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- ItemAnemia Prevalence in Women of Reproductive Age in Low- and Middle-Income Countries Between 2000 and 2018(Springer Nature, 2021) Kinyoki, D; Osgood-Zimmerman, AE; Bhattacharjee, NV; Schaeffer, LE; Lazzar-Atwood, A; Lu, D; Ewald, SB; Donkers, KM; Letourneau, ID; Collison, M; Schipp, MF; Abajobir, A; Abbasi, S; Abbasi, N; Abbasifard, M; Abbasi-Kangevari, M; Abbastabar, H; Abd-Allah, F; Abdelalim, A; Abd-Elsalam, SM; Abdoli, A; Abdollahpour, I; Abedi, A; Abolhassani, H; Abraham, B; Abreu, LG; Abrigo, MRM; Abualhasan, A; Abu-Gharbieh, E; Abushouk, AI; Accrombessi, MMK; Adabi, M; Adebayo, OM; Adegbosin, AE; Adekanmbi, V; Adetokunboh, OO; Adeyinka, DA; Adham, D; Advani, SM; Agasthi, P; Aghaali, M; Ahmad, S; Ahmad, T; Ahmadi, K; Ahmadi, S; Ahmed, MB; Aichour, MTE; Aji, B; Akinyemi, OO; Aklilu, A; Akunna, CJ; Al-Aly, Z; Alanzi, TM; Alcalde-Rabanal, JE; Alemu, BW; Alemu, A; Alhassan, RK; Alif, SM; Alipour, V; Alizade, H; Aljunid, SM; Almasi-Hashiani, A; Al-Mekhlafi, HM; Al-Raddadi, RM; Alvis-Guzman, N; Amini, S; Amiri, F; Amugsi, DA; Anber, NH; Ancuceanu, R; Andrei, T; Anegago, MT; Anjomshoa, M; Ansari, F; Ansari-Moghaddam, A; Anteneh, ZA; Antriyandarti, E; Anvari, D; Anwer, R; Aqeel, M; Arabloo, J; Arab-Zozani, M; Aremu, O; Areri, HA; Artaman, A; Arzani, A; Asaad, M; Asadi-Aliabadi, M; Asadi-Pooya, AA; Asemahagn, MA; Asghari Jafarabadi, M; Ashebir, MM; Ataro, Z; Athari, SM; Athari, SS; Atout, MMW; Ausloos, M; Awoke, N; Ayala Quintanilla, BP; Ayano, GAnemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations.
- ItemGlobal Age-sex-specific Fertility, Mortality, Healthy Life Expectancy (HALE), and Population Estimates in 204 Countries and Territories, 1950–2019: A Comprehensive Demographic Analysis for the Global Burden of Disease Study 2019(Elsevier BV, 2020-10) Wang, H; Abbas, KM; Abbasifard, M; Abbasi-Kangevari, M; Abbastabar, H; Abd-Allah, F; Abdelalim, A; Abolhassani, H; Abreu, LG; Abrigo, MRM; Abushouk, AI; Adabi, M; Adair, T; Adebayo, OM; Adedeji, IA; Adekanmbi, V; Adeoye, AM; Adetokunboh, OO; Advani, SM; Afshin, A; Aghaali, M; Agrawal, A; Ahmadi, K; Ahmadieh, H; Ahmed, MB; Al-Aly, Z; Alam, K; Alam, T; Alanezi, FM; Alanzi, TM; Alcalde-Rabanal, JE; Ali, M; Alicandro, G; Alijanzadeh, M; Alinia, C; Alipour, V; Alizade, H; Aljunid, SM; Allebeck, P; Almadi, MAH; Almasi-Hashiani, A; Al-Mekhlafi, HM; Altirkawi, KA; Alumran, AK; Alvis-Guzman, N; Amini-Rarani, M; Aminorroaya, A; Amit, AML; Ancuceanu, R; Andrei, CL; Androudi, S; Angus, C; Anjomshoa, M; Ansari, F; Ansari, I; Ansari-Moghaddam, A; Antonio, CAT; Antony, CM; Anvari, D; Appiah, SCY; Arabloo, J; Arab-Zozani, M; Aravkin, AY; Aremu, O; Ärnlöv, J; Aryal, KK; Asadi-Pooya, AA; Asgari, S; Asghari Jafarabadi, M; Atteraya, MS; Ausloos, M; Avila-Burgos, L; Avokpaho, EFGA; Ayala Quintanilla, BP; Ayano, G; Ayanore, MA; Azarian, G; Babaee, E; Badiye, AD; Bagli, E; Bahrami, MA; Bakhtiari, A; Balassyano, S; Banach, M; Banik, PC; Barker-Collo, SL; Bärnighausen, TW; Barzegar, A; Basu, S; Baune, BT; Bayati, M; Bazmandegan, G; Bedi, N; Bell, ML; Bennett, DA; Bensenor, IM; Berhe, K; Berman, AE; Bertolacci, GJ; Bhageerathy, R; Bhala, N; Bhattacharyya, K; Bhutta, ZA; Bijani, A; Biondi, A; Bisanzio, D; Bisignano, C; Biswas, RK; Bjørge, T; Bohlouli, S; Bohluli, M; Bolla, SRR; Borzì, AM; Borzouei, S; Brady, OJ; Braithwaite, D; Brauer, M; Briko, AN; Briko, NI; Bumgarner, BR; Burugina Nagaraja, S; Butt, ZA; Caetano dos Santos, FL; Cai, T; Callender, CSKH; Cámera, LLAA; Campos-Nonato, IR; Cárdenas, R; Carreras, G; Carrero, JJ; Carvalho, F; Castaldelli-Maia, JM; Castelpietra, G; Castro, F; Catalá-López, F; Cederroth, CR; Cerin, E; Chattu, VK; Chin, KL; Chu, D-T; Ciobanu, LG; Cirillo, M; Comfort, H; Costa, VM; Cowden, RG; Cromwell, EA; Croneberger, AJ; Cunningham, M; Dahlawi, SMA; Damiani, G; D'Amico, E; Dandona, L; Dandona, R; Dargan, PI; Darwesh, AM; Daryani, A; Das Gupta, R; das Neves, J; Davletov, K; De Leo, D; Denova-Gutiérrez, E; Deribe, K; Dervenis, N; Desai, R; Dhungana, GP; Dias da Silva, D; Diaz, D; Dippenaar, IN; Djalalinia, S; Do, HT; Dokova, K; Doku, DT; Dorostkar, F; Doshi, CP; Doshmangir, L; Doyle, KE; Dubljanin, E; Duraes, AR; Edvardsson, D; Effiong, A; El Sayed, I; El Tantawi, M; Elbarazi, I; El-Jaafary, SI; Emamian, MH; Eskandarieh, S; Esmaeilzadeh, F; Estep, K; Farahmand, M; Faraj, A; Fareed, M; Faridnia, R; Faro, A; Farzadfar, F; Fattahi, N; Fazaeli, AA; Fazlzadeh, M; Feigin, VL; Fereshtehnejad, S-M; Fernandes, E; Ferreira, ML; Filip, I; Fischer, F; Flohr, C; Foigt, NA; Folayan, MO; Fomenkov, AA; Freitas, M; Fukumoto, T; Fuller, JE; Furtado, JM; Gad, MM; Gakidou, E; Gallus, S; Gebrehiwot, AM; Gebremedhin, KB; Gething, PW; Ghamari, F; Ghashghaee, A; Gholamian, A; Gilani, SA; Gitimoghaddam, M; Glushkova, EV; Gnedovskaya, EV; Gopalani, SV; Goulart, AC; Gugnani, HC; Guo, Y; Gupta, R; Gupta, SS; Haagsma, JA; Haj-Mirzaian, A; Haj-Mirzaian, A; Halvaei, I; Hamadeh, RR; Hamagharib Abdullah, K; Han, C; Handiso, DW; Hankey, GJ; Haririan, H; Haro, JM; Hasaballah, AI; Hassanipour, S; Hassankhani, H; Hay, SI; Heibati, B; Heidari-Soureshjani, R; Henny, K; Henry, NJ; Herteliu, C; Heydarpour, F; Hole, MK; Hoogar, P; Hosgood, HD; Hossain, N; Hosseinzadeh, M; Hostiuc, M; Hostiuc, S; Househ, M; Hoy, DG; Hu, G; Huda, TM; Ibitoye, SE; Ikuta, KS; Ilesanmi, OS; Ilic, IM; Ilic, MD; Imani-Nasab, MH; Islam, M; Iso, H; Iwu, CJ; Jaafari, J; Jacobsen, KH; Jahagirdar, D; Jahanmehr, N; Jalali, A; Jalilian, F; James, SL; Janjani, H; Jenabi, E; Jha, RP; Jha, V; Ji, JS; Jonas, JB; Joukar, F; Jozwiak, JJ; Jürisson, M; Kabir, Z; Kalani, H; Kalankesh, LR; Kamiab, Z; Kanchan, T; Kapoor, N; Karch, A; Karimi, SE; Karimi, SA; Kassebaum, NJ; Katikireddi, SV; Kawakami, N; Kayode, GA; Keiyoro, PN; Keller, C; Khader, YS; Khalid, N; Khan, EA; Khan, M; Khang, Y-H; Khater, AM; Khater, MM; Khazaei, S; Khazaie, H; Khodayari, MT; Khubchandani, J; Kianipour, N; Kim, C-I; Kim, Y-E; Kim, YJ; Kinfu, Y; Kisa, A; Kisa, S; Kissimova-Skarbek, K; Kivimäki, M; Komaki, H; Kopec, JA; Kosen, S; Koul, PA; Koyanagi, A; Kravchenko, MA; Krishan, K; Krohn, KJ; Kuate Defo, B; Kumar, GA; Kumar, M; Kumar, P; Kumar, V; Kusuma, D; Kyu, HH; La Vecchia, C; Lacey, B; Lal, DK; Lalloo, R; Lami, FH; Lansky, S; Larson, SL; Larsson, AO; Lasrado, S; Lassi, ZS; Lazarus, JV; Lee, PH; Lee, SWH; Leever, AT; LeGrand, KE; Leonardi, M; Li, S; Lim, L-L; Lim, SS; Linn, S; Lodha, R; Logroscino, G; Lopez, AD; Lopukhov, PD; Lotufo, PA; Lozano, R; Lu, A; Lunevicius, R; Madadin, M; Maddison, ER; Magdy Abd El Razek, H; Magdy Abd El Razek, M; Mahasha, PW; Mahdavi, MM; Malekzadeh, R; Mamun, AA; Manafi, N; Mansour-Ghanaei, F; Mansouri, B; Mansournia, MA; Mapoma, CC; Martini, S; Martins-Melo, FR; Masaka, A; Mastrogiacomo, CI; Mathur, MR; May, EA; McAlinden, C; McGrath, JJ; McKee, M; Mehndiratta, MM; Mehri, F; Mehta, KM; Meitei, WB; Memiah, PTN; Mendoza, W; Menezes, RG; Mengesha, EW; Mensah, GA; Meretoja, A; Meretoja, TJ; Mestrovic, T; Michalek, IM; Mihretie, KM; Miller, TR; Mills, EJ; Milne, GJ; Mirrakhimov, EM; Mirzaei, H; Mirzaei, M; Mirzaei-Alavijeh, M; Misganaw, AT; Moazen, B; Moghadaszadeh, M; Mohamadi, E; Mohammad, DK; Mohammad, Y; Mohammad Gholi Mezerji, N; Mohammadbeigi, A; Mohammadian-Hafshejani, A; Mohammadpourhodki, R; Mohammed, H; Mohammed, S; Mohebi, F; Mohseni Bandpei, MA; Mokari, A; Mokdad, AH; Momen, NC; Monasta, L; Mooney, MD; Moradi, G; Moradi, M; Moradi-Joo, M; Moradi-Lakeh, M; Moradzadeh, R; Moraga, P; Moreno Velásquez, I; Morgado-da-Costa, J; Morrison, SD; Mosser, JF; Mouodi, S; Mousavi, SM; Mousavi Khaneghah, A; Mueller, UO; Musa, KI; Muthupandian, S; Nabavizadeh, B; Naderi, M; Nagarajan, AJ; Naghavi, M; Naghshtabrizi, B; Naik, G; Najafi, F; Nangia, V; Nansseu, JR; Ndwandwe, DE; Negoi, I; Negoi, RI; Ngunjiri, JW; Nguyen, HLT; Nguyen, TH; Nigatu, YT; Nikbakhsh, R; Nikpoor, AR; Nixon, MR; Nnaji, CA; Nomura, S; Noubiap, JJ; Nouraei Motlagh, S; Nowak, C; Oţoiu, A; Odell, CM; Oh, I-H; Oladnabi, M; Olagunju, AT; Olusanya, BO; Olusanya, JO; Omar Bali, A; Ong, KL; Onwujekwe, OE; Ortiz, A; Otstavnov, N; Otstavnov, SS; Øverland, S; Owolabi, MO; P A, M; Padubidri, JR; Pakshir, K; Palladino, R; Pana, A; Panda-Jonas, S; Park, J; Pasupula, DK; Patel, JR; Patel, SK; Patton, GC; Paulson, KR; Pazoki Toroudi, H; Pease, SA; Peden, AE; Pepito, VCF; Peprah, EK; Pereira, A; Pereira, DM; Perico, N; Pigott, DM; Pilgrim, T; Pilz, TM; Piradov, MA; Pirsaheb, M; Pokhrel, KN; Postma, MJ; Pourjafar, H; Pourmalek, F; Pourshams, A; Poznańska, A; Prada, SI; Prakash, S; Preotescu, L; Quazi Syed, Z; Rabiee, M; Rabiee, N; Radfar, A; Rafiei, A; Raggi, A; Rahman, MA; Rajabpour-Sanati, A; Ram, P; Ranabhat, CL; Rao, SJ; Rasella, D; Rashedi, V; Rastogi, P; Rathi, P; Rawal, L; Remuzzi, G; Renjith, V; Renzaho, AMN; Resnikoff, S; Rezaei, N; Rezai, MS; Rezapour, A; Rickard, J; Roever, L; Ronfani, L; Roshandel, G; Rostamian, M; Rubagotti, E; Rwegerera, GM; Sabour, S; Saddik, B; Sadeghi, E; Sadeghi, M; Saeedi Moghaddam, S; Safari, Y; Safi, S; Safiri, S; Sagar, R; Sahebkar, A; Sahraian, MA; Sajadi, SM; Salahshoor, MR; Salama, JS; Salamati, P; Salem, MRR; Salimi, Y; Salomon, JA; Salz, I; Samad, Z; Samy, AM; Sanabria, J; Santric-Milicevic, MM; Saraswathy, SYI; Sartorius, B; Sarveazad, A; Sathian, B; Sathish, T; Sattin, D; Saylan, M; Schaeffer, LE; Schiavolin, S; Schwebel, DC; Schwendicke, F; Sekerija, M; Senbeta, AM; Senthilkumaran, S; Sepanlou, SG; Serván-Mori, E; Shabani, M; Shahabi, S; Shahbaz, M; Shaheen, AA; Shaikh, MA; Shalash, AS; Shams-Beyranvand, M; Shamsi, M; Shamsizadeh, M; Shannawaz, M; Sharafi, K; Sharafi, Z; Sharara, F; Sharma, R; Shaw, DH; Sheikh, A; Shin, JI; Shiri, R; Shrime, MG; Shuval, K; Siabani, S; Sigfusdottir, ID; Sigurvinsdottir, R; Silva, DAS; Simonetti, B; Simpson, KE; Singh, JA; Skiadaresi, E; Skryabin, VY; Soheili, A; Sokhan, A; Sorensen, RJD; Soriano, JB; Sorrie, MB; Soyiri, IN; Spurlock, EE; Sreeramareddy, CT; Stockfelt, L; Stokes, MA; Stubbs, JL; Sudaryanto, A; Sufiyan, MB; Suliankatchi Abdulkader, R; Sykes, BL; Tabarés-Seisdedos, R; Tabb, KM; Tadakamadla, SK; Taherkhani, A; Tang, M; Taveira, N; Taylor, HJ; Teagle, WL; Tehrani-Banihashemi, A; Teklehaimanot, BF; Tessema, ZT; Thankappan, KR; Thomas, N; Thrift, AG; Titova, MV; Tohidinik, HR; Tonelli, M; Topor-Madry, R; Topouzis, F; Tovani-Palone, MRR; Traini, E; Tran, BX; Travillian, R; Trias-Llimós, S; Truelsen, TC; Tudor Car, L; Unnikrishnan, B; Upadhyay, E; Vacante, M; Vakilian, A; Valdez, PR; Valli, A; Vardavas, C; Vasankari, TJ; Vasconcelos, AMN; Vasseghian, Y; Veisani, Y; Venketasubramanian, N; Vidale, S; Violante, FS; Vlassov, V; Vollset, SE; Vos, T; Vujcic, IS; Vukovic, A; Vukovic, R; Waheed, Y; Wallin, MT; Walters, MK; Wang, H; Wang, Y-P; Watson, S; Wei, J; Weiss, J; Weldesamuel, GT; Werdecker, A; Westerman, R; Whiteford, HA; Wiangkham, T; Wiens, KE; Wijeratne, T; Wiysonge, CS; Wojtyniak, B; Wolfe, CDA; Wondmieneh, AB; Wool, EE; Wu, A-M; Wu, J; Xu, G; Yamada, T; Yamagishi, K; Yano, Y; Yaya, S; Yazdi-Feyzabadi, V; Yearwood, JA; Yeheyis, TY; Yilgwan, CS; Yip, P; Yonemoto, N; Yoon, S-J; Yoosefi Lebni, J; York, HW; Younis, MZ; Younker, TP; Yousefi, Z; Yousefinezhadi, T; Yousuf, AY; Yusefzadeh, H; Zahirian Moghadam, T; Zakzuk, J; Zaman, SB; Zamani, M; Zamanian, M; Zandian, H; Zhang, Z-J; Zheng, P; Zhou, M; Ziapour, A; Murray, CJLNo abstract.
- ItemThe Global Distribution of Lymphatic Filariasis, 2000–18: A Geospatial Analysis(Elsevier, 2020) Deshpande, A; Miller-Petrie, MK; Lindstedt, PA; Baumann, MM; Johnson, KB; Blacker, BF; Abbastabar, H; Abd-Allah, F; Abdelalim, A; Abdollahpour, I; Abegaz, KH; Abejie, AN; Abreu, LG; Abrigo, MRM; Abualhasan, A; Accrombessi, MMK; Adamu, AA; Adebayo, OM; Adedeji, IA; Adedoyin, RA; Adekanmbi, V; Adetokunboh, OO; Adhikari, TB; Afarideh, M; Agudelo-Botero, M; Ahmadi, M; Ahmadi, K; Ahmed, MB; Ahmed, AE; Akalu, TY; Akanda, AS; Alahdab, F; Al-Aly, Z; Alam, S; Alam, N; Alamene, GM; Alanzi, TM; Albright, J; Albujeer, A; Alcalde-Rabanal, JE; Alebel, A; Alemu, ZA; Ali, M; Alijanzadeh, M; Alipour, V; Aljunid, SM; Almasi, A; Almasi-Hashiani, A; Al-Mekhlafi, HM; Altirkawi, KA; Alvis-Guzman, N; Alvis-Zakzuk, NJ; Amini, S; Amit, AML; Amul, GGH; Andrei, CL; Anjomshoa, M; Ansariadi, A; Antonio, CAT; Antony, B; Antriyandarti, E; Arabloo, J; Aref, HMA; Aremu, O; Armoon, B; Arora, A; Aryal, KK; Arzani, A; Asadi-Aliabadi, M; Asmelash, D; Atalay, HT; Athari, SM; Athari, SS; Atre, SR; Ausloos, M; Awasthi, S; Awoke, N; Ayala Quintanilla, BP; Ayano, G; Ayanore, MA; Aynalem, YA; Azari, S; Azman, AS; Babaee, E; Badawi, A; Bagherzadeh, M; Bakkannavar, SM; Balakrishnan, S; Banach, M; Banoub, JAM; Barac, A; Barboza, MA; Bärnighausen, TW; Basu, S; Bay, VD; Bayati, M; Bedi, N; Beheshti, M; Behzadifar, M; Behzadifar, MBackground: Lymphatic filariasis is a neglected tropical disease that can cause permanent disability through disruption of the lymphatic system. This disease is caused by parasitic filarial worms that are transmitted by mosquitos. Mass drug administration (MDA) of antihelmintics is recommended by WHO to eliminate lymphatic filariasis as a public health problem. This study aims to produce the first geospatial estimates of the global prevalence of lymphatic filariasis infection over time, to quantify progress towards elimination, and to identify geographical variation in distribution of infection. Methods: A global dataset of georeferenced surveyed locations was used to model annual 2000–18 lymphatic filariasis prevalence for 73 current or previously endemic countries. We applied Bayesian model-based geostatistics and time series methods to generate spatially continuous estimates of global all-age 2000–18 prevalence of lymphatic filariasis infection mapped at a resolution of 5 km2 and aggregated to estimate total number of individuals infected. Findings: We used 14 927 datapoints to fit the geospatial models. An estimated 199 million total individuals (95% uncertainty interval 174–234 million) worldwide were infected with lymphatic filariasis in 2000, with totals for WHO regions ranging from 3·1 million (1·6–5·7 million) in the region of the Americas to 107 million (91–134 million) in the South-East Asia region. By 2018, an estimated 51 million individuals (43–63 million) were infected. Broad declines in prevalence are observed globally, but focal areas in Africa and southeast Asia remain less likely to have attained infection prevalence thresholds proposed to achieve local elimination. Interpretation: Although the prevalence of lymphatic filariasis infection has declined since 2000, MDA is still necessary across large populations in Africa and Asia. Our mapped estimates can be used to identify areas where the probability of meeting infection thresholds is low, and when coupled with large uncertainty in the predictions, indicate additional data collection or intervention might be warranted before MDA programmes cease. Funding: Bill & Melinda Gates Foundation.
- ItemMapping Geographical Inequalities in Access to Drinking Water and Sanitation Facilities in Low-income and Middle-income Countries, 2000–17(Elsevier, 2020) Deshpande, A; Miller-Petrie, MK; Lindstedt, PA; Baumann, MM; Johnson, KB; Blacker, BF; Abbastabar, H; Abd-Allah, F; Abdelalim, A; Abdollahpour, I; Abegaz, KH; Abejie, AN; Abreu, LG; Abrigo, MRM; Abualhasan, A; Accrombessi, MMK; Adamu, AA; Adebayo, OM; Adedeji, IA; Adedoyin, RA; Adekanmbi, V; Adetokunboh, OO; Adhikari, TB; Afarideh, M; Agudelo-Botero, M; Ahmadi, M; Ahmadi, K; Ahmed, MB; Ahmed, AE; Akalu, TY; Akanda, AS; Alahdab, F; Al-Aly, Z; Alam, S; Alam, N; Alamene, GM; Alanzi, TM; Albright, J; Albujeer, A; Alcalde-Rabanal, JE; Alebel, A; Alemu, ZA; Ali, M; Alijanzadeh, M; Alipour, V; Aljunid, SM; Almasi, A; Almasi-Hashiani, A; Al-Mekhlafi, HM; Altirkawi, KA; Alvis-Guzman, N; Alvis-Zakzuk, NJ; Amini, S; Amit, AML; Amul, GGH; Andrei, CL; Anjomshoa, M; Ansariadi, A; Antonio, CAT; Antony, B; Antriyandarti, E; Arabloo, J; Aref, HMA; Aremu, O; Armoon, B; Arora, A; Aryal, KK; Arzani, A; Asadi-Aliabadi, M; Asmelash, D; Atalay, HT; Athari, SM; Athari, SS; Atre, SR; Ausloos, M; Awasthi, S; Awoke, N; Ayala Quintanilla, BP; Ayano, G; Ayanore, MA; Aynalem, YA; Azari, S; Azman, AS; Babaee, E; Badawi, A; Bagherzadeh, M; Bakkannavar, SM; Balakrishnan, S; Banach, M; Banoub, JAM; Barac, A; Barboza, MA; Bärnighausen, TW; Basu, S; Bay, VD; Bayati, M; Bedi, N; Beheshti, M; Behzadifar, M; Behzadifar, MBackground: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation: Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation. Funding: Bill & Melinda Gates Foundation.
- ItemMeasuring Universal Health Coverage Based on an Index of Effective Coverage of Health Services in 204 Countries and Territories, 1990–2019: A Systematic Analysis for the Global Burden of Disease Study 2019(Elsevier, 2020) Lozano, R; Fullman, N; Mumford, JE; Knight, M; Barthelemy, CM; Abbafati, C; Abbastabar, H; Abd-Allah, F; Abdollahi, M; Abedi, A; Abolhassani, H; Abosetugn, AE; Abreu, LG; Abrigo, MRM; Abu Haimed, AK; Abushouk, AI; Adabi, M; Adebayo, OM; Adekanmbi, V; Adelson, J; Adetokunboh, OO; Adham, D; Advani, SM; Afshin, A; Agarwal, G; Agasthi, P; Aghamir, SMK; Agrawal, A; Ahmad, T; Akinyemi, RO; Alahdab, F; Al-Aly, Z; Alam, K; Albertson, SB; Alemu, YM; Alhassan, RK; Ali, M; Ali, S; Alipour, V; Aljunid, SM; Alla, F; Almadi, MAH; Almasi, A; Almasi-Hashiani, A; Almasri, NA; Al-Mekhlafi, HM; Almulhim, AM; Alonso, J; Al-Raddadi, RM; Altirkawi, KA; Alvis-Guzman, N; Alvis-Zakzuk, NJ; Amini, S; Amini-Rarani, M; Amiri, F; Amit, AML; Amugsi, DA; Ancuceanu, R; Anderlini, D; Andrei, CL; Androudi, S; Ansari, F; Ansari-Moghaddam, A; Antonio, CAT; Antony, CM; Antriyandarti, E; Anvari, D; Anwer, R; Arabloo, J; Arab-Zozani, M; Aravkin, AY; Aremu, O; Ärnlöv, J; Asaad, M; Asadi-Aliabadi, M; Asadi-Pooya, AA; Ashbaugh, C; Athari, SS; Atout, MMDW; Ausloos, M; Avila-Burgos, L; Ayala Quintanilla, BP; Ayano, G; Ayanore, MA; Aynalem, YA; Aynalem, GL; Ayza, MA; Azari, S; Azzopardi, PS; B, DB; Babaee, E; Badiye, AD; Bahrami, MA; Baig, AA; Bakhshaei, MH; Bakhtiari, A; Bakkannavar, SM; Balachandran, A; Balassyano, S; Banach, MBackground: Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings: Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation: The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC. Funding: Bill & Melinda Gates Foundation.