevelopmentassistancewasprovidedtomaintainorimprovehealth.Thepandemicledtoanunprecedentedincreaseindevelopmentassistancetargetedtowardshealth;in2020and2021,43•1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, 43•1billionindevelopmentassistancewasprovidedtomaintainorimprovehealth.Thepandemicledtoanunprecedentedincreaseindevelopmentassistancetargetedtowardshealth;in2020and2021,1•8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and $37•8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12•2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the healthrelated COVID-19 response is 252•2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11-21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained. Funding Bill & Melinda Gates Foundation.

SN Social Sciences

Political speech acts are critical for politicians launching a regime because they can provide in... more Political speech acts are critical for politicians launching a regime because they can provide information that can be used to control people's thoughts and opinions. The purpose of this study was to conduct a qualitative content analysis of the inaugural and ascension addresses of Nigerian heads of state and presidents. The textual data used in this analysis were the ascension and inaugural addresses of Nigerian Heads of State and Presidents from 1960 to 2019. They were extracted and analysed using text-mining techniques. Textual data were clustered about their topical content using Latent Dirichlet Allocation (LDA), and speech cohesion between these addresses was examined using a similarity matrix and heatmap. Furthermore, term frequency and association analyses were performed to examine the high-frequency terms (tokens) and the terms (tokens) that are strongly correlated within each of the ascension/inaugural addresses (corpus). The summarization of characters and words in the ascension and inaugural addresses reveals that the Civilian Presidents used more characters and words than the Military Heads of State. There was an increase in the number of characters and words in the ascension and inaugural addresses among those who had served the nation multiple times. The total sentiment score in the ascension/inaugural addresses from 1960 to 2019 by Civilian Presidents and Military Heads of State revealed that the Civilian Presidents expressed more trust, surprise, sadness, joy, fear, disgust and anticipation in their addresses than the Military Heads of State. The most occurring term (token) in the ascension/inaugural addresses was the word government which appeared 221 times. The most token in the corpus government was found to be moderately correlated with the following tokens: loss, existing and majority. Similarly, economic was found to be moderately correlated with these tokens: inflation, building, education, exchange, loan, workers and technical. In this study, all the ascension/inaugural addresses share similar topic distribution: as seen in Abacha's and Muritala's addresses; and Shonekan's inaugural address was very similar to Balewa, Azikwe and Babangida's addresses; Babangida's ascension, Abdulsalam's 1998 ascension, Jonathan's 2010 inaugural Extended author information available on the last page of the article SN Soc Sci (2022) 2:279 279 Page 2 of 21 and Buhari's 2015 inaugural addresses discussed similar topics to Obasanjo's 1976 ascension address. The highest average sentiment score was observed in Obasanjo's 2003 inaugural address and the lowest score was in Buhari's 1983 ascension address. The sentiment score for the ascension/inaugural addresses showed that Civilian Presidents inaugural addresses expressed more positive, joy, trust and anticipation than Military Heads of State. These emotions showed that the Civilian President's inaugural addresses are better when compared to Military Heads of State in terms of the sentiment scores.

ANDKOLAD Nigeria Ltd., Obafemi Awolowo University, Teaching Hospital Complex, Ile-Ife, Osun State, 2019

Abstract Structural equation modeling (SEM) is an efficient statistical technique for the analysi... more Abstract
Structural equation modeling (SEM) is an efficient statistical technique for the analysis and evaluation of complex relations involving observed and unobserved (latent) variables. Unfortunately, its application in Public Health research has been very limited in this setting. The current paper documents basic theories, principles and application of SEM to research in Public Health. We also present results of an empirical application of SEM using epidemiological data from a study on the psychosocial functioning and quality of life of adolescents in Nigeria. The relations between the constructs and the observed variables were measured. The results showed that poor psychosocial functioning negatively impacts on the quality of life of adolescents in Nigeria. Structural equation modeling is applicable to public health research and the results of the empirical analysis presents the contributions by SEM to public health research. There is need to encourage researchers in public health to apply SEM in their research.
Keywords: Structural equation Modeling; Public Health, Psychosocial Functioning, Quality of Life, Adolescents