Papers by SEGUN EMMANUEL IBITOYE
PLOS ONE, Dec 13, 2022
Background Women performing strenuous domestic tasks (especially those in developing countries) a... more Background Women performing strenuous domestic tasks (especially those in developing countries) are at risk of experiencing musculoskeletal pain (MSP). Physical, psychosocial, and social conditions of work in rural environments contribute to women's domestic work experiences (DWEs) and the risk of MSP. The impact of DWEs on women's health is especially severe in water-insecure countries like Nigeria. This study examines the relationship between a recently developed measure of DWEs and self-reported pain in the lower back (LBP), neck/ shoulder (NSP), and elbow/hand/wrist regions (EHWP) among rural Nigerian women. Methods Interviewer-administered survey data were collected from 356 women in four rural communities of Ibadan, Nigeria. Binary and ordinal logistic regression models were used to examine the relationship between DWE factor scores, sociodemographic characteristics, and musculoskeletal pain symptoms and severity after controlling for sociodemographic covariates. Effect estimates of association were presented using the odds ratio (OR), and the corresponding 95% confidence interval (CI) at p-value of 0.05. Findings Among 356 participants, the 2-month prevalence of LBP was 58%, NSP was 30%, and EWHP 30%. High DWE scores were significantly associated with higher odds of experiencing and having more severe LBP, NSP, and EHWP. Specifically, the odds of LBP [(OR = 2.88; 95% CI = 1.64-5.11), NSP (OR = 4.58; 95% CI = 2.29-9.40) and EHWP (OR = 1.88; 95% CI = 1.26-3.77)] were significantly higher among women who perceived their domestic work responsibilities as very stressful (i.e., 'high stress appraisal') compared to those with lower stress appraisal scores. Those who were time-pressured and
The Lancet
Background Understanding the magnitude of cancer burden attributable to potentially modifiable ri... more Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4•45 million (95% uncertainty interval 4•01-4•94) deaths and 105 million (95•0-116) DALYs for both sexes combined, representing 44•4% (41•3-48•4) of all cancer deaths and 42•0% (39•1-45•6) of all DALYs. There were 2•88 million (2•60-3•18) risk-attributable cancer deaths in males (50•6% [47•8-54•1] of all male cancer deaths) and 1•58 million (1•36-1•84) risk-attributable cancer deaths in females (36•3% [32•5-41•3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20•4% (12•6-28•4) and DALYs by 16•8% (8•8-25•0), with the greatest percentage increase in metabolic risks (34•7% [27•9-42•8] and 33•3% [25•8-42•0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Funding Bill & Melinda Gates Foundation.
The Lancet Infectious Diseases
Background The global burden of lower respiratory infections (LRIs) and corresponding risk factor... more Background The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across all age groups by sex, for 204 countries and territories. Methods In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used clinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466–469, 470.0, 480–482.8, 483.0–483.9, 484.1–484.2, 484.6–484.7, and 487–489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4–B97.6, J09–J15.8, J16–J16.9, J20–J21.9, J91.0, P23.0–P23.4, and U04–U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23 109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age–sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and claims and inpatient data. Additionally, we estimated age–sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors. Findings Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240–275) LRI incident episodes in males and 232 million (217–248) in females. In the same year, LRIs accounted for 1·30 million (95% UI 1·18–1·42) male deaths and 1·20 million (1·07–1·33) female deaths. Age-standardised incidence and mortality rates were 1·17 times (95% UI 1·16–1·18) and 1·31 times (95% UI 1·23–1·41) greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126·0% [95% UI 121·4–131·1]) and deaths (100·0% [83·4–115·9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for LRI deaths in males younger than 5 years (–70·7% [–77·2 to –61·8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53·0% [95% UI 37·7–61·8] in males and 56·4% [40·7–65·1] in females), and more than a quarter of LRI deaths among those aged 5–14 years were attributable to household air pollution (PAF 26·0% [95% UI 16·6–35·5] for males and PAF 25·8% [16·3–35·4] for females). PAFs of male LRI deaths attributed to smoking were 20·4% (95% UI 15·4–25·2) in those aged 15–49 years, 30·5% (24·1–36·9) in those aged 50–69 years, and 21·9% (16·8–27·3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21·1% (95% UI 14·5–27·9) in those aged 15–49 years and 18·2% (12·5–24·5) in those aged 50–69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11·7% (95% UI 8·2–15·8) of LRI deaths. Interpretation The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children younger than 5 years was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, including promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities.
Additional file 4. Themes and sub-themes for qualitative data analysis.
Additional file 2. Key Informant interview guide for School Principals.
TEXILA INTERNATIONAL JOURNAL OF ACADEMIC RESEARCH, 2021
Self-injection of DMPA-SC method is one of the Government of Nigeria’s (GON) national family plan... more Self-injection of DMPA-SC method is one of the Government of Nigeria’s (GON) national family planning goals to address the unmet need for contraception. Some studies on DMPA-SC/SI have demonstrated its feasibility to improve modern contraceptive uptake. However, there is a gap in the predictors of method uptake and continuation across self-injecting and provider-administered in Nigeria. This study explored the uptake of self-injection DMPA-SC contraceptives among women in two geopolitical zones of Nigeria. The study employed 20 focused group discussions (FGDs) and 40 In-depth interviews (IDIs). Self-structured pretested questionnaire to elicit information from 844 women registered for Family Planning in selected health facilities. Descriptive statistics were calculated and multivariate logistic regression was used to model determinants of DMPA-SC/SI family planning uptake. Six months of Secondary Data from the Health Management Information system (HMIS) was used to triangulate the t...
The Lancet HIV, 2021
The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. U... more The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1-38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78-0·91) per female living with HIV in 2019, 0·99 male infections (0·91-1·10) for every female infection, and 1·02 male deaths (0·95-1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58-35·43, and a 39·66% decrease in deaths, 36·49-42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05-0·06) and the global incidence-to-mortality ratio was 1·94 (1·76-2·12). No regions met suggested thresholds for progress. Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH.
The Lancet Infectious Diseases, 2021
Background Tuberculosis is a major contributor to the global burden of disease, causing more than... more Background Tuberculosis is a major contributor to the global burden of disease, causing more than a million deaths annually. Given an emphasis on equity in access to diagnosis and treatment of tuberculosis in global health targets, evaluations of differences in tuberculosis burden by sex are crucial. We aimed to assess the levels and trends of the global burden of tuberculosis, with an emphasis on investigating differences in sex by HIV status for 204 countries and territories from 1990 to 2019. Methods We used a Bayesian hierarchical Cause of Death Ensemble model (CODEm) platform to analyse 21 505 siteyears of vital registration data, 705 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, and 680 site-years of mortality surveillance data to estimate mortality due to tuberculosis among HIV-negative individuals. We used a population attributable fraction approach to estimate mortality related to HIV and tuberculosis coinfection. A compartmental meta-regression tool (DisMod-MR 2.1) was then used to synthesise all available data sources, including prevalence surveys, annual case notifications, population-based tuberculin surveys, and tuberculosis cause-specific mortality, to produce estimates of incidence, prevalence, and mortality that were internally consistent. We further estimated the fraction of tuberculosis mortality that is attributable to independent effects of risk factors, including smoking, alcohol use, and diabetes, for HIV-negative individuals. For individuals with HIV and tuberculosis coinfection, we assessed mortality attributable to HIV risk factors including unsafe sex, intimate partner violence (only estimated among females), and injection drug use. We present 95% uncertainty intervals for all estimates. Findings Globally, in 2019, among HIV-negative individuals, there were 1•18 million (95% uncertainty interval 1•08-1•29) deaths due to tuberculosis and 8•50 million (7•45-9•73) incident cases of tuberculosis. Among HIV-positive individuals, there were 217 000 (153 000-279 000) deaths due to tuberculosis and 1•15 million (1•01-1•32) incident cases in 2019. More deaths and incident cases occurred in males than in females among HIV-negative individuals globally in 2019, with 342 000 (234 000-425 000) more deaths and 1•01 million (0•82-1•23) more incident cases in males than in females. Among HIV-positive individuals, 6250 (1820-11 400) more deaths and 81 100 (63 300-100 000) more incident cases occurred among females than among males in 2019. Age-standardised mortality rates among HIV-negative males were more than two times greater in 105 countries and age-standardised incidence rates were more than 1•5 times greater in 74 countries than among HIV-negative females in 2019. The fraction of global tuberculosis deaths among HIV-negative individuals attributable to alcohol use, smoking, and diabetes was 4•27 (3•69-5•02), 6•17 (5•48-7•02), and 1•17 (1•07-1•28) times higher, respectively, among males than among females in 2019. Among individuals with HIV and tuberculosis coinfection, the fraction of mortality attributable to injection drug use was 2•23 (2•03-2•44) times greater among males than females, whereas the fraction due to unsafe sex was 1•06 (1•05-1•08) times greater among females than males. Interpretation As countries refine national tuberculosis programmes and strategies to end the tuberculosis epidemic, the excess burden experienced by males is important. Interventions are needed to actively communicate, especially to men, the importance of early diagnosis and treatment. These interventions should occur in parallel with efforts to minimise excess HIV burden among women in the highest HIV burden countries that are contributing to excess HIV and tuberculosis coinfection burden for females. Placing a focus on tuberculosis burden among HIV-negative males and HIV and tuberculosis coinfection among females might help to diminish the overall burden of tuberculosis. This strategy will be crucial in reaching both equity and burden targets outlined by global health milestones. Funding Bill & Melinda Gates Foundation.
The Lancet Neurology, 2021
Background Regularly updated data on stroke and its pathological types, including data on their i... more Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12•2 million (95% UI 11•0-13•6) incident cases of stroke, 101 million (93•2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6•55 million (6•00-7•02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11•6% [10•8-12•2] of total deaths) and the third-leading cause of death and disability combined (5•7% [5•1-6•2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70•0% (67•0-73•0), prevalent strokes increased by 85•0% (83•0-88•0), deaths from stroke increased by 43•0% (31•0-55•0), and DALYs due to stroke increased by 32•0% (22•0-42•0). During the same period, age-standardised rates of stroke incidence decreased by 17•0% (15•0-18•0), mortality decreased by 36•0% (31•0-42•0), prevalence decreased by 6•0% (5•0-7•0), and DALYs decreased by 36•0% (31•0-42•0). However, among people younger than 70 years, prevalence rates increased by 22•0% (21•0-24•0) and incidence rates increased by 15•0% (12•0-18•0). In 2019, the age-standardised stroke-related mortality rate was 3•6 (3•5-3•8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3•7 (3•5-3•9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62•4% of all incident strokes in 2019 (7•63 million [6•57-8•96]), while intracerebral haemorrhage constituted 27•9% (3•41 million [2•97-3•91]) and subarachnoid haemorrhage constituted 9•7% (1•18 million [1•01-1•39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79•6 million [67•7-90•8] DALYs or 55•5% [48•2-62•0] of total stroke DALYs), high bodymass index (34•9 million [22•3-48•6] DALYs or 24•3% [15•7-33•2]), high fasting plasma glucose (28•9 million [19•8-41•5] DALYs or 20•2% [13•8-29•1]), ambient particulate matter pollution (28•7 million [23•4-33•4] DALYs or 20•1% [16•6-23•0]), and smoking (25•3 million [22•6-28•2] DALYs or 17•6% [16•4-19•0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastestgrowing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries. Funding Bill & Melinda Gates Foundation.
The Lancet HIV, 2021
Background High-resolution estimates of HIV burden across space and time provide an important too... more Background High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15-49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000-18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV ...
Archives of Environmental & Occupational Health, 2020
Abstract Laptop use comes with potential reproductive health risks for men. This study assessed t... more Abstract Laptop use comes with potential reproductive health risks for men. This study assessed the knowledge of reproductive health hazards and factors associated with direct use of laptop on the lap among male undergraduates of the University of Ibadan, Nigeria. A cross-sectional study conducted among 444 male undergraduates using multi-stage sampling and data collected through a validated questionnaire. Mean age was 21.0 years ± 2.6. Knowledge and perception of reproductive health hazards associated with direct laptop use were fairly good but practice was high. The knowledge of reproductive health hazards associated with direct laptop use on the lap was not associated with use (p = 0.08) and factors influencing use include; influence by colleagues (67.6%), non-availability of laptop cooling pads (42.6%), high cost of cooling pads (39.9%), perception of convenience (41.7%). Interventions on laptop ergonomics awareness and provision of affordable laptop ergonomic products for university students are recommended.
The Lancet Global Health, 2021
Background Despite a substantial reduction in the use of solid fuels worldwide, exposure to house... more Background Despite a substantial reduction in the use of solid fuels worldwide, exposure to household air pollution (HAP) from use of these fuels for cooking remains a leading risk factor for global disease burden. Among environmental risk factors, the contribution of HAP to disease burden is second only to ambient particulate matter pollution. We present updates to our modeling methodology as well as our latest findings on attributable burden estimates. Methods We estimated HAP-attributable burden for cataract, chronic obstructive pulmonary disease, ischaemic heart disease, lower respiratory infections, lung cancer, neonatal disorders, stroke, and type 2 diabetes for 204 countries and territories from 1990 to 2019. We used spatio-temporal Gaussian Process Regression to model data from observational surveys and censuses reporting primary cooking fuel to estimate the proportion of individuals using a specific solid-fuel type (wood, coal/charcoal, agricultural residues, or dung) by location. We converted the fuel exposure estimates to year, location, and sex/age-specific PM 2•5 exposures with a regression mapping function using household air pollution measurements. Using a Bayesian meta-regression tool, we estimated relative risk as a function of PM 2•5 exposure for each disease based upon a systematic review of the epidemiological literature on indoor and ambient air pollution. We then combined our exposure estimates and relative risks to estimate population attributable fractions and attributable burden for each cause. Findings In 2019, 91•5 million global disability-adjusted life years (DALYs) (95% uncertainty interval 67•0-119) were attributable to HAP, a decline of more than 50% from 1990. We estimated 2•31 million (1•63-3•12) global deaths were attributable to HAP and accounted for over 4% of all deaths in 2019. HAP-attributable burden remains highest in sub-Saharan Africa and south Asia, with 3770•3 (2876•4-4720•2) and 2068•0 (1412•5-2799•7) age-standardised DALYs per 100 000 population, respectively. Interpretation Although the disease burden attributable to HAP decreased considerably between 1990 and 2019, it remains a significant risk factor. Our internally consistent methodology and comprehensive approach to estimation of HAP-attributable burden provides a robust resource for global health interventions. Efforts to transition to cleaner household energy sources should be accelerated. Funding Bill & Melinda Gates Foundation.
BMC Medicine, 2021
Background Human immunodeficiency virus (HIV) remains a public health priority in Latin America. ... more Background Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of ...
Nature Medicine, 2020
An amendment to this paper has been published and can be accessed via a link at the top of the pa... more An amendment to this paper has been published and can be accessed via a link at the top of the paper.
The Lancet, 2020
(2020). Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-... more (2020). Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000-17: analysis for the Global Burden of Disease Study 2017. The Lancet.
BMC Medicine
Background Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is sti... more Background Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15–59 years across SSA. Methods We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees...
The Lancet Global Health, 2020
Background Lymphatic filariasis is a neglected tropical disease that can cause permanent disabili... more Background Lymphatic filariasis is a neglected tropical disease that can cause permanent disability through disruption of the lymphatic system. This disease is caused by parasitic filarial worms that are transmitted by mosquitos. Mass drug administration (MDA) of antihelmintics is recommended by WHO to eliminate lymphatic filariasis as a public health problem. This study aims to produce the first geospatial estimates of the global prevalence of lymphatic filariasis infection over time, to quantify progress towards elimination, and to identify geographical variation in distribution of infection. Methods A global dataset of georeferenced surveyed locations was used to model annual 2000-18 lymphatic filariasis prevalence for 73 current or previously endemic countries. We applied Bayesian model-based geostatistics and time series methods to generate spatially continuous estimates of global all-age 2000-18 prevalence of lymphatic filariasis infection mapped at a resolution of 5 km² and aggregated to estimate total number of individuals infected. Findings We used 14 927 datapoints to fit the geospatial models. An estimated 199 million total individuals (95% uncertainty interval 174-234 million) worldwide were infected with lymphatic filariasis in 2000, with totals for WHO regions ranging from 3•1 million (1•6-5•7 million) in the region of the Americas to 107 million (91-134 million) in the SouthEast Asia region. By 2018, an estimated 51 million individuals (43-63 million) were infected. Broad declines in prevalence are observed globally, but focal areas in Africa and southeast Asia remain less likely to have attained infection prevalence thresholds proposed to achieve local elimination. Interpretation Although the prevalence of lymphatic filariasis infection has declined since 2000, MDA is still necessary across large populations in Africa and Asia. Our mapped estimates can be used to identify areas where the probability of meeting infection thresholds is low, and when coupled with large uncertainty in the predictions, indicate additional data collection or intervention might be warranted before MDA programmes cease. Funding Bill & Melinda Gates Foundation.
The Lancet Oncology, 2021
Background In estimating the global burden of cancer, adolescents and young adults with cancer ar... more Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1•19 million (95% UI 1•11-1•28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59•6 [54•5-65•7] per 100 000 person-years) and high-middle SDI countries (53•2 [48•8-57•9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14•2 [12•9-15•6] per 100 000 person-years) and middle SDI (13•6 [12•6-14•8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23•5 million (21•9-25•2) DALYs to the global burden of disease, of which 2•7% (1•9-3•6) came from YLDs and 97•3% (96•4-98•1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts.
Open Access Journal of Contraception, 2021
Background: Injectable contraceptives are fast becoming the method of choice among women in sub-S... more Background: Injectable contraceptives are fast becoming the method of choice among women in sub-Saharan Africa (SSA). Specifically, the subcutaneously administered depotmedroxyprogesterone acetate (DMPA-SC) is gaining traction as a convenient, private and effective method to address unmet need for family planning (FP). The objective of this study was to determine the trend in DMPA-SC use in Nigeria. Methods: Data was extracted from the National Health Management Information System (NHMIS) FP register on DMPA-SC uptake in public health facilities and through community-oriented resource providers (CORPS) in 10 Nigerian states. The linear trend model was adopted in data analysis based on lowest measure of dispersion and/or highest adjusted coefficient of determination (R 2). The statistical significance was determined at 5%. Results: There was an upward trend in the use of DMPA-SC among clients who received the service through health providers, CORPS and self-injection in the 10 project states over a period of 12 months (August 2019-July 2020). In addition, the linear trend model showed that for every unit increase in months, the average number of women expected to use DMPA-SC through health providers, CORPS and self-injection will increase by 1308.3 (Yt = 3799.7 +1308.3*t), 756.73 (Yt = −1030.8 +756.73*t) and 77.864 (Yt = −159.7 +77.864*t) respectively. In all models, the adjusted coefficient of determination was 99.9% which showed good model fitness. The results also showed that the number of DMPA-SC clients varied across the project states with Niger (32,988) and Oyo (31,511) states reporting the highest number of clients over the period of 12 months. Conclusion: There was an increasing use of DMPA-SC and self-injection among clients over time. Health facility and community-based FP programs should be strengthened to ensure improved access to FP services.
The Lancet, 2021
Background Documentation of patterns and long-term trends in mortality in young people, which ref... more Background Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10-24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10-24 years by age group (10-14 years, 15-19 years, and 20-24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10-24 years with that in children aged 0-9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10-24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). Findings In 2019 there were 1•49 million deaths (95% uncertainty interval 1•39-1•59) worldwide in people aged 10-24 years, of which 61% occurred in males. 32•7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32•1% were due to communicable, nutritional, or maternal causes; 27•0% were due to non-communicable diseases; and 8•2% were due to self-harm. Since 1950, deaths in this age group decreased by 30•0% in females and 15•3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10-14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15-19 years was 1•3% in males and 1•6% in females, almost half that of males aged 1-4 years (2•4%), and around a third less than in females aged 1-4 years (2•5%). The proportion of global deaths in people aged 0-24 years that occurred in people aged 10-24 years more than doubled between 1950 and 2019, from 9•5% to 21•6%. Interpretation Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10-24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group. Funding Bill & Melinda Gates Foundation.
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Papers by SEGUN EMMANUEL IBITOYE