Director of Implementation Science for Global Health
Assistant Professor of Global Health
Dr. Emmanuel Peprah’s research interests lie at the confluence of understanding what, why, and how some evidence-based interventions work in some populations and not others. The programattic focus of his research is understanding the contextual factors that influence the burden of co-morbidity in people living with HIV/AIDS (PLWH), with a particular focus on cardiovascular disease risk factors and mental health. As the burden of non-communicable diseases (NCDs) continues to increase, there is an opportunity to integrate NCD management into HIV care with implemention strategies that leverage the global infrasturcture designed to improve care delivery for PLWH. Dr. Peprah has built collaborations with multidisciplinary teams of investigators, both nationally and internationally, to address the high burden of comorbidity in PLWH globally. He is also the founder of the Baakoye Foundation, a nonprofit philanthropic organization dedicated to serving people in sub-Saharan Africa, and co-founder of the Washington Leaders Index (WLI), which aims to empower the next generation of emerging leaders through active, innovative, and inclusive leadership programs. Both nonprofit organizations serve the needs of children and people globally within the domains of education and health.
Before joining GPH, Dr. Peprah was a senior program official at the National Institutes of Health (NIH), where he worked with senior leadership to oversee strategic planning, initiative development, and implementation of research priorities in the areas of translational research, implementation science, and global health. He led and managed HIV/AIDS programs and a $10 million portfolio as part of the National Heart, Lung, and Blood Institute’s Trans-Omics for Precision Medicine Program. He was instrumental in launching the Human, Heredity, and Health in Africa (H3Africa) Initiative, a multimillion trans-NIH program, and served on its executive board. Dr. Peprah has received several awards for strategic planning, management, and implementation of large-scale NIH programs.
BS, Biology, Texas A&M University, Commerce, TXPhD, Molecular Biology & Biomedical Science, Meharry Medical College, Nashville, TN
Dissemination and Implementation of Evidence-based ProgramsHIV/AIDSImplementation scienceInter-organizational NetworksTranslational science
Addressing gaps in international blood availability and transfusion safety in low- and middle-income countries: a NHLBI workshopCuster, B., Zou, S., Glynn, S. A., Makani, J., Tayou Tagny, C., El Ekiaby, M., Sabino, E. C., Choudhury, N., Teo, D., Nelson, K., Peprah, E., Price, L. S., & Engelgau, M. M.
Page(s)1307-1317In April 2017, a workshop sponsored by the National Heart, Lung, and Blood Institute, Division of Blood Diseases and Resources, and the Center for Translation Research and Implementation Science was held to discuss blood availability and transfusion safety in low- and middle-income countries (LMICs). The purpose of the workshop was to identify research opportunities for implementation science (IS) to improve the availability of safe blood and blood components and transfusion practices in LMICs. IS describes the late stages of the translational research spectrum and studies optimal and sustainable strategies to deliver proven-effective interventions. Regional working groups were formed to focus on opportunities and challenges in East Africa, Central/West Africa, Middle East and North Africa, Latin America and the Caribbean, Southeast Asia, Western Pacific Asia, Eastern Europe, and Central Asia. The need for an "adequate supply of safe blood" emerged as the major overriding theme. Among the regional working groups, common cross-cutting themes were evident. The majority of research questions, priorities, and strategies fell into the categories of blood availability, blood transfusion safety, appropriate use of blood, quality systems, health economics and budgeting, and training and education in IS. The workshop also brought into focus inadequate country-level data that can be used as the basis for IS initiatives. A mixed approach of needs assessment and targeted interventions with sufficient evidence base to move toward sustainment is an appropriate next step for blood availability and transfusion safety research in LMICs.
Building on the HIV chronic care platform to address noncommunicable diseases in sub-Saharan Africa: A research agendaVorkoper, S., Kupfer, L. E., Anand, N., Patel, P., Beecroft, B., Tierney, W. M., Ferris, R., El-Sadr, W. M., Bacon, M., Berman, J., Berzon, R., Bongomin, P., Bremer, A., Castor, D., Collins, P., Dirks, R., Dominguez, G., Ejigu, A. A., Engelgau, M., Farmer, M., Flanigan, J., Goosby, E., Henry, R., Huchko, M., Johnson, M., Juma, K., Langley, C., Levitt, N., Mensah, G., Matanje-Mwagomba, B., McGuire, H., Miotti, P., Nuche-Berenguer, B., Nugent, R., Park, P., Pastakia, S., Peprah, E., Rabkin, M., Ramogola-Masire, D., Rausch, D., Reid, M., Sahasrabuddhe, V., Williams, C., Williams, M., Von Zinkernagel, D., & Yonga, G.
Page(s)S107-S113Objective: The remarkable progress made in confronting the global HIV epidemic offers a unique opportunity to address the increasing threat of noncommunicable diseases (NCDs). However, questions remain about how to enhance the HIV platforms to deliver integrated HIV and NCD care to people living with HIV (PLHIV) in sub-Saharan Africa (SSA). We aimed to develop a priority research agenda to advance this effort. Methods: Researchers, policymakers, and implementers from the United States and SSA conducted three scoping reviews on HIV/NCD prevention and care focused on clinical, health system, and community levels. Based on the review findings and expert inputs, we conducted iterative consensus-development activities to generate a prioritized research agenda. Results: Population-level data on NCD prevalence among PLHIV in SSA are sparse. The review identified NCD screening and management approaches that could be integrated into HIV programs in SSA. However, few studies focused on the effectiveness, cost, and best practices for integrated chronic care platforms, making it difficult to derive policy recommendations. To address these gaps, we propose a prioritized research agenda focused on developing evidence-based service delivery models, increasing human capacity through workforce education, generating data through informatics platforms and research, managing the medication supply chain, developing new financing and sustainability models, advancing research-informed policy, and addressing other crosscutting health system issues. Conclusion: Based on collaborative, interdisciplinary efforts, a research agenda was developed to provide guidance that advances efforts to adapt the current health system to deliver integrated chronic care for PLHIV and the population at large.
Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017Failed generating bibliography.Abstract
Journal titleThe Lancet
Page(s)1684-1735Background: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. Methods: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. Findings: Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. Interpretation: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing. Funding: Bill & Melinda Gates Foundation.
Implementation Research to Address the United States Health Disadvantage: Report of a National Heart, Lung, and Blood Institute WorkshopEngelgau, M. M., Narayan, K. M., Ezzati, M., Salicrup, L. A., Belis, D., Aron, L. Y., Beaglehole, R., Beaudet, A., Briss, P. A., Chambers, D. A., Devaux, M., Fiscella, K., Gottlieb, M., Hakkinen, U., Henderson, R., Hennis, A. J., Hochman, J. S., Jan, S., Koroshetz, W. J., Mackenbach, J. P., Marmot, M. G., Martikainen, P., McClellan, M., Meyers, D., Parsons, P. E., Rehnberg, C., Sanghavi, D., Sidney, S., Siega-Riz, A. M., Straus, S., Woolf, S. H., Constant, S., Creazzo, T. L., De Jesus, J. M., Gavini, N., Lerner, N. B., Mishoe, H. O., Nelson, C., Peprah, E., Punturieri, A., Sampson, U., Tracy, R. L., & Mensah, G. A.
Journal titleGlobal Heart
Page(s)65-72Four decades ago, U.S. life expectancy was within the same range as other high-income peer countries. However, during the past decades, the United States has fared worse in many key health domains resulting in shorter life expectancy and poorer health—a health disadvantage. The National Heart, Lung, and Blood Institute convened a panel of national and international health experts and stakeholders for a Think Tank meeting to explore the U.S. health disadvantage and to seek specific recommendations for implementation research opportunities for heart, lung, blood, and sleep disorders. Recommendations for National Heart, Lung, and Blood Institute consideration were made in several areas including understanding the drivers of the disadvantage, identifying potential solutions, creating strategic partnerships with common goals, and finally enhancing and fostering a research workforce for implementation research. Key recommendations included exploring why the United States is doing better for health indicators in a few areas compared with peer countries; targeting populations across the entire socioeconomic spectrum with interventions at all levels in order to prevent missing a substantial proportion of the disadvantage; assuring partnership have high-level goals that can create systemic change through collective impact; and finally, increasing opportunities for implementation research training to meet the current needs. Connecting with the research community at large and building on ongoing research efforts will be an important strategy. Broad partnerships and collaboration across the social, political, economic, and private sectors and all civil society will be critical—not only for implementation research but also for implementing the findings to have the desired population impact. Developing the relevant knowledge to tackle the U.S. health disadvantage is the necessary first step to improve U.S. health outcomes.
Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017Failed generating bibliography.Abstract
Journal titleThe Lancet
Page(s)2091-2138Background: Efforts 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. Methods: We 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. Findings: The 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 varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030. Funding: Bill & Melinda Gates Foundation.
Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017Failed generating bibliography.Abstract
Journal titleThe Lancet
Page(s)1995-2051Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4–52·0). The TFR decreased from 4·7 livebirths (4·5–4·9) to 2·4 livebirths (2·2–2·5), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3–200·8) since 1950, from 2·6 billion (2·5–2·6) to 7·6 billion (7·4–7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9–1·2) in Cyprus to a high of 7·1 livebirths (6·8–7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07–0·09) in South Korea to 2·4 livebirths (2·2–2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3–0·4) in Puerto Rico to a high of 3·1 livebirths (3·0–3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill & Melinda Gates Foundation.
Big data science: Opportunities and challenges to address minority health and health disparities in the 21st centuryZhang, X., Pérez-Stable, E. J., Bourne, P. E., Peprah, E., Duru, O. K., Breen, N., Berrigan, D., Wood, F., Jackson, J. S., Wong, D. W., & Denny, J.
Journal titleEthnicity and Disease
Page(s)95-106Addressing minority health and health disparities has been a missing piece of the puzzle in Big Data science. This article focuses on three priority opportunities that Big Data science may offer to the reduction of health and health care disparities. One opportunity is to incorporate standardized information on demographic and social determinants in electronic health records in order to target ways to improve quality of care for the most disadvantaged populations over time. A second opportunity is to enhance public health surveillance by linking geographical variables and social determinants of health for geographically defined populations to clinical data and health outcomes. Third and most importantly, Big Data science may lead to a better understanding of the etiology of health disparities and understanding of minority health in order to guide intervention development. However, the promise of Big Data needs to be considered in light of significant challenges that threaten to widen health disparities. Care must be taken to incorporate diverse populations to realize the potential benefits. Specific recommendations include investing in data collection on small sample populations, building a diverse workforce pipeline for data science, actively seeking to reduce digital divides, developing novel ways to assure digital data privacy for small populations, and promoting widespread data sharing to benefit under-resourced minority-serving institutions and minority researchers. With deliberate efforts, Big Data presents a dramatic opportunity for reducing health disparities but without active engagement, it risks further widening them.
Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990-2013: Findings from the Global Burden of Disease Study 2013Moradi-Lakeh, M., Forouzanfar, M. H., Vollset, S. E., El Bcheraoui, C., Daoud, F., Afshin, A., Charara, R., Khalil, I., Higashi, H., Abd El Razek, M. M., Kiadaliri, A. A., Alam, K., Akseer, N., Al-Hamad, N., Ali, R., Almazroa, M. A., Alomari, M. A., Al-Rabeeah, A. A., Alsharif, U., Altirkawi, K. A., Atique, S., Badawi, A., Barrero, L. H., Basulaiman, M., Bazargan-Hejazi, S., Bedi, N., Bensenor, I. M., Buchbinder, R., Danawi, H., Dharmaratne, S. D., Zannad, F., Farvid, M. S., Fereshtehnejad, S. M., Farzadfar, F., Fischer, F., Gupta, R., Hamadeh, R. R., Hamidi, S., Horino, M., Hoy, D. G., Hsairi, M., Husseini, A., Javanbakht, M., Jonas, J. B., Kasaeian, A., Khan, E. A., Khubchandani, J., Knudsen, A. K., Kopec, J. A., Lunevicius, R., Abd El Razek, H. M., Majeed, A., Malekzadeh, R., Mate, K., Mehari, A., Meltzer, M., Memish, Z. A., Mirarefin, M., Mohammed, S., Naheed, A., Obermeyer, C. M., Oh, I. H., Park, E. K., Peprah, E., Pourmalek, F., Qorbani, M., Rafay, A., Rahimi-Movaghar, V., Shiri, R., Rahman, S. U., Rai, R. K., Rana, S. M., Sepanlou, S. G., Shaikh, M. A., Shiue, I., Sibai, A. M., Silva, D. A., Singh, J. A., Skogen, J. C., Terkawi, A. S., Ukwaja, K. N., Westerman, R., Yonemoto, N., Yoon, S. J., Younis, M. Z., Zaidi, Z., Zaki, M. E., Lim, S. S., Wang, H., Vos, T., Naghavi, M., Lopez, A. D., Murray, C. J., & Mokdad, A. H.
Journal titleAnnals of the Rheumatic Diseases
Page(s)1365-1373Objectives We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR). Methods The burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs). Results For musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3-1703.4) in 1990 to 1606.0 (95% UI 1141.2-2130.4) in 2013. During 1990-2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7-3.0) in 1990 to 4.7% (95% UI 3.6-5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2-136.0 for low back pain, 27.3-49.7 for neck pain, 9.7-37.3 for osteoarthritis (OA), 0.6-2.2 for rheumatoid arthritis and 0.1-0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries. Conclusions This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness.
Perspectives from NHLBI Global Health Think Tank Meeting for Late Stage (T4) Translation ResearchEngelgau, M. M., Peprah, E., Sampson, U. K., Mishoe, H., Benjamin, I. J., Douglas, P. S., Hochman, J. S., Ridker, P. M., Brandes, N., Checkley, W., El-Saharty, S., Ezzati, M., Hennis, A., Jiang, L., Krumholz, H. M., Lamourelle, G., Makani, J., Narayan, K. M., Ohene-Frempong, K., Straus, S. E., Stuckler, D., Chambers, D. A., Belis, D., Bennett, G. C., Boyington, J. E., Creazzo, T. L., De Jesus, J. M., Krishnamurti, C., Lowden, M. R., Punturieri, A., Shero, S. T., Young, N. S., Zou, S., & Mensah, G. A.
Journal titleGlobal Heart
Page(s)341-348Almost three-quarters (74%) of all the noncommunicable disease burden is found within low- and middle-income countries. In September 2014, the National Heart, Lung, and Blood Institute held a Global Health Think Tank meeting to obtain expert advice and recommendations for addressing compelling scientific questions for late stage (T4) research—research that studies implementation strategies for proven effective interventions—to inform and guide the National Heart, Lung, and Blood Institute's global health research and training efforts. Major themes emerged in two broad categories: 1) developing research capacity; and 2) efficiently defining compelling scientific questions within the local context. Compelling scientific questions included how to deliver inexpensive, scalable, and sustainable interventions using alternative health delivery models that leverage existing human capital, technologies and therapeutics, and entrepreneurial strategies. These broad themes provide perspectives that inform an overarching strategy needed to reduce the heart, lung, blood, and sleep disorders disease burden and global health disparities.
Refining Current Scientific Priorities and Identifying New Scientific Gaps in HIV-Related Heart, Lung, Blood, and Sleep ResearchTwigg, H. L., Crystal, R., Currier, J., Ridker, P., Berliner, N., Kiem, H. P., Rutherford, G., Zou, S., Glynn, S., Wong, R., Peprah, E., Engelgau, M., Creazzo, T., Colombini-Hatch, S., & Caler, E.
Journal titleAIDS Research and Human Retroviruses
Page(s)889-897The National Heart, Lung, and Blood Institute (NHLBI) AIDS Program's goal is to provide direction and support for research and training programs in areas of HIV-related heart, lung, blood, and sleep (HLBS) diseases. To better define NHLBI current HIV-related scientific priorities and with the goal of identifying new scientific priorities and gaps in HIV-related HLBS research, a wide group of investigators gathered for a scientific NHLBI HIV Working Group on December 14-15, 2015, in Bethesda, MD. The core objectives of the Working Group included discussions on: (1) HIV-related HLBS comorbidities in the antiretroviral era; (2) HIV cure; (3) HIV prevention; and (4) mechanisms to implement new scientific discoveries in an efficient and timely manner so as to have the most impact on people living with HIV. The 2015 Working Group represented an opportunity for the NHLBI to obtain expert advice on HIV/AIDS scientific priorities and approaches over the next decade.
Burden of diarrhea in the eastern mediterranean region, 1990-2013: Findings from the global burden of disease study 2013Khalil, I., Colombara, D. V., Forouzanfar, M. H., Troeger, C., Daoud, F., Moradi-Lakeh, M., El Bcheraoui, C., Rao, P. C., Afshin, A., Charara, R., Abate, K. H., Abd El Razek, M. M., Abd-Allah, F., Abu-Elyazeed, R., Kiadaliri, A. A., Akanda, A. S., Akseer, N., Alam, K., Alasfoor, D., Ali, R., AlMazroa, M. A., Alomari, M. A., Salem Al-Raddadi, R. M., Alsharif, U., Alsowaidi, S., Altirkawi, K. A., Alvis-Guzman, N., Ammar, W., Antonio, C. A., Asayesh, H., Asghar, R. J., Atique, S., Awasthi, A., Bacha, U., Badawi, A., Barac, A., Bedi, N., Bekele, T., Bensenor, I. M., Betsu, B. D., Bhutta, Z., Abdulhak, A. A., Butt, Z. A., Danawi, H., Dubey, M., Endries, A. Y., Faghmous, I. M., Farid, T., Farvid, M. S., Farzadfar, F., Fereshtehnejad, S. M., Fischer, F., Anderson Fitchett, J. R., Gibney, K. B., Mohamed Ginawi, I. A., Gishu, M. D., Gugnani, H. C., Gupta, R., Hailu, G. B., Hamadeh, R. R., Hamidi, S., Harb, H. L., Hedayati, M. T., Hsairi, M., Husseini, A., Jahanmehr, N., Javanbakht, M., Jibat, T., Jonas, J. B., Kasaeian, A., Khader, Y. S., Khan, A. R., Khan, E. A., Khan, G., Khoja, T. A., Kinfu, Y., Kissoon, N., Koyanagi, A., Lal, A., Abdul Latif, A. A., Lunevicius, R., Abd El Razek, H. M., Majeed, A., Malekzadeh, R., Mehari, A., Mekonnen, A. B., Melaku, Y. A., Memish, Z. A., Mendoza, W., Misganaw, A., Ibrahim Mohamed, L. A., Nachega, J. B., Nguyen, Q. L., Nisar, M. I., Peprah, E., Platts-Mills, J. A., Pourmalek, F., Qorbani, M., Rafay, A., Rahimi-Movaghar, V., Ur Rahman, S., Rai, R. K., Rana, S. M., Ranabhat, C. L., Rao, S. R., Refaat, A. H., Riddle, M., Roshandel, G., Ruhago, G. M., Saleh, M. M., Sanabria, J. R., Sawhney, M., Sepanlou, S. G., Setegn, T., Sliwa, K., Sreeramareddy, C. T., Sykes, B. L., Tavakkoli, M., Tedla, B. A., Terkawi, A. S., Ukwaja, K., Uthman, O. A., Westerman, R., Wubshet, M., Yenesew, M. A., Yonemoto, N., Younis, M. Z., Zaidi, Z., El Sayed Zaki, M., Al Rabeeah, A. A., Wang, H., Naghavi, M., Vos, T., Lopez, A. D., Murray, C. J., & Mokdad, A. H.
Journal titleAmerican Journal of Tropical Medicine and Hygiene
Page(s)1319-1329Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low-and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden.
Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: The Global Burden of Disease Study 2015Wang, H., Wolock, T. M., Carter, A., Nguyen, G., Kyu, H. H., Gakidou, E., Hay, S. I., Mills, E. J., Trickey, A., Msemburi, W., Coates, M. M., Mooney, M. D., Fraser, M. S., Sligar, A., Salomon, J., Larson, H. J., Friedman, J., Abajobir, A. A., Abate, K. H., Abbas, K. M., Razek, M. M., Abd-Allah, F., Abdulle, A. M., Abera, S. F., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Abyu, G. Y., Adebiyi, A. O., Adedeji, I. A., Adelekan, A. L., Adofo, K., Adou, A. K., Ajala, O. N., Akinyemiju, T. F., Akseer, N., Lami, F. H., Al-Aly, Z., Alam, K., Alam, N. K., Alasfoor, D., Aldhahri, S. F., Aldridge, R. W., Alegretti, M. A., Aleman, A. V., Alemu, Z. A., Alfonso-Cristancho, R., Ali, R., Alkerwi, A., Alla, F., Mohammad, R., Al-Raddadi, S., Alsharif, U., Abdulle, A., Alvis-Guzman, N., Amare, A. T., Amberbir, A., Amegah, A. K., Ammar, W., Amrock, S. M., Antonio, C. A., Anwari, P., Ärnlöv, J., Artaman, A., Asayesh, H., Asghar, R. J., Assadi, R., Atique, S., Atkins, L. S., Avokpaho, E. F., Awasthi, A., Quintanilla, B. P., Bacha, U., Badawi, A., Barac, A., Bärnighausen, T., Basu, A., Bayou, T. A., Bayou, Y. T., Bazargan-Hejazi, S., Beardsley, J., Bedi, N., Bennett, D. A., Bensenor, I. M., Betsu, B. D., Beyene, A. S., Bhatia, E., Bhutta, Z. A., Biadgilign, S., Bikbov, B., Birlik, S. M., Bisanzio, D., Brainin, M., Brazinova, A., Breitborde, N. J., Brown, A., Burch, M., Butt, Z. A., Campuzano, J. C., Cárdenas, R., Carrero, J. J., Ali, R., Rivas, J. C., Catalá-López, F., Chang, H. Y., Chang, J. C., Chavan, L., Chen, W., Chiang, P. P., Chibalabala, M., Chisumpa, V. H., Choi, J. Y., Christopher, D. J., Ciobanu, L. G., Cooper, C., Dahiru, T., Damtew, S. A., Dandona, L., Dandona, R., Das Neves, J., De Jager, P., De Leo, D., Degenhardt, L., Dellavalle, R. P., Deribe, K., Deribew, A., Des Jarlais, D. C., Dharmaratne, S. D., Ding, E. L., Doshi, P. P., Driscoll, T. R., Dubey, M., Elshrek, Y. M., Elyazar, I., Endries, A. Y., Ermakov, S. P., Eshrati, B., Esteghamati, A., Faghmous, I. D., Farinha, C. S., Faro, A., Farvid, M. S., Farzadfar, F., Fereshtehnejad, S. M., Fernandes, J. C., Fischer, F., Fitchett, J. R., Foigt, N., Fullman, N., Fürst, T., Gankpé, F. G., Gebre, T., Gebremedhin, A. T., Gebru, A. A., Geleijnse, J. M., Gessner, B. D., Gething, P. W., Ghiwot, T. T., Giroud, M., Gishu, M. D., Glaser, E., Goenka, S., Goodridge, A., Gopalani, S. V., Goto, A., Gugnani, H. C., Guimaraes, M. D., Gupta, R., Gupta, R., Gupta, V., Haagsma, J., Hafezi-Nejad, N., Hagan, H., Hailu, G. B., Hamadeh, R. R., Hamidi, S., Hammami, M., Hankey, G. J., Hao, Y., Harb, H. L., Harikrishnan, S., Haro, J. M., Harun, K. M., Havmoeller, R., Hedayati, M. T., Heredia-Pi, I. B., Hoek, H. W., Horino, M., Horita, N., Hosgood, H. D., Hoy, D. G., Hsairi, M., Hu, G., Huang, H., Huang, J. J., Iburg, K. M., Idrisov, B. T., Innos, K., Iyer, V. J., Jacobsen, K. H., Jahanmehr, N., Jakovljevic, M. B., Javanbakht, M., Jayatilleke, A. U., Des Jarlais, D., Jha, V., Jiang, G., Jiang, Y., Jibat, T., Jonas, J. B., Kabir, Z., Kamal, R., Kan, H., Karch, A., Karema, C. K., Karletsos, D., Kasaeian, A., Kaul, A., Kawakami, N., Kayibanda, J. F., Keiyoro, P. N., Kemp, A. H., Kengne, A. P., Kesavachandran, C. N., Khader, Y. S., Khalil, I., Khan, A. R., Khan, E. A., Khang, Y. H., Khubchandani, J., Kim, Y. J., Kinfu, Y., Kivipelto, M., Kokubo, Y., Kosen, S., Koul, P. A., Koyanagi, A., Defo, B. K., Bicer, B. K., Kulkarni, V. S., Kumar, G. A., Lal, D. K., Lam, H., Lam, J. O., Langan, S. M., Lansingh, V. C., Larsson, A., Leigh, J., Leung, R., Li, Y., Lim, S. S., Lipshultz, S. E., Hagan, H., Lloyd, B. K., Logroscino, G., Lotufo, P. A., Lunevicius, R., Razek, H. M., Mahdavi, M., Majdan, M., Majeed, A., Makhlouf, C., Malekzadeh, R., Mapoma, C. C., Marcenes, W., Martinez-Raga, J., Marzan, M. B., Masiye, F., Mason-Jones, A. J., Mayosi, B. M., McKee, M., Meaney, P. A., Mehndiratta, M. M., Mekonnen, A. B., Melaku, Y. A., Memiah, P., Memish, Z. A., Mendoza, W., Meretoja, A., Meretoja, T. J., Mhimbira, F. A., Miller, T. R., Mikesell, J., Mirarefin, M., Mohammad, K. A., Mohammed, S., Mokdad, A. H., Monasta, L., Moradi-Lakeh, M., Mori, R., Mueller, U. O., Murimira, B., Murthy, G. V., Naheed, A., Naldi, L., Nangia, V., Nash, D., Nawaz, H., Nejjari, C., Ngalesoni, F. N., De Dieu Ngirabega, J., Nguyen, Q. L., Nisar, M. I., Norheim, O. F., Norman, R. E., Nyakarahuka, L., Ogbo, F. A., Oh, I. H., Ojelabi, F. A., Olusanya, B. O., Olusanya, J. O., Opio, J. N., Oren, E., Ota, E., Padukudru, M. A., Park, H. Y., Park, J. H., Patil, S. T., Patten, S. B., Paul, V. K., Pearson, K., Peprah, E. K., Pereira, C. C., Perico, N., Pesudovs, K., Petzold, M., Phillips, M. R., Pillay, J. D., Plass, D., Polinder, S., Pourmalek, F., Prokop, D. M., Qorbani, M., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, M., Rahman, M. H., Rahman, S. U., Rai, R. K., Rajsic, S., Ram, U., Rana, S. M., Rao, P. V., Remuzzi, G., Rojas-Rueda, D., Ronfani, L., Roshandel, G., Roy, A., Ruhago, G. M., Saeedi, M. Y., Sagar, R., Saleh, M. M., Sanabria, J. R., Santos, I. S., Sarmiento-Suarez, R., Sartorius, B., Sawhney, M., Schutte, A. E., Schwebel, D. C., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Shaikh, M. A., Sharma, R., She, J., Sheikhbahaei, S., Shen, J., Shibuya, K., Shin, H. H., Sigfusdottir, I. D., Silpakit, N., Silva, D. A., Silveira, D. G., Simard, E. P., Sindi, S., Singh, J. A., Singh, O. P., Singh, P. K., Peprah, E., Sliwa, K., Soneji, S., Sorensen, R. J., Soriano, J. B., Soti, D. O., Sreeramareddy, C. T., Stathopoulou, V., Steel, N., Sunguya, B. F., Swaminathan, S., Sykes, B. L., Tabarés-Seisdedos, R., Talongwa, R. T., Tavakkoli, M., Taye, B., Tedla, B. A., Tekle, T., Shifa, G. T., Temesgen, A. M., Terkawi, A. S., Tesfay, F. H., Tessema, G. A., Thapa, K., Thomson, A. J., Thorne-Lyman, A. L., Tobe-Gai, R., Topor-Madry, R., Towbin, J. A., Tran, B. X., Dimbuene, Z. T., Tsilimparis, N., Tura, A. K., Ukwaja, K. N., Uneke, C. J., Uthman, O. A., Venketasubramanian, N., Vladimirov, S. K., Vlassov, V. V., Vollset, S. E., Wang, L., Weiderpass, E., Weintraub, R. G., Werdecker, A., Westerman, R., Wijeratne, T., Wilkinson, J. D., Wiysonge, C. S., Wolfe, C. D., Won, S., Wong, J. Q., Xu, G., Yadav, A. K., Yakob, B., Yalew, A. Z., Yano, Y., Yaseri, M., Yebyo, H. G., Yip, P., Yonemoto, N., Yoon, S. J., Younis, M. Z., Yu, C., Yu, S., Zaidi, Z., Zaki, M. E., Zeeb, H., Zhang, H., Zhao, Y., Zodpey, S., Zoeckler, L., Zuhlke, L. J., Lopez, A. D., & Murray, C. J.
Journal titleThe Lancet HIVBackground: Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015. Methods: For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification. Findings: Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1-3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5-2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6-40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7-1·9 million) in 2005, to 1·2 million deaths (1·1-1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections. Interpretation: Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030. Funding: Bill & Melinda Gates Foundation, and National Institute of Mental Health and National Institute on Aging, National Institutes of Health.
Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013Mokdad, A. H., Forouzanfar, M. H., Daoud, F., El Bcheraoui, C., Moradi-Lakeh, M., Khalil, I., Afshin, A., Tuffaha, M., Charara, R., Barber, R. M., Wagner, J., Cercy, K., Kravitz, H., Coates, M. M., Robinson, M., Estep, K., Steiner, C., Jaber, S., Mokdad, A. A., O’Rourke, K. F., Chew, A., Kim, P., El Razek, M. M., Abdalla, S., Abd-Allah, F., Abraham, J. P., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Al-Nehmi, A. A., Akanda, A. S., Al Ahmadi, H., Al Khabouri, M. J., Al Lami, F. H., Al Rayess, Z. A., Alasfoor, D., AlBuhairan, F. S., Aldhahri, S. F., Alghnam, S., Alhabib, S., Al-Hamad, N., Ali, R., Ali, S. D., Alkhateeb, M., AlMazroa, M. A., Alomari, M. A., Al-Raddadi, R., Alsharif, U., Al-Sheyab, N., Alsowaidi, S., Al-Thani, M., Altirkawi, K. A., Amare, A. T., Amini, H., Ammar, W., Anwari, P., Asayesh, H., Asghar, R., Assabri, A. M., Assadi, R., Bacha, U., Badawi, A., Bakfalouni, T., Basulaiman, M. O., Bazargan-Hejazi, S., Bedi, N., Bhakta, A. R., Bhutta, Z. A., Bin Abdulhak, A. A., Boufous, S., Bourne, R. R., Danawi, H., Das, J., Deribew, A., Ding, E. L., Durrani, A. M., Elshrek, Y., Ibrahim, M. E., Eshrati, B., Esteghamati, A., Faghmous, I. A., Farzadfar, F., Feigl, A. B., Fereshtehnejad, S. M., Filip, I., Fischer, F., Gankpé, F. G., Ginawi, I., Gishu, M. D., Gupta, R., Habash, R. M., Hafezi-Nejad, N., Hamadeh, R. R., Hamdouni, H., Hamidi, S., Harb, H. L., Hassanvand, M. S., Hedayati, M. T., Heydarpour, P., Hsairi, M., Husseini, A., Jahanmehr, N., Jha, V., Jonas, J. B., Karam, N. E., Kasaeian, A., Kassa, N. A., Kaul, A., Khader, Y., Khalifa, S. E., Khan, E. A., Khan, G., Khoja, T., Khosravi, A., Kinfu, Y., Defo, B. K., Balaji, A. L., Lunevicius, R., Obermeyer, C. M., Malekzadeh, R., Mansourian, M., Marcenes, W., Farid, H. M., Mehari, A., Mehio-Sibai, A., Memish, Z. A., Mensah, G. A., Mohammad, K. A., Nahas, Z., Nasher, J. T., Nawaz, H., Nejjari, C., Nisar, M. I., Omer, S. B., Parsaeian, M., Peprah, E., Pervaiz, A., Pourmalek, F., Qato, D. M., Qorbani, M., Radfar, A., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, S. U., Rai, R. K., Rana, S. M., Rao, S. R., Refaat, A. H., Resnikoff, S., Roshandel, G., Saade, G., Saeedi, M. Y., Sahraian, M. A., Saleh, S., Sanchez-Riera, L., Satpathy, M., Sepanlou, S. G., Setegn, T., Shaheen, A., Shahraz, S., Sheikhbahaei, S., Shishani, K., Sliwa, K., Tavakkoli, M., Terkawi, A. S., Uthman, O. A., Westerman, R., Younis, M. Z., El Sayed Zaki, M., Zannad, F., Roth, G. A., Wang, H., Naghavi, M., Vos, T., Al Rabeeah, A. A., Lopez, A. D., & Murray, C. J.
Journal titleThe Lancet Global Health
Page(s)e704-e713Background The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. Since our Global Burden of Disease Study 2010 (GBD 2010), the region has faced unrest as a result of revolutions, wars, and the so-called Arab uprisings. The objective of this study was to present the burden of diseases, injuries, and risk factors in the eastern Mediterranean region as of 2013. Methods GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Our GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods. In this systematic analysis, we use data from GBD 2013 to analyse the burden of disease and injuries in the eastern Mediterranean region specifically. Findings The leading cause of death in the region in 2013 was ischaemic heart disease (90·3 deaths per 100 000 people), which increased by 17·2% since 1990. However, diarrhoeal diseases were the leading cause of death in Somalia (186·7 deaths per 100 000 people) in 2013, which decreased by 26·9% since 1990. The leading cause of disability-adjusted life-years (DALYs) was ischaemic heart disease for males and lower respiratory infection for females. High blood pressure was the leading risk factor for DALYs in 2013, with an increase of 83·3% since 1990. Risk factors for DALYs varied by country. In low-income countries, childhood wasting was the leading cause of DALYs in Afghanistan, Somalia, and Yemen, whereas unsafe sex was the leading cause in Djibouti. Non-communicable risk factors were the leading cause of DALYs in high-income and middle-income countries in the region. DALY risk factors varied by age, with child and maternal malnutrition affecting the younger age groups (aged 28 days to 4 years), whereas high bodyweight and systolic blood pressure affected older people (aged 60–80 years). The proportion of DALYs attributed to high body-mass index increased from 3·7% to 7·5% between 1990 and 2013. Burden of mental health problems and drug use increased. Most increases in DALYs, especially from non-communicable diseases, were due to population growth. The crises in Egypt, Yemen, Libya, and Syria have resulted in a reduction in life expectancy; life expectancy in Syria would have been 5 years higher than that recorded for females and 6 years higher for males had the crisis not occurred. Interpretation Our study shows that the eastern Mediterranean region is going through a crucial health phase. The Arab uprisings and the wars that followed, coupled with ageing and population growth, will have a major impact on the region's health and resources. The region has historically seen improvements in life expectancy and other health indicators, even under stress. However, the current situation will cause deteriorating health conditions for many countries and for many years and will have an impact on the region and the rest of the world. Based on our findings, we call for increased investment in health in the region in addition to reducing the conflicts. Funding Bill & Melinda Gates Foundation.
DS-Connect: A Promising Tool to Improve Lives and Engage Down Syndrome Communities WorldwidePeprah, E., Parisi, M. A., Kaeser, L., Bardhan, S., Oster-Granite, M. L., & Maddox, Y. T.
Journal titleGlobal Heart
Page(s)337-340Down syndrome (DS) is the most common genetic cause of intellectual and developmental disabilities in the United States with an estimated birth prevalence of 1:691 births; however, worldwide estimates of the number of individuals with intellectual and developmental disabilities, including DS, remain speculative. Little is known about the global health impact of DS, such as heart defects, gastrointestinal malformations, and other medical and behavioral issues. Further research is needed to develop the next generation of novel therapies and compounds aimed at improving cognition, reducing dementia, and mitigating other manifestations of DS. To address these challenges, the National Institutes of Health has created the first web-based, voluntary registry and data resource called DS-Connect: The Down Syndrome Registry to collect demographic and health information about individuals with DS.
Endothelial dysfunction: A unifying hypothesis for the burden of cardiovascular diseases in sub-Saharan AfricaSampson, U. K., Engelgau, M., Peprah, E., & Mensah, G. A.
Journal titleCardiovascular Journal of Africa
Page(s)S56-S60It is well established that the leading causes of death and disability worldwide are cardiovascular diseases (CVD), chief among which is ischaemic heart disease. However, it is also recognised that ischaemic heart disease frequently coexists with other vascular conditions, such as cerebrovascular, renovascular and peripheral vascular disease, thus raising the notion of a common underlying pathobiology, albeit with differing manifestations, dictated by the implicated vascular bed. The understanding that common metabolic and behavioural risk factors as well as social determinants and drivers are convergent in the development of CVD evokes the idea that the dysfunction of a common bio-molecular platform is central to the occurrence of these diseases. The state of endothelial activation, otherwise known as endothelial dysfunction, occurs when reactive oxygen signalling predominates due to an uncoupled state of endothelial nitric oxide synthase (eNOS). This can be a physiological response to stimulation of the innate immune system or a pathophysiological response triggered by cardiovascular disease risk factors. The conventional wisdom is that the endothelium plays an important role in the initiation, progression and development of CVD and other non-communicable diseases. Consequently, the endothelium has remarkable relevance in clinical and public health practice as well as in health education, health promotion, and disease- and risk-factor prevention strategies. It also presents a plausible unifying hypothesis for the burden of CVD seen globally and in sub-Saharan Africa. Importantly, the heterogeneity in individual responses to metabolic, behavioural, and social drivers of CVD may stem from a complex interplay of these drivers with genomic, epigenetic and environmental factors that underpin eNOS uncoupling. Therefore, further biomedical research into the underlying genetic and other mechanisms of eNOS uncoupling may enlighten and shape strategies for addressing the burden of CVD in sub-Saharan Africa and other regions of the world.
Opportunities and Challenges in Chronic Chagas CardiomyopathyMensah, G. A., Burns, K. M., Peprah, E., Sampson, U. K., & Engelgau, M. M.
Journal titleGlobal Heart
Understanding decreased fertility in women carriers of the FMR1 premutation: A possible mechanism for Fragile X-Associated Primary Ovarian Insufficiency (FXPOI)Peprah, E.
Journal titleReproductive Health
Issue1Fragile X syndrome (FXS) and its associated disorders are caused by the expansion of the CGG repeat in the 5′ untranslated region of the fragile X mental retardation 1 gene (FMR1). The full mutation, defined as >200 cytosine-guanine-guanine (CGG) triplet repeats, causes FXS. Individuals with 55-199 CGG repeats, classified as premutation carriers, are affected by two distinct disorders depending on their premutation status. Disorders associated with premutation carriers include: Fragile X-associated Tremor Ataxia Syndrome (FXTAS) and Fragile X-associated Primary Ovarian Insufficiency (FXPOI). The molecular similarities of FXTAS and FXPOI (e.g. overabundance of FMR1 transcript and intranuclear inclusions) suggest that similar molecular mechanisms underlie both FXTAS and FXPOI. The current hypothesis describes the underlying mechanism for FXTAS as an mRNA gain-of-function mutation, however the underlying mechanism for FXPOI remains unresolved. New data suggests that repeat associated non-AUG (RAN) translation could underlie FXPOI.
DNA repair/replication transcripts are down regulated in patients with Fragile X SyndromeXu, H., Rosales-Reynoso, M. A., Barros-Núñez, P., & Peprah, E.
Journal titleBMC research notes
Issue1Background: Fragile X Syndrome (FXS) and its associated disorders are caused by the expansion of the CGG repeat in the 5' untranslated region of the fragile X mental retardation 1 (FMR1) gene, with disease classification based on the number of CGG repeats. The mechanisms of repeat expansion are dependent on the presence of cis elements and the absence of trans factors both of which are not mutually exclusive and contribute to repeat instability. Expansions associated with trans factors are due to the haploinsuffient or reduced expression of several DNA repair/metabolizing proteins. The reduction of expression in trans factors has been primarily conducted in animal models without substantial examination of many of these expansion mechanisms and trans factors in humans. Results: To understand the trans factors and pathways associated with trinucleotide repeat expansion we have analyzed two microarray datasets which characterized the transcript expression in patients with FXS and in controls. Conclusion: We observed significant down regulation of DNA damage/repair pathway transcripts. This observation was consistent in both datasets, which used different populations. Within these datasets, several transcripts overlapped in the direction of association and fold change. Further characterization of these genes will be critical to understand their role in trinucleotide repeat instability in FXS.
Examination of FMR1 transcript and protein levels among 74 premutation carriersPeprah, E., He, W., Allen, E., Oliver, T., Boyne, A., & Sherman, S. L.
Journal titleJournal of Human Genetics
Page(s)66-68Fragile X-associated disorders are caused by a CGG trinucleotide repeat expansion in the 5′-untranslated region of the FMR1 gene. Expansion of the CGG trinucleotide repeats to >200 copies (that is, a full mutation) induces methylation of the FMR1 gene, with transcriptional silencing being the eventual outcome. Previous data have shown that FMR1 premutation carriers (individuals with 55-199 repeats) have increased FMR1 mRNA levels with decreased protein (fragile X mental retardation protein (FMRP)) levels. However, the point at which this translational inefficiency occurs, given the increased transcription mechanism, has not yet been explored and remains to be elucidated. We examined the repeat length group, FMR1 transcript and FMRP levels in 74 males with a wide range of repeat lengths using analysis of covariance to better characterize this association. Results showed that the mean FMRP level among carriers with 80-89 repeats was significantly higher than the mean levels among lower (54-79) and higher (90-120) premutation carriers, in spite of the increasing transcript level with repeat length. Taken together, these results suggest that the 80-89-repeat group may lead to different properties that increase the efficiency of translation compared with other premutation repeat size groups.
Genetic diversity of the Fragile X syndrome Gene (FMR1) in a large sub-saharan West African populationPeprah, E., Allen, E. G., Williams, S. M., Woodard, L. M., & Sherman, S. L.
Journal titleAnnals of Human Genetics
Page(s)316-325Summary: Fragile X syndrome (OMIM #300624) is caused by the expansion of a CGG trinucleotide repeat found in the 5′ untranslated region of the X-linked FMR1 gene. Although examinations of characteristics associated with repeat instability and expansion of the CGG repeat upon transmission from parent to offspring has occurred in various world populations, none has been conducted in large Sub-Saharan African populations. We have examined the FMR1 CGG repeat structure in a sample of 350 males drawn from the general population of Ghana. We found that Ghanaians and African Americans have similar allele frequency distributions of CGG repeat and its flanking STR markers, DXS548 and FRAXAC1. However, the distribution of the more complex marker, FRAXAC2, is significantly different. The haplotype structure of the FMR1 locus indicated that Ghanaians share several haplotypes with African Americans and Caucasians that are associated with the expanded full mutation. In Ghanaians, the majority of repeat structures contained two AGG interruptions, however, the majority of intermediate alleles (35-49) lacked AGG interruptions. Overall, we demonstrate that allelic diversity of the FMR1 locus among Ghanaians is comparable to African Americans, but includes a minority of CGG array structures not found in other populations.
Characterization of the mitochondrial inner membrane protein translocator Tim17 from Trypanosoma bruceiSingha, U. K., Peprah, E., Williams, S., Walker, R., Saha, L., & Chaudhuri, M.
Journal titleMolecular and Biochemical Parasitology
Page(s)30-43Mitochondrial protein translocation machinery in the kinetoplastid parasites, like Trypanosoma brucei, has been characterized poorly. In T. brucei genome database, one homolog for a protein translocator of mitochondrial inner membrane (Tim) has been found, which is closely related to Tim17 from other species. The T. brucei Tim17 (TbTim17) has a molecular mass 16.2 kDa and it possesses four characteristic transmembrane domains. The protein is localized in the mitochondrial inner membrane. The level of TbTim17 protein is 6-7-fold higher in the procyclic form that has a fully active mitochondrion, than in the mammalian bloodstream form of T. brucei, where many of the mitochondrial activities are suppressed. Knockdown of TbTim17 expression by RNAi caused a cessation of cell growth in the procyclic form and reduced growth rate in the bloodstream form. Depletion of TbTim17 decreased mitochondrial membrane potential more in the procyclic than bloodstream form. However, TbTim17 knockdown reduced the expression level of several nuclear encoded mitochondrial proteins in both the forms. Furthermore, import of presequence containing nuclear encoded mitochondrial proteins was significantly reduced in TbTim17 depleted mitochondria of the procyclic as well as the bloodstream form, confirming that TbTim17 is critical for mitochondrial protein import in both developmental forms. Together, these show that TbTim17 is the translocator of nuclear encoded mitochondrial proteins and its expression is regulated according to mitochondrial activities in T. brucei.