Double Burden Of Disease Research Articles

Factors influencing protective gear use in crisis-affected Afghanistan during COVID-19

Abstract Background Afghanistan has faced considerable challenges in healthcare delivery during the COVID-19 pandemic. These challenges were compounded by limited health literacy, shortages of skilled health workers, and fragile health infrastructure, which increased the country’s double burden of disease. The World Health Organization (WHO) recommended the use of masks as part of a comprehensive strategy to mitigate the spread of SARS-CoV-2. Nevertheless, research on mask-wearing practices in Afghanistan is limited. This study aims to investigate the factors influencing the wearing of protective gear, including masks, during the COVID-19 pandemic in Afghanistan. Methods This study analyzed 16,058 households from the 2020 Afghanistan Multi-Sector Needs Assessment (MSNA) survey data. This survey was conducted between August and September 2020 by the Racial and Ethnic Approaches to Community Health (REACH) Initiative. Sampling weighted multivariable binary logistic regression analysis was performed. Results Recent internally displaced persons (IDPs) and returnees in Afghanistan were more likely to wear protective gear to prevent COVID-19 compared to non-recent IDPs. Factors such as household sizes, household income, knowledge of humanitarian support, and the distance to healthcare facilities were significantly associated with the likelihood of wearing protective gear. Conclusions The study suggests that certain factors place crisis-affected populations in Afghanistan at high risk in COVID-19 preventive behaviors, especially in wearing protective gear. The findings in this study indicate that public health interventions should focus on improving healthcare accessibility and enhancing information dissemination while considering socioeconomic factors. Additionally, this study highlights the need for access to personal protective gear during outbreaks of infectious disease, such as the COVID-19 pandemic. Key messages • Socioeconomic factors and accessibility on health services and information can affect COVID-19 preventive behaviors in crisis-affected populations. • This study can inform public health professionals to develop adequate interventions during infectious disease outbreaks.

Integrating the exposome and one health approach to national health surveillance: an opportunity for Latin American countries in health preventive management.

The exposome approach, emphasizing lifelong environmental exposures, is a holistic framework exploring the intricate interplay between genetics and the environment in shaping health outcomes. Complementing this, the one health approach recognizes the interconnectedness of human and ecological health within a shared ecosystem, extending to planetary health, which encompasses the entire planet. Integrating Disease Surveillance Systems with exposome, one health, and planetary health signifies a paradigm shift in health management, fostering a comprehensive public health framework. This publication advocates for combining traditional health surveillance with exposome and one health/planetary health approach, proposing a three-step approach: ecological analysis, territorial intervention in identified issues, and an analytical phase for assessing interventions. Particularly relevant for Latin American countries facing a double burden of diseases, integrating the exposome into traditional health surveillance proves cost-effective by leveraging existing data and environmental measurements. In conclusion, the integration of exposome and one health approaches into traditional health surveillance presents a robust framework for monitoring population health, especially in regions like Latin America with complex health challenges. This innovative approach enables tailored interventions, disease outbreak predictions, and a holistic understanding of the intricate links between human health and the environment, offering substantial benefits for public health and disease prevention despite existing challenges.

Post-independence health research productivity in Portuguese-speaking African countries: A bibliometric analysis of 43 years of research and higher education in Mozambique

BackgroundAfrica has a high double burden of infectious and non-communicable diseases underscoring the critical need for robust scientific research. However, it is also associated with low scientific research productivity. Mozambique, which gained independence in 1975, serves as a poignant example. However, there remains a notable scarcity of evidence evaluating the country's trajectory in scientific and academic development. This study aims to evaluate 43 years of health-related scientific knowledge production through bibliometric analysis, focusing on key indicators. Additionally, it seeks to characterize the higher education institutions within the country. MethodsThe data was retrieved from the Web of Science Core Collection using an advanced search tool with Boolean research strategies, covering the period from 1976 to 2022 for all PALOP and 1976 to 2019 for Mozambique. To map Mozambican higher institutions, information was sourced from the Ministry of Science Technology and Higher Education database. Descriptive statistics were employed to summarize the findings, while the VOSviewer program version 1.6.19 was utilized to visualize distance-based bibliometric networks, focusing on co-authorship among institutions and keyword co-occurrence. ResultsPortuguese-speaking African countries (PALOP) contribute 2.5 % (10,933 out of 442,309) to Africa's total scientific output, with Mozambique leading at 63.6 % (6,951 publications) followed by Angola at 16.6 % (1,811 publications). All PALOP countries experienced decreased scientific productivity during the third year of the COVID-19 pandemic. In Mozambique, over 70 % (1,710 out of 2,380) of health-related publications from 2011 to 2019 were concentrated in this period. Key journals for health sciences include PLOS ONE, Malaria Journal, and Tropical Medicine & International Health, focusing on HIV, malaria, and tuberculosis. Higher education institutions in Mozambique show regional disparities, with 67.9 % in the South and only 8.9 % in the North, indicating significant inequality in their distribution across the country. ConclusionThis study highlights Mozambique's significant progress in health research productivity over 43 years, establishing it as a leader among PALOP countries. The substantial increase in publications, particularly after 2008, underscores the nation's growing research capacity and commitment to addressing critical health challenges such as HIV, malaria, and tuberculosis. However, regional disparities in higher education access and limited research contributions from private universities remain high in Mozambique.

The Chilean exposome-based system for ecosystems (CHiESS): a framework for national data integration and analytics platform.

The double burden of diseases and scarce resources in developing countries highlight the need to change the conceptualization of health problems and translational research. Contrary to the traditional paradigm focused on genetics, the exposome paradigm proposed in 2005 that complements the genome is an innovative theory. It involves a holistic approach to understanding the complexity of the interactions between the human being’s environment throughout their life and health. This paper outlines a scalable framework for exposome research, integrating diverse data sources for comprehensive public health surveillance and policy support. The Chilean exposome-based system for ecosystems (CHiESS) project proposes a conceptual model based on the ecological and One Health approaches, and the development of a technological dynamic platform for exposome research, which leverages available administrative data routinely collected by national agencies, in clinical records, and by biobanks. CHiESS considers a multilevel exposure for exposome operationalization, including the ecosystem, community, population, and individual levels. CHiESS will include four consecutive stages for development into an informatic platform: (1) environmental data integration and harmonization system, (2) clinical and omics data integration, (3) advanced analytical algorithm development, and (4) visualization interface development and targeted population-based cohort recruitment. The CHiESS platform aims to integrate and harmonize available secondary administrative data and provide a complete geospatial mapping of the external exposome. Additionally, it aims to analyze complex interactions between environmental stressors of the ecosystem and molecular processes of the human being and their effect on human health. Moreover, by identifying exposome-based hotspots, CHiESS allows the targeted and efficient recruitment of population-based cohorts for translational research and impact evaluation. Utilizing advanced technologies such as Artificial Intelligence (AI), Internet of Things (IoT), and blockchain, this framework enhances data security, real-time monitoring, and predictive analytics. The CHiESS model is adaptable for international use, promoting global health collaboration and supporting sustainable development goals.

Atypical presentation of asthma patients with airway fungal infection presenting with possible pulmonary tuberculosis

Background. Low- and middle-income countries, including Sudan, are confronted by the double burden of chronic respiratory diseases and tuberculosis. The presentation of asthma with airway fungal infection can mimic that of pulmonary tuberculosis (PTB), especially in TB endemic countries. Objectives. The study aimed to describe the atypical presentation of asthma with airway fungal infection among patients, some of whom were initially misdiagnosed for PTB, and report their treatment outcomes. Methods. A cross-sectional study was conducted at Abu-Anga Specialized Chest Hospital between January 2017 and December 2019. The study population included asthma patients who tested positive for airway fungal infection (AF) but had negative sputum GeneXpert results for Mycobacterium tuberculosis (MTB), and PTB patients who had positive GeneXpert results for MTB and negative direct smear and culture for fungi. Logistic regression was used to evaluate the association between dependent and independent variables. Results. We recruited a total of 224 patients, including 83 AF patients (mean age 42.2 ± 13.61 years) and 141 PTB patients (mean age 35.4 ± 15.54 years). Females comprised 49.4% of the AF group and 20.6% of the PTB group. PTB radiological features were present in 81.6% of PTB patients versus 9.6% of the AF patients. Among the AF group, fungal culture showed that 20.5% had Aspergillus, and 79.5% had Candida. Wheeze (OR 4.56, 95% CI 2.44-8.55, P<0.001), hemoptysis (OR 3.97, 95% CI 1.99-7.94, P<0.001), and hyperinflation on chest x-ray (OR 16.89, 95% CI 8.28-34.45, P<0.001) were associated with the AF group. The majority of AF patients (90.4%) had favorable treatment outcomes with oral antifungal therapy at 4 months. Conclusion. Asthma with airway fungal infection is underdiagnosed and can be misdiagnosed as PTB, especially in TB endemic settings. Once recognized, satisfactory treatment outcomes could be achieved with the recommended medications.

Synergic activity of FGFR2 and MEK inhibitors in the treatment of FGFR2-amplified cancers of unknown primary

Patients with cancer of unknown primary (CUP) carry the double burden of an aggressive disease and reduced access to therapies. Experimental models are pivotal for CUP biology investigation and drug testing. We derived two CUP cell lines (CUP#55 and #96), and corresponding patient-derived xenografts (PDXs), from ascites tumor cells. CUP cell lines and PDXs underwent histological, immune-phenotypical, molecular, and genomic characterization confirming the features of the original tumor. The tissue-of-origin prediction was obtained from the tumor microRNA expression profile and confirmed by single-cell transcriptomics. Genomic testing and FISH analysis identified FGFR2 gene amplification in both models, in the form of homogenously staining region (HSR) in CUP#55 and double minutes in CUP#96. FGFR2 was recognized as the main oncogenic driver and therapeutic target. FGFR2-targeting drug BGJ-398 (infigratinib) in combination with the MEK inhibitor trametinib proved to be synergic and exceptionally active, both in vitro and in vivo. The effects of the combined treatment by single-cell gene expression analysis revealed a remarkable plasticity of tumor cells and the greater sensitivity of cells with epithelial phenotype. This study brings personalized therapy closer to CUP patients and provides the rationale for FGFR2 and MEK targeting in metastatic tumors with FGFR2 pathway activation.

Mortality among extrapulmonary tuberculosis patients in the HIV endemic setting: lessons from a tertiary level hospital in Mbeya, Tanzania

Extrapulmonary tuberculosis (EPTB) has received less attention than pulmonary tuberculosis due to its non-contagious nature. EPTB can affect any organ and is more prevalent in people living with HIV. Low- and middle-income countries are now facing the double burden of non-communicable diseases (NCDs) and HIV, complicating the management of patients with symptoms that could be compatible with both EPTB and NCDs. Little is known about the risk of death of patients presenting with symptoms compatible with EPTB. We included patients with a clinical suspicion of EPTB from a tertiary level hospital in Mbeya, Tanzania, to assess their risk of dying. A total of 113 (61%) patients were classified as having EPTB, and 72 (39%) as having non-TB, with corresponding mortality rates of 40% and 41%. Associated factors for mortality in the TB groups was hospitalization and male sex. Risk factors for hospitalization was having disease manifestation at any site other than lymph nodes, and comorbidities. Our results imply that NCDs serve as significant comorbidities amplifying the mortality risk in EPTB. To strive towards universal health coverage, focus should be on building robust health systems that can tackle both infectious diseases, such as EPTB, and NCDs.

Morbidity pattern of communicable diseases in a tertiary care hospital in metropolitan city of western Maharashtra

Background: In India, infectious diseases continue to be predominant with emerging non-communicable diseases, imposing a double burden of diseases on health care system. Hence, the tertiary health care hospital-based study was done to compare the morbidity pattern of communicable diseases with respect to non-communicable diseases. Methods: A 2 years’ record-based data of admitted patients was collected in a tertiary health care hospital. The data was analysed using Microsoft Excel version 365. Significance of association and difference in proportions has been checked with chi-square test and Z test for SEDP respectively at significance level of 0.05. Results: During the study period of two years, 6818 patients were admitted in the hospital, of which 74.51% suffered from communicable diseases while 25.49% suffered from other types of disease including non-communicable diseases. Of the 5080, patients with communicable diseases, 57.74% were males and 42.26% were females. Communicable diseases and non-communicable diseases had male predominance (p<0.05) and was higher amongst age group 0-15 years (p<0.05). Hospital stay was prolonged in patients suffering from communicable disease (p<0.05). Significant increased difference was found in AFI, Malaria, Dengue and in Leptospirosis prevalence and significant decreased difference was found in acute gastroenteritis, IV, Covid-19, Respiratory infections and enteric fever (p<0.05). Conclusions: Communicable diseases continue to be a major threat to public health system in India. Through effective surveillance programmes, any change in trends of disease can be identified and suitable measures can be adapted to control and prevent it.

Examining the factors contributing to a reduction in hardship financing among inpatient households in India

In India, the rising double burden of diseases and the low fiscal capacity of the government forces people to resort to hardship financing. This study aimed to examine the factors contributing to the reduction in hardship financing among inpatient households in India. The study relies on two rounds of National Sample Surveys with a sample of 34,478 households from the 71st round (2014) and 56,681 households from the 75th round (2018). We employed multivariable logistic regression and multivariate decomposition analyses to explore the factors associated with hardship financing in Indian households with hospitalized member(s) and assess the contributing factors to the reduction in hardship financing between 2014 and 2018. Notably, though hardship financing for inpatient households has decreased between 2014 and 2018, households with catastrophic health expenditure (CHE) had higher odds of hardship financing than those without CHE. While factors such as CHE, prolonged hospitalization, and private hospitals had impoverishing effects on hardship financing in 2014 and 2018, the decomposition model showed the potential of CHE (32%), length of hospitalization (32%), and private hospitals (24%) to slow down this negative impact over time. The findings showed the potential for further improvements in financial health protection for inpatient care over time, and underscore the need for continuing efforts to strengthen the implementation of public programs and schemes in India such as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY).

Out-of-pocket expenditures associated with double disease burden in Pakistan: a quantile regression analysis

BackgroundPakistan is currently experiencing a double burden of disease. Families with members having both communicable and noncommunicable diseases are at a greater risk of impoverishment due to enormous out-of-pocket payments. This study examines the percentile distribution of the determinants of the out-of-pocket expenditure on the double disease burden.MethodThe study extracted a sample of 6,775 households with at least one member experiencing both communicable and noncommunicable diseases from the Household Integrated Economic Survey 2018-19. The dataset is cross-sectional and nationally representative. Quantile regression was used to analyze the association of various socioeconomic factors with the OOP expenditure associated with double disease burden.ResultsOverall, 28.5% of households had double disease in 2018-19. The households with uneducated heads, male heads, outpatient healthcare, patients availing public sector healthcare services, and rural and older members showed a significant association with the prevalence of double disease. The out-of-pocket expenditure was higher for depression, liver and kidney disease, hepatitis, and pneumonia in the upper percentiles. The quantile regression results showed that an increased number of communicable and noncommunicable diseases was associated with higher monthly OOP expenditure in the lower percentiles (10th percentile, coefficient 312, 95% CI: 92–532), and OOP expenditure was less pronounced among the higher percentiles (75th percentile, coefficient 155, 95% CI: 30–270). The households with older members were associated with higher OOP expenditure at higher tails (50th and 75th percentiles) compared to lower (10th and 25th percentiles). Family size was associated with higher OOPE at lower percentiles than higher ones.ConclusionThe coexistence of communicable and noncommunicable diseases is associated with excessive private healthcare costs in Pakistan. The results call for addressing the variations in financial costs associated with double diseases.

Current major public health challenges

After COVID-19 pandemic, there are still many public health challenges in the world. The double burden of communicable and non-communicable diseases is still heavy in many countries. Mental health and injury are crucial public health problems which are often neglected. Environmental health and food and drug safety are closely related to human health, to which further management and intervention are needed. These problems have different impacts on people at different life stages, resulting in health problems throughout the life course. The current status of public health is far from the requirements set by the Sustainable Development Goals of United Nations or the initiative of "Healthy China 2030". It is necessary for governments and related departments of all countries to consider public health in all policy development to tackle the major challenge to public health.

Priority nutrients to address malnutrition and diet-related diseases in Australia and New Zealand.

The double burden of malnutrition and diet-related disease has been attributed to diets high in ultra-processed and discretionary foods, with increased sugars, saturated fats, and sodium, and insufficient dietary fibre. There is a limited understanding of the role of other macronutrients and micronutrients. Determine the highest priority nutrients to address both malnutrition and diet-related disease in Australia and New Zealand, for each demographic group and the total population. A novel four-step methodological approach was undertaken to identify: 1. Demographic (age-sex) groups; 2. Health priorities; 3. Potential nutrients based on inadequacy, increased requirements, and health priority association; and 4. Priority nutrients. Nutrient intake data was obtained from the most recent Australian and New Zealand nutrition surveys. Health priorities were based on national statistical data and expert consultation. High-level scientific literature (systematic reviews) was scoped for associations with health priorities and the suitability of recommended intakes. A quantitative scoring matrix was developed and used to determine the highest priority nutrients, with scoring over three domains: extent of inadequacy; consensus for increased requirements; and degree of association with health priorities. Nutritional inadequacies were common, with 22 of 31 essential nutrients consumed below recommended levels. Nine priority nutrients were identified across the demographic groups, with each demographic group characterised by a specific subset of these. Six nutrients were highest priority within the total population: vitamin D, calcium, omega-3 fatty acids, magnesium, folate, dietary fibre. The extent of nutritional inadequacies in Australia and New Zealand is high, both within each demographic group and the entire population, relative to both recommended intakes and key health outcomes. The methodology can be applied to other countries and globally. Findings make a significant contribution to understanding the nutrients to prioritise in future-proofing the health of the Australian and New Zealand populations. Guidelines and policies can target priority nutrients to address the malnutrition and diet-related disease double burden.

Navigating Nigeria's Health Landscape: Population Growth and Its Health Implications.

This comprehensive analysis examines the multifaceted impacts of population growth on public health in Nigeria. Drawing parallels with Omran's epidemiological transition model (that focuses on the intricate means that patterns of health and illness are changing, as well as the relationships that exist between these patterns and the sociological, demographic, and economic factors that influence them) and referencing experiences from Chile and Ceylon. The study highlights a substantial rise in Nigeria's population causing a double burden of infectious and non-communicable diseases, leading to higher morbidity, and mortality rates, increased healthcare costs, decreased productivity, and health inequalities, posing significant challenges to the country's healthcare system. Furthermore, the correlation between low education levels and health outcomes underscores the importance of addressing systemic deficiencies in Nigeria's educational sector. The article emphasizes the urgent need for strategic interventions to mitigate the adverse effects of population growth on health. Recommendations include revitalizing primary healthcare centers, fostering public-private partnerships to enhance healthcare accessibility, leveraging technological advancements like telemedicine, and promoting initiatives to improve nutrition and environmental sustainability. Moreover, prioritizing education on reproductive health and family planning emerges as a crucial strategy to manage population growth sustainably. In conclusion, the article underscores the imperative for collaborative efforts across sectors to navigate Nigeria's evolving health landscape amidst increasing population growth. By implementing targeted policies and interventions, Nigeria can strive toward achieving universal health coverage, enhancing health outcomes, and ultimately raising the standard of living for its populace.

Health Technology Assessment in China’s Health Care Sector: Development and Applications

ABSTRACT China’s health system is facing severe challenges from social transition and the double burden of population aging and non-communicable diseases. Addressing the tension between the public’s increasing demand for health services and the limited availability of medical resources has become a critical issue for health care policymakers and medical insurance fund administrators. In promoting its medical insurance system reform, China is actively developing health technology assessment (HTA) with principles and applications adapted to the Chinese context. This study aims to analyze the evolution of HTA in China with a focus on context, actors, process, content, and challenges encountered through applying a modified verson of Walt and Gilson’s policy triangle framework. Currently, HTA plays an indispensable part in the reform of China’s health care and medical insurance system, especially in the formulation and adjustment of the National Reimbursement Drug List (NRDL). While HTA is increasingly used in China, there remain challenges, such as the slow development of HTA related disciplines, lack of an independent national HTA authority, and limited scope in the use of HTA. Despite the identified challenges, HTA has the potential to support a wide range of applications in China’s health care sector, building on the progress achieved over the last three decades.

Determinants of Eating Habits and Body Mass Index in transition; A Comparative Cross-Sectional Study of Public and Private Schools of Lahore

Background Pakistan is facing a double burden of disease. Nutrition has an impact on nutritionally related non-communicable diseases. Malnutrition in adolescent age continues in adulthood so interventions in this stage can help us fight this emerging problem. Objective: To determine the nutritional status of school-going adolescents and their eating patterns and then compare them between public and private secondary schools of Lahore. Methods This analytical cross-sectional study was done on 372 school-going adolescents from 01.03.2023 to 20.06.2023 (3.5 months). A self-structured questionnaire was filled with interviews by convenience sampling. Weight and height were measured and BMI was plotted on WHO z charts to determine the nutritional status. Data were entered and analyzed by SPSS Version 21. The chi-square test was used to compare BMI and its determinants. Factors found significant were subjected to Binary logistic regression. P-value ≤ 0.05 was taken as significant. Results Out of the 372 school-going adolescent participants had a mean age of 14.86 years SD ± 1.75 (164 males and 208 females). 76(20.43%) were underweight, 201 (54.03%) had normal weight, 66(17.74%) were overweight and 29(7.8%) were obese. Public Schools had higher odds of undernutrition AOR 1.49 and lower odds of overweight and obesity AOR 0.38. Males had a reduced chance of undernutrition AOR 0.59 while the increased odds of overweight/ Obesity AOR 1.81. Age groups 11 to 15 years had reduced odds of undernutrition as compared to 16 to 19 years AOR 0.53 and increased odds of overweight/ obesity as compared to 16 to 19 years AOR 2 .00. Conclusion There is a significant difference in the nutritional status and eating habits of adolescents between public and private schools. Undernutrition is higher in public schools, among females and age 16 to 19 years. Nutritional interventions should be strengthened in school health services

PREVENTION OF NON-COMMUNICABLE DISEASES (NCDs) THROUGH EXAMINATION, EARLY DETECTION AND INCREASING KNOWLEDGE

Indonesia is facing a double burden of disease where infectious diseases are still a problem and at the same time non-communicable diseases (NCDs) are increasing, causing the burden on society and the state to become increasingly heavy socially and economically. Efforts to improve people's quality of life still receive little attention. The Healthy Society Movement (GERMAS) through efforts to detect non-communicable diseases (PTM) needs to continue to be strengthened. GERMAS is a joint movement which is not only the responsibility of the government through the health service but is also the responsibility of the community, including academics. Several obstacles to the implementation of germas include limited access and not yet optimal community participation. Purpose of Community Service. increasing the achievement of Early Detection of NCDs for the community in the working area of ​​the Sako Palembang Community Health Center in 2023. The solution to the problem is carried out through screening and Early Detection as well as increasing understanding of NCDs in the community through counseling and personal education in the working area of ​​the Sako Palembang Community Health Center in 2023. Activities are carried out through the preparatory stages , implementation and evaluation . The resulting output is in the form of increasing knowledge, understanding and behavior for the community in the work area of ​​the Sako Palembang Community Health Center in 2023, in addition to producing booklets/posters and community service publications.

Pendampingan Kader dalam Deteksi Dini dan Edukasi CERDIK sebagai Upaya Pengendalian Penyakit Tidak Menular (PTM)

Indonesia is currently facing a double burden of disease, namely infectious diseases (infectious diseases) and non-communicable diseases (degenerative diseases), which are increasing. Currently, non- communicable diseases (NCDs) have replaced infectious diseases as the dominant disease and are the cause of higher deaths compared to infectious diseases. That there has been an increase in key NCD indicators. The increase in cases of non-communicable diseases (NCDs) will significantly increase the burden on society and the government, because handling them requires a long time, large costs and high technology. PTM cases are not transmitted, but they are deadly and cause individuals to become unproductive or less productive. NCDs can be prevented by controlling risk factors through early detection. One of the government's efforts is the CERDIK program to control Non-Communicable Diseases (NCDs). This program is implemented to prevent deaths due to non-communicable diseases by emphasizing promotive and preventive aspects. Based on the background above, this activity aims to support government programs in efforts to control NCDs by assisting cadres in early detection and smart education as part of controlling NCDs. Training activities are carried out by providing demonstrations and teaching how to do early detection related to screening, measuring vital signs, checking body weight, height, body mass index, checking blood sugar, cholesterol and uric acid. Apart from that, cadres are also given clever education regarding controlling non-communicable diseases. The results of the evaluation that have been carried out are that the majority of cadres are in the good category regarding knowledge and attitudes in early detection of PTM.

The burden of diseases and risk factors in Bangladesh, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Bangladesh has made substantial progress in improving socioeconomic and health indicators over the past 50 years, but data on national disease burden are scarce. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to estimate the burden of diseases and risk factors in Bangladesh from 1990 to 2019. For this systematic analysis, we analysed data from vital registration systems, surveys, and censuses using multistage modelling processes to estimate life expectancy at birth, mortality rate, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). Additionally, we compared the health status of Bangladesh with that of the other countries in the GBD south Asia region-Bhutan, India, Nepal, and Pakistan. Life expectancy at birth in Bangladesh increased from 58·2 years (95% uncertainty interval 57·1-59·2) in 1990 to 74·6 years (72·4-76·7) in 2019. Between 1990 and 2019, the age-standardised mortality rate decreased from 1509·3 (1428·6-1592·1) to 714·4 (604·9-838·2) deaths per 100 000 population. In 2019, non-communicable diseases represented 14 of the top 20 causes of death; the leading three causes were stroke, ischaemic heart disease, and chronic obstructive pulmonary disease. High blood pressure, high fasting plasma glucose, and smoking were the top three risk factors. From 1990 to 2019, the rate of all-cause DALYs decreased by 54·9% (48·8-60·4). In 2019, the leading causes of DALYs and YLLs were neonatal disorders, stroke, and ischaemic heart disease, whereas musculoskeletal disorders, depressive disorders, and low back pain were the leading causes of YLDs. Bangladesh has the lowest age-standardised rates of mortality, YLDs, and YLLs and the highest life expectancy at birth in south Asia. Over the past 30 years, mortality rates have reduced by more than half in Bangladesh. Bangladesh must now address the double burden of communicable and non-communicable diseases. Cost-effective, multisectoral efforts are needed to prevent and control non-communicable diseases, promote healthy lifestyles, and prevent premature mortality and disabilities. Bill & Melinda Gates Foundation. For the Bangla translation of the abstract see Supplementary Materials section.

The Effects of a Nutritional Education Package Titled "Eat a Rainbow Every Day" on Eating Behaviors and Physical Activity of Elementary School Children

Background: In school age children, a healthy nutritional behavior can prevent double burden of malnutrition and chronic diseases. Nutritional education has a key role in adopting a healthy lifestyle. This study aims to evaluate the effectiveness of an educational package on the nutritional knowledge and practices, physical activity (PA), and body mass index (BMI) of elementary school children in Zahedan, southeast Iran. Methods: In this quasi-experimental before-after study, a total of 734 elementary school children‎, aged 10–14 years, recruited by census sampling method completed the survey. Each student received 8 hours of training and they were provided with a booklet that included a weekly chart for recording intake of food groups and PA by students for 3 months. A semi-structured questionnaire that included questions on the students' nutritional knowledge, eating behavior, PA performance, and BMI before and after the intervention was used for data collection. Paired t-test, McNemar's, and Friedman tests were used for data analysis. Results: Before the intervention, the mean score of nutritional knowledge was 7.5 and the prevalence of underweight and overweight/obesity was 17.4% and 0.4%, respectively. After the intervention, the results showed a significant increase in the nutritional knowledge scores, the number of days with 30 min PA per week, and the frequency of consumption of dairy products, animal protein, and fruits. Also, in comparison with before intervention, a significant decrease was found in the prevalence of underweight and overweight/obesity of school children after the intervention. Conclusion: This multifaceted nutritional education intervention was associated with improved nutritional knowledge score, PA, and being underweight in elementary school children.

The Magnitude of Hypertension and Its Contributing Factors Among Patients Receiving Antiretroviral Therapy in Public Hospitals in Harar City, Eastern Ethiopia: A Cross-Sectional Study.

Although people living with HIV (PLHIV) are surviving longer due to the development of highly active antiretroviral therapy (HAART), hypertension continues to be a significant obstacle for human immunodeficiency virus (HIV) positive patients. This study aims to determine the prevalence of hypertension and its contributing factors among patients receiving HAART in public hospitals in Harar City, Eastern Ethiopia. A hospital-based cross-sectional study was conducted among adult PLHIV who receive HAART in public hospitals in Harar City, Eastern Ethiopia, from 20 March to 14 April 2023. A simple random sampling technique was employed to select a total of 406 clients (382 participated in the study). Data were collected through patient interview and chart review using a questionnaire. The binary logistic regression was used for data analysis. The association was declared statistically significant at a p-value less than 0.05. The magnitude/prevalence of hypertension was 23% (95% CI: 19.1, 27.5) in study settings from a total of 382 adults who participated in this study. Factors significantly associated with hypertension in a multivariable binary logistic regression model include residence (rural residence, AOR = 1.95, 95% CI: 1.04, 3.65); body mass index (obese, AOR = 4.35, 95% CI: 1.08, 16.77); cigarette smoking (past cigarette smoking, AOR = 4.7, 95% CI: 1.10, 21.8); and HAART regimen change (AOR = 0.44, 95% CI: 0.20, 0.97). The prevalence of hypertension observed among adult PLHIV in the study settings was high. Adults from rural areas, with a history of past smoking cigarette, and obesity need close attention during their clinic visits for more health education to reduce risk factors. The changed HAART regimen was associated with a reduced risk of hypertension. Generally, hypertensive PLHIV need consideration for their double burden of communicable and non-communicable diseases during disease management and hospital guideline development.