Trend of Socio-Demographic Index and Mortality Estimates in Iran and its Neighbors, 1990-2015; Findings of the Global Burden of Diseases 2015 Study.

BACKGROUND: The Global burden of disease and injuries study (GBD 2015) reports expected measures for years of life lost (YLL) based on socio-demographic index (SDI) of countries, as well as the observed measures. In this extended GBD 2015 report, we reviewed total and cause-specific deaths and YLL for Iran and all its neighboring countries between 1990 and 2015. METHODS: We extracted data from the GBD 2015 database. Observed YLL measures were calculated by multiplying the number of deaths by standard life expectancy at each age. SDI was a composite index, calculated based on income per capita, average years of schooling, and total fertility rate. The GBD world population was used for age standardization. RESULTS: All-ages crude death rate in Iran reduced from 665.6 per 100,000 population (95% uncertainty interval: 599.3-731.6) in 1990 to 487.2 (414.9-566.1) in 2015. The ratio of observed to expected YLL (O/E ratio) for all-causes ranged between 0.54 (Turkey) and 1.95 (Russia) in 2015. For Iran, the all-causes O/E ratio was less than 1 in all years (1990-2015), except 2003. However, cause-specific O/E ratio was more than 1 for some causes, including the top leading causes of YLL (ischemic heart disease, road injuries, and cerebrovascular disorders). Ischemic heart disease was the first or second cause of YLL in all comparator countries except Afghanistan. CONCLUSION: The leading YLL causes with high O/E ratios should be prioritized in public health efforts. In addition to research evidence, countries with low O/E ratios should be scrutinized to find feasible innovative interventions.

The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990-2013.

The Eastern Mediterranean Region (EMR) is witnessing an increase in chronic disorders, including mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the Global Burden of Disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost-YLLs) and nonfatal outcomes (years lived with disability-YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of the total disease burden in the EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years of age. The highest proportion of DALYs occurred in the 25-49 age group, with a peak in the 35-39 years age group (5344 DALYs/100,000). The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Within the mental disorders group in EMR, depressive disorders accounted for most DALYs, followed by anxiety disorders. Among EMR countries, Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to the global level. Our findings call for EMR ministries of health to increase provision of mental health services and to address the stigma of mental illness. Moreover, our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability. Indeed, mental health problems, if not properly addressed, will lead to an increased burden of diseases in the region.

The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013.

BACKGROUND: With recent improvements in vaccines and treatments against viral hepatitis, an improved understanding of the burden of viral hepatitis is needed to inform global intervention strategies. We used data from the Global Burden of Disease (GBD) Study to estimate morbidity and mortality for acute viral hepatitis, and for cirrhosis and liver cancer caused by viral hepatitis, by age, sex, and country from 1990 to 2013. METHODS: We estimated mortality using natural history models for acute hepatitis infections and GBD's cause-of-death ensemble model for cirrhosis and liver cancer. We used meta-regression to estimate total cirrhosis and total liver cancer prevalence, as well as the proportion of cirrhosis and liver cancer attributable to each cause. We then estimated cause-specific prevalence as the product of the total prevalence and the proportion attributable to a specific cause. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs). FINDINGS: Between 1990 and 2013, global viral hepatitis deaths increased from 0·89 million (95% uncertainty interval [UI] 0·86-0·94) to 1·45 million (1·38-1·54); YLLs from 31·0 million (29·6-32·6) to 41·6 million (39·1-44·7); YLDs from 0·65 million (0·45-0·89) to 0·87 million (0·61-1·18); and DALYs from 31·7 million (30·2-33·3) to 42·5 million (39·9-45·6). In 2013, viral hepatitis was the seventh (95% UI seventh to eighth) leading cause of death worldwide, compared with tenth (tenth to 12th) in 1990. INTERPRETATION: Viral hepatitis is a leading cause of death and disability worldwide. Unlike most communicable diseases, the absolute burden and relative rank of viral hepatitis increased between 1990 and 2013. The enormous health loss attributable to viral hepatitis, and the availability of effective vaccines and treatments, suggests an important opportunity to improve public health. FUNDING: Bill & Melinda Gates Foundation.

Susceptibility and irritability of adult forms of main malaria vectors against insecticides used in the indoor residual sprays in Muzaffargarh District, Pakistan: a field survey.

In southern Punjab, Pakistan, Muzaffargarh District is known to have insecticide-resistant Anopheles and drug-resistant Plasmodium spp. In this part of the country, five anopheline mosquitoes, Anopheles stephensi Liston, Anopheles culicifacies Giles, Anopheles fluviatilis James, Anopheles superpictus Grassi, and Anopheles subpictus Grassi (Diptera: Culicidae) are known as malaria vectors. Among these, An. culicifacies is the primary and An. stephensi is the secondary malaria vector. Outbreaks of malaria usually occur after rainy episodes. We conducted field surveys to collect field strains of An. culicifacies and An. stephensi mosquitoes from different areas of Muzaffargarh District. We determined susceptibility and irritability levels of their adult stages to the discriminative dose of different insecticides. For this purpose, we used World Health Organization's established criteria for assessment. Mortality was calculated after 1 h exposure and for 24 h recovery period for various insecticides. An. stephensi was found to be significantly resistant to dichlorodiphenyltrichloroethane (DDT, an organochlorine), dieldrin (a chlorinated hydrocarbon), and malathion (organophosphorus), with lethal times (LT50) of 83.17, 52.48, and 37.53, respectively. However, the species was significantly sensitive to permethrin, deltamethrin (pyrethroids), and fenitrothion (organophosphate) with LT50 of 2.85, 2.34, and 13.18, respectively. Among these, permethrin showed more promising results against adult An. stephensi. When analyzed for irritancy, we found that among pyrethroids, permethrin was the most irritant insecticide for both An. stephensi and An. culicifacies. DDT and dieldrin showed least irritancy with 0.42 +/- 0.08 and 0.77 +/- 0.12 takeoffs per minute per adult, respectively, against An. stephensi. The mean number of takeoffs per minute per adult with permethrin showed significant irritancy for permethrin when compared with DDT. Based on this study, we conclude that the use of organochlorine (DDT) and chlorinated hydrocarbon (dieldrin) should not be reintroduced in Malaria Control Programme in Pakistan until there is enough evidence to do so at any stage in future, and the use of pyrethroids should continue, with preference to permethrin for better control of malariaby indoor residual spraying.