Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. MethodsGBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each agesex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobac...

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3•5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.

Background: The practice of female genital mutilation (FGM) is highly prevalent in countries in African and the Middle East and is present at all levels of society, due to beliefs that it ensures girls' purification for their marriage. Objective: To examine the effect of education and economic development on FGM by selected co-variants. Methods: Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) (2010–13) data sets were used. The data used were from six selected African countries: Burkina Faso, Chad, Guinea, Mali, Sierra Leone and Somalia. Findings: The prevalence of FGM was significantly higher in Somalia (98.6%), Guinea (97.8%) and Mali (92.6%) in comparison with other selected countries. The results showed that education was statistically significant (168.34; P<0.001) in changing the percentage of FGM practices in the selected countries. The economic status of women was directly associated with mutilation practices, with FGM less likely to be found among higher educated women. Conclusions: In these countries, various programmes are run by the government, which have not affected FGM practices, as community beliefs are often stronger than a government programme. It may take a long time for significant decline of FGM, but increasing women's education level may lead to an immediate reduction in prevalence.

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Female genital mutilation (FGM) practice is unhygienic and unhealthy traditional practices which have affected girls and women’s health adversely for all-time, and such practice is prevalent in many African countries. This study intended to examine factors associated with the FGM prevalence, attitudes toward the discontinuation of the practice, and consequences of FGM practice on reproductive health in terms of sexual transmitted infections/symptoms (STIs/STSs) among women of reproductive ages in Senegal. To fulfill the study objective on factors associated the prevalence of FGM and attitudes toward the continuation of FGM practice, the 2019 Senegal Demographic Health Survey (DHS) data sets were used based on binary logit and multinomial logit regression models. The results show that rural areas, married women, women of Muslim religion, Poular women, women of lower education and lower wealth, and women who were never exposed to social media reported a higher prevalence rate of FGM and were more likely to support continuation of FGM practice. To fulfill the research goal on consequences of FGM practice on STIs/STSs, the 2010 – 2011 DHS was employed because the 2019 DHS did not collect data on STIs/STSs. FGM practice was associated with lower knowledge about STIs/STSs and higher prevalence of STIs/STSs. Our findings suggest that education promotion, poverty reduction, rural development, and dissemination of the adverse consequences of FGM practice could help reduce FGM practices. These findings could have important implications for achieving the sustainable development goals.