Muawiyyah Sufiyan - Academia.edu (original) (raw)

Papers by Muawiyyah Sufiyan

Annals of Tropical Pathology, 2020

Background: Brucellosis is a neglected underdiagnosed zoonotic disease of worldwide distribution ... more Background: Brucellosis is a neglected underdiagnosed zoonotic disease of worldwide distribution with varying symptoms similar to those occurring in other febrile illnesses. A recent screening survey conducted among butchers in Bauchi state reported a high prevalence of human brucellosis; however, its burden among patients with other febrile illnesses is unknown. We determine the seroprevalence and factors associated with risk of brucellosis among febrile patients attending health-care facilities (HCFs) in Bauchi metropolis, North-Eastern Nigeria. Methodology: We conducted a hospital-based descriptive cross-sectional study of 382 participants using a multistage sampling technique. Brucella antibodies were detected using Rose Bengal plate test, and a questionnaire was used to identify risk factors associated with human brucellosis. Data analyses were conducted using Epi Info version 7.0. Bivariate and multivariate analyses were conducted at P = 0.05. Results: Fifty-seven (14.9%) of t...

Annals of Nigerian Medicine, 2012

INtRoduCtIoN G lobally, deaths and injuries from road crashes are a major and growing public heal... more INtRoduCtIoN G lobally, deaths and injuries from road crashes are a major and growing public health problem. More than 20 million people are severely injured or killed on the world's road each year and the burden falls most heavily on low income countries. [1] This is due to the fact that pedestrians and motorcycles make up the largest proportion of the road traffic and are less protected from accidents per kilometres travelled, and therefore, are at a far greater risk than the drivers and passengers of cars and motor vehicles. [2] A B S T R A C T Background: Globally, deaths and injuries from road crashes are a major and growing public health problem. More than 20 million people are severely injured or killed on the world's road each year and the burden falls most heavily on low income countries. Commercial motorcycling is gaining acceptance by all, as the transport system possesses several features which are adapted to the contemporary Nigerian society. However, many of the commercial motorcycle riders lack proper knowledge on road safety measures as such together with the passengers they carry are exposed to all the hazards of motorcycling including accidents. Aim: To assess the knowledge, attitude and compliance with safety protective devices among commercial motorcyclists in Tudun-Wada Zaria local Government area of Kaduna state Northwestern Nigeria. Materials and Methods: A cross-sectional descriptive study was carried out among 250 commercial motorcyclists who were randomly selected using multistage sampling technique in Tudun-Wada ward of Zaria local Government Area of Kaduna state. A pre-tested structured interviewer-administered questionnaire was used as the tool for data collection. Data was analyzed using SPSS version 19.0 and Epi-info 6.0. Results: All the 250 respondents were males; with majority (72.4%) of them within the age range 20-29 years. Thirty percent of the respondents had no formal education and 28.8% of them are not registered with appropriate authorities. Majority of the respondents (75.6%) did not receive any formal training before commencement of the business. Also, 89.2% have poor knowledge on safety protective devices, while 95.2% have a poor attitude. In terms of compliance with safety protective devices, 86.4% of the respondents have poor compliance. None of the respondents had helmet worn during the survey period. Seventy six percent (76.4%) of the respondents have been involved in accident and 68.6% of which occurred 6 months preceding the study with lower limb most affected (accounting for 44.5%). Conclusion: Commercial motorcycling is essentially done by males who have not received any formal training for the job; hence, they lack adequate basic knowledge on safety protective devices and as such their attitude and compliance with safety protective device is poor. The predominant type of injury they sustained was that of the lower limb, and a significant proportion of them sustained multiple injuries. There is a statistically significant relationship between the educational status of the respondents and their attitude towards use of safety protective devices. Therefore, ensuring formal training, vigorous enlightenment campaigns and enforcement on the use of safety protective devices by the relevant key authorities is necessary in order to reduce the high prevalence of accidents and injuries among commercial motorcycle riders.

The Lancet Infectious Diseases, 2019

Background Many countries have shown marked declines in diarrhoeal disease mortality among childr... more Background Many countries have shown marked declines in diarrhoeal disease mortality among children younger than 5 years. With this analysis, we provide updated results on diarrhoeal disease mortality among children younger than 5 years from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) and use the study's comparative risk assessment to quantify trends and effects of risk factors, interventions, and broader sociodemographic development on mortality changes in 195 countries and territories from 1990 to 2017. Methods This analysis for GBD 2017 had three main components. Diarrhoea mortality was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive, Bayesian, ensemble modelling tool; and the attribution of risk factors and interventions for diarrhoea were modelled in a counterfactual framework that combines modelled population-level prevalence of the exposure to each risk or intervention with the relative risk of diarrhoea given exposure to that factor. We assessed the relative and absolute change in diarrhoea mortality rate between 1990 and 2017, and used the change in risk factor exposure and sociodemographic status to explain differences in the trends of diarrhoea mortality among children younger than 5 years. Findings Diarrhoea was responsible for an estimated 533 768 deaths (95% uncertainty interval 477 162-593 145) among children younger than 5 years globally in 2017, a rate of 78•4 deaths (70•1-87•1) per 100 000 children. The diarrhoea mortality rate ranged between countries by over 685 deaths per 100 000 children. Diarrhoea mortality per 100 000 globally decreased by 69•6% (63•1-74•6) between 1990 and 2017. Among the risk factors considered in this study, those responsible for the largest declines in the diarrhoea mortality rate were reduction in exposure to unsafe sanitation (13•3% decrease, 11•2-15•5), childhood wasting (9•9% decrease, 9•6-10•2), and low use of oral rehydration solution (6•9% decrease, 4•8-8•4). Interpretation Diarrhoea mortality has declined substantially since 1990, although there are variations by country. Improvements in sociodemographic indicators might explain some of these trends, but changes in exposure to risk factors-particularly unsafe sanitation, childhood growth failure, and low use of oral rehydration solution-appear to be related to the relative and absolute rates of decline in diarrhoea mortality. Although the most effective interventions might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting against diarrhoea that have already reduced diarrhoea mortality could further avert many thousands of deaths due to this illness. Funding Bill & Melinda Gates Foundation.

International Journal of Public Health, 2017

Objectives We used data from the Global Burden of Disease 2015 study (GBD) to calculate the burde... more Objectives We used data from the Global Burden of Disease 2015 study (GBD) to calculate the burden of lower respiratory infections (LRIs) in the 22 countries of the Eastern Mediterranean Region (EMR) from 1990 to 2015. Methods We conducted a systematic analysis of mortality and morbidity data for LRI and its specific etiologic factors, including pneumococcus, Haemophilus influenzae type b, Respiratory syncytial virus, and influenza virus. We used modeling methods to estimate incidence, deaths, and disability-adjusted life-years (DALYs). We calculated burden attributable to known risk factors for LRI. Results In 2015, LRIs were the fourth-leading cause of DALYs, causing 11,098,243 (95% UI 9,857,095-12,396,566) DALYs and 191,114 (95% UI 170,934-210,705) deaths. The LRI DALY rates were higher than global estimates in 2015. The highest and lowest age-standardized rates of DALYs were observed in Somalia and Lebanon, respectively. Undernutrition in childhood and ambient particulate matter air pollution in the elderly were the main risk factors. Conclusions Our findings call for public health strategies to reduce the level of risk factors in each age group, especially vulnerable child and elderly populations.

International Journal of Public Health, 2017

Objectives To estimate incidence, mortality, and disability-adjusted life years (DALYs) caused by... more Objectives To estimate incidence, mortality, and disability-adjusted life years (DALYs) caused by cancer in the Eastern Mediterranean Region (EMR) between 2005 and 2015. Methods Vital registration system and cancer registry data from the EMR region were analyzed for 29 cancer groups in 22 EMR countries using the Global Burden of Disease Study 2015 methodology. Results In 2015, cancer was responsible for 9.4% of all deaths and 5.1% of all DALYs. It accounted for 722,646 new cases, 379,093 deaths, and 11.7 million DALYs. Between 2005 and 2015, incident cases increased by 46%, deaths by 33%, and DALYs by 31%. The increase in cancer incidence was largely driven by population growth and population aging. Breast cancer, lung cancer, and leukemia were the most common cancers, while lung, breast, and stomach cancers caused most cancer deaths. Conclusions Cancer is responsible for a substantial disease burden in the EMR, which is increasing. There is an urgent need to expand cancer prevention, screening, and awareness programs in EMR countries as well as to improve diagnosis, treatment, and palliative care services.

Lancet (London, England), Jan 7, 2015

Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and year... more Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally...

Importance - Cancer is the second leading cause of death worldwide. Current estimates on the burd... more Importance - Cancer is the second leading cause of death worldwide. Current estimates on the burden of cancer are needed for cancer control planning. Objective - To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 32 cancers in 195 countries and territories from 1990 to 2015. Evidence Review - Cancer mortality was estimated using vital registration system data, cancer registry incidence data (transformed to mortality estimates using separately estimated mortality to incidence [MI] ratios), and verbal autopsy data. Cancer incidence was calculated by dividing mortality estimates through the modeled MI ratios. To calculate cancer prevalence, MI ratios were used to model survival. To calculate YLDs, prevalence estimates were multiplied by disability weights. The YLLs were estimated by multiplying age-specific cancer deaths by the reference life expectancy. DALYs were estimated as the sum of YLDs ...

Archives of Medicine and Surgery, 2016

Context: The birth of a baby is a major reason for celebration worldwide. Yet, in most countries ... more Context: The birth of a baby is a major reason for celebration worldwide. Yet, in most countries of the world, pregnancy and childbirth is a perilous journey. In Kaduna State, Northwestern Nigeria, the estimated maternal mortality ratio figure is 1025/100,000 live births. Despite the higher rates of maternal deaths, there is no empirical evidence on women's knowledge, perception, and attitudes toward pregnancy danger signs in Kaduna State. Aims: To determine the knowledge, attitude, and perception of pregnancy danger signs among women of childbearing age (15–49 years) in Samaru community Sabon-Gari Local Government Area in Kaduna State. Settings and Design: A community-based descriptive, cross-sectional study was conducted among 185 women of reproductive age group. Subjects and Methods: Participants were randomly selected using a multistage sampling technique. Pretested structured interviewer administered questionnaire was used for data collection. The completed questionnaires w...

Background: Cooking gas refill attendants play important role in the use of gas in Zaria. The aim... more Background: Cooking gas refill attendants play important role in the use of gas in Zaria. The aim of this study was to assess the knowledge, attitude and safety measure practices among cooking gas refill attendants in Zaria metropolis, Kaduna State, Nigeria. A cross sectional study was conducted in January, 2019 among cooking gas refill attendants using structured intervieweradministered questionnaire and checklist. It was a wholepopulation study of 121 participants. The data was collected using Open Data Kit (ODK) software version 1.21.1 installed in an android device and analyzed using SPSS version 25.0. The results were summarized and presented in tables and charts; p value was set at < 0.05 for statistical significance. Majority (79.6%) of the respondents were within the productive age group of 25 to 44 years with median age 36 years, married (57.9%) and more than half (52.1%) of the respondents had secondary education and all respondents were males. The overall scores for kn...

The Lancet

Background Alcohol use is a leading risk factor for death and disability, but its overall associa... more Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted lifeyears (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2•2% (95% uncertainty interval [UI] 1•5-3•0) of age-standardised female deaths and 6•8% (5•8-8•0) of agestandardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3•8% (95% UI 3•2-4•3) of female deaths and 12•2% (10•8-13•6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2•3% (95% UI 2•0-2•6) and male attributable DALYs were 8•9% (7•8-9•9). The three leading causes of attributable deaths in this age group were tuberculosis (1•4% [95% UI 1•0-1•7] of total deaths), road injuries (1•2% [0•7-1•9]), and self-harm (1•1% [0•6-1•5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27•1% (95% UI 21•2-33•3) of total alcohol-attributable female deaths and 18•9% (15•3-22•6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0•0-0•8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption. Funding Bill & Melinda Gates Foundation.

international journal of public health, 2017

Objectives We used data from the Global Burden of Disease 2015 study (GBD) to calculate the burde... more Objectives We used data from the Global Burden of Disease 2015 study (GBD) to calculate the burden of lower respiratory infections (LRIs) in the 22 countries of the Eastern Mediterranean Region (EMR) from 1990 to 2015. Methods We conducted a systematic analysis of mortality and morbidity data for LRI and its specific etiologic factors, including pneumococcus, Haemophilus influenzae type b, Respiratory syncytial virus, and influenza virus. We used modeling methods to estimate incidence, deaths, and disability-adjusted life-years (DALYs). We calculated burden attributable to known risk factors for LRI. Results In 2015, LRIs were the fourth-leading cause of DALYs, causing 11,098,243 (95% UI 9,857,095–12,396,566) DALYs and 191,114 (95% UI 170,934–210,705) deaths. The LRI DALY rates were higher than global estimates in 2015. The highest and lowest age-standardized rates of DALYs were observed in Somalia and Lebanon, respectively. Undernutrition in childhood and ambient particulate matter...

international journal of public health, 2017

Objectives To estimate incidence, mortality, and disability- adjusted life years (DALYs) caused b... more Objectives To estimate incidence, mortality, and disability- adjusted life years (DALYs) caused by cancer in the Eastern Mediterranean Region (EMR) between 2005 and 2015. Methods Vital registration system and cancer registry data from the EMR region were analyzed for 29 cancer groups in 22 EMR countries using the Global Burden of Disease Study 2015 methodology. Results In 2015, cancer was responsible for 9.4% of all deaths and 5.1% of all DALYs. It accounted for 722,646 new cases, 379,093 deaths, and 11.7 million DALYs. Between 2005 and 2015, incident cases increased by 46%, deaths by 33%, and DALYs by 31%. The increase in cancer incidence was largely driven by population growth and population aging. Breast cancer, lung cancer, and leukemia were the most common cancers, while lung, breast, and stomach cancers caused most cancer deaths. Conclusions Cancer is responsible for a substantial disease burden in the EMR, which is increasing. There is an urgent need to expand cancer preventi...

Annals of Nigerian Medicine, 2012

Background: Worldwide, about a half of mortalities in children are directly or indirectly attribu... more Background: Worldwide, about a half of mortalities in children are directly or indirectly attributable to malnutrition. In Nigeria, malnutrition has also been reported to be associated with increased morbidity and mortality, such that 30-40% of deaths in the preschool age group are associated with malnutrition. Therefore, assessing the factors attributing to malnutrition is central to reducing and preventing these high mortalities. One attributable factor to malnutrition is the level of maternal literacy. Objective: The study aimed to assess the effect of maternal literacy on the nutritional status of children under 5 years of age in Babban-dodo, Zaria, Northwestern Nigeria. Methodology: A cross-sectional descriptive study of 300 children aged less than 5 years and their mothers/caregivers was conducted, using a multistage sampling technique. The study involved collecting information on the sociodemographic characteristics of the respondents and the anthropometric measurements (weight, height, mid-upper arm circumference) of the eligible children. The data were analyzed using statistical software SPSS 19.0 and Epi-Info version 6.0. Result: Out of the 300 children studied, 87 (29%) were found to have under weight, 21 (7%) were wasted, and 93 (31%) were stunted. The majority (65%) of the mothers/caregivers have no form of formal education. There was a significant statistical association between maternal literacy status and occurrence of malnutrition (specifically stunting) among the children studied. (X 2 = 26.2, df = 1, P < 0.05). Conclusion: Maternal literacy has a significant relationship with the nutritional status of children. Therefore, there is the need to promote and encourage female/girl child education in the communities in order to empower them to know the right type of food and the right way to give it in the right quantity. This will help to prevent the occurrence of malnutrition among children, especially those under the age of 5 years.

The Lancet Infectious Diseases, 2019

Background Despite large reductions in under-5 lower respiratory infection (LRI) mortality in man... more Background Despite large reductions in under-5 lower respiratory infection (LRI) mortality in many locations, the pace of progress for LRIs has generally lagged behind that of other childhood infectious diseases. To better inform programmes and policies focused on preventing and treating LRIs, we assessed the contributions and patterns of risk factor attribution, intervention coverage, and sociodemographic development in 195 countries and territories by drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) LRI estimates. Methods We used four strategies to model LRI burden: the mortality due to LRIs was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive ensemble modelling tool; the incidence of LRIs was modelled using population representative surveys, health-care utilisation data, and scientific literature in a compartmental meta-regression tool; the attribution of risk factors for LRI...

Infection Control & Hospital Epidemiology

Background: Adverse events following immunization (AEFI) surveillance largely depends on the abil... more Background: Adverse events following immunization (AEFI) surveillance largely depends on the ability of the healthcare worker (HCW) to timely detect and report cases using the correct reporting tools through an appropriate system. AEFI surveillance is carried out regularly during both routine immunization services and supplemental immunization activities in the state. Objective: We assessed knowledge of adverse events following immunization reporting tools and system among primary HCWs in Jigawa state, northwestern Nigeria. Method: A descriptive cross-sectional design was used for this study. A multistage sampling technique was used to select 290 HCWs that had spent at least 6 months in immunization units of primary healthcare centers of Jigawa state. Data were collected using pretested self-administered structured questionnaire with open and closed ended questions and were analyzed using IBM SPSS version 20 software. All statistical tests were 2-tailed with P < .05 as the statis...

PloS one, 2018

HIV and AIDS care requires frequent visits to the hospital. Patient satisfaction with care servic... more HIV and AIDS care requires frequent visits to the hospital. Patient satisfaction with care services during hospital visits is important in considering quality and outcome of care. Increasing number of patients needing treatment led to the decentralization of care to lower level hospitals without documented patient perception on the quality of services. The study determined and compared patient satisfaction with HIV and AIDS care services in public and private hospitals and identified the factors that influence it. This was a cross-sectional comparative study of patients receiving antiretroviral treatment in public and private hospitals in Anambra State. The sampling frame for the hospitals consisted of all registered public and private hospitals that have rendered antiretroviral services for at least one year. There were three public urban, nine public rural, eleven private urban and ten private rural hospitals that met the criteria. One hospital was selected by simple random sampli...

Lancet (London, England), Jun 2, 2018

A key component of achieving universal health coverage is ensuring that all populations have acce... more A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers ...

The Lancet

Monitoring levels and trends in premature mortality is crucial to understanding how societies can... more Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends. We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016. The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72·3% (95% uncertainty interval [UI] 71·2-73·2) of deaths in 2016 with 19·3% (18·5-20·4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8·43% (8·00-8·67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006-16-age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1·80 million deaths (95% UI 1·59 million to 1·89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176-181) increase in deaths in ages 90-94 years and a 210% (208-212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2·89%); the median annualised rate of change for all other causes was lower (a decrease of 1·59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs…

The Lancet Infectious Diseases

Annals of Tropical Pathology, 2020

Background: Brucellosis is a neglected underdiagnosed zoonotic disease of worldwide distribution ... more Background: Brucellosis is a neglected underdiagnosed zoonotic disease of worldwide distribution with varying symptoms similar to those occurring in other febrile illnesses. A recent screening survey conducted among butchers in Bauchi state reported a high prevalence of human brucellosis; however, its burden among patients with other febrile illnesses is unknown. We determine the seroprevalence and factors associated with risk of brucellosis among febrile patients attending health-care facilities (HCFs) in Bauchi metropolis, North-Eastern Nigeria. Methodology: We conducted a hospital-based descriptive cross-sectional study of 382 participants using a multistage sampling technique. Brucella antibodies were detected using Rose Bengal plate test, and a questionnaire was used to identify risk factors associated with human brucellosis. Data analyses were conducted using Epi Info version 7.0. Bivariate and multivariate analyses were conducted at P = 0.05. Results: Fifty-seven (14.9%) of t...

Annals of Nigerian Medicine, 2012

INtRoduCtIoN G lobally, deaths and injuries from road crashes are a major and growing public heal... more INtRoduCtIoN G lobally, deaths and injuries from road crashes are a major and growing public health problem. More than 20 million people are severely injured or killed on the world's road each year and the burden falls most heavily on low income countries. [1] This is due to the fact that pedestrians and motorcycles make up the largest proportion of the road traffic and are less protected from accidents per kilometres travelled, and therefore, are at a far greater risk than the drivers and passengers of cars and motor vehicles. [2] A B S T R A C T Background: Globally, deaths and injuries from road crashes are a major and growing public health problem. More than 20 million people are severely injured or killed on the world's road each year and the burden falls most heavily on low income countries. Commercial motorcycling is gaining acceptance by all, as the transport system possesses several features which are adapted to the contemporary Nigerian society. However, many of the commercial motorcycle riders lack proper knowledge on road safety measures as such together with the passengers they carry are exposed to all the hazards of motorcycling including accidents. Aim: To assess the knowledge, attitude and compliance with safety protective devices among commercial motorcyclists in Tudun-Wada Zaria local Government area of Kaduna state Northwestern Nigeria. Materials and Methods: A cross-sectional descriptive study was carried out among 250 commercial motorcyclists who were randomly selected using multistage sampling technique in Tudun-Wada ward of Zaria local Government Area of Kaduna state. A pre-tested structured interviewer-administered questionnaire was used as the tool for data collection. Data was analyzed using SPSS version 19.0 and Epi-info 6.0. Results: All the 250 respondents were males; with majority (72.4%) of them within the age range 20-29 years. Thirty percent of the respondents had no formal education and 28.8% of them are not registered with appropriate authorities. Majority of the respondents (75.6%) did not receive any formal training before commencement of the business. Also, 89.2% have poor knowledge on safety protective devices, while 95.2% have a poor attitude. In terms of compliance with safety protective devices, 86.4% of the respondents have poor compliance. None of the respondents had helmet worn during the survey period. Seventy six percent (76.4%) of the respondents have been involved in accident and 68.6% of which occurred 6 months preceding the study with lower limb most affected (accounting for 44.5%). Conclusion: Commercial motorcycling is essentially done by males who have not received any formal training for the job; hence, they lack adequate basic knowledge on safety protective devices and as such their attitude and compliance with safety protective device is poor. The predominant type of injury they sustained was that of the lower limb, and a significant proportion of them sustained multiple injuries. There is a statistically significant relationship between the educational status of the respondents and their attitude towards use of safety protective devices. Therefore, ensuring formal training, vigorous enlightenment campaigns and enforcement on the use of safety protective devices by the relevant key authorities is necessary in order to reduce the high prevalence of accidents and injuries among commercial motorcycle riders.

The Lancet Infectious Diseases, 2019

Background Many countries have shown marked declines in diarrhoeal disease mortality among childr... more Background Many countries have shown marked declines in diarrhoeal disease mortality among children younger than 5 years. With this analysis, we provide updated results on diarrhoeal disease mortality among children younger than 5 years from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) and use the study's comparative risk assessment to quantify trends and effects of risk factors, interventions, and broader sociodemographic development on mortality changes in 195 countries and territories from 1990 to 2017. Methods This analysis for GBD 2017 had three main components. Diarrhoea mortality was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive, Bayesian, ensemble modelling tool; and the attribution of risk factors and interventions for diarrhoea were modelled in a counterfactual framework that combines modelled population-level prevalence of the exposure to each risk or intervention with the relative risk of diarrhoea given exposure to that factor. We assessed the relative and absolute change in diarrhoea mortality rate between 1990 and 2017, and used the change in risk factor exposure and sociodemographic status to explain differences in the trends of diarrhoea mortality among children younger than 5 years. Findings Diarrhoea was responsible for an estimated 533 768 deaths (95% uncertainty interval 477 162-593 145) among children younger than 5 years globally in 2017, a rate of 78•4 deaths (70•1-87•1) per 100 000 children. The diarrhoea mortality rate ranged between countries by over 685 deaths per 100 000 children. Diarrhoea mortality per 100 000 globally decreased by 69•6% (63•1-74•6) between 1990 and 2017. Among the risk factors considered in this study, those responsible for the largest declines in the diarrhoea mortality rate were reduction in exposure to unsafe sanitation (13•3% decrease, 11•2-15•5), childhood wasting (9•9% decrease, 9•6-10•2), and low use of oral rehydration solution (6•9% decrease, 4•8-8•4). Interpretation Diarrhoea mortality has declined substantially since 1990, although there are variations by country. Improvements in sociodemographic indicators might explain some of these trends, but changes in exposure to risk factors-particularly unsafe sanitation, childhood growth failure, and low use of oral rehydration solution-appear to be related to the relative and absolute rates of decline in diarrhoea mortality. Although the most effective interventions might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting against diarrhoea that have already reduced diarrhoea mortality could further avert many thousands of deaths due to this illness. Funding Bill & Melinda Gates Foundation.

International Journal of Public Health, 2017

Objectives We used data from the Global Burden of Disease 2015 study (GBD) to calculate the burde... more Objectives We used data from the Global Burden of Disease 2015 study (GBD) to calculate the burden of lower respiratory infections (LRIs) in the 22 countries of the Eastern Mediterranean Region (EMR) from 1990 to 2015. Methods We conducted a systematic analysis of mortality and morbidity data for LRI and its specific etiologic factors, including pneumococcus, Haemophilus influenzae type b, Respiratory syncytial virus, and influenza virus. We used modeling methods to estimate incidence, deaths, and disability-adjusted life-years (DALYs). We calculated burden attributable to known risk factors for LRI. Results In 2015, LRIs were the fourth-leading cause of DALYs, causing 11,098,243 (95% UI 9,857,095-12,396,566) DALYs and 191,114 (95% UI 170,934-210,705) deaths. The LRI DALY rates were higher than global estimates in 2015. The highest and lowest age-standardized rates of DALYs were observed in Somalia and Lebanon, respectively. Undernutrition in childhood and ambient particulate matter air pollution in the elderly were the main risk factors. Conclusions Our findings call for public health strategies to reduce the level of risk factors in each age group, especially vulnerable child and elderly populations.

International Journal of Public Health, 2017

Objectives To estimate incidence, mortality, and disability-adjusted life years (DALYs) caused by... more Objectives To estimate incidence, mortality, and disability-adjusted life years (DALYs) caused by cancer in the Eastern Mediterranean Region (EMR) between 2005 and 2015. Methods Vital registration system and cancer registry data from the EMR region were analyzed for 29 cancer groups in 22 EMR countries using the Global Burden of Disease Study 2015 methodology. Results In 2015, cancer was responsible for 9.4% of all deaths and 5.1% of all DALYs. It accounted for 722,646 new cases, 379,093 deaths, and 11.7 million DALYs. Between 2005 and 2015, incident cases increased by 46%, deaths by 33%, and DALYs by 31%. The increase in cancer incidence was largely driven by population growth and population aging. Breast cancer, lung cancer, and leukemia were the most common cancers, while lung, breast, and stomach cancers caused most cancer deaths. Conclusions Cancer is responsible for a substantial disease burden in the EMR, which is increasing. There is an urgent need to expand cancer prevention, screening, and awareness programs in EMR countries as well as to improve diagnosis, treatment, and palliative care services.

Lancet (London, England), Jan 7, 2015

Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and year... more Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally...

Importance - Cancer is the second leading cause of death worldwide. Current estimates on the burd... more Importance - Cancer is the second leading cause of death worldwide. Current estimates on the burden of cancer are needed for cancer control planning. Objective - To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 32 cancers in 195 countries and territories from 1990 to 2015. Evidence Review - Cancer mortality was estimated using vital registration system data, cancer registry incidence data (transformed to mortality estimates using separately estimated mortality to incidence [MI] ratios), and verbal autopsy data. Cancer incidence was calculated by dividing mortality estimates through the modeled MI ratios. To calculate cancer prevalence, MI ratios were used to model survival. To calculate YLDs, prevalence estimates were multiplied by disability weights. The YLLs were estimated by multiplying age-specific cancer deaths by the reference life expectancy. DALYs were estimated as the sum of YLDs ...

Archives of Medicine and Surgery, 2016

Context: The birth of a baby is a major reason for celebration worldwide. Yet, in most countries ... more Context: The birth of a baby is a major reason for celebration worldwide. Yet, in most countries of the world, pregnancy and childbirth is a perilous journey. In Kaduna State, Northwestern Nigeria, the estimated maternal mortality ratio figure is 1025/100,000 live births. Despite the higher rates of maternal deaths, there is no empirical evidence on women's knowledge, perception, and attitudes toward pregnancy danger signs in Kaduna State. Aims: To determine the knowledge, attitude, and perception of pregnancy danger signs among women of childbearing age (15–49 years) in Samaru community Sabon-Gari Local Government Area in Kaduna State. Settings and Design: A community-based descriptive, cross-sectional study was conducted among 185 women of reproductive age group. Subjects and Methods: Participants were randomly selected using a multistage sampling technique. Pretested structured interviewer administered questionnaire was used for data collection. The completed questionnaires w...

Background: Cooking gas refill attendants play important role in the use of gas in Zaria. The aim... more Background: Cooking gas refill attendants play important role in the use of gas in Zaria. The aim of this study was to assess the knowledge, attitude and safety measure practices among cooking gas refill attendants in Zaria metropolis, Kaduna State, Nigeria. A cross sectional study was conducted in January, 2019 among cooking gas refill attendants using structured intervieweradministered questionnaire and checklist. It was a wholepopulation study of 121 participants. The data was collected using Open Data Kit (ODK) software version 1.21.1 installed in an android device and analyzed using SPSS version 25.0. The results were summarized and presented in tables and charts; p value was set at < 0.05 for statistical significance. Majority (79.6%) of the respondents were within the productive age group of 25 to 44 years with median age 36 years, married (57.9%) and more than half (52.1%) of the respondents had secondary education and all respondents were males. The overall scores for kn...

The Lancet

Background Alcohol use is a leading risk factor for death and disability, but its overall associa... more Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted lifeyears (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2•2% (95% uncertainty interval [UI] 1•5-3•0) of age-standardised female deaths and 6•8% (5•8-8•0) of agestandardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3•8% (95% UI 3•2-4•3) of female deaths and 12•2% (10•8-13•6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2•3% (95% UI 2•0-2•6) and male attributable DALYs were 8•9% (7•8-9•9). The three leading causes of attributable deaths in this age group were tuberculosis (1•4% [95% UI 1•0-1•7] of total deaths), road injuries (1•2% [0•7-1•9]), and self-harm (1•1% [0•6-1•5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27•1% (95% UI 21•2-33•3) of total alcohol-attributable female deaths and 18•9% (15•3-22•6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0•0-0•8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption. Funding Bill & Melinda Gates Foundation.

international journal of public health, 2017

Objectives We used data from the Global Burden of Disease 2015 study (GBD) to calculate the burde... more Objectives We used data from the Global Burden of Disease 2015 study (GBD) to calculate the burden of lower respiratory infections (LRIs) in the 22 countries of the Eastern Mediterranean Region (EMR) from 1990 to 2015. Methods We conducted a systematic analysis of mortality and morbidity data for LRI and its specific etiologic factors, including pneumococcus, Haemophilus influenzae type b, Respiratory syncytial virus, and influenza virus. We used modeling methods to estimate incidence, deaths, and disability-adjusted life-years (DALYs). We calculated burden attributable to known risk factors for LRI. Results In 2015, LRIs were the fourth-leading cause of DALYs, causing 11,098,243 (95% UI 9,857,095–12,396,566) DALYs and 191,114 (95% UI 170,934–210,705) deaths. The LRI DALY rates were higher than global estimates in 2015. The highest and lowest age-standardized rates of DALYs were observed in Somalia and Lebanon, respectively. Undernutrition in childhood and ambient particulate matter...

international journal of public health, 2017

Objectives To estimate incidence, mortality, and disability- adjusted life years (DALYs) caused b... more Objectives To estimate incidence, mortality, and disability- adjusted life years (DALYs) caused by cancer in the Eastern Mediterranean Region (EMR) between 2005 and 2015. Methods Vital registration system and cancer registry data from the EMR region were analyzed for 29 cancer groups in 22 EMR countries using the Global Burden of Disease Study 2015 methodology. Results In 2015, cancer was responsible for 9.4% of all deaths and 5.1% of all DALYs. It accounted for 722,646 new cases, 379,093 deaths, and 11.7 million DALYs. Between 2005 and 2015, incident cases increased by 46%, deaths by 33%, and DALYs by 31%. The increase in cancer incidence was largely driven by population growth and population aging. Breast cancer, lung cancer, and leukemia were the most common cancers, while lung, breast, and stomach cancers caused most cancer deaths. Conclusions Cancer is responsible for a substantial disease burden in the EMR, which is increasing. There is an urgent need to expand cancer preventi...

Annals of Nigerian Medicine, 2012

Background: Worldwide, about a half of mortalities in children are directly or indirectly attribu... more Background: Worldwide, about a half of mortalities in children are directly or indirectly attributable to malnutrition. In Nigeria, malnutrition has also been reported to be associated with increased morbidity and mortality, such that 30-40% of deaths in the preschool age group are associated with malnutrition. Therefore, assessing the factors attributing to malnutrition is central to reducing and preventing these high mortalities. One attributable factor to malnutrition is the level of maternal literacy. Objective: The study aimed to assess the effect of maternal literacy on the nutritional status of children under 5 years of age in Babban-dodo, Zaria, Northwestern Nigeria. Methodology: A cross-sectional descriptive study of 300 children aged less than 5 years and their mothers/caregivers was conducted, using a multistage sampling technique. The study involved collecting information on the sociodemographic characteristics of the respondents and the anthropometric measurements (weight, height, mid-upper arm circumference) of the eligible children. The data were analyzed using statistical software SPSS 19.0 and Epi-Info version 6.0. Result: Out of the 300 children studied, 87 (29%) were found to have under weight, 21 (7%) were wasted, and 93 (31%) were stunted. The majority (65%) of the mothers/caregivers have no form of formal education. There was a significant statistical association between maternal literacy status and occurrence of malnutrition (specifically stunting) among the children studied. (X 2 = 26.2, df = 1, P < 0.05). Conclusion: Maternal literacy has a significant relationship with the nutritional status of children. Therefore, there is the need to promote and encourage female/girl child education in the communities in order to empower them to know the right type of food and the right way to give it in the right quantity. This will help to prevent the occurrence of malnutrition among children, especially those under the age of 5 years.

The Lancet Infectious Diseases, 2019

Background Despite large reductions in under-5 lower respiratory infection (LRI) mortality in man... more Background Despite large reductions in under-5 lower respiratory infection (LRI) mortality in many locations, the pace of progress for LRIs has generally lagged behind that of other childhood infectious diseases. To better inform programmes and policies focused on preventing and treating LRIs, we assessed the contributions and patterns of risk factor attribution, intervention coverage, and sociodemographic development in 195 countries and territories by drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) LRI estimates. Methods We used four strategies to model LRI burden: the mortality due to LRIs was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive ensemble modelling tool; the incidence of LRIs was modelled using population representative surveys, health-care utilisation data, and scientific literature in a compartmental meta-regression tool; the attribution of risk factors for LRI...

Infection Control & Hospital Epidemiology

Background: Adverse events following immunization (AEFI) surveillance largely depends on the abil... more Background: Adverse events following immunization (AEFI) surveillance largely depends on the ability of the healthcare worker (HCW) to timely detect and report cases using the correct reporting tools through an appropriate system. AEFI surveillance is carried out regularly during both routine immunization services and supplemental immunization activities in the state. Objective: We assessed knowledge of adverse events following immunization reporting tools and system among primary HCWs in Jigawa state, northwestern Nigeria. Method: A descriptive cross-sectional design was used for this study. A multistage sampling technique was used to select 290 HCWs that had spent at least 6 months in immunization units of primary healthcare centers of Jigawa state. Data were collected using pretested self-administered structured questionnaire with open and closed ended questions and were analyzed using IBM SPSS version 20 software. All statistical tests were 2-tailed with P < .05 as the statis...

PloS one, 2018

HIV and AIDS care requires frequent visits to the hospital. Patient satisfaction with care servic... more HIV and AIDS care requires frequent visits to the hospital. Patient satisfaction with care services during hospital visits is important in considering quality and outcome of care. Increasing number of patients needing treatment led to the decentralization of care to lower level hospitals without documented patient perception on the quality of services. The study determined and compared patient satisfaction with HIV and AIDS care services in public and private hospitals and identified the factors that influence it. This was a cross-sectional comparative study of patients receiving antiretroviral treatment in public and private hospitals in Anambra State. The sampling frame for the hospitals consisted of all registered public and private hospitals that have rendered antiretroviral services for at least one year. There were three public urban, nine public rural, eleven private urban and ten private rural hospitals that met the criteria. One hospital was selected by simple random sampli...

Lancet (London, England), Jun 2, 2018

A key component of achieving universal health coverage is ensuring that all populations have acce... more A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers ...

The Lancet

Monitoring levels and trends in premature mortality is crucial to understanding how societies can... more Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends. We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016. The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72·3% (95% uncertainty interval [UI] 71·2-73·2) of deaths in 2016 with 19·3% (18·5-20·4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8·43% (8·00-8·67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006-16-age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1·80 million deaths (95% UI 1·59 million to 1·89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176-181) increase in deaths in ages 90-94 years and a 210% (208-212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2·89%); the median annualised rate of change for all other causes was lower (a decrease of 1·59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs…

The Lancet Infectious Diseases