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Journal of Nutrition. 2004 May; 134(5):1175-1180.The WHO recently conducted, within its Global Burden of Disease 2000 Study, a Comparative Risk Assessment (CRA) to estimate the global health effect of low fruit and vegetable intake. This paper summarizes the methods used to obtain exposure data for the CRA and provides estimates of worldwide fruit and vegetable intakes. Intakes were derived from 26 national population-based surveys, complemented with food supply statistics. Estimates were stratified by 14 subregions, 8 age groups, and gender. Subregions were categorized on the bases of child mortality under age 5 y and 15- to 59-y-old male mortality (A: very low child and adult mortality; B: low child and adult mortality; C: low child, high adult mortality; D: high child and adult mortality; E: high child, very high adult mortality). Mean intakes were highest in Europe A [median = 449 g/(person • d)] and the Western Pacific Region A. They were lowest in America B [median = 192 g/(person • d)], and low in Europe C, the South East Asian Regions B and D, and Africa E. Children and elderly individuals generally had lower intakes than middle-aged adults. SDs varied considerably by region, gender, and age [overall median = 223 g/(person • d)]. Assessing exposure levels for the CRA had major methodological limitations, particularly due to the lack of nationally representative intake data. The results showed mean intakes generally lower than current recommendations, with large variations among subregions. If the burden of disease attributable to dietary factors is to be assessed more accurately, more countries will have to assess the dietary intake of their populations using comparable methods. (author's)
New York, New York, United Nations, 1992. viii, 400 p. (ST/ESA/SER.A/128)Available child mortality data are provided since the 1960s for 82 developing countries, arranged alphabetically, with a population of >1 million. The scope and methodology of the data, the main findings, a guide to the notation and layout of the database, and country specific profiles are included. Available data are included from many different sources without adjustment; graphs are provided. There is a brief discussion of the nature of child mortality and the methods used to measure it such as the crude death rate, age specific death rates, the infant mortality rate, <5 mortality, mortality 1-5 years, and model life tables for age specific child mortality. There is also discussion of the various data sources and estimation methods: vital registration data, prospective surveys, household surveys, prospective sample surveys, surveillance systems, retrospective questions in censuses and surveys, questions on recent household deaths by age, Brass method questions to whom on aggregate number of children born or dead, questions on women's most recent birth and survival, and maternity histories. Commentary is provided on the common index approach and the intersurvey change approach to evaluation of child mortality estimates. There is not 1 best method for measuring mortality. Countries with the most complete reporting of vital registration data are Hong Kong, Israel, Mauritius, Puerto Rico, and Singapore. Countries with incomplete data which does not provide a good measure of child mortality are Egypt, El Salvador, Guatemala, Jamaica, and Trinidad and Tobago. Brass estimates which agree with vital registration data include the following countries: Costa Rica, Cuba, Kuwait, and Peninsular Malaysia. Indirect estimates which confirm vital registration data pertain to Chile and Uruguay. Brass questions provide satisfactory results in Costa Rica, Cuba, Egypt, El Salvador, Guatemala, Jamaica, Sri Lanka, and Trinidad and Tobago. Underestimates are expected for Argentina and Egypt. Indirect methods applied to census data provide good estimates for 23 countries, indirect methods applied to survey data yields good estimates for 21 countries, and direct calculations from maternity histories provide good estimates for 20 countries. 17 countries have poor results from maternity histories alone. Child mortality may have fallen by >50% in developing countries between 1960-85.
In: International Population Conference / Congres International de la Population, Montreal 1993, 24 August - 1st September. Volume 3, [compiled by] International Union for the Scientific Study of Population [IUSSP]. Liege, Belgium, IUSSP, 1993. 269-78.Modeling life table functions by statistical methods, begun at the Population Branch of the UN in the early 1950s, resulted in the publication of a set of model life tables. From 158 life tables for various countries and periods, the UN analysts noted that the probability of dying in a certain age interval provides excellent approximation when the parameters defining the polynomial are obtained by the method of least squares. Factor analysis of probabilities of dying from a set of 154 abridged life tables was found to produce 5 factors in an earlier study by Ledermann and Breas. In this study of 120 life tables each for males and females, a principal component analysis produced only 2 factors with eigenvalues greater than 1. Together these 2 factors explained 97 and 98%, respectively, of the male and the female variance. The 1st factor loadings were found to be inversely related to age, while the opposite was the case with the 2nd set. They could reproduce life expectancy with a high degree of accuracy, the squared multiple correlations being .98 for male and .97 for female life tables. In conjunction with suitable pairs of factor scores, model life tables can be constructed. The method is also suitable for the determination of factor scores of any life table which are indicators of the states of mortality at younger and older ages. Combinations of these factor scores can also generate sets of life tables with identical life expectancies. In replicating the analysis of Ledermann and Breas with these data, 4 factors with a 5th bordering on significance together explained only 91% of the variance compared with the 97% and 98% found by the current study. The 2 dimensions of life tables represented by the 2 factors provide an interesting comparison with their counterparts, namely region and life expectancy. A comparison of this model with the Brass relational logit model revealed it was similar to a special case of this model derived by retaining only the 1st factor. The 2-factor model should produce better results.
[The health-for-all strategy: are we reaching our targets to reduce mortality?] Helse for alle-strategien--nar vi malene for redusert dodelighet?
Tidsskrift for den Norske Laegeforening. 1992; 112(1):57-63.The author examines Norway's efforts toward attaining the WHO goal of health for all by the year 2000. "This article presents and discusses the sub-goals for expectation of life and mortality, and analyzes the possibilities of reaching them." Consideration is given to reductions in mortality from accidents, cardiovascular effects, and cancer; age-specific mortality rates; and deaths from suicide and homicide. (SUMMARY IN ENG) (EXCERPT)
In: D'Souza AA, de Souza A, ed. Population growth and human development. New Delhi, India, Indian Social Institute, 1974. 17-26.Although demographic statistics are grossly inadequate, a fairly convincing panorama of the population situation and trends has been prepared by demographers based on fragmentary information, coupled with assumptions and tested against collateral information. Population study reveals a 1st stage early in the recent historic perspective during which fertility and mortality rates were very high and the corresponding rates of natural growth were low. The 2nd stage of the transition begins with a decline in the death rates while fertility rates remained at high levels, and even increases, population growth accelerates during this period. This stage is characterized by rapid urbanization provoked by displacement of population from rural areas to urban centers. Fertility rates begin to decrease at a later period, in some cases more than 20 years after the decline of death rates--tending to level off with death rates at low levels. In this stage, population growth is near zero and has in some cases decreased. The entire transition may take at least 50 years. The key question is how to determine the crucial character of the interactions between population and the critical problems of our society: poverty; underdevelopment; gaps of income between and within countries; food; and environment. In 3 symposia at Cairo, Honolulu, and Stockholm, it was concluded that there were 3 schools of thought. 1 considered rapid population growth as a major cause of structural rigidities of the less developed economies, and therefore reduction of population growth as a 1st priority for improvement of living standards. Another, putting its faith in technological innovation, considered that the way to development was by socioeconomic changes rather than demographic paths of action. The 3rd considered the demograpic approach as one of many leading to the attainment of economic and social progress. The consensus was that there are limits to the growth of population both in the short-term and in the long-term. A World Population Conference held in Bucharest, Rumania in 1974 addressed the issues of recent population trends; relations between population change and economic and social development; relations between population, resources, and environment; and population, family, and well being.
Journal of Tropical Pediatrics. 1983 Aug; 29(4):217-9.The World Health Organization (WHO) launched the Expanded Program of Immunization (EPI) in 1974 based on the belief that most countries already had some elements of national immunization activities which could be successfully expanded if the program became a national priority with a commitment from the government to provide managerial manpower and funds. The federal government of Nigeria quickly adopted the policy of WHO on EPI and urged the state governments to set up administrative arrangements for planning and implementation of EPI. The program started off in Oyo State of Nigeria after a pilot study conducted at Ikire in Irewole Local Government area in 1975. The stated objectives of the programs were: to provide immunization service to at least 85% of the target population e.g. children under 4 years; and to integrate immunization programs into routine activities of all static primary health centers in the state. This study focuses on administration of the immunization program in the Oranmiyan Local Government area of Oyo State, within the structure of the local government health system and the field health administration of the state government. This study shows that the stated objectives of the EPI are not likely to be achieved in the near future because of low coverage of the eligible population, due to inadequate community involvement in the planning and implementation of the program; 2) poor communication between different government departments; and 3) inadequate publicity. The effect of improvement in health status because of immunization programs, has been very difficult to demonstrate in Nigeria because a lack of accurate data on birth, morbidity, and mortality patterns of the population. Other socioeconomic and health factors of significance in the battle against infectious diseases include environmental sanitation, adequate and safe water supply, housing and nutrition. Nevertheless, immunization programs constitute one of the most economical and effective approaches to the prevention of communicable diseases and can produce dramatic effects in the battle to lower infant and childhood mortaltiy rates in the developing countries if they are well implemented.
[Unpublished] 1981. Paper presented at International Union for the Scientific Study of Population, Committee on Factors Affecting Mortality and the Length of Life, Seminar on Methodology and Data Collection in Mortality Studies, Dakar, Senegal, July 1981. Published in: Methodologies for the Collection and Analysis of Mortality Data. Proceedings of a Seminar in Dakar, Senegal, July 7-10, 1981, [edited by] Jacques Vallin, John H. Pollard and Larry Heligman. Liege, Belgium, Ordina, 1984. p. 179-201. 25 p. (UNFPA Project No. INT/76/P14; Entry No. 0451; INT76P140451)An explanation of a theoretical actuarial/demographic basis for the statistical model of the new UN model life tables introduces this paper. The new tables are based on observed age patterns of mortality for developing countries. Age-specific death rates were calculated and evaluated on a country by country basis, and 36 male life tables and 36 female life tables that were shown to be of high quality were chosen as the basis for construction of model life tables. The methodology of model life table construction followed by Coale and Demeny, the regression approach followed by Ledermann, and the principal components analysis approach are described, as is the variant of classical principal components analysis used to construct the tables. 4 major age patterns of mortality were found, which have been labelled the Latin American pattern, the Chilean pattern, the South Asian pattern, and the Far Eastern pattern. The 5th pattern, the general pattern, is constructed as an average of all the life tables in the refined data set, without considerations of cluster. The 1st principal component vector models the age patterns of mortality change, the 2nd models characteristic differences in mortality under age 5, and the 3rd affects mortality during the childbearing ages for females and at various ages for males. Other products of the UN model life table project are described.
In: Holland, W.W., Ipsen, J., and Kostrzewski, J., eds. Measurement of levels of health. Copenhagen, Denmark, World Health Organization, Regional Office for Europe, 1979. (WHO Regional Publications, European Series No. 7) p. 413-417The ratio of accident mortality rate to total mortality rate indicates both the importance of accidents within the total mortality and the socioeconomic and industrial development of a country. WHO between 1950 and 1971 studied accident mortality in childhood in various countries and found the average accident mortality in 1 to 4 years olds was 32.4/100,000 for males and 22.8/100,000 for females. This rate decreased to 23.1 for 5 to 14 year old males and 10.9 for females in the same age group. Types of accidents vary by country with Asia and Oceania reporting more accidental drownings than motor vehicle accidents for boys age 1 to 4. Home accidents are more frequent among the older age group.
Myocardial infarction community registers: a WHO International Collaborative Study coordinated by the Regional Office for Europe.
In: Holland, W.W., Ipsen, J., and Kostrzewski, J., eds. Measurement of levels of health. Copenhagen, Denmark, World Health Organization, Regional Office for Europe, 1979. (WHO Regional Publications, European Series No. 7) p. 341-352In 1967, it was shown that cardiovascular disease accounted for 39% of all male deaths between the ages of 25 and 64 years old in 29 technologically advanced countries. 75% of these deaths were due to IHD (Ischaemic Heart Disease) with the most frequent clinical syndrome being AMI (acute myocardial infarction). WHO office for central cardiovascular disease is studying the national mortality statistics and hospital mortality data covering a population of 3.5 million aged 20-65. Statistics showed that there was as much as a 3-1/2 hour delay in reaching the hospital, 1/4 of which is attributed to the delay between the time a physician is called and the 1st examination, but the greatest delay was the time lost before a physician is called. 32% of all deaths in 1 year occur within 30 minutes of onset, so approximately 13% are dead before medical assistance arrives. The biggest delay, created by the patient's reluctance to call for medical assistance, cannot be overcome by medical organizational solutions. The WHO/EURO CVD programs are establishing pilot areas for control of CVD, setting up rehabilitation and secondary prevention for AMI patients, and preparing registers of the diseases for further studies.
Syncrisis: the dynamics of health. An analytic series on the interactions of health and socioeconomic development. V. El Salvador.
Washington, D.C., U.S. Government Printing Office, October 1972. (Syncrisis: The Dynamics of Health, No. 5) 53 pThis brief overview focuses on the basic health situation in El Salvador. An attempt is made to point to the interactions between health and other sectors in the hope that this will influence others to think in the direction of multisector influences. The 3 main health problems in El Salvador relate to nutrition, health services, and sanitation. There is a tremendous burden placed on a society by a weak and ill population, and this is especially true in El Salvador where over 1/2 the children are malnourished and simple childhood diseases are often fatal. However, there seem to be no government or other programs to alleviate this problem, and nutrition is only dealt with in relation to adult literacy programs. Improvement of the nutritional status of the population would benefit the health and well being of the population. Regarding the availability of health services, some form of health facility is available to 85.6% of the population, but over 1/2 these facilities are not permanently staffed. There are, however, more sophisticated facilities which are fairly evenly distributred throughout the country. Deaths which are not certified by a physician are at a high of 65%, indicating that medical care was not available at or near the time of death for the majority of those dying. The country has a good transportation system; there are not any obvious cultural barriers to seeking modern medical care, and yet the people of El Salvador, young and old alike die from a lack of care. It is encouraging that in the area of sanitation there is at least much activity. Poor sanitation is 1 of the basic underlying causes for a large percentage of the diseases, and until this problem is resolved, the country will continue to experience preventable diseases.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1982; 35(1):2-10.The goal of health for all by the year 2000 was first stated at the 1977 World Health Assembly and global strategy was launched at the 32nd World Health Assembly in 1979. This article focuses on life expectancy at birth as the most widely used indicator of the health status of populations and also the health status indicators most closely correlated with socioeconomic development. Developing countries have set a target of life expectancy of 60 years; at present 86% of these countries are exposed to mortality conditions which leave life expectancy at age 50. Among 80 countries with GNP per capita of more than $500 61 have life expectancy over 60 years and of the 35 with a life expectancy of 70 or more 28 have GNP over $2500. The largest concentration of countries below the target level is in Asia. Discovering the leading causes of death is crucial in raising life expectancy; in developed countries they are cardiovascular disease, malignant neoplasms, and accidents, accounting for 70% of all deaths. In developing countries there is variation with regard to level of modernization of the cause of death structure but in at least 1/2 the 3 latter causes are also predominant with diarrheal disease and infectious and parasitic conditions related to malnutrition the main causes in the other 1/2. When assessing the health care needs of developing countries the difference between countries regarding their ability to reduce mortality from the traditional diseases must be considered before deciding on use of resources.
In: United Nations [UN]. Economic and Social Commission for Asia and the Pacific [ESCAP]. Population of Australia. Vol. 1. New York, New York, UN, 1982. 160-82. (Country Monograph Series No. 9; ST/ESCAP/210)Major trends in Australian mortality levels and patterns over the past century have included a declining level of mortality, changes in the distribution of the major causes of death, and changing male-female mortality differentials. In 1978, the crude death rate was 7.6/1000 population, the infant mortality rate was 12.2/1000 live births, and average life expectancy was 70.2 years for men and 77.2 years for women. The most frequent causes of death were ischemic heart disease (32.5% of male and 27% of female deaths), cancer (18.9% of male and 18.4% of female deaths), and cerebrovascular diseases (10% of male and 18% of female deaths). These statistics place Australia in the group of countries with the lowest mortality and highest life expectancy. Mortality declines have been greatest at the youngest ages. Most infant mortality is now concentrated in the neonatal period, especially at less than 1 day of age. Differences between male and female mortality rates have widened in recent years, due both to the decreasing significance of deaths among women from maternal causes or infectious diseases and the increasing incidence among men of mortality from accidents, lung cancer, and coronary heart disease. A narrowing gap of mortality has been observed between the states. However, higher infant and overall mortality rates persist in the Northern Territory where the Aboriginal population is concentrated. Although there are no systematic data on urban-rural mortality differentials, studies have found a higher incidence of deaths from pneumonia in the rural areas and greater mortality from lung cancer in the urban centers. The mortality of overseas-born Australians has been noted to converge toward that of native-born Australians the longer their duration of residence in the country. Recent population projections prepared by the Australian Bureau of Statistics include 2 sets of assumptions about future mortality trends. The 1st predicts an infant mortality rate of 7.7/1000 live births by 2001. The 2nd projects an annual 1.5% decline in age-specific mortality rates, resulting in an average life expectancy at birth in the year 2001 of 73.6 years for males and 80.3 years for females. A basic question facing government policymakers is the extent to which the incidence of diseases associated with biological degeneration can be controlled or cured by intervention or life style changes.