In this study, we report findings from exit surveys of patients receiving HIV and non-HIV services at a diverse sample of facilities across Zambia.
Verbal autopsy (VA) is recognized as the only feasible alternative to comprehensive medical certification of deaths in settings with no or unreliable vital registration systems. However, a barrier to its use by national registration systems has been the amount of time and cost needed for data collection. In this paper we describe a shortened version of the VA instrument developed for the Population Health Metrics Research Consortium Gold Standard Verbal Autopsy Validation Study using a systematic approach.
In the absence of comprehensive medical certification of deaths, the only feasible way to collect essential mortality data is verbal autopsy (VA). The Tariff Method was developed by the Population Health Metrics Research Consortium to ascertain causes of death from VA information. We describe the further development of the Tariff Method.
Globally, countries are increasingly prioritizing the reduction of health inequalities and provision of universal health coverage. While national benchmarking has become more common, such work at subnational levels is rare. The timely and rigorous measurement of local levels and trends in key health interventions and outcomes is vital to identifying areas of progress and detecting early signs of stalled or declining health system performance.
The Global Burden of Diseases, Injuries, and Risk Factors study (GBD) used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs, and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region, and by country.
Exposure to ambient air pollution is a major risk factor for global disease. Assessment of the impacts of air pollution on population health and the evaluation of trends relative to other major risk factors requires regularly updated, accurate, spatially resolved exposure estimates.
Many major causes of disability in the Global Burden of Disease (GBD) study present with a range of severity, and for most causes finding population distributions of severity can be difficult due to issues of sparse data, inconsistent measurement, and need to account for comorbidities. We developed an indirect approach to obtain severity distributions empirically from survey data.
Vitamin D deficiency has been correlated with several diseases and injuries including diabetes, osteoporosis, fractures, and falls. In the Kingdom of Saudi Arabia (KSA), current data on vitamin D status are lacking. To inform Saudi public health authorities on the current status of blood levels vitamin D deficiency, we analyzed data from the Saudi Health Interview Survey.
We conducted a large national survey in the Kingdom of Saudi Arabia in 2013. We report on the health status of Saudi women and their health challenges.
Recent evidence suggests that stroke is increasing as a cause of morbidity and mortality in younger adults, where it carries particular significance for working individuals. Accurate and up-to-date estimates of stroke burden are important for planning stroke prevention and management in younger adults. This study aims to estimate prevalence, mortality, and disability-adjusted life years (DALYs) and their trends for total, ischemic stroke (IS), and hemorrhagic stroke (HS) in the world for 1990–2013 in adults aged 20–64 years.
Global stroke epidemiology is changing rapidly. Although age-standardized rates of stroke mortality have decreased worldwide in the past two decades, the absolute numbers of people who have a stroke every year, and live with the consequences of stroke or die from their stroke, are increasing. Regular updates on the current level of stroke burden are important for advancing our knowledge on stroke epidemiology and facilitating organization and planning of evidence-based stroke care.
World mapping is an important tool to visualize stroke burden and its trends in various regions and countries. Geographic patterns are shown of incidence, prevalence, mortality, disability-adjusted life years (DALYs) and years lived with disability (YLDs) and their trends for ischemic stroke and hemorrhagic stroke in the world for 1990–2013.
Accurate information on stroke burden in men and women is important for evidence-based healthcare planning and resource allocation. Previously, limited research suggested that the absolute number of deaths from stroke in women was greater than in men, but the incidence and mortality rates were greater in men. However, sex differences in various metrics of stroke burden on a global scale have not been a subject of comprehensive and comparable assessment for most regions of the world, nor have sex differences in stroke burden been examined for trends over time.
Recent outbreaks of measles in the Americas have received news and popular attention, noting the importance of vaccination to population health. To estimate the potential increase in immunization coverage and reduction in days at risk if every opportunity to vaccinate a child was used, we analyzed vaccination histories of children 11–59 months of age from large household surveys in Mesoamerica.
There is a global commitment to reduce premature cardiovascular diseases (CVDs) 25% by 2025. The purpose of the present report is to (1) describe global trends and regional variation in premature mortality attributable to CVD, (2) review past and current approaches to the measurement of these trends, and (3) describe the limitations of existing models of epidemiological transitions for explaining the observed distribution and trends of CVD mortality.
Understanding the determinants of timely antiretroviral therapy (ART) initiation is useful for HIV programs intent on developing models of care that reduce delays in treatment initiation while maintaining a high quality of care. We analyzed patient- and facility-level determinants of time to ART initiation among patients who initiated ART in Kenya.
Following the methods of the Global Burden of Disease Study 2013 (GBD 2013), we have systematically analyzed all available demographic and epidemiological data sources for China at the provincial level. We assessed levels of and trends in all-cause mortality, causes of death, and years of life lost (YLL) in all 33 province-level administrative units in mainland China, all of which we refer to as provinces, for the years between 1990 and 2013.
In the past two decades, the under-5 mortality rate in China has fallen substantially, but progress with regard to the Millennium Development Goal (MDG) 4 at the subnational level has not been quantified. We aimed to estimate under-5 mortality rates in mainland China for the years 1970 to 2012.
Chronic diseases and their risk factors are believed to be common in the Kingdom of Saudi Arabia (KSA). Most of them require long-term management through medications. We examined patterns of medication use for chronic health conditions (CHC) in KSA based on a national survey.
The Global Burden of Disease (GBD) study assesses health losses from diseases, injuries, and risk factors using disability-adjusted life-years, which need a set of disability weights to quantify health levels associated with nonfatal outcomes. The objective of this study was to estimate disability weights for the GBD 2013 study.
The Global Burden of Disease (GBD) study is a longstanding effort to report consistent and comprehensive measures of disease burden for the world. In this paper, we describe the methods used to estimate the global burden of stroke for the GBD 2013 study. Pathologic subtypes of stroke are modeled separately for two mutually exclusive and exhaustive categories: (1) ischemic stroke and (2) hemorrhagic and other non-ischemic strokes. Acute and chronic strokes are estimated separately. The GBD 2013 study has incorporated large amounts of new data on stroke death rates, incidence, and case fatality. Disease modeling methods have been updated to better integrate mortality and incidence data. Future efforts will focus on incorporating data on the regional variation in severity of disability. Stroke remains a new area for disease modeling. A better understanding of stroke incidence, mortality, and severity, and how it varies among countries, can help guide priority setting and improve health policy related to this important condition.
Mortality for children with congenital heart disease (CHD) has declined with improved surgical techniques and neonatal screening; however, as these patients live longer, accurate estimates of the prevalence of adults with CHD are lacking.
Verbal autopsy is gaining increasing acceptance as a method for determining the underlying cause of death when the cause of death given on death certificates is unavailable or unreliable, and there are now a number of alternative approaches for mapping from verbal autopsy interviews to the underlying cause of death. For public health applications, the population-level aggregates of the underlying causes are of primary interest, expressed as the cause-specific mortality fractions (CSMFs) for a mutually exclusive, collectively exhaustive cause list. Although it allows for relative comparisons of alternative methods, CSMF Accuracy provides misleading numbers in absolute terms, because even random allocation of underlying causes yields relatively high CSMF accuracy. Therefore, the objective of this study was to develop and test a measure of CSMF that corrects this problem.
Modifiable risks account for a large fraction of disease and death, but clinicians and patients lack tools to identify high-risk populations or compare the possible benefit of different interventions.
United Nations member states have agreed to reduce premature cardiovascular disease (CVD) mortality 25% by 2025. Global CVD risk factor targets have been recommended. We produced estimates to show how selected risk factor reduction would affect CVD mortality for different regions and countries.