India was one of the major World Health Organization (WHO) member countries to launch its National Mental Health Programme (NMHP) in 1982 in accordance with WHO's recommendations to deliver mental health services to the people under the framework of general health care system in the community. NMHP underwent major strategic revisions over its course, starting from setting a district as the unit for program planning and implementation under the District Mental Health Program (DMHP) to incorporating it with the National Rural Health Mission (NRHM) for effectively scaling up the program. The program also underwent evaluations by government bodies and independent agencies and was reviewed by many researchers. The program has been partly successful in terms of enhancing its reach to community, improving service delivery, and getting increased budgetary allocation, but at the same time, its impact was limited by financial and human resource constraints, lack of community participation, ineffective training, poor NGO/private partnership, and lack of a robust monitoring and evaluation (M and E) system. The latest National Mental Health Policy and the incorporation of its objectives have given a new impetus to the ongoing NMHP, however, its implementation needs to be monitored and the impact is yet to be evaluated. We attempted to review the available literature pertaining to NMHP and DMHP to highlight the determinants of its outcome, with special emphasis on on-going programs and to provide some important future directions.
Background: Over the past decade there have been rapid advances in psychiatry genetics and there is a growing concern about the clinical and practical relevance of this knowledge. Efforts are being made to know the perspectives of patients and family members regarding family risk and genetic counselling. However, the area remains largely unexplored in psychiatric research from Asian countries. Aim: The primary purpose of the study was to explore the perceptions related to family risk among Indian patients with bipolar disorder and their family members. The study also aimed to explore the related perceptions for etiology of bipolar disorder. Method: Patients with bipolar disorder type I and family members of patients with bipolar disorder type I were invited to take part in in-depth interviews after informed consent, targeting a sample of diversity. The qualitative data were analysed using thematic analysis. Results: Eight key themes emerged: (1) higher emphasis on external or situational causes; (2) causal explanations are governed by cultural beliefs; (3) help-seeking is a shared, rather than a personal, decision; (4) the perceived genetic risk is low but worrisome; (5) worries and apprehensions are focused mainly on future generations; (6) there is a desire to modify the perceived genetic risk; (7) knowledge of precise risk can be beneficial as well as anxiety provoking; and (8) there is a need for information on preventive measures. Conclusion: The study provides culture-specific perspectives on the causation of illness and explores a sensitive and personal matter of perceived family risk in an Indian sample. It emphasizes the need to further explore the perceptions of family risk in a given cultural context.
Background: Driving on Indian roads is a stressful experience. A lacuna of research on aggressive driving experiences in the Indian set-up highlights the need to address this growing concern for individuals, society and mental health professionals. Aim: To explore and compare driving-related anger triggers and anger expression among high- and low-angry Indian drivers. Method: Two hundred randomly chosen drivers from the city of Delhi were administered a semi-structured questionnaire intended to understand driving-related aggression. Results: Honking, overtaking from the wrong side, loud music in other cars and hot and humid climate significantly increased the risk of experiencing anger among high-angry drivers. High-angry drivers were significantly more likely to engage in direct and aggressive expression of anger, including overtaking, verbal abuse, yelling and arguing, not giving space to other drivers, fighting, and hitting and bumping other cars in protest. Passive anger expressions such as holding grudges against other drivers and eating or drinking something to cool down were significantly more likely to be used by low-angry drivers. Conclusions: Drivers who are high on anger have a significantly higher risk of experiencing anger triggered by a variety of individual and environmental factors on Indian roads and are more susceptible to engage in aggressive driving behaviour.
Objectives: To assess and compare the changes in disability scores associated with Bipolar Depression (BD) and Unipolar Depression (UD) over 1 year. Methods: A longitudinal study was taken up in adults diagnosed with unipolar or bipolar depressive disorder with current depressive episode. Diagnosis was made according to Schedule for Clinical Assessment in Neuropsychiatry. Severity scoring was done using Hamilton's Depression (HAM-D) rating scale and Hamilton's Anxiety (HAM-A) rating scale. Disability was assessed using Indian Disability Evaluation and Assessment Scale (IDEAS) and London handicap Scale (LHS) at baseline, 6 and 12 months. Results: Sixty participants were recruited (42 UD and 18 BD). No significant differences were seen in socio-demographic parameters, except higher education levels and males being overrepresented in UD. Significant differences at baseline were seen in HAM-D ( p = .001) and HAM-A ( p = .003) scores. The extent of disability was seen to correlate with severity of illness only in case of BD at baseline. No significant differences were seen in the IDEAS scores at baseline. IDEAS score improved at each follow-up assessment ( p < .001). LHS showed significant improvement over time in UD ( p < .001), but not BD ( p = .076). Percentage individuals meeting cut-off for benchmark disability (>40%) were comparable at baseline but were significantly more in the BD at 12-months ( p = .049). Conclusion and implications: Disability in psychiatry occurs equally amongst unipolar and bipolar depressive disorders and tends to improve over time, although the level of improvement may differ. It may not always correspond to severity of illness. These factors should be considered while certifying disability.
Introduction: Research in the last two decades has documented a high level of burden in caregivers of bipolar disorder. The present study is aimed at studying family burden among relatives of patients with bipolar affective disorder. Methods: Thirty four consecutive hospitalized patients with bipolar affective disorder currently in mania and their relatives were assessed twice: at the time of admission and during follow-up four weeks after discharge. A semi-structured performa designed for the study was completed. Patients were assessed on Young's Mania Rating Scale and relatives were assessed on Family Burden Assessment Scale. Results: More than 90% of family members reported severe subjective (rated by relative) and objective burden (rated by interviewer) at admission; none of them was free of burden. At the time of follow-up, about one quarter (23.5%) and two thirds (64.7%) of family members did not experience any objective and subjective burden respectively; subjective and objective family burden was moderate in about one third (35.3%) and a half (52.9%), respectively. None of the family members reported severe burden subjectively, while the objective burden was rated to be severe in a quarter (23.5%) of family members. Limitations: The study was limited by the lack of a control group from an outpatient setting as hospitalization increases family burden. Also, the rater at the second assessment was not blind to ratings at the first assessment. Conclusions: Almost all the family members experienced severe burden initially. Even when symptoms subsided, family members continued to experience burden specifically related to finances. Objective burden was significantly higher than subjective burden.
Background: Mental Health Literacy (MHL) is the ability to recognize mental disorders, along with knowledge of professional help available, effective self-help strategies, skills to give support to others, and knowledge of how to prevent mental disorders. Adequate MHL is linked to better health-seeking behavior and management of mental illness. Aim: To assess the MHL related to depression and anxiety among adolescents of age 15 to 19 years residing in Delhi Methods: A survey was conducted among adolescents in southeast Delhi. MHL was assessed using sex-matched vignettes of Common Mental Disorders (CMDs) like depression and anxiety. MHL was assessed under domains of identifications of disorders, help-seeking behavior, knowledge about prevention, and stigmatizing attitude toward the respective illness. Statistical analysis was done in STATA and percentage of participants with adequate MHL in various domains was calculated, and difference between various groups was examined using chi-square test. Results: A total of 491 adolescents participated (response rate of 87.2%) of whom a 50.3% were girls and 57.8% were 15 to 17 years of age. Only 50 (10.2%) participants identified depression vignette as that of depression and 51 (10.4%) identified vignette of anxiety disorder as the same. No statistically significant gender differential in MHL was seen ( p value = .8). The stigmatizing attitude, assessed by asking a series of questions suggesting stigma toward the particular illness, was observed among almost all participants (depression -99.4%, and anxiety disorders -96.1%). 18.3% and 18.7% of participants reported correct knowledge about the prevention of depression and anxiety respectively. Four hundred and twenty-two (86%) identified the need to seek help for symptoms reported in vignettes. Of these, 234 (55%) preferred parents, and 62 (14.7%) look after friends for any help. Conclusion: Adolescents residing in Delhi reported poor MHL for Common Mental Disorders. High stigma and poor help-seeking behavior was also observed among the participants toward CMDs
Background: Depression is a leading cause of disability and the conventional management has several limitations. Recent studies demonstrated the benefits of yoga in psychological disorders. Aims: To evaluate the efficacy of the Integrated Yoga Module (IYM) to standard care with added yogic education on lifestyle modification (YELM) in patients with clinical depression. Methods: A PROBE trial was conducted at a single tertiary care hospital in India. Adults aged 18 to 64 with clinical depression were randomized to either an IYM or an active control group using a computer-generated mixed block randomization sequence. Both groups received YELM in addition to standard care and the intervention group practiced IYM, for 8 weeks. The primary outcome was the reduction in depression symptoms assessed using the Beck Depression Inventory (BDI-II), and secondary outcomes involved self-compassion, brief resilience, positive and negative experiences, and quality of life, evaluated at 8 weeks. Results: The mean ± SD age of participants was 32.2 ± 10.0 and 54.3% were females. The IYM group showed statistically significant improvements in BDI-II scores β = −6.7 (95% CI [−10.8, −2.5]; p = .001), resilience β = 0.4 (95% CI [0.02, 0.80]; p = .037), physical health domain of WHOQOL - BREF β = 10.1 (95% CI [0.7, 19.5]; p = .035) and negative emotions (SPANE-N) β = 2.8 (95% CI [0.1, 5.4]; p = .037). However, no significant differences were found in SCS-SF β = −0.3 (95% CI [−0.7, 0.0]; p = .053). Conclusions: IYM as an adjunct is superior to conventional medical management in reducing symptoms and improving positive psychological resources in clinical depression.
Background India has made substantial progress in improving child survival over the past few decades, but a comprehensive understanding of child mortality trends at disaggregated geographical levels is not available. We present a detailed analysis of subnational trends of child mortality to inform efforts aimed at meeting the India National Health Policy (NHP) and Sustainable Development Goal (SDG) targets for child mortality. Methods We assessed the under-5 mortality rate (U5MR) and neonatal mortality rate (NMR) from 2000 to 2017 in 5 × 5 km grids across India, and for the districts and states of India, using all accessible data from various sources including surveys with subnational geographical information. The 31 states and groups of union territories were categorised into three groups using their Socio-demographic Index (SDI) level, calculated as part of the Global Burden of Diseases, Injuries, and Risk Factors Study on the basis of per-capita income, mean education, and total fertility rate in women younger than 25 years. Inequality between districts within the states was assessed using the coefficient of variation. We projected U5MR and NMR for the states and districts up to 2025 and 2030 on the basis of the trends from 2000 to 2017 and compared these projections with the NHP 2025 and SDG 2030 targets for U5MR (23 deaths and 25 deaths per 1000 livebirths, respectively) and NMR (16 deaths and 12 deaths per 1000 livebirths, respectively). We assessed the causes of child death and the contribution of risk factors to child deaths at the state level. Findings U5MR in India decreased from 83·1 (95% uncertainty interval [UI] 76·7–90·1) in 2000 to 42·4 (36·5–50·0) per 1000 livebirths in 2017, and NMR from 38·0 (34·2–41·6) to 23·5 (20·1–27·8) per 1000 livebirths. U5MR varied 5·7 times between the states of India and 10·5 times between the 723 districts of India in 2017, whereas NMR varied 4·5 times and 8·0 times, respectively. In the low SDI states, 275 (88%) districts had a U5MR of 40 or more per 1000 livebirths and 291 (93%) districts had an NMR of 20 or more per 1000 livebirths in 2017. The annual rate of change from 2010 to 2017 varied among the districts from a 9·02% (95% UI 6·30–11·63) reduction to no significant change for U5MR and from an 8·05% (95% UI 5·34–10·74) reduction to no significant change for NMR. Inequality between districts within the states increased from 2000 to 2017 in 23 of the 31 states for U5MR and in 24 states for NMR, with the largest increases in Odisha and Assam among the low SDI states. If the trends observed up to 2017 were to continue, India would meet the SDG 2030 U5MR target but not the SDG 2030 NMR target or either of the NHP 2025 targets. To reach the SDG 2030 targets individually, 246 (34%) districts for U5MR and 430 (59%) districts for NMR would need a higher rate of improvement than they had up to 2017. For all major causes of under-5 death in India, the death rate decreased between 2000 and 2017, with the highest decline for infectious diseases, intermediate decline for neonatal disorders, and the smallest decline for congenital birth defects, although the magnitude of decline varied widely between the states. Child and maternal malnutrition was the predominant risk factor, to which 68·2% (65·8–70·7) of under-5 deaths and 83·0% (80·6–85·0) of neonatal deaths in India could be attributed in 2017; 10·8% (9·1–12·4) of under-5 deaths could be attributed to unsafe water and sanitation and 8·8% (7·0–10·3) to air pollution. Interpretation India has made gains in child survival, but there are substantial variations between the states in the magnitude and rate of decline in mortality, and even higher variations between the districts of India. Inequality between districts within states has increased for the majority of the states. The district-level trends presented here can provide crucial guidance for targeted efforts needed in India to reduce child mortality to meet the Indian and global child survival targets. District-level mortality trends along with state-level trends in causes of under-5 and neonatal death and the risk factors in this Article provide a comprehensive reference for further planning of child mortality reduction in India.
Background - The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed. Methods - We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI). Findings - Worldwide, the age-standardised prevalence of daily smoking was 25·0% (95% uncertainty interval [UI] 24·2–25·7) for men and 5·4% (5·1–5·7) for women, representing 28·4% (25·8–31·1) and 34·4% (29·4–38·6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11·5% of global deaths (6·4 million [95% UI 5·7–7·0 million]) were attributable to smoking worldwide, of which 52·2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015. Interpretation - The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years.
Background The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed. Methods We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI). Findings Worldwide, the age-standardised prevalence of daily smoking was 25·0% (95% uncertainty interval [UI] 24·2–25·7) for men and 5·4% (5·1–5·7) for women, representing 28·4% (25·8–31·1) and 34·4% (29·4–38·6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11·5% of global deaths (6·4 million [95% UI 5·7–7·0 million]) were attributable to smoking worldwide, of which 52·2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smokingattributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015. Interpretation The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years.
Background The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed. Methods We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI). Findings Worldwide, the age-standardised prevalence of daily smoking was 25.0% (95% uncertainty interval [UI] 24.2-25.7) for men and 5.4% (5.1-5.7) for women, representing 28.4% (25.8-31.1) and 34.4% (29.4-38.6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11.5% of global deaths (6.4 million [95% UI 5.7-7.0 million]) were attributable to smoking worldwide, of which 52.2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015. Interpretation The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years.
Correction in: LANCET Volume: 390 Issue: 10103 Pages: 1644-1644 Published: OCT 7 2017 . ; Background The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed. Methods We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI). Findings Worldwide, the age-standardised prevalence of daily smoking was 25.0% (95% uncertainty interval [UI] 24.2-25.7) for men and 5.4% (5.1-5.7) for women, representing 28.4% (25.8-31.1) and 34.4% (29.4-38.6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11.5% of global deaths (6.4 million [95% UI 5.7-7.0 million]) were attributable to smoking worldwide, of which 52.2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015. Interpretation The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years. ; Bill & Melinda Gates Foundation and Bloomberg Philanthropies. ; Peer Reviewed
High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. ; his work was primarily supported by the Bill & Melinda Gates Foundation (grant OPP1132415). Additionally, O Adetokunboh acknowledges the support of the Department of Science and Innovation, and National Research Foundation of South Africa. M Ausloos, A Pana, and C Herteliu are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation, Executive Agency for Higher Education, Research, Development and Innovation Funding (Romania; project number PN-III-P4-ID-PCCF-2016-0084). T W Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. M J Bockarie is supported by the European and Developing Countries Clinical Trials Partnership. F Carvalho and E Fernandes acknowledge support from Portuguese national funds (Fundação para a Ciência e Tecnologia and Ministério da Ciência, Tecnologia e Ensino Superior; UIDB/50006/2020, UIDB/04378/2020, and UIDP/04378/2020. K Deribe is supported by the Wellcome Trust (grant 201900/Z/16/Z) as part of his International Intermediate Fellowship. B-F Hwang was partially supported by China Medical University (CMU107-Z-04), Taichung, Taiwan. M Jakovljevic acknowledges support of the Serbia Ministry of Education Science and Technological Development (grant OI 175 014). M N Khan acknowledges the support of Jatiya Kabi Kazi Nazrul Islam University, Bangladesh. Y J Kim was supported by the Research Management Centre, Xiamen University Malaysia, Malaysia, (XMUMRF/2020-C6/ITCM/0004). K Krishnan is supported by University Grants Commission Centre of Advanced Study, (CAS II), awarded to the Department of Anthropology, Panjab University, Chandigarh, India. M Kumar would like to acknowledge National Institutes of Health and Fogarty International Cente (K43TW010716). I Landires is a member of the Sistema Nacional de Investigación, which is supported by the Secretaría Nacional de Ciencia, Tecnología e Innovación, Panama. W Mendoza is a program analyst in population and development at the UN Population Fund Country Office in Peru, which does not necessarily endorse this study. M Phetole received institutional support from the Grants, Innovation and Product Development Unit, South African Medical Research Council. O Odukoya acknowledges support from the Fogarty International Center of the US National Institutes of Health (K43TW010704). The content is solely the responsibility of the authors and does not necessarily represent the official views of the US National Institutes of Health. O Oladimeji is grateful for the support from Walter Sisulu University, Eastern Cape, South Africa, the University of Botswana, Botswana, and the University of Technology of Durban, Durban, South Africa. J R Padubidri acknowledges support from Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, India. G C Patton is supported by an Australian Government National Health and Medical Research Council research fellowship. P Rathi acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal India. A I Ribeiro was supported by National Funds through Fundação para a Ciência e Tecnologia, under the programme of Stimulus of Scientific Employment–Individual Support (CEECIND/02386/2018). A M Samy acknowledges the support of the Egyptian Fulbright Mission Program. F Sha was supported by the Shenzhen Social Science Fund (SZ2020C015) and the Shenzhen Science and Technology Program (KQTD20190929172835662). A Sheikh is supported by Health Data Research UK. N Taveira acknowledges partial funding by Fundação para a Ciência e Tecnologia, Portugal, and Aga Khan Development Network—Portugal Collaborative Research Network in Portuguese-speaking countries in Africa (332821690), and by the European and Developing Countries Clinical Trials Partnership (RIA2016MC-1615). C S Wiysonge is supported by the South African Medical Research Council. Y Zhang was supported by the Science and Technology Research Project of Hubei Provincial Department of Education (Q20201104) and Open Fund Project of Hubei Province Key Laboratory of Occupational Hazard Identification and Control (OHIC2020Y01).Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations
High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. ; his work was primarily supported by the Bill & Melinda Gates Foundation (grant OPP1132415). Additionally, O Adetokunboh acknowledges the support of the Department of Science and Innovation, and National Research Foundation of South Africa. M Ausloos, A Pana, and C Herteliu are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation, Executive Agency for Higher Education, Research, Development and Innovation Funding (Romania; project number PN-III-P4-ID-PCCF-2016-0084). T W Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. M J Bockarie is supported by the European and Developing Countries Clinical Trials Partnership. F Carvalho and E Fernandes acknowledge support from Portuguese national funds (Fundação para a Ciência e Tecnologia and Ministério da Ciência, Tecnologia e Ensino Superior; UIDB/50006/2020, UIDB/04378/2020, and UIDP/04378/2020. K Deribe is supported by the Wellcome Trust (grant 201900/Z/16/Z) as part of his International Intermediate Fellowship. B-F Hwang was partially supported by China Medical University (CMU107-Z-04), Taichung, Taiwan. M Jakovljevic acknowledges support of the Serbia Ministry of Education Science and Technological Development (grant OI 175 014). M N Khan acknowledges the support of Jatiya Kabi Kazi Nazrul Islam University, Bangladesh. Y J Kim was supported by the Research Management Centre, Xiamen University Malaysia, Malaysia, (XMUMRF/2020-C6/ITCM/0004). K Krishnan is supported by University Grants Commission Centre of Advanced Study, (CAS II), awarded to the Department of Anthropology, Panjab University, Chandigarh, India. M Kumar would like to acknowledge National Institutes of Health and Fogarty International Cente (K43TW010716). I Landires is a member of the Sistema Nacional de Investigación, which is supported by the Secretaría Nacional de Ciencia, Tecnología e Innovación, Panama. W Mendoza is a program analyst in population and development at the UN Population Fund Country Office in Peru, which does not necessarily endorse this study. M Phetole received institutional support from the Grants, Innovation and Product Development Unit, South African Medical Research Council. O Odukoya acknowledges support from the Fogarty International Center of the US National Institutes of Health (K43TW010704). The content is solely the responsibility of the authors and does not necessarily represent the official views of the US National Institutes of Health. O Oladimeji is grateful for the support from Walter Sisulu University, Eastern Cape, South Africa, the University of Botswana, Botswana, and the University of Technology of Durban, Durban, South Africa. J R Padubidri acknowledges support from Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, India. G C Patton is supported by an Australian Government National Health and Medical Research Council research fellowship. P Rathi acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal India. A I Ribeiro was supported by National Funds through Fundação para a Ciência e Tecnologia, under the programme of Stimulus of Scientific Employment–Individual Support (CEECIND/02386/2018). A M Samy acknowledges the support of the Egyptian Fulbright Mission Program. F Sha was supported by the Shenzhen Social Science Fund (SZ2020C015) and the Shenzhen Science and Technology Program (KQTD20190929172835662). A Sheikh is supported by Health Data Research UK. N Taveira acknowledges partial funding by Fundação para a Ciência e Tecnologia, Portugal, and Aga Khan Development Network—Portugal Collaborative Research Network in Portuguese-speaking countries in Africa (332821690), and by the European and Developing Countries Clinical Trials Partnership (RIA2016MC-1615). C S Wiysonge is supported by the South African Medical Research Council. Y Zhang was supported by the Science and Technology Research Project of Hubei Provincial Department of Education (Q20201104) and Open Fund Project of Hubei Province Key Laboratory of Occupational Hazard Identification and Control (OHIC2020Y01).Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations
