SummaryBackgroundA key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016.MethodsDrawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita.FindingsIn 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China,...

Objectives The objective of this study was to map the global risk of the major arboviral diseases transmitted by Aedes aegypti and Aedes albopictus by identifying areas where the diseases are reported, either through active transmission or travel-related outbreaks, as well as areas where the diseases are not currently reported but are nonetheless suitable for the vector. Methods Data relating to five arboviral diseases (Zika, dengue fever, chikungunya, yellow fever, and Rift Valley fever (RVF)) were extracted from some of the largest contemporary databases and paired with data on the known distribution of their vectors, A. aegypti and A. albopictus. The disease occurrence data for the selected diseases were compiled from literature dating as far back as 1952 to as recent as 2017. The resulting datasets were aggregated at the country level, except in the case of the USA, where state-level data were used. Spatial analysis was used to process the data and to develop risk maps. Results Out of the 250 countries/territories considered, 215 (86%) are potentially suitable for the survival and establishment of A. aegypti and/or A. albopictus. A. albopictus has suitability foci in 197 countries/territories, while there are 188 that are suitable for A. aegypti. There is considerable variation in the suitability range among countries/territories, but many of the tropical regions of the world provide high suitability over extensive areas. Globally, 146 (58.4%) countries/territories reported at least one arboviral disease, while 123 (49.2%) reported more than one of the above diseases. The overall numbers of countries/territories reporting autochthonous vector-borne occurrences of Zika, dengue, chikungunya, yellow fever, and RVF, were 85, 111, 106, 43, and 39, respectively. Conclusions With 215 countries/territories potentially suitable for the most important arboviral disease vectors and more than half of these reporting cases, arboviral diseases are indeed a global public health threat. The increasing proportion of reports that include multiple arboviral diseases highlights the expanding range of their common transmission vectors. The shared features of these arboviral diseases should motivate efforts to combine interventions against these diseases.

SummaryBackgroundEfforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment.MethodsWe measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator.FindingsThe global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level...

A serological survey to investigate risk factors for Foot and Mouth Disease (FMD) occurrence was conducted between October 2007 and March 2008 in Southern Ethiopia. Antibodies against non-structural protein of FMD virus (using 3abc ELISA) were measured as indicator of exposure to the virus. The seroprevalence of FMD was 9.5% (95%CI = 7.7 - 11.3, n = 1020) and 48.1% (95% CI = 36.8 - 59.4%, n = 79), respectively at animal and herd levels. Within herd seropositivity was ranged from 6.7 to 46.7% with 18.6% (95%CI = 14.6 - 22.5%) risk of being seropositive for an animal in positive herds. The most important herd level risk factors identified were pastoral system (OR = 16.3, 95% CI = 2.0 -133.7) compared to sedentary, low altitude (OR = 7.5, 95% CI 1.4 -40.7) compared to high altitude, keeping cattle with small ruminants (OR = 5.1, 95% CI 1.0 -25.2) when compared to one species or alone. Seroprevalence was significantly higher (P <0.05) in South Omo than Sidama and Gamo Gofa areas. The odds of seropositivity were 2.8 and 2.3 times higher in the adult (>4 years) and maturing animals (3-4 years) compared to young age category (<3 years). Both multivariable logistic and negative binomial regressions depicted that production system was the major risk factor for FMD seropositivity. Consequently, higher prevalence of FMD in pastoral system where animals are an integral part of life has substantial livelihood and economic implications, which signifies the need for devising control measures.

BackgroundDespite of the sanitation measures in municipal abattoirs to reduce contamination, Escherichia coli continues to be a health hazard. The present study was conducted on 150 apparently healthy slaughtered cattle at municipal abattoir and in 50 different butcher shops in Hawassa town, Ethiopia. The objectives of the study were investigating the occurrence and antimicrobial resistance of E. coli O157:H7 isolated from fecal samples, carcasses swab, contacts surfaces (swabs of meat handlers hands, knife and clothes of meat transporters) as well as from butcher shops (meat samples, swabs from cutting board swab, butcher men hand and knife surface). E. coli O157:H7 was isolated and identified using bacteriological culture, biochemical tests and Biolog identification system. All E. coli O157:H7 isolates were then checked for their antimicrobial susceptibility pattern using eleven selected antimicrobial discs.ResultsOf the entire set of 630 samples, 2.4% (15/630) (95% CI = 1.3–3.9%) were positive for E. coli O157:H7. When disaggregated by the sources of the samples, E. coli O157:H7 were prevalent in 2.8% (11 of 390) of the abattoir samples, of which 4.7% of the fecal sample and 2.7% of the carcass swabs. And E. coli O157:H7 were positive in 1.7% (4 of 240) of butcher shop specimens of which 2% of meat sample and 3.3% of Cutting board swabs. No statistically significant difference in the prevalence of E. coli 0157: H7 between sex, origin, and breed of cattle. The isolated E. coli O157:H7 were found to be100% susceptible to cefotaxime, ceftriaxone, gentamycin, kanamycin and nalidixic acid.ConclusionThis study concludes the occurrence of E. coli O157:H7 and the presence of multiple antibiotic resistance profiles in cattle slaughtered at Hawassa municipal abattoir and retail meat sold at butcher shops. This indicates high risk to public health especially in Ethiopia where many people consume raw or under cooked meat. Regulatory control of antibiotics usage in livestock production and pharmaco-epidemiological surveillance in food animals and animal products is hereby recommended to ensure consumer safety.