The distribution of haemoglobin C and its prevalence in newborns in Africa
Identifieur interne : 000169 ( Ncbi/Merge ); précédent : 000168; suivant : 000170The distribution of haemoglobin C and its prevalence in newborns in Africa
Auteurs : Frédéric B. Piel [Royaume-Uni] ; Rosalind E. Howes [Royaume-Uni] ; Anand P. Patil [Royaume-Uni] ; Oscar A. Nyangiri [Kenya] ; Peter W. Gething [Royaume-Uni] ; Samir Bhatt [Royaume-Uni] ; Thomas N. Williams [Kenya, Royaume-Uni] ; David J. Weatherall [Royaume-Uni] ; Simon I. Hay [Royaume-Uni]Source :
- Scientific Reports [ 2045-2322 ] ; 2013.
Abstract
Haemoglobin C (HbC) is one of the commonest structural haemoglobin variants in human populations. Although HbC causes mild clinical complications, its diagnosis and genetic counselling are important to prevent inheritance with other haemoglobinopathies. Little is known about its contemporary distribution and the number of newborns affected. We assembled a global database of population surveys. We then used a Bayesian geostatistical model to create maps of HbC frequency across Africa and paired our predictions with high-resolution demographics to calculate heterozygous (AC) and homozygous (CC) newborn estimates and their associated uncertainty. Data were too sparse outside Africa for this methodology to be applied. The highest frequencies were found in West Africa but HbC was commonly found in other parts of the continent. The expected annual numbers of AC and CC newborns in Africa were 672,117 (interquartile range (IQR): 642,116-705,163) and 28,703 (IQR: 26,027-31,958), respectively. These numbers are about two times previous estimates.
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DOI: 10.1038/srep01671
PubMed: 23591685
PubMed Central: 3628164
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Piel</name><affiliation wicri:level="1"><nlm:aff id="a1"><institution>Spatial Ecology and Epidemiology Group, Tinbergen Building, Department of Zoology, University of Oxford</institution>, South Parks Road, Oxford OX1 3PS, United Kingdom</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>, South Parks Road, Oxford OX1 3PS</wicri:regionArea><wicri:noRegion>Oxford OX1 3PS</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="a2"><institution>Evolutionary Ecology of Infectious Disease Group, Tinbergen Building, Department of Zoology, University of Oxford</institution>, South Parks Road, Oxford OX1 3PS, United Kingdom</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>, South Parks Road, Oxford OX1 3PS</wicri:regionArea><wicri:noRegion>Oxford OX1 3PS</wicri:noRegion></affiliation></author><author><name sortKey="Howes, Rosalind E" sort="Howes, Rosalind E" uniqKey="Howes R" first="Rosalind E." last="Howes">Rosalind E. Howes</name><affiliation wicri:level="1"><nlm:aff id="a1"><institution>Spatial Ecology and Epidemiology Group, Tinbergen Building, Department of Zoology, University of Oxford</institution>, South Parks Road, Oxford OX1 3PS, United Kingdom</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>, South Parks Road, Oxford OX1 3PS</wicri:regionArea><wicri:noRegion>Oxford OX1 3PS</wicri:noRegion></affiliation></author><author><name sortKey="Patil, Anand P" sort="Patil, Anand P" uniqKey="Patil A" first="Anand P." last="Patil">Anand P. 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Piel</name><affiliation wicri:level="1"><nlm:aff id="a1"><institution>Spatial Ecology and Epidemiology Group, Tinbergen Building, Department of Zoology, University of Oxford</institution>, South Parks Road, Oxford OX1 3PS, United Kingdom</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>, South Parks Road, Oxford OX1 3PS</wicri:regionArea><wicri:noRegion>Oxford OX1 3PS</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="a2"><institution>Evolutionary Ecology of Infectious Disease Group, Tinbergen Building, Department of Zoology, University of Oxford</institution>, South Parks Road, Oxford OX1 3PS, United Kingdom</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>, South Parks Road, Oxford OX1 3PS</wicri:regionArea><wicri:noRegion>Oxford OX1 3PS</wicri:noRegion></affiliation></author><author><name sortKey="Howes, Rosalind E" sort="Howes, Rosalind E" uniqKey="Howes R" first="Rosalind E." last="Howes">Rosalind E. 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Gething</name><affiliation wicri:level="1"><nlm:aff id="a1"><institution>Spatial Ecology and Epidemiology Group, Tinbergen Building, Department of Zoology, University of Oxford</institution>, South Parks Road, Oxford OX1 3PS, United Kingdom</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>, South Parks Road, Oxford OX1 3PS</wicri:regionArea><wicri:noRegion>Oxford OX1 3PS</wicri:noRegion></affiliation></author><author><name sortKey="Bhatt, Samir" sort="Bhatt, Samir" uniqKey="Bhatt S" first="Samir" last="Bhatt">Samir Bhatt</name><affiliation wicri:level="1"><nlm:aff id="a1"><institution>Spatial Ecology and Epidemiology Group, Tinbergen Building, Department of Zoology, University of Oxford</institution>, South Parks Road, Oxford OX1 3PS, United Kingdom</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>, South Parks Road, Oxford OX1 3PS</wicri:regionArea><wicri:noRegion>Oxford OX1 3PS</wicri:noRegion></affiliation></author><author><name sortKey="Williams, Thomas N" sort="Williams, Thomas N" uniqKey="Williams T" first="Thomas N." last="Williams">Thomas N. Williams</name><affiliation wicri:level="1"><nlm:aff id="a3"><institution>Kenya Medical Research Institute/Wellcome Trust Programme, Centre for Geographic Medicine Research-Coast, PO Box 230, Kilifi District Hospital</institution>, Kilifi, Kenya</nlm:aff><country xml:lang="fr">Kenya</country><wicri:regionArea>, Kilifi</wicri:regionArea><wicri:noRegion>Kilifi</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="a4"><institution>Department of Medicine, Imperial College</institution>, St Mary's Hospital, Praed Street, London W21NY, United Kingdom</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>, St Mary's Hospital, Praed Street, London W21NY</wicri:regionArea><wicri:noRegion>London W21NY</wicri:noRegion></affiliation></author><author><name sortKey="Weatherall, David J" sort="Weatherall, David J" uniqKey="Weatherall D" first="David J." last="Weatherall">David J. Weatherall</name><affiliation wicri:level="1"><nlm:aff id="a5"><institution>Weatherall Institute of Molecular Medicine, John Radcliffe Hospital</institution>, Oxford OX3 9DS, United Kingdom</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>, Oxford OX3 9DS</wicri:regionArea><wicri:noRegion>Oxford OX3 9DS</wicri:noRegion></affiliation></author><author><name sortKey="Hay, Simon I" sort="Hay, Simon I" uniqKey="Hay S" first="Simon I." last="Hay">Simon I. Hay</name><affiliation wicri:level="1"><nlm:aff id="a1"><institution>Spatial Ecology and Epidemiology Group, Tinbergen Building, Department of Zoology, University of Oxford</institution>, South Parks Road, Oxford OX1 3PS, United Kingdom</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>, South Parks Road, Oxford OX1 3PS</wicri:regionArea><wicri:noRegion>Oxford OX1 3PS</wicri:noRegion></affiliation></author></analytic><series><title level="j">Scientific Reports</title><idno type="eISSN">2045-2322</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Haemoglobin C (HbC) is one of the commonest structural haemoglobin variants in human populations. Although HbC causes mild clinical complications, its diagnosis and genetic counselling are important to prevent inheritance with other haemoglobinopathies. Little is known about its contemporary distribution and the number of newborns affected. We assembled a global database of population surveys. We then used a Bayesian geostatistical model to create maps of HbC frequency across Africa and paired our predictions with high-resolution demographics to calculate heterozygous (AC) and homozygous (CC) newborn estimates and their associated uncertainty. Data were too sparse outside Africa for this methodology to be applied. The highest frequencies were found in West Africa but HbC was commonly found in other parts of the continent. The expected annual numbers of AC and CC newborns in Africa were 672,117 (interquartile range (IQR): 642,116-705,163) and 28,703 (IQR: 26,027-31,958), respectively. These numbers are about two times previous estimates.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Itano, H A" uniqKey="Itano H">H. A. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Sci Rep</journal-id><journal-id journal-id-type="iso-abbrev">Sci Rep</journal-id><journal-title-group><journal-title>Scientific Reports</journal-title></journal-title-group><issn pub-type="epub">2045-2322</issn><publisher><publisher-name>Nature Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23591685</article-id><article-id pub-id-type="pmc">3628164</article-id><article-id pub-id-type="pii">srep01671</article-id><article-id pub-id-type="doi">10.1038/srep01671</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>The distribution of haemoglobin C and its prevalence in newborns in Africa</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Piel</surname><given-names>Frédéric B.</given-names></name><xref ref-type="corresp" rid="c1">a</xref><xref ref-type="aff" rid="a1">1</xref><xref ref-type="aff" rid="a2">2</xref></contrib><contrib contrib-type="author"><name><surname>Howes</surname><given-names>Rosalind E.</given-names></name><xref ref-type="aff" rid="a1">1</xref></contrib><contrib contrib-type="author"><name><surname>Patil</surname><given-names>Anand P.</given-names></name><xref ref-type="aff" rid="a1">1</xref></contrib><contrib contrib-type="author"><name><surname>Nyangiri</surname><given-names>Oscar A.</given-names></name><xref ref-type="aff" rid="a3">3</xref></contrib><contrib contrib-type="author"><name><surname>Gething</surname><given-names>Peter W.</given-names></name><xref ref-type="aff" rid="a1">1</xref></contrib><contrib contrib-type="author"><name><surname>Bhatt</surname><given-names>Samir</given-names></name><xref ref-type="aff" rid="a1">1</xref></contrib><contrib contrib-type="author"><name><surname>Williams</surname><given-names>Thomas N.</given-names></name><xref ref-type="aff" rid="a3">3</xref><xref ref-type="aff" rid="a4">4</xref></contrib><contrib contrib-type="author"><name><surname>Weatherall</surname><given-names>David J.</given-names></name><xref ref-type="aff" rid="a5">5</xref></contrib><contrib contrib-type="author"><name><surname>Hay</surname><given-names>Simon I.</given-names></name><xref ref-type="aff" rid="a1">1</xref></contrib><aff id="a1"><label>1</label><institution>Spatial Ecology and Epidemiology Group, Tinbergen Building, Department of Zoology, University of Oxford</institution>, South Parks Road, Oxford OX1 3PS, United Kingdom</aff><aff id="a2"><label>2</label><institution>Evolutionary Ecology of Infectious Disease Group, Tinbergen Building, Department of Zoology, University of Oxford</institution>, South Parks Road, Oxford OX1 3PS, United Kingdom</aff><aff id="a3"><label>3</label><institution>Kenya Medical Research Institute/Wellcome Trust Programme, Centre for Geographic Medicine Research-Coast, PO Box 230, Kilifi District Hospital</institution>, Kilifi, Kenya</aff><aff id="a4"><label>4</label><institution>Department of Medicine, Imperial College</institution>, St Mary's Hospital, Praed Street, London W21NY, United Kingdom</aff><aff id="a5"><label>5</label><institution>Weatherall Institute of Molecular Medicine, John Radcliffe Hospital</institution>, Oxford OX3 9DS, United Kingdom</aff></contrib-group><author-notes><corresp id="c1"><label>a</label><email>fred.piel@zoo.ox.ac.uk</email></corresp></author-notes><pub-date pub-type="epub"><day>17</day><month>04</month><year>2013</year></pub-date><pub-date pub-type="collection"><year>2013</year></pub-date><volume>3</volume><elocation-id>1671</elocation-id><history><date date-type="received"><day>19</day><month>10</month><year>2011</year></date><date date-type="accepted"><day>02</day><month>04</month><year>2013</year></date></history><permissions><copyright-statement>Copyright © 2013, Macmillan Publishers Limited. All rights reserved</copyright-statement><copyright-year>2013</copyright-year><copyright-holder>Macmillan Publishers Limited. All rights reserved</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/3.0/"><pmc-comment>author-paid</pmc-comment>
<license-p>This work is licensed under a Creative Commons Attribution 3.0 Unported License. To view a copy of this license, visit <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/3.0/">http://creativecommons.org/licenses/by/3.0/</ext-link></license-p></license></permissions><abstract><p>Haemoglobin C (HbC) is one of the commonest structural haemoglobin variants in human populations. Although HbC causes mild clinical complications, its diagnosis and genetic counselling are important to prevent inheritance with other haemoglobinopathies. Little is known about its contemporary distribution and the number of newborns affected. We assembled a global database of population surveys. We then used a Bayesian geostatistical model to create maps of HbC frequency across Africa and paired our predictions with high-resolution demographics to calculate heterozygous (AC) and homozygous (CC) newborn estimates and their associated uncertainty. Data were too sparse outside Africa for this methodology to be applied. The highest frequencies were found in West Africa but HbC was commonly found in other parts of the continent. The expected annual numbers of AC and CC newborns in Africa were 672,117 (interquartile range (IQR): 642,116-705,163) and 28,703 (IQR: 26,027-31,958), respectively. These numbers are about two times previous estimates.</p></abstract></article-meta></front><floats-group><fig id="f1"><label>Figure 1</label><caption><title>Global distribution of surveys on HbC.</title><p>Green dots and orange triangles indicate surveys which found HbC to be present and absent from the population sample respectively. Created with ESRI ArcGIS 10.1.</p></caption><graphic xlink:href="srep01671-f1"></graphic></fig><fig id="f2"><label>Figure 2</label><caption><title>Summary map of HbC predicted allele frequency in Africa.</title><p>Raster map (5 km × 5 km) of HbC allele frequency (posterior mean) generated by a Bayesian model-based geostatistical framework. Created with ESRI ArcGIS 10.1.</p></caption><graphic xlink:href="srep01671-f2"></graphic></fig><fig id="f3"><label>Figure 3</label><caption><title>Uncertainty map in HbC predicted allele frequency in Africa.</title><p>Interquartile range (50% probability) of the per-pixel predicted allele frequency. Created with ESRI ArcGIS 10.1.</p></caption><graphic xlink:href="srep01671-f3"></graphic></fig><fig id="f4"><label>Figure 4</label><caption><title>Schematic overview of the approach.</title><p>Blue diamonds describe input data. Orange boxes denote models and experimental procedures. Green rods indicate output data. Created with Microsoft Office Visio 2007.</p></caption><graphic xlink:href="srep01671-f4"></graphic></fig><table-wrap position="float" id="t1"><label>Table 1</label><caption><title>National demographic indicators and estimates of HbC allele frequency and newborns affected within the AFRO WHO region</title></caption><table frame="hsides" rules="groups" border="1"><colgroup><col align="left"></col><col align="center"></col><col align="center"></col><col align="center"></col><col align="center"></col><col align="center"></col><col align="center"></col><col align="center"></col></colgroup><thead valign="bottom"><tr><th align="justify" valign="top" charoff="50">Country/Region</th><th align="justify" valign="top" charoff="50">Total population (in thousands)</th><th align="justify" valign="top" charoff="50">CBR<xref ref-type="fn" rid="t1-fn1">1</xref></th><th align="center" valign="top" charoff="50">Surveys</th><th align="justify" valign="top" charoff="50">HbC AF (IQR<xref ref-type="fn" rid="t1-fn2">2</xref>)</th><th align="justify" valign="top" charoff="50">AC newborns/yr (IQR<xref ref-type="fn" rid="t1-fn2">2</xref>)</th><th align="justify" valign="top" charoff="50">CC newborns/yr (IQR<xref ref-type="fn" rid="t1-fn2">2</xref>)</th><th align="justify" valign="top" charoff="50">M&D<xref ref-type="fn" rid="t1-fn3">3</xref></th></tr></thead><tbody valign="top"><tr><td align="justify" valign="top" charoff="50">Algeria</td><td align="char" valign="top" char="." charoff="50">35,423</td><td align="char" valign="top" char="." charoff="50">0.0192</td><td align="char" valign="top" char="." charoff="50">15</td><td align="justify" valign="top" charoff="50">0.003 (0.002–0.005)</td><td align="char" valign="top" char="(" charoff="50">3,439 (1,839–7,119)</td><td align="char" valign="top" char="(" charoff="50">46 (15–159)</td><td align="char" valign="top" char="." charoff="50">72</td></tr><tr><td align="justify" valign="top" charoff="50">Angola</td><td align="char" valign="top" char="." charoff="50">18,994</td><td align="char" valign="top" char="." charoff="50">0.0399</td><td align="char" valign="top" char="." charoff="50">1</td><td align="justify" valign="top" charoff="50">0.001 (0.000–0.006)</td><td align="char" valign="top" char="(" charoff="50">1,510 (257–9,539)</td><td align="char" valign="top" char="(" charoff="50">4 (0–102)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Benin</td><td align="char" valign="top" char="." charoff="50">9,219</td><td align="char" valign="top" char="." charoff="50">0.0383</td><td align="char" valign="top" char="." charoff="50">9</td><td align="justify" valign="top" charoff="50">0.064 (0.046–0.090)</td><td align="char" valign="top" char="(" charoff="50">41,915 (32,952–52,400)</td><td align="char" valign="top" char="(" charoff="50">1,892 (1,188–3,200)</td><td align="char" valign="top" char="." charoff="50">746</td></tr><tr><td align="justify" valign="top" charoff="50">Botswana</td><td align="char" valign="top" char="." charoff="50">1,977</td><td align="char" valign="top" char="." charoff="50">0.0229</td><td align="char" valign="top" char="." charoff="50">0</td><td align="justify" valign="top" charoff="50">0.000 (0.000–0.000)</td><td align="char" valign="top" char="(" charoff="50">0 (0–11)</td><td align="char" valign="top" char="(" charoff="50">0 (0–0)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Burkina Faso</td><td align="char" valign="top" char="." charoff="50">16,250</td><td align="char" valign="top" char="." charoff="50">0.0424</td><td align="char" valign="top" char="." charoff="50">42</td><td align="justify" valign="top" charoff="50">0.130 (0.108–0.158)</td><td align="char" valign="top" char="(" charoff="50">131,454 (117,825–146,173)</td><td align="char" valign="top" char="(" charoff="50">9,592 (7,258–13,259)</td><td align="char" valign="top" char="." charoff="50">3,730</td></tr><tr><td align="justify" valign="top" charoff="50">Burundi</td><td align="char" valign="top" char="." charoff="50">8,519</td><td align="char" valign="top" char="." charoff="50">0.0333</td><td align="char" valign="top" char="." charoff="50">1</td><td align="justify" valign="top" charoff="50">0.000 (0.000–0.002)</td><td align="char" valign="top" char="(" charoff="50">132 (31–578)</td><td align="char" valign="top" char="(" charoff="50">0 (0–1)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Cameroon</td><td align="char" valign="top" char="." charoff="50">19,957</td><td align="char" valign="top" char="." charoff="50">0.0349</td><td align="char" valign="top" char="." charoff="50">11</td><td align="justify" valign="top" charoff="50">0.001 (0.000–0.001)</td><td align="char" valign="top" char="(" charoff="50">400 (146–1,127)</td><td align="char" valign="top" char="(" charoff="50">0 (0–3)</td><td align="char" valign="top" char="." charoff="50">5</td></tr><tr><td align="justify" valign="top" charoff="50">Cape Verde</td><td align="char" valign="top" char="." charoff="50">513</td><td align="char" valign="top" char="." charoff="50">0.0199</td><td align="char" valign="top" char="." charoff="50">2</td><td align="justify" valign="top" charoff="50">0.000 (0.000–0.001)</td><td align="char" valign="top" char="(" charoff="50">1 (0–10)</td><td align="char" valign="top" char="(" charoff="50">0 (0–0)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Central African Republic</td><td align="char" valign="top" char="." charoff="50">4,506</td><td align="char" valign="top" char="." charoff="50">0.0345</td><td align="char" valign="top" char="." charoff="50">0</td><td align="justify" valign="top" charoff="50">0.000 (0.000–0.001)</td><td align="char" valign="top" char="(" charoff="50">27 (4–187)</td><td align="char" valign="top" char="(" charoff="50">0 (0–0)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Chad</td><td align="char" valign="top" char="." charoff="50">11,509</td><td align="char" valign="top" char="." charoff="50">0.0434</td><td align="char" valign="top" char="." charoff="50">5</td><td align="justify" valign="top" charoff="50">0.002 (0.001–0.004)</td><td align="char" valign="top" char="(" charoff="50">1,282 (390–4,183)</td><td align="char" valign="top" char="(" charoff="50">7 (1–58)</td><td align="char" valign="top" char="." charoff="50">6</td></tr><tr><td align="justify" valign="top" charoff="50">Comoros</td><td align="char" valign="top" char="." charoff="50">691</td><td align="char" valign="top" char="." charoff="50">0.0357</td><td align="char" valign="top" char="." charoff="50">0</td><td align="justify" valign="top" charoff="50">0.000 (0.000–0.000)</td><td align="char" valign="top" char="(" charoff="50">0 (0–1)</td><td align="char" valign="top" char="(" charoff="50">0 (0–0)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Congo</td><td align="char" valign="top" char="." charoff="50">3,760</td><td align="char" valign="top" char="." charoff="50">0.0346</td><td align="char" valign="top" char="." charoff="50">1</td><td align="justify" valign="top" charoff="50">0.001 (0.000–0.003)</td><td align="char" valign="top" char="(" charoff="50">112 (21–898)</td><td align="char" valign="top" char="(" charoff="50">0 (0–6)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Congo, the Democratic Republic of the</td><td align="char" valign="top" char="." charoff="50">67,829</td><td align="char" valign="top" char="." charoff="50">0.0421</td><td align="char" valign="top" char="." charoff="50">4</td><td align="justify" valign="top" charoff="50">0.001 (0.000–0.001)</td><td align="char" valign="top" char="(" charoff="50">1,813 (594–6,213)</td><td align="char" valign="top" char="(" charoff="50">2 (0–30)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Côte d'Ivoire</td><td align="char" valign="top" char="." charoff="50">21,571</td><td align="char" valign="top" char="." charoff="50">0.0330</td><td align="char" valign="top" char="." charoff="50">3</td><td align="justify" valign="top" charoff="50">0.028 (0.017–0.049)</td><td align="char" valign="top" char="(" charoff="50">42,277 (27,050–64,339)</td><td align="char" valign="top" char="(" charoff="50">1,244 (576–2,922)</td><td align="char" valign="top" char="." charoff="50">935</td></tr><tr><td align="justify" valign="top" charoff="50">Equatorial Guinea</td><td align="char" valign="top" char="." charoff="50">693</td><td align="char" valign="top" char="." charoff="50">0.0359</td><td align="char" valign="top" char="." charoff="50">0</td><td align="justify" valign="top" charoff="50">0.001 (0.000–0.004)</td><td align="char" valign="top" char="(" charoff="50">38 (10–177)</td><td align="char" valign="top" char="(" charoff="50">0 (0–1)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Eritrea</td><td align="char" valign="top" char="." charoff="50">5,204</td><td align="char" valign="top" char="." charoff="50">0.0344</td><td align="char" valign="top" char="." charoff="50">0</td><td align="justify" valign="top" charoff="50">0.000 (0.000–0.002)</td><td align="char" valign="top" char="(" charoff="50">20 (1–379)</td><td align="char" valign="top" char="(" charoff="50">0 (0–1)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Ethiopia</td><td align="char" valign="top" char="." charoff="50">84,996</td><td align="char" valign="top" char="." charoff="50">0.0300</td><td align="char" valign="top" char="." charoff="50">1</td><td align="justify" valign="top" charoff="50">0.000 (0.000–0.002)</td><td align="char" valign="top" char="(" charoff="50">470 (36–6,754)</td><td align="char" valign="top" char="(" charoff="50">0 (0–21)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Gabon</td><td align="char" valign="top" char="." charoff="50">1,501</td><td align="char" valign="top" char="." charoff="50">0.0270</td><td align="char" valign="top" char="." charoff="50">1</td><td align="justify" valign="top" charoff="50">0.004 (0.001–0.009)</td><td align="char" valign="top" char="(" charoff="50">299 (81–838)</td><td align="char" valign="top" char="(" charoff="50">1 (0–9)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Gambia</td><td align="char" valign="top" char="." charoff="50">1,751</td><td align="char" valign="top" char="." charoff="50">0.0369</td><td align="char" valign="top" char="." charoff="50">12</td><td align="justify" valign="top" charoff="50">0.005 (0.003–0.008)</td><td align="char" valign="top" char="(" charoff="50">609 (302–1,138)</td><td align="char" valign="top" char="(" charoff="50">2 (1–9)</td><td align="char" valign="top" char="." charoff="50">8</td></tr><tr><td align="justify" valign="top" charoff="50">Ghana</td><td align="char" valign="top" char="." charoff="50">24,339</td><td align="char" valign="top" char="." charoff="50">0.0303</td><td align="char" valign="top" char="." charoff="50">18</td><td align="justify" valign="top" charoff="50">0.074 (0.061–0.090)</td><td align="char" valign="top" char="(" charoff="50">98,153 (87,225–110,939)</td><td align="char" valign="top" char="(" charoff="50">4,707 (3,601–6,546)</td><td align="char" valign="top" char="." charoff="50">2,501</td></tr><tr><td align="justify" valign="top" charoff="50">Guinea</td><td align="char" valign="top" char="." charoff="50">10,324</td><td align="char" valign="top" char="." charoff="50">0.0376</td><td align="char" valign="top" char="." charoff="50">1</td><td align="justify" valign="top" charoff="50">0.013 (0.007–0.023)</td><td align="char" valign="top" char="(" charoff="50">11,186 (5,931–19,970)</td><td align="char" valign="top" char="(" charoff="50">162 (49–497)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Guinea-Bissau</td><td align="char" valign="top" char="." charoff="50">1,647</td><td align="char" valign="top" char="." charoff="50">0.0374</td><td align="char" valign="top" char="." charoff="50">1</td><td align="justify" valign="top" charoff="50">0.003 (0.001–0.006)</td><td align="char" valign="top" char="(" charoff="50">303 (108–815)</td><td align="char" valign="top" char="(" charoff="50">1 (0–6)</td><td align="char" valign="top" char="." charoff="50">1</td></tr><tr><td align="justify" valign="top" charoff="50">Kenya</td><td align="char" valign="top" char="." charoff="50">40,835</td><td align="char" valign="top" char="." charoff="50">0.0369</td><td align="char" valign="top" char="." charoff="50">1</td><td align="justify" valign="top" charoff="50">0.001 (0.000–0.003)</td><td align="char" valign="top" char="(" charoff="50">1,048 (170–7,501)</td><td align="char" valign="top" char="(" charoff="50">1 (0–29)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Lesotho</td><td align="char" valign="top" char="." charoff="50">2,064</td><td align="char" valign="top" char="." charoff="50">0.0271</td><td align="char" valign="top" char="." charoff="50">0</td><td align="justify" valign="top" charoff="50">0.000 (0.000–0.000)</td><td align="char" valign="top" char="(" charoff="50">0 (0–2)</td><td align="char" valign="top" char="(" charoff="50">0 (0–0)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Liberia</td><td align="char" valign="top" char="." charoff="50">4,102</td><td align="char" valign="top" char="." charoff="50">0.0376</td><td align="char" valign="top" char="." charoff="50">12</td><td align="justify" valign="top" charoff="50">0.004 (0.002–0.007)</td><td align="char" valign="top" char="(" charoff="50">1,275 (620–2,476)</td><td align="char" valign="top" char="(" charoff="50">6 (2–21)</td><td align="char" valign="top" char="." charoff="50">4</td></tr><tr><td align="justify" valign="top" charoff="50">Madagascar</td><td align="char" valign="top" char="." charoff="50">20,146</td><td align="char" valign="top" char="." charoff="50">0.0346</td><td align="char" valign="top" char="." charoff="50">0</td><td align="justify" valign="top" charoff="50">0.000 (0.000–0.000)</td><td align="char" valign="top" char="(" charoff="50">0 (0–11)</td><td align="char" valign="top" char="(" charoff="50">0 (0–0)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Malawi</td><td align="char" valign="top" char="." charoff="50">15,690</td><td align="char" valign="top" char="." charoff="50">0.0445</td><td align="char" valign="top" char="." charoff="50">0</td><td align="justify" valign="top" charoff="50">0.000 (0.000–0.000)</td><td align="char" valign="top" char="(" charoff="50">4 (0–97)</td><td align="char" valign="top" char="(" charoff="50">0 (0–0)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Mali</td><td align="char" valign="top" char="." charoff="50">13,362</td><td align="char" valign="top" char="." charoff="50">0.0450</td><td align="char" valign="top" char="." charoff="50">7</td><td align="justify" valign="top" charoff="50">0.078 (0.049–0.128)</td><td align="char" valign="top" char="(" charoff="50">79,506 (58,011–106,112)</td><td align="char" valign="top" char="(" charoff="50">4,354 (2,257–9,952)</td><td align="char" valign="top" char="." charoff="50">1,616</td></tr><tr><td align="justify" valign="top" charoff="50">Mauritania</td><td align="char" valign="top" char="." charoff="50">3,359</td><td align="char" valign="top" char="." charoff="50">0.0327</td><td align="char" valign="top" char="." charoff="50">1</td><td align="justify" valign="top" charoff="50">0.023 (0.009–0.066)</td><td align="char" valign="top" char="(" charoff="50">5,309 (2,136–11,459)</td><td align="char" valign="top" char="(" charoff="50">145 (24–808)</td><td align="char" valign="top" char="." charoff="50">18</td></tr><tr><td align="justify" valign="top" charoff="50">Mauritius</td><td align="char" valign="top" char="." charoff="50">1,297</td><td align="char" valign="top" char="." charoff="50">0.0125</td><td align="char" valign="top" char="." charoff="50">0</td><td align="justify" valign="top" charoff="50">0.000 (0.000–0.000)</td><td align="char" valign="top" char="(" charoff="50">0 (0–0)</td><td align="char" valign="top" char="(" charoff="50">0 (0–0)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Mozambique</td><td align="char" valign="top" char="." charoff="50">23,418</td><td align="char" valign="top" char="." charoff="50">0.0363</td><td align="char" valign="top" char="." charoff="50">0</td><td align="justify" valign="top" charoff="50">0.000 (0.000–0.000)</td><td align="char" valign="top" char="(" charoff="50">2 (0–68)</td><td align="char" valign="top" char="(" charoff="50">0 (0–0)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Namibia</td><td align="char" valign="top" char="." charoff="50">2,212</td><td align="char" valign="top" char="." charoff="50">0.0252</td><td align="char" valign="top" char="." charoff="50">0</td><td align="justify" valign="top" charoff="50">0.001 (0.000–0.003)</td><td align="char" valign="top" char="(" charoff="50">32 (3–378)</td><td align="char" valign="top" char="(" charoff="50">0 (0–2)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Niger</td><td align="char" valign="top" char="." charoff="50">15,885</td><td align="char" valign="top" char="." charoff="50">0.0477</td><td align="char" valign="top" char="." charoff="50">3</td><td align="justify" valign="top" charoff="50">0.025 (0.015–0.049)</td><td align="char" valign="top" char="(" charoff="50">40,670 (24,006–69,159)</td><td align="char" valign="top" char="(" charoff="50">1,196 (527–3,068)</td><td align="char" valign="top" char="." charoff="50">734</td></tr><tr><td align="justify" valign="top" charoff="50">Nigeria</td><td align="char" valign="top" char="." charoff="50">158,255</td><td align="char" valign="top" char="." charoff="50">0.0393</td><td align="char" valign="top" char="." charoff="50">16</td><td align="justify" valign="top" charoff="50">0.011 (0.008–0.015)</td><td align="char" valign="top" char="(" charoff="50">148,423 (112,961–197,818)</td><td align="char" valign="top" char="(" charoff="50">3,099 (1,822–5,948)</td><td align="char" valign="top" char="." charoff="50">3,278</td></tr><tr><td align="justify" valign="top" charoff="50">Rwanda</td><td align="char" valign="top" char="." charoff="50">10,277</td><td align="char" valign="top" char="." charoff="50">0.0406</td><td align="char" valign="top" char="." charoff="50">1</td><td align="justify" valign="top" charoff="50">0.001 (0.000–0.002)</td><td align="char" valign="top" char="(" charoff="50">446 (129–1,554)</td><td align="char" valign="top" char="(" charoff="50">0 (0–3)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Sao Tome and Principe</td><td align="char" valign="top" char="." charoff="50">165</td><td align="char" valign="top" char="." charoff="50">0.0299</td><td align="char" valign="top" char="." charoff="50">0</td><td align="justify" valign="top" charoff="50">0.004 (0.001–0.026)</td><td align="char" valign="top" char="(" charoff="50">36 (3–305)</td><td align="char" valign="top" char="(" charoff="50">0 (0–6)</td><td align="char" valign="top" char="." charoff="50">1</td></tr><tr><td align="justify" valign="top" charoff="50">Senegal</td><td align="char" valign="top" char="." charoff="50">12,866</td><td align="char" valign="top" char="." charoff="50">0.0359</td><td align="char" valign="top" char="." charoff="50">3</td><td align="justify" valign="top" charoff="50">0.007 (0.004–0.014)</td><td align="char" valign="top" char="(" charoff="50">7,326 (3,508–14,548)</td><td align="char" valign="top" char="(" charoff="50">56 (13–230)</td><td align="char" valign="top" char="." charoff="50">64</td></tr><tr><td align="justify" valign="top" charoff="50">Sierra Leone</td><td align="char" valign="top" char="." charoff="50">5,837</td><td align="char" valign="top" char="." charoff="50">0.0365</td><td align="char" valign="top" char="." charoff="50">0</td><td align="justify" valign="top" charoff="50">0.009 (0.004–0.022)</td><td align="char" valign="top" char="(" charoff="50">4,508 (1,575–11,076)</td><td align="char" valign="top" char="(" charoff="50">40 (6–228)</td><td align="char" valign="top" char="." charoff="50">64</td></tr><tr><td align="justify" valign="top" charoff="50">South Africa</td><td align="char" valign="top" char="." charoff="50">50,523</td><td align="char" valign="top" char="." charoff="50">0.0205</td><td align="char" valign="top" char="." charoff="50">1</td><td align="justify" valign="top" charoff="50">0.000 (0.000–0.000)</td><td align="char" valign="top" char="(" charoff="50">1 (0–61)</td><td align="char" valign="top" char="(" charoff="50">0 (0–0)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Swaziland</td><td align="char" valign="top" char="." charoff="50">1,195</td><td align="char" valign="top" char="." charoff="50">0.0287</td><td align="char" valign="top" char="." charoff="50">0</td><td align="justify" valign="top" charoff="50">0.000 (0.000–0.000)</td><td align="char" valign="top" char="(" charoff="50">0 (0–1)</td><td align="char" valign="top" char="(" charoff="50">0 (0–0)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Tanzania, United Republic of</td><td align="char" valign="top" char="." charoff="50">45,028</td><td align="char" valign="top" char="." charoff="50">0.0410</td><td align="char" valign="top" char="." charoff="50">13</td><td align="justify" valign="top" charoff="50">0.000 (0.000–0.001)</td><td align="char" valign="top" char="(" charoff="50">558 (123–3,033)</td><td align="char" valign="top" char="(" charoff="50">0 (0–8)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Togo</td><td align="char" valign="top" char="." charoff="50">6,774</td><td align="char" valign="top" char="." charoff="50">0.0310</td><td align="char" valign="top" char="." charoff="50">3</td><td align="justify" valign="top" charoff="50">0.082 (0.059–0.112)</td><td align="char" valign="top" char="(" charoff="50">29,093 (23,448–35,050)</td><td align="char" valign="top" char="(" charoff="50">1,594 (989–2,702)</td><td align="char" valign="top" char="." charoff="50">446</td></tr><tr><td align="justify" valign="top" charoff="50">Uganda</td><td align="char" valign="top" char="." charoff="50">33,798</td><td align="char" valign="top" char="." charoff="50">0.0439</td><td align="char" valign="top" char="." charoff="50">1</td><td align="justify" valign="top" charoff="50">0.001 (0.000–0.004)</td><td align="char" valign="top" char="(" charoff="50">2,721 (618–12,531)</td><td align="char" valign="top" char="(" charoff="50">4 (0–69)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Zambia</td><td align="char" valign="top" char="." charoff="50">13,254</td><td align="char" valign="top" char="." charoff="50">0.0465</td><td align="char" valign="top" char="." charoff="50">2</td><td align="justify" valign="top" charoff="50">0.000 (0.000–0.000)</td><td align="char" valign="top" char="(" charoff="50">23 (1–221)</td><td align="char" valign="top" char="(" charoff="50">0 (0–0)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">Zimbabwe</td><td align="char" valign="top" char="." charoff="50">12,645</td><td align="char" valign="top" char="." charoff="50">0.0287</td><td align="char" valign="top" char="." charoff="50">0</td><td align="justify" valign="top" charoff="50">0.000 (0.000–0.000)</td><td align="char" valign="top" char="(" charoff="50">2 (0–40)</td><td align="char" valign="top" char="(" charoff="50">0 (0–0)</td><td align="char" valign="top" char="." charoff="50">0</td></tr><tr><td align="justify" valign="top" charoff="50">AFRO region</td><td align="char" valign="top" char="." charoff="50">888,817</td><td align="justify" valign="top" charoff="50">0.0357</td><td align="char" valign="top" char="." charoff="50">198</td><td align="justify" valign="top" charoff="50">0.011 (0.011–0.012)</td><td align="char" valign="top" char="(" charoff="50">672,117 (642,116–705,163)</td><td align="char" valign="top" char="(" charoff="50">28,703 (26,027–31,958)</td><td align="char" valign="top" char="." charoff="50">14,227</td></tr></tbody></table><table-wrap-foot><fn id="t1-fn1"><p><sup>1</sup>CBR: Crude birth rate.</p></fn><fn id="t1-fn2"><p><sup>2</sup>IQR: interquartile range.</p></fn><fn id="t1-fn3"><p><sup>3</sup>M&D: Modell & Darlison, 2008.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc><affiliations><list><country><li>Kenya</li><li>Royaume-Uni</li></country></list><tree><country name="Royaume-Uni"><noRegion><name sortKey="Piel, Frederic B" sort="Piel, Frederic B" uniqKey="Piel F" first="Frédéric B." last="Piel">Frédéric B. Piel</name></noRegion><name sortKey="Bhatt, Samir" sort="Bhatt, Samir" uniqKey="Bhatt S" first="Samir" last="Bhatt">Samir Bhatt</name><name sortKey="Gething, Peter W" sort="Gething, Peter W" uniqKey="Gething P" first="Peter W." last="Gething">Peter W. Gething</name><name sortKey="Hay, Simon I" sort="Hay, Simon I" uniqKey="Hay S" first="Simon I." last="Hay">Simon I. Hay</name><name sortKey="Howes, Rosalind E" sort="Howes, Rosalind E" uniqKey="Howes R" first="Rosalind E." last="Howes">Rosalind E. Howes</name><name sortKey="Patil, Anand P" sort="Patil, Anand P" uniqKey="Patil A" first="Anand P." last="Patil">Anand P. Patil</name><name sortKey="Piel, Frederic B" sort="Piel, Frederic B" uniqKey="Piel F" first="Frédéric B." last="Piel">Frédéric B. Piel</name><name sortKey="Weatherall, David J" sort="Weatherall, David J" uniqKey="Weatherall D" first="David J." last="Weatherall">David J. Weatherall</name><name sortKey="Williams, Thomas N" sort="Williams, Thomas N" uniqKey="Williams T" first="Thomas N." last="Williams">Thomas N. Williams</name></country><country name="Kenya"><noRegion><name sortKey="Nyangiri, Oscar A" sort="Nyangiri, Oscar A" uniqKey="Nyangiri O" first="Oscar A." last="Nyangiri">Oscar A. Nyangiri</name></noRegion><name sortKey="Williams, Thomas N" sort="Williams, Thomas N" uniqKey="Williams T" first="Thomas N." last="Williams">Thomas N. Williams</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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