Global fertility in 204 countries and territories, 1950–2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021
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18 May 2024Elsevier B.V.
The Lancet
2024#403Issue 104402057 - 2099 pp.
Background: Accurate assessments of current and future fertility—including overall trends and changing population age structures across countries and regions—are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios. Methods: To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10–54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted utilising the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. To capture time-series trends in CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a proportion of each 5-year ASFR was predicted using a linear mixed-effects model with fixed-effects covariates (female educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future forecasts from the estimated distribution for each metric, with 95% uncertainty intervals (UIs) given as the 2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed skill values—a metric assessing gain in forecasting accuracy—by comparing predicted versus observed ASFRs from the past 15 years (2007–21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline. Findings: During the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63–5·06) to 2·23 (2·09–2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137–147), declining to 129 million (121–138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining above 2·1—canonically considered replacement-level fertility—in 94 (46·1%) countries and territories in 2021. This included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths in 2021 (29·2% [28·7–29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021 was below replacement experienced one or more subsequent years with higher fertility; only three of these locations rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59–2·08) in 2050 and 1·59 (1·25–1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa was forecast to increase to more than half of the worlds livebirths in 2100, to 41·3% (39·6–43·1) in 2050 and 54·3% (47·1–59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the six other super-regions—decreasing, for example, in south Asia from 24·8% (23·7–25·8) in 2021 to 16·7% (14·3–19·1) in 2050 and 7·1% (4·4–10·1) in 2100—but was forecast to increase modestly in the north Africa and Middle East and high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global TFRs of 1·65 (1·40–1·92) in 2050 and 1·62 (1·35–1·95) in 2100. The forecasting skill metric values for the IHME model were positive across all age groups, indicating that the model is better than the constant prediction. Interpretation: Fertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world. Funding: Bill & Melinda Gates Foundation.
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Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
Department of Applied Mathematics, University of Washington, Seattle, WA, United States
Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
Department of Internal Medicine, University of Washington, Seattle, WA, United States
Department of Cardiology, University of Washington, Seattle, WA, United States
Department of Family Medicine, University of Washington, Seattle, WA, United States
Department of Neurology, University of Washington, Seattle, WA, United States
Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States
Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA, United States
Department of Global Health, University of Washington, Seattle, WA, United States
Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Orthodontics Department, Mashhad University of Medical Sciences, Mashhad, Iran
Clinical Research Development Unit, Mashhad University of Medical Sciences, Mashhad, Iran
Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
International Unesco Center for Health-related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Department of Medical Genetics, Mashhad University of Medical Sciences, Mashhad, Iran
Department of Clinical Governance and Quality Improvement, Aleta Wondo Hospital, Aleta Wondo, Ethiopia
Doheny Eye Institute, University of California Los Angeles, Pasadena, CA, United States
Department of Orthopedic Surgery, Harvard University, Boston, MA, United States
Department of Pediatrics, Harvard University, Boston, MA, United States
T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
Center for Primary Care, Harvard University, Boston, MA, United States
Harvard Business School, Harvard University, Boston, MA, United States
Division of Cardiovascular Medicine, Harvard University, Boston, MA, United States
Department of Neurological Surgery, Brigham and Womens Hospital, Harvard University, Boston, MA, United States
Maternal Fetal Care Center, Harvard University, Boston, MA, United States
Department of Ophthalmology, Harvard University, Boston, MA, United States
Department of Health Policy and Management, Harvard University, Boston, MA, United States
Radiology and Data Science Department, Harvard University, Boston, MA, United States
Department of Health Policy and Oral Epidemiology, Harvard University, Boston, MA, United States
Department of Global Health and Social Medicine, Harvard University, Boston, MA, United States
Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, United States
Division of General Internal Medicine, Harvard University, Boston, MA, United States
Department of Orthopaedic Surgery, Tehran, Iran
Department of Anesthesiology, Tehran, Iran
Department of Biotechnology, Tehran, Iran
National Nutrition and Food Technology Research Institute, Tehran, Iran
Research Institute of Dental Sciences, Tehran, Iran
Urology Department, Tehran, Iran
Department of Medical Genetics, Tehran, Iran
Center for Comprehensive Genetic Services, Tehran, Iran
Department of Immunology, Tehran, Iran
Department of Health Policy and Management, Tehran, Iran
Safety Promotion and Injury Prevention Research Center, Tehran, Iran
Department of Epidemiology, Tehran, Iran
Department of Neurosurgery, Tehran, Iran
Social Determinants of Health Research Center, Tehran, Iran
Department of Microbiology and Infectious Diseases, Tehran, Iran
School of Medicine, Tehran, Iran
Department of Biology and Anatomical Sciences, Tehran, Iran
Ophthalmic Research Center (ORC), Tehran, Iran
Emergency Department, Tehran, Iran
Department of Medical Education, Tehran, Iran
Shahid Beheshti University of Medical Sciences, Tehran, Iran
Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
Research Center for Immunodeficiencies, Tehran University of Medical Sciences, Tehran, Iran
Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
Department of Health Information Management, Tehran University of Medical Sciences, Tehran, Iran
Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Department of Scientific Research, Tehran University of Medical Sciences, Tehran, Iran
Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
Ophthalmology Department, Tehran University of Medical Sciences, Tehran, Iran
Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
Students Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
Childrens Medical Center, Tehran University of Medical Sciences, Tehran, Iran
Department of Pediatric Cardiology, Tehran University of Medical Sciences, Tehran, Iran
Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Tehran, Iran
Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
Water Quality Research Center, Tehran University of Medical Sciences, Tehran, Iran
Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
Department of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Department of Cardiology, Tehran University of Medical Sciences, Tehran, Iran
Stem Cell and Center of Regenerative Medicine, Tehran University of Medical Sciences, Tehran, Iran
Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Tehran, Iran
Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences, Tehran, Iran
Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran
Department of Pharmaceutical Care, Tehran University of Medical Sciences, Tehran, Iran
Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
Cancer Research Center, Tehran University of Medical Sciences, Tehran, Iran
Cancer Biology Research Center, Tehran University of Medical Sciences, Tehran, Iran
Department of Pathology, Tehran University of Medical Sciences, Tehran, Iran
Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Epidemiology Department, Alexandria University, Alexandria, Egypt
Pediatric Dentistry and Dental Public Health Department, Alexandria University, Alexandria, Egypt
Tropical Health Department, Alexandria University, Alexandria, Egypt
Pathology Department, Alexandria University, Alexandria, Egypt
Tropical Medicine Department, Tanta University, Tanta, Egypt
Department of Small Animal Clinical Sciences, University of Saskatchewan, Saskatoon, SK, Canada
Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
Department of Medicine, University of Setif Algeria, Sétif, Algeria
Department of Physiotherapy, Bayero University Kano, Kano, Nigeria
Community Medicine Department, Bayero University Kano, Kano, Nigeria
Department of Nursing Science, Bayero University Kano, Kano, Nigeria
Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, Hong Kong
School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong
Department of Midwifery, Dilla University, Dilla, Ethiopia
Department of Public Health, Dilla University, Dilla, Ethiopia
Department of Public Health, Haramaya University, Harar, Ethiopia
Department of Medical Laboratory Sciences, Haramaya University, Harar, Ethiopia
Department of Health Policy and Management, Haramaya University, Harar, Ethiopia
Department of Clinical Pharmacy, Haramaya University, Harar, Ethiopia
Department of Community Medicine, Babcock University, Ilishan-Remo, Nigeria
Department of Medical Physiology, Babcock University, Ilishan-Remo, Nigeria
Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden
Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden
Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
Health Management and Economics Research Center, Tehran, Iran
Center for Educational Research in Medical Educaion (CERMS), Tehran, Iran
Minimally Invasive Surgery Research Center, Tehran, Iran
Eye Research Center, Tehran, Iran
Comprehensive Research Laboratory, Tehran, Iran
Department of Physiology, Tehran, Iran
Physiology Research Center, Tehran, Iran
Colorectal Research Center, Tehran, Iran
Iran University of Medical Sciences, Tehran, Iran
Khatam Al-anbia Hospital, Shefa Neuroscience Research Center, Tehran, Iran
Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, Poznan, Poland
Department of Public Health, Madda Walabu University, Addis Ababa, Ethiopia
Nutrition and Dietetics Department, Jimma University, Addis Ababa, Ethiopia
USAID-JSI, Jimma University, Addis Ababa, Ethiopia
Department of Pediatric Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Brazil
Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
Department of Clinical Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
Department of Adult Health Nursing, Aksum University, Aksum, Ethiopia
Department of Nursing, Aksum University, Aksum, Ethiopia
Department of Research, Philippine Institute for Development Studies, Quezon City, Philippines
Department of Nursing, Al Zaytoonah University of Jordan, Amman, Jordan
Department of Pharmacology and Toxicology, Usmanu Danfodiyo University, Sokoto, Sokoto, Nigeria
Department of Veterinary Public Health and Preventive Medicine, Usmanu Danfodiyo University, Sokoto, Sokoto, Nigeria
Nigerian Institute of Medical Research, Lagos, Nigeria
Clinical Sciences Department, Sharjah, United Arab Emirates
College of Medicine, Sharjah, United Arab Emirates
Department of Pharmacy Practice and Pharmacotherapeutics, Sharjah, United Arab Emirates
Department of Physiotherapy, Sharjah, United Arab Emirates
Department of Basic Biomedical Sciences, Sharjah, United Arab Emirates
Sharjah Institute for Medical Research, Sharjah, United Arab Emirates
Department of Clinical Nutrition and Dietetics, Sharjah, United Arab Emirates
Department of Medicinal Chemistry, Sharjah, United Arab Emirates
University of Sharjah, Sharjah, United Arab Emirates
Institute of Community and Public Health, Birzeit University, Ramallah, Palestine
Department of Public Health, Wolkite University, Wolkite, Ethiopia
Midwifery Department, Wolkite University, Wolkite, Ethiopia
College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
Department of Epidemiology and Biostatistics, Bahir Dar University, Bahir Dar, Ethiopia
Department of Midwifery, Bahir Dar University, Bahir Dar, Ethiopia
School of Health Science, Bahir Dar University, Bahir Dar, Ethiopia
Health Promotion and Behavioural Science Department, Bahir Dar University, Bahir Dar, Ethiopia
Department of Physiology, Bahir Dar University, Bahir Dar, Ethiopia
Department of Pharmacy, Bahir Dar University, Bahir Dar, Ethiopia
Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
Public Health Department, University of KwaZulu-Natal, Durban, South Africa
Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, Nigeria
Department of Animal Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, United States
Department of Molecular Biology and Genetics, Abu Dhabi, United Arab Emirates
Department of Biology, Abu Dhabi, United Arab Emirates
Khalifa University, Abu Dhabi, United Arab Emirates
Institute of Public Health, Walden University, Al Ain, United Arab Emirates
Hiv and Infectious Diseases Department, Jhpiego, Abuja, Nigeria
Department of Adolescent Research and Care, Adolescent Friendly Research Initiative and Care, Ado Ekiti, Nigeria
DSI-NRF Centre of Excellence for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
Division of Epidemiology & Biostatistics, Stellenbosch University, Cape Town, South Africa
South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Cape Town, South Africa
Department of Epidemiology, Stellenbosch University, Cape Town, South Africa
Department of Industrial Psychology, Stellenbosch University, Cape Town, South Africa
Department of Biochemistry, Osun State University, Osogbo, Nigeria
Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
Department of Physiology, University of Medical Sciences, Ondo, Ondo, Nigeria
Department of Microbiology, University of Medical Sciences, Ondo, Ondo, Nigeria
Department of Anatomy, University of Medical Sciences, Ondo, Ondo, Nigeria
Department of Biosciences and Biotechnology, University of Medical Sciences, Ondo, Ondo, Nigeria
Faculty of Medicine, Universitas Padjadjaran (Padjadjaran University), Bandung, Indonesia
Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran (Padjadjaran University), Bandung, Indonesia
Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
Institute for Advanced Medical Research and Training, University of Ibadan, Ibadan, Nigeria
Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
Department of Health Promotion and Education, University of Ibadan, Ibadan, Nigeria
Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
College of Medicine, University of Ibadan, Ibadan, Nigeria
Department of Medicine, University of Ibadan, Ibadan, Nigeria
Department of Radiology, Baltimore, MD, United States
Department of Epidemiology and Population Health, Baltimore, MD, United States
Department of Biostatistics, Baltimore, MD, United States
Department of Neurosurgery, Baltimore, MD, United States
Department of Health Policy and Management, Baltimore, MD, United States
Department of International Health, Baltimore, MD, United States
Johns Hopkins University, Baltimore, MD, United States
Department of Life Sciences, University of Management and Technology, Lahore, Pakistan
Department of Community Medicine, King Edward Memorial Hospital, Lahore, Pakistan
Department of Public Health, Public Health Institute, Lahore, Pakistan
Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
Department of Geography and Planning, Queens University, Kingston, ON, Canada
Department of Biomedical and Molecular Sciences, Queens University, Kingston, ON, Canada
School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
Department of Medical Biochemistry, Shaqra University, Shaqra, Saudi Arabia
Department of Pharmacology, Shaqra University, Shaqra, Saudi Arabia
School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia
National Centre of Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
Research School of Population Health, Australian National University, Canberra, ACT, Australia
Public Health Foundation of India, Gandhinagar, India
Department of Clinical Nursing, University of Jordan, Amman, Jordan
Department of Health and Biological Sciences, Abasyn University, Peshawar, Pakistan
Department of Natural Sciences, Labanese American University, Beirut, Lebanon
Department of Epidemiology and Health Statistics, Southeast University, Nanjing, China
Department of Pharmacy Practice, Riphah Institute of Pharmaceutical Sciences, Islamabad, Pakistan
Division of Infectious Diseases and Global Public Health (IDGPH), University of California, San Diego, CA, United States
Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
Unit of Basic Medical Sciences, University of Khartoum, Khartoum, Sudan
Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
Department of Biosciences, Comsats Institute of Information Technology, Islamabad, Pakistan
Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
Family Medicine Department, United Arab Emirates University, Al Ain, United Arab Emirates
Department of Computer Science and Software Engineering, United Arab Emirates University, Al Ain, United Arab Emirates
Department of Pathology and Microbiology, University of Duhok, Duhok, Iraq
Brody School of Medicine, Greenville, NC, United States
Department of Computer Science, Greenville, NC, United States
Department of Physiology, Greenville, NC, United States
East Carolina University, Greenville, NC, United States
Department of Food and Nutrition Policy and Planning Research, National Institute of Nutrition, Tehran, Iran
Faculty of Medicine and Public Health, Jenderal Soedirman University, Purwokerto, Indonesia
Microbiology, Immunology and Parasitology Department, St. Pauls Hospital Millennium Medical College, Addis Ababa, Ethiopia
Microbial, Cellular and Molecular Biology Department, Addis Ababa University, Addis Ababa, Ethiopia
School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
School of Population Health, University of New South Wales, Sydney, NSW, Australia
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
Department of Cardiology, Fudan University, Shanghai, China
Department of Health Management Center, Fudan University, Shanghai, China
Department of Management, Policy, and Community Health, University of Texas, Houston, TX, United States
Geriatric and Long Term Care Department, Hamad Medical Corporation, Doha, Qatar
Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
Department of Nursing, Al Al-Bayt University, Mafraq, Jordan
Community and Mental Health Department, Al Al-Bayt University, Mafraq, Jordan
Institute of Global Health, Heidelberg University, Heidelberg, Germany
Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
Department of Clinical Sciences, Ajman University, Ajman, United Arab Emirates
Center for Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
Department of Biology, University of Bahrain, Sakhir, Bahrain
John T. Milliken Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO, United States
Brown School, Washington University in St. Louis, St. Louis, MO, United States
Department of Surgery, Washington University in St. Louis, St. Louis, MO, United States
Clinical Epidemiology Center, Us Department of Veterans Affairs (VA), St. Louis, MO, United States
Murdoch Business School, Murdoch University, Perth, WA, Australia
School of Nursing, Yarmouk University, Irbid, Jordan
School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
Department of Engineering, Western Sydney University, Sydney, NSW, Australia
Health Information Management and Technology Department, Dammam, Saudi Arabia
Forensic Medicine Division, Dammam, Saudi Arabia
Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
Department of Medicine, Royal Jordanian Medical Services, Amman, Jordan
Global Health Entrepreneurship, Tokyo Medical and Dental University, Tokyo, Japan
Pediatric Intensive Care Unit, King Saud University, Riyadh, Saudi Arabia
Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia
Section of Adult Hematology, King Saud University, Riyadh, Saudi Arabia
Department of Physiology, King Saud University, Riyadh, Saudi Arabia
Global Centre for Environmental Remediation, University of Newcastle, Newcastle, NSW, Australia
Department of Womens Health, University of Newcastle, Newcastle, NSW, Australia
Cooperative Research Centre for Contamination Assessment and Remediation of the Environment, Newcastle, NSW, Australia
College of Nursing, Qatar University, Doha, Qatar
Department of Physical Education, Qatar University, Doha, Qatar
Qu Health, Qatar University, Doha, Qatar
Department of Population Medicine, Qatar University, Doha, Qatar
Psychological Sciences Association, Amman, Jordan
Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Ghana
Department of Epidemiology and Biostatistics, University of Health and Allied Sciences, Ho, Ghana
Department of Microbiology and Immunology, University of Health and Allied Sciences, Ho, Ghana
Department of Zoology, Abdul Wali Khan University Mardan, Mardan, Pakistan
Department of Botany, Abdul Wali Khan University Mardan, Mardan, Pakistan
Erbil Technical Health College, Erbil Polytechnic University, Erbil, Iraq
School of Pharmacy, Tishk International University, Erbil, Iraq
Department of Biological Sciences, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
Department of Medical Rehabilitation (Physiotherapy), University of Maiduguri, Maiduguri, Nigeria
Department of Biosciences, Jamia Millia Islamia, New Delhi, India
Centre for Interdisciplinary Research in Basic Sciences (CIRBSc), Jamia Millia Islamia, New Delhi, India
Center for Biotechnology and Microbiology, University of Swat, Swat, Pakistan
School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
Department of Public Health, Qom University of Medical Sciences, Qom, Iran
Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
Medical Laboratories, Qassim University, Buraydah, Saudi Arabia
Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
Liverpool Orthopaedic and Trauma Service, University of Liverpool, Liverpool, United Kingdom
Department of Surgery, University of Liverpool, Liverpool, United Kingdom
Department of Health Policy and Management, Kuwait University, Kuwait
Department of Surgery, Kuwait University, Kuwait
International Centre for Casemix and Clinical Coding, National University of Malaysia, Bandar Tun Razak, Malaysia
Department of Dentistry, Sanaa, Yemen
Department of Public Health and Community Medicine, Irbid, Jordan
Department of Medicine, Nazarbayev University, Astana, Kazakhstan
Department of Parasitology, University of Malaya, Kuala Lumpur, Malaysia
Department of Parasitology, Sanaa University, Sanaa, Yemen
Department of Urology, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
Department of Cardiac Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
Nuffield Department of Orthopaedics, University of Oxford, Oxford, United Kingdom
Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
Health Economics Research Centre, University of Oxford, Oxford, United Kingdom
Department of Rehabilitation Sciences and Physical Therapy, Jordan University of Science and Technology, Irbid, Jordan
Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
Department of Epidemiology and Population Health, Khalifa University of Science, Technology & Research, Abu Dhabi, United Arab Emirates
Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
Department of Prosthodontics and Implant Dentistry, Taibah University, Medinah, Saudi Arabia
Department of Prosthodontics, Ibb University, Ibb, Yemen
Department of Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
Pediatric Dentistry Department, King Abdulaziz University, Jeddah, Saudi Arabia
Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
Department of Dental Public Health, King Abdulaziz University, Jeddah, Saudi Arabia
Jaber Al Ahmad Al Sabah Hospital, Ministry of Health, Kuwait, Kuwait
Institute of Molecular Biology and Biotechnology, Lahore, Pakistan
University Institute of Public Health, Lahore, Pakistan
University College of Medicine & Dentistry, Lahore, Pakistan
University Institute of Radiological Sciences and Medical Imaging Technology, Lahore, Pakistan
University Institute of Diet and Nutritional Sciences, Lahore, Pakistan
Department of Technology, Lahore, Pakistan
Research Centre for Health Sciences (RCHS), Lahore, Pakistan
The University of Lahore, Lahore, Pakistan
Department of Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
Medicine Department, Indiana University School of Medicine, Indianapolis, IN, United States
Lisbon Institute of Global Mental Health, Nova University of Lisbon, Lisboa, Portugal
Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nsukka, Nigeria
Research Group in Hospital Management and Health Policies, Universidad de la Costa (University of the Coast), Barranquilla, Colombia
Research Group in Health Economics, University of Cartagena, Cartagena, Colombia
Department of Clinical Pharmacology and Toxicology, Umm Al-Qura University, Makkah, Saudi Arabia
Department of Medical Sciences, Azal University for Human Development, Sanaa, Yemen
Department of Clinical Sciences, University of Science and Technology of Fujairah, Fujairah, United Arab Emirates
Department of Pediatrics, Cleveland Clinic, Cleveland, OH, United States
Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States
Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
Department of Pediatric Cardiology, Boston, MA, United States
Boston Childrens Hospital, Boston, MA, United States
School of Graduate Studies, Lingnan University, Hong Kong, Hong Kong
Public Heath Department, Cairo University, Cairo, Egypt
Department of Neurology, Cairo University, Cairo, Egypt
Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Department of Environmental Health Engineering, Isfahan University of Medical Sciences, Isfahan, Iran
Cardiac Rehabilitation Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
College of Public Health, Medical and Veterinary Sciences, Townsville, QLD, Australia
James Cook University, Townsville, QLD, Australia
Department of Maternal and Child Wellbeing, African Population and Health Research Center, Nairobi, Kenya
Department of Medicine, University of Jos, Jos, Nigeria
Department of Obstetrics and Gynecology, University of Jos, Jos, Nigeria
Department of Internal Medicine, Jos University Teaching Hospital, Jos, Nigeria
Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Department of Cardiology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharma
Institute for Health Metrics and Evaluation
Department of Applied Mathematics
Department of Health Metrics Sciences
Department of Internal Medicine
Department of Cardiology
Department of Family Medicine
Department of Neurology
Department of Anesthesiology & Pain Medicine
Division of Plastic and Reconstructive Surgery
Department of Global Health
Faculty of Medicine
Dental Research Center
Orthodontics Department
Clinical Research Development Unit
Metabolic Syndrome Research Center
International Unesco Center for Health-related Basic Sciences and Human Nutrition
Applied Biomedical Research Center
Biotechnology Research Center
Department of Medical Genetics
Department of Clinical Governance and Quality Improvement
Doheny Eye Institute
Department of Orthopedic Surgery
Department of Pediatrics
T.H. Chan School of Public Health
Center for Primary Care
Harvard Business School
Division of Cardiovascular Medicine
Department of Neurological Surgery
Maternal Fetal Care Center
Department of Ophthalmology
Department of Health Policy and Management
Radiology and Data Science Department
Department of Health Policy and Oral Epidemiology
Department of Global Health and Social Medicine
Harvard T.H. Chan School of Public Health
Beth Israel Deaconess Medical Center
Division of General Internal Medicine
Department of Orthopaedic Surgery
Department of Anesthesiology
Department of Biotechnology
National Nutrition and Food Technology Research Institute
Research Institute of Dental Sciences
Urology Department
Department of Medical Genetics
Center for Comprehensive Genetic Services
Department of Immunology
Department of Health Policy and Management
Safety Promotion and Injury Prevention Research Center
Department of Epidemiology
Department of Neurosurgery
Social Determinants of Health Research Center
Department of Microbiology and Infectious Diseases
School of Medicine
Department of Biology and Anatomical Sciences
Ophthalmic Research Center (ORC)
Emergency Department
Department of Medical Education
Shahid Beheshti University of Medical Sciences
Non-communicable Diseases Research Center
Advanced Diagnostic and Interventional Radiology Research Center
The Institute of Pharmaceutical Sciences (TIPS)
School of Pharmacy
Research Center for Immunodeficiencies
Hematology
Urology Research Center
Department of Health Information Management
Translational Ophthalmology Research Center
School of Medicine
Department of Scientific Research
Multiple Sclerosis Research Center
Digestive Diseases Research Institute
Ophthalmology Department
Department of Radiology
Students Scientific Research Center (SSRC)
Center for Research and Training in Skin Diseases and Leprosy
Sina Trauma and Surgery Research Center
Childrens Medical Center
Department of Pediatric Cardiology
Department of Obstetrics and Gynecology
Department of Epidemiology and Biostatistics
Tehran Heart Center
Water Quality Research Center
Department of Pharmacology
Department of Medicine
Department of Cardiology
Stem Cell and Center of Regenerative Medicine
Iranian Research Center for HIV/AIDS
Endocrinology and Metabolism Research Center (EMRC)
Department of Neurology
Department of Pharmaceutical Care
Research Center for Rational Use of Drugs
Cancer Research Center
Cancer Biology Research Center
Department of Pathology
Faculty of Medicine
Epidemiology Department
Pediatric Dentistry and Dental Public Health Department
Tropical Health Department
Pathology Department
Tropical Medicine Department
Department of Small Animal Clinical Sciences
Department of Community Health and Epidemiology
Department of Medicine
Department of Physiotherapy
Community Medicine Department
Department of Nursing Science
Department of Rehabilitation Sciences
School of Nursing
Department of Midwifery
Department of Public Health
Department of Public Health
Department of Medical Laboratory Sciences
Department of Health Policy and Management
Department of Clinical Pharmacy
Department of Community Medicine
Department of Medical Physiology
Department of Medical Biochemistry and Biophysics
Department of Neurobiology
Department of Molecular Medicine and Surgery
Department of Global Public Health
Health Management and Economics Research Center
Center for Educational Research in Medical Educaion (CERMS)
Minimally Invasive Surgery Research Center
Eye Research Center
Comprehensive Research Laboratory
Department of Physiology
Physiology Research Center
Colorectal Research Center
Iran University of Medical Sciences
Khatam Al-anbia Hospital
Department of Physical Pharmacy and Pharmacokinetics
Department of Public Health
Nutrition and Dietetics Department
USAID-JSI
Department of Pediatric Dentistry
Department of Nutrition
Department of Maternal and Child Nursing and Public Health
Department of Clinical Medicine
Clinical Hospital
Department of Adult Health Nursing
Department of Nursing
Department of Research
Department of Nursing
Department of Pharmacology and Toxicology
Department of Veterinary Public Health and Preventive Medicine
Nigerian Institute of Medical Research
Clinical Sciences Department
College of Medicine
Department of Pharmacy Practice and Pharmacotherapeutics
Department of Physiotherapy
Department of Basic Biomedical Sciences
Sharjah Institute for Medical Research
Department of Clinical Nutrition and Dietetics
Department of Medicinal Chemistry
University of Sharjah
Institute of Community and Public Health
Department of Public Health
Midwifery Department
College of Medicine and Health Sciences
Department of Epidemiology and Biostatistics
Department of Midwifery
School of Health Science
Health Promotion and Behavioural Science Department
Department of Physiology
Department of Pharmacy
Department of Health Promotion
Public Health Department
Department of Medical Rehabilitation
Department of Animal Sciences
Department of Child Dental Health
Department of Obstetrics and Gynecology
Department of Molecular Biology and Genetics
Department of Biology
Khalifa University
Institute of Public Health
Hiv and Infectious Diseases Department
Department of Adolescent Research and Care
DSI-NRF Centre of Excellence for Epidemiological Modelling and Analysis (SACEMA)
Division of Epidemiology & Biostatistics
South African Centre for Epidemiological Modelling and Analysis (SACEMA)
Department of Epidemiology
Department of Industrial Psychology
Department of Biochemistry
Department of Public Health
Department of Physiology
Department of Microbiology
Department of Anatomy
Department of Biosciences and Biotechnology
Faculty of Medicine
Center of Excellence in Higher Education for Pharmaceutical Care Innovation
Department of Epidemiology and Medical Statistics
Institute for Advanced Medical Research and Training
Faculty of Public Health
Department of Health Promotion and Education
Department of Community Medicine
College of Medicine
Department of Medicine
Department of Radiology
Department of Epidemiology and Population Health
Department of Biostatistics
Department of Neurosurgery
Department of Health Policy and Management
Department of International Health
Johns Hopkins University
Department of Life Sciences
Department of Community Medicine
Department of Public Health
Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia
Department of General Surgery and Medical-Surgical Specialties
Department of Biomedical and Biotechnological Sciences
Department of Clinical and Experimental Medicine
Department of Geography and Planning
Department of Biomedical and Molecular Sciences
School of Public Health
Department of Medical Biochemistry
Department of Pharmacology
School of Medicine and Psychology
National Centre of Epidemiology and Population Health
Research School of Population Health
Public Health Foundation of India
Department of Clinical Nursing
Department of Health and Biological Sciences
Department of Natural Sciences
Department of Epidemiology and Health Statistics
Department of Pharmacy Practice
Division of Infectious Diseases and Global Public Health (IDGPH)
Institute of Endemic Diseases
Unit of Basic Medical Sciences
Swiss Tropical and Public Health Institute
Department of Biosciences
Institute of Public Health
College of Medicine and Health Sciences
Family Medicine Department
Department of Computer Science and Software Engineering
Department of Pathology and Microbiology
Brody School of Medicine
Department of Computer Science
Department of Physiology
East Carolina University
Department of Food and Nutrition Policy and Planning Research
Faculty of Medicine and Public Health
Microbiology
Microbial
School of Public Health
St George and Sutherland Clinical School
School of Population Health
School of Psychiatry
Centre for Social Research in Health
School of Public Health and Community Medicine
The George Institute for Global Health
Institute of Neuroscience
Department of Cardiology
Department of Health Management Center
Department of Management
Geriatric and Long Term Care Department
Rumailah Hospital
Department of Surgery
Department of Nursing
Community and Mental Health Department
Institute of Global Health
Heidelberg Institute of Global Health (HIGH)
Department of Clinical Sciences
Center for Medical and Bio-Allied Health Sciences Research
Department of Biology
John T. Milliken Department of Internal Medicine
Brown School
Department of Surgery
Clinical Epidemiology Center
Murdoch Business School
School of Nursing
School of Nursing and Midwifery
Department of Engineering
Health Information Management and Technology Department
Forensic Medicine Division
Imam Abdulrahman Bin Faisal University
Department of Medicine
Global Health Entrepreneurship
Pediatric Intensive Care Unit
Department of Cardiac Sciences
Section of Adult Hematology
Department of Physiology
Global Centre for Environmental Remediation
Department of Womens Health
Cooperative Research Centre for Contamination Assessment and Remediation of the Environment
College of Nursing
Department of Physical Education
Qu Health
Department of Population Medicine
Psychological Sciences Association
Institute of Health Research
Department of Health Policy Planning and Management
Department of Epidemiology and Biostatistics
Department of Microbiology and Immunology
Department of Zoology
Department of Botany
Erbil Technical Health College
School of Pharmacy
Department of Biological Sciences
Department of Medical Rehabilitation (Physiotherapy)
Department of Biosciences
Centre for Interdisciplinary Research in Basic Sciences (CIRBSc)
Center for Biotechnology and Microbiology
School of Public Health and Preventive Medicine
School of Public Health and Preventative Medicine
Department of Human-Centred Computing
Department of Public Health
Social Determinants of Health Research Center
Medical Laboratories
Department of Molecular and Clinical Pharmacology
Institute of Infection and Global Health
Liverpool Orthopaedic and Trauma Service
Department of Surgery
Department of Health Policy and Management
Department of Surgery
International Centre for Casemix and Clinical Coding
Department of Dentistry
Department of Public Health and Community Medicine
Department of Medicine
Department of Parasitology
Department of Parasitology
Department of Urology
Department of Cardiac Surgery
Nuffield Department of Surgical Sciences
Nuffield Department of Orthopaedics
Nuffield Department of Population Health
Nuffield Department of Medicine
Health Economics Research Centre
Department of Rehabilitation Sciences and Physical Therapy
Department of Clinical Pharmacy
Department of Epidemiology and Population Health
Department of Respiratory Care
Department of Prosthodontics and Implant Dentistry
Department of Prosthodontics
Department of Community Medicine
Department of Family and Community Medicine
Pediatric Dentistry Department
Rabigh Faculty of Medicine
Department of Dental Public Health
Jaber Al Ahmad Al Sabah Hospital
Institute of Molecular Biology and Biotechnology
University Institute of Public Health
University College of Medicine & Dentistry
University Institute of Radiological Sciences and Medical Imaging Technology
University Institute of Diet and Nutritional Sciences
Department of Technology
Research Centre for Health Sciences (RCHS)
The University of Lahore
Department of Specialty Internal Medicine
Medicine Department
Lisbon Institute of Global Mental Health
Department of Clinical Pharmacy and Pharmacy Management
Research Group in Hospital Management and Health Policies
Research Group in Health Economics
Department of Clinical Pharmacology and Toxicology
Department of Medical Sciences
Department of Clinical Sciences
Department of Pediatrics
Department of Internal Medicine
Lerner Research Institute
Department of Pediatric Cardiology
Boston Childrens Hospital
School of Graduate Studies
Public Heath Department
Department of Neurology
Social Determinants of Health Research Center
School of Medicine
Department of Environmental Health Engineering
Cardiac Rehabilitation Research Center
Medicine
College of Public Health
James Cook University
Department of Maternal and Child Wellbeing
Department of Medicine
Department of Obstetrics and Gynecology
Department of Internal Medicine
Faculty of Pharmacy
Department of Cardiology
Department of Internal Medicine and Rheumatology
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