Levels and Trends of Maternal Mortality and Morbidity by Cause in North Africa and Middle East, 1990 to 2019: An Analysis for the Global Burden of Disease Study 2019

Background: Since 1990, the maternal mortality significantly decreased at global scale as well as the North Africa and Middle East. However, estimates for mortality and morbidity by cause and age at national scale in this region are not available. Method(s): This study is part of the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. Here we report maternal mortality and morbidity by age and cause across 21 countries in the region from 1990 to 2019. Result(s): Between 1990 and 2019, maternal mortality ratio (MMR) dropped from 148.8 (129.6-171.2) to 94.3 (73.4-121.1) per 100 000 live births in North Africa and Middle East. In 1990, MMR ranged from 6.0 (5.3-6.8) in Kuwait to 502.9 (375.2-655.3) per 100 000 live births in Afghanistan. Respective figures for 2019 were 5.1 (4.0-6.4) in Kuwait to 269.9 (195.8-368.6) in Afghanistan. Percentages of deaths under 25 years was 26.0% in 1990 and 23.8% in 2019. Maternal hemorrhage, indirect maternal deaths, and other maternal disorders rank 1st to 3rd in the entire region. Ultimately, there was an evident decrease in MMR along with increase in socio-demographic index from 1990 to 2019 in all countries in the region and an evident convergence across nations. Conclusion(s): MMR has significantly declined in the region since 1990 and only five countries (Afghanistan, Sudan, Yemen, Morocco, and Algeria) out of 21 nations didn't achieve the Sustainable Development Goal (SDG) target of 70 deaths per 100 000 live births in 2019. Despite the convergence in trends, there are still disparities across countries.Copyright © 2022 Academy of Medical Sciences of I.R. Iran. All rights reserved.

The state of health in Pakistan and its provinces and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding health trends and estimating the burden of disease at the national and subnational levels helps policy makers track progress and identify disparities in overall health performance. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides comprehensive estimates for Pakistan. Comparison of health indicators since 1990 provides valuable insights about Pakistan's ability to strengthen its health-care system, reduce inequalities, improve female and child health outcomes, achieve universal health coverage, and meet the UN Sustainable Development Goals. We present estimates of the burden of disease, injuries, and risk factors for Pakistan provinces and territories from 1990 to 2019 based on GBD 2019 to improve health and health outcomes in the country. Methods We used methods and data inputs from GBD 2019 to estimate socio-demographic index, total fertility rate, cause-specific deaths, years of life lost, years lived with disability, disability-adjusted life-years, healthy life expectancy, and risk factors for 286 causes of death and 369 causes of non-fatal health loss in Pakistan and its four provinces and three territories from 1990 to 2019. To generate estimates for Pakistan at the national and subnational levels, we used 68 location-years of data to estimate Pakistan-specific demographic indicators, 316 location-years of data for Pakistan-specific causes of death, 579 location-years of data for Pakistan-specific non-fatal outcomes, 296 location-years of data for Pakistan-specific risk factors, and 3089 location-years of data for Pakistan-specific covariates. Findings Life expectancy for both sexes in Pakistan increased nationally from 61 center dot 1 (95% uncertainty interval [UI] 60 center dot 0-62 center dot 1) years in 1990 to 65 center dot 9 (63 center dot 8-67 center dot 8) years in 2019;however, these gains were not uniform across the provinces and federal territories. Pakistan saw a narrowing of the difference in healthy life expectancy between the sexes from 1990 to 2019, as health gains for women occurred at faster rates than for men. For women, life expectancy increased by 8 center dot 2% (95% UI 6middot3-13middot8) between 1990 and 2019, whereas the male life expectancy increased by 7 center dot 6% (3 center dot 5-11 center dot 8). Neonatal disorders, followed by ischaemic heart disease, stroke, diarrhoeal diseases, and lower respiratory infections were the leading causes of all-age premature mortality in 2019. Child and maternal malnutrition, air pollution, high systolic blood pressure, dietary risks, and tobacco consumption were the leading all-age risk factors for death and disability-adjusted life-years at the national level in 2019. Five non-communicable diseases-ischaemic heart disease, stroke, congenital defects, cirrhosis, and chronic kidney disease-were among the ten leading causes of years of life lost in Pakistan. Burden varied by socio-demographic index. Notably, Balochistan and Khyber Pakhtunkhwa had the lowest observed gains in life expectancy. Dietary iron deficiency was the leading cause of years lived with disability for both men and women in 1990 and 2019. Low birthweight and short gestation and particulate matter pollution were the leading contributors to overall disease burden in both 1990 and 2019 despite moderate improvements, with a 23 center dot 5% (95% UI 3 center dot 8-39 center dot 2) and 27 center dot 6% (14 center dot 3-38 center dot 6) reduction in age-standardised attributable DALY rates during the study period. Interpretation Our study shows that progress has been made on reducing Pakistan's disease burden since 1990, but geographical, age, and sex disparities persist. Equitable investment in the health system, as well as the prioritisation of high-impact policy interventions and programmes, are needed to save lives and improve health outcomes. Pakistan is facing several domestic and foreign challenges-the Taliban's return to power in Afghanistan, political turmoil, catastrophic flooding, the COVID-19 pandemic-that will shape the trajectory of the country's health and development. Pakistan must address the burden of infectious disease and curb rising rates of non-communicable diseases. Prioritising these three areas will enhance Pakistan's ability to achieve universal health coverage, meet its Sustainable Development Goals, and improve the overall health outcomes.

Load Balancing Simulation Android Application as an Online Learning Media

Learning activities during the covid pandemic are carried out online. Learning materials are delivered synchronously or asynchronously. Asynchronous techniques allow students to learn independently, and materials can be studied repeatedly. One way that can be used to convey material is through simulation. The students will understand the learning material better using simulation. The simulation made in this paper is a load balancing material simulation. This material is studied by students in computer network studies at both high school and college. Load balancing is a technique for dividing the load on the server. The algorithms discussed in this simulation are round-robin and least connected. In this simulation, the user is invited to interact with the application and see the difference between the two algorithms. The method used to create the application consists of five stages. The stages are problem analysis, application design, development, and testing. This simulation application is made using GameMakerStudio 14.9 and can be installed on Android devices. The application was tested on 20 users with vocational education backgrounds and students. More than 50% of users say this application is easy to use and the material is easy to understand. © The Authors, published by EDP Sciences.

Designing Smart Restaurant for Reopening During the Relaxation of Lockdown in the Time of Corona Pandemic

Considering the changes that the world is going through, since the emergence of the Coronavirus 'COVID 19' and the following versions of the same virus which has fast spreading behavior among all countries and sometimes worse health effects on the human. It seems that its economic and social repercussions will be significant and influential at the global and national levels, as the outbreak imposed by taking a set of precautionary measures and measures represented in 'isolation' with quarantine or social distancing and restaurant closures. These procedures cause poverty among workers in malls and restaurants and economical losses, so countries start to relax the lockdown. This work aims to propose some procedures in designing restaurants for reopening during the relaxation of lockdown to reduce human contact through designing a waiter robot moves by line follower approach in a restaurant to serve meals to customers and also designing a wireless network to send the customizers orders from the tables to the kitchen. © 2022 IEEE.

Global response

This chapter discusses when and how the World Health Organization (WHO) declared Coronavirus Disease 2019 (COVID-19) a pandemic following its first emergence in Wuhan, China. Different countries around the world tried to contain the virus through taking cautionary steps by initiating at least a 2-week lockdown and by following recommendations on implementing social distancing of 6 feet, the wearing of masks in public, and washing hands with warm water and soap for at least 20s. COVID-19 is believed to have originated from bats and believed to have spread all around the world before it was first diagnosed in Wuhan, China. As the virus swept the world, some countries, such as Italy, faced a shortage of hospital beds. New York, which also faced a hospital bed shortage very early on during the pandemic, was declared an epicenter of the virus in the United States. Moreover, nursing homes in many developing countries were badly hit and reported a high number of deaths related to COVID-19. © 2022 Elsevier Inc. All rights reserved.

A Systematic Review of COVID-19 Transmission Dynamics and Clinical Response on Cruise Ships Globally between January and October 2020

Background. Cruise ships provide an ideal setting for efficient transmission of SARS-CoV- 2 given a socially dense exposure environment. No systematic review of transmission of COVID-19 on cruise ships to date has been completed. Methods. MEDLINE was searched in accordance with PRIMSA guidelines for COVID-19 cases associated with cruise ships. A list of cruise ships with COVID-19 was crossed referenced with the Centers for Disease Controls' list of cruise ships that had at least one COVID-19 case associated with them within 14 days of disembarkation. News articles were also searched for epidemiologic information. 43 full text articles from MEDLINE and 177 from news sources were included in the final analysis. Narratives of the outbreak in ships with over 100 cases are presented. Results. A total of 80 ships and 104 unique voyages on cruise ships were identified with at least one COVID-19 case before 30 October 2020. Nineteen ships had more than one voyage with a case of COVID-19. The median number of cases per ship was three (intraquartile range (IQR) 1-17.8), with two notable outliers the Diamond Princess and Ruby Princess which had 712 and 907 cases respectively. The median attack rate for COVID-19 was 0.2% (IQR 0.03% -1.5%), though this distribution was skewed to the right with a mean attack rate of 3.7%. 25.9% of voyages had at least one associated death. Outbreaks involving only crew were later than outbreaks with guests and crew. Conclusion. COVID-19 can spread easily on cruise ships in a susceptible population when there is an absence of mitigation measures due to the confined space and high-density of contact networks. This can not only create super spreader events but also facilitate international spread.

SELECTING A RIGHT ONLINE EDUCATIONAL PARADIGM IN COVID-19 PANDEMIC

ABSTRACT: Educational Systems are broadly divided into three categories of conventional, online and blended. The CoViD-19 pandemic has squeezed the world to rely almost completely on online educational systems (OES) and the choice of proper educational paradigm has become very critical. There are a number of key aspects associated with such OES but the two most important are learning management systems (LMS) and video conferencing systems (VCS). In this paper, we have critically analyzed various OES with respect to LMS and VCS. The analysis is presented in the form of parametric comparisons and it would play a vital contributing role in the selection of a proper OES.