Khalid Altirkawi | University of Sharjah (original) (raw)

Papers by Khalid Altirkawi

Frontiers in Pediatrics, 2021

Lancet, 2024

Background Estimates of demographic metrics are crucial to assess levels and trends of population... more Background Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period.

lancet neurology, 2024

Background Disorders affecting the nervous system are diverse and include neurodevelopmental diso... more Background Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. Methods We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disabilityadjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. Findings Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378-521), affecting 3•40 billion (3•20-3•62) individuals (43•1%, 40•5-45•9 of the global population); global DALY counts attributed to these conditions increased by 18•2% (8•7-26•7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33•6% (27•6-38•8), and age-standardised rates of DALYs attributed to these conditions decreased by 27•0% (21•5-32•4). Age-standardised prevalence was almost stable, with a change of 1•5% (0•7-2•4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. Interpretation As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed. Funding Bill & Melinda Gates Foundation.

The Lancet, 2020

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based... more The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3•5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.

lancet Hematology, 2023

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.

The Lancet. Global health, Oct 24, 2016

The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Eg... more The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. Since our Global Burden of Disease Study 2010 (GBD 2010), the region has faced unrest as a result of revolutions, wars, and the so-called Arab uprisings. The objective of this study was to present the burden of diseases, injuries, and risk factors in the eastern Mediterranean region as of 2013. GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Our GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods. In this systemati...

frontiers in pediatrics, 2022

Background: Data on SARS-CoV-2 in infants ≤90 days are limited with conflicting reports regarding... more Background: Data on SARS-CoV-2 in infants ≤90 days are limited with conflicting reports regarding its presentation and outcomes. Methods: We conducted an ambispective cohort study using prospectively collected Health Electronic Surveillance Network Database by the Ministry of Health, Saudi Arabia. Infants of ≤90 days of age who had a positive RT-PCR test for SARS-CoV-2 virus were included. Patients were divided in Early neonatal (0-6 days), late neonatal (7-27 days), and post-neonatal (28-90 days) groups and were compared for clinical characteristics and outcomes by contacting parents and collecting information retrospectively. Results: Of 1,793 infants, 898 infants were included for analysis. Most infants in the early neonatal group had no features of infection (tested based on maternal positivity), whereas most infants in the late and post-neonatal groups were tested because of clinical features of infection. Fever and respiratory signs were the most common presenting feature in the late and post-neonatal groups. Hospitalization was higher in the early neonatal group (80%), compared to the two other groups. The overall mortality in the cohort was 1.6%. Conclusion: SARS-CoV-2 infection in infants ≤90 days might not be as rare as previously reported. The clinical presentation varies based on age at positive RT-PCR result.

Sudanese journal of paediatrics, 2014

The increased attention that "medical professionalism" has received lately exposes the ... more The increased attention that "medical professionalism" has received lately exposes the deficit in our educational system and indicates the need for more work to be done to ensure an effective teaching and assessment of this competency. The concerted efforts made by many reputable organizations are great steps in the right direction. Nonetheless, many medical schools are still lagging behind. Literature has been clear about the importance of formal teaching in establishing professional behaviors in the medical school graduates; failing in this regard is certain to have unfavorable outcomes. Furthermore, current literature suggests many teaching strategies and assessment tools that can help in achieving this goal. However, many inadequacies are still there. Teaching professionalism requires, in addition to an explicit core curriculum that spans the continuum of medical education, special efforts in terms of imparting the non cognitive skills as well. Respectable role-models ...

The efficacy of surfactant preparations used in the prevention and treatment of respiratory distr... more The efficacy of surfactant preparations used in the prevention and treatment of respiratory distress syndrome (RDS) is a well known fact; however, many controversies remain. The debate over which surfactant to be used, when and what is the best mode of delivery is still raging. Currently, animal-derived surfactants are preferred and clearly recommended by various practice guidelines, but new synthetic surfactants containing peptides that mimic the action of surfactant proteins are emerging and they seem to have a comparable efficacy profile to the natural surfactants. It is hoped that with further improvements, they will outperform their natural counterparts in terms of reliability and cost-effectiveness. Early surfactant administration was shown to further reduce the risk of RDS and its complications. However, as nasal continuous positive airway pressure (nCPAP) is becoming increasingly the preferred first-line therapy for RDS, the less invasive approaches of respiratory support al...

The Lancet

Background Efforts to establish the 2015 baseline and monitor early implementation of the UN Sust... more Background Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of "leaving no one behind", it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment. Methods We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the healthrelated SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2•5th percentile and 100 as the 97•5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings The global median health-related SDG index in 2017 was 59•4 (IQR 35•4-67•3), ranging from a low of 11•6 (95% uncertainty interval 9•6-14•0) to a high of 84•9 (83•1-86•7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030.

Sudanese journal of paediatrics, 2014

Trisomy 18 is a relatively common autosomal trisomy syndrome. It is due to either full or partial... more Trisomy 18 is a relatively common autosomal trisomy syndrome. It is due to either full or partial presence of an extra copy of chromosome 18. Its prevalence correlates positively with advanced maternal age. Affected infants usually exhibit a variable pattern of anomalies including growth restriction, marked psychomotor and cognitive disability and an array of physical findings including characteristic craniofacial features, clenched fists with overriding fingers, small fingernails, underdeveloped thumbs, short sternum and heart and kidney anomalies. The majority of these infants die within the first year of life; only 5% to 10% of them survive longer. Their death is primarily due to cardio-respiratory failure. In this case report of trisomy 18 we tried to highlight the importance of antenatal diagnosis and to emphasize the need for proper counseling at different points of time starting from the moment the condition is suspected until the point when diagnosis is confirmed and thereaf...

Lancet , 2021

Background Documentation of patterns and long-term trends in mortality in young people, which ref... more Background Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10-24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10-24 years by age group (10-14 years, 15-19 years, and 20-24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10-24 years with that in children aged 0-9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10-24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). Findings In 2019 there were 1•49 million deaths (95% uncertainty interval 1•39-1•59) worldwide in people aged 10-24 years, of which 61% occurred in males. 32•7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32•1% were due to communicable, nutritional, or maternal causes; 27•0% were due to non-communicable diseases; and 8•2% were due to self-harm. Since 1950, deaths in this age group decreased by 30•0% in females and 15•3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10-14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15-19 years was 1•3% in males and 1•6% in females, almost half that of males aged 1-4 years (2•4%), and around a third less than in females aged 1-4 years (2•5%). The proportion of global deaths in people aged 0-24 years that occurred in people aged 10-24 years more than doubled between 1950 and 2019, from 9•5% to 21•6%. Interpretation Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10-24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group. Funding Bill & Melinda Gates Foundation.

frontiers in pediatrics, 2021

The objective of this study is to describe the clinical presentations, radiological and laborator... more The objective of this study is to describe the clinical presentations, radiological and laboratory findings, and outcomes of COVID-19 disease in infants ≤90 days of age at presentation. We conducted a retrospective study of infants in this age group who were found to be SARS-CoV-2 positive. Asymptomatic infants who were identified through routine testing following delivery to COVID-19-positive mothers were excluded. We classified infants according to their presentation: asymptomatic, mildly symptomatic, moderately symptomatic, and severely/critically symptomatic. A total of 36 infants were included. Of them, two were asymptomatic and four had severe/critical presentation. Of the severely symptomatic infants, two were considered as multisystem inflammatory syndrome in children (MIS-C) and there was one death. One infant in the severe symptomatic group presented with cardiac failure, with the possibility of congenital infection. Another infant presented with cardiogenic shock. None of these infants received antiviral medication. The study found that infants ≤90 days can present with a severe form of COVID-19 disease. Multisystem inflammatory syndrome in children, although rarely reported in infants, is a possible complication of COVID-19 disease and can be associated with significant morbidity and mortality.

Frontiers in Pediatrics, 2021

Background: Vertical transmission of SARS-CoV-2 is under investigation. A few reports suggest the... more Background: Vertical transmission of SARS-CoV-2 is under investigation. A few reports suggest the possibility of SARS-CoV-2 transmission from mothers to their neonates. Most neonates have mild symptoms, but some develop multi-system involvement and shock.
Case Presentation: We report two cases of possible SARS-CoV-2 vertical transmission from mothers to their neonates. The first case shows maternal infection with SARS-CoV-2 in the second trimester followed by recurrent infection in the third trimester right before the delivery. The infant demonstrated respiratory distress soon after delivery along with myocardial dysfunction and multi-organ system involvement. The second case shows maternal infection with SARS-COV-2 at the time of delivery with preterm labor secondary to placental abruption, with that delivery resulting in the preterm neonate requiring non-invasive ventilation with multi-system involvement in the context of persistently positive SARS-COV-2 PCR in the neonate. Both neonates were treated with IVIG along with steroids. Both neonates recovered fully and were discharged and allowed to go home.
Conclusion: In neonates, COVID-19 usually presents as an asymptomatic or mild illness; some may develop a more severe course. Our two cases, however, demonstrate that multi-system involvement, although rare, is possible. This report also supports the current evidence of possible vertical transmission from mothers to their neonates. This multi-system involvement might be underreported and should be considered in neonates with respiratory distress when born to mothers suffering of COVID-19.

Dubai Medical Journal, 2021

Abstract Objectives: To assess the status of care provided in the neonatal intensive care unit at... more Abstract
Objectives: To assess the status of care provided in the neonatal intensive care unit at our institution and to track the changes in rates of mortality and major morbidities of very low birth weight infants, delivered over two periods.
Materials and Methods: We analyzed retrospectively the records of preterm infants, with birth weights <1,500 g and gestational age <33 weeks. Infants studied were born over two periods; the first extends from January 1999 to December 2007 and the second from January 2011 to December 2018. We compared the rates of survival to discharge and major morbidities of the infants in these two periods and, as a corollary, to the rates published in 2007 by the National Institute of Child Health and Human Development (NICHD) neonatal research network.
Results: Five hundred and twelve infants were included in the second period of this study. The survival-to-discharge rate was 84%, and it varied among infants based on their gestational ages. Generally, morbidities reported in the second period were less than their counterparts in the first one and comparable to NICHD ones. The most common morbidities were respiratory distress syndrome, 88.5%; retinopathy of prematurity, 28.3%; patent ductus arteriosus (PDA), 27.9%; and sepsis/meningitis, 25.6%. Conclusion: Most of the assessed morbidity rates have decreased over time, except for periventricular leukomalacia which increased. The survival-to-discharge rates have not improved as expected; this trend seems concerning and warrants further investigation.

journal of nature and science of medicine, 2020

Objectives: A proper neurobehavioral development is important for acquiring the skills of a healt... more Objectives: A proper neurobehavioral development is important for acquiring the skills of a healthy and productive life. Determining
intraventricular hemorrhage (IVH) impact on different aspects of development may help in mitigation, and probably, prevention of the
developmental delays. Materials and Methods: We evaluated the developmental quotients (DQ) of very low birth weight (VLBW) infants, who
experienced IVH during neonatal period, at 24–36 months of their corrected age, using Gesell schedules of child development. Furthermore,
we assessed the relationship between the severity, extent and sidedness of IVH, and total DQ, its subdomains, and common neurological and
non‑neurological comorbidities. Results: The study included 54 patients (36 males and 18 females). Bilateral IVH was more common in
females, who exhibited also a trend toward left‑sided IVH. Patient’s sex, birth‑weight, and gestational age, however, have not shown significant
associations with the total DQ, or its subdomains. Severe IVH was significantly associated with both cerebral palsy, and reduction in total DQ,
but not in its personal‑social subdomain. Left‑sided IVH was associated with a significant reduction in total DQ, but right‑sidedness showed
no such association. Periventricular leukomalacia was significantly associated with reduction in total DQ and in its personal‑social subdomain.
No significant associations were detected in patients with the non‑neurological comorbidities. Conclusions: VLBW infants with left‑sided,
bilateral or severe IVH are at higher risk of worse neurobehavioral outcomes at 24–36 months of age. Non‑neurological comorbidities seem
to have little impact on the DQ and its subdomains assessed at this age.

Exclusive breastfeeding for the nutrition of healthy term infants is currently considered as the ... more Exclusive breastfeeding for the nutrition of healthy term infants is currently considered as the gold standard. Indeed, the widely held prejudice
against human milk is something of the past. However, the universal acceptance of this fact on mothers’ part is still to be achieved. Meanwhile,
the widespread of baby‑friendly hospital initiative movement makes it increasingly harder to question the safety or efficacy of this practice,
even in the face of some concerning reports of unwanted outcomes. Apparently, there is a need for better compliance with safe sleep instructions
while actively promoting breastfeeding practices. In some specific situations, breastfeeding becomes impractical, extremely difficult, or even
contraindicated. Using a suitable formula in these circumstances becomes a must. Given all of this, a greater emphasis should be placed on
efforts to improve the quality of currently available formulas and/or creating new ones that better meet the nutritional needs of all infants.

The Lancet

Background Population estimates underpin demographic and epidemiological research and are used to... more Background Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10-54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10-14 years and 50-54 years was estimated from data on fertility in women aged 15-19 years and 45-49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings From 1950 to 2017, TFRs decreased by 49•4% (95% uncertainty interval [UI] 46•4-52•0). The TFR decreased from 4•7 livebirths (4•5-4•9) to 2•4 livebirths (2•2-2•5), and the ASFR of mothers aged 10-19 years decreased from 37 livebirths (34-40) to 22 livebirths (19-24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83•8 million people per year since 1985. The global population increased by 197•2% (193•3-200•8) since 1950, from 2•6 billion (2•5-2•6) to 7•6 billion (7•4-7•9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2•0%; this rate then remained nearly constant until 1970 and then decreased to 1•1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2•5% in 1963 to 0•7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2•7%. The global average age increased from 26•6 years in 1950 to 32•1 years in 2017, and the proportion of the population that is of working age (age 15-64 years) increased from 59•9% to 65•3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1•0 livebirths (95% UI 0•9-1•2) in Cyprus to a high of 7•1 livebirths (6•8-7•4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0•08 livebirths (0•07-0•09) in South Korea to 2•4 livebirths (2•2-2•6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0•3 livebirths (0•3-0•4) in Puerto Rico to a high of 3•1 livebirths (3•0-3•2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2•0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger.

the lancet , 2021

Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortal... more Background
Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 live births, and reduction of death of children younger than 5 years to less than 25 per 1000 live births, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 live births computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71•2 deaths per 1000 live births (95% uncertainty interval [UI] 68•3-74•0) in 2000 to 37•1 (33•2-41•7) in 2019 while global NMR correspondingly declined more slowly from 28•0 deaths per 1000 live births (26•8-29•5) in 2000 to 17•9 (16•3-19•8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9•65 million (95% UI 9•05-10•30) in 2000 and 5•05 million (4•27-6•02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3•76 million [95% UI 3•53-4•02]) in 2000 to 48% (2•42 million; 2•06-2•86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0•80 (95% UI 0•71-0•86) deaths per 1000 live births and U5MR to 1•44 (95% UI 1•27-1•58) deaths per 1000 live births, and in 2019, there were as many as 1•87 million (95% UI 1•35-2•58; 37% [95% UI 32-43]) of 5•05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Funding Bill & Melinda Gates Foundation.

Injury Prevention, 2020

BackgroundWhile there is a long history of measuring death and disability from injuries, modern r... more BackgroundWhile there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.MethodsIn this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.ResultsGBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in te...

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