Background: Family planning is imperative in the control of population growth by preventing unint... more Background: Family planning is imperative in the control of population growth by preventing unintended pregnancies and reducing other pregnancy-related risks. However, the effectiveness of family planning is constrained by unmet needs. This study determined the proportion and identify factors associated with unmet family planning needs among women of childbearing age in The Gambia. Methods: We utilized cross-sectional population-based Demographic and Health Survey (DHS) data from Gambian women aged 15-49 years in 2013. The outcome measured was the total unmet/met need for FP. The sample comprised 10,233 women aged 15-49 years old. Chisquare test and multivariable logistic regression analysis were used. Results: Of the 10,233 eligible women recruited in the study, the mean age was 27.4±9.1 years while 67.5% were married. Overall, 17.6% of women reported unmet FP need, of whom 14.0% and 3.6% reported unmet birth spacing and birth limitation needs, respectively. The women's age, region, ethnicity, number of live children, number of household/family members, the optimal number of children, and husband/partners' desire for the children were found as significant determinants of unmet FP needs. Furthermore, breastfeeding has been identified as the key reason for the non-use of FP in mothers. Conclusions: The study findings suggest a need to expand FP programs and related strategic communications especially for younger women in order to improve their contraceptive prevalence. Improving women empowerment and accessibility to FP will help to lessen the current trend towards rising unmet needs in The Gambia.
Global journal of epidemiology and infectious disease, Jun 5, 2022
Background: Reproductive health is a critical component of overall health and development. Unmet ... more Background: Reproductive health is a critical component of overall health and development. Unmet contraceptive needs are one of the regularly cited measures of the efficacy of family planning (FP) initiatives. This study set out to determine the magnitude and associated factors of unmet need for FP among women of reproductive-aged (15-49 years) in the provincial areas of The Gambia. Methods: The study used a community-based cross-sectional analytical design. A multistage sampling strategy, comprising simple random and cluster sampling, was utilized to obtain a sample of 643 childbearing women (15-49 years) from rural Gambia's sampled clusters. Data collection was conducted using pre-tested structured interview questionnaires. The association was examined using chi-square/fisher's exact test with a significance level of p<0.05. Binary logistic regression analysis was performed to examine the effect of sociodemographic and cultural determinants on unmet FP need, with corresponding computed adjusted odds ratios (aOR). IBM SPSS version 24 was used for data entry and analysis. Results: The unmet need for FP among the study participants was 25.2%; unmet need for spacing and unmet need for limiting was 17.4% and 7.8%, respectively. The total demand for FP was 59.4%, while the satisfaction of demand for FP was 57.6%. The significant predictors of unmet need for FP were woman's age at first pregnancy (aOR=0.899, p=0.033), LGA of origin (aOR=0.240, p=0.001) and frequency of using contraceptives (aOR=1.587, p=0.032). Conclusion: The present study demonstrated a high unmet need for FP among rural women in The Gambia, with the most often cited reason for non-use being fear of side effects. Hence, it is necessary to concentrate FP services for rural populations, stressing education regarding contraceptive side effects, service quality, and gender equality. Additionally, the study suggests that male participation and religious leaders' involvement in FP programs be strengthened and mainstreamed, as well as the establishment of a communication program that specifically promotes inter-spousal communication.
Background: Family planning (FP) methods have been found as an efficient approach of reducing fer... more Background: Family planning (FP) methods have been found as an efficient approach of reducing fertility and are therefore widely supported in order to decrease population growth, particularly in poor nations. Promoting contraception availability among women (15-49) age has also been shown to be an efficient public health strategy for improving maternal and newborn health outcomes. This paper aimed at exploring the pooled prevalence of contraceptive uptake and its contextual determinants among women of childbearing age in The Gambia. Methods: The Gambia Demographic and Health Survey (GDHS) in both 2013 and 2019-20 was used for this study. Data were obtained from a pooled 22,098 women aged 15-49 (10,233 for 2013 and 11,865 for 2019-20) through a stratified two-stage cluster sampling approach. Percentages and chi-square tests were used and variables with p-value <0.05 were included into the model. A multivariable logistic regression model was used to assess the predictors of contraceptive usage at 95% confidence interval (CIs) with computed adjusted odds ratios (aORs). All the study data were analyzed using Stata version 15. Results: The weighted pooled prevalence of modern contraceptive utilization in The Gambia was 10.1%. Younger age, compared with women aged 25-29; 30-34; 35-39; 40-44; primary education (aOR=1.25, 95% CI=1.05-1.49); secondary education (aOR=1.57, 95% CI= 1.32-1.85); Higher education (aOR=1.90, 95% CI=1.34-12.69); living in urban areas (aOR=1.49, 95% CI= 1.25-1.79); parity 2-4 (aOR=1.21, 95% CI= 1.01-1.47); told about FP at health facility (aOR=2.97, 95% CI= 2.61-3.38), and no desire for many children (aOR=1.96, 95% CI= 1.62-2.37) were more like to use modern contraceptives among Gambian women. Conclusion: The programme certainly needs to consider improvements in the quality of care being offered to acceptors. Government agencies should target these programs and campaigns on regional FP demands and provide suitable culturally sensitive and regionally adaptive services to the communities' contexts. The programme should intensify its efforts in rural and urban settings to improve accessibility to and availability of FP services.
Background: Despite the common restrictive abortion laws, abortion remains widespread in sub-Saha... more Background: Despite the common restrictive abortion laws, abortion remains widespread in sub-Saharan Africa (SSA) countries. Women still utilize abortion services and put their lives and health at risk because abortion can only be procured illegally in private facilities such as mid-level or small patent medicine store that may be manned by unskilled providers or through a non-medicated approach. The objective of this study was to determine median years and factors of time to rst abortion after sexual debut among Congolese women. Methods: We used data from the most recent Republic of Congo Demographic and Health Survey (DHS). A total sample of 3,622 women aged 15-49 years was analyzed. We estimated the overall prevalence of abortion and median years to rst abortion. Furthermore, we examined the factors of time to rst abortion after sexual debut using multivariable Cox regression and reported the estimates using adjusted Hazard Ratio (aHR) and 95% con dence intervals (CI). Statistical signi cance was determined at p<0.05. Results: The prevalence of abortion was 60.0% and median years of time to rst abortion after sexual debut was 9.0. The prominent reasons for abortion were due to too short birth interval (23.8%), lack of money (21.0%) and that husband/partner did not need a child at that time (14.0%). Women's age and region were notable factors in timing to rst abortion. Furthermore, women from poorer, middle, richer and richest households had 34%, 67%, 86% and 94% higher risk of abortion respectively, when compared with women from poorest households (aHR estimates). Women currently in union/living with a man and formerly in union had 41% and 29% reduction in the risk of abortion respectively, when compared with those never in union (aHR estimates). In addition, women with primary and secondary+ education had 42% and 76% higher risk of abortion respectively, when compared with women with no formal education (aHR estimates). Conclusion: There was high prevalence of abortion with short years at rst abortion. Abortion was associated with women's characteristics. There is need for unwanted pregnancy prevention intervention and the improvement in pregnancy care to reduce adverse pregnancy outcomes among women. Variables De nitions/categories Age (in years)
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 &amp; Melinda Gates Foundation.
The impact of chronic diseases on labour force participation is not frequently examined or consid... more The impact of chronic diseases on labour force participation is not frequently examined or considered as part of cost-of-illness studies. The aim of this study was to determine the impact of chronic diseases on labour force participation among South African women. This study included 6126 women from the 2016 South African Demographic and Health Survey. Labour force participation/employment was the outcome variable. Data were analyzed in percentage and multivariable binary logistic regression. Results showed that approximately 28.7% of women participated in the labour force and about 5.0% had diabetes. The prevalence of diabetes among women who are not in the labour force was 5.5%, whereas those in the labour force reported 3.8% prevalence of diabetes. The diabetic women had 35% reduction in labour force participation when compared with non-diabetic women (aOR = 0.65; 95% CI: 0.48 to 0.89). Geographical region was associated with labour force participation. Rural women and those curr...
Background. Renal failure is a leading cause of morbidity and mortality in many resource-constrai... more Background. Renal failure is a leading cause of morbidity and mortality in many resource-constrained settings. In developing countries, little has been known about the prevalence and predisposing factors of renal failure using population-based data. The objective of this study was to examine the prevalence and associated factors of renal failure among women of reproductive age in Burundi. Methods. We used nationally representative cross-sectional data from the 2016-2017 Burundi Demographic and Health Survey (BDHS). Data on 17,269 women of reproductive age were included. The outcome variable was a renal failure as determined by the patient’s report. Percentage, chi-square test, and multivariable logistic regression model were used to analyze the data. The results from the logistic regression model were presented as adjusted odds ratio (AOR) and confidence interval (95% CI). The significance level was set at p < 0.05 . Results. The overall prevalence of renal failure was 5.0% (95% ...
Background Vaccination has long been recognized as one of the most effective ways to reduce child... more Background Vaccination has long been recognized as one of the most effective ways to reduce child mortality. It has played a significant role, particularly for children, and is considered a major achievement and relevant in preventing childhood diseases worldwide. This study looks at the uptake and determinants of childhood vaccination status among children under the age of one year, for Gambia, Sierra Leon, and Liberia. Method Data from 2019 to 20 Demographic and Health Survey (DHS) data from Gambia, Sierra Leone, and Liberia were pooled for the analysis used in this study. Data were obtained from a total weighted sample of 5,368 children aged 0–12 months through a stratified two-stage cluster sampling approach. A multivariable logistic regression model was used to assess the predictors of childhood vaccination uptake at 95% confidence interval (CIs) with computed adjusted odds ratios (aORs). Results The weighted sample pooled prevalence of full vaccination among children under 12 ...
Sub-Saharan Africa (SSA) countries are facing an epidemiological shift from infectious diseases t... more Sub-Saharan Africa (SSA) countries are facing an epidemiological shift from infectious diseases to chronic diseases, such as cardiovascular diseases (CVDs). The burden of CVDs in a population results from the persistence of several factors. This study was to determine the prevalence and determinants of heart and lung disease. We used Benin Demographic and Health Survey (BDHS) population-based cross-sectional data. BDHS 2017–18 is the fifth of its kind. A total of 7712 women of reproductive age were included in this study. Heart and lung diseases were the outcome variables. Percentage and logistic regression model were used. The level of statistical significance was set at 5%. The prevalence of heart disease was 1.3% (95% CI: 1.0–1.7%) and lung disease was approximately 1.5% (95% CI: 1.2–1.9%). Women who had diabetes were 3.57 times as likely to have heart disease when compared with those who did not have diabetes (AOR = 3.57; 95% CI: 1.51–8.45). Furthermore, women who had diabetes were 4.55 times as likely to have lung diseases when compared with those who did not have diabetes (AOR = 4.55; 95% CI: 2.06–10.06). Women who had hypertension were 3.18 times as likely to have heart disease when compared with those who had no hypertension (AOR = 3.18; 95% CI: 2.02–4.98). Women’s geographical region was also significantly associated with heart and lung disease. Diabetes, hypertension, and geographical region were determinants of heart and lung disease. Health policymakers and government need to focus on widespread prevention and control interventions of heart and lung disease through improved screening for risk factors and early detection especially among high-risk women. The government should also create nationwide awareness and educate people about heart and lung disease and its fatality rate.
Background Health-care needs change throughout the life course. It is thus crucial to assess whet... more Background Health-care needs change throughout the life course. It is thus crucial to assess whether health systems provide access to quality health care for all ages. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019), we measured the Healthcare Access and Quality (HAQ) Index overall and for select age groups in 204 locations from 1990 to 2019. Methods We distinguished the overall HAQ Index (ages 0-74 years) from scores for select age groups: the young (ages 0-14 years), working (ages 15-64 years), and post-working (ages 65-74 years) groups. For GBD 2019, HAQ Index construction methods were updated to use the arithmetic mean of scaled mortality-to-incidence ratios (MIRs) and risk-standardised death rates (RSDRs) for 32 causes of death that should not occur in the presence of timely, quality health care. Across locations and years, MIRs and RSDRs were scaled from 0 (worst) to 100 (best) separately, putting the HAQ Index on a different relative scale for each age group. We estimated absolute convergence for each group on the basis of whether the HAQ Index grew faster in absolute terms between 1990 and 2019 in countries with lower 1990 HAQ Index scores than countries with higher 1990 HAQ Index scores and by Socio-demographic Index (SDI) quintile. SDI is a summary metric of overall development. Findings Between 1990 and 2019, the HAQ Index increased overall (by 19•6 points, 95% uncertainty interval 17•9-21•3), as well as among the young (22•5, 19•9-24•7), working (17•2, 15•2-19•1), and post-working (15•1, 13•2-17•0) age groups. Large differences in HAQ Index scores were present across SDI levels in 2019, with the overall index ranging from 30•7 (28•6-33•0) on average in low-SDI countries to 83•4 (82•4-84•3) on average in high-SDI countries. Similarly large ranges between low-SDI and high-SDI countries, respectively, were estimated in the HAQ Index for the young (40•4-89•0), working (33•8-82•8), and post-working (30•4-79•1) groups. Absolute convergence in HAQ Index was estimated in the young group only. In contrast, divergence was estimated among the working and post-working groups, driven by slow progress in low-SDI countries. Interpretation Although major gaps remain across levels of social and economic development, convergence in the young group is an encouraging sign of reduced disparities in health-care access and quality. However, divergence in the working and post-working groups indicates that health-care access and quality is lagging at lower levels of social and economic development. To meet the needs of ageing populations, health systems need to improve health-care access and quality for working-age adults and older populations while continuing to realise gains among the young. Funding Bill & Melinda Gates Foundation.
Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevent... more Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-ofpocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Cooperation and Development (OECD)&#39;s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings In 2019, at the onset of the COVID-19 pandemic, US$9•2 trillion (95% uncertainty interval [UI] 9•1-9•3) was spent on health worldwide. We found great disparities in the amount of resources devoted to health, with high-income countries spending $7•3 trillion (95% UI 7•2-7•4) in 2019; 293•7 times the $24•8 billion (95% UI 24•3-25•3) spent by low-income countries in 2019. That same year, $43•1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1•8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and $37•8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12•2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the healthrelated COVID-19 response is 252•2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11-21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained.
Background Previous global analyses, with known underdiagnosis and single cause per death attribu... more Background Previous global analyses, with known underdiagnosis and single cause per death attribution systems, provide only a small insight into the suspected high population health effect of sickle cell disease. Completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, this study delivers a comprehensive global assessment of prevalence of sickle cell disease and mortality burden by age and sex for 204 countries and territories from 2000 to 2021. Methods We estimated cause-specific sickle cell disease mortality using standardised GBD approaches, in which each death is assigned to a single underlying cause, to estimate mortality rates from the International Classification of Diseases (ICD)-coded vital registration, surveillance, and verbal autopsy data. In parallel, our goal was to estimate a more accurate account of sickle cell disease health burden using four types of epidemiological data on sickle cell disease: birth incidence, age-specific prevalence, with-condition mortality (total deaths), and excess mortality (excess deaths). Systematic reviews, supplemented with ICD-coded hospital discharge and insurance claims data, informed this modelling approach. We employed DisMod-MR 2.1 to triangulate between these measures-borrowing strength from predictive covariates and across age, time, and geography-and generated internally consistent estimates of incidence, prevalence, and mortality for three distinct genotypes of sickle cell disease: homozygous sickle cell disease and severe sickle cell β-thalassaemia, sickle-haemoglobin C disease, and mild sickle cell β-thalassaemia. Summing the three models yielded final estimates of incidence at birth, prevalence by age and sex, and total sickle cell disease mortality, the latter of which was compared directly against cause-specific mortality estimates to evaluate differences in mortality burden assessment and implications for the Sustainable Development Goals (SDGs). Findings Between 2000 and 2021, national incidence rates of sickle cell disease were relatively stable, but total births of babies with sickle cell disease increased globally by 13•7% (95% uncertainty interval 11•1-16•5), to 515 000 (425 000-614 000), primarily due to population growth in the Caribbean and western and central sub-Saharan Africa. The number of people living with sickle cell disease globally increased by 41•4% (38•3-44•9), from 5•46 million (4•62-6•45) in 2000 to 7•74 million (6•51-9•2) in 2021. We estimated 34 400 (25 000-45 200) cause-specific all-age deaths globally in 2021, but total sickle cell disease mortality burden was nearly 11-times higher at 376 000 (303 000-467 000). In children younger than 5 years, there were 81 100 (58 800-108 000) deaths, ranking total sickle cell disease mortality as 12th (compared to 40th for cause-specific sickle cell disease mortality) across all causes estimated by the GBD in 2021. Interpretation Our findings show a strikingly high contribution of sickle cell disease to all-cause mortality that is not apparent when each death is assigned to only a single cause. Sickle cell disease mortality burden is highest in children, especially in countries with the greatest under-5 mortality rates. Without comprehensive strategies to address morbidity and mortality associated with sickle cell disease, attainment of SDG 3.1, 3.2, and 3.4 is uncertain. Widespread data gaps and correspondingly high uncertainty in the estimates highlight the urgent need for routine and sustained surveillance efforts, further research to assess the contribution of conditions associated with sickle cell disease, and widespread deployment of evidence-based prevention and treatment for those with sickle cell disease.
Objective We investigated the prevalence and risk factors of ARI in children under 5 years old in... more Objective We investigated the prevalence and risk factors of ARI in children under 5 years old in 37 SSA countries. Methods Data from Demographic and Health Survey (DHS) of 37 African countries was examined in this analysis. Data from children under the age of 5 years old were examined. Forest plot was used to identify disparities in the occurrence of ARIs across SSA countries. Results We observed a higher prevalence of ARI among children under 5 in Uganda, Kenya, Sao Tome and Principe (9% each), Gabon, Chad, Eswatini (8% each), Burundi, Ethiopia, Congo Democratic Republic (7.0% each). The prevalence of ARI among under-five children who sought medical advice/treatment from health facility was higher in South Africa (88%), Sierra Leone (86%), Tanzanian (85%), Guinea (83%) and Uganda (80%). The prevalence rate of ARI among under-five children who received antibiotics was higher in Tanzania (61%), Sao Tome and Principe (60%), Rwanda and Congo (58% each), Angola (56.0%), Mozambique (54....
Background Low back pain is highly prevalent and the main cause of years lived with disability (Y... more Background Low back pain is highly prevalent and the main cause of years lived with disability (YLDs). We present the most up-to-date global, regional, and national data on prevalence and YLDs for low back pain from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. Methods Population-based studies from 1980 to 2019 identified in a systematic review, international surveys, US medical claims data, and dataset contributions by collaborators were used to estimate the prevalence and YLDs for low back pain from 1990 to 2020, for 204 countries and territories. Low back pain was defined as pain between the 12th ribs and the gluteal folds that lasted a day or more; input data using alternative definitions were adjusted in a network meta-regression analysis. Nested Bayesian meta-regression models were used to estimate prevalence and YLDs by age, sex, year, and location. Prevalence was projected to 2050 by running a regression on prevalence rates using Socio-demographic Index as a predictor, then multiplying them by projected population estimates. Findings In 2020, low back pain affected 619 million (95% uncertainty interval 554-694) people globally, with a projection of 843 million (759-933) prevalent cases by 2050. In 2020, the global age-standardised rate of YLDs was 832 per 100 000 (578-1070). Between 1990 and 2020, age-standardised rates of prevalence and YLDs decreased by 10•4% (10•9-10•0) and 10•5% (11•1-10•0), respectively. A total of 38•8% (28•7-47•0) of YLDs were attributed to occupational factors, smoking, and high BMI. Interpretation Low back pain remains the leading cause of YLDs globally, and in 2020, there were more than half a billion prevalent cases of low back pain worldwide. While age-standardised rates have decreased modestly over the past three decades, it is projected that globally in 2050, more than 800 million people will have low back pain. Challenges persist in obtaining primary country-level data on low back pain, and there is an urgent need for more high-quality, primary, country-level data on both prevalence and severity distributions to improve accuracy and monitor change.
Background The health risks associated with moderate alcohol consumption continue to be debated. ... more Background The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods For this analysis, we constructed burden-weighted dose-response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15-95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15-39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0-0) and 0•603 (0•400-1•00) standard drinks per day, and the NDE varied between 0•002 (0-0) and 1•75 (0•698-4•30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0•114 (0-0•403) to 1•87 (0•500-3•30) standard drinks per day and an NDE that ranged between 0•193 (0-0•900) and 6•94 (3•40-8•30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59•1% (54•3-65•4) were aged 15-39 years and 76•9% (73•0-81•3) were male. Interpretation There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. Funding Bill &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Melinda Gates Foundation.
Journal of Management Science & Engineering Research
HIV counseling and testing (HCT) has become paramount in the prevention and control of HIV/AIDS w... more HIV counseling and testing (HCT) has become paramount in the prevention and control of HIV/AIDS worldwide. However, the uptake of HCT has been very slow globally, especially in sub-Saharan Africa. Student nurses formed the largest group undergoing health care training in the country compared to doctors and other health cadres. According to WHO, they are part of the most vulnerable group to HIV infection, judging by the fact that they interact more with patients/clients than other healthcare professionals. This study aimed to determine the prevalence of HCT uptake, knowledge, and attitude and evaluate influencing factors among student nurses and midwives in public nursing schools. An institutional-based cross-sectional study design was employed to collect data from 305 randomly selected nursing students and midwives using a validated and reliable self-administered questionnaire. Descriptive statistics (percentages, mean and standard deviation) and inferential statistics (chi square, ...
Fishing is a well-known industry, and there are certain risks of work-related diseases and accide... more Fishing is a well-known industry, and there are certain risks of work-related diseases and accidents, occupational hazards and safety issues. This study aimed at examining the determinants of occupational hazards and injuries among fishermen at Tanji fishing site, a major fish-landing site in the Gambia, West Africa. An analytical cross-sectional design was conducted in August to October 2019. Structured questionnaires were administered to fishermen at Tanji fishing site. A simple random sampling method was used to select fishermen in this study. Data entry and processing for preliminary data analysis was done using Stata version 15. Descriptive and bivariate analysis using chi-square/fisher exact test as well as binary logistics regression analysis were used. The adjusted risk ratios (aRRs) and confidence intervals of 95% were calculated. A P-value
A significant public health concern that disproportionately affects women is human immunodeficien... more A significant public health concern that disproportionately affects women is human immunodeficiency virus (HIV). Prenuptial HIV testing is no doubt a major step for people to learn their HIV status. In this study, the coverage of prenuptial HIV testing and its associated factors were examined among reproductive-aged Rwandese women. This study included a total of 14,634 reproductive-aged Rwandese women using 2019–20 Rwanda Demographic and Health Survey (RDHS). The coverage of prenuptial HIV/AIDS testing and the variables influencing it were evaluated using percentage and multilevel logit model. The level of significance was set at p<0.05. The weighted prevalence of prenuptial HIV/AIDS testing was 45.9% (95%CI: 44.8%-47.1%). The respondents who attained primary and secondary+ education had 31% (OR = 1.31; 95%CI: 1.09–1.59) and 56% (OR = 1.56; 95%CI: 1.25–1.95) higher odds of prenuptial HIV/AIDS testing, when compared with uneducated women. Those who got married or had their first s...
Background Benign prostatic hyperplasia is a common urological disease affecting older men worldw... more Background Benign prostatic hyperplasia is a common urological disease affecting older men worldwide, but comprehensive data about the global, regional, and national burden of benign prostatic hyperplasia and its trends over time are scarce. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated global trends in, and prevalence of, benign prostatic hyperplasia and disability-adjusted life-years (DALYs) due to benign prostatic hyperplasia, in 21 regions and 204 countries and territories from 2000 to 2019. Methods This study was conducted with GBD 2019 analytical and modelling strategies. Primary prevalence data came from claims from three countries and from hospital inpatient encounters from 45 locations. A Bayesian metaregression modelling tool, DisMod-MR version 2.1, was used to estimate the age-specific, location-specific, and yearspecific prevalence of benign prostatic hyperplasia. Age-standardised prevalence was calculated by the direct method using the GBD reference population. Years lived with disability (YLDs) due to benign prostatic hyperplasia were estimated by multiplying the disability weight by the symptomatic proportion of the prevalence of benign prostatic hyperplasia. Because we did not estimate years of life lost associated with benign prostatic hyperplasia, disabilityadjusted life-years (DALYs) equalled YLDs. The final estimates were compared across Socio-demographic Index (SDI) quintiles. The 95% uncertainty intervals (UIs) were estimated as the 25th and 975th of 1000 ordered draws from a bootstrap distribution. Findings Globally, there were 94•0 million (95% UI 73•2 to 118) prevalent cases of benign prostatic hyperplasia in 2019, compared with 51•1 million (43•1 to 69•3) cases in 2000. The age-standardised prevalence of benign prostatic hyperplasia was 2480 (1940 to 3090) per 100 000 people. Although the global number of prevalent cases increased by 70•5% (68•6 to 72•7) between 2000 and 2019, the global age-standardised prevalence remained stable (-0•770% [-1•56 to 0•0912]). The age-standardised prevalence in 2019 ranged from 6480 (5130 to 8080) per 100 000 in eastern Europe to 987 (732 to 1320) per 100 000 in north Africa and the Middle East. All five SDI quintiles observed an increase in the absolute DALY burden between 2000 and 2019. The most rapid increases in the absolute DALY burden were seen in the middle SDI quintile (94•7% [91•8 to 97•6]), the low-middle SDI quintile (77•3% [74•1 to 81•2]), and the low SDI quintile (77•7% [72•9 to 83•2]). Between 2000 and 2019, age-standardised DALY rates changed less, but the three lower SDI quintiles (low, low-middle, and middle) saw small increases, and the two higher SDI quintiles (high and high-middle SDI) saw small decreases. Interpretation The absolute burden of benign prostatic hyperplasia is rising at an alarming rate in most of the world, particularly in low-income and middle-income countries that are currently undergoing rapid demographic and epidemiological changes. As more people are living longer worldwide, the absolute burden of benign prostatic hyperplasia is expected to continue to rise in the coming years, highlighting the importance of monitoring and planning for future health system strain. Funding Bill & Melinda Gates Foundation.
Background: Family planning is imperative in the control of population growth by preventing unint... more Background: Family planning is imperative in the control of population growth by preventing unintended pregnancies and reducing other pregnancy-related risks. However, the effectiveness of family planning is constrained by unmet needs. This study determined the proportion and identify factors associated with unmet family planning needs among women of childbearing age in The Gambia. Methods: We utilized cross-sectional population-based Demographic and Health Survey (DHS) data from Gambian women aged 15-49 years in 2013. The outcome measured was the total unmet/met need for FP. The sample comprised 10,233 women aged 15-49 years old. Chisquare test and multivariable logistic regression analysis were used. Results: Of the 10,233 eligible women recruited in the study, the mean age was 27.4±9.1 years while 67.5% were married. Overall, 17.6% of women reported unmet FP need, of whom 14.0% and 3.6% reported unmet birth spacing and birth limitation needs, respectively. The women's age, region, ethnicity, number of live children, number of household/family members, the optimal number of children, and husband/partners' desire for the children were found as significant determinants of unmet FP needs. Furthermore, breastfeeding has been identified as the key reason for the non-use of FP in mothers. Conclusions: The study findings suggest a need to expand FP programs and related strategic communications especially for younger women in order to improve their contraceptive prevalence. Improving women empowerment and accessibility to FP will help to lessen the current trend towards rising unmet needs in The Gambia.
Global journal of epidemiology and infectious disease, Jun 5, 2022
Background: Reproductive health is a critical component of overall health and development. Unmet ... more Background: Reproductive health is a critical component of overall health and development. Unmet contraceptive needs are one of the regularly cited measures of the efficacy of family planning (FP) initiatives. This study set out to determine the magnitude and associated factors of unmet need for FP among women of reproductive-aged (15-49 years) in the provincial areas of The Gambia. Methods: The study used a community-based cross-sectional analytical design. A multistage sampling strategy, comprising simple random and cluster sampling, was utilized to obtain a sample of 643 childbearing women (15-49 years) from rural Gambia's sampled clusters. Data collection was conducted using pre-tested structured interview questionnaires. The association was examined using chi-square/fisher's exact test with a significance level of p<0.05. Binary logistic regression analysis was performed to examine the effect of sociodemographic and cultural determinants on unmet FP need, with corresponding computed adjusted odds ratios (aOR). IBM SPSS version 24 was used for data entry and analysis. Results: The unmet need for FP among the study participants was 25.2%; unmet need for spacing and unmet need for limiting was 17.4% and 7.8%, respectively. The total demand for FP was 59.4%, while the satisfaction of demand for FP was 57.6%. The significant predictors of unmet need for FP were woman's age at first pregnancy (aOR=0.899, p=0.033), LGA of origin (aOR=0.240, p=0.001) and frequency of using contraceptives (aOR=1.587, p=0.032). Conclusion: The present study demonstrated a high unmet need for FP among rural women in The Gambia, with the most often cited reason for non-use being fear of side effects. Hence, it is necessary to concentrate FP services for rural populations, stressing education regarding contraceptive side effects, service quality, and gender equality. Additionally, the study suggests that male participation and religious leaders' involvement in FP programs be strengthened and mainstreamed, as well as the establishment of a communication program that specifically promotes inter-spousal communication.
Background: Family planning (FP) methods have been found as an efficient approach of reducing fer... more Background: Family planning (FP) methods have been found as an efficient approach of reducing fertility and are therefore widely supported in order to decrease population growth, particularly in poor nations. Promoting contraception availability among women (15-49) age has also been shown to be an efficient public health strategy for improving maternal and newborn health outcomes. This paper aimed at exploring the pooled prevalence of contraceptive uptake and its contextual determinants among women of childbearing age in The Gambia. Methods: The Gambia Demographic and Health Survey (GDHS) in both 2013 and 2019-20 was used for this study. Data were obtained from a pooled 22,098 women aged 15-49 (10,233 for 2013 and 11,865 for 2019-20) through a stratified two-stage cluster sampling approach. Percentages and chi-square tests were used and variables with p-value <0.05 were included into the model. A multivariable logistic regression model was used to assess the predictors of contraceptive usage at 95% confidence interval (CIs) with computed adjusted odds ratios (aORs). All the study data were analyzed using Stata version 15. Results: The weighted pooled prevalence of modern contraceptive utilization in The Gambia was 10.1%. Younger age, compared with women aged 25-29; 30-34; 35-39; 40-44; primary education (aOR=1.25, 95% CI=1.05-1.49); secondary education (aOR=1.57, 95% CI= 1.32-1.85); Higher education (aOR=1.90, 95% CI=1.34-12.69); living in urban areas (aOR=1.49, 95% CI= 1.25-1.79); parity 2-4 (aOR=1.21, 95% CI= 1.01-1.47); told about FP at health facility (aOR=2.97, 95% CI= 2.61-3.38), and no desire for many children (aOR=1.96, 95% CI= 1.62-2.37) were more like to use modern contraceptives among Gambian women. Conclusion: The programme certainly needs to consider improvements in the quality of care being offered to acceptors. Government agencies should target these programs and campaigns on regional FP demands and provide suitable culturally sensitive and regionally adaptive services to the communities' contexts. The programme should intensify its efforts in rural and urban settings to improve accessibility to and availability of FP services.
Background: Despite the common restrictive abortion laws, abortion remains widespread in sub-Saha... more Background: Despite the common restrictive abortion laws, abortion remains widespread in sub-Saharan Africa (SSA) countries. Women still utilize abortion services and put their lives and health at risk because abortion can only be procured illegally in private facilities such as mid-level or small patent medicine store that may be manned by unskilled providers or through a non-medicated approach. The objective of this study was to determine median years and factors of time to rst abortion after sexual debut among Congolese women. Methods: We used data from the most recent Republic of Congo Demographic and Health Survey (DHS). A total sample of 3,622 women aged 15-49 years was analyzed. We estimated the overall prevalence of abortion and median years to rst abortion. Furthermore, we examined the factors of time to rst abortion after sexual debut using multivariable Cox regression and reported the estimates using adjusted Hazard Ratio (aHR) and 95% con dence intervals (CI). Statistical signi cance was determined at p<0.05. Results: The prevalence of abortion was 60.0% and median years of time to rst abortion after sexual debut was 9.0. The prominent reasons for abortion were due to too short birth interval (23.8%), lack of money (21.0%) and that husband/partner did not need a child at that time (14.0%). Women's age and region were notable factors in timing to rst abortion. Furthermore, women from poorer, middle, richer and richest households had 34%, 67%, 86% and 94% higher risk of abortion respectively, when compared with women from poorest households (aHR estimates). Women currently in union/living with a man and formerly in union had 41% and 29% reduction in the risk of abortion respectively, when compared with those never in union (aHR estimates). In addition, women with primary and secondary+ education had 42% and 76% higher risk of abortion respectively, when compared with women with no formal education (aHR estimates). Conclusion: There was high prevalence of abortion with short years at rst abortion. Abortion was associated with women's characteristics. There is need for unwanted pregnancy prevention intervention and the improvement in pregnancy care to reduce adverse pregnancy outcomes among women. Variables De nitions/categories Age (in years)
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 &amp; Melinda Gates Foundation.
The impact of chronic diseases on labour force participation is not frequently examined or consid... more The impact of chronic diseases on labour force participation is not frequently examined or considered as part of cost-of-illness studies. The aim of this study was to determine the impact of chronic diseases on labour force participation among South African women. This study included 6126 women from the 2016 South African Demographic and Health Survey. Labour force participation/employment was the outcome variable. Data were analyzed in percentage and multivariable binary logistic regression. Results showed that approximately 28.7% of women participated in the labour force and about 5.0% had diabetes. The prevalence of diabetes among women who are not in the labour force was 5.5%, whereas those in the labour force reported 3.8% prevalence of diabetes. The diabetic women had 35% reduction in labour force participation when compared with non-diabetic women (aOR = 0.65; 95% CI: 0.48 to 0.89). Geographical region was associated with labour force participation. Rural women and those curr...
Background. Renal failure is a leading cause of morbidity and mortality in many resource-constrai... more Background. Renal failure is a leading cause of morbidity and mortality in many resource-constrained settings. In developing countries, little has been known about the prevalence and predisposing factors of renal failure using population-based data. The objective of this study was to examine the prevalence and associated factors of renal failure among women of reproductive age in Burundi. Methods. We used nationally representative cross-sectional data from the 2016-2017 Burundi Demographic and Health Survey (BDHS). Data on 17,269 women of reproductive age were included. The outcome variable was a renal failure as determined by the patient’s report. Percentage, chi-square test, and multivariable logistic regression model were used to analyze the data. The results from the logistic regression model were presented as adjusted odds ratio (AOR) and confidence interval (95% CI). The significance level was set at p < 0.05 . Results. The overall prevalence of renal failure was 5.0% (95% ...
Background Vaccination has long been recognized as one of the most effective ways to reduce child... more Background Vaccination has long been recognized as one of the most effective ways to reduce child mortality. It has played a significant role, particularly for children, and is considered a major achievement and relevant in preventing childhood diseases worldwide. This study looks at the uptake and determinants of childhood vaccination status among children under the age of one year, for Gambia, Sierra Leon, and Liberia. Method Data from 2019 to 20 Demographic and Health Survey (DHS) data from Gambia, Sierra Leone, and Liberia were pooled for the analysis used in this study. Data were obtained from a total weighted sample of 5,368 children aged 0–12 months through a stratified two-stage cluster sampling approach. A multivariable logistic regression model was used to assess the predictors of childhood vaccination uptake at 95% confidence interval (CIs) with computed adjusted odds ratios (aORs). Results The weighted sample pooled prevalence of full vaccination among children under 12 ...
Sub-Saharan Africa (SSA) countries are facing an epidemiological shift from infectious diseases t... more Sub-Saharan Africa (SSA) countries are facing an epidemiological shift from infectious diseases to chronic diseases, such as cardiovascular diseases (CVDs). The burden of CVDs in a population results from the persistence of several factors. This study was to determine the prevalence and determinants of heart and lung disease. We used Benin Demographic and Health Survey (BDHS) population-based cross-sectional data. BDHS 2017–18 is the fifth of its kind. A total of 7712 women of reproductive age were included in this study. Heart and lung diseases were the outcome variables. Percentage and logistic regression model were used. The level of statistical significance was set at 5%. The prevalence of heart disease was 1.3% (95% CI: 1.0–1.7%) and lung disease was approximately 1.5% (95% CI: 1.2–1.9%). Women who had diabetes were 3.57 times as likely to have heart disease when compared with those who did not have diabetes (AOR = 3.57; 95% CI: 1.51–8.45). Furthermore, women who had diabetes were 4.55 times as likely to have lung diseases when compared with those who did not have diabetes (AOR = 4.55; 95% CI: 2.06–10.06). Women who had hypertension were 3.18 times as likely to have heart disease when compared with those who had no hypertension (AOR = 3.18; 95% CI: 2.02–4.98). Women’s geographical region was also significantly associated with heart and lung disease. Diabetes, hypertension, and geographical region were determinants of heart and lung disease. Health policymakers and government need to focus on widespread prevention and control interventions of heart and lung disease through improved screening for risk factors and early detection especially among high-risk women. The government should also create nationwide awareness and educate people about heart and lung disease and its fatality rate.
Background Health-care needs change throughout the life course. It is thus crucial to assess whet... more Background Health-care needs change throughout the life course. It is thus crucial to assess whether health systems provide access to quality health care for all ages. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019), we measured the Healthcare Access and Quality (HAQ) Index overall and for select age groups in 204 locations from 1990 to 2019. Methods We distinguished the overall HAQ Index (ages 0-74 years) from scores for select age groups: the young (ages 0-14 years), working (ages 15-64 years), and post-working (ages 65-74 years) groups. For GBD 2019, HAQ Index construction methods were updated to use the arithmetic mean of scaled mortality-to-incidence ratios (MIRs) and risk-standardised death rates (RSDRs) for 32 causes of death that should not occur in the presence of timely, quality health care. Across locations and years, MIRs and RSDRs were scaled from 0 (worst) to 100 (best) separately, putting the HAQ Index on a different relative scale for each age group. We estimated absolute convergence for each group on the basis of whether the HAQ Index grew faster in absolute terms between 1990 and 2019 in countries with lower 1990 HAQ Index scores than countries with higher 1990 HAQ Index scores and by Socio-demographic Index (SDI) quintile. SDI is a summary metric of overall development. Findings Between 1990 and 2019, the HAQ Index increased overall (by 19•6 points, 95% uncertainty interval 17•9-21•3), as well as among the young (22•5, 19•9-24•7), working (17•2, 15•2-19•1), and post-working (15•1, 13•2-17•0) age groups. Large differences in HAQ Index scores were present across SDI levels in 2019, with the overall index ranging from 30•7 (28•6-33•0) on average in low-SDI countries to 83•4 (82•4-84•3) on average in high-SDI countries. Similarly large ranges between low-SDI and high-SDI countries, respectively, were estimated in the HAQ Index for the young (40•4-89•0), working (33•8-82•8), and post-working (30•4-79•1) groups. Absolute convergence in HAQ Index was estimated in the young group only. In contrast, divergence was estimated among the working and post-working groups, driven by slow progress in low-SDI countries. Interpretation Although major gaps remain across levels of social and economic development, convergence in the young group is an encouraging sign of reduced disparities in health-care access and quality. However, divergence in the working and post-working groups indicates that health-care access and quality is lagging at lower levels of social and economic development. To meet the needs of ageing populations, health systems need to improve health-care access and quality for working-age adults and older populations while continuing to realise gains among the young. Funding Bill & Melinda Gates Foundation.
Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevent... more Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-ofpocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Cooperation and Development (OECD)&#39;s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings In 2019, at the onset of the COVID-19 pandemic, US$9•2 trillion (95% uncertainty interval [UI] 9•1-9•3) was spent on health worldwide. We found great disparities in the amount of resources devoted to health, with high-income countries spending $7•3 trillion (95% UI 7•2-7•4) in 2019; 293•7 times the $24•8 billion (95% UI 24•3-25•3) spent by low-income countries in 2019. That same year, $43•1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1•8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and $37•8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12•2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the healthrelated COVID-19 response is 252•2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11-21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained.
Background Previous global analyses, with known underdiagnosis and single cause per death attribu... more Background Previous global analyses, with known underdiagnosis and single cause per death attribution systems, provide only a small insight into the suspected high population health effect of sickle cell disease. Completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, this study delivers a comprehensive global assessment of prevalence of sickle cell disease and mortality burden by age and sex for 204 countries and territories from 2000 to 2021. Methods We estimated cause-specific sickle cell disease mortality using standardised GBD approaches, in which each death is assigned to a single underlying cause, to estimate mortality rates from the International Classification of Diseases (ICD)-coded vital registration, surveillance, and verbal autopsy data. In parallel, our goal was to estimate a more accurate account of sickle cell disease health burden using four types of epidemiological data on sickle cell disease: birth incidence, age-specific prevalence, with-condition mortality (total deaths), and excess mortality (excess deaths). Systematic reviews, supplemented with ICD-coded hospital discharge and insurance claims data, informed this modelling approach. We employed DisMod-MR 2.1 to triangulate between these measures-borrowing strength from predictive covariates and across age, time, and geography-and generated internally consistent estimates of incidence, prevalence, and mortality for three distinct genotypes of sickle cell disease: homozygous sickle cell disease and severe sickle cell β-thalassaemia, sickle-haemoglobin C disease, and mild sickle cell β-thalassaemia. Summing the three models yielded final estimates of incidence at birth, prevalence by age and sex, and total sickle cell disease mortality, the latter of which was compared directly against cause-specific mortality estimates to evaluate differences in mortality burden assessment and implications for the Sustainable Development Goals (SDGs). Findings Between 2000 and 2021, national incidence rates of sickle cell disease were relatively stable, but total births of babies with sickle cell disease increased globally by 13•7% (95% uncertainty interval 11•1-16•5), to 515 000 (425 000-614 000), primarily due to population growth in the Caribbean and western and central sub-Saharan Africa. The number of people living with sickle cell disease globally increased by 41•4% (38•3-44•9), from 5•46 million (4•62-6•45) in 2000 to 7•74 million (6•51-9•2) in 2021. We estimated 34 400 (25 000-45 200) cause-specific all-age deaths globally in 2021, but total sickle cell disease mortality burden was nearly 11-times higher at 376 000 (303 000-467 000). In children younger than 5 years, there were 81 100 (58 800-108 000) deaths, ranking total sickle cell disease mortality as 12th (compared to 40th for cause-specific sickle cell disease mortality) across all causes estimated by the GBD in 2021. Interpretation Our findings show a strikingly high contribution of sickle cell disease to all-cause mortality that is not apparent when each death is assigned to only a single cause. Sickle cell disease mortality burden is highest in children, especially in countries with the greatest under-5 mortality rates. Without comprehensive strategies to address morbidity and mortality associated with sickle cell disease, attainment of SDG 3.1, 3.2, and 3.4 is uncertain. Widespread data gaps and correspondingly high uncertainty in the estimates highlight the urgent need for routine and sustained surveillance efforts, further research to assess the contribution of conditions associated with sickle cell disease, and widespread deployment of evidence-based prevention and treatment for those with sickle cell disease.
Objective We investigated the prevalence and risk factors of ARI in children under 5 years old in... more Objective We investigated the prevalence and risk factors of ARI in children under 5 years old in 37 SSA countries. Methods Data from Demographic and Health Survey (DHS) of 37 African countries was examined in this analysis. Data from children under the age of 5 years old were examined. Forest plot was used to identify disparities in the occurrence of ARIs across SSA countries. Results We observed a higher prevalence of ARI among children under 5 in Uganda, Kenya, Sao Tome and Principe (9% each), Gabon, Chad, Eswatini (8% each), Burundi, Ethiopia, Congo Democratic Republic (7.0% each). The prevalence of ARI among under-five children who sought medical advice/treatment from health facility was higher in South Africa (88%), Sierra Leone (86%), Tanzanian (85%), Guinea (83%) and Uganda (80%). The prevalence rate of ARI among under-five children who received antibiotics was higher in Tanzania (61%), Sao Tome and Principe (60%), Rwanda and Congo (58% each), Angola (56.0%), Mozambique (54....
Background Low back pain is highly prevalent and the main cause of years lived with disability (Y... more Background Low back pain is highly prevalent and the main cause of years lived with disability (YLDs). We present the most up-to-date global, regional, and national data on prevalence and YLDs for low back pain from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. Methods Population-based studies from 1980 to 2019 identified in a systematic review, international surveys, US medical claims data, and dataset contributions by collaborators were used to estimate the prevalence and YLDs for low back pain from 1990 to 2020, for 204 countries and territories. Low back pain was defined as pain between the 12th ribs and the gluteal folds that lasted a day or more; input data using alternative definitions were adjusted in a network meta-regression analysis. Nested Bayesian meta-regression models were used to estimate prevalence and YLDs by age, sex, year, and location. Prevalence was projected to 2050 by running a regression on prevalence rates using Socio-demographic Index as a predictor, then multiplying them by projected population estimates. Findings In 2020, low back pain affected 619 million (95% uncertainty interval 554-694) people globally, with a projection of 843 million (759-933) prevalent cases by 2050. In 2020, the global age-standardised rate of YLDs was 832 per 100 000 (578-1070). Between 1990 and 2020, age-standardised rates of prevalence and YLDs decreased by 10•4% (10•9-10•0) and 10•5% (11•1-10•0), respectively. A total of 38•8% (28•7-47•0) of YLDs were attributed to occupational factors, smoking, and high BMI. Interpretation Low back pain remains the leading cause of YLDs globally, and in 2020, there were more than half a billion prevalent cases of low back pain worldwide. While age-standardised rates have decreased modestly over the past three decades, it is projected that globally in 2050, more than 800 million people will have low back pain. Challenges persist in obtaining primary country-level data on low back pain, and there is an urgent need for more high-quality, primary, country-level data on both prevalence and severity distributions to improve accuracy and monitor change.
Background The health risks associated with moderate alcohol consumption continue to be debated. ... more Background The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods For this analysis, we constructed burden-weighted dose-response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15-95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15-39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0-0) and 0•603 (0•400-1•00) standard drinks per day, and the NDE varied between 0•002 (0-0) and 1•75 (0•698-4•30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0•114 (0-0•403) to 1•87 (0•500-3•30) standard drinks per day and an NDE that ranged between 0•193 (0-0•900) and 6•94 (3•40-8•30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59•1% (54•3-65•4) were aged 15-39 years and 76•9% (73•0-81•3) were male. Interpretation There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. Funding Bill &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Melinda Gates Foundation.
Journal of Management Science & Engineering Research
HIV counseling and testing (HCT) has become paramount in the prevention and control of HIV/AIDS w... more HIV counseling and testing (HCT) has become paramount in the prevention and control of HIV/AIDS worldwide. However, the uptake of HCT has been very slow globally, especially in sub-Saharan Africa. Student nurses formed the largest group undergoing health care training in the country compared to doctors and other health cadres. According to WHO, they are part of the most vulnerable group to HIV infection, judging by the fact that they interact more with patients/clients than other healthcare professionals. This study aimed to determine the prevalence of HCT uptake, knowledge, and attitude and evaluate influencing factors among student nurses and midwives in public nursing schools. An institutional-based cross-sectional study design was employed to collect data from 305 randomly selected nursing students and midwives using a validated and reliable self-administered questionnaire. Descriptive statistics (percentages, mean and standard deviation) and inferential statistics (chi square, ...
Fishing is a well-known industry, and there are certain risks of work-related diseases and accide... more Fishing is a well-known industry, and there are certain risks of work-related diseases and accidents, occupational hazards and safety issues. This study aimed at examining the determinants of occupational hazards and injuries among fishermen at Tanji fishing site, a major fish-landing site in the Gambia, West Africa. An analytical cross-sectional design was conducted in August to October 2019. Structured questionnaires were administered to fishermen at Tanji fishing site. A simple random sampling method was used to select fishermen in this study. Data entry and processing for preliminary data analysis was done using Stata version 15. Descriptive and bivariate analysis using chi-square/fisher exact test as well as binary logistics regression analysis were used. The adjusted risk ratios (aRRs) and confidence intervals of 95% were calculated. A P-value
A significant public health concern that disproportionately affects women is human immunodeficien... more A significant public health concern that disproportionately affects women is human immunodeficiency virus (HIV). Prenuptial HIV testing is no doubt a major step for people to learn their HIV status. In this study, the coverage of prenuptial HIV testing and its associated factors were examined among reproductive-aged Rwandese women. This study included a total of 14,634 reproductive-aged Rwandese women using 2019–20 Rwanda Demographic and Health Survey (RDHS). The coverage of prenuptial HIV/AIDS testing and the variables influencing it were evaluated using percentage and multilevel logit model. The level of significance was set at p<0.05. The weighted prevalence of prenuptial HIV/AIDS testing was 45.9% (95%CI: 44.8%-47.1%). The respondents who attained primary and secondary+ education had 31% (OR = 1.31; 95%CI: 1.09–1.59) and 56% (OR = 1.56; 95%CI: 1.25–1.95) higher odds of prenuptial HIV/AIDS testing, when compared with uneducated women. Those who got married or had their first s...
Background Benign prostatic hyperplasia is a common urological disease affecting older men worldw... more Background Benign prostatic hyperplasia is a common urological disease affecting older men worldwide, but comprehensive data about the global, regional, and national burden of benign prostatic hyperplasia and its trends over time are scarce. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated global trends in, and prevalence of, benign prostatic hyperplasia and disability-adjusted life-years (DALYs) due to benign prostatic hyperplasia, in 21 regions and 204 countries and territories from 2000 to 2019. Methods This study was conducted with GBD 2019 analytical and modelling strategies. Primary prevalence data came from claims from three countries and from hospital inpatient encounters from 45 locations. A Bayesian metaregression modelling tool, DisMod-MR version 2.1, was used to estimate the age-specific, location-specific, and yearspecific prevalence of benign prostatic hyperplasia. Age-standardised prevalence was calculated by the direct method using the GBD reference population. Years lived with disability (YLDs) due to benign prostatic hyperplasia were estimated by multiplying the disability weight by the symptomatic proportion of the prevalence of benign prostatic hyperplasia. Because we did not estimate years of life lost associated with benign prostatic hyperplasia, disabilityadjusted life-years (DALYs) equalled YLDs. The final estimates were compared across Socio-demographic Index (SDI) quintiles. The 95% uncertainty intervals (UIs) were estimated as the 25th and 975th of 1000 ordered draws from a bootstrap distribution. Findings Globally, there were 94•0 million (95% UI 73•2 to 118) prevalent cases of benign prostatic hyperplasia in 2019, compared with 51•1 million (43•1 to 69•3) cases in 2000. The age-standardised prevalence of benign prostatic hyperplasia was 2480 (1940 to 3090) per 100 000 people. Although the global number of prevalent cases increased by 70•5% (68•6 to 72•7) between 2000 and 2019, the global age-standardised prevalence remained stable (-0•770% [-1•56 to 0•0912]). The age-standardised prevalence in 2019 ranged from 6480 (5130 to 8080) per 100 000 in eastern Europe to 987 (732 to 1320) per 100 000 in north Africa and the Middle East. All five SDI quintiles observed an increase in the absolute DALY burden between 2000 and 2019. The most rapid increases in the absolute DALY burden were seen in the middle SDI quintile (94•7% [91•8 to 97•6]), the low-middle SDI quintile (77•3% [74•1 to 81•2]), and the low SDI quintile (77•7% [72•9 to 83•2]). Between 2000 and 2019, age-standardised DALY rates changed less, but the three lower SDI quintiles (low, low-middle, and middle) saw small increases, and the two higher SDI quintiles (high and high-middle SDI) saw small decreases. Interpretation The absolute burden of benign prostatic hyperplasia is rising at an alarming rate in most of the world, particularly in low-income and middle-income countries that are currently undergoing rapid demographic and epidemiological changes. As more people are living longer worldwide, the absolute burden of benign prostatic hyperplasia is expected to continue to rise in the coming years, highlighting the importance of monitoring and planning for future health system strain. Funding Bill & Melinda Gates Foundation.
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Papers by Amadou Barrow