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      The global burden of kidney disease and the sustainable development goals Translated title: Charge mondiale de la maladie rénale et objectifs de développement durable Translated title: La carga global de la insuficiencia renal y los objetivos de desarrollo sostenible Translated title: العبء العالمي لمرض الكلى وأهداف التنمية المستدامة Translated title: 全球肾病负担和可持续发展目标 Translated title: Глобальное бремя хронической болезни почек и цели в области устойчивого развития

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          Abstract

          Kidney disease has been described as the most neglected chronic disease. Reliable estimates of the global burden of kidney disease require more population-based studies, but specific risks occur across the socioeconomic spectrum from poverty to affluence, from malnutrition to obesity, in agrarian to post-industrial settings, and along the life course from newborns to older people. A range of communicable and noncommunicable diseases result in renal complications and many people who have kidney disease lack access to care. The causes, consequences and costs of kidney diseases have implications for public health policy in all countries. The risks of kidney disease are also influenced by ethnicity, gender, location and lifestyle.  Increasing economic and health disparities, migration, demographic transition, unsafe working conditions and environmental threats, natural disasters and pollution may thwart attempts to reduce the morbidity and mortality from kidney disease. A multisectoral approach is needed to tackle the global burden of kidney disease. The sustainable development goals (SDGs) emphasize the importance of a multisectoral approach to health. We map the actions towards achieving all of the SDGs that have the potential to improve understanding, measurement, prevention and treatment of kidney disease in all age groups. These actions can also foster treatment innovations and reduce the burden of such disease in future generations.

          Résumé

          La maladie rénale est décrite comme la maladie chronique la plus négligée. Si d'autres études en population sont nécessaires pour établir des estimations fiables de la charge mondiale de la maladie rénale, les risques spécifiques sont présents dans l'ensemble du spectre socioéconomique, à la fois en situation de pauvreté et de richesse, de malnutrition et d'obésité, dans des environnements agricoles et postindustriels, et à tous les âges, aussi bien chez les nouveau-nés que chez les personnes âgées. Diverses maladies transmissibles et non transmissibles entraînent des complications rénales et de nombreuses personnes atteintes de maladie rénale n'ont pas accès aux soins. Les causes, les conséquences et les coûts de la maladie rénale ont une incidence sur la politique de santé publique dans tous les pays. Le risque de développer une maladie rénale est également influencé par l'origine ethnique, le sexe, le lieu et le mode de vie. L'accroissement des disparités économiques et sanitaires, les migrations, la transition démographique, les conditions de travail dangereuses, les menaces environnementales, les catastrophes naturelles et la pollution sont susceptibles de faire échouer les tentatives de réduction de la morbidité et de la mortalité liées à la maladie rénale. Une approche multisectorielle est nécessaire pour faire face à la charge mondiale de la maladie rénale. Les objectifs de développement durable (ODD) soulignent l'importance d'une approche multisectorielle en matière de santé. Nous établissons une cartographie des actions à entreprendre pour atteindre tous les ODD qui sont susceptibles d'améliorer la connaissance, la mesure, la prévention et le traitement de la maladie rénale dans toutes les tranches d'âge. Ces actions peuvent également favoriser les innovations thérapeutiques et réduire la charge de cette affection pour les générations futures.

          Resumen

          La insuficiencia renal se ha descrito como la enfermedad crónica más olvidada. Serían necesarios más estudios basados en la población para obtener estimaciones fiables de la carga mundial de la insuficiencia renal, pero existen riesgos específicos en todo el espectro socioeconómico desde la pobreza hasta la prosperidad, desde la desnutrición hasta la obesidad, en contextos agrarios y postindustriales, y a lo largo de la vida desde recién nacidos hasta la tercera edad. Una variedad de enfermedades contagiosas y no contagiosas producen complicaciones renales y muchas personas que padecen una insuficiencia renal no tienen acceso a la atención. Las causas, las consecuencias y los costes de las insuficiencias renales tienen implicaciones para la política de salud pública en todos los países. Los riesgos de la insuficiencia renal también están influenciados por la raza, el sexo, la ubicación y el estilo de vida.  El aumento de las disparidades económicas y de salud, la migración, la transición demográfica, las condiciones de trabajo inseguras y las amenazas ambientales, los desastres naturales y la contaminación pueden frustrar los intentos de reducir la morbilidad y la mortalidad por insuficiencia renal. Se necesita un enfoque multisectorial para abordar la carga mundial de la insuficiencia renal. Los Objetivos de Desarrollo Sostenible (ODS) hacen hincapié en la importancia de un enfoque multisectorial de la salud. Planificamos las acciones para alcanzar todos los ODS con el potencial de mejorar la comprensión, la medición, la prevención y el tratamiento de la insuficiencia renal en todos los grupos de edad. Estas acciones también pueden fomentar innovaciones en el tratamiento y reducir la carga de dicha enfermedad en las generaciones futuras.

          ملخص

          وُصف مرض الكلى بأنه المرض المزمن الأكثر عرضة للإهمال. ولا سبيل إلى الخروج بتقديرات موثوقة لحجم العبء العالمي لمرض الكلى من دون إجراء المزيد من الدراسات المستندة إلى الشرائح السكانية، إلا أن هناك مخاطر محددة تقع في مختلف أنحاء الطيف الاجتماعي الاقتصادي، ما بين الفقر إلى الثراء، ومن سوء التغذية إلى السِمنة الزائدة، وفي البيئات الزراعية إلى ما بعد الصناعية، وعلى مدار الحياة بدءًا من المولودين حديثًا حتى المسنين. وهناك عدد من الأمراض السارية وغير السارية التي تؤدي إلى إصابة الكلى بمضاعفات، ولا يتسنى للعديد من المصابين بمرض الكلى سبل الحصول على الرعاية. كما أن لمسببات أمراض الكلى وتبعاتها ونفقاتها تبعات تقع على عاتق سياسة الصحة العمومية في جميع البلدان. كما تتأثر مخاطر الإصابة بمرض الكلى بعوامل الأصل العرقي والنوع الاجتماعي والموقع ونمط الحياة. وقد يؤدي تزايد الفوارق الاقتصادية والصحية، وعوامل الهجرة، والانتقال الديموغرافي، وظروف العمل غير الآمنة، والتهديدات البيئية، والكوارث الطبيعية، والتلوث إلى تقويض المحاولات الساعية إلى الحد من نسب الإصابة والوفيات الناتجة عن مرض الكلى. ويلزم اتباع نهج متعدد القطاعات للتعامل مع العبء العالمي لمرض الكلى. وتؤكد أهداف التنمية المستدامة على أهمية اتباع نهج متعدد القطاعات للتعاطي مع الصحة. ونحن نعمل على توجيه الإجراءات نحو تحقيق جميع أهداف التنمية المستدامة القادرة على تحسين مستويات فهم مرض الكلى وقياسه والوقاية منه وعلاجه في جميع الفئات العمرية. كما يمكن لهذه الإجراءات أن تعزز من سبل التطوير في مجال العلاج، وتحد من حجم العبء الناتج عن المرض في أوساط الأجيال المقبلة.

          摘要

          肾病被视为全球最被忽视的慢性疾病。全球肾病负担的可靠预估需要更多基于人群的研究,但是特定风险的发生横跨社会各经济范围,从贫困到富裕,从营养不良到肥胖,从农耕时代到后工业时代,生命周期从新生儿到老年人。肾脏并发症导致一系列可传染和不可传染的疾病,许多患有肾病的人缺乏治疗途径。肾病的成因、结果和成本对所有国家的公众健康政策都有影响。肾病的风险也受种族、性别、地点和生活方式的影响。日益扩大的经济健康差距、移民、人口转型、不安全的工作条件和环境威胁、自然灾害与污染可能会阻碍试图降低肾病发病率和死亡率的努力。解决全球肾病负担需要多部门合作。可持续发展目标强调多部门合作解决健康问题的重要性。我们列出达成可持续发展目标所采取的措施,这些措施有提升各年龄群体对肾病理解、测量、预防和治愈的潜力。这些措施也可以促进治疗创新,减轻子孙后代的肾病负担。

          Резюме

          Хроническая болезнь почек известна как одно из тех хронических заболеваний, которым уделяется меньше всего внимания. Надежные оценки глобального бремени хронической болезни почек требуют проведения исследований, более ориентированных на популяционный уровень, но определенные риски возникают во всем социально-экономическом спектре: от нищеты до богатства, от недоедания до ожирения, от аграрного до постиндустриального сегментов общества, а также в течение всей жизни от новорожденных до взрослых людей. Ряд инфекционных и неинфекционных заболеваний приводит к осложнениям, затрагивающим почки, а многие люди с хронической болезнью почек не имеют возможности получить медицинскую помощь. Причины, последствия и расходы, связанные с заболеваниями почек, имеют значение для политики общественного здравоохранения во всех странах. Риск развития хронической болезни почек также зависит от этнической принадлежности, пола, территории проживания и образа жизни.  Рост диспропорций в области экономики и здравоохранения, миграция населения, демографические изменения, небезопасные условия труда и экологические угрозы, стихийные бедствия и природное загрязнение могут помешать попыткам снизить заболеваемость хронической болезнью почек и связанную с ней смертность. Для решения проблемы глобального бремени хронической болезни почек необходим многосекторальный подход. Цели в области устойчивого развития подчеркивают важность многосекторального подхода к здравоохранению. Авторы составили план действий по достижению всех целей в области устойчивого развития, которые могут улучшить понимание аспектов хронической болезни почек во всех возрастных группах, а также исследование, профилактику и лечение этой болезни. Эти действия могут также способствовать инновациям в области лечения и уменьшить бремя этого заболевания для будущих поколений.

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          Most cited references 39

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          Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

          Summary Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Methods We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography–year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4–61·9) in 1980 to 71·8 years (71·5–72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7–17·4), to 62·6 years (56·5–70·2). Total deaths increased by 4·1% (2·6–5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8–18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6–16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9–14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1–44·6), malaria (43·1%, 34·7–51·8), neonatal preterm birth complications (29·8%, 24·8–34·9), and maternal disorders (29·1%, 19·3–37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000–183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000–532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. Interpretation At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Funding Bill & Melinda Gates Foundation.
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            Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016

            Summary Background Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends. Methods We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016. Findings The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72·3% (95% uncertainty interval [UI] 71·2–73·2) of deaths in 2016 with 19·3% (18·5–20·4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8·43% (8·00–8·67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006–16—age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1·80 million deaths (95% UI 1·59 million to 1·89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176–181) increase in deaths in ages 90–94 years and a 210% (208–212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2·89%); the median annualised rate of change for all other causes was lower (a decrease of 1·59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe. Interpretation The past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs might reflect outcomes from conditions that required high levels of care but for which effective treatments remain elusive, potentially increasing costs to health systems. Funding Bill & Melinda Gates Foundation.
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              Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

              Summary Background Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. Findings Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95% uncertainty interval 2·9–3·0) for men and 3·5 years (3·4–3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78–0·92) and 1·2 years (1·1–1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. Interpretation Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. Funding Bill & Melinda Gates Foundation.
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                Author and article information

                Journal
                Bull World Health Organ
                Bull. World Health Organ
                BLT
                Bulletin of the World Health Organization
                World Health Organization
                0042-9686
                1564-0604
                01 June 2018
                20 April 2018
                : 96
                : 6
                : 414-422D
                Affiliations
                [a ]Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006 Zurich, Switzerland.
                [b ]Department of Medicine, University of Calgary , Calgary, Canada.
                [c ]Department of Medicine, Duke University , Durham, United States of America.
                Author notes
                Correspondence to Valerie A Luyckx (email: Valerie.luyckx@ 123456uzh.ch ).
                BLT.17.206441
                10.2471/BLT.17.206441
                5996218
                (c) 2018 The authors; licensee World Health Organization.

                This is an open access article distributed under the terms of the Creative Commons Attribution IGO License ( http://creativecommons.org/licenses/by/3.0/igo/legalcode), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

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