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Child mortality estimation: Methods used to adjust for bias due to AIDS in estimating trends in under-five mortality.
PLOS Medicine. 2012 Aug; 9(8):e1001298.In most low- and middle-income countries, child mortality is estimated from data provided by mothers concerning the survival of their children using methods that assume no correlation between the mortality risks of the mothers and those of their children. This assumption is not valid for populations with generalized HIV epidemics, however, and in this review, we show how the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) uses a cohort component projection model to correct for AIDS-related biases in the data used to estimate trends in under-five mortality. In this model, births in a given year are identified as occurring to HIV-positive or HIV-negative mothers, the lives of the infants and mothers are projected forward using survivorship probabilities to estimate survivors at the time of a given survey, and the extent to which excess mortality of children goes unreported because of the deaths of HIV-infected mothers prior to the survey is calculated. Estimates from the survey for past periods can then be adjusted for the estimated bias. The extent of the AIDS-related bias depends crucially on the dynamics of the HIV epidemic, on the length of time before the survey that the estimates are made for, and on the underlying non-AIDS child mortality. This simple methodology (which does not take into account the use of effective antiretroviral interventions) gives results qualitatively similar to those of other studies.
[Crisis in human resources for health: millennium development goals for maternal and child health threatened] Tekort aan gezondheidswerkers in Afrika: millenniumdoelstellingen voor moeder- en kindzorg in gevaar.
Nederlands Tijdschrift Voor Geneeskunde. 2010; 154(5):A1159.International migration of health care workers from low-income countries to the West has increased considerably in recent years, thereby jeopardizing the achievements of The Millennium Development Goals, especially number 4 (reduction of child mortality) and 5 (improvement of maternal health).This migration, as well as the HIV/AIDS epidemic, lack of training of health care personnel and poverty, are mainly responsible for this health care personnel deficit. It is essential that awareness be raised amongst donors and local governments so that staffing increases, and that infection prevention measures be in place for their health care personnel. Western countries should conduct a more ethical recruitment of health care workers, otherwise a new millennium development goal will have to be created: to reduce the human resources for health crisis.
Lancet. 2003 Nov; 362(9395):1557.In a follow up to demands by the 2001 Commission on Macroeconomics and Health (CMH) for a massive increase in health investment, ministers in charge of health, finance, and planning from 40 developing countries met on Oct 29–30 to discuss progress and priorities. Aside from lip service paid to recent achievements, the assessment from the WHO-convened conference was bleak. “Two years on, the world still has not shown determination to increase health investment enough to measurably impact major diseases that affect the world’s poor”, said WHO. (excerpt)
In: Population policies and programmes. Proceedings of the United Nations Expert Group Meeting on Population Policies and Programmes, Cairo, Egypt, 12-16 April 1992. New York, New York, United Nations, 1993. 27-41. (ST/ESA/SER.R/128)The world population reached 5.4 billion in mid-1991, and it is growing by 1.7% per annum. The medium-variant United Nations population projection for the year 2025 is now 8.5 billion, 260 million more than the United Nations projection in 1982. This implies reducing the total fertility rate in the developing countries from 3.8 to 3.3 by the year 2000 and increasing contraceptive prevalence from 51 to 59%. This will involve extending family planning services to 2 billion people. For the first time, fertility is declining worldwide, as governments have adopted fertility reduction measures through primary health care education, employment, housing, and the enhanced status of women. Since the 1960s, contraceptive prevalence in developing countries has grown from less than 10% to slightly over 50%. However, 300 million men and women worldwide who desire to plan their families lack contraceptives. Life expectancy has been increasing: for the world, it is 65.5 years for 1990-1995. Infant mortality rates have been halved. Child mortality has plummeted, but in more than one-third of the developing countries it still exceeds 100 deaths/1000 live births. Globally, child immunization coverage increased from only 5% in 1974 to 80% in 1990. At the beginning of the 1980s, only about 100,000 persons worldwide were infected with HIV. During the 1980s, 5-10 million people became infected. WHO projects that the cumulative global total of HIV infections will be between 30 and 40 million by 2000. The European governments are concerned with growing international migration. Currently, 34.5% of governments have adopted policies to lower immigration. In the early 1970s, the number of refugees worldwide was about 3.5 million; by the late 1980s, they had increased to nearly 17 million. A Program of Action for the Least Developed Countries for the 1990s was adopted in September 1990 to strengthen the partnership with the international donor community.
Bangkok, Thailand, WHO/UNESCO AIDS Education and Health Promotion Materials Exchange Centre for Asia and the Pacific, 1990. , 10,  p.A resource booklet for use by Asian and Pacific country AIDS education programs, published on World AIDS Day, 1 December 1990 entitled "AIDS and Women" is made up of a background introduction, a set of 1-page country profiles, and annexes chiefly documents issued by international agencies on AIDS and topics related to women. Women are particularly vulnerable in the oncoming AIDS epidemic both because they are getting infected in higher numbers, and because they bear the burdens of family care, income and food production, caring for the sick, and the personal, social and economic problems resulting from death of a spouse. While women increasingly become infected via heterosexual intercourse, and they must decide whether to become pregnant, they often do not have the power to coerce a partner to use condoms, nor do they have the benefit of literacy or education to deal with the issues. Female education, of in-school and out-of-school women, will help a country's total fertility rate and infant mortality rate, but is more important for controlling AIDS. Each country statistical profile includes demographic and health items such as population, age structure, life expectancy, birth, death and total fertility rate, infant, maternal and under-5 mortality rates, adult female illiteracy rate, expenditure on health and education, and number of reported AIDS cases.
[Unpublished] 1991. Presented at the Demographic and Health Surveys World Conference, Washington, D.C., August 5-7, 1991. 8 p.The maternal and child health/family planning (MCH/FP) program at WHO specifies the priorities for MCH/FP in the 1990s. Results of the Demographic and Health Surveys (DHS) in many, but not all, developing countries have shown overall improvement in fertility and maternal and child health, especially in the family planning and child survival movements. Maternal mortality did not change, however. Moreover, maternal mortality in some countries exceeded natural maternal mortality. These elevations sparked a 3rd movement in the late 1980s, safe motherhood. These results confirm that the public health community cannot become complacent. Indeed it must strengthen the infrastructure, management, and performance of the health system to maintain gains. This involves identifying a novel strategy to priority setting and program development which are adapted to the changing needs and circumstances of each country, and even within each country. In fact, firm program strategies and policies need to concentrate on maternal health and morbidity, newborn care, breast feeding, perinatal infections, and HIV/AIDS. Based on DHS data and on evaluations of MCH/FP programs, WHO lists crucial principles for successful programs. The 1st principle includes equity in access and use of social resources which includes disaggregating data according to geographic and population subgroups to find appropriate strategies to close the widening gap within and between countries. The next principle is community and health care provider participation and ownership. Indeed successful MCH/FP programs are those where the community identifies problems and needs and evaluates the program. The 3rd principle encompasses quality data collection to assess quality of care and program effectiveness. WHO has proposed 5 priorities for organization and management of MCH/FP programs. 1 priority which WHO suspects will generate the most debate is integration of family planning, child survival, and safe motherhood programs.
Lancet. 1990 Jul 28; 336(8709):221-4.The World Health Organization (WHO) has developed an acquired immunodeficiency syndrome (AIDS) projection model based on available human immunodeficiency virus (HIV) serologic survey data and annual rates of progression from HIV infection to AIDS. The model assumes a progression rate to AIDS, for adults, of 75% within 15 years and 95% within 20 years, and, for children, of 25% in the 1st year, 45% by the end of the 2nd year, 60% by the end of the 3rd year, and 80% by the 4th year. Application of this model suggests that, by early 1990, over 3 million women, most of whom were of childbearing age and 80% of whom are in sub-Saharan Africa, were infected with HIV. The model further suggests that, by the end of 1989, there will be excess of 800,000 AIDS cases in African women and close to 300,000 pediatric AIDS cases; by the end of 1992, these figures are projected to be 600,000 cases in women and 600,000 cases in children. Since the majority of these African cases will go undiagnosed, and untreated, death can be expected to occur within a year after symptoms. AIDS will obviously have a major impact on child and adult mortality rates in regions such as sub-Saharan Africa. In countries where 10% or 20% of pregnant women are HIV- infected (a not uncommon phenomenon in Central African cities), the child mortality rate can be expected to be 118 or 136/1000 live births, respectively. In addition, a 5-10% prevalence of HIV infection among sexually active adults in these cities can be expected to double or triple the adult mortality rate by the early 1990s and lead to a 10% increase in the number of uninfected orphans in Africa. As growing numbers of women and children become infected with the HIV virus, African governments will be forced to address the need for greater social support to these families.
GLOBAL AIDS FACTFILE. GPA DIGEST. 1989; 1-4.The keynote address by WHO Global Programme on AIDS director Jonathan Mann and the recommendations resulting from the International Conference on the Implications of AIDS for Mothers and Children, held in Paris in November 1989 are presented. Of the 6 million AIDS victims about 1.3 are women. More women are predicted to develop AIDS in the next 2 years than in the 1st decade of the pandemic. In a population with a child morality of 100/1000, if 10% of mothers are infected, child mortality will increase by 18%. HIV infection rates among pregnant women are reported at 4.3% in Newark, New Jersey, 3.6% in Miami, 3.1% in New York City, and 1% in Paris. AIDS with its destruction of families, abandonment, discrimination and fear, challenges the inequities of the status quo. We need to reverse the deficiencies in health and social services to women and children, to provide health services such as safe blood transfusion where women are the greatest users, to clarify reproductive rights for HIV-infected women, to research such topics as the effect of zidovudine in women and children, and the efficacy of vaginal virucidal agents. HIV/AIDS prevention and control must be integrated into existing maternal and child health services. Women should be included in decision-making on policies affecting AIDS. The Paris declaration on Women, Children and AIDS has 15 points of implementation urged upon governments, the UN, non-governmental organizations, health professionals, scientists and the public, beginning with mobilizing resources to prevent and care for HIV infections in women and children, and ending with recognizing the role of women in the Global-AIDS strategy.
In: AIDS and associated cancers in Africa, edited by G. Giraldo, E. Beth-Giraldo, N. Clumeck, Md-R. Gharbi, S.K. Kyalwazi, G. de The. Basel, Switzerland, Karger, 1988. 6-10.The global acquired immunodeficiency syndrome (AIDS) epidemic has, in fact, been comprised of 3 successive epidemics. The 1st of these epidemics is infection with human immunodeficiency virus (HIV), which has already affected 5-10 million people worldwide. The 2nd epidemic, following the 1st but with a delay of several years, is the epidemic of AIDS and other related conditions. By September 1987, a total of 59,563 cases of AIDS had been reported to the World Health Organization (WHO) from 123 countries. However, given the reluctance of some countries to report AIDS and underrecognition of the syndrome, WHO believes the actual number of global AIDS cases is closer to 100,000. 10-30% of HIV-infected persons appear to develop AIDS within a 5-year period, suggesting that 500,000-3 million new cases of AIDS will emerge during the next 5 years. The 3rd epidemic is the wave of economic, social, and political reaction to the 1st 2 epidemics. Since AIDS most often affects individuals in the most economically and socially productive age groups, it can be expected to have a devastating effect on social and economic development in Third World countries. In areas where 10% or more of pregnant women are infected with HIV, projected gains in infant and child health anticipated through child survival initiatives will be cancelled out. AIDS is also having a devastating effect on the health care system in Third World countries as AIDS patients consume limited supplies of drugs, require costly diagnostic tests, and occupy limited numbers of hospital beds. Fear and ignorance about AIDS has threatened free travel between countries and open international exchange and communication. WHO believes the spread of AIDS can be stopped, but only through a sustained, longterm commitment that extends beyond the boundaries of individual countries. AIDS control will require both committed national AIDS programs and strong international leadership, coordination, and cooperation.
[Unpublished] 1988. Presented at the 116th Annual Meeting of the American Public Health Association [APHA], Boston, Massachusetts, November 13-17, 1988. 7 p.In most developing countries, particularly those in Africa and the Caribbean, equal numbers of women as men are affected by the acquired immunodeficiency syndrome (AIDS) and have the potential to infect their fetuses. Thus, any consideration of the AIDS problem in developing countries must give serious attention to women and children. Current research suggests a perinatal transmission rate of 30-40% and there is concern that AIDS-related pediatric deaths will undermine child survival efforts in countries that have begun to reduce infant and child mortality rates. A number of clinical issues that are now poorly understood require immediate research so that findings can be incorporated into AIDS prevention strategies. Among these issues are: the impact of pregnancy on progression of human immunodeficiency virus (HIV) infection to AIDS; factors that affect an HIV-infected mother's chance of infecting her fetus; the safety of breastfeeding; immunization; the relationships between HIV infection and various contraceptives; and the potential impact of HIV infection on fertility. The extent and nature of the social and financial impact of AIDS at the family and community levels must also be better understood. In the interim, UNICEF has proposed 6 programmatic approaches to prevent women from becoming infected, to prevent perinatal transmission, and to address the AIDS-related needs of women and children. 1st, traditional birth attendants should be trained in AIDS prevention measures and provided with supplies to ensure infection control. 2nd, women must be able to receive consistent, appropriate advice from both maternal-child health workers and family planning staff about contraception and their future health. 3rd, the issue of counseling for women should be broadened beyond that associated with routine prenatal HIV screening. 4th, AIDS education efforts for school-age children must be expanded. 5th, more attention should be given to the social service needs of AIDS-infected women and children. And 6th, there is an urgent need to improve protocols and treatment facilities for those affected with HIV and AIDS.
POPULATION TODAY. 1989 Feb; 17(2):4.World governments have reported a total of 132,977 cases of acquired immunodeficiency syndrome (AIDS) to the World Health Organization (WHO) to date; 59,229 of these AIDS cases were reported in 1988 alone. Moreover, WHO officials consider these statistics to greatly underestimate the true extent of the problem. At least 300,000-350,000 people are believed to have AIDS, with an additional 5-10 million infected with the human immunodeficiency virus (HIV). WHO projects over 1 million AIDS cases by 1992. In the US, 32,399 AIDS cases were reported to the Centers for Disease Control in 1988, for a cumulative case total since June 1981 of 82,406 cases. This total includes 1341 cases involving children. At least 10,911 people died of AIDS in the US in 1988, with a cumulative total since 1981 of 46,134 deaths. If current trends continue, the US National Institute of Child Health and Human Development expects AIDS to become the 5th leading cause of death for those aged 1-24 years. At present, AIDS is the 9th leading cause of death of children 1-4 years old and the 7th cause of death for those 15-24 years of age.