Jurnas S0140673621012071

Articles
Global, regional, and national progress towards Sustainable

Development Goal 3.2 for neonatal and child health:
all-cause and cause-specific mortality findings from the
Global Burden of Disease Study 2019
GBD 2019 Under-5 Mortality Collaborators*
Summary
Lancet 2021; 398: 870–905 Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction
Published Online of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less
August 17, 2021 than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential
https://doi.org/10.1016/
S0140-6736(21)01207-1
trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk
Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than
See Comment page 821
5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects
*Collaborators listed at the end
of the paper
of COVID-19, and a novel framework for quantifying optimal child survival.
Correspondence to:
Dr Nicholas J Kassebaum, Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for
Department of Health Metrics detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal
Sciences, University of mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories,
Washington, 3980 15th Avenue,
Northeast Seattle, WA 98105,
notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially
USA targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all
[email protected] GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second
is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access
and Quality Index.
Findings Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3–74·0) in
2000 to 37·1 (33·2–41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per
1000 live births (26·8–29·5) in 2000 to 17·9 (16·3–19·8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR
at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference
scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet
the NMR targets. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05–10·30) in 2000
and 5·05 million (4·27–6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million
[95% UI 3·53–4·02]) in 2000 to 48% (2·42 million; 2·06–2·86) in 2019. NMR and U5MR were generally higher in
males than in females, although there was no statistically significant difference at the global level. Neonatal
disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower
respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis
suggests NMR could be reduced to as low as 0·80 (95% UI 0·71–0·86) deaths per 1000 livebirths and U5MR to 1·44
(95% UI 1·27–1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35–2·58;
37% [95% UI 32–43]) of 5·05 million more deaths of children younger than 5 years than the survival potential
frontier.
Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower
in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet
either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded
delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity,
continued focus on poverty reduction and education, and investment in strengthening health systems across the
development spectrum have the potential to substantially improve U5MR. Given the widespread effects of
COVID-19, considerable effort will be required to maintain and accelerate progress.
Funding Bill & Melinda Gates Foundation.
Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0
license.
870 www.thelancet.com Vol 398 September 4, 2021

Articles
Research in context
Evidence before this study SDG 3.2 explicitly prioritises ending preventable child deaths.
During the Millennium Development Goal (MDG) era (2000–15), Therefore, based on all-cause and cause-specific mortality
numerous organisations comprehensively described global estimates from GBD 2019, this study introduces a novel,
progress in reducing child and neonatal mortality (MDG 4), reproducible, and holistic heuristic for quantifying optimal child
but the early Sustainable Development Goal (SDG) period has survival. Within this framework are two complementary cause-
seen few comparable efforts to track progress and none to date specific benchmarks: a global optimum, based on the lowest
have attempted to quantify the preventable portion of child observed neonatal and under-5 mortality, and a survival
mortality (SDG 3.2). Past preventable mortality analyses have potential frontier, based on stochastic frontier analysis of
focused on health-care delivery, or were limited to high-income observed mortality and the Healthcare Access and Quality
countries and adult populations. The most recent child mortality Index. The latter allows for comparing performance between
report from the UN Inter-agency Group for Child Mortality similar countries, and specifically helps those countries with
Estimation (UNIGME), published in 2017 for the year 2015, high mortality to establish intermediate goals.
reports on all-cause mortality only. The Global Burden of
Implications of all the available evidence
Diseases, Injuries, and Risk Factors Study (GBD) is the only
The prevention of child deaths accelerated in the MDG era.
annual assessment of trends in all-cause mortality and cause-
In the emerging SDG period, progress to prevent child deaths
specific mortality by detailed age groups for all locations with a
remains slowest in neonates. The study findings highlight
population greater than 50 000 people from 1990 to the
regions with potential imbalances in health priorities.
present that is compliant with the Guidelines for Accurate and
The findings can also identify causes of death with the most
Transparent Health Estimates Reporting.
potential for reduction, and those with the greatest need for
Added value of this study resources, expertise, and service delivery, or for basic research
This analysis presents levels and trends in all-cause and cause- into prevention and treatment. To reach the SDG targets
specific neonatal and under-5 mortality from 2000 to 2019. by 2030, policy makers must focus on balancing priorities
Multiple future health scenarios for child mortality in 2030 between early newborn care while continuing prenatal and
were constructed to represent potential trajectories, including older child health initiatives. Strengthening quality health
the potential impacts of the COVID-19 pandemic and scenarios systems and ensuring effective investment in high-burden
with targeted improvements in neonatal survival. Additionally, countries are imperative in order to scale up interventions.
this study presents for the first time all-cause mortality Equally pressing are the needs to examine within-country
estimates for granular age groups of 0–6 days, 7–27 days, disparities and pursue integrative action on other determinants
1–5 months, 6–11 months, 12–23 months, and 2–4 years. of health.
Introduction health (SDG 3) is one of several goals related to healthier

Under-5 mortality rate (U5MR) and neonatal mortality lives, wellbeing, and equity.3 Even within SDG 3, the
rate (NMR) are important indicators reflecting multiple SDG agenda is broader than the MDG agenda, reflecting a
aspects of societal wellbeing such as access to nutrition growing understanding of the intersectional nature of
and food; basic infrastructure such as housing, water, health outcomes with basic infrastructural considerations
and sanitation; education; agency; financial security; such as health system performance, sustainability, and
access to preventive and treatment health services; and environment. This intersectional perspective is illustrated
future human capital. The UN Millennium Development in the language of initiatives such as the call from the
Goals (MDGs) are credited with mobilising global action UN Global Strategy for Women’s, Children’s and
on child health, and manifested as an unprecedented, Adolescents’ Health 2016–2030 to integrate survival,
accelerated reduction in child mortality and resulted prevention, thriving, and enabling environ ments,4 the
in 58 countries achieving the MDG 4 target of reducing Every Newborn Action Plan, the World Bank’s Global
U5MR by two-thirds.1,2 Sustainable Development Goal Financing Facility for Women, Children and Adolescents,
(SDG) 3.2 specifically calls to, “By 2030, end preventable The Lancet Global Health Commission on High Quality
deaths of newborn babies and children under 5 years of Health Systems, and the Countdown to 2030.5–7 Although
age, with all countries aiming to reduce neonatal this broader focus has not necessarily led to child and
mortality to at least as low as 12 per 1000 live births and neonatal health receiving less investment in development
under-5 mortality to at least as low as 25 per 1000 live assistance for health (DAH; which, for child and neonatal
births.”3 The SDG focus on equity was codified here in a health, grew by 2·66% from 2015 to 2019 and remained
shifting from relative global targets, that were mainstays the second largest DAH focus area in 2019), the growth in
in the MDG agenda, to absolute targets for each country. investment in this period was less than during the period
The SDG framework aims to build on the successes of between 2000 and 2015, when DAH for child and neonatal
the MDG era, albeit with a notably broader lens in which health increased by 314%.8
www.thelancet.com Vol 398 September 4, 2021 871

Articles
There has not yet been a comprehensive assessment which were estimated at the subnational level from 1990
of NMR and U5MR in the SDG era. Selected publications to 2019, inclusive. Results in this study are presented
assessed interim progress towards part of SDG 3.2 only for countries and territories. All-cause mortality
or provided projections to 2030,9–13 but none have been estimation covers six under-5 age groups: 0–6 days (early
comprehensive with respect to cause, age, trends, neonatal), 7–27 days (late neonatal), 1–5 months,
geography, and progress towards 2030 targets. The 6–11 months, 12–23 months, and 2–4 years. Cause-
comprehensive nature of the Global Burden of Diseases, specific mortality estimates cover four age groups: early
Injuries, and Risk Factors Study (GBD) 2019 lends itself neonatal, late neonatal, 28–364 days, and 1–4 years.
to a detailed analysis of levels, trends, and drivers of Although we present all six age groups, we mainly focus
change for specific age groups, causes, and locations. on results for the aggregate neonatal age group
Additionally, there has not been any previous effort, to (<28 days) and the under-5 age group (0–4 years), to
our knowledge, to empirically explore the concept of best align with the SDG under-5 and neonatal targets.
preventable mortality in children. Although preventable Similarly, we focus on the years 2000, which marks the
death has been theoretically defined since the early establishment of the MDGs, 2015, which marks the
2000s, the definitions has usually been through a health- establishment of the SDGs, and 2019, which is the most
care delivery lens14,15 rather than a more holistic lens recent year of GBD estimates.
of preventability that might be interpreted as the
intended wording of SDG 3.2. Furthermore, although Data sources
the Organisation for Economic Co-operation and All-cause mortality data were compiled from 203 of
Development (OECD) and Eurostat convened to provide 204 countries and territories ranging from the years 2000
a more uniform approach to interpreting avoidable to 2019, for a total of 3097 location-years. Vital registration
deaths in 2019, this was with a singular focus on high- covered a total of 14 889 022 global under-5 deaths in this
income countries and the adult population.16 period (appendix p 119). A total of 8000 unique sources
In this study, based on GBD 2019, we have three were used in estimating cause-specific mortality in
objectives. First, we aim to present a detailed, com GBD 2019. All input data sources for each component of
For more on the GBD 2019 Data prehensive numerical assessment of progress towards analysis are available for download from the GBD 2019
Input Sources Tool see http:// SDG 3.2 targets for all-cause NMR and U5MR at the Data Input Sources Tool.
ghdx.healthdata.org/gbd-2019/
data-input-sources
global, regional, and national level, including a series
of scenarios that reflect possible trends over the next All-cause mortality estimation and assessment of
decade including the potential effects of the COVID-19 progress towards SDG 3.2
pandemic on young children. Second, we aim to evaluate All-cause mortality estimation closely followed the esti
comparative progress in cause-specific mortality in mation techniques as described for previous iterations
neonates and children from 2000 to 2019 to highlight of GBD,2,18,19 detailed in the appendix (p 9). Progress
successes and potential focus areas for improvement. towards SDG 3.2 was assessed by examining U5MR and
Third, we aim to better define a holistic focus of preventable NMR in 2019. NMR is calculated as the probability of
mortality by exploring two different measures of optimal death between birth and 28 days and U5MR is calculated
child survival that can both inform global progress and as the probability of death between birth and 5 years,
provide a benchmark for intermediate progress evaluation and each metric is expressed as the number of deaths
in high-mortality settings. In so doing, this study seeks to per 1000 livebirths. Aggregate mortality probabilities
meet the needs of an expansive, integrative SDG agenda, were benchmarked against the SDG thresholds of
and to highlight the locations, age groups, and causes 25 under-5 deaths per 1000 livebirths and 12 neonatal
of preventable deaths, to inform policy and public health deaths per 1000 livebirths.
priorities aiming to achieve SDG 3.2. This manuscript To assess relative progress across age groups, we
was produced as part of the GBD Collaborator Network compared the proportion of under-5 deaths occurring in
and in accordance with the GBD Protocol. each age group with the ratio of change in age-specific
deaths to change in total under-5 deaths, for the
Methods periods 2000–14 and 2015–19. If progress towards
Overview SDG 3.2 is equal across age groups, the percentage
This study is compliant with the Guidelines for Accurate contribution to progress and the percentage of total
and Transparent Health Estimates Reporting (GATHER;17 deaths would be equal. If the percentage of deaths is
See Online for appendix appendix p 9). A brief summary of each component of greater than the percentage of progress for an age group,
our study is described below. Extensive methodological then that age group is making slower progress towards
details are provided in the appendix (pp 10–86). the target.
Dimensions of the GBD study Cause-specific mortality estimation

GBD 2019 includes all-cause and cause-specific mortality GBD 2019 includes 369 causes of disease and injury in a
by age and sex for 204 countries and territories, 21 of mutually exclusive and collectively exhaustive hierarchy

Articles
of four levels (appendix p 87). Some conditions only an all-cause mortality minimum that was calculated
result in fatal burden (eg, sudden infant death syn using the same approach. The scaling step was added to
drome), whereas others cause only disability (eg, scabies); account for potential differences due to small numbers
most causes have both fatal and non-fatal burden. in low-mortality settings or geographical differences in
Comprehensive methods for cause-specific mortality cause assignment that can occur between, for example,
estimation for GBD have been previously described20 and subcauses of neonatal disorders. This method is
are detailed in the appendix (p 35). We present most analogous to that used by GBD to calculate a global
results at level 3 because this level is sufficiently detailed standard life expectancy for the purposes of calculating
to reflect important cause groupings for the age groups years of life lost and therefore can be interpreted to
presented in this analysis (eg, neonatal disorders and represent the optimum potential for reductions in child
congenital birth defects), but not so detailed as to obscure mortality based on current technology and health delivery
important groupings of related conditions. systems.
Second, to help with developing intermediate goals and
Scenarios for 2030 and beyond to evaluate progress in higher-mortality settings, we
U5MR and NMR were projected for six scenarios, all calculated a survival potential frontier using stochastic
computed at the national level, up to 2030 as previously frontier analysis22 to evaluate the historical relationship
described.21 The first three scenarios represent the between cause-specific neonatal and under-5 mortality
reference, better-than-reference, and worse-than-refer rates and HAQ Index,23 which is an aggregate metric of
ence scenarios, while a fourth represents the 2030 NMR health system per formance across all age groups
and U5MR in the absence of COVID-19. The remaining combined. The specific formulation of the stochastic
two scenarios are intended to assess outcomes for frontier analysis is described in detail in the appendix
interventions that focus only on specific age groups, to (p 70), but briefly, it uses a spline to estimate the expected
evaluate if opportunity is greater in a particular age group lower bound of mortality for a given value of HAQ Index.
than in others, and to show the limits of achievement Stochastic frontier analysis was chosen to quantify
when efforts do not consider distinct needs of different system inefficiency because of its flexibility in shape, its
age groups. For the first of these age-specific scenarios, assumption of performance possibilities given static
neonatal mortality is at the better-than-reference level system inputs, and the fact that it allows for random
and remaining under-5 mortality stays at reference level effects in the model rather than assuming uniformity of
(neonatal scenario), and for the second, mortality for inputs across locations.
children aged 28–364 days is at the better-than-reference All components of the analysis are based on 1000 draws
level and neonatal mortality stays at the reference level of the posterior distribution of the quantity of interest
(child scenario). Many strategies to address neonatal by age, sex, location, and year. Point estimates are the
mortality are fundamentally different from strategies mean of the draws, and 95% uncertainty intervals (UIs)
targeting older infants and children, so these two represent the 2·5th and 97·5th percentiles.
scenarios are a broad representation of those differences.
Presentation of results
Assessment of optimal survival potential Results are presented by country, GBD super-region,
Our approach to inform an assessment of preventable and Socio-demographic Index (SDI)24 quintile. SDI is a
mortality focused on the quantification of two different composite index of income per capita, educational
measures of optimal child survival based on historical attainment, and inverse fertility, and it is used to
trends. The first measure, what we term the global categorise countries into SDI quintiles: low SDI (ie, low
optimum, represents a universal level at which all income per capita, low educational attainment, high
additional mortality is theoretically avoidable given fertility), low-middle SDI, middle SDI, high-middle SDI,
current medical knowledge and technology. This is and high SDI. Full results for GBD 2019 are available
analogous to the GBD method used for estimating global in an online visualisation at GBD Compare and for For more on the GBD Compare
standard life expectancy. The second measure, what we download from the GBD Results Tool. see https://vizhub.healthdata.
org/gbd-compare
term the survival potential frontier, aims to quantify the
For more on the GBD Results
amount of mortality that is avoidable given the country’s Role of the funding source Tool see http://ghdx.healthdata.
level of Healthcare Access and Quality (HAQ) Index, The funders of the study had no role in study design, org/gbd-results-tool
thereby accounting for the differential resources available data collection, data analysis, data interpretation, or
for health investment in different locations. writing of the report.
First, we calculated the global optimum for NMR and
U5MR based on the aggregate of the lowest observed Results
age-specific and cause-specific mortality rates in locations All-cause mortality and progress towards SDG 3.2
with populations higher than 10 000 children younger Over the past two decades, there has been a substantial
than 5 years (to remove noise associated with small decrease in global deaths of children younger than
numbers) between 2000 and 2019, scaling them to match 5 years, from 9·65 million (95% UI 9·05–10·30) in 2000,

874
Neonatal deaths NMR Under-5 deaths U5MR
2000 2015 2019 2019 2030* 2000 2015 2019 2019 2030*
SDI regions
Articles
Global 3 760 000 2 820 000 2 420 000 17·9 15·4 9 650 000 6 100 000 5 050 000 37·1 29·6
(3 530 000–4 020 000) (2 480 000–3 200 000) (2 060 000–2 860 000) (16·3–19·8) (9 050 000–10 300 000) (5 350 000–6 910 000) (4 270 000–6 020 000) (33·2–41·7)
Low SDI 1 260 000 1 190 000 1 110 000 27·0 21·4 4 010 000 3 040 000 2 670 000 71·8 47·0
(1 190 000–1 340 000) (1 030 000–1 370 000) (918 000–1 340 000) (24·0–30·8) (3 780 000–4 260 000) (2 630 000–3 520 000) (2 220 000–3 240 000) (63·3–82·5)
Low-middle SDI 1 480 000 1 020 000 841 000 21·7 19·1 3 390 000 1 890 000 1 490 000 42·0 30·3
(1 370 000–1 600 000) (883 000–1 170 000) (716 000–985 000) (19·7–24·0) (3 140 000–3 630 000) (1 640 000–2 150 000) (1 260 000–1 750 000) (37·8–46·7)
Middle SDI 777 000 479 000 368 000 10·1 16·3 1 730 000 912 000 686 000 18·9 27·3
(724 000–835 000) (419 000–546 000) (312 000–432 000) (9·11–11·2) (1 610 000–1 850 000) (803 000–1 040 000) (583 000–810 000) (17·1–21·0)
High-middle SDI 199 000 104 000 78 100 5·10 3·30 427 000 197 000 150 000 9·36 6·12
(187 000–213 000) (94 200–115 000) (67 100–90 900) (4·71–5·55) (400 000–455 000) (180 000–217 000) (130 000–172 000) (8·66–10·2)
High SDI 43 500 30 500 26 800 2·60 2·57 84 400 55 800 48 600 4·70 5·02
(41 600–45 300) (29 300–31 700) (24 300–29 600) (2·51–2·70) (81 000–88 300) (54 200–57 600) (44 500–53 200) (4·56–4·86)
GBD super-regions
Central Europe, 57 800 39 400 30 800 5·88 4·95 127 000 77 900 61 100 11·5 9·34
eastern Europe, (54 300–61 800) (35 500–43 800) (26 400–36 000) (5·35–6·52) (119 000–135 000) (70 200–86 900) (52 200–72 100) (10·4–12·8)
and central Asia
Central Asia 31 600 25 400 20 500 10·8 8·99 75 400 49 300 39 700 20·7 16·2
(28 300–35 100) (21 900–29 400) (17 200–24 600) (9·62–12·2) (68 200–82 900) (42 200–57 700) (33 200–48 400) (18·3–23·7)
Armenia 661 310 230 5·96 4·46 1290 605 452 11·4 8·90
(595–733) (256–378) (181–292) (5·04–7·21) (1140–1460) (502–732) (357–575) (9·55–13·7)
Azerbaijan 4450 3410 2590 16·8 14·0 9530 5750 4310 27·6 21·5
(3710–5260) (2860–3990) (2130–3110) (14·8–19·4) (8060–11 100) (4760–6910) (3430–5370) (23·2–33·4)
Georgia 1060 376 266 5·79 4·04 1740 669 482 10·2 7·02
(892–1250) (308–457) (208–336) (4·76–7·10) (1480–2040) (553–811) (382–603) (8·57–12·5)
Kazakhstan 3260 2520 1970 5·60 4·09 8300 5420 4330 12·1 8·86
(2790–3780) (2050–3070) (1530–2600) (4·61–6·88) (7250–9410) (4450–6550) (3410–5540) (10·1–14·7)
Kyrgyzstan 1960 2060 1560 10·8 8·57 4380 3290 2520 17·4 13·0
(1760–2170) (1870–2230) (1360–1790) (9·91–11·8) (3910–4890) (3090–3490) (2210–2870) (15·9–19·0)
Mongolia 1270 990 773 9·29 6·89 3400 1810 1430 17·0 10·2
(1120–1430) (836–1170) (633–966) (7·86–11·1) (3030–3780) (1550–2120) (1180–1770) (14·5–20·4)
Tajikistan 4310 4100 3730 14·7 11·8 12 500 9220 8100 32·1 21·8
(3650–5070) (3440–4800) (3180–4380) (13·2–16·4) (11 200–13 900) (7780–11 000) (6540–10 000) (27·5–37·3)
Turkmenistan 2260 1870 1510 13·4 10·3 5990 3620 2870 25·2 19·4
(1900–2640) (1590–2170) (1290–1770) (11·7–15·1) (5240–6870) (3000–4260) (2380–3480) (21·4–29·6)
Uzbekistan 12 300 9760 7900 11·1 10·0 28 300 18 900 15 200 21·2 18·2
(10 600–14 400) (7900–11 900) (6360–10 000) (9·25–13·4) (24 700–32 800) (15 400–22 900) (12 400–19 200) (17·8–25·7)
Central Europe 8250 3720 2930 2·72 1·99 16 700 6990 5550 5·06 3·67
(7940–8590) (3560–3890) (2340–3670) (2·44–3·03) (16 200–17 200) (6690–7290) (4520–6800) (4·52–5·63)
Albania 845 266 217 5·77 4·81 1760 550 451 11·9 9·15
(739–980) (202–345) (150–317) (4·39–7·68) (1530–2030) (450–676) (344–595) (9·94–14·4)
Bosnia and 320 138 103 3·95 3·22 438 191 143 5·41 4·38
Herzegovina (294–344) (125–153) (85·3–126) (3·35–4·67) (406–471) (173–211) (120–173) (4·59–6·39)
Bulgaria 534 258 214 3·54 2·71 1220 532 447 7·29 5·61
(487–582) (236–280) (168–271) (3·03–4·16) (1160–1280) (502–566) (359–556) (6·21–8·57)
Croatia 236 115 90·5 2·56 1·93 361 181 141 3·95 2·96
(220–254) (104–126) (67·5–120) (2·17–3·02) (339–383) (165–198) (107–184) (3·35–4·67)
(Table continues on next page)
www.thelancet.com Vol 398 September 4, 2021

2000 2015 2019 2019 2030* 2000 2015 2019 2019 2030*
(Continued from previous page)
Czech Republic 236 174 159 1·45 1·08 483 342 293 2·64 1·87
(215–256) (158–190) (123–201) (1·26–1·67) (454–513) (318–365) (232–369) (2·28–3·06)
Hungary 572 252 173 2·09 1·37 1020 489 336 4·00 2·80
(530–615) (229–275) (132–224) (1·81–2·42) (970–1070) (458–521) (262–428) (3·46–4·62)
Montenegro 77·4 18·1 15·1 2·29 1·60 116 29·8 24·9 3·74 2·58
(68·7–86·7) (15·4–21·4) (12·5–18·3) (1·96–2·67) (104–130) (25·5–34·6) (20·6–30·0) (3·19–4·38)
North 226 155 123 5·52 4·13 399 239 191 8·51 6·00
Macedonia (203–248) (140–170) (99·9–149) (4·70–6·49) (366–434) (215–263) (155–230) (7·23–10·0)
Poland 1920 988 787 2·15 1·36 3530 1770 1420 3·85 2·60

(1780–2060) (916–1060) (579–1060) (1·84–2·52) (3380–3680) (1680–1850) (1070–1880) (3·29–4·51)
Romania 2090 884 690 3·98 3·17 5130 1790 1420 8·03 5·89
(1920–2260) (815–953) (556–842) (3·50–4·60) (5010–5260) (1710–1870) (1160–1730) (7·02–9·33)
Serbia 865 269 196 2·45 1·47 1590 454 334 4·12 2·42
(736–1010) (250–291) (154–245) (2·08–2·92) (1360–1860) (426–486) (263–421) (3·51–4·93)
Slovakia 266 174 141 2·52 1·85 533 364 301 5·33 4·45
(243–289) (160–187) (106–186) (2·15–2·97) (502–565) (340–389) (232–390) (4·53–6·27)
Slovenia 57·9 31·4 23·8 1·26 0·930 96·1 49·4 38·1 1·98 1·43
(53·4–63·0) (28·1–35·3) (17·9–31·5) (1·09–1·46) (88·8–104) (44·1–55·4) (29·3–49·5) (1·70–2·31)
Eastern Europe 18 000 10 300 7340 3·27 2·41 34 500 21 600 15 900 6·87 5·29
(17 400–18 600) (9920–10 600) (6140–8710) (3·02–3·55) (33 900–35 200) (21 000–22 200) (13 300–18 600) (6·26–7·54)
Belarus 746 328 244 2·38 1·51 1510 730 562 5·31 3·64
(628–875) (271–394) (188–310) (1·99–2·90) (1280–1780) (607–884) (437–729) (4·44–6·46)
Estonia 67·4 19·7 15·1 1·14 0·710 142 46·0 35·6 2·65 1·64
(62·2–72·9) (17·5–22·1) (12·4–18·4) (0·980–1·35) (132–152) (40·9–51·5) (29·5–43·4) (2·27–3·14)
Latvia 139 55·4 41·0 2·14 1·54 272 108 82·8 4·21 3·01
(127–152) (50·2–60·3) (33·9–49·5) (1·86–2·50) (256–288) (98·3–117) (69·3–99·3) (3·63–4·95)
Lithuania 156 70·8 48·6 1·80 1·20 369 155 110 4·00 2·83
(145–167) (63·4–78·3) (41·9–56·2) (1·65–1·98) (350–389) (143–168) (93·8–130) (3·52–4·62)
Moldova 734 374 278 8·64 6·69 1240 536 399 12·2 8·96
(639–847) (304–460) (214–361) (7·14–10·7) (1090–1430) (438–647) (315–505) (10·2–14·7)
Russia 12 400 7040 4990 3·00 2·19 24 500 15 200 11 200 6·53 5·04
(11 900–12 900) (6790–7270) (4010–6050) (2·65–3·38) (24 200–24 900) (15 000–15 500) (9190–13 400) (5·75–7·41)
Ukraine 3760 2360 1720 4·45 3·45 6440 4770 3500 8·76 7·05
(3460–4080) (2130–2600) (1390–2120) (3·89–5·12) (6110–6770) (4360–5180) (2920–4260) (7·85–9·73)
High income 47 600 35 400 31 200 2·78 2·39 88 900 63 500 55 600 4·95 4·14
(46 200–49 000) (34 300–36 500) (27 400–35 500) (2·70–2·88) (88 200–89 700) (62 700–64 400) (49 700–62 600) (4·78–5·12)
Australasia 1060 886 794 2·14 1·77 1980 1530 1380 3·73 2·96
(1020–1110) (847–927) (677–931) (2·03–2·26) (1930–2030) (1480–1580) (1200–1590) (3·53–3·95)
Australia 863 710 647 2·08 1·68 1550 1220 1110 3·57 2·80
(824–902) (680–744) (558–751) (1·98–2·18) (1510–1590) (1180–1250) (973–1260) (3·41–3·76)
New Zealand 199 175 147 2·46 2·21 431 313 270 4·53 3·80
(187–212) (165–187) (120–180) (2·26–2·68) (411–452) (296–331) (225–325) (4·16–4·95)
Articles
875
876
Articles
2000 2015 2019 2019 2030* 2000 2015 2019 2019 2030*
High-income Asia 3830 1730 1430 1·04 0·810 9500 4440 3670 2·62 2·03
Pacific (3530–4140) (1590–1870) (1290–1590) (0·990–1·08) (9190–9820) (4240–4650) (3350–4000) (2·52–2·71)
Brunei 36·4 34·7 31·9 4·85 4·43 70·8 66·8 60·2 9·19 8·27
(32·0–41·1) (30·8–39·2) (24·4–41·7) (4·09–5·73) (63·2–79·0) (59·4–75·0) (46·7–77·5) (7·73–10·9)
Japan 2100 964 782 0·870 0·640 5290 2740 2240 2·43 1·86
(1860–2370) (880–1050) (697–880) (0·850–0·890) (5190–5410) (2650–2830) (2060–2450) (2·36–2·51)
Singapore 95·7 58·8 50·5 0·880 0·650 198 123 105 1·82 1·35
(86·6–106) (44·2–78·8) (35·2–71·0) (0·770–1·00) (183–215) (96·5–157) (79·1–140) (1·60–2·09)
South Korea 1600 673 567 1·37 1·15 3930 1500 1260 3·03 2·43
(1450–1770) (589–774) (481–658) (1·23–1·51) (3660–4200) (1370–1650) (1100–1450) (2·82–3·26)
High-income 19 900 16 800 15 200 3·61 3·29 35 400 29 500 26 600 6·32 5·57
North America (18 700–21 000) (15 800–17 700) (14 000–16 500) (3·55–3·67) (35 200–35 700) (29 200–29 800) (24 600–28 700) (6·18–6·47)
Canada 1200 1220 1110 2·98 2·66 2040 2010 1820 4·86 4·23
(1120–1280) (1140–1310) (996–1250) (2·86–3·10) (2000–2090) (1960–2060) (1640–2010) (4·67–5·07)
Greenland 9·98 4·92 4·10 5·14 3·78 18·8 9·09 7·59 9·47 6·69
(8·56–11·5) (3·88–6·22) (2·66–6·22) (3·74–6·97) (15·9–22·0) (7·09–11·6) (4·97–11·4) (6·85–12·9)
USA† 18 700 15 500 14 000 3·67 3·36 33 400 27 500 24 700 6·46 5·71
(17 500–19 800) (14 600–16 400) (13 000–15 300) (3·62–3·73) (33 100–33 600) (27 200–27 800) (23 000–26 700) (6·33–6·60)
Southern Latin 9300 6180 5240 5·38 4·30 17 100 11 100 9370 9·61 7·59
America (9060–9520) (5950–6420) (4140–6640) (5·08–5·72) (16 900–17 300) (10 900–11 300) (7600–11 600) (9·09–10·2)
Argentina 7380 4810 4120 5·89 4·67 13 400 8710 7420 10·6 8·37
(7150–7610) (4590–5020) (3300–5160) (5·70–6·10) (13 200–13 500) (8580–8840) (6110–9050) (10·3–11·0)
Chile 1420 1140 907 3·98 3·31 2840 1960 1560 6·84 5·44
(1360–1500) (1090–1180) (686–1200) (3·41–4·65) (2750–2930) (1880–2030) (1200–2020) (5·87–7·99)
Uruguay 493 240 211 4·54 3·37 884 439 388 8·29 6·11
(442–545) (207–276) (154–286) (3·97–5·19) (818–955) (395–486) (289–516) (7·26–9·48)
Western Europe 13 500 9810 8550 2·00 1·61 24 900 17 000 14 700 3·42 2·69
(13 000–14 000) (9300–10 300) (7370–9960) (1·91–2·10) (24 700–25 200) (16 600–17 300) (12 900–16 800) (3·29–3·57)
Andorra 1·11 0·585 0·516 0·820 0·540 2·59 1·30 1·11 1·77 1·16
(0·900–1·35) (0·469–0·729) (0·384–0·674) (0·690–0·980) (2·06–3·15) (1·06–1·62) (0·843–1·43) (1·48–2·10)
Austria 238 186 166 1·90 1·52 445 307 282 3·22 2·50
(217–257) (170–201) (141–192) (1·69–2·10) (427–463) (294–322) (252–316) (3·03–3·42)
Belgium 343 258 230 1·89 1·48 690 480 423 3·48 2·68
(303–387) (222–291) (189–279) (1·78–2·01) (666–715) (457–502) (354–505) (3·27–3·71)
Cyprus 43·4 28·7 27·3 1·80 1·31 77·3 49·3 47·9 3·17 2·32
(38·7–48·6) (24·4–33·3) (19·9–36·6) (1·42–2·24) (69·6–85·7) (42·2–57·1) (35·4–63·2) (2·52–3·94)
Denmark 216 157 145 2·31 1·90 371 237 218 3·48 2·73
(187–245) (143–171) (118–179) (2·12–2·52) (348–392) (221–255) (179–264) (3·20–3·79)
Finland 136 65·4 58·9 1·18 0·860 244 125 110 2·20 1·63
(124–149) (59·4–71·9) (49·3–70·5) (1·08–1·29) (230–258) (117–134) (94·0–130) (2·01–2·41)
France 2150 1740 1480 2·05 1·72 4160 3110 2600 3·60 2·87
(1910–2370) (1590–1900) (1270–1720) (1·95–2·16) (4080–4250) (3040–3190) (2280–2960) (3·42–3·79)
Germany 2110 1610 1440 1·95 1·64 4120 2730 2450 3·33 2·63
(1920–2280) (1490–1730) (1320–1580) (1·88–2·03) (4050–4190) (2660–2790) (2250–2670) (3·21–3·47)

2000 2015 2019 2019 2030* 2000 2015 2019 2019 2030*
Greece 390 242 188 2·17 1·54 643 484 339 3·85 2·87
(361–416) (223–262) (152–233) (1·99–2·38) (617–671) (459–508) (279–413) (3·53–4·21)
Iceland 9·77 6·69 6·28 1·45 1·20 15·9 10·9 9·95 2·31 1·84
(8·00–11·8) (5·23–8·58) (3·84–9·95) (1·04–2·00) (13·1–19·0) (8·48–13·8) (6·21–15·5) (1·65–3·20)
Ireland 221 157 124 2·04 1·60 385 253 200 3·25 2·48
(201–241) (141–175) (97·7–157) (1·88–2·21) (364–407) (234–274) (160–249) (3·00–3·54)
Israel 483 369 331 1·72 1·27 920 675 609 3·18 2·37
(425–544) (325–413) (265–408) (1·65–1·79) (896–944) (656–696) (508–724) (3·06–3·30)
Italy 1710 982 770 1·75 1·20 2980 1710 1320 2·98 2·14

(1510–1890) (906–1050) (680–878) (1·69–1·81) (2930–3030) (1670–1750) (1190–1480) (2·88–3·08)
Luxembourg 14·0 9·02 8·56 1·32 1·00 27·3 16·7 15·5 2·42 1·84
(11·7–16·5) (7·20–11·1) (5·35–13·3) (0·930–1·83) (23·4–31·9) (13·5–20·6) (9·89–23·7) (1·71–3·38)
Malta 19·7 18·7 16·3 3·80 3·08 31·1 27·7 24·7 5·74 4·68
(17·2–22·4) (15·2–22·7) (10·8–24·0) (2·96–4·83) (27·4–35·3) (23·1–33·1) (16·8–35·7) (4·54–7·23)
Monaco 0·477 0·320 0·287 1·02 0·830 1·26 0·808 0·727 2·58 2·03
(0·323–0·667) (0·229–0·433) (0·220–0·367) (0·850–1·23) (0·895–1·69) (0·606–1·05) (0·560–0·925) (2·15–3·10)
Netherlands 777 425 421 2·37 1·94 1280 674 659 3·72 2·96
(723–828) (383–469) (345–513) (2·26–2·49) (1240–1310) (653–697) (550–790) (3·54–3·91)
Norway 155 92·9 80·1 1·41 1·10 284 166 142 2·50 1·93
(145–164) (87·3–99·0) (68·0–94·5) (1·32–1·51) (272–297) (157–174) (123–164) (2·34–2·67)
Portugal 405 178 129 1·61 1·08 841 313 229 2·82 1·78
(363–445) (154–202) (100–166) (1·49–1·75) (802–884) (289–340) (181–286) (2·60–3·06)
San Marino 0·977 0·655 0·606 1·95 1·57 1·83 1·23 1·13 3·63 2·85
(0·724–1·27) (0·493–0·861) (0·466–0·773) (1·62–2·33) (1·35–2·39) (0·928–1·61) (0·873–1·44) (3·03–4·36)
Spain 1090 760 603 1·63 1·20 2130 1400 1130 2·98 2·19
(983–1200) (680–833) (493–731) (1·39–1·86) (2090–2170) (1360–1430) (996–1290) (2·88–3·10)
Sweden 193 180 165 1·41 1·12 357 335 302 2·58 2·07
(182–203) (153–208) (141–191) (1·27–1·54) (341–375) (317–352) (265–345) (2·38–2·81)
Switzerland 269 263 227 2·57 2·26 457 375 323 3·66 3·04
(244–294) (242–284) (200–259) (2·43–2·72) (440–475) (358–392) (286–365) (3·46–3·88)
UK† 2510 2070 1920 2·45 2·09 4440 3470 3210 4·10 3·41
(2420–2610) (1800–2290) (1590–2310) (2·14–2·76) (4350–4530) (3400–3550) (2810–3660) (3·97–4·25)
Latin America and 181 000 112 000 93 900 9·56 7·77 397 000 226 000 187 000 19·0 14·3
Caribbean (164 000–198 000) (94 800–131 000) (74 900–116 000) (8·28–11·1) (369 000–427 000) (192 000–263 000) (149 000–231 000) (16·2–22·3)
Andean Latin 22 700 14 900 12 600 9·42 7·58 56 000 29 600 24 900 18·6 14·3
America (20 100–25 400) (12 400–17 800) (9620–16 300) (8·38–10·6) (51 000–61 500) (25 000–34 800) (19 200–31 900) (16·5–21·1)
Bolivia 6710 5560 4840 14·8 12·2 18 300 11 400 9630 29·5 22·7
(5980–7470) (4680–6610) (3880–5990) (12·6–17·7) (16 500–20 100) (9660–13 400) (7800–11 800) (25·2–35·1)
Ecuador 5400 3050 2720 7·74 6·22 11 300 5980 5300 15·1 11·5
(4430–6510) (2290–3990) (1870–3830) (6·19–9·65) (9570–13 100) (4730–7430) (3790–7240) (12·7–18·1)
Peru 10 600 6290 5010 7·61 5·92 26 400 12 200 9980 15·1 11·4
(9120–12 200) (4750–8220) (3550–6960) (6·37–9·11) (23 100–29 700) (9430–15 400) (7070–13 800) (12·6–18·1)
Articles
877
878
2000 2015 2019 2019 2030* 2000 2015 2019 2019 2030*
Caribbean 18 100 17 200 15 800 19·3 16·5 44 900 36 300 32 000 38·8 28·9
Articles
(16 500–19 800) (14 200–20 300) (12 300–20 000) (15·8–23·3) (40 800–49 200) (31 000–42 500) (26 000–39 000) (33·2–45·3)
Antigua and 13·4 6·15 5·34 5·35 4·47 20·9 12·2 10·4 10·3 8·97
Barbuda (10·8–16·4) (4·56–8·09) (3·80–7·37) (4·61–6·19) (16·9–25·4) (9·04–16·2) (7·22–14·6) (8·61–12·3)
The Bahamas 38·0 28·1 24·7 6·08 5·32 80·5 53·8 48·2 11·7 10·3
(31·0–45·1) (20·4–39·2) (18·5–32·7) (4·94–7·62) (67·4–94·1) (41·1–71·1) (37·0–62·2) (9·94–14·2)
Barbados 40·6 27·0 24·7 8·64 7·85 57·4 38·0 34·9 12·2 10·9
(33·5–48·9) (20·5–34·8) (17·0–35·3) (7·24–10·3) (47·5–68·7) (29·2–48·6) (24·1–49·7) (10·2–14·5)
Belize 87·6 72·9 69·1 9·13 8·21 174 124 116 15·4 12·4
(76·5–101) (60·3–86·7) (56·4–83·9) (7·97–10·6) (150–202) (101–147) (92·3–144) (13·0–18·6)
Bermuda 2·43 1·66 1·40 2·71 2·31 4·76 2·96 2·44 4·66 3·72
(1·91–3·08) (1·32–2·05) (0·971–1·95) (2·24–3·28) (3·94–5·80) (2·39–3·63) (1·76–3·34) (3·92–5·54)
Cuba 608 330 236 2·26 1·67 1260 703 503 4·74 3·40
(553–664) (294–368) (188–291) (1·98–2·59) (1210–1310) (666–741) (409–608) (4·12–5·43)
Dominica 15·8 14·6 13·5 16·2 19·0 25·8 23·6 21·7 26·0 29·7
(12·6–19·4) (11·2–18·6) (9·43–18·9) (13·6–19·3) (20·6–31·5) (18·3–30·1) (15·3–30·2) (21·8–31·0)
Dominican 5570 4450 3910 16·9 14·8 10 100 6740 5850 25·2 20·4
Republic (4700–6490) (3460–5560) (2800–5370) (14·1–20·2) (8860–11 400) (5430–8290) (4230–7950) (21·1–30·2)
Grenada 19·8 14·1 12·1 8·62 7·58 35·4 23·1 19·5 13·8 11·7
(15·0–25·6) (10·4–18·9) (8·43–17·1) (7·26–10·2) (27·5–44·3) (17·1–30·9) (13·6–27·5) (11·6–16·5)
Guyana 418 241 217 15·0 12·7 692 377 333 23·1 19·1
(354–490) (179–319) (153–303) (12·6–17·9) (606–777) (278–495) (236–462) (19·4–27·4)
Haiti 8840 10 300 9810 29·5 24·4 28 200 25 400 22 600 68·3 47·8
(7850–9890) (8020–12 900) (7690–12 200) (23·0–36·8) (24 900–31 800) (21 600–29 900) (18 800–27 000) (58·7–79·5)
Jamaica 732 525 454 12·6 11·7 1010 656 568 15·7 13·4
(578–913) (407–670) (320–627) (10·6–15·0) (807–1240) (513–839) (403–785) (13·1–18·7)
Puerto Rico 432 150 128 5·03 4·17 650 239 197 7·67 6·49
(399–467) (133–167) (94·5–171) (4·27–5·92) (617–686) (223–258) (148–259) (6·52–9·04)
Saint Kitts and 12·2 8·43 7·10 10·2 8·77 18·9 12·7 10·7 15·3 11·4
Nevis (10·3–14·5) (6·57–10·8) (5·55–9·00) (8·82–11·9) (16·1–22·2) (9·88–16·1) (8·32–13·6) (13·1–17·9)
Saint Lucia 38·1 22·6 18·9 10·6 9·87 55·9 31·4 26·3 14·6 13·0
(30·9–46·0) (16·5–30·8) (12·9–27·1) (8·89–12·6) (45·5–67·7) (22·9–42·9) (18·0–37·4) (12·2–17·4)
Saint Vincent 35·3 18·1 14·8 9·74 8·49 55·2 28·4 23·4 15·2 12·5
and the (29·0–41·9) (13·8–23·7) (10·5–20·5) (8·26–11·5) (44·3–68·0) (21·6–37·3) (16·4–32·8) (12·8–18·2)
Grenadines
Suriname 246 182 155 16·8 13·8 414 281 238 25·7 20·4
(210–287) (146–224) (109–215) (14·1–20·0) (353–481) (228–344) (169–326) (21·6–30·6)
Trinidad and 327 185 156 10·1 8·84 478 281 238 15·2 13·1
Tobago (274–393) (140–238) (110–218) (8·48–12·1) (397–575) (219–354) (169–329) (12·7–18·2)
Virgin Islands 14·9 7·08 5·90 4·62 3·57 22·7 10·6 8·76 6·79 5·26
(12·2–17·8) (5·50–8·98) (4·21–8·11) (3·91–5·46) (18·8–27·2) (8·16–13·3) (6·28–12·0) (5·74–8·05)
Central Latin 70 000 40 600 33 200 7·50 6·02 143 000 80 100 65 400 14·8 11·2
America (61 400–79 900) (34 000–48 200) (26 400–41 200) (6·65–8·47) (130 000–157 000) (67 100–94 100) (50 700–83 700) (12·4–17·5)
Colombia 13 400 6610 5410 6·68 5·21 24 900 12 500 10 300 12·6 9·85
(11 300–15 700) 5020–8340) (3660–7660) (5·27–8·35) (22 000–28 200) (9900–15 400) (7410–13 900) (10·6–15·0)
Costa Rica 553 412 338 5·07 4·32 959 641 532 7·93 6·59
(503–606) (375–452) (242–466) (4·33–5·94) (889–1040) (589–695) (388–717) (6·76–9·30)

2000 2015 2019 2019 2030* 2000 2015 2019 2019 2030*
El Salvador 1770 792 593 5·26 3·86 4290 1680 1240 10·9 7·90
(1400–2150) (606–1020) (412–835) (4·11–6·59) (3730–4950) (1340–2100) (896–1690) (9·18–13·1)
Guatemala 7130 3830 3440 8·35 6·22 18 100 10 400 8870 21·7 14·8
(6170–8200) (3090–4680) (2460–4720) (7·07–9·86) (16 000–20 300) (8520–12 500) (6410–12 100) (18·3–25·8)
Honduras 3300 2500 2180 9·33 7·53 6880 4570 3970 17·2 12·9
(2790–3850) (1990–3110) (1710–2720) (7·81–11·1) (5900–7990) (3650–5630) (3140–4940) (14·4–20·5)
Mexico 35 300 19 200 15 700 7·44 6·12 69 800 37 400 30 300 14·4 11·2
(28 000–43 400) (15 400–24 200) (12 100–20 200) (6·52–8·53) (61 700–78 900) (30 500–45 200) (24 200–37 500) (12·2–17·1)
Nicaragua 1930 1070 860 6·58 4·84 4570 2350 1880 14·4 10·0

(1580–2280) (823–1360) (653–1100) (5·40–8·01) (3930–5230) (1930–2830) (1530–2300) (12·1–17·1)
Panama 617 539 490 6·42 4·98 1430 1210 1100 14·5 11·5
(509–741) (447–646) (355–665) (5·39–7·64) (1200–1700) (1000–1440) (818–1460) (12·1–17·3)
Venezuela 5990 5640 4240 8·83 7·64 11 700 9370 7220 14·8 11·8
(5650–6320) (4850–6590) (3000–5870) (7·42–10·5) (11 100–12 400) (8140–10 800) (5200–9880) (12·4–17·6)
Tropical Latin 70 000 39 600 32 300 9·96 8·10 154 000 79 800 64 600 19·8 15·1
America (61 000–79 000) (32 300–47 300) (25 500–39 700) (8·41–11·8) (138 000–169 000) (66 800–95 400) (51 300–79 200) (16·7–23·4)
Brazil† 68 100 38 700 31 600 10·1 8·26 150 000 77 700 62 800 20·0 15·3
(59 200–77 200) (31 500–46 500) (24 900–38 700) (8·55–12·0) (135 000–166 000) (65 100–92 700) (49 900–77 000) (16·9–23·7)
Paraguay 1900 853 733 5·80 4·53 3490 2060 1770 14·0 12·0
(1590–2220) (648–1100) (525–1010) (4·88–6·90) (2950–4040) (1580–2650) (1280–2410) (11·8–16·6)
North Africa and 298 000 182 000 150 000 12·2 9·82 682 000 382 000 300 000 24·4 18·2
Middle East (268 000–328 000) (159 000–210 000) (129 000–173 000) (11·1–13·3) (623 000–742 000) (333 000–442 000) (255 000–353 000) (22·3–26·7)
Afghanistan 38 900 34 900 37 400 25·0 19·5 120 000 83 800 81 400 55·3 37·2
(32 600–45 400) (29 100–41 100) (31 300–44 200) (21·6–28·4) (108 000–133 000) (71 000–99 000) (67 900–97 200) (47·9–63·5)
Algeria 15 600 13 600 10 700 12·0 10·4 29 400 22 200 17 300 19·5 16·0
(12 800–18 600) (11 200–16 100) (8220–13 400) (9·83–14·4) (25 400–33 700) (19 000–25 900) (14 500–20 500) (17·0–22·4)
Bahrain 64·5 42·9 30·7 2·36 1·57 158 126 87·3 6·53 5·02
(57·6–72·6) (35·9–51·4) (24·6–38·7) (2·13–2·59) (142–175) (107–147) (69·8–109) (5·79–7·36)
Egypt 40 500 15 400 11 800 5·55 3·11 84 400 47 400 32 600 15·3 8·27
(33 400–47 600) (12 000–20 100) (8250–16 200) (4·20–7·20) (72 600–96 300) (38 200–57 600) (24 600–42 600) (12·8–18·3)
Iran 33 700 18 000 9140 6·77 5·19 60 800 29 100 15 200 11·1 7·83
(27 500–40 300) (15 500–20 800) (7440–11 100) (6·09–7·44) (50 200–72 500) (25 500–33 200) (12 700–18 400) (10·2–12·0)
Iraq 22 100 12 300 9130 9·49 7·51 40 700 23 000 15 000 15·7 11·9
(19 500–25 000) (9300–16 300) (6610–12 800) (7·92–11·5) (35 800–46 000) (18 100–29 100) (11 000–20 700) (13·2–18·9)
Jordan 2160 2070 2130 8·80 6·72 3610 3540 3640 15·3 11·3
(1830–2520) (1610–2660) (1570–2930) (7·46–10·6) (3040–4220) (2750–4520) (2680–5010) (13·0–18·3)
Kuwait 262 369 310 5·09 4·46 500 659 555 9·18 8·03
(234–292) (324–422) (242–402) (4·30–5·99) (463–545) (599–730) (440–708) (7·75–10·8)
Lebanon 1050 684 521 4·82 3·65 1920 1290 983 8·99 6·99
(813–1330) (497–938) (373–734) (4·02–5·89) (1510–2420) (958–1730) (708–1380) (7·51–11·0)
Libya 1650 560 458 5·62 4·43 3240 1470 1110 13·3 10·4
(1350–1990) (436–712) (351–583) (4·73–6·69) (2640–3890) (1180–1800) (869–1390) (11·4–15·7)
Morocco 22 200 9820 6760 11·1 7·92 40 800 16 200 11 100 17·9 11·9
(17 600–27 300) (7510–12 500) (5120–8700) (9·74–12·5) (33 500–48 200) (11 700–21 900) (7860–15 400) (15·0–21·4)
Oman 478 504 418 5·38 4·25 926 958 809 10·4 8·17
(408–553) (445–564) (357–482) (4·86–5·90) (792–1070) (842–1070) (690–937) (9·40–11·4)
Articles
879
880
2000 2015 2019 2019 2030* 2000 2015 2019 2019 2030*
Palestine 1720 1050 800 6·36 5·67 3750 2060 1560 12·4 10·1
Articles
(1450–2000) (803–1320) (606–1060) (5·38–7·63) (3350–4160) (1620–2580) (1180–2060) (10·5–14·8)

Qatar 107 127 113 4·22 3·45 199 239 214 8·02 6·62
(85·9–133) (103–155) (90·6–144) (3·52–5·13) (165–239) (195–291) (172–274) (6·71–9·74)
Saudi Arabia 5910 1670 1200 2·64 1·48 13 000 3830 2610 5·73 3·39
(4690–7240) (1320–2100) (950–1520) (2·20–3·24) (9880–16 500) (3060–4750) (2070–3300) (4·77–7·01)
Sudan 43 600 30 700 25 700 21·3 17·0 124 000 65 100 50 700 41·9 30·0
(36 800–50 700) (24 800–37 300) (20 600–32 500) (18·9–24·1) (111 000–137 000) (51 100–81 800) (37 300–68 600) (35·7–50·0)
Syria 5300 3320 1590 6·88 5·92 10 800 8940 3210 13·6 12·0
(4670–5950) (2850–3830) (1320–1900) (5·72–8·32) (10 000–11 700) (7980–10 100) (2560–3990) (11·7–15·8)
Tunisia 3590 1610 1140 6·82 5·33 6140 2700 1920 11·3 8·45
(2900–4370) (1260–2010) (903–1420) (5·73–8·12) (5160–7180) (2170–3290) (1530–2380) (9·49–13·5)
Turkey 28 200 10 900 8380 8·54 6·62 61 200 19 500 15 100 15·4 11·4
(23 400–33 500) (8610–13 800) (6710–10 400) (7·15–10·2) (51 700–71 300) (15 500–24 300) (12 100–18 700) (12·9–18·4)
United Arab 305 227 145 2·58 2·40 587 455 295 4·96 4·37
Emirates (269–341) (173–298) (109–197) (2·18–3·10) (532–641) (352–599) (220–399) (4·19–5·97)
Yemen 30 100 23 900 21 600 22·8 18·7 75 800 49 200 44 200 46·7 35·1
(25 300–35 200) (19 300–29 200) (17 700–26 000) (18·8–27·4) (67 600–84 400) (40 800–58 800) (36 700–53 100) (40·2–54·4)
South Asia 1 560 000 1 110 000 899 000 26·9 21·8 3 040 000 1 760 000 1 360 000 40·5 29·0
(1 410 000–1 730 000) (958 000–1 280 000) (761 000–1 060 000) (24·2–30·0) (2 780 000–3 330 000) (1 510 000–2 020 000) (1 140 000–1 610 000) (36·0–46·0)
Bangladesh 146 000 70 100 52 600 19·8 14·2 295 000 108 000 77 900 29·2 18·4
(130 000–163 000) (54 500–87 600) (40 400–66 300) (16·4–23·7) (267 000–325 000) (90 000–128 000) (63 000–94 200) (24·9–34·2)
Bhutan 796 379 287 20·6 15·0 1580 602 445 31·5 22·2
(661–929) (279–499) (207–393) (17·5–24·2) (1320–1830) (443–788) (322–602) (26·7–36·9)
India 1 070 000 720 000 558 000 23·8 18·8 2 130 000 1 150 000 841 000 35·8 24·6
(938 000–1 220 000) (606 000–844 000) (456 000–689 000) (20·1–28·8) (1 900 000–2 380 000) (970 000–1 350 000) (692 000–1 040 000) (30·2–43·0)
Nepal 32 500 14 700 11 700 19·0 13·5 65 900 24 200 18 000 29·1 18·9
(28 500–36 700) (12 000–18 000) (9610–14 100) (15·6–23·0) (59 300–73 100) (20 500–28 600) (14 700–21 800) (24·8–34·1)
Pakistan 309 000 305 000 277 000 41·6 34·5 552 000 478 000 420 000 63·3 48·0
(264 000–356 000) (246 000–374 000) (226 000–333 000) (34·2–50·0) (495 000–614 000) (395 000–569 000) (346 000–507 000) (53·9–74·3)
Southeast Asia, 507 000 250 000 194 000 7·23 6·17 1 280 000 519 000 405 000 14·8 11·7
east Asia, and (471 000–543 000) (215 000–288 000) (162 000–230 000) (6·29–8·27) (1 200 000–1 380 000) (456 000–590 000) (349 000–467 000) (13·2–16·4)
Oceania
East Asia 243 000 86 700 59 300 3·83 2·89 652 000 185 000 136 000 8·56 5·89
(222 000–263 000) (77 800–96 600) (51 500–67 700) (3·37–4·37) (594 000–717 000) (166 000–206 000) (119 000–155 000) (7·52–9·76)
China 229 000 82 700 56 400 3·78 2·77 610 000 177 000 131 000 8·52 5·70
(208 000–249 000) (74 000–92 300) (49 100–64 400) (3·31–4·31) (556 000–666 000) (158 000–198 000) (114 000–149 000) (7·45–9·71)
North Korea 13 100 3510 2420 6·91 5·85 39 200 6430 4460 12·6 9·55
(9580–18 000) (2720–4470) (1920–3110) (5·74–8·45) (25 000–69 700) (5000–8140) (3530–5680) (10·5–15·4)
Taiwan (province 967 532 405 2·31 2·30 2300 1030 815 4·51 3·98
of China) (889–1050) (498–570) (330–497) (1·97–2·75) (2230–2380) (988–1080) (672–998) (3·85–5·38)
Oceania 5900 7360 7540 18·1 15·4 17 400 20 200 19 900 48·4 39·0
(5080–6800) (5910–9040) (5970–9450) (15·2–21·4) (15 000–20 000) (16 300–24 700) (15 800–25 000) (40·7–57·5)
American Samoa 12·2 5·67 5·14 4·86 3·88 24·6 12·2 10·8 10·2 7·72
(10·5–14·0) (4·58–6·85) (3·94–6·47) (4·23–5·52) (20·7–28·9) (9·61–15·3) (7·95–14·4) (8·72–12·0)
Cook Islands 2·21 0·412 0·303 1·10 0·940 5·00 0·942 0·685 2·46 1·98
(1·71–2·81) (0·326–0·519) (0·243–0·375) (0·930–1·31) (3·87–6·33) (0·742–1·20) (0·547–0·848) (2·06–2·94)

2000 2015 2019 2019 2030* 2000 2015 2019 2019 2030*
Federated States 42·2 16·4 13·4 6·85 5·05 105 35·6 28·4 14·5 10·5
of Micronesia (34·0–51·4) (12·7–20·5) (10·4–16·9) (5·72–8·22) (87·3–125) (27·8–44·4) (22·1–35·9) (12·1–17·4)
Fiji 217 198 177 10·0 8·70 471 432 387 21·7 18·8
(172–272) (152–255) (128–241) (8·41–12·0) (376–590) (338–554) (281–521) (18·2–25·9)
Guam 20·2 24·6 23·6 7·18 7·31 41·3 46·0 43·9 13·3 12·6
(18·1–22·5) (21·6–28·1) (18·8–29·6) (6·16–8·40) (36·8–46·1) (41·5–51·3) (35·6–53·7) (11·6–15·3)

Kiribati 54·1 48·5 44·5 14·6 12·0 157 116 101 33·6 25·4
(44·8–65·3) (37·0–63·4) (32·3–60·2) (12·3–17·5) (130–190) (88·7–151) (74·0–137) (28·1–40·0)
Marshall Islands 24·5 13·9 11·7 9·38 7·74 57·9 29·2 24·3 19·3 16·9
(19·7–29·6) (11·1–17·6) (9·32–15·1) (7·84–11·4) (49·9–66·6) (23·5–36·5) (19·4–31·0) (16·2–23·4)
Nauru 5·85 3·71 3·04 10·1 8·58 17·7 8·94 7·03 23·2 18·7
(4·75–7·19) (2·96–4·61) (2·45–3·89) (8·44–12·2) (15·2–20·3) (7·27–11·0) (5·65–8·95) (19·5–28·1)
Niue 0·415 0·224 0·205 8·12 6·92 1·01 0·520 0·472 18·6 15·0
(0·313–0·540) (0·173–0·284) (0·160–0·259) (6·81–9·68) (0·775–1·28) (0·399–0·656) (0·367–0·595) (15·5–22·2)
Northern 9·67 2·73 2·22 4·40 3·89 17·5 6·00 4·69 9·11 8·07
Mariana Islands (7·70–11·8) (2·25–3·28) (1·82–2·69) (3·60–5·29) (14·0–21·3) (4·77–7·39) (3·68–5·83) (7·73–10·7)
Palau 3·22 1·52 1·15 6·04 5·15 7·78 3·72 2·77 14·0 11·3
(2·44–4·16) (1·15–1·97) (0·876–1·53) (5·05–7·38) (5·78–10·3) (2·82–4·76) (2·11–3·66) (11·7–17·0)
Papua New 4690 6280 6530 19·6 16·8 14 400 17 600 17 600 53·8 43·4
Guinea (4010–5470) (5020–7740) (5180–8160) (16·5–23·3) (12 300–16 700) (14 100–21 600) (14 000–22 000) (45·3–63·9)
Samoa 30·9 24·0 22·3 6·28 5·35 65·1 49·9 46·4 13·2 11·4
(21·8–42·2) (17·5–32·9) (15·8–31·0) (5·24–7·52) (47·2–86·9) (36·6–67·4) (32·8–64·1) (11·1–15·9)
Solomon Islands 325 272 245 11·5 9·36 767 593 519 24·6 19·2
(261–398) (216–333) (197–301) (9·65–13·8) (620–935) (474–728) (421–638) (20·6–29·4)
Tokelau 0·406 0·139 0·119 3·19 2·71 0·961 0·338 0·286 7·73 6·24
(0·322–0·506) (0·110–0·176) (0·0935–0·149) (2·54–3·97) (0·767–1·19) (0·265–0·420) (0·229–0·351) (6·45–9·28)
Tonga 26·9 17·5 14·5 6·36 5·37 56·4 38·0 31·4 13·6 13·7
(22·0–32·6) (13·5–22·8) (10·5–19·7) (5·31–7·61) (46·7–67·1) (29·4–48·7) (22·9–42·3) (11·4–16·3)
Tuvalu 4·62 1·70 1·42 6·63 5·65 10·6 3·50 2·92 13·7 11·0
(4·00–5·32) (1·26–2·22) (1·06–1·93) (5·51–8·10) (9·00–12·5) (2·66–4·52) (2·19–3·90) (11·4–16·7)
Vanuatu 99·6 93·4 88·3 11·6 9·73 223 201 185 24·4 20·0
(78·1–125) (75·2–115) (70·4–110) (9·68–13·8) (175–277) (163–246) (148–228) (20·5–29·2)
Southeast Asia 259 000 156 000 127 000 11·6 9·17 615 000 314 000 250 000 22·6 16·5
(233 000–283 000) (129 000–187 000) (102 000–156 000) (9·92–13·6) (563 000–665 000) (269 000–367 000) (209 000–297 000) (20·1–25·6)
Cambodia 12 200 7330 6280 16·9 13·1 35 200 14 200 11 600 31·3 21·6
(11 100–13 300) (5800–9240) (4810–8280) (14·4–20·3) (31 600–38 900) (11 200–17 800) (8890–15 300) (26·5–37·5)
Indonesia 115 000 66 500 52 400 13·7 10·5 260 000 129 000 98 900 25·5 17·8
(102 000–129 000) (50 800–83 100) (40 900–65 500) (10·9–17·0) (236 000–283 000) (106 000–153 000) (80 600–121 000) (21·6–30·2)
Laos 7790 3960 3470 19·9 12·8 21 600 8680 7100 40·9 18·8
(6960–8770) (3270–4670) (2760–4280) (16·9–23·2) (19 600–23 900) (7220–10 300) (5650–8900) (35·0–47·5)
Malaysia 2460 2340 1910 3·55 2·82 4840 4270 3410 6·42 4·91
(2240–2680) (2060–2590) (1540–2330) (3·01–4·20) (4720–4980) (4160–4380) (2790–4150) (5·43–7·59)
Maldives 134 99·9 81·9 9·58 8·08 241 169 140 16·2 13·6
Articles
(112–159) (76·4–131) (60·0–113) (8·05–11·5) (205–283) (131–217) (103–192) (13·7–19·4)

881
882
Articles
2000 2015 2019 2019 2030* 2000 2015 2019 2019 2030*
Mauritius 228 120 104 8·07 6·79 349 192 163 12·6 10·7
(208–249) (109–132) (77·5–136) (6·90–9·39) (326–372) (177–206) (124–211) (10·8–14·7)
Myanmar 48 300 26 600 22 200 21·0 16·2 135 000 55 000 42 800 40·3 28·6
(40 000–57 000) (21 200–32 400) (16 300–28 700) (17·3–24·8) (117 000–156 000) (43 800–67 900) (32 100–56 300) (34·3–47·1)
Philippines 37 800 31 200 27 400 10·2 8·59 87 100 69 000 60 000 22·6 17·5
(32 500–44 100) (21 800–41 700) (19 700–36 400) (7·91–13·0) (77 600–97 500) (55 700–84 400) (47 800–73 200) (19·0–26·7)
Seychelles 13·6 12·7 10·7 7·15 6·12 20·6 20·3 17·3 11·5 9·79
(11·7–15·7) (10·5–15·0) (8·09–14·0) (6·18–8·26) (17·7–23·7) (16·8–24·2) (13·1–22·6) (9·89–13·4)
Sri Lanka 3300 1750 1300 4·37 3·16 5880 3060 2290 7·61 5·38
(3050–3560) (1430–2130) (882–1860) (3·46–5·45) (5510–6240) (2560–3630) (1640–3150) (6·38–9·08)
Thailand 7780 2790 2120 3·63 2·39 16 100 6030 4570 7·63 4·97
(6400–9410) (2380–3230) (1660–2670) (2·99–4·26) (13 800–19 000) (5510–6560) (3760–5480) (6·84–8·48)
Timor-Leste 966 622 602 15·5 12·4 3150 1340 1230 32·1 21·0
(869–1080) (512–748) (486–741) (13·1–18·6) (2790–3550) (1110–1610) (1000–1520) (27·2–38·5)
Vietnam 22 200 12 300 9200 6·83 5·21 44 300 22 600 17 100 12·4 9·42
(19 400–25 200) (9830–15 400) (7010–12 300) (5·76–8·27) (39 400–49 800) (18 100–28 400) (13 000–22 700) (10·5–15·0)
Sub-Saharan 1 120 000 1 090 000 1 020 000 27·9 23·6 4 020 000 3 070 000 2 680 000 74·1 54·4
Africa (1 050 000–1 190 000) (938 000–1 270 000) (847 000–1 250 000) (24·7–31·6) (3 790 000–4 270 000) (2 640 000–3 550 000) (2 220 000–3 250 000) (65·3–85·2)
Central sub- 124 000 114 000 100 000 22·5 17·7 509 000 333 000 260 000 58·8 36·5
Saharan Africa (111 000–137 000) (98 400–132 000) (85 800–120 000) (19·8–25·8) (468 000–553 000) (289 000–387 000) (222 000–310 000) (51·7–67·5)
Angola 28 700 26 200 24 000 21·7 16·9 116 000 73 000 58 800 54·2 33·7
(25 200–32 100) (21 900–31 100) (20 100–28 400) (19·1–24·5) (105 000–127 000) (60 900–85 700) (48 100–70 800) (46·4–62·9)
Central African 7730 8060 7770 39·3 35·4 28 300 26 900 24 000 123 95·2
Republic (6570–8970) (6320–10 200) (6150–9930) (33·2–47·4) (24 500–32 100) (21 900–32 600) (19 200–30 000) (105–146)
Congo 3400 3240 2680 18·4 15·3 12 100 7540 5760 39·5 27·8
(Brazzaville) (2910–3940) (2770–3770) (2250–3170) (16·0–21·0) (10 900–13 400) (6410–8770) (4810–6890) (33·7–46·1)
DR Congo 81 900 74 700 64 700 22·0 17·6 346 000 222 000 168 000 57·9 36·0
(71 700–93 100) (62 800–88 800) (53 500–79 500) (18·7–26·3) (311 000–385 000) (187 000–263 000) (141 000–205 000) (49·2–69·1)
Equatorial 1090 795 683 17·7 14·4 3710 1890 1450 38·1 24·2
Guinea (886–1300) (589–1060) (492–952) (14·8–21·6) (3060–4430) (1420–2500) (1050–2010) (31·9–46·3)
Gabon 1140 797 680 15·8 13·5 2940 1600 1300 30·1 21·4
(921–1380) (594–1070) (487–952) (13·2–19·0) (2370–3530) (1200–2110) (928–1810) (25·3–36·4)
Eastern sub- 424 000 378 000 353 000 24·9 20·6 1 450 000 941 000 814 000 58·3 41·1
Saharan Africa (392 000–457 000) (317 000–448 000) (286 000–439 000) (21·6–29·0) (1 360 000–1 550 000) (794 000–1 110 000) (658 000–1 010 000) (50·5–68·1)
Burundi 10 700 11 100 11 200 24·0 19·3 43 300 32 100 29 700 65·4 42·7
(8930–12 600) (9470–12 900) (9420–13 400) (21·3–27·2) (39 100–47 900) (26 600–38 400) (23 800–37 400) (55·7–77·8)
Comoros 934 553 469 27·9 22·0 2140 1050 836 49·8 35·2
(763–1130) (439–680) (369–589) (23·5–33·8) (1770–2560) (846–1290) (663–1040) (42·1–59·9)
Djibouti 864 863 750 21·2 17·2 2670 2080 1670 47·0 34·4
(729–1020) (693–1060) (593–943) (17·6–25·8) (2260–3130) (1680–2530) (1330–2080) (39·4–56·9)
Eritrea 4510 4220 3870 19·3 15·7 16 000 11 300 9400 47·5 30·7
(3690–5480) (3180–5620) (2800–5360) (16·1–23·5) (13 300–19 100) (8600–14 800) (6860–12 900) (39·8–57·5)
Ethiopia 144 000 110 000 97 900 26·6 21·5 426 000 229 000 190 000 52·4 34·6
(130 000–161 000) (88 300–135 000) (77 200–126 000) (22·6–31·6) (387 000–469 000) (187 000–277 000) (150 000–243 000) (44·7–62·4)

2000 2015 2019 2019 2030* 2000 2015 2019 2019 2030*
Kenya 32 000 29 200 26 400 19·7 16·3 99 300 64 500 54 100 40·6 28·1
(27 700–36 400) (23 900–35 100) (21 200–32 300) (16·8–23·1) (89 300–111 000) (52 900–76 800) (43 700–65 700) (34·6–47·7)
Madagascar 21 400 21 100 19 800 23·0 18·7 70 600 55 100 48 200 56·6 37·3
(18 500–24 600) (17 000–25 600) (15 900–24 500) (19·4–27·7) (61 900–79 800) (45 200–65 800) (39 100–59 000) (48·1–67·7)
Malawi 19 500 14 700 13 700 25·0 19·6 80 000 38 600 31 800 59·1 39·6
(17 900–21 400) (12 000–17 900) (10 600–17 600) (21·4–29·6) (74 100–86 300) (32 000–46 800) (24 900–40 800) (50·6–70·0)
Mozambique 34 600 30 400 29 000 25·8 20·2 130 000 88 900 76 500 69·4 47·0
(31 200–38 300) (25 400–36 200) (23 700–35 800) (21·9–30·7) (117 000–143 000) (74 700–105 000) (62 800–93 800) (59·0–82·8)
Rwanda 11 100 7490 7030 19·9 15·1 47 000 18 800 16 300 46·6 28·3

(9090–13 100) (6050–8990) (5750–8640) (17·5–22·8) (42 900–50 900) (15 300–23 200) (12 600–21 200) (39·6–55·8)
Somalia 20 800 25 800 27 000 30·9 25·2 77 700 81 300 80 600 95·4 67·6
(17 300–24 700) (20 500–32 300) (20 900–35 200) (25·9–37·5) (66 700–89 600) (65 100–100 000) (62 900–104 000) (80·8–114)
South Sudan 13 200 13 300 12 000 33·0 29·7 47 100 41 400 33 100 92·6 66·3
(11 300–15 100) (10 600–16 300) (9670–14 900) (28·0–38·8) (41 100–53 200) (33 500–50 200) (26 800–40 600) (78·9–108)
Tanzania 52 100 52 300 50 000 23·9 20·0 186 000 133 000 118 000 57·1 41·8
(46 700–57 900) (42 700–63 600) (39 300–63 700) (20·4–28·3) (171 000–202 000) (110 000–161 000) (93 200–150 000) (48·9–67·7)
Uganda 42 600 43 000 40 800 25·6 21·9 163 000 107 000 91 700 58·4 43·3
(39 500–46 100) (36 700–50 200) (33 300–50 400) (22·0–30·0) (153 000–174 000) (91 600–124 000) (75 000–112 000) (50·4–68·7)
Zambia 14 600 13 800 13 100 21·1 17·4 62 300 36 000 31 500 51·8 35·8
(12 900–16 400) (10 900–17 500) (9930–17 300) (17·9–25·4) (56 300–68 700) (28 800–44 500) (24 200–41 300) (44·0–61·8)
Southern sub- 45 700 41 000 35 900 21·4 19·9 128 000 83 800 70 700 42·0 36·0
Saharan Africa (40 100–51 300) (33 800–49 500) (28 600–45 700) (18·5–25·1) (113 000–145 000) (69 400–101 000) (56 300–89 800) (36·3–49·3)
Botswana 1200 1070 1000 20·7 18·8 3360 2190 2000 41·3 36·0
(920–1510) (796–1430) (735–1380) (17·5–25·0) (2710–4060) (1630–2880) (1460–2750) (34·7–49·9)
Eswatini 746 557 506 16·9 14·8 3160 1680 1430 47·3 37·7
(645–857) (458–678) (413–628) (14·4–19·8) (2780–3570) (1390–2030) (1170–1760) (40·4–55·3)
Lesotho 2330 1540 1350 28·6 24·7 5890 3750 3030 64·4 52·8
(2010–2670) (1070–2080) (919–1840) (22·1–36·2) (5230–6620) (3050–4560) (2370–3740) (54·9–75·6)
Namibia 1260 1100 1020 16·2 14·3 3610 2480 2200 35·0 28·4
(1100–1460) (845–1400) (767–1360) (13·5–19·8) (3110–4200) (1930–3180) (1680–2900) (29·6–42·2)
South Africa 30 300 25 300 21 400 20·7 18·5 80 600 47 100 38 500 36·9 29·7
(25 700–35 300) (20 200–31 800) (16 900–27 600) (17·7–24·5) (67 900–94 900) (37 600–58 900) (30 200–49 400) (31·6–43·6)
Zimbabwe 9850 11 400 10 500 23·4 22·1 31 600 26 600 23 600 52·4 45·8
(8870–10 900) (9280–14 000) (8310–13 500) (20·1–27·7) (28 900–34 600) (22 000–31 800) (18 600–29 900) (45·0–62·0)
Western sub- 522 000 557 000 535 000 32·5 27·8 1 930 000 1 710 000 1 530 000 95·3 71·1
Saharan Africa (483 000–563 000) (487 000–643 000) (448 000–644 000) (29·3–36·4) (1 820 000–2 040 000) (1 490 000–1 960 000) (1 280 000–1 860 000) (84·7–109)
Benin 12 300 15 600 15 400 30·5 26·8 42 000 45 700 42 000 85·0 65·9
(10 200–14 900) (12 700–18 700) (12 600–19 100) (26·4–35·6) (38 800–45 700) (39 000–53 300) (34 300–51 500) (73·8–99·3)
Burkina Faso 21 500 26 000 26 900 28·6 24·0 99 300 101 000 98 800 109 82·5
(18 400–24 700) (20 800–32 200) (21 100–34 500) (24·2–34·4) (89 400–109 000) (83 800–122 000) (78 300–125 000) (93·0–129)
Cameroon 20 900 23 400 21 700 24·2 18·6 80 000 75 400 64 000 71·7 48·6
(18 200–24 100) (18 200–29 300) (17 100–27 000) (18·5–30·7) (72 300–88 000) (62 100–89 300) (52 500–77 200) (61·2–84·0)
Articles
883
884
Articles

2000 2015 2019 2019 2030* 2000 2015 2019 2019 2030*
Cape Verde 226 135 103 9·46 7·65 647 246 187 17·0 11·6
(189–271) (106–171) (74·3–141) (8·16–11·0) (544–773) (194–309) (135–253) (14·7–19·8)
Chad 18 200 23 600 25 400 32·2 26·9 76 600 84 600 85 600 113 83·2
(16 700–19 700) (19 300–28 600) (20 800–31 100) (27·6–38·0) (70 000–83 900) (72 200–99 100) (70 400–105 000) (97·0–133)
Côte d’Ivoire 35 300 34 500 30 400 34·2 28·3 101 000 78 900 64 800 73·3 48·2
(28 800–42 100) (27 600–42 300) (24 500–36 900) (27·9–41·4) (90 700–112 000) (66 800–92 500) (54 300–77 100) (62·8–85·6)
The Gambia 2020 1610 1410 19·4 14·7 5460 3330 2710 37·8 23·2
(1730–2360) (1210–2110) (1030–1920) (16·4–23·4) (4690–6260) (2550–4300) (1990–3680) (31·9–45·5)
Ghana 24 100 21 600 19 800 23·1 19·5 66 800 52 900 44 300 52·2 40·5
(21 100–27 100) (16 800–27 000) (14 000–27 000) (18·7–28·1) (60 700–72 900) (43 200–63 400) (33 300–58 400) (44·9–60·7)
Guinea 17 600 15 100 14 600 30·6 23·4 61 800 51 300 45 400 97·1 67·1
(16 100–19 200) (12 000–18 700) (11 600–18 200) (26·4–35·4) (56 100–67 700) (43 000–60 800) (36 400–55 800) (83·8–112)
Guinea-Bissau 2700 2210 1980 31·5 24·3 8630 5280 4430 71·2 45·6
(2300–3130) (1770–2720) (1630–2330) (27·9–35·4) (7560–9700) (4280–6370) (3540–5420) (60·7–83·0)
Liberia 5380 3650 3220 23·6 18·3 21 000 10 800 8280 60·9 37·8
(4810–6020) (2820–4680) (2370–4420) (20·0–28·3) (19 300–22 800) (8520–13 300) (6120–11 200) (51·9–72·6)
Mali 29 400 36 400 38 000 39·5 32·0 104 000 111 000 110 000 118 86·2
(25 300–33 700) (29 600–44 400) (30 800–47 200) (34·2–46·2) (95 300–113 000) (94 400–129 000) (89 500–135 000) (103–138)
Mauritania 3800 3100 2610 23·9 18·9 9230 5860 4660 42·8 29·2
(3290–4370) (2610–3680) (2130–3270) (21·3–26·9) (8260–10 300) (4790–7160) (3580–6100) (36·6–50·8)
Niger 26 200 28 300 30 600 26·8 21·1 138 000 121 000 120 000 111 71·1
(23 100–29 500) (23 600–33 800) (25 900–36 200) (23·6–30·6) (125 000–153 000) (101 000–143 000) (99 500–147 000) (94·5–131)
Nigeria 271 000 294 000 277 000 36·4 32·0 1 010 000 886 000 773 000 104 78·0
(239 000–305 000) (247 000–350 000) (224 000–346 000) (31·7–42·3) (936 000–1 080 000) (760 000–1 030 000) (628 000–957 000) (90·6–120)
São Tomé and 108 71·9 56·8 12·1 9·77 386 160 119 25·4 17·4
Príncipe (92·1–125) (55·3–91·2) (41·0–77·4) (10·2–14·3) (333–441) (124–203) (87·0–161) (21·4–30·0)
Senegal 13 900 12 900 11 700 25·0 20·1 43 800 27 100 22 800 49·3 32·6
(12 400–15 600) (11 200–14 900) (9750–14 100) (22·5–27·9) (40 600–47 300) (23 400–31 400) (18 400–28 600) (42·8–57·6)
Sierra Leone 10 000 8370 8030 28·6 20·8 39 100 32 500 28 100 102 67·7
(8720–11 400) (6630–10 400) (6410–10 100) (24·2–33·7) (35 000–43 400) (27 600–38 200) (22 900–34 300) (88·6–117)
Togo 7270 6710 5930 24·9 19·0 23 700 18 500 15 000 63·2 41·8
(6170–8540) (5610–7970) (4770–7340) (21·4–28·8) (20 900–26 600) (15 400–22 300) (12 000–19 000) (53·9–75·3)
Count data are given to three significant figures. Data in parentheses are 95% uncertainty intervals. NMR=neonatal mortality rate. U5MR=under-5 mortality rate. SDI=Socio-demographic Index. GBD=Global Burden of Diseases, Injuries, and Risk Factors
Study. *Reference scenario. †Subnational analyses are done in these countries and data is available in the appendix (p 109).
Table: Neonatal and under-5 deaths in 2000, 2015, and 2019, by country, GBD region, GBD super-region, and SDI, and at the global level for both sexes combined; and neonatal mortality rate in 2019 with reference
scenario for 2030

Articles
to 6·10 million (5·35–6·91) in 2015, and to 5·05 million A B

(4·27–6·02) in 2019 (table). Of these deaths, 3·76 mil
3
lion (95% UI 3·53–4·02; 39%) in 2000, 2·82 million 0
(2·48–3·20; 46%) in 2015, and 2·42 million (2·06–2·86;
Under-5 deaths (millions)

48%) in 2019 occurred in neonates (aged <28 days). In –2
2
ARC in qx
each year analysed, the largest share of the global
deaths of children younger than 5 years occurred in –4
the sub-Saharan Africa and south Asia super-regions.
Although U5MR declined in each successive period in 1
–6
all super-regions, the proportion of global deaths in
children younger than 5 years in these two super-regions
increased from 73% (7·07 million deaths [95% UI 2000 2005 2010 2015 2019 2000 2005 2010 2015 2019
Year Year
6·57–7·59]) in 2000 to 80% (4·04 million [3·36–4·86])
deaths in 2019. The share of under-5 deaths also shifted C D
towards lower SDI groups in this period, with the 0·5 0·5
Change in proportion of under-5 deaths
Change in proportion of under-5 deaths

proportion of under-5 deaths in the low SDI quintile
0·4 0·4
increasing from 42% (4·01 million deaths [95% UI
3·78–4·26]) in 2000 to 53% (2·67 million deaths 0·3 0·3
[2·22–3·24]) in 2019. 0·2 0·2
Global U5MR and NMR both are falling short of SDG
targets. Global U5MR declined from 71·2 (95% UI 0·1 0·1
68·3–74·0) in 1990 to 37·1 (95% UI 33·2–41·7) deaths 0 0

per 1000 livebirths in 2019, with corresponding changes
–0·1 –0·1
in NMR from 28·0 (95% UI 26·8–29·5) in 1990 to
0 0·1 0·2 0·3 0·4 0·5 0 0·1 0·2 0·3 0·4 0·5
17·9 (16·3–19·8) deaths per 1000 livebirths (table). The
Proportion of under-5 deaths in 2000 Proportion of under-5 deaths in 2015
countries with the highest U5MR in 2019 were Central
Age groups SDI quintile
African Republic, Mali, and Chad, whereas Andorra, Early neonatal (0–6 days) 6−11 months Low SDI High−middle SDI
Singapore, and Slovenia were found to have the lowest Late neonatal (7–27 days) 12−23 months Low−middle SDI High SDI
1−5 months 2−4 years Middle SDI
U5MR. As for 2019 neonatal mortality, the highest
rate was observed in Pakistan, followed by Mali and Figure 1: Global all-cause under-5 mortality by age, year, and SDI
Central African Republic. The countries with the lowest (A) Under-5 deaths (in millions) for 2000–19. (B) ARC in qx for each year between 2000 and 2019. (C) Proportion
2019 NMR were Andorra, Japan, and Singapore. U5MR of under-5 deaths in 2000 compared with the ratio of age-specific to total under-5 absolute change in deaths
between 2000 and 2015 by SDI quintile. (D) Proportion of under-5 deaths in 2015 compared to ratio of
and NMR declined in every country between 2000 age-specific to total under-5 absolute change in deaths between 2015 and 2019 by SDI quintile. The shaded areas
and 2019, apart from Dominica, Guam, and Northern in panels A and B represent 95% uncertainty intervals. The black line in panels C and D represents line of
Mariana Islands (appendix p 311). equivalence, such that points above the line indicate age and SDI groups in which change outpaces overall under-5
We found evidence of accelerated reduction in global mortality change and points below the line indicate age and SDI groups in which change underperforms relative to
overall under-5 mortality change. ARC=annualised rate of change. qx=probability of death. SDI=Socio-
U5MR, but the largest number of deaths, as well as the demographic Index.
slowest progress, occurred in the early neonatal age
group (figure 1A, B). In all SDI quintiles, decline in NMR Vanuatu, and Solomon Islands—had a U5MR below
lagged behind mortality declines in other age groups this threshold, making a total of 136 (67%; table).
(figure 1C, D). There is evidence of relative progress in In 2015, 126 (62%) of 204 countries had an NMR
neonatal mortality in the time period between 2015 below the SDG 3.2 threshold of 12 neonatal deaths
and 2019, compared with between 2000 and 2015, but per 1000 livebirths (figure 2B). By 2019, an additional
early neonatal progress in this more recent time period is seven countries—Syria, Iraq, Kyrgyzstan, Uzbekistan,
still slower than overall under-5 progress in low SDI Morocco, Solomon Islands, and Vanuatu—had achieved
settings (figure 1D). The proportion of neonatal death an NMR below this threshold, making a total of
broadly increases as SDI increases: in 2019, in the low 133 (65%).
SDI quintile, 1·11 million (41%) of 2·67 million deaths in Under-5 mortality in each analysed year was
children younger than 5 years were neonatal deaths, and somewhat higher in males than in females, although
in the high SDI quintile 26 800 (55%) of 48 600 deaths this difference was not statistically significant at the
in children younger than 5 years were neonatal deaths global level (appendix p 99). U5MR declined in both
(appendix p 120). males and females in the periods between 2000
In 2015, 128 (63%) of 204 countries already had an and 2015, and between 2015 and 2019 (appendix p 99).
U5MR below the SDG 3.2 threshold of 25 deaths of The 2019 male-to-female ratio of U5MR does not
children younger than 5 years per 1000 livebirths change meaningfully with SDI; this ratio ranges
(figure 2A). By 2019, eight additional countries—Syria, from 1·08 in low-middle SDI to 1·18 in high SDI
Uzbekistan, Guatemala, Philippines, Guyana, Nauru, in 2019 (appendix p 99).

Articles
Target achieved
By 2015
By 2019
By 2030
Beyond 2030
Eastern
Caribbean and central America Persian Gulf Balkan Peninsula Southeast Asia West Africa Mediterranean
Northern Europe
Eastern
Caribbean and central America Persian Gulf Balkan Peninsula Southeast Asia West Africa Mediterranean
Northern Europe
Figure 2: Map of individual countries’ progress toward achieving the Sustainable Development Goals 3.2 target of (A) reducing neonatal mortality rate to the threshold of 12 neonatal deaths per
1000 livebirths, and reducing under-5 mortality rate to the threshold of 25 under-5 deaths per 1000 livebirths (B), under the reference scenario

Articles
Maternal and neonatal disorders Neoplasms Urinary diseases and male infertility
Respiratory infections and tuberculosis Transport injuries Skin and subcutaneous diseases
Enteric infections Digestive diseases Substance use disorders
Congenital birth defects Cardiovascular diseases Diabetes and kidney diseases
Neglected tropical diseases and malaria Sudden infant death syndrome Chronic respiratory diseases
Other infectious diseases Self-harm and interpersonal violence
Unintentional injuries Haemoglobinopathies and haemolytic anaemias
HIV/AIDS and sexually transmitted infections Neurological disorders
Nutritional deficiencies Endocrine, metabolic, blood, and immune disorders
Neonatal 28 days and older
Global
Low SDI
Low-middle SDI
Middle SDI
High-middle SDI
High SDI
Andean Latin America

Australasia
Caribbean
Central Asia
Central Europe
Central Latin America
Central Sub-Saharan Africa
East Asia
Eastern Europe
Eastern Sub-Saharan Africa
High-income Asia Pacific
High-income North America
North Africa and Middle East
Oceania
South Asia
Southeast Asia
Southern Latin America
Southern Sub-Saharan Africa
Tropical Latin America
Western Europe
Western Sub-Saharan Africa
0 0·25 0·50 0·75 1·00 0 0·25 0·50 0·75 1·00
Proportion of deaths (cause−fraction) Proportion of deaths (cause−fraction)
Figure 3: Neonatal and remaining under-5 cause-specific mortality, by region and SDI
Values presented are cause fractions: the proportion of total age-specific deaths with a particular underlying cause of death. Causes are presented at Level 2 in the
hierarchy, with other non-communicable diseases disaggregated to include congenital birth defects, sudden infant death syndrome, haemoglobinopathies and
haemolytic anaemias, endocrine, metabolic, blood, and immune disorders, and urinary diseases and male infertility separately. Total under-5 mortality is split at
28 days to include neonatal (<28 days) separately from children between 28 days and 5 years of age. SDI=Socio-demographic Index.
Levels and trends in cause-specific mortality (–11·3% [95% UI –13·7 to –9·0]), HIV/AIDS (–10·2%
The leading level 3 causes of global under-5 mortality [–12·3 to –7·8]), and tuberculosis (–7·8 [–9·9 to –5·6]).
in 2019 were neonatal disorders, which accounted In 2019, causes of death varied by age, sex, and SDI
for 37·3% (95% UI 35·6–38·8) of deaths in children (figure 3; appendix p 100). The most common level 3
younger than 5 years, followed by lower respiratory causes of death in children younger than 5 years were
infections (13·3% [12·1–14·4]), diarrhoeal diseases neonatal disorders, lower respiratory infections, and
(9·9% [8·3–11·6]), congenital birth defects (9·4% diarrhoeal diseases in the low SDI quintile, and neonatal
[8·0–11·8]), and malaria (7·1% [3·5–12·0]; figure 3; disorders, congenital birth defects, and sudden infant
appendix p 100). Leading subcauses of neonatal death syndrome in the high SDI quintile (appendix
disorders and congenital birth defects and leading p 100). The level 3 causes with the largest male-to-female
global aetiologies of lower respiratory infections and ratio of mortality in the under-5 age group at the global
diarrhoeal disease can be found in the appendix level in 2019 were vascular intestinal disorders (5·99)
(pp 106, 121). and inguinal, femoral, and abdominal hernia (2·90), and
Of the 15 level 3 causes that accounted for more those with the lowest ratio were gallbladder and biliary
than 30 000 global under-5 deaths in 2019, the greatest diseases (0·29) and pancreatitis (0·29; appendix p 100).
reduction in deaths between 2000 and 2015 was
observed in measles, which saw a –9·2% (95% UI Scenarios for 2030 and beyond
–10·4 to –8·0) mean annual percentage change In our reference scenario, by 2030, 154 (75%) of
(appendix p 129). Measles was followed by protein- 204 countries are projected to have a U5MR lower than
energy malnutrition (–6·5% [–8·2 to –4·7]) and HIV/ the SDG threshold of 25 under-5 deaths per 1000 livebirths,
AIDS (–6·0% [–6·9 to –5·0]). Among these same 15 high- and 139 (68%) are expected to have an NMR lower than
mortality causes, and for the period 2015–19, the three the SDG threshold of 12 neonatal deaths per 1000 livebirths
with the greatest reduction in deaths were mea sles (figure 2, appendix p 93). In the better-than-reference

Articles
NMR U5MR
SDI quintile
125
Low SDI
PAK
40 MLI Low−middle SDI
Middle SDI MLI
NGA High−middle SDI NER
High SDI BFA
Targets 100 SLE NGA
SDG 3·2 target
Global optimum
30
Survival potential frontier
Deaths per 1000 livebirths
75
CMR
BWA
20 BTN
DOM
50
KIR AZE
ERI SDN
JAM DZA BWA
VUT
KNA MDV KIR
10 MHL AZE
JOR TUR 25 VUT
FSM TUV TUN ALB MHL TKM DZA
EGY MDV ALB
PRI KWT FSM TON
TON WSM WSM NIU JOR
MYS LBN MLT TUR KWT
ASM BHR CAN TUV ASM VIR CUB
USA OMN USA MLT
TKL ARE CUB MCO TKL
SGP MYS LBN CZE SVN
COK LTU EST 0 ARE LTU
0 JPN AND COK EST SGP AND
25 50 75 100 25 50 75 100
HAQ Index HAQ Index
Figure 4: 2019 NMR and U5MR by HAQ Index at the national level
204 countries were analysed, and the colour of each point indicates the SDI quintile that the country belongs to. HAQ Index ranges from 0 (worst) to 100 (best). The survival potential frontier, global
optimum, and SDG targets are indicated as lines on the graph. Grey shaded bands represent 95% UIs. Countries are labelled with their ISO3 country code in bold when their ratio to the survival
potential frontier is in the highest 10% of all countries and in italics when their ratio to the survival potential frontier is in the lowest 10% of all countries. ISO3 codes and corresponding location names
are listed in the appendix (p 11). NMR=neonatal mortality rate. HAQ=Healthcare Access and Quality. SDG=Sustainable Development Goal. SDI=Socio-demographic Index. U5MR=under-5 mortality
rate. UI=uncertainty interval.
scenario, 164 (80%) countries would reach the SDG the global optimum U5MR is 1·44 (95% UI 1·27–1·58).
U5MR target, and 145 (71%) countries would reach the Sex differences in mortality are similar below the global
SDG NMR target (appendix p 93). In the neonatal optimum as compared to overall mortality, with an NMR
scenario, 155 (76%) countries would meet the U5MR male-to-female ratio of 1·05 (95% UI 1·00–1·09) and a
target, and in the child scenario, 158 (77%) countries U5MR male-to-female ratio of 1·12 (95% UI 1·05–1·18).
would meet the U5MR target. In the counterfactual 16 causes of death have a global optimum of zero
scenario without the COVID-19 pandemic, our results deaths and are therefore classified as 100% preventable
suggest 154 (75%) countries would have a U5MR below by this framework. With the exceptions of exposure to
the SDG threshold and 140 (69%) countries would have forces of nature and conflict and terrorism, all of these
an NMR below the SDG threshold by 2030. preventable deaths are infectious conditions. If all
countries reduced mortality to the global optimum,
Global optimum and survival potential frontier the leading level 3 global under-5 causes of death would
There were an estimated 9·45 million (95% UI be neonatal disorders; congenital birth defects; lower
8·86–10·05) under-5 deaths more than the global respiratory infections; sudden infant death syndrome;
optimum in 2000 and 4·85 million (4·09–5·80) more and endocrine, metabolic, blood, and immune disorders.
than the global optimum in 2019 (appendix p 130). These When looking at mortality along the spectrum of
deaths represent 98% of all 9·65 million under-5 deaths HAQ Index, our analysis suggests that in 2000, as many
in 2000 and 96% of all 5·05 million under-5 deaths as 1·50 million (95% UI 1·31–1·72) neonatal deaths were
in 2019. In 2019, only 198 000 (95% UI 169 000–224 000) above the survival potential frontier, accounting for 40%
under-5 deaths worldwide were below the global (95% UI 37–43) of 3·76 million neonatal deaths. In the
optimum, and of these 108 000 (93 000–122 000; 55%) same year, analysis suggests that 3·94 million (95% UI
were neonatal deaths. Based on this analysis, and on 3·49–4·40) under-5 deaths were above the survival
current technology and health delivery systems, the potential frontier: 41% (95% UI 39–43) of 9·65 million
global optimum NMR is 0·80 (95% UI 0·71–0·86) and under-5 deaths). In 2019, the number of deaths occurring

Articles
above the survival potential frontier was smaller, but the infections ranked second in both observed and expected),
fraction of the overall mortality above the survival while 40% of diarrhoea deaths were above the frontier
potential frontier remained similar: 0·88 million (95% UI (ranked third in observed and fourth in expected;
0·62–1·20; 36% [95% UI 30–42]) of 2·42 million neonatal appendix p 94).
deaths and 1·87 million (1·35–2·58; 37% [32–43]) of
5·05 million under-5 deaths (figure 4). If all 204 countries Discussion
were to improve performance to meet the survival Main findings
potential frontier without changing their HAQ Index Declines of U5MR and NMR have continued to
level from 2019, 143 (70%) would have mortality below the accelerate worldwide. Of 204 countries, our reference
NMR SDG threshold and 149 (73%) would have mortality scenario suggests that, by 2030, 154 (75%) are likely to
below the U5MR SDG threshold, and 43 (70%) out of meet the U5MR SDG target and 139 (68%) the NMR
61 countries not achieving both SDG targets would be SDG target. However, the concomitant findings of
from the sub-Saharan Africa super-region. The countries growing relative inequity and a large remaining
where U5MR lags the most relative to HAQ Index in 2019 proportion of preventable deaths shows there is much
are Nigeria, Turkey, Mali, and Maldives. The countries more work to be done. If every country were at the
where NMR lags the most relative to HAQ Index in 2019 global optimum in 2019, global U5MR would have
are Maldives, Turkey, and Azerbaijan. The countries with been 1·44 (95% UI 1·27–1·58) deaths per 1000 livebirths
the most success at preventing under-5 mortality and and NMR would have been 0·80 (95% UI 0·71–0·86)
neonatal mortality relative to their HAQ Index are Cook deaths per 1000 livebirths.
Islands, United Arab Emirates, and Tokelau (figure 4). Thankfully, although children have been found to be at
Global under-5 mortality above the survival potential risk of developing multisystem inflammatory syn
frontier in 2019 consisted of 1·56 million (95% UI drome25 as result of COVID-19, they appear to be less at
1·11–2·17; 83%) deaths due to communicable, maternal, risk of severe illness and death. It is important to
neonatal, and nutritional (CMNN) diseases, 0·23 million reiterate, however, how the complex, multisector
(0·15–0·33; 12%) deaths due to non-communicable determinants of health that substantially affect child
diseases, and 0·08 million (0·06–0·11; 5%) deaths due to survival could be negatively affected by COVID-19, an
injuries (appendix p 130). If all regions had mortality understanding that is likely to continue to evolve in the
rates at their survival potential frontier levels in 2019, coming months and years. Risks include,26 but are not
the distribution of under-5 deaths would skew slightly limited to, the potential disruption of routine perinatal
towards non-communicable diseases but would not and clinical care for children, worsened in-facility
fundamentally change; 2·58 million (95% UI 2·35–2·81; outcomes due to overburdened medical systems, loss of
81%) deaths would be due to CMNN diseases, caretakers from the pandemic impacting child health
0·46 million (0·40–0·52; 15%) deaths would be due and wellbeing, suspended vaccination campaigns,
to non-communicable diseases, and 0·13 million financial and economic pressures leading to food
(0·11–0·15; 4%) deaths would be due to injuries insecurity and malnutrition, disruption of supply chains
(appendix p 130). Of the 48 level 3 causes that were leading to decreased availability of highly active
accountable for more than 5000 global under-5 deaths antiretroviral therapy medications for HIV/AIDS, inter
in 2019, those with the lowest proportion of cause-specific rupted prevention of mother-to-child transmission
deaths above the survival potential frontier were programmes, decreased malaria prevention and
sudden infant death syndrome (27% [95% UI 15–43] of treatment, and disruption of domestic economies and
SIDS deaths above the survival potential frontier), other education systems. Mitigating these risks will require
malignant neoplasms (28% [21–36]), varicella and herpes even more focus and attention on an equilibrium
zoster (29% [23–36]), and congenital birth defects strategy for neonatal and child health.
(30% [23–37]; appendix p 94). Of the same 48 causes, Our analysis suggests the need for a five-pronged
those with the highest proportion of cause-specific deaths strategy to optimise child survival in the SDG era that
above the survival potential frontier were invasive augments community-based strategies and efforts to
non-typhoidal salmonella, other neglected tropical dis address social determinants of health (eg, education,
eases, haemoglobinopathies and haemolytic anaemias, family planning, financial security) that proved effective
and malaria, all with over 50% above the survival during the MDG era. The central theme is that, to achieve
potential frontier. The leading causes of death overall SDG targets by 2030, investments should strive for
were also those with the highest above-survival potential equilibrium and overall system strengthening, with a
frontier mortality rates, and the rank order would remain particular focus on inequality, rather than simply shifting
similar even if all regions had cause-specific mortality attention to individual priorities.
rates at their survival potential frontier levels in 2019:
33% of each of neonatal disorders and lower respiratory Comprehensive neonatal care
infections deaths were above the survival frontier Neonatal deaths comprise an increasing share of global
(neonatal disorders ranked first and lower respiratory under-5 deaths, indicating a generalised need to improve

Articles
neonatal programmes along the entire SDI spectrum. remote areas, and creating a health information system,
Although not explicitly stated in SDG targets or in our leading to better survival.32
analysis, reductions in stillbirths should also be targeted
through comprehensive maternal and neonatal care. Continued investment and scale-up of community-
Reducing early neonatal mortality, and stillbirth based initiatives
mortality, should start with expansion of community and Community-based strategies such as primary health-care
facility-based strategies targeted towards pregnancy, promotion and integrated management of childhood
labour, delivery, and the postnatal period.27 Nepal is an illness33 are an important pillar of prevention. Successful
example of a country that explicitly prioritised the community activities include vaccination campaigns,
neonatal period and integrated community and facility- insecticide-treated bednets for malaria, and mother-
based approaches, leading to accelerated improvements to-child HIV/AIDS transmission prevention.34 Further
in neonatal and under-5 mortality.28 The first step is efforts are required, however, to increase uptake and
encouraging and supporting facility-based delivery coverage of additional community-based activities such
by skilled providers with the training and resources as ensuring optimal maternal nutrition and iron and folic
available to perform resuscitative efforts for women and acid supplementation35 (to target low birthweight and
neonates when needed.5 Basic activities include skin-to- neural tube defects), reducing household air pollution
skin contact, timely breathing assistance for intrapartum and second-hand smoke, Haemophilus influenzae type B
asphyxia, chlorhexidine umbilical cord cleansing for and pneumococcal vaccination, and access to antibiotics36
sepsis prevention, and early screening for congenital for lower respiratory infections. Similarly, treatment
birth defects.5 Improvements also need to be made to campaigns for diarrhoea such as oral rehydra tion
neonatal care after delivery. Advancements are needed solution, zinc, and rotavirus vaccines have been
for in-hospital activities such as intensive care for successful, but must be accompanied by reductions in
prematurity, advanced resuscitation for intrapartum malnutrition and improvements in clean water and
asphyxia, full support for sepsis beyond antibiotics, sanitation to achieve more than 90% reduction in rates
breastfeeding education and support, and surgical care of diarrhoea from the 2015 levels.37
for neonatal emergencies and birth defects that have
been shown to be associated with improved neonatal Targeting inequity across and within countries
survival.27,29,30 Postnatal check-ups are also required for Relative inequity has grown over the 29 years since the
prompt diagnosis and treatment of new illnesses that first GBD study, with the 51 countries in the Countdown
can be life-threatening in young neonates. Crosscutting, to 2030 initiative in sub-Saharan Africa and south Asia
longitudinal neonatal care is not possible without now accounting for 80% of all child mortality and
augmenting hospital infrastructure, supply chains, and facing stark within-country disparities.6,38 Within-country
qualified health-care workers, and must be accounted for disparities exist throughout the SDI spectrum and are
in national health plans.5 related to race and ethnicity, urban-rural geography,
mother’s education, and income.34 Global and national
Optimising health systems to scale up interventions achievement of SDG 3.2 will hinge on our collective
Providing technology and supplies alone, without ability to target inequality both across and within
coordinated investment in the strengthening of health countries.
systems, will be insufficient for achieving the SDG Progress for the countries in the Countdown to 2030
targets. Moving beyond survival is the cornerstone of programme is monitored by key intervention coverage
the SDGs, which requires enabling environments, milestones,6 but must be met with national ownership
as outlined in the UN Global Strategy for Women’s, and effective international investment. On an inter
Children’s and Adolescents’ Health 2016–30 agenda.4 national level, the World Bank’s Global Financing Facility
Per our analysis, more than 90% of countries have the is an example of a performance-based, country-led
potential to achieve the SDG targets by optimising their mechanism to strengthen health systems and multi
current health systems. Efforts to counter shortages and sectoral approaches,6 but the promise of this programme
retain skilled health-care workers, reinforce facility has not reached countries like Central African Republic
infrastructure and supplies including oxygen,31 develop and Chad, which are not only the furthest from achieving
and strengthen referral networks, and expand integrated the SDG targets with lowest key intervention coverage,
services7 are needed to achieve access and quality of care but are also cited as receiving the least development
for improving survival rates for children younger than assistance funding.39 These countries contrasts with
5 years, particularly around the time of birth.27,29 Liberia is countries like Rwanda and Bangladesh. In Rwanda, a
an example of a country that has made important revised national health policy successfully aligned
progress in health system strengthening. Despite the international donors to nationally driven goals of
odds of civil war and the Ebola virus epidemic, Liberia comprehensive child health care and health system
heavily invested in paying and supervising community strengthening, and were associated with a dramatic
health workers, providing medical supply chains to reduction in under-5 mortality.32 In Bangladesh, the

Articles
government partnered with domestic and international performance as a whole.6 Uses of our preventable
non-governmental organisations to target areas of the mortality analyses include being able to identify the
country most in need with delivering known inter causes with the most potential for improvement
ventions, performing local effectiveness research, and (largest proportion above the global optimum or
prioritising women’s empowerment.28 stochastic frontier analysis), the regions with potential
Peru and Brazil are examples of middle and high-middle imbalances in health priorities (largest ratio above
SDI countries that have targeted inequity internally. Peru frontier or discrepancies in ratio between neonates and
substantially reduced under-5 mortality by adopting children aged 1–59 months), causes where there are
the 2002 Acuerdo Nacional,28 a national health policy needs for better distributional allocation of resources,
targeting extreme poverty that deployed health workers to expertise, or delivery (those where the frontier is largely
impoverished communities, completed community-based flat until decreasing sharply in high HAQ Index
intervention research to increase perinatal care coverage, settings), and the causes where there is the greatest
and codified collective responsibility for improving health need for basic research into prevention and treatment
outcomes. Brazil sanctioned governmental conditional (largest proportion below the global optimum). This
cash transfers targeting prenatal care, immunisation, preventable death framework thus introduces a novel,
child health check-ups, and nutritional education.28 useful, and potentially powerful tool for developing
Although the specific solutions for targeting inequity and comprehensive, evidence-based strategies for advancing
marginalised populations vary, the essential component child survival on multiple fronts.
is that the efforts to increase equity must be explicit,
sustained, and universal because it is present throughout Limitations
the world. This analysis has several limitations. First, it shares the
limitations of the overall GBD analysis,20,24 including it
Prioritising research into specific causes of child mortality being a descriptive study; limitations on data availability
Many of the leading causes of death are also the source of because of reporting lags or because of disruptions
the most mortality above both the global optimum and in settings with conflict, natural disasters, or domestic
the survival potential frontier, include neonatal disorders, governance crises; variable data granularity with respect
congenital birth defects, sudden infant death syndrome, to age, sex, and cause detail; varying quality and com
many childhood cancers, and important infections like pleteness of mortality reporting systems; and the core
lower respiratory infections, diarrhoea, and meningitis. GBD assumption of each death having only a single
These causes are prime targets for additional dedicated underlying cause, where, clinically, there is close inter-
primary research on disease mechanisms for effective relatedness of many causes, especially in the very young.
prevention, detection, and treatment. Sudden infant Second, our future health scenario analyses are
death syndrome is particularly notable as only 27% of the benchmarked against past trends and are ecological in
mortality burden is above the survival potential frontier, nature. This limits the ability of the analysis to be used for
it is the top cause of death in older infants and children causal inference, and also means it is limited in its ability
in the high SDI quintile, and comparatively little is to capture disruptions that could arise as a consequence
known about its pathophysiology. of future crises, such as the COVID-19 pandemic. Third,
This entire analysis draws on the overall strength and although our framework for preventable mortality is
rigour of GBD 2019, the only comprehensive analysis conceptually simple, reproducible, and a powerful tool
of fertility, population, mortality, and outcomes for for tracking context-specific progress, it is also limited by
specific diseases and injuries that currently exists. The its inherently retrospective nature, its inability to
UN Inter-agency Group for Child Mortality Estimation parse competing risks or factors that might influence
last published estimates for 201711 but has not reported geographical variability, and that it does not make special
on causes of mortality since 2015,12,40 at which time there consideration for causes like vaccine-preventable diseases
was broad agreement in the top causes of death globally, that some experts contend are entirely preventable.
but some important differences existed in cause Finally, the definition of livebirth has varied in countries
categories that limited our ability to make direct and over time. Although our study has utilised a large
comparisons. amount of empirical data on death in the under-5 age
Measuring preventable death with the intersection of groups, directly or indirectly measured, such information
HAQ Index and SDG targets has not been explored in is based on potentially different definitions of livebirths,
previous literature and necessarily extends beyond the thus affecting the accuracy of our results. Although we do
scope of the OECD and Eurostat taskforce that only account for source specific biases, difference in definitions
focuses on adult health outcomes.16 This method is of livebirths as one of them, in our U5MR estimation
more holistic than previous avertable mortality frame process, future model development should be done to
works such as the Countdown to 2030 report that explicitly account for the effect of definition of livebirths
analysed only a composite coverage index of specific on the accurate estimation of mortality in the under-5
interventions, but did not measure the health system age groups.

Articles
Future directions Jacqueline Elizabeth Alcalde-Rabanal, Ayman Al-Eyadhy, Tilahun Ali,

Future work is required to measure and understand the Gianfranco Alicandro, Sheikh Mohammad Alif, Vahid Alipour,
Hesam Alizade, Syed Mohamed Aljunid, Amir Almasi-Hashiani,
direct (severe illness and death) and indirect (determinants Nihad A Almasri, Hesham M Al-Mekhlafi, Jordi Alonso,
of health) effects of COVID-19 on child mortality. First, Rajaa M Al-Raddadi, Khalid A Altirkawi, Arwa Khalid Alumran,
this work will include collecting data on disruptions in Nelson Alvis-Guzman, Nelson J Alvis-Zakzuk,
basic childhood health services (eg, vaccines, integrated Edward Kwabena Ameyaw, Saeed Amini, Mostafa Amini-Rarani,
Arianna Maever L Amit, Dickson A Amugsi, Robert Ancuceanu,
management of childhood illness, well-child visits), Deanna Anderlini, Catalina Liliana Andrei, Fereshteh Ansari,
nutritional status (eg, food supply and distribution), Alireza Ansari-Moghaddam, Carl Abelardo T Antonio,
perinatal health (eg, maternal and neonatal care), and Ernoiz Antriyandarti, Davood Anvari, Razique Anwer,
socioeconomic indicators such as fertility, education, and Muhammad Aqeel, Jalal Arabloo, Morteza Arab-Zozani, Timur Aripov,
Johan Ärnlöv, Kurnia Dwi Artanti, Afsaneh Arzani, Malke Asaad,
household income. A second direction is to work towards Mehran Asadi-Aliabadi, Ali A Asadi-Pooya,
an integrated framework for women’s, maternal, and Mohammad Asghari Jafarabadi, Seyyed Shamsadin Athari,
child health because of the inherent links between the Seyyede Masoume Athari, Desta Debalkie Atnafu, Alok Atreya,
health of mothers and their children. Third, integrating Madhu Sudhan Atteraya, Marcel Ausloos, Asma Tahir Awan,
Beatriz Paulina Ayala Quintanilla, Getinet Ayano,
information from prevention and intervention trials Martin Amogre Ayanore, Yared Asmare Aynalem, Samad Azari,
into developing future health scenarios is a priority in Ghasem Azarian, Zelalem Nigussie Azene, Darshan B B,
order to provide information to motivated policy makers Ebrahim Babaee, Ashish D Badiye, Atif Amin Baig, Maciej Banach,
as to what their most effective options might be. Fourth, Palash Chandra Banik, Suzanne Lyn Barker-Collo, Hiba Jawdat Barqawi,
Quique Bassat, Sanjay Basu, Bernhard T Baune, Mohsen Bayati,
following the momentum of the Institute for Health Neeraj Bedi, Ettore Beghi, Massimiliano Beghi, Michelle L Bell,
Metrics and Evaluation’s Local Burden of Disease project, Salaheddine Bendak, Derrick A Bennett, Isabela M Bensenor,
developing increasing local estimates of cause-specific Kidanemaryam Berhe, Adam E Berman, Yihienew Mequanint Bezabih,
and age-specific disease burden is crucial to guide local Akshaya Srikanth Bhagavathula, Dinesh Bhandari, Nikha Bhardwaj,
Pankaj Bhardwaj, Krittika Bhattacharyya, Suraj Bhattarai,
efforts at improving survival, and assess within-country Zulfiqar A Bhutta, Boris Bikbov, Antonio Biondi,
disparities further. Binyam Minuye Birihane, Raaj Kishore Biswas, Somayeh Bohlouli,
Achieving SDG 3.2 will require focus on equilibrium, Nicola Luigi Bragazzi, Alexey V Breusov, Andre R Brunoni,
Katrin Burkart, Sharath Burugina Nagaraja, Reinhard Busse,
which will involve balancing early newborn care with
Zahid A Butt, Florentino Luciano Caetano dos Santos,
continuing prenatal and older child health initiatives, Lucero Cahuana-Hurtado, Paulo Camargos, Luis Alberto Cámera,
strengthening quality health systems, scaling up inter Rosario Cárdenas, Giulia Carreras, Juan J Carrero, Felix Carvalho,
ventions, addressing within-country disparities, and Joao Mauricio Castaldelli-Maia, Carlos A Castañeda-Orjuela,
Giulio Castelpietra, Ester Cerin, Jung-Chen Chang,
pursuing integrative action on social determinants of
Wagaye Fentahun Chanie, Jaykaran Charan, Souranshu Chatterjee,
health. All these steps forward promote the SDG agenda Soosanna Kumary Chattu, Vijay Kumar Chattu, Sarika Chaturvedi,
of moving beyond mere survival, for the wellbeing of Simiao Chen, Daniel Youngwhan Cho, Jee-Young Jasmine Choi,
young children worldwide. Dinh-Toi Chu, Liliana G Ciobanu, Massimo Cirillo, Joao Conde,
Vera Marisa Costa, Rosa A S Couto, Berihun Assefa Dachew,
Contributors Saad M A Dahlawi, Hancheng Dai, Xiaochen Dai, Lalit Dandona,
Katherine R Paulson, Tahiya Alam, Kelly Bienhoff, Molly R Nixon, Rakhi Dandona, Parnaz Daneshpajouhnejad, Gary L Darmstadt,
Simon I Hay, Christopher J L Murray, Haidong Wang, and Jai K Das, Claudio Alberto Dávila-Cervantes, Adrian C Davis,
Nicholas J Kassebaum managed the estimation or publication process. Kairat Davletov, Fernando Pio De la Hoz, Diego De Leo, Farah Deeba,
Katherine R Paulson, Aruna M Kamath, and Nicholas J Kassebaum Edgar Denova-Gutiérrez, Nikolaos Dervenis, Assefa Desalew,
wrote the first draft of the manuscript. Katherine R Paulson, Keshab Deuba, Sagnik Dey, Samath Dhamminda Dharmaratne,
Tahiya Alam, Kelly Bienhoff, Haidong Wang, and Nicholas J Kassebaum Sameer Dhingra, Govinda Prasad Dhungana, Diana Dias da Silva,
had primary responsibility for applying analytical methods to produce Daniel Diaz, Fariba Dorostkar, Leila Doshmangir, Eleonora Dubljanin,
estimates. Katherine R Paulson, Aruna M Kamath, Haidong Wang, Andre Rodrigues Duraes, Arielle Wilder Eagan, Hisham Atan Edinur,
and Nicholas J Kassebaum had primary responsibility for seeking, Ferry Efendi, Sahar Eftekharzadeh, Iman El Sayed, Maha El Tantawi,
cataloguing, extracting, or cleaning data, and designing or coding figures Iffat Elbarazi, Islam Y Elgendy, Shaimaa I El-Jaafary, Amir Emami,
and tables. Please see the appendix (p 71) for individual authors’ Shymaa Enany, Oghenowede Eyawo, Sayeh Ezzikouri,
contributions to the research. All authors had full access to all data in the Pawan Sirwan Faris, Farshad Farzadfar, Nazir Fattahi,
study and had final responsibility for the decision to submit for Nelsensius Klau Fauk, Mehdi Fazlzadeh, Valery L Feigin,
publication. Tomas Y Ferede, Seyed-Mohammad Fereshtehnejad,
GBD 2019 Under-5 Mortality Collaborators Eduarda Fernandes, Pietro Ferrara, Irina Filip, Florian Fischer,
Katherine R Paulson, Aruna M Kamath, Tahiya Alam, Kelly Bienhoff, James L Fisher, Nataliya A Foigt, Morenike Oluwatoyin Folayan,
Gdiom Gebreheat Abady, Jaffar Abbas, Mohsen Abbasi-Kangevari, Masoud Foroutan, Richard Charles Franklin, Marisa Freitas,
Hedayat Abbastabar, Foad Abd-Allah, Sherief M Abd-Elsalam, Sara D Friedman, Takeshi Fukumoto, Mohamed M Gad,
Amir Abdoli, Aidin Abedi, Hassan Abolhassani, Lucas Guimarães Abreu, Abhay Motiramji Gaidhane, Shilpa Gaidhane, Santosh Gaihre,
Eman Abu-Gharbieh, Niveen M E Abu-Rmeileh, Silvano Gallus, Alberto L Garcia-Basteiro, MA Garcia-Gordillo,
Abdelrahman I Abushouk, Aishatu L Adamu, Oladimeji M Adebayo, William M Gardner, Mariana Gaspar Fonseca,
Adeyinka Emmanuel Adegbosin, Victor Adekanmbi, Ketema Bizuwork Gebremedhin, Lemma Getacher, Ahmad Ghashghaee,
Olatunji O Adetokunboh, Daniel Adedayo Adeyinka, Jose C Adsuar, Asadollah Gholamian, Syed Amir Gilani, Tiffany K Gill,
Khashayar Afshari, Mohammad Aghaali, Marcela Agudelo-Botero, Giorgia Giussani, Elena V Gnedovskaya, Myron Anthony Godinho,
Bright Opoku Ahinkorah, Tauseef Ahmad, Keivan Ahmadi, Amit Goel, Mahaveer Golechha, Philimon N Gona,
Muktar Beshir Ahmed, Budi Aji, Yonas Akalu, Sameer Vali Gopalani, Houman Goudarzi, Michal Grivna,
Oluwaseun Oladapo Akinyemi, Addis Aklilu, Ziyad Al-Aly, Harish Chander Gugnani, Davide Guido, Rafael Alves Guimarães,
Khurshid Alam, Fahad Mashhour Alanezi, Turki M Alanzi, Rajat Das Gupta, Rajeev Gupta, Nima Hafezi-Nejad,

Articles
Mohammad Rifat Haider, Arvin Haj-Mirzaian, Samer Hamidi, Jean Jacques Noubiap, Virginia Nuñez-Samudio, Vincent Ebuka Nwatah,
Asif Hanif, Graeme J Hankey, Arief Hargono, Ahmed I Hasaballah, Bogdan Oancea, Oluwakemi Ololade Odukoya, Felix Akpojene Ogbo,
Md Mehedi Hasan, Syed Shahzad Hasan, Amr Hassan, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya,
Soheil Hassanipour, Hadi Hassankhani, Rasmus J Havmoeller, Ahmed Omar Bali, Obinna E Onwujekwe, Alberto Ortiz, Adrian Otoiu,
Khezar Hayat, Reza Heidari-Soureshjani, Nathaniel J Henry, Nikita Otstavnov, Stanislav S Otstavnov, Mayowa O Owolabi,
Claudiu Herteliu, Michael K Hole, Ramesh Holla, Naznin Hossain, Mahesh P A, Jagadish Rao Padubidri, Smita Pakhale, Keyvan Pakshir,
Mostafa Hosseini, Mehdi Hosseinzadeh, Mihaela Hostiuc, Pramod Kumar Pal, Raffaele Palladino, Adrian Pana,
Sorin Hostiuc, Mowafa Househ, Junjie Huang, Ayesha Humayun, Songhomitra Panda-Jonas, Anamika Pandey, Ashok Pandey,
Bing-Fang Hwang, Ivo Iavicoli, Segun Emmanuel Ibitoye, Kevin S Ikuta, Seithikurippu R Pandi-Perumal, Helena Ullyartha Pangaribuan,
Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Ana Melisa Pardo-Montaño, Eun-Kee Park, Sangram Kishor Patel,
Sumant Inamdar, Leeberk Raja Inbaraj, Khalid Iqbal, Usman Iqbal, George C Patton, Shrikant Pawar, Hamidreza Pazoki Toroudi,
M Mofizul Islam, Sheikh Mohammed Shariful Islam, Hiroyasu Iso, Amy E Peden, Veincent Christian Filipino Pepito, Emmanuel K Peprah,
Masao Iwagami, Chidozie C D Iwu, Jalil Jaafari, Kathryn H Jacobsen, Jeevan Pereira, Jorge Pérez-Gómez, Norberto Perico, Konrad Pesudovs,
Jagnoor Jagnoor, Vardhmaan Jain, Manthan Dilipkumar Janodia, Thomas Pilgrim, Marina Pinheiro, Michael A Piradov,
Tahereh Javaheri, Fatemeh Javanmardi, Shubha Jayaram, Meghdad Pirsaheb, James A Platts-Mills, Khem Narayan Pokhrel,
Achala Upendra Jayatilleke, Ensiyeh Jenabi, Ravi Prakash Jha, John S Ji, Maarten J Postma, Hadi Pourjafar, Sergio I Prada, Sanjay Prakash,
Oommen John, Jost B Jonas, Tamas Joo, Nitin Joseph, Farahnaz Joukar, Elisabetta Pupillo, Zahiruddin Quazi Syed, Navid Rabiee, Amir Radfar,
Jacek Jerzy Jozwiak, Mikk Jürisson, Ali Kabir, Zubair Kabir, Ata Rafiee, Alireza Rafiei, Alberto Raggi, Shadi Rahimzadeh,
Leila R Kalankesh, Naser Kamyari, Tanuj Kanchan, Neeti Kapoor, Mohammad Hifz Ur Rahman, Amir Masoud Rahmani,
Behzad Karami Matin, André Karch, Salah Eddin Karimi, Kiana Ramezanzadeh, Juwel Rana, Chhabi Lal Ranabhat, Sowmya J Rao,
Getinet Kassahun, Gbenga A Kayode, Ali Kazemi Karyani, Davide Rasella, Prateek Rastogi, Priya Rathi, David Laith Rawaf,
Laura Kemmer, Nauman Khalid, Rovshan Khalilov, Salman Rawaf, Wasiq Faraz Rawasia, Reza Rawassizadeh,
Mohammad Khammarnia, Ejaz Ahmad Khan, Gulfaraz Khan, Robert C Reiner Jr, Giuseppe Remuzzi, Andre M N Renzaho,
Maseer Khan, Md Nuruzzaman Khan, Young-Ho Khang, Khaled Khatab, Bhageerathy Reshmi, Serge Resnikoff, Negar Rezaei, Nima Rezaei,
Amir M Khater, Mona M Khater, Maryam Khayamzadeh, Aziz Rezapour, Seyed Mohammad Riahi, Daniela Ribeiro,
Ardeshir Khosravi, Daniel Kim, Young-Eun Kim, Yun Jin Kim, Jennifer Rickard, Leonardo Roever, Luca Ronfani,
Ruth W Kimokoti, Adnan Kisa, Sezer Kisa, Niranjan Kissoon, Dietrich Rothenbacher, Enrico Rubagotti, Susan Fred Rumisha,
Jacek A Kopec, Soewarta Kosen, Parvaiz A Koul, Paul MacDaragh Ryan, Basema Saddik, Ehsan Sadeghi,
Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi, Sahar Saeedi Moghaddam, Rajesh Sagar, Amirhossein Sahebkar,
Kewal Krishan, Vijay Krishnamoorthy, Barthelemy Kuate Defo, Mohammad Reza Salahshoor, Sana Salehi, Marwa Rashad Salem,
Burcu Kucuk Bicer, Vaman Kulkarni, G Anil Kumar, Manasi Kumar, Hamideh Salimzadeh, Joshua A Salomon, Yoseph Leonardo Samodra,
Nithin Kumar, Om P Kurmi, Dian Kusuma, Carlo La Vecchia, Ben Lacey, Abdallah M Samy, Juan Sanabria, Milena M Santric-Milicevic,
Ratilal Lalloo, Faris Hasan Lami, Iván Landires, Anders O Larsson, Sivan Yegnanarayana Iyer Saraswathy, Abdur Razzaque Sarker,
Savita Lasrado, Zohra S Lassi, Paolo Lauriola, Paul H Lee, Nizal Sarrafzadegan, Arash Sarveazad, Brijesh Sathian,
Shaun Wen Huey Lee, Yo Han Lee, James Leigh, Matilde Leonardi, Thirunavukkarasu Sathish, Davide Sattin, Sonia Saxena,
Sonia Lewycka, Bingyu Li, Shanshan Li, Juan Liang, Lee-Ling Lim, Ganesh Kumar Saya, Mete Saylan, Silvia Schiavolin, Markus P Schlaich,
Miteku Andualem Limenih, Ro-Ting Lin, Xuefeng Liu, Rakesh Lodha, David C Schwebel, Falk Schwendicke, Subramanian Senthilkumaran,
Alan D Lopez, Rafael Lozano, Alessandra Lugo, Raimundas Lunevicius, Sadaf G Sepanlou, Edson Serván-Mori, Feng Sha, Omid Shafaat,
Mark T Mackay, Shilpashree Madhava Kunjathur, Saeed Shahabi, Mohammad Shahbaz, Amira A Shaheen, Izza Shahid,
Francesca Giulia Magnani, D R Mahadeshwara Prasad, Mina Maheri, Masood Ali Shaikh, Saeed Shakiba, Ali S Shalash,
Morteza Mahmoudi, Azeem Majeed, Venkatesh Maled, Afshin Maleki, Mehran Shams-Beyranvand, Mohammed Shannawaz, Kiomars Sharafi,
Shokofeh Maleki, Reza Malekzadeh, Ahmad Azam Malik, Aziz Sheikh, Sara Sheikhbahaei, Wondimeneh Shibabaw Shiferaw,
Deborah Carvalho Malta, Abdullah A Mamun, Borhan Mansouri, Mika Shigematsu, Jae Il Shin, Rahman Shiri, Ivy Shiue, Kerem Shuval,
Mohammad Ali Mansournia, Gabriel Martinez, Santi Martini, Tariq Jamal Siddiqi, Negussie Boti Sidemo, Inga Dora Sigfusdottir,
Francisco Rogerlândio Martins-Melo, Seyedeh Zahra Masoumi, Rannveig Sigurvinsdottir, João Pedro Silva, Jonathan I S Silverberg,
Pallab K Maulik, Colm McAlinden, John J McGrath, Biagio Simonetti, Balbir Bagicha Singh, Jasvinder A Singh,
Carlo Eduardo Medina-Solís, Entezar Mehrabi Nasab, Deepika Singhal, Dhirendra Narain Sinha, Eirini Skiadaresi,
Fabiola Mejia-Rodriguez, Ziad A Memish, Walter Mendoza, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina,
Ritesh G Menezes, Endalkachew Worku Mengesha, George A Mensah, David A Sleet, Badr Hasan Sobaih, Mohammad Reza Sobhiyeh,
Atte Meretoja, Tuomo J Meretoja, Abera M Mersha, Tomislav Mestrovic, Shahin Soltani, Joan B Soriano, Emma Elizabeth Spurlock,
Bartosz Miazgowski, Tomasz Miazgowski, Irmina Maria Michalek, Chandrashekhar T Sreeramareddy, Paschalis Steiropoulos,
Ted R Miller, GK Mini, Mohammad Miri, Andreea Mirica, Mark A Stokes, Stefan Stortecky, Mu’awiyyah Babale Sufiyan,
Erkin M Mirrakhimov, Hamed Mirzaei, Maryam Mirzaei, Rizwan Suliankatchi Abdulkader, Gerhard Sulo, Carolyn B Swope,
Babak Moazen, Masoud Moghadaszadeh, Bahram Mohajer, Bryan L Sykes, Mindy D Szeto, Miklós Szócska,
Osama Mohamad, Yousef Mohammad, Seyyede Momeneh Mohammadi, Rafael Tabarés-Seisdedos, Eyayou Girma Tadesse, Amir Taherkhani,
Abdollah Mohammadian-Hafshejani, Shafiu Mohammed, Animut Tagele Tamiru, Md Ismail Tareque, Arash Tehrani-Banihashemi,
Ali H Mokdad, Mariam Molokhia, Lorenzo Monasta, Stefania Mondello, Mohamad-Hani Temsah, Fisaha Haile Tesfay, Gizachew Assefa Tessema,
Mohammad Ali Moni, Catrin E Moore, Ghobad Moradi, Masoud Moradi, Zemenu Tadesse Tessema, Kavumpurathu Raman Thankappan,
Rahmatollah Moradzadeh, Paula Moraga, Lidia Morawska, Rekha Thapar, Musliu Adetola Tolani, Marcos Roberto Tovani-Palone,
Shane Douglas Morrison, Jonathan F Mosser, Eugenio Traini, Bach Xuan Tran, Jaya Prasad Tripathy,
Amin Mousavi Khaneghah, Ghulam Mustafa, Mehdi Naderi, Giorgos Tsapparellas, Aristidis Tsatsakis, Lorainne Tudor Car,
Ahamarshan Jayaraman Nagarajan, Shankar Prasad Nagaraju, Riaz Uddin, Anayat Ullah, Chukwuma David Umeokonkwo,
Mohsen Naghavi, Behshad Naghshtabrizi, Brigid Unim, Bhaskaran Unnikrishnan, Era Upadhyay,
Mukhammad David Naimzada, Vinay Nangia, Muhammad Shariq Usman, Marco Vacante, Maryam Vaezi,
Sreenivas Narasimha Swamy, Bruno Ramos Nascimento, Sahel Valadan Tahbaz, Pascual R Valdez, Tommi Juhani Vasankari,
Muhammad Naveed, Javad Nazari, Rawlance Ndejjo, Ionut Negoi, Narayanaswamy Venketasubramanian, Madhur Verma,
Ruxandra Irina Negoi, Evangelia Nena, Samata Nepal, Francesco S Violante, Vasily Vlassov, Bay Vo, Giang Thu Vu,
Henok Biresaw Netsere, Georges Nguefack-Tsague, Yohannes Dibaba Wado, Yasir Waheed, Richard G Wamai,
Josephine W Ngunjiri, Chi Thi Yen Nguyen, Cuong Tat Nguyen, Yanping Wang, Yanzhong Wang, Yuan-Pang Wang, Paul Ward,
Huong Lan Thi Nguyen, Yeshambel T Nigatu, Samuel Negash Nigussie, Andrea Werdecker, Ronny Westerman,
Molly R Nixon, Chukwudi A Nnaji, Shuhei Nomura, Nurulamin M Noor, Nuwan Darshana Wickramasinghe, Lauren B Wilner,

Articles
Charles Shey Wiysonge, Ai-Min Wu, Chenkai Wu, Yang Xie, (E Abu-Gharbieh PhD), Clinical Sciences Department
Seyed Hossein Yahyazadeh Jabbari, Kazumasa Yamagishi, (H J Barqawi MPhil), Department of Family and Community Medicine
Srikanth Yandrapalli, Sanni Yaya, Vahid Yazdi-Feyzabadi, Paul Yip, (B Saddik PhD), University of Sharjah, Sharjah, United Arab Emirates;
Naohiro Yonemoto, Seok-Jun Yoon, Mustafa Z Younis, Institute of Community and Public Health
Zabihollah Yousefi, Taraneh Yousefinezhadi, Chuanhua Yu, (Prof N M Abu-Rmeileh PhD), Birzeit University, Ramallah, Palestine;
Sifat Shahana Yusuf, Syed Saoud Zaidi, Sojib Bin Zaman, Harvard Medical School (A I Abushouk MD), Center for Primary Care
Mohammad Zamani, Maryam Zamanian, (S Basu PhD), Department of Global Health and Social Medicine
Mikhail Sergeevich Zastrozhin, Anasthasia Zastrozhina, (A W Eagan MSW), Division of Cardiology (I Y Elgendy MD), Division of
Yunquan Zhang, Zhi-Jiang Zhang, Xiu-Ju George Zhao, Arash Ziapour, General Internal Medicine (Prof A Sheikh MD), Harvard University,
Simon I Hay, Christopher J L Murray, Haidong Wang, and Boston, MA, USA; Department of Medicine (A I Abushouk MD),
Nicholas J Kassebaum. Department of Entomology (A M Samy PhD), Neurology Department
(Prof A S Shalash PhD), Ain Shams University, Cairo, Egypt;
Affiliations
Community Medicine Department (A L Adamu MSc), Bayero University
Institute for Health Metrics and Evaluation (K R Paulson MPH,
Kano, Kano, Nigeria; Infectious Diseases Epidemiology
T Alam MPH, K Bienhoff MA, K Burkart PhD, X Dai PhD,
(A L Adamu MSc), Department of Non-Communicable Disease
Prof L Dandona MD, Prof R Dandona PhD, Prof S D Dharmaratne MD,
Epidemiology (M Iwagami PhD), London School of Hygiene & Tropical
Prof V L Feigin PhD, W M Gardner AB, K S Ikuta MD, L Kemmer PhD,
Medicine, London, UK; College of Medicine (O M Adebayo MD),
Prof A D Lopez PhD, Prof R Lozano MD, Prof A H Mokdad PhD,
Department of Health Policy and Management (O O Akinyemi FWACP),
J F Mosser MD, Prof M Naghavi MD, M R Nixon PhD,
Department of Community Medicine (O S Ilesanmi PhD), Department
R C Reiner Jr PhD, E E Spurlock BA, L B Wilner MPH,
of Medicine (Prof M O Owolabi DrM), University College Hospital,
Prof S I Hay FMedSci, Prof C J L Murray DPhil, H Wang PhD,
Ibadan, Ibadan, Nigeria; School of Medicine (A E Adegbosin MD),
N J Kassebaum MD), Department of Anesthesiology & Pain Medicine
Griffith University, Gold Coast, QLD, Australia; Department of
(A M Kamath MD, V Krishnamoorthy MD, N J Kassebaum MD),
Population Health Sciences (V Adekanmbi PhD), Faculty of Life
Department of Health Metrics Sciences, School of Medicine
Sciences and Medicine (M Molokhia PhD), School of Population Health
(K Burkart PhD, Prof R Dandona PhD, Prof S D Dharmaratne MD,
and Environmental Sciences (Y Wang PhD), King’s College London,
Prof A D Lopez PhD, Prof R Lozano MD, Prof A H Mokdad PhD,
London, UK; Centre of Excellence for Epidemiological Modelling and
Prof M Naghavi MD, R C Reiner Jr PhD, Prof S I Hay FMedSci,
Analysis (O O Adetokunboh PhD), Stellenbosch University,
Prof C J L Murray DPhil, H Wang PhD, N J Kassebaum MD), Division
Stellenbosch, South Africa; Department of Global Health
of Plastic Surgery (D Y Cho MD), Division of Allergy and Infectious
(O O Adetokunboh PhD), Stellenbosch University, Cape Town,
Diseases (K S Ikuta MD), University of Washington, Seattle, WA, USA;
South Africa; Department of Community Health and Epidemiology
Department of Nursing (G G Abady MSc), Adigrat University, Adigrat,
(D A Adeyinka MPH), University of Saskatchewan, Saskatoon, SK,
Ethiopia; Antai College of Economics (J Abbas PhD), Shanghai Jiao Tong
Canada; Department of Public Health (D A Adeyinka MPH), Federal
University, Shanghai, China; Social Determinants of Health Research
Ministry of Health, Abuja, Nigeria; Sport Science Department
Center (M Abbasi-Kangevari MD), Obesity Research Center
(J C Adsuar PhD), University of Extremadura, Badajoz, Spain;
(A Haj-Mirzaian MD), Department of Pharmacology
Department of Dermatology (K Afshari MD), University of
(K Ramezanzadeh PharmD), Department of Epidemiology
Massachusetts Medical School, Worcester, MA, USA; Department of
(M Shahbaz MSc), Injury Prevention and Safety Promotion Research
Epidemiology and Biostatistics (M Aghaali PhD), Qom University of
Center (T Yousefinezhadi PhD), Shahid Beheshti University of Medical
Medical Sciences, Qom, Iran; Center for Policy, Population & Health
Sciences, Tehran, Iran (M Khayamzadeh MD); Advanced Diagnostic
Research (Prof M Agudelo-Botero PhD), Center of Complexity Sciences
and Interventional Radiology Research Center (H Abbastabar PhD),
(Prof D Diaz PhD), Department of Economic Geography
Research Center for Immunodeficiencies (H Abolhassani PhD,
(A M Pardo-Montaño PhD), National Autonomous University of Mexico,
Prof N Rezaei PhD), Department of Pharmacology (K Afshari MD,
Mexico City, Mexico; The Australian Centre for Public and Population
A Haj-Mirzaian MD), Non-communicable Diseases Research Center
Health Research (ACPPHR) (B O Ahinkorah MPH, E K Ameyaw MPhil),
(Prof F Farzadfar DSc, B Mohajer MD, N Rezaei PhD,
University of Technology Sydney, Sydney, NSW, Australia; Department
S Saeedi Moghaddam MSc), Department of Environmental Health
of Epidemiology and Health Statistics (T Ahmad MS), Southeast
Engineering (M Fazlzadeh PhD, Prof A Maleki PhD), School of
University, Nanjing, China; Lincoln Medical School (K Ahmadi PhD),
Medicine (N Hafezi-Nejad MD), School of Nursing and Midwifery
Universities of Nottingham & Lincoln, Lincoln, UK; Department of
(R Heidari-Soureshjani MSc), Department of Epidemiology and
Epidemiology (M B Ahmed MPH), Jimma University, Jimma, Ethiopia;
Biostatistics (Prof M Hosseini PhD, M Mansournia PhD), Pediatric
Australian Center for Precision Health (M B Ahmed MPH), School of
Chronic Kidney Disease Research Center (Prof M Hosseini PhD), Health
Pharmacy and Medical Sciences (L G Ciobanu PhD), University of
Equity Research Center (A Khosravi PhD), Digestive Diseases Research
South Australia, Adelaide, SA, Australia; Faculty of Medicine and Public
Institute (Prof R Malekzadeh MD, H Salimzadeh PhD,
Health (B Aji DrPH), Jenderal Soedirman University, Purwokerto,
S G Sepanlou MD), Tehran Heart Center (E Mehrabi Nasab MD),
Indonesia; Department of Medical Physiology (Y Akalu MSc),
Endocrinology and Metabolism Research Center (N Rezaei PhD), Faculty
Department of Reproductive Health (Z N Azene MPH), Institute of
of Medicine (S Shakiba MD), Tehran University of Medical Sciences,
Public Health (W F Chanie MPH), Department of Epidemiology
Tehran, Iran; Department of Neurology (Prof F Abd-Allah MD,
(B A Dachew PhD), School of Midwifery (M A Limenih MSc), School of
S I El-Jaafary MD, A Hassan MD), National Hepatology and Tropical
Nursing (H B Netsere MS), Department of Midwifery (A T Tamiru MSc),
Medicine Research Institute (A M Khater MD), Department of Medical
Department of Epidemiology and Biostatistics (Z T Tessema MSc),
Parasitology (M M Khater MD), Cairo University, Cairo, Egypt; Tropical
University of Gondar, Gondar, Ethiopia; Department of Health Policy
Medicine Department (S M Abd-Elsalam MD), Tanta University, Tanta,
and Management (O O Akinyemi FWACP), Department of Health
Egypt; Department of Parasitology and Mycology (A Abdoli PhD),
Promotion and Education (S E Ibitoye MPH), Department of
Jahrom University of Medical Sciences, Jahrom, Iran; Department of
Community Medicine (O S Ilesanmi PhD), Department of Medicine
Orthopaedic Surgery (A Abedi MD), Department of Radiology
(Prof M O Owolabi DrM), University of Ibadan, Ibadan, Nigeria;
(S Salehi MD), University of Southern California, Los Angeles, CA, USA;
Department of Medical Laboratory Sciences (A Aklilu MSc), Department
Department of Laboratory Medicine (H Abolhassani PhD), Karolinska
of Nursing (A M Mersha MSc), Department of Public Health
University Hospital, Huddinge, Sweden; Department of Pediatric
(N B Sidemo MPH), Department of Biomedical Sciences
Dentistry (Prof L G Abreu PhD), Department of Pediatrics
(E G Tadesse MSc), Arba Minch University, Arba Minch, Ethiopia;
(Prof P Camargos PhD), Department of Maternal and Child Nursing and
John T Milliken Department of Internal Medicine (Z Al-Aly MD),
Public Health (Prof D C Malta PhD), Department of Clinical Medicine
Washington University in St Louis, St Louis, MO, USA; Clinical
(Prof B R Nascimento PhD), Clinical Hospital
Epidemiology Center (Z Al-Aly MD), Department of Veterans Affairs,
(Prof B R Nascimento PhD), Federal University of Minas Gerais,
St Louis, MO, USA; Murdoch Business School (K Alam PhD), Murdoch
Belo Horizonte, Brazil; Department of Clinical Sciences

Articles
University, Perth, WA, Australia; Health Information Management and Population Dynamics and Sexual and Reproductive Health
Technology Department (T M Alanzi PhD), Department of Health (Y D Wado PhD), African Population and Health Research Center,
Information Management and Technology (A K Alumran PhD), Nairobi, Kenya; Pharmacy Department (Prof R Ancuceanu PhD),
Environmental Health Department (S M A Dahlawi PhD), Forensic Cardiology Department (C Andrei PhD), Internal Medicine Department
Medicine Division (Prof R G Menezes MD), (M Hostiuc PhD), Department of Legal Medicine and Bioethics
Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (S Hostiuc PhD), Department of General Surgery (I Negoi PhD),
(F M Alanezi PhD); Center for Health System Research Department of Anatomy and Embryology (R I Negoi PhD), Carol Davila
(J E Alcalde-Rabanal PhD, E Serván-Mori PhD), Center for Nutrition and University of Medicine and Pharmacy, Bucharest, Romania; Centre for
Health Research (E Denova-Gutiérrez DSc), Research in Nutrition and Sensorimotor Performance (D Anderlini MD), School of Dentistry
Health (F Mejia-Rodriguez MSc), National Institute of Public Health, (R Lalloo PhD), Queensland Brain Institute (Prof J J McGrath MD),
Cuernavaca, Mexico; Pediatric Intensive Care Unit (A Al-Eyadhy MD, School of Health and Rehabilitation Sciences (R Uddin PhD),
K A Altirkawi MD, M Temsah MD), Internal Medicine Department The University of Queensland, Brisbane, QLD, Australia; Neurology
(Y Mohammad MD), Department of Pediatrics (B H Sobaih MD), Department (D Anderlini MD), Royal Brisbane and Women’s Hospital,
King Saud University, Riyadh, Saudi Arabia; Department of Psychiatry Brisbane, QLD, Australia; Research Center for Evidence Based Medicine
(T Ali MSc), School of Public Health (W F Chanie MPH), School of (F Ansari PhD), Department of Biostatistics and Epidemiology
Nursing and Midwifery (A Desalew MSc), Haramaya University, Harar, (Prof M Asghari Jafarabadi PhD), Department of Health Policy and
Ethiopia; Directorate for Social Statistics and Population Census Management (L Doshmangir PhD), School of Nursing and Midwifery
(G Alicandro PhD), Italian National Institute of Statistics, Rome, Italy; (H Hassankhani PhD), School of Management and Medical
Epidemiology and Preventive Medicine (S M Alif PhD), School of Public Informatics (L R Kalankesh PhD), Social Determinants of Health
Health and Preventive Medicine (S Li PhD), The School of Clinical Research Center (S Karimi PhD), Biotechnology Research Center
Sciences at Monash Health (S Zaman MPH), Monash University, (M Moghadaszadeh PhD), Molecular Medicine Research Center
Melbourne, VIC, Australia; Health Management and Economics (M Moghadaszadeh PhD), Alzahra Teaching Hospital (M Vaezi MD),
Research Center (V Alipour PhD, J Arabloo PhD, S Azari PhD, Women’s Reproductive Health Research Center (M Vaezi MD), Tabriz
A Ghashghaee BSc, M Hosseinzadeh PhD, A Rezapour PhD), University of Medical Sciences, Tabriz, Iran; Razi Vaccine and Serum
Department of Health Economics (V Alipour PhD), Preventive Medicine Research Institute (F Ansari PhD), Agricultural Research, Education,
and Public Health Research Center (M Asadi-Aliabadi MSc, and Extension Organization (AREEO), Tehran, Iran; Department of
E Babaee PhD, A Tehrani-Banihashemi PhD), Department of Medical Epidemiology and Biostatistics (Prof A Ansari-Moghaddam PhD),
Laboratory Sciences (F Dorostkar PhD), Student Research Committee Health Promotion Research Center (M Khammarnia PhD), Zahedan
(A Ghashghaee BSc), Minimally Invasive Surgery Research Center University of Medical Sciences, Zahedan, Iran; Department of Applied
(A Kabir MD), Department of Physiology (H Pazoki Toroudi PhD), Social Sciences (C T Antonio MD), Hong Kong Polytechnic University,
Physiology Research Center (H Pazoki Toroudi PhD), Colorectal Hong Kong, China; Agribusiness Study Program
Research Center (A Sarveazad PhD), Department of Community and (E Antriyandarti DrAgrSc), Sebelas Maret University, Surakarta,
Family Medicine (A Tehrani-Banihashemi PhD), Iran University of Indonesia; Department of Parasitology (D Anvari PhD), Department of
Medical Sciences, Tehran, Iran; Infectious and Tropical Disease Immunology (Prof A Rafiei PhD), Molecular and Cell Biology Research
Research Center (H Alizade PhD), Hormozgan University of Medical Center (Prof A Rafiei PhD), Department of Environmental Health
Sciences, Bandar Abbas, Iran; Department of Health Policy and (Prof Z Yousefi PhD), Mazandaran University of Medical Sciences, Sari,
Management (Prof S M Aljunid PhD), Kuwait University, Safat, Kuwait; Iran; Department of Parasitology (D Anvari PhD), Iranshahr University
International Centre for Casemix and Clinical Coding of Medical Sciences, Iranshahr, Iran; Department of Pathology
(Prof S M Aljunid PhD), National University of Malaysia, (R Anwer PhD), Imam Mohammad Ibn Saud Islamic University,
Bandar Tun Razak, Malaysia; Department of Epidemiology Riyadh, Saudi Arabia; Department of Psychology (M Aqeel PhD,
(A Almasi-Hashiani PhD, R Moradzadeh PhD, M Zamanian PhD), M Aqeel PhD), Foundation University Islamabad, Rawalpandi, Pakistan;
Department of Health Services Management (S Amini PhD), Social Determinants of Health Research Center (M Arab-Zozani PhD),
Department of Pediatrics (J Nazari MD), Arak University of Medical Cardiovascular Diseases Research Center (S Riahi PhD), Birjand
Sciences, Arak, Iran; Physiotherapy Department University of Medical Sciences, Birjand, Iran; Public Health and
(Prof N A Almasri PhD), The University of Jordan, Amman, Jordan; Healthcare Management (T Aripov PhD), Tashkent Institute of
Medical Research Center (H M Al-Mekhlafi PhD), Epidemiology Postgraduate Medical Education, Tashkent, Uzbekistan; Boston
Department (M Khan MD), Jazan University, Jazan, Saudi Arabia Children’s Hospital, Boston, MA, USA (T Aripov PhD); Department of
(Prof N Bedi MD); Department of Parasitology (H M Al-Mekhlafi PhD), Neurobiology, Care Sciences and Society (Prof J Ärnlöv PhD),
Sana’a University, Sana’a, Yemen; Research Program of Epidemiology Department of Medical Epidemiology and Biostatistics
and Public Health (J Alonso MD), Pompeu Fabra University, Barcelona, (Prof J J Carrero PhD), Department of Global Public Health
Spain; Department of Experimental and Health Sciences (J Alonso MD), (K Deuba DrPH), Department of Neurobiology (S Fereshtehnejad PhD),
Biomedical Research Networking Center in Epidemiology and Public Karolinska Institute, Stockholm, Sweden; School of Health and Social
Health (CiberESP), Madrid, Spain; Department of Community Medicine Studies (Prof J Ärnlöv PhD), Dalarna University, Falun, Sweden;
(R M Al-Raddadi PhD), Rabigh Faculty of Medicine (A A Malik PhD), Department of Epidemiology (K D Artanti MSc, A Hargono Dr),
King Abdulaziz University, Jeddah, Saudi Arabia; Research Group in Community Health Nursing (F Efendi PhD), Faculty of Public Health
Hospital Management and Health Policies (Prof N Alvis-Guzman PhD), (S Martini PhD), Universitas Airlangga (Airlangga University), Surabaya,
Department of Economic Sciences (N J Alvis-Zakzuk Mc), Universidad Indonesia; School of Nursing and Midwifery (A Arzani DrPH), Student
de la Costa (University of the Coast), Barranquilla, Colombia; Research Research Committee (M Zamani MD), Babol University of Medical
Group in Health Economics (Prof N Alvis-Guzman PhD), University of Sciences, Babol, Iran (A Arzani DrPH); Department of Plastic Surgery
Cartagena, Cartagena, Colombia; National Health Observatory (M Asaad MD), University of Texas, Houston, TX, USA; Epilepsy
(N J Alvis-Zakzuk MSc, C A Castañeda-Orjuela MD), National Institute Research Center (Prof A A Asadi-Pooya MD), Health Human Resources
of Health, Bogota, Colombia; Health Management and Economics Research Center (M Bayati PhD), Bacteriology and Virology Department
Reasearch Center (M Amini-Rarani PhD), Department of Pathology (A Emami PhD), Burn and Wound Healing Research Center
(P Daneshpajouhnejad MD), Isfahan Cardiovascular Research Institute (F Javanmardi MSc), Non-communicable Disease Research Center
(Prof N Sarrafzadegan MD), Department of Radiology and Interventional (Prof R Malekzadeh MD, S G Sepanlou MD), Department of
Neuroradiology (O Shafaat MD), Isfahan University of Medical Sciences, Parasitology and Mycology (Prof K Pakshir PhD), Health Policy Research
Isfahan, Iran; School of Medicine and Public Health (A L Amit BS), Center (S Shahabi PhD), Shiraz University of Medical Sciences, Shiraz,
Ateneo De Manila University, Manila, Philippines; College of Medicine Iran; Neurology Department (Prof A A Asadi-Pooya MD),
(A L Amit BS), Department of Health Policy and Administration Thomas Jefferson University, Philadelphia, PA, USA; Department of
(C T Antonio MD), University of the Philippines Manila, Manila, Biostatistics and Epidemiology (Prof M Asghari Jafarabadi PhD),
Philippines; Maternal and Child Wellbeing (D A Amugsi PhD), Department of Immunology (S Athari MPH), Department of Anatomical

Articles
Sciences (S Mohammadi PhD), Zanjan University of Medical Sciences, Nuffield Department of Clinical Medicine (N J Henry BS), Centre for
Zanjan, Iran; Department of Biology (S Athari MPH), Department of Tropical Medicine and Global Health (S Lewycka PhD), Big Data
Nutrition and Food Sciences (H Pourjafar PhD), Maragheh University of Institute (C E Moore PhD), The George Institute for Global Health
Medical Sciences, Maragheh, Iran; Department of Health System and (Prof S Yaya PhD), University of Oxford, Oxford, UK; Department of
Health Economics (D D Atnafu MPH), Department of Internal Medicine Internal Medicine (I M Bensenor PhD, Prof A R Brunoni PhD),
(Y M Bezabih MD), Department of Reproductive Health and Population Department of Psychiatry (Prof A R Brunoni PhD,
Studies (E W Mengesha MPH), Bahir Dar University, Bahir Dar, Prof J Castaldelli-Maia PhD, Y Wang PhD), University of São Paulo,
Ethiopia; Department of Forensic Medicine (A Atreya MD), Lumbini São Paulo, Brazil; Department of Nutrition and Dietetics
Medical College, Palpa, Nepal; Department of Social Welfare (K Berhe MPH), School of Public Health (F H Tesfay PhD), Mekelle
(M S Atteraya PhD), Keimyung University, Daegu, South Korea; School University, Mekelle, Ethiopia; Department of Medicine
of Business (Prof M Ausloos PhD), Department of Health Sciences (A E Berman MD), Medical College of Georgia at Augusta University,
(P H Lee PhD), University of Leicester, Leicester, UK; Department of Augusta, GA, USA; One Health (Y M Bezabih MD), University of
Statistics and Econometrics (Prof M Ausloos PhD, Prof C Herteliu PhD, Nantes, Nantes, France; Department of Social and Clinical Pharmacy
A Mirica PhD, Prof A Otoiu PhD, A Pana MD), Bucharest University of (A S Bhagavathula PharmD), Charles University, Hradec Kralova,
Economic Studies, Bucharest, Romania; School of Nursing and Health Czech Republic; Institute of Public Health (A S Bhagavathula PharmD,
Sciences (A T Awan DrPH), Capella University, Minneapolis, MN, USA; I Elbarazi DrPH, Prof M Grivna PhD), Department of Medical
Continuing Education- Grant Writing Academy (A T Awan DrPH), Microbiology & Immunology (Prof G Khan PhD), United Arab Emirates
University of Nevada, Las Vegas, NV, USA; The Judith Lumley Centre University, Al Ain, United Arab Emirates; School of Public Health
(B Ayala Quintanilla PhD), School of Nursing and Midwifery (D Bhandari MSc, G A Tessema PhD), Adelaide Medical School
(F Efendi PhD), School of Psychology and Public Health (M Islam PhD), (L G Ciobanu PhD, T K Gill PhD), Robinson Research Institute
La Trobe University, Melbourne, VIC, Australia; School of Public Health (Z S Lassi PhD), Centre for Heart Rhythm Disorders (J Noubiap MD),
(G Ayano MSc, B A Dachew PhD, T R Miller PhD, G A Tessema PhD), University of Adelaide, Adelaide, SA, Australia; Public Health Research
Curtin University, Perth, WA, Australia; Department of Health Policy Laboratory (D Bhandari MSc), Tribhuvan University, Kathmandu, Nepal;
Planning and Management (M A Ayanore PhD), University of Health Department of Anatomy (Prof N Bhardwaj MD), Government Medical
and Allied Sciences, Ho, Ghana; Department of Nursing College Pali, Pali, India; Department of Community Medicine and
(Y A Aynalem MSc, W S Shiferaw MSc), Department of Public Health Family Medicine (P Bhardwaj MD), School of Public Health
(L Getacher MPH), Debre Berhan University, Debre Berhan, Ethiopia; (P Bhardwaj MD), Department of Pharmacology (J Charan MD),
Department of Environmental Health Engineering (G Azarian PhD), Department of Forensic Medicine and Toxicology (T Kanchan MD),
Autism Spectrum Disorders Research Center (E Jenabi PhD), All India Institute of Medical Sciences, Jodhpur, India; Department of
Department of Biostatistics (N Kamyari MSc), Department of Midwifery Statistical and Computational Genomics (K Bhattacharyya MSc),
(S Masoumi PhD), Research Center for Molecular Medicine National Institute of Biomedical Genomics, Kalyani, India; Department
(A Taherkhani PhD), Hamadan University of Medical Sciences, of Statistics (K Bhattacharyya MSc), University of Calcutta, Kolkata,
Hamadan, Iran; Kasturba Medical College, Mangalore (D B B MD, India; Department of Global Health (S Bhattarai MD), Global Institute
R Holla MD, J Padubidri MD, P Rathi MD), Manipal College of for Interdisciplinary Studies, Kathmandu, Nepal; Centre for Global
Pharmaceutical Sciences (Prof M D Janodia PhD), Department of Child Health (Prof Z A Bhutta PhD), Department of Medicine
Nephrology (Prof S Nagaraju DM), Department of Health Information (V Chattu MD), University of Toronto, Toronto, ON, Canada; Centre of
Management (B Reshmi PhD), Manipal Academy of Higher Education, Excellence in Women & Child Health (Prof Z A Bhutta PhD), Division of
Manipal, India (B Reshmi PhD); Department of Forensic Science Women and Child Health (J K Das MD), Aga Khan University, Karachi,
(A D Badiye MSc, N Kapoor MSc), Government Institute of Forensic Pakistan; Mario Negri Institute for Pharmacological Research, Ranica,
Science, Nagpur, India; Unit of Biochemistry (A A Baig PhD), Universiti Italy (B Bikbov MD); Department of General Surgery and Medical-
Sultan Zainal Abidin (Sultan Zainal Abidin University), Surgical Specialties (Prof A Biondi PhD, M Vacante PhD), University of
Kuala Terengganu, Malaysia; Department of Hypertension Catania, Catania, Italy; Ethiopian Public Health Institute, Addis Ababa,
(Prof M Banach PhD), Medical University of Lodz, Lodz, Poland; Ethiopia (B M Birihane MSc); Department of Nursing
Polish Mothers’ Memorial Hospital Research Institute, Lodz, Poland (B M Birihane MSc), Debre Tabor University, Debretabor, Ethiopia;
(Prof M Banach PhD); Department of Non-communicable Diseases Transport and Road Safety (TARS) Research Centre (R Biswas MSc),
(P C Banik MPhil), Bangladesh University of Health Sciences, Dhaka, Department of Medicine (O John MD), School of Medicine
Bangladesh; School of Psychology (Prof S L Barker-Collo PhD), (P K Maulik PhD), World Health Organization (WHO) Centre on
University of Auckland, Auckland, New Zealand; Barcelona Institute for eHealth (M Moni PhD), School of Public Health and Community
Global Health (Prof Q Bassat MD), University of Barcelona, Barcelona, Medicine (A E Peden PhD), School of Optometry and Vision Science
Spain; Catalan Institution for Research and Advanced Studies (ICREA), (Prof K Pesudovs PhD, Prof S Resnikoff MD), University of
Barcelona, Spain (Prof Q Bassat MD, A Koyanagi MD); School of Public New South Wales, Sydney, NSW, Australia; Department of Veterinary
Health (S Basu PhD, Prof S Saxena MD), Department of Surgery and Medicine (S Bohlouli PhD), Islamic Azad University, Kermanshah, Iran;
Cancer (Prof A C Davis PhD), Imperial College Business School University of Genoa, Genoa, Italy (N L Bragazzi PhD); Institute of
(D Kusuma DSc), Department of Primary Care and Public Health Medicine (Prof A V Breusov DSc), RUDN University, Moscow, Russia;
(Prof A Majeed MD, R Palladino MD, Prof S Rawaf MD), WHO Department of Community Medicine (Prof S Burugina Nagaraja MD),
Collaborating Centre for Public Health Education and Training Employee State Insurance Post Graduate Institute of Medical Sciences
(D L Rawaf MD), Imperial College London, London, UK; Department of and Research, Bangalore, India; Department of Health Care
Psychiatry (Prof B T Baune PhD), Institute for Epidemiology and Social Management (Prof R Busse PhD), Technical University of Berlin, Berlin,
Medicine (A Karch MD), University of Münster, Münster, Germany; Germany; School of Public Health and Health Systems (Z A Butt PhD),
Department of Psychiatry (Prof B T Baune PhD), Melbourne Medical University of Waterloo, Waterloo, ON, Canada; Al Shifa School of Public
School, Melbourne, VIC, Australia; School of Public Health Health (Z A Butt PhD), Al Shifa Trust Eye Hospital, Rawalpindi,
(Prof N Bedi MD), Dr D Y Patil University, Mumbai, India; Department Pakistan; Institute of Microengineering (F Caetano dos Santos PhD),
of Neuroscience (E Beghi MD, E Pupillo PharmD), Department of Federal Polytechnic School of Lausanne, Lausanne, Switzerland; School
Environmental Health Sciences (S Gallus DSc, A Lugo PhD), Laboratory of Public Health and Administration (L Cahuana-Hurtado PhD),
of Neurological Disorders (G Giussani PhD), Mario Negri Institute for Peruvian University Cayetano Heredia, Lima, Peru; Internal Medicine
Pharmacological Research, Milan, Italy; Mental Health (M Beghi MD), Department (Prof L A Cámera MD), Hospital Italiano de Buenos Aires,
AUSL Romagna, Ravenna, Italy; School of the Environment Buenos Aires, Argentina; Board of Directors (Prof L A Cámera MD),
(Prof M L Bell PhD), Department of Genetics (S Pawar PhD), Yale Argentine Society of Medicine, Buenos Aires, Argentina
University, New Haven, CT, USA; Department of Industrial Engineering (Prof P R Valdez MEd); Department of Health Care
(S Bendak PhD), Haliç University, Istanbul, Turkey; Nuffield (Prof R Cárdenas DSc), Metropolitan Autonomous University, Mexico
Department of Population Health (D A Bennett PhD, B Lacey PhD), City, Mexico; Institute for Cancer Research, Prevention and Clinical

Articles
Network, Florence, Italy (G Carreras PhD); Research Unit on Applied Prof M M Santric-Milicevic PhD), School of Public Health and Health
Molecular Biosciences (UCIBIO) (Prof F Carvalho PhD, V M Costa PhD, Management (Prof M M Santric-Milicevic PhD), University of Belgrade,
J P Silva PhD), Department of Chemical Sciences (R A S Couto MD, Belgrade, Serbia; School of Medicine (Prof A R Duraes PhD), Institute of
D Ribeiro PhD), Laboratory of Toxicology (Prof D Dias da Silva PhD), Collective Health (Prof D Rasella PhD), Federal University of Bahia,
Associated Laboratory for Green Chemistry (LAQV) (Prof E Fernandes Salvador, Brazil; Department of Internal Medicine (Prof A R Duraes
PhD, M Freitas PhD), Department of Chemistry (M Pinheiro PhD), PhD), Escola Bahiana de Medicina e Saúde Pública (Bahiana School of
University of Porto, Porto, Portugal; Epidemiology and Public Health Medicine and Public Health), Salvador, Brazil; Department of Social
Evaluation Group (C A Castañeda-Orjuela MD), Department of Public Services (A W Eagan MSW), Tufts Medical Center, Boston, MA, USA;
Health (Prof F P De la Hoz PhD), National University of Colombia, School of Health Sciences (H A Edinur PhD), Universiti Sains Malaysia
Bogota, Colombia; Department of Medicine (G Castelpietra PhD), (University of Science Malaysia), Kubang Kerian, Malaysia; Division of
University of Udine, Udine, Italy; Department of Mental Health Urology (S Eftekharzadeh MD), Children’s Hospital of Philadelphia,
(G Castelpietra PhD), Healthcare Agency “Friuli Occidentale”, Philadelphia, PA, USA; Biomedical Informatics and Medical Statistics
Pordenone, Italy; Mary MacKillop Institute for Health Research Department (I El Sayed PhD), Pediatric Dentistry and Dental Public
(Prof E Cerin PhD), Australian Catholic University, Melbourne, VIC, Health Department (Prof M El Tantawi PhD), Alexandria University,
Australia; School of Public Health (Prof E Cerin PhD), Centre for Suicide Alexandria, Egypt; Division of Cardiology (I Y Elgendy MD),
Research and Prevention (Prof P Yip PhD), Department of Social Work Massachusetts General Hospital, Boston, MA, USA; Department of
and Social Administration (Prof P Yip PhD), University of Hong Kong, Microbiology and Immunology (S Enany PhD), Suez Canal University,
Hong Kong, China; College of Medicine (J Chang PhD), National Taiwan Ismailia, Egypt; Faculty of Health (O Eyawo PhD), York University,
University, Taipei, Taiwan; Department of Nursing (J Chang PhD), Toronto, BC, Canada; Department of Virology (S Ezzikouri PhD),
National Taiwan University Hospital, Taipei, Taiwan; Department of Pasteur Institute of Morocco, Casablanca, Morocco; Department of
Microbiology & Infection Control (S Chatterjee MD), Medanta Medicity, Biology and Biotechnology “Lazzaro Spallanzani” (P S Faris PhD),
Gurugram, India; Department of Public Health (S Chattu PhD), Texila University of Pavia, Pavia, Italy; Department of Biology (P S Faris PhD),
American University, Georgetown, Guyana; Global Institute of Public Cihan University-Erbil, Erbil, Iraq; Research Center for Environmental
Health (GIPH), Thiruvananthapuram, India (V Chattu MD); Research Determinants of Health (N Fattahi PhD, Prof B Karami Matin PhD,
Department (S Chaturvedi PhD), Dr D Y Patil University, Pune, India; A Kazemi Karyani PhD, M Moradi PhD, Prof M Pirsaheb PhD,
Heidelberg Institute of Global Health (HIGH) (S Chen DSc, Prof E Sadeghi PhD, K Sharafi PhD, S Soltani PhD), Clinical Research
B Moazen MSc, S Mohammed PhD), Department of Ophthalmology Development Center (S Maleki MSc, M Naderi PhD), Substance Abuse
(Prof J B Jonas MD, S Panda-Jonas MD), Heidelberg University, Prevention Research Center (B Mansouri PhD), Department of
Heidelberg, Germany; Biomedical Informatics (J J Choi PhD), Seoul Rehabilitation and Sports Medicine (M Mirzaei MSc), Department of
National University Hospital, Seoul, South Korea; Center for Anatomical Sciences (M R Salahshoor PhD), Department of Vascular
Biomedicine and Community Health (D Chu PhD), VNU-International and Endovascular Surgery (M Sobhiyeh MD), Department of Health
School, Hanoi, Vietnam; Department of Public Health Education and Health Promotion (A Ziapour PhD), Kermanshah
(Prof M Cirillo MD, Prof I Iavicoli PhD, R Palladino MD), University of University of Medical Sciences, Kermanshah, Iran; College of Medicine
Naples Federico II, Naples, Italy; Nova Medical School (J Conde PhD), and Public Health (N K Fauk MSc, Prof P Ward PhD), Southgate
Nova University of Lisbon, Lisbon, Portugal; College of Environmental Institute for Health and Society (F H Tesfay PhD), Flinders University,
Sciences and Engineering (Prof H Dai PhD), Peking University, Beijing, Adelaide, SA, Australia; Institute of Resource Governance and Social
China; Department of Research (A Pandey PhD), Public Health Change, Kupang, Indonesia (N K Fauk MSc); Department of
Foundation of India, Gurugram, India (Prof L Dandona MD, Environmental Health Engineering (M Fazlzadeh PhD), Ardabil
Prof R Dandona PhD, G Kumar PhD); Indian Council of Medical University of Medical Science, Ardabil, Iran; National Institute for
Research, New Delhi, India (Prof L Dandona MD); Department of Stroke and Applied Neurosciences (Prof V L Feigin PhD), Auckland
Pathology (P Daneshpajouhnejad MD), Department of Radiology and University of Technology, Auckland, New Zealand; Third Department of
Radiological Science (N Hafezi-Nejad MD, O Shafaat MD, Neurology (E V Gnedovskaya PhD), Research Center of Neurology,
S Sheikhbahaei MD), Johns Hopkins University, Baltimore, MD, USA; Moscow, Russia (Prof V L Feigin PhD, Prof M A Piradov DSc); School of
Department of Pediatrics (Prof G L Darmstadt MD), Center for Health Nursing (T Y Ferede MSc), School of Midwifery (G Kassahun MSc),
Policy & Center for Primary Care and Outcomes Research Hawassa University, Hawassa, Ethiopia; Division of Neurology
(Prof J A Salomon PhD), Stanford University, Stanford, CA, USA; (S Fereshtehnejad PhD), School of International Development and
Department of Population and Development (C A Dávila-Cervantes Global Studies (Prof S Yaya PhD), University of Ottawa, Ottawa, ON,
PhD), Latin American Faculty of Social Sciences Mexico, Mexico City, Canada; Research Center on Public Health (P Ferrara MD), University of
Mexico; Ear Institute (Prof A C Davis), Division of Psychology and Milan Bicocca, Monza, Italy; Psychiatry Department (I Filip MD), Kaiser
Language Sciences (M Kumar PhD), Medical Research Council Clinical Permanente, Fontana, CA, USA; School of Health Sciences (I Filip MD),
Trials Unit (N M Noor MRCP), University College London, London, UK; AT Still University, Mesa, AZ, USA; Institute of Gerontological Health
Health Research Institute (K Davletov PhD), Al Farabi Kazakh National Services and Nursing Research (F Fischer PhD), Ravensburg-Weingarten
University, Almaty, Kazakhstan; Australian Institute for Suicide University of Applied Sciences, Weingarten, Germany; James Cancer
Research and Prevention (Prof D De Leo DSc), Griffith University, Hospital (J L Fisher PhD), Ohio State University, Columbus, OH, USA;
Mount Gravatt, QLD, Australia; Centre for Interdisciplinary Research in Institute of Gerontology (N A Foigt PhD), National Academy of Medical
Basic Sciences (F Deeba PhD), Jamia Millia Islamia, Delhi, India; Sciences of Ukraine, Kyiv, Ukraine; Department of Child Dental Health
St Paul’s Eye Unit (N Dervenis MD), Royal Liverpool University (Prof M O Folayan FWACS), Obafemi Awolowo University, Ile-Ife,
Hospital, Liverpool, UK; Department of Ophthalmology Nigeria; Department of Medical Parasitology (M Foroutan PhD), Abadan
(N Dervenis MD), Aristotle University of Thessaloniki, Thessaloniki, Faculty of Medical Sciences, Abadan, Iran; School of Public Health,
Greece; National Centre for AIDS and STD Control (K Deuba DrPH), Medical, and Veterinary Sciences (R C Franklin PhD), James Cook
Save the Children, Kathmandu, Nepal; Centre for Atmospheric Sciences University, Douglas, QLD, Australia; School of Global Public Health
(S Dey PhD), Indian Institute of Technology Delhi, New Delhi, India; (S D Friedman BA, E K Peprah PhD), New York University, New York,
Department of Community Medicine (Prof S D Dharmaratne MD), NY, USA; Department of Dermatology (T Fukumoto PhD), Kobe
University of Peradeniya, Peradeniya, Sri Lanka; Department of University, Kobe, Japan; Department of Cardiovascular Medicine
Pharmacy Practice (S Dhingra PhD), National Institute of (M M Gad MD), Department of Internal Medicine (V Jain MD),
Pharmaceutical Education and Research, Hajipur, India; Department of Cleveland Clinic, Cleveland, OH, USA; Gillings School of Global Public
Microbiology (G P Dhungana MSc), Far Western University, Health (M M Gad MD), University of North Carolina Chapel Hill,
Mahendranagar, Nepal; Faculty of Veterinary Medicine and Zootechnics Chapel Hill, NC, USA; Department of Community Medicine
(Prof D Diaz PhD), Autonomous University of Sinaloa, Culiacán (Prof A M Gaidhane MD, Prof Z Quazi Syed PhD), Department of
Rosales, Mexico; Institute of Microbiology and Immunology Medicine (S Gaidhane PhD), Department of Ophthalmology
(E Dubljanin PhD), Faculty of Medicine (I M Ilic PhD, (Prof D Singhal MD), Datta Meghe Institute of Medical Sciences,

Articles
Wardha, India; Nutrition Innovation Centre for Food and Health Pharmacy Administration and Clinical Pharmacy (K Hayat MS),
(NICHE) (S Gaihre PhD), Ulster University, Coleraine, UK; Department Xian Jiaotong University, Xian, China; School of Business
of Tuberculosis (A L Garcia-Basteiro PhD), Manhiça Health Research (Prof C Herteliu PhD), London South Bank University, London, UK;
Center (CISM), Manhiça, Mozambique; Viral and Bacterial Infections Department of Pediatrics (M K Hole MD), University of Texas Austin,
Research Program (A L Garcia-Basteiro PhD), Barcelona Institute for Austin, TX, USA; Department of Pharmacology (N Hossain MPhil),
Global Health, Barcelona, Spain; Faculty of Business and Management Bangladesh Industrial Gases Limited, Tangail, Bangladesh; Clinical
(M Garcia-Gordillo PhD), Universidad Autonóma de Chile (Autonomous Legal Medicine Department (S Hostiuc PhD), National Institute of Legal
University of Chile), Talca, Chile; National Health Service, London, UK Medicine Mina Minovici, Bucharest, Romania; College of Science and
(M Gaspar Fonseca PhD); Department of Nursing and Midwifery Engineering (Prof M Househ PhD), Hamad Bin Khalifa University,
(K B Gebremedhin MSc), Addis Ababa University, Addis Ababa, Doha, Qatar; Jockey Club School of Public Health and Primary Care
Ethiopia; Young Researchers and Elite Club (A Gholamian MSc), Islamic (J Huang MD), The Chinese University of Hong Kong, Hong Kong,
Azad University, Rasht, Iran; Department of Biology (A Gholamian MSc), China; Department of Public Health and Community Medicine
Department of Microbiology (S Valadan Tahbaz PhD), Islamic Azad (Prof A Humayun PhD), Shaikh Khalifa Bin Zayed Al-Nahyan Medical
University, Tehran, Iran; Faculty of Allied Health Sciences College, Lahore, Pakistan; Department of Occupational Safety and
(Prof S Gilani PhD), University Institute of Public Health (A Hanif PhD, Health (Prof B Hwang PhD), College of Public Health (R Lin PhD),
A A Malik PhD), The University of Lahore, Lahore, Pakistan; Afro-Asian China Medical University, Taichung, Taiwan; Department of
Institute, Lahore, Pakistan (Prof S Gilani PhD); School of Public Health Epidemiology (Prof M D Ilic PhD), University of Kragujevac, Kragujevac,
and Community Medicine (M A Godinho MBBS), University of Serbia; Division of Gastroenterology and Hepatology (S Inamdar MD),
New South Wales, Kensington, NSW, Australia; Department of University of Arkansas for Medical Sciences, Little Rock, AR, USA;
Gastroenterology (Prof A Goel DM), Sanjay Gandhi Postgraduate Division of Community Health and Family Medicine (L R Inbaraj MD),
Institute of Medical Sciences, Lucknow, India; Health Systems and Bangalore Baptist Hospital, Bangalore, India; Department of Human
Policy Research (M Golechha PhD), Indian Institute of Public Health Nutrition (K Iqbal DrPH), Khyber Medical University, Peshawar,
Gandhinagar, Gandhinagar, India; Department of Exercise and Health Pakistan; College of Public Health (U Iqbal PhD), Taipei Medical
Sciences (P N Gona PhD), University of Massachusetts Boston, Boston, University, Taipei, Taiwan; Institute for Physical Activity and Nutrition
MA, USA; Hudson College of Public Health (S V Gopalani MPH), (S Islam PhD), Department of Psychology (M A Stokes PhD), Deakin
University of Oklahoma Health Sciences Center, Oklahoma City, OK, University, Burwood, VIC, Australia; Sydney Medical School
USA; Department of Health and Social Affairs (S V Gopalani MPH), (S Islam PhD), Asbestos Diseases Research Institute (J Leigh MD),
Government of the Federated States of Micronesia, Palikir, Federated School of Veterinary Science (B B Singh PhD), University of Sydney,
States of Micronesia; Department of Respiratory Medicine Sydney, NSW, Australia; Public Health Department of Social Medicine
(H Goudarzi PhD), Center for Environmental and Health Sciences (Prof H Iso MD), Graduate School of Medicine (Prof K Yamagishi MD),
(H Goudarzi PhD), Hokkaido University, Sapporo, Japan; Department of Osaka University, Suita, Japan; Department of Health Services Research
Public Health and Preventive Medicine (Prof M Grivna PhD), Charles (M Iwagami PhD), Research and Development Center for Health
University, Prague, Czech Republic; Department of Microbiology Services (Prof K Yamagishi MD), University of Tsukuba, Tsukuba, Japan;
(Prof H C Gugnani PhD), Department of Epidemiology School of Health Systems and Public Health (C C D Iwu MSc),
(Prof H C Gugnani PhD), Saint James School of Medicine, The Valley, University of Pretoria, Pretoria, South Africa; Department of Global and
Anguilla; UO Neurologia, Salute Pubblica e Disabilità (D Guido PhD, Community Health (K H Jacobsen PhD), George Mason University,
M Leonardi MD, F G Magnani PhD, A Raggi PhD, D Sattin PsyD, Fairfax, VA, USA; The George Institute for Global Health
S Schiavolin MSc), Fondazione IRCCS Istituto Neurologico Carlo Besta (J Jagnoor PhD), University of New South Wales, New Delhi, India;
(Neurology, Public Health and Disability Unit, Carlo Besta Neurological Health Informatic Lab (T Javaheri PhD), Department of Computer
Institute), Milan, Italy; Institute of Tropical Pathology and Public Health Science (R Rawassizadeh PhD), Boston University, Boston, MA, USA;
(IPTSP) (R A Guimarães MSc), Federal University of Goias, Goiânia, Department of Biochemistry (Prof S Jayaram MD), Government Medical
Brazil; Department of Epidemiology and Biostatistics (R Gupta MPH), College, Mysuru, India; Postgraduate Institute of Medicine
University of South Carolina, Columbia, SC, USA; Centre for (A U Jayatilleke PhD), University of Colombo, Colombo, Sri Lanka;
Noncommunicable Diseases and Nutrition (R Gupta MPH), BRAC Faculty of Graduate Studies (A U Jayatilleke PhD), Institute for Violence
University, Dhaka, Bangladesh; Department of Preventive Cardiology and Injury Prevention, Colombo, Sri Lanka; Department of Community
(Prof R Gupta MD), Eternal Heart Care Centre & Research Institute, Medicine (R P Jha MSc), Dr Baba Saheb Ambedkar Medical College &
Jaipur, India; Department of Medicine (Prof R Gupta MD), Mahatma Hospital, Delhi, India; Department of Community Medicine
Gandhi University Medical Sciences, Jaipur, India; Department of Social (R P Jha MSc), Banaras Hindu University, Varanasi, India;
and Public Health (M Haider PhD), Ohio University, Athens, OH, USA; Environmental Research Center (J S Ji DSc), Global Health Research
School of Health and Environmental Studies (Prof S Hamidi DrPH), Center (C Wu PhD), Duke Kunshan University, Kunshan, China;
Hamdan Bin Mohammed Smart University, Dubai, United Arab Nicholas School of the Environment (J S Ji DSc), Department of
Emirates; Medical School (Prof G J Hankey MD), Dobney Hypertension Anesthesiology (V Krishnamoorthy MD), Duke Global Health Institute
Centre (Prof M P Schlaich MD), University of Western Australia, Perth, (C Wu PhD), Duke University, Durham, NC, USA; Renal and
WA, Australia; Department of Neurology (Prof G J Hankey MD), Cardiovascular Division (O John MD), Research Division
Sir Charles Gairdner Hospital, Perth, WA, Australia; Department of (P K Maulik PhD), The George Institute for Global Health, New Delhi,
Zoology and Entomology (A I Hasaballah PhD), Al Azhar University, India; Beijing Institute of Ophthalmology (Prof J B Jonas MD), Beijing
Cairo, Egypt; Institute for Social Science Research (M Hasan MPH, Tongren Hospital, Beijing, China; Health Services Management Training
A A Mamun PhD), ARC Centre of Excellence for Children and Families Centre (T Joo MSc), Faculty of Health and Public Administration
over the Life Course (M Hasan MPH), The University of Queensland, (M Szócska PhD), Semmelweis University, Budapest, Hungary;
Indooroopilly, QLD, Australia; Department of Pharmacy (S Hasan PhD), Department of Community Medicine (N Joseph MD, V Kulkarni MD,
University of Huddersfield, Huddersfield, UK; School of Biomedical N Kumar MD, R Thapar MD), Department of Forensic Medicine and
Sciences and Pharmacy (S Hasan PhD), University of Newcastle, Toxicology (Prof P Rastogi MD), Kasturba Medical College
Newcastle, NSW, Australia; Gastrointestinal and Liver Diseases Research (Prof B Unnikrishnan MD), Manipal Academy of Higher Education,
Center (S Hassanipour PhD, F Joukar PhD), Caspian Digestive Disease Mangalore, India; Department of Family Medicine and Public Health
Research Center (S Hassanipour PhD, F Joukar PhD), Department of (J J Jozwiak PhD), University of Opole, Opole, Poland; Institute of
Environmental Health Engineering (J Jaafari PhD), Guilan University of Family Medicine and Public Health (M Jürisson PhD), University of
Medical Sciences, Rasht, Iran; Independent Consultant, Tabriz, Iran Tartu, Tartu, Estonia; School of Public Health (Z Kabir PhD), School of
(H Hassankhani PhD); Skaane University Hospital Medicine (P M Ryan PhD), University College Cork, Cork, Ireland;
(R J Havmoeller PhD), Skaane County Council, Malmoe, Sweden; International Research Center of Excellence (G A Kayode PhD), Institute
Institute of Pharmaceutical Sciences (K Hayat MS), University of of Human Virology Nigeria, Abuja, Nigeria; Julius Centre for Health
Veterinary and Animal Sciences, Lahore, Pakistan; Department of Sciences and Primary Care (G A Kayode PhD), Institute for Risk

Articles
Assessment Sciences (IRAS) (E Traini MSc), Utrecht University, Utrecht, Shenzhen University, Shenzhen, China; West China Second University
Netherlands; School of Food and Agricultural Sciences (N Khalid PhD), Hospital (Prof J Liang MD, Prof Y Wang MD), National Office for
University of Management and Technology, Lahore, Pakistan; Maternal and Child Health Surveillance, Chengdu, China; West China
Department of Biophysics and Biochemistry (Prof R Khalilov PhD), Second University Hospital (Prof J Liang MD, Prof Y Wang MD),
Baku State University, Baku, Azerbaijan; Russian Institute for Advanced National Center of Birth Defects Monitoring of China, Chengdu, China;
Study (Prof R Khalilov PhD), Moscow State Pedagogical University, Department of Medicine (L Lim MRCP), University of Malaya,
Moscow, Russia; Department of Epidemiology and Biostatistics Kuala Lumpur, Malaysia; Department of Medicine and Therapeutics
(E A Khan MPH), Health Services Academy, Islamabad, Pakistan; (L Lim MRCP), The Chinese University of Hong Kong, Shatin, NT,
Department of Population Science (M Khan PhD), Jatiya Kabi Kazi China; Asbestos Diseases Research Institute, Concord, NSW, Australia
Nazrul Islam University, Mymensingh, Bangladesh; Department of (R Lin PhD); Department of Systems, Populations, and Leadership
Health Policy and Management (Prof Y Khang MD), Institute of Health (X Liu PhD), University of Michigan, Ann Arbor, MI, USA; Department
Policy and Management (Prof Y Khang MD), Seoul National University, of Paediatrics (Prof R Lodha MD), Department of Psychiatry
Seoul, South Korea; Faculty of Health and Wellbeing (K Khatab PhD), (Prof R Sagar MD), All India Institute of Medical Sciences, New Delhi,
Sheffield Hallam University, Sheffield, UK; College of Arts and Sciences India; Melbourne School of Population and Global Health
(K Khatab PhD), Ohio University, Zanesville, OH, USA; The Iranian (Prof A D Lopez PhD), School of Health Sciences (A Meretoja MD),
Academy of Medical Sciences, Tehran, Iran (M Khayamzadeh MD); Department of Pediatrics (Prof G C Patton MD), University of
Deputy for Public Health (A Khosravi PhD), Ministry of Health and Melbourne, Melbourne, VIC, Australia; Department of General Surgery
Medical Education, Tehran, Iran; Department of Health Sciences (Prof R Lunevicius DSc), Liverpool University Hospitals NHS
(Prof D Kim DrPH), Cultures, Societies and Global Studies, & Integrated Foundation Trust, Liverpool, UK; Department of Surgery
Initiative for Global Health (R G Wamai PhD), Northeastern University, (Prof R Lunevicius DSc), Department of International Public Health
Boston, MA, USA; Big Data Department (Y Kim PhD), National Health (V E Nwatah MD), University of Liverpool, Liverpool, UK; Neurology
Insurance Service, Wonju, South Korea; School of Traditional Chinese Department (M T Mackay PhD), Royal Children’s Hospital, Melbourne,
Medicine (Y Kim PhD), Xiamen University Malaysia, Sepang, Malaysia; VIC, Australia; Clinical Sciences Department (M T Mackay PhD),
Department of Nutrition (R W Kimokoti MD), Simmons University, Population Health Theme (Prof G C Patton MD), Murdoch Childrens
Boston, MA, USA; School of Health Sciences (Prof A Kisa PhD), Research Institute, Melbourne, VIC, Australia; Department of
Kristiania University College, Oslo, Norway; Global Community Health Biochemistry (S Madhava Kunjathur MD), BGS Global Institute of
and Behavioral Sciences (Prof A Kisa PhD), Tulane University, Medical Sciences, Bengaluru, India; Department of Forensic Medicine &
New Orleans, LA, USA; Department of Nursing and Health Promotion Toxicology (D Mahadeshwara Prasad MD), Mysore Medical College &
(S Kisa PhD), Oslo Metropolitan University, Oslo, Norway; Department Research Institute, Mysooru, India; Department of Public Health
of Pediatrics (Prof N Kissoon MD), School of Population and Public (M Maheri PhD), Urmia University of Medical Science, Urmia, Iran;
Health (J A Kopec PhD, Prof N Sarrafzadegan MD), University of British Radiology and Precision Health Program (M Mahmoudi PhD), Michigan
Columbia, Vancouver, BC, Canada; Arthritis Research Canada, State University, East Lansing, MI, USA; Department of Forensic
Richmond, BC, Canada (J A Kopec PhD); Independent Consultant, Medicine (Prof V Maled MD), Shri Dharmasthala Manjunatheshwara
Jakarta, Indonesia (S Kosen MD); Department of Internal and University, Dharwad, India; Department of Forensic Medicine
Pulmonary Medicine (Prof P A Koul MD), Sheri Kashmir Institute of (Prof V Maled MD), Rajiv Gandhi University of Health Sciences,
Medical Sciences, Srinagar, India; Kasturba Medical College, Udupi, Bangalore, India; Environmental Health Research Center
India (S Koulmane Laxminarayana MD); CIBERSAM (A Koyanagi MD), (Prof A Maleki PhD), Social Determinants of Health Research Center
San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain; (G Moradi PhD), Department of Epidemiology and Biostatistics
Department of Anthropology (K Krishan PhD), Panjab University, (G Moradi PhD), Kurdistan University of Medical Sciences, Sanandaj,
Chandigarh, India; Department of Demography Iran; Department of Economics (Prof G Martinez PhD), Autonomous
(Prof B Kuate Defo PhD), Department of Social and Preventive Medicine Technology Institute of Mexico, Mexico City, Mexico; Indonesian Public
(Prof B Kuate Defo PhD), University of Montreal, Montreal, QC, Canada; Health Association, Surabaya, Indonesia (S Martini PhD); Campus
Faculty of Medicine (B Kucuk Bicer PhD), Gazi University, Ankara, Caucaia (F R Martins-Melo PhD), Federal Institute of Education, Science
Turkey; Department of Psychiatry (M Kumar PhD), School of Public and Technology of Ceará, Caucaia, Brazil; Department of Ophthalmology
Health (R G Wamai PhD), University of Nairobi, Nairobi, Kenya; Faculty (C McAlinden PhD), Singleton Hospital, Swansea, UK; National Centre
of Health and Life Sciences (O P Kurmi PhD), Coventry University, for Register-based Research (Prof J J McGrath MD), Aarhus University,
Coventry, UK; Department of Medicine (O P Kurmi PhD), Population Aarhus, Denmark; Department of Dentistry (C E Medina-Solís MSc),
Health Research Institute (T Sathish PhD), McMaster University, Autonomous University of Hidalgo State, Pachuca, Mexico; College of
Hamilton, ON, Canada; Faculty of Public Health (D Kusuma DSc), Medicine (Prof Z A Memish MD), Alfaisal University, Riyadh,
University of Indonesia, Depok, Indonesia; Department of Clinical Saudi Arabia; Research & Innovation Center (Prof Z A Memish MD),
Sciences and Community Health (Prof C La Vecchia MD), University of Ministry of Health, Riyadh, Saudi Arabia; Peru Country Office
Milan, Milan, Italy; National Institute for Health Research (NIHR) (W Mendoza MD), United Nations Population Fund (UNFPA), Lima,
Oxford Biomedical Research Centre, Oxford, UK (B Lacey PhD); Peru; Center for Translation Research and Implementation Science
Department of Community and Family Medicine (F H Lami PhD), (G A Mensah MD), National Institutes of Health, Bethesda, MD, USA;
University of Baghdad, Baghdad, Iraq; Unit of Genetics and Public Department of Medicine (G A Mensah MD), School of Public Health
Health (Prof I Landires MD), Unit of Microbiology and Public Health and Family Medicine (C A Nnaji MPH, Prof C S Wiysonge MD),
(V Nuñez-Samudio PhD), Institute of Medical Sciences, Las Tablas, University of Cape Town, Cape Town, South Africa; Neurology Unit
Panama; Department of Public Health (V Nuñez-Samudio PhD), (A Meretoja MD), Breast Surgery Unit (T J Meretoja MD), Helsinki
Ministry of Health, Herrera, Panama (Prof I Landires MD); Department University Hospital, Helsinki, Finland; University of Helsinki, Helsinki,
of Medical Sciences (Prof A O Larsson PhD), Uppsala University, Finland (T J Meretoja MD); Clinical Microbiology and Parasitology Unit
Uppsala, Sweden; Department of Clinical Chemistry and Pharmacology (T Mestrovic PhD), Zora Profozic Polyclinic, Zagreb, Croatia; University
(Prof A O Larsson PhD), Uppsala University Hospital, Uppsala, Sweden; Centre Varazdin (T Mestrovic PhD), University North, Varazdin, Croatia;
Department of Otorhinolaryngology (S Lasrado MS), Father Muller Center for Innovation in Medical Education (B Miazgowski MD),
Medical College, Mangalore, India; Institute of Clinical Physiology Department of Propedeutics of Internal Diseases & Arterial
(P Lauriola MD), National Research Council, Pisa, Italy; School of Hypertension (Prof T Miazgowski MD), Pomeranian Medical University,
Pharmacy (S W H Lee PhD), Monash University, Bandar Sunway, Szczecin, Poland (B Miazgowski MD); Woman-Mother-Child
Malaysia; School of Pharmacy (S W H Lee PhD), Taylor’s University Department (I Michalek PhD), Lausanne University Hospital, Lausanne,
Lakeside Campus, Subang Jaya, Malaysia; Graduate School of Public Switzerland; Pacific Institute for Research & Evaluation, Calverton, MD,
Health (Y Lee PhD), Ajou University, Suwon-si, South Korea; Oxford USA (T R Miller PhD); Global Institute of Public Health
University Clinical Research Unit (S Lewycka PhD), Wellcome Trust (Prof G Mini PhD), Ananthapuri Hospitals and Research Institute,
Asia Programme, Hanoi, Vietnam; Department of Sociology (B Li PhD), Trivandrum, India; Women’s Social and Health Studies Foundation,

Articles
Trivandrum, India (Prof G Mini PhD); Department of Environmental Prof C S Wiysonge MD); Department of Health Policy and Management
Health (M Miri PhD), Non-communicable Diseases Research Center (S Nomura PhD), Keio University, Tokyo, Japan; Department of Global
(M Miri PhD), Sabzevar University of Medical Sciences, Sabzevar, Iran; Health Policy (S Nomura PhD), University of Tokyo, Tokyo, Japan;
Internal Medicine Programme (Prof E M Mirrakhimov PhD), Department of Gastroenterology (N M Noor MRCP), Cambridge
Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan; Department of University Hospitals, Cambridge, UK; Department of Pediatrics
Atherosclerosis and Coronary Heart Disease (Prof E M Mirrakhimov (V E Nwatah MD), National Hospital, Abuja, Nigeria; Administrative and
PhD), National Center of Cardiology and Internal Disease, Bishkek, Economic Sciences Department (Prof B Oancea PhD), University of
Kyrgyzstan; Research Center for Biochemistry and Nutrition in Bucharest, Bucharest, Romania; Department of Community Health and
Metabolic Diseases (H Mirzaei PhD), Kashan University of Medical Primary Care (O O Odukoya MSc), University of Lagos, Idi Araba,
Sciences, Kashan, Iran; Institute of Addiction Research (ISFF) Nigeria; Department of Family and Preventive Medicine
(B Moazen MSc), Frankfurt University of Applied Sciences, Frankfurt, (O O Odukoya MSc), University of Utah, Salt Lake City, UT, USA;
Germany; Department of Radiation Oncology (O Mohamad MD), Translational Health Research Institute (F A Ogbo PhD), Western
University of California San Francisco, San Francisco, CA, USA; Sydney University, Sydney, NSW, Australia; Centre for Healthy Start
Department of Epidemiology and Biostatistics Initiative, Lagos, Nigeria (B O Olusanya PhD, J O Olusanya MBA);
(A Mohammadian-Hafshejani PhD), Shahrekord University of Medical Diplomacy and Public Relations Department (A Omar Bali PhD),
Sciences, Shahrekord, Iran; Health Systems and Policy Research Unit University of Human Development, Sulaimaniyah, Iraq; Department of
(S Mohammed PhD), Department of Community Medicine Pharmacology and Therapeutics (Prof O E Onwujekwe PhD), University
(M B Sufiyan MD), Department of Surgery (M A Tolani FWACS), of Nigeria Nsukka, Enugu, Nigeria; Department of Medicine
Ahmadu Bello University, Zaria, Nigeria; Clinical Epidemiology and (Prof A Ortiz MD), (Princess University Hospital) (Prof J B Soriano MD),
Public Health Research Unit (L Monasta DSc, L Ronfani PhD, Autonomous University of Madrid, Madrid, Spain; Department of
E Traini MSc), Burlo Garofolo Institute for Maternal and Child Health, Nephrology and Hypertension (Prof A Ortiz MD), The Institute for
Trieste, Italy; Department of Biomedical and Dental Sciences and Health Research Foundation Jiménez Díaz University Hospital, Madrid,
Morphofunctional Imaging (Prof S Mondello MD), Messina University, Spain; Department of Project Management (S S Otstavnov PhD),
Messina, Italy; Computer, Electrical, and Mathematical Sciences and Department of Health Care Administration and Economics
Engineering Division (P Moraga PhD), King Abdullah University of (Prof V Vlassov MD), National Research University Higher School of
Science and Technology, Thuwal, Saudi Arabia; International Laboratory Economics, Moscow, Russia; Department of Respiratory Medicine
for Air Quality and Health (Prof L Morawska PhD), Queensland (Prof M P A DNB), Jagadguru Sri Shivarathreeswara Academy of Health
University of Technology, Brisbane, QLD, Australia; Section of Plastic Education and Research, Mysore, India; Department of Medicine
Surgery (S D Morrison MD), University of Michigan School of Medicine, (S Pakhale MD), Ottawa Hospital Research Institute, Ottawa, ON,
Ann Arbor, MI, USA; Department of Food Science Canada; Department of Neurology (Prof P K Pal DM), National Institute
(Prof A Mousavi Khaneghah PhD), University of Campinas (Unicamp), of Mental Health and Neurosciences, Bengalore, India; Department of
Campinas, Brazil; Department of Pediatric Medicine Health Metrics (A Pana MD), Center for Health Outcomes & Evaluation,
(Prof G Mustafa MD), The Children’s Hospital & The Institute of Child Bucharest, Romania; Research Department (A Pandey MPH), Nepal
Health, Multan, Pakistan; Department of Pediatrics & Pediatric Health Research Council, Kathmandu, Nepal; Research Department
Pulmonology (Prof G Mustafa MD), Institute of Mother & Child Care, (A Pandey MPH), Public Health Research Society Nepal, Kathmandu,
Multan, Pakistan; Research and Analytics Department Nepal; Corporate (S R Pandi-Perumal MSc), Somnogen Canada Inc,
(A J Nagarajan MTech), Initiative for Financing Health and Human Toronto, ON, Canada; National Institute of Health Research and
Development, Chennai, India; Department of Research and Analytics Development (H U Pangaribuan MSc), Ministry of Health, Jakarta,
(A J Nagarajan MTech), Bioinsilico Technologies, Chennai, India; Indonesia; Department of Medical Humanities and Social Medicine
Department of Cardiology (B Naghshtabrizi MD), Hamedan University (Prof E Park PhD), Kosin University, Busan, South Korea; Department of
of Medical Sciences, Hamadan, Iran; Laboratory of Public Health Poverty, Gender and Youth (S K Patel PhD), Population Council,
Indicators Analysis and Health Digitalization (M Naimzada MD, New Delhi, India; School of Public Health, Medical, and Veterinary
N Otstavnov BA, S S Otstavnov PhD), Moscow Institute of Physics and Sciences (A E Peden PhD), James Cook University, Townsville, NSW,
Technology, Dolgoprudny, Russia; Experimental Surgery and Oncology Australia; Center for Research and Innovation (V F Pepito MSc),
Laboratory (M Naimzada MD), Kursk State Medical University, Kursk, Ateneo De Manila University, Pasig City, Philippines; Department of
Russia; Suraj Eye Institute, Nagpur, India (V Nangia MD); Mysore Orthopedics (J Pereira MS), Yenepoya Medical College, Mangalore,
Medical College and Research Institute (Prof S Narasimha Swamy MD), India; Departamento de Didáctica de la Expresión Musical, Plástica y
Government Medical College, Mysore, India; Department of Corportal (Prof J Pérez-Gómez PhD), University of Extremadura,
Biotechnology (M Naveed PhD), University of Central Punjab, Lahore, Cáceres, Spain; Mario Negri Institute for Pharmacological Research,
Pakistan; Department of Disease Control and Environmental Health Bergamo, Italy (N Perico MD, Prof G Remuzzi MD); Department of
(R Ndejjo MSc), Makerere University, Kampala, Uganda; Department of Cardiology (T Pilgrim MD, S Stortecky MD), University of Bern, Bern,
General Surgery (I Negoi PhD), Emergency Hospital of Bucharest, Switzerland; Division of Infectious Diseases and International Health
Bucharest, Romania; Cardio-Aid, Bucharest, Romania (R I Negoi PhD); (J A Platts-Mills MD), University of Virginia, Charlottesville, VA, USA;
Department of Medicine (E Nena MD, P Steiropoulos MD), Democritus HIV and Mental Health Department (K N Pokhrel PhD), Integrated
University of Thrace, Alexandroupolis, Greece; Department of Development Foundation Nepal, Kathmandu, Nepal; University Medical
Community Medicine (S Nepal MD), Kathmandu University, Palpa, Center Groningen (Prof M J Postma PhD), School of Economics and
Nepal; College of Medicine and Health Sciences (H B Netsere MS), Business (Prof M J Postma PhD), University of Groningen, Groningen,
Bahir Dar University, Gondar, Ethiopia; Department of Public Health Netherlands; Dietary Supplements and Probiotic Research Center
(G Nguefack-Tsague PhD), University of Yaoundé I, Yaoundé, (H Pourjafar PhD), School of Medicine (M Shams-Beyranvand MSc),
Cameroon; Department of Biological Sciences (J W Ngunjiri DrPH), Alborz University of Medical Sciences, Karaj, Iran; Centro de
University of Embu, Embu, Kenya; Department of Research Investigaciones Clinicas (S I Prada PhD), Fundación Valle del Lili
Methodology and Biostatistics (C T Y Nguyen BSc), Vinmec Institute of (Clinical Research Center, Valle del Lili Foundation), Cali, Colombia;
Applied Sciences and Regenerative Medicine, Hanoi, Vietnam; Institute Centro PROESA (PROESA Center) (S I Prada PhD), Centro de
for Global Health Innovations (C T Nguyen MPH, H L T Nguyen MPH), Investigaciones en Anomalías Congénitas y Enfermedades Raras (Center
Duy Tan University, Hanoi, Vietnam; Institute for Mental Health and for Research in Congenital Anomalies and Rare Diseases)
Policy (Y T Nigatu PhD), Centre for Addiction and Mental Health, (E Rubagotti PhD), Universidad ICESI (ICESI University), Cali,
Toronto, ON, Canada; Department of Clinical Epidemiology Colombia; Department of Neurology (Prof S Prakash DM), Smt BKS
(Y T Nigatu PhD), Institute for Clinical Evaluative Sciences, Ottowa, ON, Medical Institute and Research Center, Vadodara, India; Department of
Canada; Department of Public Health (S N Nigussie MPH), Mizan-Tepi Chemistry (N Rabiee MSc), Sharif University of Technology, Tehran,
University, Mizan Teferi, Ethiopia; South African Medical Research Iran; College of Medicine (A Radfar MD), University of Central Florida,
Council, Cape Town, South Africa (C A Nnaji MPH, Orlando, FL, USA; Department of Medicine (A Rafiee MSc), University

Articles
of Alberta, Edmonton, AB, Canada; Department of Natural Science Edinburgh, Edinburgh, UK; National Institute of Infectious Diseases,
(S Rahimzadeh MSc), Middlesex University, London, UK; Department of Tokyo, Japan (M Shigematsu PhD); College of Medicine
Community Medicine (M Rahman PhD), Maharishi Markandeshwar (Prof J Shin MD), Yonsei University, Seoul, South Korea; Finnish
Medical College & Hospital, Solan, India; Future Technology Research Institute of Occupational Health, Helsinki, Finland (R Shiri PhD);
Center (A Rahmani PhD), National Yunlin University of Science and Research Executive Agency (I Shiue PhD), European Commission,
Technology, Yunlin, Taiwan; Institute of Research and Development Brussels, Belgium; School of Public Health (K Shuval PhD), University
(A Rahmani PhD), Duy Tan University, Da Nang, Vietnam; Department of Haifa, Haifa, Israel; The Cooper Institute, Dallas, TX, USA
of Public Health (J Rana MPH), North South University, Dhaka, (K Shuval PhD); Department of Medicine (T J Siddiqi MB), Department
Bangladesh; Department of Biostatistics and Epidemiology of Internal Medicine (M S Usman MB), Department of Pharmaceutics
(J Rana MPH), University of Massachusetts Amherst, Amherst, MA, (S Zaidi PhD), Dow University of Health Sciences, Karachi, Pakistan;
USA; Research Department (C L Ranabhat PhD), Policy Research Department of Psychology (Prof I D Sigfusdottir PhD, R Sigurvinsdottir
Institute, Kathmandu, Nepal; Health and Public Policy Department PhD), Reykjavik University, Reykjavik, Iceland; Department of Health
(C L Ranabhat PhD), Global Center for Research and Development, and Behavior Studies (Prof I D Sigfusdottir PhD), Graduate School of
Kathmandu, Nepal; Department of Oral Pathology (S Rao MDS), Architecture, Planning and Preservation (C B Swope MPH), Columbia
Srinivas Institute of Dental Sciences, Mangalore, India; University University, New York, NY, USA; Department of Dermatology
College London Hospitals, London, UK (D L Rawaf MD); Academic (J I S Silverberg MD), George Washington University, Washington, DC,
Public Health England (Prof S Rawaf MD), Public Health England, USA; Department of Law, Economics, Management and Quantitative
London, UK; River Region Cardiology Associates, Montgomery, WV, Methods (Prof B Simonetti PhD), University of Sannio, Benevento, Italy;
USA (W F Rawasia MD); School of Medicine WSB University in Gdańsk, Gdańsk, Poland (Prof B Simonetti PhD);
(Prof A M N Renzaho PhD), Translational Health Research Institute School of Public Health & Zoonoses (B B Singh PhD), Guru Angad Dev
(Prof A M N Renzaho PhD), Western Sydney University, Campbelltown, Veterinary & Animal Sciences University, Ludhiana, India; Medicine
NSW, Australia; Brien Holden Vision Institute, Sydney, Australia Service (Prof J A Singh MD), US Department of Veterans Affairs,
(Prof S Resnikoff MD); Network of Immunity in Infection, Malignancy Birmingham, AL, USA; Department of Ophthalmology
and Autoimmunity (NIIMA) (Prof N Rezaei PhD), Universal Scientific (Prof D Singhal MD), Gmers Medical College and Civil Hospital,
Education and Research Network (USERN), Tehran, Iran; Department of Ahmedabad, India; Department of Epidemiology (D N Sinha PhD),
Surgery (J Rickard MD), University of Minnesota, Minneapolis, MN, School of Preventive Oncology, Patna, India; Department of
USA; Department of Surgery (J Rickard MD), University Teaching Epidemiology (D N Sinha PhD), Healis Sekhsaria Institute for Public
Hospital of Kigali, Kigali, Rwanda; Department of Clinical Research Health, Mumbai, India; Department of Ophthalmology
(L Roever PhD), Federal University of Uberlândia, Uberlândia, Brazil; (E Skiadaresi MD), Hywel Dda University Health Board, Llanelli, UK;
Institute of Epidemiology and Medical Biometry Department No16 (V Y Skryabin MD), Laboratory of Genetics and
(Prof D Rothenbacher MD), Ulm University, Ulm, Germany; Genomics (Prof M S Zastrozhin PhD), Moscow Research and Practical
African Genome Center (E Rubagotti PhD), Mohammed VI Centre on Addictions, Moscow, Russia; Therapeutic Department
Polytechnic University (UM6P), Ben Guerir, Morocco; Malaria Atlas (A A Skryabina MD), Balashiha Central Hospital, Balashikha, Russia;
Project (S F Rumisha PhD), Telethon Kids Institute, Perth, WA, Division of Injury Prevention (Prof D A Sleet PhD), Centers for Disease
Australia; Department of Health Statistics (S F Rumisha PhD), National Control and Prevention (CDC), Atlanta, GA, USA; Rollins School of
Institute for Medical Research, Dar es Salaam, Tanzania; Applied Public Health (Prof D A Sleet PhD), Emory University, Atlanta, GA,
Biomedical Research Center (A Sahebkar PhD), Biotechnology Research USA; Department of Pediatrics (B H Sobaih MD), King Khalid
Center (A Sahebkar PhD), Mashhad University of Medical Sciences, University Hospital, Riyadh, Saudi Arabia; Centro de Investigación
Mashhad, Iran; Public Health and Community Medicine Department Biomédica en Red Enfermedades Respiratorias (CIBERES) (Center for
(M R Salem MD), Cairo University, Giza, Egypt; Faculty of Medicine Biomedical Research in Respiratory Diseases Network), Madrid, Spain
(Y L Samodra MPH), Duta Wacana Christian University, Yogyakarta, (Prof J B Soriano MD); Division of Community Medicine
Indonesia; Department of Surgery (Prof J Sanabria MD), Marshall (C T Sreeramareddy MD), International Medical University,
University, Huntington, WV, USA; Department of Nutrition and Kuala Lumpur, Malaysia; Department of Statistics
Preventive Medicine (Prof J Sanabria MD), Case Western Reserve (R Suliankatchi Abdulkader MD), Manonmaniam Sundaranar
University, Cleveland, OH, USA; Department of Community Medicine University, Abishekapatti, India; National Institute of Epidemiology
(S Y Saraswathy PhD), PSG Institute of Medical Sciences and Research, (R Suliankatchi Abdulkader MD), Indian Council of Medical Research,
Coimbatore, India; PSG-FAIMER South Asia Regional Institute, Chennai, India; Norwegian Institute of Public Health, Bergen, Norway
Coimbatore, India (S Y Saraswathy PhD); Health Economics (G Sulo PhD); Department of Criminology, Law, and Society
Department (A R Sarker PhD), Bangladesh Institute of Development (Prof B L Sykes PhD), University of California Irvine, Irvine, CA, USA;
Studies (BIDS), Dhaka, Bangladesh; Department of Geriatrics and Long Department of Dermatology (M D Szeto BS), University of Colorado,
Term Care (B Sathian PhD), Hamad Medical Corporation, Doha, Qatar; Aurora, CO, USA; Department of Medicine
Faculty of Health & Social Sciences (B Sathian PhD), Bournemouth (Prof R Tabarés-Seisdedos PhD), University of Valencia, Valencia, Spain;
University, Bournemouth, UK; Department of Preventive and Social Carlos III Health Institute (Prof R Tabarés-Seisdedos PhD), Biomedical
Medicine (G Saya MD), Jawaharlal Institute of Postgraduate Medical Research Networking Center for Mental Health Network (CiberSAM),
Education and Research, Puducherry, India; Market Access Madrid, Spain; Department of Population Science and Human Resource
(M Saylan MD), Bayer, Istanbul, Turkey; Hypertension and Kidney Development (Prof M I Tareque PhD), University of Rajshahi, Rajshahi,
Disease Laboratory (Prof M P Schlaich MD), Baker Heart and Diabetes Bangladesh; Department of Public Health and Community Medicine
Institute, Melbourne, VIC, Australia; Department of Psychology (Prof K R Thankappan MD), Central University of Kerala, Kasaragod,
(D C Schwebel PhD), School of Medicine (Prof J A Singh MD), India; Department of Pathology and Legal Medicine
University of Alabama at Birmingham, Birmingham, AL, USA; Oral (M R Tovani-Palone PhD), University of São Paulo, Ribeirão Preto,
Diagnosis, Digital Health and Health Services Research (Prof F Brazil; Modestum LTD, London, UK (M R Tovani-Palone PhD);
Schwendicke PhD), Charité University Medical Center Berlin, Berlin, Department of Health Economics (B X Tran PhD), Hanoi Medical
Germany; Emergency Department (S Senthilkumaran MD), Manian University, Hanoi, Vietnam; Department of Community Medicine
Medical Centre, Erode, India; Center for Biomedical Information (J P Tripathy MD), All India Institute of Medical Sciences, Nagpur, India;
Technology (F Sha PhD), Shenzhen Institutes of Advanced Technology, Faculty of Engineering and Technology (G Tsapparellas MSc), Liverpool
Shenzhen, China; Public Health Division (A A Shaheen PhD), An-Najah John Moores University, Liverpool, UK; Department of Medicine
National University, Nablus, Palestine; Department of Internal Medicine (Prof A Tsatsakis DSc), University of Crete, Heraklion, Greece; Lee Kong
(I Shahid MBBS), Ziauddin University, Karachi, Pakistan; Independent Chian School of Medicine (L Tudor Car PhD), Nanyang Technological
Consultant, Karachi, Pakistan (M A Shaikh MD); Department of University, Singapore, Singapore; Institute for Physical Activity and
Community Medicine (M Shannawaz PhD), BLDE University, Vijayapur, Nutrition (R Uddin PhD), Deakin University, Melbourne, VIC, Australia;
India; Centre for Medical Informatics (Prof A Sheikh MD), University of Multidisciplinary Department (A Ullah MS), National University of

Articles
Medical Sciences (NUMS), Rawalpindi, Pakistan; Department of the Italian Ministry of Health and SOBI; payment or honoraria for
Community Medicine (C D Umeokonkwo MPH), Alex Ekwueme lectures, presentations, speakers’ bureaus, manuscript writing, or
Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria; educational events from Arvell Therapeutics; support for attending
Department of Cardiovascular, Endocrine-metabolic Diseases and Aging meetings and/or travel from ILAE and EAN, all outside the submitted
(B Unim PhD), National Institute of Health, Rome, Italy; Amity Institute work. Reinhard Busse reports leadership or fiduciary role in other board,
of Biotechnology (E Upadhyay PhD), Amity University Rajasthan, Jaipur, society, committee, or advocacy group, paid or unpaid with the
India; Clinical Cancer Research Center (S Valadan Tahbaz PhD, Robert Koch Institute as member of the scientific advisory committee,
S Yahyazadeh Jabbari MD), Milad General Hospital, Tehran, Iran; German Burden 2020 project, all outside the submitted work.
Velez Sarsfield Hospital, Buenos Aires, Argentina (Prof P R Valdez MEd); Joao Conde reports grants or contracts from the European Research
UKK Institute, Tampere, Finland (Prof T J Vasankari MD); Raffles Council grant agreement No 848325 (ERC starting grant); patents
Neuroscience Centre (Prof N Venketasubramanian MBBS), Raffles planned issued or pending for TRPV2 antagonists WO2019054891 -
Hospital, Singapore, Singapore; Yong Loo Lin School of Medicine Instituto de Medicina Molecular (PT), Hydrogel Particles, Compositions,
(Prof N Venketasubramanian MBBS), National University of Singapore, and Methods- WO US US20170333304A1 - Massachusetts Institute of
Singapore, Singapore; Department of Community Medicine and Family Technology (USA), and Theranostic nanoprobes for overcoming cancer
Medicine (M Verma MD), All India Institute of Medical Sciences, multidrug resistance and methods- WO US WO2016134232A1 -
Bathinda, India; Department of Medical and Surgical Sciences Massachusetts Institute Of Technology (USA), all outside the submitted
(Prof F S Violante MD), University of Bologna, Bologna, Italy; work. Irina Filip reports payment or honoraria for lectures,
Occupational Health Unit (Prof F S Violante MD), Sant’Orsola Malpighi presentations, speakers’ bureaus, manuscript writing, or educational
Hospital, Bologna, Italy; Faculty of Information Technology (B Vo PhD), events from Avicenna Medical and Clinical Research Institute.
Ho Chi Minh City University of Technology (HUTECH), Claudiu Herteliu reports grants or contracts from Romanian National
Ho Chi Minh City, Vietnam; Center of Excellence in Behavioral Medicine Authority for scientific research and innovation, CNDS-UEFISCDI,
(G T Vu BA), Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam; project number PN-III-P4-ID-PCCF-2016-0084, research grant
Foundation University Medical College (Prof Y Waheed PhD), (October, 2018, to September, 2022), understanding and modelling time–
Foundation University Islamabad, Islamabad, Pakistan; Demographic space patterns of psychology-related inequalities and polarisation, and
Change and Aging Research Area (A Werdecker PhD), Competence project number PN-III-P2-2.1-SOL-2020-2-0351, research grant
Center of Mortality-Follow-Up of the German National Cohort (June, 2021, to October, 2021), approaches within public health
(R Westerman DSc), Federal Institute for Population Research, management in the context of COVID-19 pandemic, and from the
Wiesbaden, Germany; Department of Community Medicine Ministry of Labour and Social Justice Romania, project number
(N D Wickramasinghe MD), Rajarata University of Sri Lanka, 30/PSCD/2018, research grant (September, 2018 to June, 2019), agenda
Anuradhapura, Sri Lanka; Department of Orthopaedics for skills Romania 2020–25, all outside the submitted work.
(Prof A Wu MD), Wenzhou Medical University, Wenzhou, China; Sheikh Mohammed Shariful Islam reports grants or contracts from
Department of Behavior and Operation Managemen (Y Xie MD), Beijing National Health and Medical Research Council (NHMRC) and National
Advanced Innovation Center for Big Data-based Precision Medicine, Heart Foundation of Australia Fellowships, outside the submitted work.
Beijing, China; Division of Cardiology (S Yandrapalli MD), New York Jacek Jerzy Jozwiak reports payment or honoraria for lectures,
Medical College, Valhalla, NY, USA; Division of Cardiology presentations, speakers’ bureaus, manuscript writing, or educational
(S Yandrapalli MD), Westchester Medical Center, Valhalla, NY, USA; events from Teva, Amgen, Synexus, Boehringer Ingelheim, ALAB
Health Services Management Research Center (V Yazdi-Feyzabadi PhD), Laboratories, and Zentiva, all outside the submitted work.
Department of Health Management, Policy, and Economics Nicholas J Kassebaum reports support for the present manuscript from
(V Yazdi-Feyzabadi PhD), Kerman University of Medical Sciences, the Bill & Melinda Gates Foundation as grant funding for the GBD.
Kerman, Iran; Department of Neuropsychopharmacology Kewal Krishan reports non-financial support from UGC Centre of
(N Yonemoto MPH), National Center of Neurology and Psychiatry, Advanced Study, CAS II, Department of Anthropology, Panjab
Kodaira, Japan; Department of Public Health (N Yonemoto MPH), University, Chandigarh, India, outside the submitted work.
Juntendo University, Tokyo, Japan; Department of Preventive Medicine Morteza Mahmoudi reports payment or honoraria for lectures,
(Prof S Yoon PhD), Korea University, Seoul, South Korea; Department of presentations, speakers’ bureaus, manuscript writing, or educational
Health Policy and Management (Prof M Z Younis PhD), Jackson State events for his published books, plenary lectures, and licensed patent to
University, Jackson, MS, USA; School of Medicine Seer; leadership or fiduciary role in other board, society, committee or
(Prof M Z Younis PhD), Tsinghua University, Beijing, China; advocacy group, paid or unpaid with the Academic Parity Movement,
Department of Epidemiology and Biostatistics (Prof C Yu PhD), School a non-profit organisation dedicated to addressing academic
of Medicine (Z Zhang PhD), School of Health Sciences (X G Zhao PhD), discrimination, violence, and incivility, as a cofounder, all outside the
Wuhan University, Wuhan, China; Technology Enabled Girl submitted work. Shuhei Nomura reports support for the present
Ambassadors (TEGA) Programme (S S Yusuf MPH), Girl Effect, manuscript from Ministry of Education, Culture, Sports, Science and
London, UK; Maternal and Child Health Division (S Zaman MPH), Technology of Japan (MEXT) as grant funding. Adrian Pana reports
International Centre for Diarrhoeal Disease Research, Bangladesh, grants or contracts from Romanian National Authority for Scientific
Dhaka, Bangladesh; Addictology Department Research and Innovation, CNDS-UEFISCDI, project number
(Prof M S Zastrozhin PhD), Pediatrics Department (A Zastrozhina PhD), PN-III-P4-ID-PCCF-2016-0084, research grant (October, 2018, to
Russian Medical Academy of Continuous Professional Education, September, 2022), understanding and modelling time-space patterns of
Moscow, Russia; School of Public Health (Y Zhang PhD), Hubei psychology-related inequalities and polarisation, and project number
Province Key Laboratory of Occupational Hazard Identification and PN-III-P2-2.1-SOL-2020-2-0351, research grant (June, 2021, to
Control (Y Zhang PhD), Wuhan University of Science and Technology, October, 2021), approaches within public health management in the
Wuhan, China; School of Biology and Pharmaceutical Engineering context of COVID-19 pandemic, all outside the submitted work.
(X G Zhao PhD), Wuhan Polytechnic University, Wuhan, China. Seithikurippu R Pandi-Perumal reports payment or honoraria for
lectures, presentations, speakers’ bureaus, manuscript writing, or
Declaration of interests
educational events for the volumes he edited; leadership or fiduciary role
Robert Ancuceanu reports consulting fees from AbbVie and
in other board, society, committee, or advocacy group, paid or unpaid,
AstraZeneca; payment or honoraria for lectures, presentations, speakers’
with Somnogen Canada, Toronto, Canada, as the President and Chief
bureaus, manuscript writing, or educational events from Sandoz and
Executive Officer, all outside the submitted work. Thomas Pilgrim
AbbVie; support for attending meetings and/or travel from AbbVie and
reports grants or contracts from Biotronik, Boston Scientific, and
AstraZeneca, all outside the submitted work. Marcel Ausloos reports
Edwards Lifesciences; payment or honoraria for lectures, presentations,
grants or contracts from Romanian National Authority for Scientific
speakers’ bureaus, manuscript writing, or educational events from
Research and Innovation, CNDS-UEFISCDI, project number
Biotronik, Boston Scientific, and HighLifeSAS; and being proctor for
PN-III-P4-ID-PCCF-2016-0084, outside the submitted work. Ettore Beghi
Medtronic and Boston Scientific, all outside the submitted work.
reports grants or contracts paid to their institutions from ALSA,

Articles
Maarten J Postma reports grants or contacts from Merck, Sharp & official views of the Bill & Melinda Gates Foundation or the National
Dohme, GlaxoSmithKline, Pfizer, Boehringer Ingelheim, Novavax, Institutes of Health. Lucas Guimarães Abreu acknowledges Coordenação
Bayer, Bristol Myers Squibb, AstraZeneca, Sanofi, IQVIA, BioMerieux, de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) -
WHO, EU, Seqirus, FIND, Antilope, DIKTI, LPDP, and Budi; consulting Código de Financiamento 001, Conselho Nacional de Desenvolvimento
fees from Merck, Sharp & Dohme, GlaxoSmithKline, Pfizer, Boehringer Científico e Tecnológico (CNPq) (404710/2018-2 and 310797/2019-5),
Ingelheim, Novavax, Quintiles, Bristol Myers Squibb, AstraZeneca, Fundação de Amparo à Pesquisa de Minas Gerais (FAPEMIG), and
Sanofi, Novartis, Pharmerit, IQVIA, and Seqirus; participation on a data Pró-Reitoria de Pesquisa (PRPq) of Universidade Federal de Minas
safety monitoring board or advisory board to Asc Academics as adviser; Gerais. Olatunji O Adetokunboh was supported by the National
stock or stock options in Health-Ecore and PAG, all outside the Research Foundation, and Department of Science and Innovation,
submitted work. Amir Radfar reports payment or honoraria for lectures, South Africa. Syed Mohamed Aljunid would like to acknowledge the
presentations, speakers’ bureaus, manuscript writing, or educational Department of Health Policy and Management, Faculty of Public Health,
events from Avicenna Medical and Clinical Research Institute. Kuwait University, Kuwait and International Centre for Casemix and
Jasvinder A Singh reports consulting fees from Crealta/Horizon, Clinical Coding, Faculty of Medicine, National University of Malaysia,
Medisys, Fidia, Two labs, Adept Field Solutions, Clinical Care options, Malaysia for the approval and support to participate in this research
Clearview health-care partners, Putnam associates, Focus forward, project. Marcel Ausloos, Adrian Pana, and Claudiu Herteliu are partially
Navigant consulting, Spherix, MedIQ, UBM, Trio Health, Medscape, supported by a grant of the Romanian National Authority for Scientific
WebMD, and Practice Point communications, and the National Research and Innovation, CNDS-UEFISCDI, project number
Institutes of Health and the American College of Rheumatology; PN-III-P4-ID-PCCF-2016-0084. Claudiu Herteliu and Adrian Pana are
payment or honoraria for lectures, presentations, speakers’ bureaus, partially supported by a grant of the Romanian National Authority for
manuscript writing, or educational events from Simply Speaking; Scientific Research and Innovation, CNDS-UEFISCDI, project number
support for attending meetings and travel from OMERACT, PN-III-P2-2.1-SOL-2020-2-0351. Derrick A Bennett receives support from
an international organisation that develops measures for clinical trials the Oxford National Institute for Health Research (NIHR) Biomedical
and receives arm’s length funding from 12 pharmaceutical companies, Research Centre. The views expressed are those of the author(s) and not
when travelling biannually to OMERACT meetings; leadership or necessarily those of the National Health Service (NHS), the NIHR, or the
fiduciary role in other board, society, committee, or advocacy group, Department of Health and Social Care. Felix Carvalho and Eduarda
paid or unpaid, with OMERACT as a member of the steering committee, Fernandes acknowledge UID/MULTI/04378/2019 and
with the US Food and Drug Administration (FDA) Arthritis Advisory UID/QUI/50006/2019 support with funding from FCT/MCTES through
Committee, with the Veterans Affairs Rheumatology Field Advisory national funds. Joao Conde acknowledges the European Research
Committee as a member, and with the UAB Cochrane Musculoskeletal Council, ERC starting grant agreement No 848325. Vera Marisa Costa
Group Satellite Center on Network Meta-analysis as a director and editor; acknowledges her grant (SFRH/BHD/110001/2015), received by
stock or stock options in TPT Global Tech, Vaxart pharmaceuticals, Portuguese national funds through Fundação para a Ciência e
Charlotte’s Web Holdings, and previously owned stock options in Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/
Amarin, Viking, and Moderna pharmaceuticals, all outside the CT0006. Sagnik Dey acknowledges the support of the Centre of
submitted work. Mark A Stokes reports payment or honoraria for Excellence for Research on Clean Air (CERCA) and IIT Delhi for the
lectures, presentations, speakers’ bureaus, manuscript writing, or institute chair position. Santosh Gaihre acknowledges the GCRF
educational events at the Autism Teaching Institute (Victoria, Australia); SAFEWATER Project, Ulster University, Northern Ireland.
unpaid participation on a data safety monitoring board or advisory board Sheikh Mohammed Shariful Islam acknowledges support from
with the Deakin University Human Research Ethics Committee; fellowships and funding from NHMRC and National Heart Foundation
leadership or fiduciary role in other board, society, committee, or of Australia. Oommen John is recipient of an UIPA scholarship through
advocacy group, paid or unpaid, with the Australasian Society for Autism University of New South Wales (UNSW), Sydney, Australia.
Research as a past president, with the Australasian Society for Autism Md Nuruzzaman Khan acknowledges the support of
Research as a board member, with Kidsafe (Victoria, Australia) as vice Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh.
president, with Mindful as a member of the research advisory board, Yun Jin Kim was supported by the Research Management Centre,
and with Autism Teaching Institute as chair of the research advisory Xiamen University Malaysia, Malaysia (XMUMRF/2020-C6/ITCM/0004).
board; stock or stock options in Cochlear and Medical Developments, Sindhura Lakshmi Koulmane Laxminarayana acknowledges support
all outside the submitted work. Stefan Stortecky reports grants or provided by Manipal Academy of Higher Education, Manipal, India.
contracts to their institute from Edwards Lifesciences, Medtronic, Kewal Krishan is supported by the UGC Centre of Advanced Study
Boston Scientific, and Abbott; consulting fees from BTG and Teleflex; (CAS II), awarded to the Department of Anthropology, Panjab
payment or honoraria for lectures, presentations, speakers’ bureaus, University, Chandigarh, India. Manasi Kumar would like to acknowledge
manuscript writing, or educational events from BTG and Boston NIH/FIC k43 tw010716-04. Ben Lacey acknowledges support from
Scientific; support for attending meetings and/or travel from BTG, UK Biobank, the NIHR Oxford Biomedical Research Centre, and the
all outside the submitted work. Carolyn B Swope reports support for BHF Oxford Centre of Research Excellence. Iván Landires is a member
the present manuscript from Delos Living as a former employee; of the Sistema Nacional de Investigación (SNI), which is supported by
and consulting fees from Delos Living, outside the submitted work. the Panama’s Secretaría Nacional de Ciencia, Tecnología e Innovación
Riaz Uddin reports grants or contracts from Alfred Deakin Postdoctoral (SENACYT). John J McGrath has been supported by the Danish National
Research Fellowship, Deakin University, Australia; support for attending Research Foundation (Niels Bohr Professorship), and is employed by
meetings and/or travel from Deakin University Institute for Physical The Queensland Centre for Mental Health Research which receives core
Activity and Nutrition, all outside the submitted work. funding from the Queensland Health. Stefania Mondello acknowledges
support from the Italian Ministry of Health (grant number
Data sharing
GR-2013-02354960). Jonathan F Mosser acknowledges funding from
To download the data used in these analyses, please visit the Global
BMGF (OPP1182474). Bruno Ramos Nascimento was supported in part
Health Data Exchange at http://ghdx.healthdata.org/gbd-2019.
by CNPq (Bolsa de produtividade em pesquisa, 312382/2019-7), by the
Acknowledgments Edwards Lifesciences Foundation (Every Heartbeat Matters programme
Research reported in this publication was supported by the Bill & 2020), and by FAPEMIG (grant APQ-000627-20). Shuhei Nomura
Melinda Gates Foundation, the University of Melbourne, Public Health acknowledges support from the Ministry of Education, Culture, Sports,
England, the Norwegian Institute of Public Health, the National Institute Science and Technology of Japan (MEXT). Oluwakemi Ololade Odukoya
on Aging of the National Institutes of Health (award P30AG047845), was supported by the Fogarty International Center of the National
and the National Institute of Mental Health of the National Institutes of Institutes of Health under award number K43TW010704. The content is
Health (award R01MH110163). Aruna M Kamath is funded by the solely the responsibility of the authors and does not necessarily
National Institutes of Health (T32GM086270). The content is solely the represent the official views of the National Institutes of Health.
responsibility of the authors and does not necessarily represent the Alberto Ortiz was supported by FIS/Fondos FEDER (PI18/01366,

Articles
PI19/00588, PI19/00815, DTS18/00032, ERA-PerMed-JTC2018 7 Kruk ME, Gage AD, Arsenault C, et al. High-quality health systems
(KIDNEY ATTACK AC18/00064 and PERSTIGAN AC18/00071, in the Sustainable Development Goals era: time for a revolution.
ISCIII-RETIC REDinREN RD016/0009), Sociedad Española de Lancet Glob Health 2018; 6: e1196–252.
Nefrología, FRIAT, Comunidad de Madrid en Biomedicina 8 Institute for Health Metrics and Evaluation (IHME). Financing
B2017/BMD-3686 CIFRA2-CM. Jagadish Rao Padubidri acknowledges global health 2019: tracking health spending in a time of crisis.
the Manipal Academy of Higher Education Mangalore, Mangalore, India 2020. http://www.healthdata.org/policy-report/financing-global-
for their constant support. George C Patton is supported by an NHMRC health-2019-tracking-health-spending-time-crisis (accessed
Nov 18, 2020).
senior principal research fellowship. Alberto Raggi is supported by a
grant from the Italian Ministry of Health (Ricerca Corrente, Fondazione 9 Lozano R, Fullman N, Abate D, et al. Measuring progress from
1990 to 2017 and projecting attainment to 2030 of the health-related
Istituto Neurologico C. Besta, Linea 4 Outcome Research: dagli
Sustainable Development Goals for 195 countries and territories:
Indicatori alle Raccomandazioni Cliniche). Bhageerathy Reshmi a systematic analysis for the Global Burden of Disease Study 2017.
acknowledges support from Manipal College of Health Professions, Lancet 2018; 392: 2091–138.
Manipal, India. Daniela Ribeiro acknowledges the financial support 10 Lawn JE, Blencowe H, Kinney MV, Bianchi F, Graham WJ. Evidence
from the European Union [FEDER funds through COMPETE, to inform the future for maternal and newborn health.
POCI-01-0145-FEDER-029253). Abdallah M Samy acknowledges the Best Pract Res Clin Obstet Gynaecol 2016; 36: 169–83.
support from the Egyptian Fulbright Mission Program, and being a 11 Hug L, Alexander M, You D, Alkema L. National, regional, and
member of the Egyptian Young Academy of Sciences and Technology. global levels and trends in neonatal mortality between 1990 and
Davide Sattin and Silvia Schiavolin acknowledge support by a grant from 2017, with scenario-based projections to 2030: a systematic analysis.
the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Lancet Glob Health 2019; 7: e710–20.
Neurologico C Besta, Linea 4 Outcome Research: dagli Indicatori alle 12 You D, Hug L, Ejdemyr S, et al. Global, regional, and national levels
Raccomandazioni Cliniche). Francesca Giulia Magnani acknowledges and trends in under-5 mortality between 1990 and 2015, with
support by a grant from the Italian Ministry of Health GR2016-02365049. scenario-based projections to 2030: a systematic analysis by the
Feng Sha and Bingyu Li acknowledge support by the Shenzhen Social UN Inter-agency Group for Child Mortality Estimation. Lancet 2015;
Science Fund (Grant No SZ2020C015) and the Shenzhen Science and 386: 2275–86.
Technology Program (Grant KQTD20190929172835662). Aziz Sheikh 13 McArthur JW, Rasmussen K, Yamey G. How many lives are at
acknowledges the support of the Health Data Research UK BREATHE stake? Assessing 2030 sustainable development goal trajectories for
Hub. João Pedro Silva acknowledges support from grant number maternal and child health. BMJ 2018; 360: k373.
UIDB/04378/2020 from the Applied Molecular Biosciences Unit 14 Nolte E, McKee M. Does health care save lives? Avoidable Mortality
(UCIBIO), supported through Portuguese national funds via Revisited. London: Nuffield Trust, 2004.
FCT/MCTES. David A Sleet acknowledges support from the James F and 15 Tobias M, Yeh L-C. How much does health care contribute to health
Sarah T Fries Foundation, The Bizzell Group. Mohammad Reza Sobhiyeh gain and to health inequality? Trends in amenable mortality in
New Zealand 1981–2004. Aust N Z J Public Health 2009; 33: 70–78.
acknowledges support from the Clinical Research Development center
of Imam Reza Hospital Kermanshah University of Medical Sciences, 16 Organisation for Economic Co-operation. Avoidable mortality:
OECD/Eurostat lists of preventable and treatable causes of death.
Iran. Joan B Soriano acknowledges support from the Centro de
2019. https://www.oecd.org/health/health-systems/Avoidable-
Investigación en Red de Enfermedades Respiratorias (CIBERES), mortality-2019-Joint-OECD-Eurostat-List-preventable-treatable-
Instituto de Salud Carlos III (ISCIII), Madrid, Spain. causes-of-death.pdf (accessed Nov 20, 2020).
Gizachew Assefa Tessema is a recipient of the Australian National 17 Stevens GA, Alkema L, Black RE, et al. Guidelines for accurate and
Health and Medical Research Council (NHMRC) investigator grant transparent health estimates reporting: the GATHER statement.
(APP1195716). Riaz Uddin is supported by an Alfred Deakin Postdoctoral Lancet 2016; 388: e19–23.
Research Fellowship. Bhaskaran Unnikrishnan acknowledges Katurba 18 Dicker D, Nguyen G, Abate D, et al. Global, regional, and national
Medical College, Mangalore, India. Charles Shey Wiysonge is supported age-sex-specific mortality and life expectancy, 1950–2017:
by the South African Medical Research Council. Sojib Bin Zaman a systematic analysis for the Global Burden of Disease Study 2017.
received a scholarship from the Australian Government Research Lancet 2018; 392: 1684–735.
Training Program (RTP) in support of his academic career. 19 Wang H, Liddell CA, Coates MM, et al. Global, regional, and
Yunquan Zhang acknowledges the Science and Technology national levels of neonatal, infant, and under-5 mortality during
Research Project of Hubei Provincial Department of Education (grant 1990–2013: a systematic analysis for the Global Burden of Disease
number Q20201104) and Middle Aged Technology Innovation Team Project Study 2013. Lancet 2014; 384: 957–79.
of Hubei Provincial Department of Education (grant number T2020003). 20 Vos T, Lim SS, Abbafati C, et al. Global burden of 369 diseases and
injuries in 204 countries and territories, 1990–2019: a systematic
Editorial note: the Lancet Group takes a neutral position with respect to analysis for the Global Burden of Disease Study 2019. Lancet 2020;
territorial claims in published maps and institutional affiliations. 396: 1204–22.
21 Bill & Melinda Gates Foundation. 2020 Goalkeepers Report:
References
COVID-19, a global perspective. September 2020. https://www.
1 UN Children’s Fund. The State of the World’s Children 2008:
gatesfoundation.org/goalkeepers/report/2020-report/
child Survival. New York, USA: United Nations Children’s Fund,
#GlobalPerspective (accessed Nov 20, 2020).
2007.
22 Dieleman JL, Sadat N, Chang AY, et al. Trends in future health
2 Wang H, Bhutta ZA, Coates MM, et al. Global, regional, national,
financing and coverage: future health spending and universal
and selected subnational levels of stillbirths, neonatal, infant, and
health coverage in 188 countries, 2016–40. Lancet 2018;
under-5 mortality, 1980–2015: a systematic analysis for the Global
391: 1783–98.
Burden of Disease Study 2015. Lancet 2016; 388: 1725–74.
23 Fullman N, Yearwood J, Abay SM, et al. Measuring performance on
3 Transforming Our World: the 2030 Agenda for Sustainable
the Healthcare Access and Quality Index for 195 countries and
Development. In: Rosa W, eds. A new era in global health.
territories and selected subnational locations: a systematic analysis
New York, USA: Springer Publishing Company, 2017.
from the Global Burden of Disease Study 2016. Lancet 2018;
4 Every Woman Every Child. The global strategy for women’s, 391: 2236–71.
children’s and adolescents’ health (2016–2030). 2015. https://www.
24 Wang H, Abbas KM, Abbasifard M, et al. Global age-sex-specific
everywomaneverychild.org/wp-content/uploads/2017/10/EWEC_
fertility, mortality, healthy life expectancy (HALE), and population
GSUpdate_Full_EN_2017_web-1.pdf (accessed Nov 20, 2020).
estimates in 204 countries and territories, 1950–2019:
5 WHO. Reaching the every newborn national 2020 milestones: a comprehensive demographic analysis for the Global Burden of
country progress, plans and moving forward. Geneva: World Health Disease Study 2019. Lancet 2020; 396: 1160–203.
Organization, 2017.
25 Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem
6 Boerma T, Requejo J, Victora CG, et al. Countdown to 2030: inflammatory syndrome in U.S. children and adolescents.
tracking progress towards universal coverage for reproductive, N Engl J Med 2020; 383: 334–46.
maternal, newborn, and child health. Lancet 2018; 391: 1538–48.

Articles
26 United Nations. Policy Brief: the impact of COVID-19 on children. 34 Denno DM, Paul SL. Child health and survival in a changing world.
April, 2020. https://unsdg.un.org/resources/policy-brief-impact- Pediatr Clin North Am 2017; 64: 735–54.
covid-19-children (accessed Nov 20, 2020). 35 Kancherla V, Oakley GP Jr, Brent RL. Urgent global opportunities to
27 Bhutta ZA, Das JK, Bahl R, et al. Can available interventions end prevent birth defects. Semin Fetal Neonatal Med 2014; 19: 153–60.
preventable deaths in mothers, newborn babies, and stillbirths, and 36 Troeger C, Blacker B, Khalil IA, et al. Estimates of the global,
at what cost? Lancet 2014; 384: 347–70. regional, and national morbidity, mortality, and aetiologies of lower
28 Exemplars in Global Health. Under-five mortality. 2017. https://www. respiratory infections in 195 countries, 1990–2016: a systematic
exemplars.health/topics/under-five-mortality (accessed Nov 16, 2020). analysis for the Global Burden of Disease Study 2016.
29 Akseer N, Lawn JE, Keenan W, et al. Ending preventable newborn Lancet Infect Dis 2018; 18: 1191–210.
deaths in a generation. Int J Gynaecol Obstet 2015; 37 Black R, Fontaine O, Lamberti L, et al. Drivers of the reduction in
131 (suppl 1): S43–48. childhood diarrhea mortality 1980–2015 and interventions to
30 World Health Organization. Birth defects: report by the secretariat. eliminate preventable diarrhea deaths by 2030. J Glob Health 2019;
2010. https://apps.who.int/iris/handle/10665/2378 (accessed 9: 020801.
Nov 16, 2020). 38 Burstein R, Henry NJ, Collison ML, et al. Mapping 123 million
31 Mangipudi S, Leather A, Seedat A, Davies J. Oxygen availability in neonatal, infant and child deaths between 2000 and 2017. Nature
sub-Saharan African countries: a call for data to inform service 2019; 574: 353–58.
delivery. Lancet Glob Health 2020; 8: e1123–24. 39 Golding N, Burstein R, Longbottom J, et al. Mapping under-5 and
32 Phillips DE, Bhutta ZA, Binagwaho A, et al. Learning from neonatal mortality in Africa, 2000–15: a baseline analysis for the
exemplars in global health: a road map for mitigating indirect Sustainable Development Goals. Lancet 2017; 390: 2171–82.
effects of COVID-19 on maternal and child health. BMJ Glob Health 40 Liu L, Oza S, Hogan D, et al. Global, regional, and national causes
2020; 5: e003430. of under-5 mortality in 2000–15: an updated systematic analysis
33 Costello A, Dalgish S. Towards a grand convergence for child with implications for the Sustainable Development Goals. Lancet
survival and health: a strategic review of options for the future 2016; 388: 3027–35.
building on lessons learnt from IMNCI. Geneva: World Health
Organization, 2016.

Jurnas S0140673621012071

Uploaded by

Copyright:

Available Formats

Jurnas S0140673621012071

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Jurnas S0140673621012071

Uploaded by

Copyright:

Available Formats

Articles

Global, regional, and national progress towards Sustainable

Funding Bill & Melinda Gates Foundation.

870 www.thelancet.com Vol 398 September 4, 2021

Introduction health (SDG 3) is one of several goals related to healthier

www.thelancet.com Vol 398 September 4, 2021 871

Dimensions of the GBD study Cause-specific mortality estimation

872 www.thelancet.com Vol 398 September 4, 2021

www.thelancet.com Vol 398 September 4, 2021 873

www.thelancet.com Vol 398 September 4, 2021

www.thelancet.com Vol 398 September 4, 2021

www.thelancet.com Vol 398 September 4, 2021

www.thelancet.com Vol 398 September 4, 2021

www.thelancet.com Vol 398 September 4, 2021

www.thelancet.com Vol 398 September 4, 2021

(Table continues on next page)

(1450–2000) (803–1320) (606–1060) (5·38–7·63) (3350–4160) (1620–2580) (1180–2060) (10·5–14·8)

www.thelancet.com Vol 398 September 4, 2021

www.thelancet.com Vol 398 September 4, 2021

(112–159) (76·4–131) (60·0–113) (8·05–11·5) (205–283) (131–217) (103–192) (13·7–19·4)

www.thelancet.com Vol 398 September 4, 2021

www.thelancet.com Vol 398 September 4, 2021

Neonatal deaths NMR Under-5 deaths U5MR

www.thelancet.com Vol 398 September 4, 2021

to 6·10 million (5·35–6·91) in 2015, and to 5·05 million A B

Under-5 deaths (millions)

Change in proportion of under-5 deaths

68·3–74·0) in 1990 to 37·1 (95% UI 33·2–41·7) deaths 0 0

www.thelancet.com Vol 398 September 4, 2021 885

886 www.thelancet.com Vol 398 September 4, 2021

Andean Latin America

www.thelancet.com Vol 398 September 4, 2021 887

888 www.thelancet.com Vol 398 September 4, 2021

www.thelancet.com Vol 398 September 4, 2021 889

890 www.thelancet.com Vol 398 September 4, 2021

www.thelancet.com Vol 398 September 4, 2021 891

Future directions Jacqueline Elizabeth Alcalde-Rabanal, Ayman Al-Eyadhy, Tilahun Ali,

892 www.thelancet.com Vol 398 September 4, 2021

www.thelancet.com Vol 398 September 4, 2021 893

894 www.thelancet.com Vol 398 September 4, 2021

www.thelancet.com Vol 398 September 4, 2021 895

896 www.thelancet.com Vol 398 September 4, 2021

www.thelancet.com Vol 398 September 4, 2021 897

898 www.thelancet.com Vol 398 September 4, 2021

www.thelancet.com Vol 398 September 4, 2021 899

900 www.thelancet.com Vol 398 September 4, 2021

www.thelancet.com Vol 398 September 4, 2021 901

902 www.thelancet.com Vol 398 September 4, 2021

www.thelancet.com Vol 398 September 4, 2021 903

904 www.thelancet.com Vol 398 September 4, 2021

www.thelancet.com Vol 398 September 4, 2021 905

You might also like