Mapping disparities in education across low-and-middle-income countries

Local Burden of Disease Educational Attainment Collaborators. (2020) Mapping disparities in education across low-and-middle-income countries. Nature, 577 (7789), 235–238. (doi:10.1038/s41586-019-1872-1).

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Abstract

Educational attainment is an important social determinant of maternal, newborn, and child health. As a tool for promoting gender equity, it has gained increasing traction in popular media, international aid strategies, and global agenda-setting. The global health agenda is increasingly focused on evidence of precision public health, which illustrates the subnational distribution of disease and illness; however, an agenda focused on future equity must integrate comparable evidence on the distribution of social determinants of health. Here we expand on the available precision SDG evidence by estimating the subnational distribution of educational attainment, including the proportions of individuals who have completed key levels of schooling, across all low- and middle-income countries from 2000 to 2017. Previous analyses have focused on geographical disparities in average attainment across Africa or for specific countries, but—to our knowledge—no analysis has examined the subnational proportions of individuals who completed specific levels of education across all low- and middle-income countries. By geolocating subnational data for more than 184 million person-years across 528 data sources, we precisely identify inequalities across geography as well as within populations.

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Accepted/In Press date: 12 November 2019

e-pub ahead of print date: 25 December 2019

Published date: 9 January 2020

Additional Information: Funding Information: 1Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. 2Department of Population and Family Health, Jimma University, Jimma, Ethiopia. 3Department of Neurology, Cairo University, Cairo, Egypt. 4Department of Medicine, University College Hospital, Ibadan, Nigeria. 5School of Medicine, Cardiff University, Cardiff, UK. 6Department of Community Medicine, Zabol University of Medical Sciences, Zabol, Iran. 7School of Community Health Sciences, University of Nevada, Reno, NV, USA. 8National Malaria Elimination Program, Federal Ministry of Health, Abuja, Nigeria. 9Duke Global Health Institute, Duke University, Durham, NC, USA. 10Department of Population Health Sciences, Duke University, Durham, NC, USA. 11Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, MN, USA. 12Internal Medicine Department, Washington University in St Louis, St Louis, MO, USA. 13Clinical Epidemiology Center, VA Saint Louis Health Care System, Department of Veterans Affairs, St Louis, MO, USA. 14Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico. 15Qazvin University of Medical Sciences, Qazvin, Iran. 16Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran. 17King Saud University, Riyadh, Saudi Arabia. 18Department of Health Management, Policy and Economics, Kerman University of Medical Sciences, Kerman, Iran. 19Faculty of Medicine, Mansoura University, Mansoura, Egypt. 20Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. 21Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. 22Department of Health Policy and Administration, University of the Philippines Manila, Manila, The Philippines. 23Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong, China. 24School of Health Sciences, Birmingham City University, Birmingham, UK. 25Monitoring Evaluation and Operational Research Project, ABT Associates Nepal, Lalitpur, Nepal. 26Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran. 27Department of Health Informatics, University of Ha’il, Ha’il, Saudi Arabia. 28Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania. 29Indian Institute of Public Health, Public Health Foundation of India, Gurugram, India. 30The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia. 31General Office for Research and Technological Transfer, Peruvian National Institute of Health, Lima, Peru. 32Public Health Risk Sciences Division, Public Health Agency of Canada, Toronto, Ontario, Canada. 33Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada. 34Faculty of Medicine, Alexandria University, Alexandria, Egypt. 35School of Psychology, University of Auckland, Auckland, New Zealand. 36Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia. 37Department of Community Medicine, Gandhi Medical College Bhopal, Bhopal, India. 38Jazan University, Jazan, Saudi Arabia. 39Nuffield Department of Population Health, University of Oxford, Oxford, UK. 40Department of Statistical and Computational Genomics, National Institute of Biomedical Genomics, Kalyani, India. 41Department of Statistics, University of Calcutta, Kolkata, India. 42Department of Global Health, Global Institute for Interdisciplinary Studies, Kathmandu, Nepal. 43Centre for Global Child Health, University of Toronto, Toronto, Ontario, Canada. 44Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan. 45Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran. 46Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Italy. 47Center for Neuroscience, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Panama, Panama. 48School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada. 49Al Shifa School of Public Health, Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan. 50Department of Population and Health, Metropolitan Autonomous University, Mexico City, Mexico. 51Institute of Public Health, University of Porto, Porto, Portugal. 52Applied Molecular Biosciences Unit, University of Porto, Porto, Portugal. 53Colombian National Health Observatory, National Institute of Health, Bogota, Colombia. 54Epidemiology and Public Health Evaluation Group, National University of Colombia, Bogota, Colombia. 55Gorgas Memorial Institute for Health Studies, Panama, Panama. 56School of Public Health, University of Hong Kong, Hong Kong, China. 57College of Medicine, National Taiwan University, Taipei, Taiwan. 58Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. 59Department of Rheumatology, University of Oxford, Oxford, UK. 60Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA. 61James P. Grant School of Public Health, Brac University, Dhaka, Bangladesh. 62Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany. 63Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK. 64School of Public Health, Addis Ababa University, Addis, Ababa, Ethiopia. 65School of Nutrition, Food Science and Technology, Hawassa University, Hawassa, Ethiopia. 66Department of Midwifery, Debre Markos University, Debre, Markos, Ethiopia. 67Faculty of Veterinary Medicine and Zootechnics, Autonomous University of Sinaloa, Culiacan Rosales, Mexico. 68Health Research Section, Nepal Health Research Council, Kathmandu, Nepal. 69Center of Complexity Sciences, National Autonomous University of Mexico, Mexico City, Mexico. 70Department of Midwifery, Debre Berhan University, Debre Berhan, Ethiopia. 71Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran. 72United Nations World Food Programme, New Delhi, India. 73Faculty of Medicine, University of Belgrade, Belgrade, Serbia. 74Department of Internal Medicine, Bahia School of Medicine and Public Health, Salvador, Brazil. 75Medical Board, Roberto Santos General Hospital, Salvador, Brazil. 76Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA. 77Epidemiology Department, Florida International University, Miami, FL, USA. 78Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. 79World Health Programme, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada. 80Center of Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran. 81School of Public Health, Arak University of Medical Sciences, Arak, Iran. 82Babol University of Medical Sciences, Babol, Iran. 83College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia. 84Department of Psychology, Federal University of Sergipe, Sao Cristovao, Brazil. 85Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. 86Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada. 87REQUIMTE/LAQV, University of Porto, Porto, Portugal. 88Psychiatry Department, Kaiser Permanente, Fontana, CA, USA. 89Department of Health Sciences, A. T. Still University, Mesa, AZ, USA. 90Department of Population Medicine and Health Services Research, Bielefeld University, Bielefeld, Germany. 91Department of Dermatology, Kobe University, Kobe, Japan. 92Gene Expression & Regulation Program, The Wistar Institute, Philadelphia, PA, USA. 93Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico. 94Unit of Academic Primary Care, University of Warwick, Coventry, UK. 95Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia. 96Nursing and Health Sciences Department, University of Massachusetts Boston, Boston, MA, USA. 97Department of Biostatistics and Epidemiology, University of Oklahoma, Oklahoma City, OK, USA. 98Department of Health and Social Affairs, Government of the Federated States of Micronesia, Palikir, Federated States of Micronesia. 99School of Medicine, Boston University, Boston, MA, USA. 100School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 101Department of Epidemiology and Biostatistics, Zhengzhou University, Zhengzhou, China. 102Academics and Research Department, Rajasthan University of Health Sciences, Jaipur, India. 103Department of Medicine, Mahatma Gandhi University of Medical Sciences & Technology, Jaipur, India. 104Department of Anthropology, University of Delhi, Delhi, India. 105Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran. 106Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 107Department of Radiology, Johns Hopkins University, Baltimore, MD, USA. 108Department of Family and Community Medicine, Arabian Gulf University, Manama, Bahrain. 109School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates. 110Department of Public Health, Mizan-Tepi University, Tepi, Ethiopia. 111Unit of Epidemiology and Social Medicine, University Hospital Antwerp, Antwerp, Belgium. 112School of Public Health, Curtin University, Perth, Western Australia, Australia. 113Department of Pediatrics, University of Texas Austin, Austin, TX, USA. 114Department of Pharmacology and Therapeutics, Dhaka Medical College, Dhaka, Bangladesh. 115Department of Pharmacology, Bangladesh Industrial Gases Limited, Tangail, Bangladesh. 116Department of Computer Engineering, Islamic Azad University, Tehran, Iran. 117Computer Science Department, University of Human Development, Sulaimaniyah, Iraq. Funding Information: 153Department of Psychiatry, University of Nairobi, Nairobi, Kenya. 154Division of Psychology and Language Sciences, University College London, London, UK. 155International Institute for Population Sciences, Mumbai, India. 156Department of Community and Family Medicine, University of Baghdad, Baghdad, Iraq. 157School of Nursing, Hong Kong Polytechnic University, Hong Kong, China. 158Department of Medical Statistics and Epidemiology, Sun Yat-sen University, Guangzhou, China. 159Alliance for Improving Health Outcomes Inc, Quezon City, The Philippines. 160Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia. 161Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, China. 162Department of Dentistry, Radboud University, Nijmegen, The Netherlands. 163Section for Translational Health Economics, Heidelberg University Hospital, Heidelberg, Germany. 164Department of Epidemiology and Biostatistics, University of the Philippines Manila, Manila, The Philippines. 165Department of Public Health, Trnava University, Trnava, Slovakia. 166Community-Based Participatory-Research Center (CBPR), Tehran University of Medical Sciences, Tehran, Iran. 167Knowledge Utilization Research Center (KURC), Tehran University of Medical Sciences, Tehran, Iran. 168Department of Primary Care and Public Health, Imperial College London, London, UK. 169Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. 170Noncommunicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. 171Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran. 172Campus Caucaia, Federal Institute of Education, Science and Technology of Ceará, Caucaia, Brazil. 173Public Health Department, Botho University-Botswana, Gaborone, Botswana. 174Division of Plastic Surgery, University of Washington, Seattle, WA, USA. 175Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA. 176Peru Country Office, United Nations Population Fund (UNFPA), Lima, Peru. 177Center for Translation Research and Implementation Science, National Institutes of Health, Bethesda, MD, USA. 178Department of Medicine, University of Cape Town, Cape Town, South Africa. 179Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland. 180University of Helsinki, Helsinki, Finland. 181Clinical Microbiology and Parasitology Unit, Dr Zora Profozic Polyclinic, Zagreb, Croatia. 182University Centre Varazdin, University North, Varazdin, Croatia. 183Pacific Institute for Research & Evaluation, Calverton, MD, USA. 184Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India. 185Global Institute of Public Health (GIPH), Ananthapuri Hospitals and Research Centre, Trivandrum, India. 186Faculty of Internal Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan. 187Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan. 188Institute of Addiction Research (ISFF), Frankfurt University of Applied Sciences, Frankfurt, Germany. 189Department of Food Technology, College of Agriculture, Salahaddin University-Erbil, Erbil, Iraq. 190Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden. 191Department of Information Technology, University of Human Development, Sulaimaniyah, Iraq. 192Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria. 193Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran. 194Iran National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran. 195Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy. 196Department of Public Health Medicine, University of Kwazulu-Natal, Durban, South Africa. 197Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran. 198Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran. 199Department of Epidemiology and Biostatistics, Kurdistan University of Medical Sciences, Sanandaj, Iran. 200Department of Mathematical Sciences, University of Bath, Bath, UK. 201International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia. 202Department of Surgery, University of Washington, Seattle, WA, USA. 203Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran. 204Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. 205Department of Pediatric Medicine, Nishtar Medical University, Multan, Pakistan. 206Department of Pediatrics & Pediatric Pulmonology, Institute of Mother & Child Care, Multan, Pakistan. 207Cancer Research Center, Tehran University of Medical Sciences, Tehran, Iran. 208Department of Epidemiology & Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran. 209Suraj Eye Institute, Nagpur, India. 210Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa. 211General Surgery, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania. Funding Information: The findings of this study are supported by data that are available in public online repositories, data that are publicly available upon request from the data provider, and data that are not publicly available owing to restrictions by the data provider, which were used under license for the current study, but may be available from the authors upon reasonable request and permission of the data provider. A detailed table of data sources and availability can be found in Supplementary Table 2. Interactive visualization toolsare available at https://vizhub.healthdata.org/ lbd/education. All maps presented in this study are generated by the authors; no permissions are required for publication. Administrative boundaries were retrieved from the Global Administrative Unit Layers (GAUL) dataset, implemented by FAO within the CountrySTAT and Agricultural Market Information System (AMIS) projects58. Land cover was retrieved from the online Data Pool, courtesy of the NASA EOSDIS Land Processes Distributed Active Archive Center (LP DAAC), USGS/ Earth Resources Observation and Science (EROS) Center, Sioux Falls, South Dakota50. Lakes were retrieved from the Global Lakes and Wetlands Database (GLWD), courtesy of the World Wildlife Fund and the Center for Environmental Systems Research, University of Kassel59,60. Populations were retrieved from WorldPop49,61. All maps were produced using ArcGIS Desktop 10.6. Funding Information: Acknowledgements This work was primarily supported by grant OPP1132415 from the Bill & Melinda Gates Foundation. N.G. is the recipient of a training grant from the National Institute of Child Health and Human Development (T32 HD-007242-36A1). Publisher Copyright: © 2019, The Author(s).

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