@article {10524, title = {Child and Adolescent Health From 1990 to 2015: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study.}, journal = {JAMA Pediatr}, volume = {171}, year = {2017}, month = {2017 Jun 01}, pages = {573-592}, abstract = {

Importance: Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health.

Objective: To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion.

Evidence Review: Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss.

Findings: Global child and adolescent mortality decreased from 14.18 million (95\% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95\% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75\%) in 2015 than was the case in 1990 (61\%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3\% (95\% UI, 3.1\%-5.6\%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries.

Conclusions and Relevance: Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.

}, keywords = {Adolescent, Adolescent Health, Age Factors, Cause of Death, Child, Child Health, Child Mortality, Disabled Children, Female, Global Burden of Disease, Global Health, Humans, Male, Pregnancy, Pregnancy Complications, Risk Factors, Sex Factors, Wounds and Injuries}, issn = {2168-6211}, doi = {10.1001/jamapediatrics.2017.0250}, author = {Kassebaum, Nicholas and Kyu, Hmwe Hmwe and Zoeckler, Leo and Olsen, Helen Elizabeth and Thomas, Katie and Pinho, Christine and Bhutta, Zulfiqar A and Dandona, Lalit and Ferrari, Alize and Ghiwot, Tsegaye Tewelde and Hay, Simon I and Kinfu, Yohannes and Liang, Xiaofeng and Lopez, Alan and Malta, Deborah Carvalho and Mokdad, Ali H and Naghavi, Mohsen and Patton, George C and Salomon, Joshua and Sartorius, Benn and Topor-Madry, Roman and Vollset, Stein Emil and Werdecker, Andrea and Whiteford, Harvey A and Abate, Kalkidan Hasen and Abbas, Kaja and Damtew, Solomon Abrha and Ahmed, Muktar Beshir and Akseer, Nadia and Al-Raddadi, Rajaa and Alemayohu, Mulubirhan Assefa and Altirkawi, Khalid and Abajobir, Amanuel Alemu and Amare, Azmeraw T and Antonio, Carl A T and Arnl{\"o}v, Johan and Artaman, Al and Asayesh, Hamid and Avokpaho, Euripide Frinel G Arthur and Awasthi, Ashish and Ayala Quintanilla, Beatriz Paulina and Bacha, Umar and Betsu, Balem Demtsu and Barac, Aleksandra and B{\"a}rnighausen, Till Winfried and Baye, Estifanos and Bedi, Neeraj and Bensenor, Isabela M and Berhane, Adugnaw and Bernabe, Eduardo and Bernal, Oscar Alberto and Beyene, Addisu Shunu and Biadgilign, Sibhatu and Bikbov, Boris and Boyce, Cheryl Anne and Brazinova, Alexandra and Hailu, Gessessew Bugssa and Carter, Austin and Casta{\~n}eda-Orjuela, Carlos A and Catal{\'a}-L{\'o}pez, Ferr{\'a}n and Charlson, Fiona J and Chitheer, Abdulaal A and Choi, Jee-Young Jasmine and Ciobanu, Liliana G and Crump, John and Dandona, Rakhi and Dellavalle, Robert P and Deribew, Amare and deVeber, Gabrielle and Dicker, Daniel and Ding, Eric L and Dubey, Manisha and Endries, Amanuel Yesuf and Erskine, Holly E and Faraon, Emerito Jose Aquino and Faro, Andre and Farzadfar, Farshad and Fernandes, Joao C and Fijabi, Daniel Obadare and Fitzmaurice, Christina and Fleming, Thomas D and Flor, Luisa Sorio and Foreman, Kyle J and Franklin, Richard C and Fraser, Maya S and Frostad, Joseph J and Fullman, Nancy and Gebregergs, Gebremedhin Berhe and Gebru, Alemseged Aregay and Geleijnse, Johanna M and Gibney, Katherine B and Gidey Yihdego, Mahari and Ginawi, Ibrahim Abdelmageem Mohamed and Gishu, Melkamu Dedefo and Gizachew, Tessema Assefa and Glaser, Elizabeth and Gold, Audra L and Goldberg, Ellen and Gona, Philimon and Goto, Atsushi and Gugnani, Harish Chander and Jiang, Guohong and Gupta, Rajeev and Tesfay, Fisaha Haile and Hankey, Graeme J and Havmoeller, Rasmus and Hijar, Martha and Horino, Masako and Hosgood, H Dean and Hu, Guoqing and Jacobsen, Kathryn H and Jakovljevic, Mihajlo B and Jayaraman, Sudha P and Jha, Vivekanand and Jibat, Tariku and Johnson, Catherine O and Jonas, Jost and Kasaeian, Amir and Kawakami, Norito and Keiyoro, Peter N and Khalil, Ibrahim and Khang, Young-Ho and Khubchandani, Jagdish and Ahmad Kiadaliri, Aliasghar A and Kieling, Christian and Kim, Daniel and Kissoon, Niranjan and Knibbs, Luke D and Koyanagi, Ai and Krohn, Kristopher J and Kuate Defo, Barthelemy and Kucuk Bicer, Burcu and Kulikoff, Rachel and Kumar, G Anil and Lal, Dharmesh Kumar and Lam, Hilton Y and Larson, Heidi J and Larsson, Anders and Laryea, Dennis Odai and Leung, Janni and Lim, Stephen S and Lo, Loon-Tzian and Lo, Warren D and Looker, Katharine J and Lotufo, Paulo A and Magdy Abd El Razek, Hassan and Malekzadeh, Reza and Markos Shifti, Desalegn and Mazidi, Mohsen and Meaney, Peter A and Meles, Kidanu Gebremariam and Memiah, Peter and Mendoza, Walter and Abera Mengistie, Mubarek and Mengistu, Gebremichael Welday and Mensah, George A and Miller, Ted R and Mock, Charles and Mohammadi, Alireza and Mohammed, Shafiu and Monasta, Lorenzo and Mueller, Ulrich and Nagata, Chie and Naheed, Aliya and Nguyen, Grant and Nguyen, Quyen Le and Nsoesie, Elaine and Oh, In-Hwan and Okoro, Anselm and Olusanya, Jacob Olusegun and Olusanya, Bolajoko O and Ortiz, Alberto and Paudel, Deepak and Pereira, David M and Perico, Norberto and Petzold, Max and Phillips, Michael Robert and Polanczyk, Guilherme V and Pourmalek, Farshad and Qorbani, Mostafa and Rafay, Anwar and Rahimi-Movaghar, Vafa and Rahman, Mahfuzar and Rai, Rajesh Kumar and Ram, Usha and Rankin, Zane and Remuzzi, Giuseppe and Renzaho, Andre M N and Roba, Hirbo Shore and Rojas-Rueda, David and Ronfani, Luca and Sagar, Rajesh and Sanabria, Juan Ramon and Kedir Mohammed, Muktar Sano and Santos, Itamar S and Satpathy, Maheswar and Sawhney, Monika and Sch{\"o}ttker, Ben and Schwebel, David C and Scott, James G and Sepanlou, Sadaf G and Shaheen, Amira and Shaikh, Masood Ali and She, June and Shiri, Rahman and Shiue, Ivy and Sigfusdottir, Inga Dora and Singh, Jasvinder and Silpakit, Naris and Smith, Alison and Sreeramareddy, Chandrashekhar and Stanaway, Jeffrey D and Stein, Dan J and Steiner, Caitlyn and Sufiyan, Muawiyyah Babale and Swaminathan, Soumya and Tabar{\'e}s-Seisdedos, Rafael and Tabb, Karen M and Tadese, Fentaw and Tavakkoli, Mohammad and Taye, Bineyam and Teeple, Stephanie and Tegegne, Teketo Kassaw and Temam Shifa, Girma and Terkawi, Abdullah Sulieman and Thomas, Bernadette and Thomson, Alan J and Tobe-Gai, Ruoyan and Tonelli, Marcello and Tran, Bach Xuan and Troeger, Christopher and Ukwaja, Kingsley N and Uthman, Olalekan and Vasankari, Tommi and Venketasubramanian, Narayanaswamy and Vlassov, Vasiliy Victorovich and Weiderpass, Elisabete and Weintraub, Robert and Gebrehiwot, Solomon Weldemariam and Westerman, Ronny and Williams, Hywel C and Wolfe, Charles D A and Woodbrook, Rachel and Yano, Yuichiro and Yonemoto, Naohiro and Yoon, Seok-Jun and Younis, Mustafa Z and Yu, Chuanhua and Zaki, Maysaa El Sayed and Zegeye, Elias Asfaw and Zuhlke, Liesl Joanna and Murray, Christopher J L and Vos, Theo} } @article {3531, title = {Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.}, journal = {Lancet}, volume = {384}, year = {2014}, month = {2014 Sep 13}, pages = {980-1004}, abstract = {

BACKGROUND: The fifth Millennium Development Goal (MDG 5) established the goal of a 75\% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery.

METHODS: We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95\% uncertainty intervals (UIs) for all values.

FINDINGS: 292,982 (95\% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0{\textperiodcentered}3\% (-1{\textperiodcentered}1 to 0{\textperiodcentered}6) from 1990 to 2003, and -2{\textperiodcentered}7\% (-3{\textperiodcentered}9 to -1{\textperiodcentered}5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0{\textperiodcentered}4\% (0{\textperiodcentered}2-0{\textperiodcentered}6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956{\textperiodcentered}8 (685{\textperiodcentered}1-1262{\textperiodcentered}8) in South Sudan to 2{\textperiodcentered}4 (1{\textperiodcentered}6-3{\textperiodcentered}6) in Iceland.

INTERPRETATION: Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa.

FUNDING: Bill \& Melinda Gates Foundation.

}, keywords = {Age Distribution, Cause of Death, Female, Global Health, HIV Infections, Humans, Maternal Mortality, Models, Statistical, Organizational Objectives, Pregnancy, Pregnancy Complications, Infectious, Risk Factors, Socioeconomic Factors, Time Factors}, issn = {1474-547X}, doi = {10.1016/S0140-6736(14)60696-6}, author = {Kassebaum, Nicholas J and Bertozzi-Villa, Amelia and Coggeshall, Megan S and Shackelford, Katya A and Steiner, Caitlyn and Heuton, Kyle R and Gonzalez-Medina, Diego and Barber, Ryan and Huynh, Chantal and Dicker, Daniel and Templin, Tara and Wolock, Timothy M and Ozgoren, Ayse Abbasoglu and Abd-Allah, Foad and Abera, Semaw Ferede and Abubakar, Ibrahim and Achoki, Tom and Adelekan, Ademola and Ademi, Zanfina and Adou, Ars{\`e}ne Kouablan and Adsuar, Jos{\'e} C and Agardh, Emilie E and Akena, Dickens and Alasfoor, Deena and Alemu, Zewdie Aderaw and Alfonso-Cristancho, Rafael and Alhabib, Samia and Ali, Raghib and Al Kahbouri, Mazin J and Alla, Fran{\c c}ois and Allen, Peter J and AlMazroa, Mohammad A and Alsharif, Ubai and Alvarez, Elena and Alvis-Guzm{\'a}n, Nelson and Amankwaa, Adansi A and Amare, Azmeraw T and Amini, Hassan and Ammar, Walid and Antonio, Carl A T and Anwari, Palwasha and Arnl{\"o}v, Johan and Arsenijevic, Valentina S Arsic and Artaman, Ali and Asad, Majed Masoud and Asghar, Rana J and Assadi, Reza and Atkins, Lydia S and Badawi, Alaa and Balakrishnan, Kalpana and Basu, Arindam and Basu, Sanjay and Beardsley, Justin and Bedi, Neeraj and Bekele, Tolesa and Bell, Michelle L and Bernabe, Eduardo and Beyene, Tariku J and Bhutta, Zulfiqar and Bin Abdulhak, Aref and Blore, Jed D and Basara, Berrak Bora and Bose, Dipan and Breitborde, Nicholas and C{\'a}rdenas, Rosario and Casta{\~n}eda-Orjuela, Carlos A and Castro, Ruben Estanislao and Catal{\'a}-L{\'o}pez, Ferr{\'a}n and Cavlin, Alanur and Chang, Jung-Chen and Che, Xuan and Christophi, Costas A and Chugh, Sumeet S and Cirillo, Massimo and Colquhoun, Samantha M and Cooper, Leslie Trumbull and Cooper, Cyrus and da Costa Leite, Iuri and Dandona, Lalit and Dandona, Rakhi and Davis, Adrian and Dayama, Anand and Degenhardt, Louisa and De Leo, Diego and del Pozo-Cruz, Borja and Deribe, Kebede and Dessalegn, Muluken and deVeber, Gabrielle A and Dharmaratne, Samath D and Dilmen, U{\u g}ur and Ding, Eric L and Dorrington, Rob E and Driscoll, Tim R and Ermakov, Sergei Petrovich and Esteghamati, Alireza and Faraon, Emerito Jose A and Farzadfar, Farshad and Felicio, Manuela Mendonca and Fereshtehnejad, Seyed-Mohammad and de Lima, Gra{\c c}a Maria Ferreira and Forouzanfar, Mohammad H and Fran{\c c}a, Elisabeth B and Gaffikin, Lynne and Gambashidze, Ketevan and Gankp{\'e}, Fortun{\'e} Gb{\`e}toho and Garcia, Ana C and Geleijnse, Johanna M and Gibney, Katherine B and Giroud, Maurice and Glaser, Elizabeth L and Goginashvili, Ketevan and Gona, Philimon and Gonz{\'a}lez-Castell, Dinorah and Goto, Atsushi and Gouda, Hebe N and Gugnani, Harish Chander and Gupta, Rahul and Gupta, Rajeev and Hafezi-Nejad, Nima and Hamadeh, Randah Ribhi and Hammami, Mouhanad and Hankey, Graeme J and Harb, Hilda L and Havmoeller, Rasmus and Hay, Simon I and Pi, Ileana B Heredia and Hoek, Hans W and Hosgood, H Dean and Hoy, Damian G and Husseini, Abdullatif and Idrisov, Bulat T and Innos, Kaire and Inoue, Manami and Jacobsen, Kathryn H and Jahangir, Eiman and Jee, Sun Ha and Jensen, Paul N and Jha, Vivekanand and Jiang, Guohong and Jonas, Jost B and Juel, Knud and Kabagambe, Edmond Kato and Kan, Haidong and Karam, Nadim E and Karch, Andr{\'e} and Karema, Corine Kakizi and Kaul, Anil and Kawakami, Norito and Kazanjan, Konstantin and Kazi, Dhruv S and Kemp, Andrew H and Kengne, Andre Pascal and Kereselidze, Maia and Khader, Yousef Saleh and Khalifa, Shams Eldin Ali Hassan and Khan, Ejaz Ahmed and Khang, Young-Ho and Knibbs, Luke and Kokubo, Yoshihiro and Kosen, Soewarta and Defo, Barthelemy Kuate and Kulkarni, Chanda and Kulkarni, Veena S and Kumar, G Anil and Kumar, Kaushalendra and Kumar, Ravi B and Kwan, Gene and Lai, Taavi and Lalloo, Ratilal and Lam, Hilton and Lansingh, Van C and Larsson, Anders and Lee, Jong-Tae and Leigh, James and Leinsalu, Mall and Leung, Ricky and Li, Xiaohong and Li, Yichong and Li, Yongmei and Liang, Juan and Liang, Xiaofeng and Lim, Stephen S and Lin, Hsien-Ho and Lipshultz, Steven E and Liu, Shiwei and Liu, Yang and Lloyd, Belinda K and London, Stephanie J and Lotufo, Paulo A and Ma, Jixiang and Ma, Stefan and Machado, Vasco Manuel Pedro and Mainoo, Nana Kwaku and Majdan, Marek and Mapoma, Christopher Chabila and Marcenes, Wagner and Marzan, Melvin Barrientos and Mason-Jones, Amanda J and Mehndiratta, Man Mohan and Mejia-Rodriguez, Fabiola and Memish, Ziad A and Mendoza, Walter and Miller, Ted R and Mills, Edward J and Mokdad, Ali H and Mola, Glen Liddell and Monasta, Lorenzo and de la Cruz Monis, Jonathan and Hernandez, Julio Cesar Monta{\~n}ez and Moore, Ami R and Moradi-Lakeh, Maziar and Mori, Rintaro and Mueller, Ulrich O and Mukaigawara, Mitsuru and Naheed, Aliya and Naidoo, Kovin S and Nand, Devina and Nangia, Vinay and Nash, Denis and Nejjari, Chakib and Nelson, Robert G and Neupane, Sudan Prasad and Newton, Charles R and Ng, Marie and Nieuwenhuijsen, Mark J and Nisar, Muhammad Imran and Nolte, Sandra and Norheim, Ole F and Nyakarahuka, Luke and Oh, In-Hwan and Ohkubo, Takayoshi and Olusanya, Bolajoko O and Omer, Saad B and Opio, John Nelson and Orisakwe, Orish Ebere and Pandian, Jeyaraj D and Papachristou, Christina and Park, Jae-Hyun and Caicedo, Angel J Paternina and Patten, Scott B and Paul, Vinod K and Pavlin, Boris Igor and Pearce, Neil and Pereira, David M and Pesudovs, Konrad and Petzold, Max and Poenaru, Dan and Polanczyk, Guilherme V and Polinder, Suzanne and Pope, Dan and Pourmalek, Farshad and Qato, Dima and Quistberg, D Alex and Rafay, Anwar and Rahimi, Kazem and Rahimi-Movaghar, Vafa and ur Rahman, Sajjad and Raju, Murugesan and Rana, Saleem M and Refaat, Amany and Ronfani, Luca and Roy, Nobhojit and Pimienta, Tania Georgina S{\'a}nchez and Sahraian, Mohammad Ali and Salomon, Joshua A and Sampson, Uchechukwu and Santos, Itamar S and Sawhney, Monika and Sayinzoga, Felix and Schneider, Ione J C and Schumacher, Austin and Schwebel, David C and Seedat, Soraya and Sepanlou, Sadaf G and Servan-Mori, Edson E and Shakh-Nazarova, Marina and Sheikhbahaei, Sara and Shibuya, Kenji and Shin, Hwashin Hyun and Shiue, Ivy and Sigfusdottir, Inga Dora and Silberberg, Donald H and Silva, Andrea P and Singh, Jasvinder A and Skirbekk, Vegard and Sliwa, Karen and Soshnikov, Sergey S and Sposato, Luciano A and Sreeramareddy, Chandrashekhar T and Stroumpoulis, Konstantinos and Sturua, Lela and Sykes, Bryan L and Tabb, Karen M and Talongwa, Roberto Tchio and Tan, Feng and Teixeira, Carolina Maria and Tenkorang, Eric Yeboah and Terkawi, Abdullah Sulieman and Thorne-Lyman, Andrew L and Tirschwell, David L and Towbin, Jeffrey A and Tran, Bach X and Tsilimbaris, Miltiadis and Uchendu, Uche S and Ukwaja, Kingsley N and Undurraga, Eduardo A and Uzun, Selen Beg{\"u}m and Vallely, Andrew J and van Gool, Coen H and Vasankari, Tommi J and Vavilala, Monica S and Venketasubramanian, N and Villalpando, Salvador and Violante, Francesco S and Vlassov, Vasiliy Victorovich and Vos, Theo and Waller, Stephen and Wang, Haidong and Wang, Linhong and Wang, XiaoRong and Wang, Yanping and Weichenthal, Scott and Weiderpass, Elisabete and Weintraub, Robert G and Westerman, Ronny and Wilkinson, James D and Woldeyohannes, Solomon Meseret and Wong, John Q and Wordofa, Muluemebet Abera and Xu, Gelin and Yang, Yang C and Yano, Yuichiro and Yentur, Gokalp Kadri and Yip, Paul and Yonemoto, Naohiro and Yoon, Seok-Jun and Younis, Mustafa Z and Yu, Chuanhua and Jin, Kim Yun and El Sayed Zaki, Maysaa and Zhao, Yong and Zheng, Yingfeng and Zhou, Maigeng and Zhu, Jun and Zou, Xiao Nong and Lopez, Alan D and Naghavi, Mohsen and Murray, Christopher J L and Lozano, Rafael} }