Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low‐ and middle‐income countries

Background: Abdominal pain is one of the commonest symptoms in emergency departments (EDs). Diagnosis demands full attention and critical thinking, since many diseases manifest atypically and the consequences of overlooking the symptoms may be disastrous. Despite intensive diagnostic procedures, some cases remain elusive and unclear abdominal pain (UAP) is not infrequent. Emerging evidence supports the hypothesis that functional pain might be attributed to vitamin D deficiency (VDD). People with darker or covered skin are predisposed to developing VDD. Patients in Switzerland stemming from low- and middle-income countries (LMIC) are such a population. Aim: To identify cases with UAP in LMIC patients and to compare vitamin D status with a control group. Methods: A retrospective single-center case-control study was carried out from 1 January 2013 to 31 August 2016 in all adult patients (more than 16 years old) stemming from LMIC and presenting at the university ED of Bern with abdominal pain. Vitamin D status was retrieved from these cases when available. The control group consisted of patients without abdominal pain or metabolic diseases and was matched (1:1) to the cases for age, gender, body mass index, geographic distribution, and season of vitamin D estimation. Results: A total of 10,308 cases from LMIC were reported to the ED. In total, 223 cases were identified with UAP. The status of vitamin D was available for 27 patients; 27 matched individuals were subsequently retrieved for the control group. Women made up 56.7% of the UAP group and 43.3% of the control group. The most common origin of the LMIC subjects was southern Europe (20.4%), followed by southern Asia (16.7%) and Eastern Europe (13%). Fourteen UAP patients exhibited severe VDD (< 25 nmol/L) versus one in the control group (p = 0.001). The difference remained significant if the patients were identified as having VDD (<50 nmol/L) or not (p = 0.024). Comparison of the means indicated that the UAP group had lower vitamin D levels than the control group (41.3 vs. 53.7 nmol/L, respectively), but this difference was marginal (p = 0.060) and not statistically significant. After adjustment for potential confounders, including gender, mean vitamin D levels remained non-significantly different between groups. In the sub-group analysis, vitamin D levels were lower in women than in men (p = 0.037), compared to the respective controls. Conclusion: This study showed for the first time that patients from LMIC who presented to ED with UAP displayed VDD. Validation from larger studies is warranted to evaluate the linkage of VDD with UAP

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Vitamin and Mineral Supplementation During Pregnancy on Maternal, Birth, Child Health and Development Outcomes in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Nutrients ◽

10.3390/nu12020491 ◽

2020 ◽

Vol 12 (2) ◽

pp. 491 ◽

Cited By ~ 11

Author(s):

Christina Oh ◽

Emily C. Keats ◽

Zulfiqar A. Bhutta

Keyword(s):

Systematic Review ◽

Vitamin D ◽

Child Health ◽

Low Birthweight ◽

Grey Literature ◽

Micronutrient Supplementation ◽

Maternal Anemia ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

Almost two billion people are deficient in key vitamins and minerals, mostly women and children in low- and middle-income countries (LMICs). Deficiencies worsen during pregnancy due to increased energy and nutritional demands, causing adverse outcomes in mother and child, but could be mitigated by interventions like micronutrient supplementation. To our knowledge, this is the first systematic review that aimed to compile evidence from both efficacy and effectiveness trials, evaluating different supplementation interventions on maternal, birth, child health, and developmental outcomes. We evaluated randomized controlled trials and quasi-experimental studies published since 1995 in peer-reviewed and grey literature that assessed the effects of calcium, vitamin A, iron, vitamin D, and zinc supplementation compared to placebo/no treatment; iron-folic (IFA) supplementation compared to folic acid only; multiple micronutrient (MMN) supplementation compared to IFA; and lipid-based nutrient supplementation (LNS) compared to MMN supplementation. Seventy-two studies, which collectively involved 314 papers (451,723 women), were included. Meta-analyses showed improvement in several key birth outcomes, such as preterm birth, small-for-gestational age (SGA) and low birthweight with MMN supplementation, compared to IFA. MMN also improved child outcomes, including diarrhea incidence and retinol concentration, which are findings not previously reported. Across all comparisons, micronutrient supplementation had little to no effect on mortality (maternal, neonatal, perinatal, and infant) outcomes, which is consistent with other systematic reviews. IFA supplementation showed notable improvement in maternal anemia and the reduction in low birthweight, whereas LNS supplementation had no apparent effect on outcomes; further research that compares LNS and MMN supplementation could help understand differences with these commodities. For single micronutrient supplementation, improvements were noted in only a few outcomes, mainly pre-eclampsia/eclampsia (calcium), maternal anemia (iron), preterm births (vitamin D), and maternal serum zinc concentration (zinc). These findings highlight that micronutrient-specific supplementation should be tailored to specific groups or needs for maximum benefit. In addition, they further contribute to the ongoing discourse of choosing antenatal MMN over IFA as the standard of care in LMICs.

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Shifting disease burden in low and middle-income countries: a 14-year survival analysis of childhood mortality in Bangladesh

Journal of Epidemiology & Community Health ◽

10.1136/jech-2017-208981 ◽

2017 ◽

Vol 71 (9) ◽

pp. 882-888 ◽

Cited By ~ 2

Author(s):

Olakunle Alonge ◽

Siran He ◽

Dewan Emdadul Hoque ◽

Shumona Sharmin Salam ◽

Irteja Islam ◽

...

Keyword(s):

Survival Analysis ◽

Disease Burden ◽

Childhood Mortality ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Early Childhood Developmental Status in Low- and Middle-Income Countries: National, Regional, and Global Prevalence Estimates Using Predictive Modeling

PLoS Medicine ◽

10.1371/journal.pmed.1002034 ◽

2016 ◽

Vol 13 (6) ◽

pp. e1002034 ◽

Cited By ~ 137

Author(s):

Dana Charles McCoy ◽

Evan D. Peet ◽

Majid Ezzati ◽

Goodarz Danaei ◽

Maureen M. Black ◽

...

Keyword(s):

Early Childhood ◽

Predictive Modeling ◽

Developmental Status ◽

Middle Income ◽

Global Prevalence ◽

Middle Income Countries ◽

Prevalence Estimates ◽

Low And Middle Income

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Correction: Early Childhood Developmental Status in Low- and Middle-Income Countries: National, Regional, and Global Prevalence Estimates Using Predictive Modelling

PLoS Medicine ◽

10.1371/journal.pmed.1002233 ◽

2017 ◽

Vol 14 (1) ◽

pp. e1002233 ◽

Cited By ~ 7

Author(s):

Dana Charles McCoy ◽

Evan D. Peet ◽

Majid Ezzati ◽

Goodarz Danaei ◽

Maureen M. Black ◽

...

Keyword(s):

Early Childhood ◽

Predictive Modelling ◽

Developmental Status ◽

Middle Income ◽

Global Prevalence ◽

Middle Income Countries ◽

Prevalence Estimates ◽

Low And Middle Income

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An estimation of global volume of surgically treatable epilepsy based on a systematic review and meta-analysis of epilepsy

Journal of Neurosurgery ◽

10.3171/2018.3.jns171722 ◽

2019 ◽

Vol 130 (4) ◽

pp. 1127-1141 ◽

Cited By ~ 4

Author(s):

Kerry A. Vaughan ◽

Christian Lopez Ramos ◽

Vivek P. Buch ◽

Rania A. Mekary ◽

Julia R. Amundson ◽

...

Keyword(s):

Systematic Review ◽

Latin America ◽

Meta Analysis ◽

Healthcare Resources ◽

Middle Income ◽

Income Levels ◽

Global Prevalence ◽

Middle Income Countries ◽

Active Epilepsy ◽

Low And Middle Income

OBJECTIVEEpilepsy is one of the most common neurological disorders, yet its global surgical burden has yet to be characterized. The authors sought to compile the most current epidemiological data to quantify global prevalence and incidence, and estimate global surgically treatable epilepsy. Understanding regional and global epilepsy trends and potential surgical volume is crucial for future policy efforts and resource allocation.METHODSThe authors performed a systematic literature review and meta-analysis to determine the global incidence, lifetime prevalence, and active prevalence of epilepsy; to estimate surgically treatable epilepsy volume; and to evaluate regional trends by WHO regions and World Bank income levels. Data were extracted from all population-based studies with prespecified methodological quality across all countries and demographics, performed between 1990 and 2016 and indexed on PubMed, EMBASE, and Cochrane. The current and annual new case volumes for surgically treatable epilepsy were derived from global epilepsy prevalence and incidence.RESULTSThis systematic review yielded 167 articles, across all WHO regions and income levels. Meta-analysis showed a raw global prevalence of lifetime epilepsy of 1099 per 100,000 people, whereas active epilepsy prevalence is slightly lower at 690 per 100,000 people. Global incidence was found to be 62 cases per 100,000 person-years. The meta-analysis predicted 4.6 million new cases of epilepsy annually worldwide, a prevalence of 51.7 million active epilepsy cases, and 82.3 million people with any lifetime epilepsy diagnosis. Differences across WHO regions and country incomes were significant. The authors estimate that currently 10.1 million patients with epilepsy may be surgical treatment candidates, and 1.4 million new surgically treatable epilepsy cases arise annually. The highest prevalences are found in Africa and Latin America, although the highest incidences are reported in the Middle East and Latin America. These regions are primarily low- and middle-income countries; as expected, the highest disease burden falls disproportionately on regions with the fewest healthcare resources.CONCLUSIONSUnderstanding of the global epilepsy burden has evolved as more regions have been studied. This up-to-date worldwide analysis provides the first estimate of surgical epilepsy volume and an updated comprehensive overview of current epidemiological trends. The disproportionate burden of epilepsy on low- and middle-income countries will require targeted diagnostic and treatment efforts to reduce the global disparities in care and cost. Quantifying global epilepsy provides the first step toward restructuring the allocation of healthcare resources as part of global healthcare system strengthening.

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