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Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care.
Permanente Journal. 2016 spring; 20(2):59-70.The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere, with rates similar to those found in Afghanistan and several African countries. We identify several factors that have perpetuated this health care crisis and summarize the literature highlighting the most cost-effective, evidence-based interventions proved to decrease these mortality rates in low- and middle-income countries.To create a major change in Haiti's health care infrastructure, we are implementing two strategies that are unique for low-income countries: development of a countrywide network of geographic "community care grids" to facilitate implementation of frontline interventions, and the construction of a centrally located referral and teaching hospital to provide specialty care for communities throughout the country. This hospital strategy will leverage the proximity of Haiti to North America by mobilizing large numbers of North American medical volunteers to provide one-on-one mentoring for the Haitian medical staff. The first phase of this strategy will address the child and maternal health crisis.We have begun implementation of these evidence-based strategies that we believe will fast-track improvement in the child and maternal mortality rates throughout the country. We anticipate that, as we partner with private and public groups already working in Haiti, one day Haiti's health care system will be among the leaders in that region.
Medical Anthropology. 2016 Jul-Aug; 35(4):322-37.This essay discusses the Indian government's implementation of maternal death reviews (MDR) across the country in response to a global WHO strategy called 'Beyond the Numbers.' India's MDR process attempts to better count and assess maternal deaths across the country, yet considerable challenges remain. Existing studies of the MDR process in India still reveal systemic failures including poor quality of obstetric care, as well as omissions or delays of care that are covered up or denied. An ethnographic case study suggests ways that ethnographic sensibilities or techniques could be used to harness community stakeholders or lay perspectives by privileging ambiguity, multiplicity, and conflicting views in order to reveal these systemic omissions or failures of accountability. It concludes by suggesting how ethnographic ways of knowing might elicit lay concerns or critiques that threaten the very medical privileges that the MDR process inadvertently shores up.
Lancet Global Health. 2016 Nov; 4(11):e766-e768.Along with the individual trial findings, the figure [contained in this comment]: "Log odds of neonatal mortality associated with chlorhexidine cord cleansing, by proportion of home deliveries in control group (A) and neonatal mortality in control group (B)" is consonant with the current WHO guidelines for cord care, to which we recommend no change. Cord cleanliness is part of the suite of hard-won improvements that accompany the increases in survival being seen worldwide. In settings in which neonatal mortality rates remain high, we recommend the kinds of programme that have been associated with reductions in all-cause mortality. These include improvements in institutional quality of care and efforts to improve community-based practices, both central to the 2014 Every Newborn Action Plan. (Excerpts) © The Author(s). Published by Elsevier Ltd. Open Access.
Towards the WHO target of zero childhood tuberculosis deaths: an analysis of mortality in 13 locations in Africa and Asia.
International Journal of Tuberculosis and Lung Disease. 2013 Dec; 17(12):1518-23.SETTING: Achieving the World Health Organization (WHO) target of zero paediatric tuberculosis (TB) deaths will require an understanding of the underlying risk factors for mortality. OBJECTIVE: To identify risk factors for mortality and assess the impact of human immunodeficiency virus (HIV) testing during anti-tuberculosis treatment in children in 13 TB-HIV programmes run by Medecins Sans Frontieres. DESIGN: In a retrospective cohort study, we recorded mortality and analysed risk factors using descriptive statistics and logistic regression. Diagnosis was based on WHO algorithm and smear microscopy. RESULTS: A total of 2451 children (mean age 5.2 years, SD 3.9) were treated for TB. Half (51.0%) lived in Asia, the remainder in sub-Saharan Africa; 56.0% had pulmonary TB; 6.4% were diagnosed using smear microscopy; 211 (8.6%) died. Of 1513 children tested for HIV, 935 (61.8%) were positive; 120 (12.8%) died compared with 30/578 (5.2%) HIV-negative children. Risk factors included being HIV-positive (OR 2.6, 95%CI 1.6-4.2), age <5 years (1.7, 95%CI 1.2-2.5) and having tuberculous meningitis (2.6, 95%CI 1.0-6.8). Risk was higher in African children of unknown HIV status than in those who were confirmed HIV-negative (1.9, 95%CI 1.1-3.3). CONCLUSIONS: Strategies to eliminate childhood TB deaths should include addressing the high-risk groups identified in this study, enhanced TB prevention, universal HIV testing and the development of a rapid diagnostic test.
Geneva, Switzerland, WHO, 2013.  p.The World Malaria Report 2013 summarizes information received from malaria-endemic countries and other sources, and updates the analyses presented in the 2012 report. It highlights the progress made towards global malaria targets set for 2015, and describes current challenges for global malaria control and elimination.
New York, New York, UNICEF, 2013 Sep.  p.Despite rapid progress in reducing child deaths since 1990, the world is still failing to renew the promise of survival for its most vulnerable citizens. Without faster progress on reducing preventable diseases, the world will not meet its child survival goal (MDG 4) until 2028 -- 13 years after the deadline -- and 35 million children will die between 2015 and 2028 who would otherwise have lived had we met the goal on time. Of the 6.6 million under-five deaths in 2012, most were from preventable causes such as pneumonia, diarrhoea or malaria; around 44% of deaths in children under 5 occurred during the neonatal period. Accelerating progress in child survival urgently requires greater attention to ending preventable child deaths in sub-Saharan Africa and South Asia, which together account for 4 out of 5 under-five deaths globally. West and Central Africa in particular requires a special focus for child survival, as it is lagging behind all other regions, including Eastern and Southern Africa, and has seen virtually no reduction in its annual number of child deaths since 1990.The good news is that much faster progress is possible. Country experience shows that sharp reductions in preventable child deaths are possible at all levels of national income and in all regions. A Promise Renewed is a movement based on shared responsibility for child survival, and is mobilizing and bringing together governments, civil society, the private sector and individuals in the cause of ending preventable child deaths within a generation. (Excerpts)
A Clinical Prediction Score in Addition to WHO Criteria for Anti-Retroviral Treatment Failure in Resource-Limited Settings - Experience from Lesotho.
PLoS ONE. 2012 Oct 31; 7(10):e47937.Objective: To assess the positive predictive value (PPV) of a clinical score for viral failure among patients fulfilling the WHO-criteria for anti-retroviral treatment (ART) failure in rural Lesotho. Methods: Patients fulfilling clinical and/or immunological WHO failure-criteria were enrolled. The score includes the following predictors: Prior ART exposure (1 point), CD4-count below baseline (1), 25% and 50% drop from peak CD4-count (1 and 2), hemoglobin drop=1 g/dL (1), CD4 count<100/µl after 12 months (1), new onset papular pruritic eruption (1), and adherence<95% (3). A nurse assessed the score the day blood was drawn for viral load (VL). Reported confidence intervals (CI) were calculated using Wilsons method. Results: Among 1'131 patients on ART=6 months, 134 (11.8%) had immunological and/or clinical failure, 104 (78%) had blood drawn (13 died, 10 lost to follow-up, 7 did not show up). From 92 (88%) a result could be obtained (2 samples hemolysed, 10 lost). Out of these 92 patients 47 (51%) had viral failure (=5000 copies), 27 (29%) viral suppression (<40) and 18 (20%) intermediate viremia (40-4999). Overall, 20 (22%) had a score=5. A score=5 had a PPV of 100% to detect a VL>40 copies (95%CI: 84-100), and of 90% to detect a VL=5000 copies (70-97). Within the score, adherence<95%, CD4-count<100/Âµl and papular pruritic eruption were the strongest single predictors. Among 47 patients failing, 8 (17%) died before or within 4 weeks after being switched. Overall mortality was 4 (20%) among those with score=5 and 4 (5%) if score<5 (OR 4.3; 95%CI: 0.96-18.84, p = 0.057). Conclusion: A score=5 among patients fulfilling WHO-criteria had a PPV of 100% for a detectable VL and 90% for viral failure. In settings without regular access to VL-testing, this PPV may be considered high enough to switch this patient-group to second-line treatment without confirmatory VL-test.
Prenatal care associated with reduction of neonatal mortality in Sub-Saharan Africa: evidence from Demographic and Health Surveys.
Acta Obstetricia et Gynecologica Scandinavica. 2011 Jul; 90(7):779-90.OBJECTIVE: To determine whether prenatal care by a skilled provider (physician, nurse or midwife) and specific prenatal interventions were associated with decreased neonatal mortality. DESIGN: Mothers' reports in nationally representative surveys (conducted 2003-2009) about their most recent delivery were analyzed. Setting. Sub-Saharan Africa, 17 least developed countries (UN designation). POPULATION: 89 655 women aged 15-49 years with a singleton birth within 3 years prior to survey. Methods. Logistic regression models were used to measure the associations between having a skilled prenatal provider, as well as specific interventions, and neonatal mortality. MAIN OUTCOME MEASURES: Neonatal mortality, defined as a live birth ending in death at less than one month of age. RESULTS: Overall, 70.7% of women saw a skilled prenatal provider during their previous pregnancy. Prenatal care from a skilled provider was associated with a decreased neonatal mortality risk compared with no provider [adjusted odds ratio (AOR) 0.70, 95% confidence interval (CI) 0.62-0.80] and compared with an unskilled provider (AOR 0.81, 95% CI 0.68-0.96). The most effective prenatal interventions were weight (AOR 0.71, 95% CI 0.64-0.80) and blood pressure measurements (AOR 0.77, 95% CI 0.69-0.86), and two or more tetanus immunizations (AOR 0.78, 95% CI 0.70-0.86). Four or more prenatal visits compared with none were associated with decreased neonatal mortality risk (AOR 0.68, 95% CI 0.59-0.79). CONCLUSIONS: Prenatal care provided by skilled providers, at least four prenatal visits, weight and blood pressure assessment, and two or more tetanus immunizations were associated with decreased neonatal mortality in Sub-Saharan African countries. (c) 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica(c) 2011 Nordic Federation of Societies of Obstetrics and Gynecology.
Reproductive and sexual health rights: 15 years after the International Conference on Population and Development [editorial]
International Journal of Gynaecology and Obstetrics. 2009 Aug; 106(2): p.For the past 15 years, the World Report on Women's Health has been published in the International Journal of Gynecology and Obstetrics (IJGO) every 3 years to mark the occasion of the FIGO World Congress. The topic of the 2006 World Report was promoting partnerships to improve access to women's reproductive and sexual health. It is fitting that, following the International Conference on Population and Development (ICPD) held in Cairo in 1994, the 2009 World Report addresses reproductive and sexual health rights 15 years after this significant conference took place. Despite some of the progress made in achieving reproductive and sexual health rights in many countries, many agenda items from the ICPD Programme of Action remain unfinished, and these are now emphasized in the health-related Millennium Development Goals (MDGs) 4, 5, and 6. The WHO Reproductive Health Research division has indicated that the core elements for improvement include improving prenatal, delivery, post partum, and newborn care; providing high-quality services for family planning including infertility services; eliminating unsafe abortion; combating sexually transmitted infections including HIV, reproductive tract infections, cervical cancer, and other gynecological morbidities; and promoting sexual health. It identified 6 areas of action including strengthening the capacity of health systems, improving the information base for priority settings, mobilizing political will, creating supportive legislation and regulatory frameworks, and strengthening, monitoring, evaluation, and accountability. The 2009 World Report provides the reader with a comprehensive and concise overview of what has been achieved in women's reproductive and sexual health rights since the ICPD, unmet needs, obstacles, and the feasible actions in the countdown to 2015 as outlined in the ICPD Programme of Action and the health-related MDGs. The July 2008 Summit Declaration of the G8 countries called for reproductive health to be "widely accessible," for closer links between HIV/AIDS and family planning programs, and strengthening of health systems. It is hoped that the latest global economic crisis will not negatively impact the commitments of rich countries to reproductive and sexual health programs in low-resource countries to reduce mortality and improve the quality-of-life of women and newborns around the world. (excerpt)
Journal of Tropical Pediatrics. 2008 Dec; 54(6):364-9.AIM: To assess the clinical outcomes of a combined approach to the treatment of severe acute malnutrition in an area of high HIV prevalence using: (i) an initial inpatient phase, based on WHO guidelines and (ii) an outpatient recovery phase using ready-to-use therapeutic food. METHODS: An operational prospective cohort study implemented in a referral hospital in Southern Malawi between May 2003 and 2004. Patient outcomes were compared with international standards and with audits carried out during the year preceding the study. RESULTS: Inpatient mortality was 18% compared to 29% the previous year. Programme recovery rate was 58.1% compared to 45% the previous year. The overall programme mortality rate was 25.7%. Of the total known HIV seropositive children, 49.5% died. CONCLUSIONS: Inpatient mortality and cure rates improved compared to pre-study data but the overall mortality rate did not meet international standards. Additional interventions will be needed if these standards are to be achieved.
Outcome of severely malnourished children treated according to UNICEF 2004 guidelines: a one-year experience in a zone hospital in rural Ethiopia.
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2008 Sep; 102(9):939-44.Malnutrition still has a dramatic impact on childhood mortality in sub-Saharan African countries. Very few studies have tried to evaluate the outcome of severely malnourished children treated according to the UNICEF 2004 guidelines and reported fatality rates are still very high. During 2006, 1635 children were admitted to the paediatric ward of St. Luke Catholic Hospital in Wolisso, South West Shewa, Ethiopia. Four hundred and ninety-three (30.15%) were severely malnourished and were enrolled in the study. We reviewed the registration books and inpatient charts to analyze their outcome. A mortality rate of 7.1% was found, which is significantly lower than reported in the literature. 28.6% of deaths occurred within 48 h of admission; the recovery rate was 88.4%; the drop-out rate was 4.5%. Early deaths were due to the poor condition of the children on admission, leading to failure of treatment. Late mortality was considered to be related to electrolyte imbalances, which we were unable to measure. The clinical skills of nursing and medical staff were considered an important factor in improving the outcome of malnourished patients. We found that proper implementation of WHO guidelines for the hospital treatment of severely malnourished children can lead to a relatively low mortality rate, especially when good clinical monitoring is assured.
Journal of Pediatric Gastroenterology and Nutrition. 2008 Aug; 47 Suppl 1:S10-4.In Latin America and the Caribbean, malnutrition still represents a health concern expressed mainly as stunting and micronutrient deficiencies, lessening the attention given to acute malnutrition (moderate and severe); however, the latter has a high fatality rate. Ending these avoidable deaths represents a major health and ethical challenge in the region. Acute malnutrition plus infections (mainly diarrhea and pneumonia) determine an important fraction of the fatality rate due to malnutrition in most regions, especially those with higher poverty and social instability. Application of the World Health Organization guidelines for the treatment of children with acute severe malnutrition reduces the fatality rate significantly. Among the many possibilities for treatment, systems based on day care centers and at home should be promoted. Training in the application of the World Health Organization guidelines should be incorporated into the curricula of health-related professions in countries where malnutrition is prevalent.
The Spectrum projection package: improvements in estimating mortality, ART needs, PMTCT impact and uncertainty bounds.
Sexually Transmitted Infections. 2008; 84(Suppl 1):i24-i30.The approach to national and global estimates of HIV/AIDS used by UNAIDS starts with estimates of adult HIV prevalence prepared from surveillance data using either the Estimation and Projection Package (EPP) or the Workbook. Time trends of prevalence are transferred to Spectrum to estimate the consequences of the HIV/AIDS epidemic, including the number of people living with HIV, new infections, AIDS deaths, AIDS orphans, treatment needs and the impact of treatment on survival. The UNAIDS Reference Group on Estimates, Modelling and Projections regularly reviews new data and information needs and recommends updates to the methodology and assumptions used in Spectrum. The latest update to Spectrum was used in the 2007 round of global estimates. Several new features have been added to Spectrum in the past two years. The structure of the population was reorganised to track populations by HIV status and treatment status. Mortality estimates were improved by the adoption of new approaches to estimating non-AIDS mortality by single age, and the use of new information on survival with HIV in non-treated cohorts and on the survival of patients on antiretroviral treatment (ART). A more detailed treatment of mother-to-child transmission of HIV now provides more prophylaxis and infant feeding options. New procedures were implemented to estimate the uncertainty around each of the key outputs. The latest update to the Spectrum program is intended to incorporate the latest research findings and provide new outputs needed by national and international planners.
International Journal of Gynecology and Obstetrics. 2008 Sep; 102(3):223-225.The editors of Contemporary Issues in Women's Health solicited reporters and correspondents from throughout the world to make contributions to this feature. Items submitted were stories on breastfeeding, FGM, Saudi women and ban on female drivers, and useful sources for women's health information.
In: Disease control priorities in developing countries. 2nd ed., edited by Dean T. Jamison, Joel G. Breman, Anthony R. Measham, George Alleyne, Mariam Claeson et al. Washington, D.C., World Bank, 2006. 531-549.This chapter provides an overview of neonatal deaths, presenting the epidemiology as a basis for program priorities and summarizing the evidence for interventions within a health systems framework, providing cost and impact estimates for packages that are feasible for universal scale-up. The focus of the chapter is restricted to interventions during the neonatal period. The priority interventions identified here are largely well known, yet global coverage is extremely low. The chapter concludes with a discussion of implementation in country programs with examples of scaling up, highlighting gaps in knowledge. (excerpt)
Population and Development Review. 2007 Dec; 33(4):839-843.Measured in terms of increases in average expectation of life country-by-country, the large majority of the world's population benefited from major improvements in health in the second part of the twentieth century. Notable exceptions to this favorable trend are most of the countries of sub-Saharan Africa and countries of the former Soviet Union. But the country averages conceal persistent and significant differences according to social status. The aim of the work of the Commission on Social Determinants of Health (CSDH) of the World Health Organization is to study these differences and to make recommendations for corrective action. Set up in March 2005, the 19-member Commission, chaired by Michael Marmot of University College London, published an Interim Report, titled "Achieving Health Equity: From Root Causes to Fair Outcomes," in September 2007. An excerpt from this 61-page report-the section on Health Inequality, Inequity, and Social Determinants of Health-is reproduced below. It presents a crisp statistical description of characteristic features of social differentials in health status commonly found in all countries, including those exhibiting the most favorable average expectancies of life. The presentation draws on emerging work on this topic, extensively cited in the report. (excerpt)
Indian Pediatrics. 2007 Jun 17; 44(6):413-416.Over 10 million children under five years of age die each year and 22% of these deaths occur in India. This proportion is substantially higher than for other countries, the next highest being Nigeria which accounts for 8%. Since India carries the main burden of child deaths globally, India's performance in improving child survival will define whether the Millennium Development Goal 4 will be achieved by 2015 (i.e., global child deaths reduced by two-thirds). Diarrhea and pneumonia account for approximately half the child deaths in India, and malnutrition is thought to contribute to 61% of diarrheal deaths and 53% of pneumonia deaths. In fact, some of the first studies to demonstrate the importance of this synergism between malnutrition and infection emanated from India. Part of the explanation for the important underlying role of malnutrition in child deaths is that most nutritional deficiencies, including vitamin A and zinc, impair immune function and other host defences leading to a cycle of longer lasting and more severe infections and ever-worsening nutritional status. Thus inadequate intake, infection and poor nutritional status are intimately linked. (excerpt)
Population Studies. 2007; 61(1):7-13.According to estimates published in this journal, the number of deaths of children under 5 in Iraq in the period 1991-98 resulting from the Gulf War of 1991 and the subsequent imposition of sanctions by the United Nations was between 400,000 and 500,000. These estimates have since been held to be implausibly high by a working group set up by an Independent Inquiry Committee appointed by the United Nations Secretary-General. We believe the working group's own estimates are seriously flawed and cannot be regarded as a credible challenge to our own. To obtain their estimates, they reject as unreliable the evidence of the 1999 Iraq Child and Maternal Mortality Survey - despite clear evidence of its internal coherence and supporting evidence from another, independent survey. They prefer to rely on the 1987 and 1997 censuses and on data obtained in a format that had elsewhere been rejected as unreliable 30 years earlier. (author's)
Online Journal of Issues in Nursing. 2006 Jan 31; 11(1): p..In Zambia, the incidence of tuberculosis (TB) has greatly increased in the last 10 years. This article describes Zambia and highlights the country's use of the United Nations Millennium Development Goals as a framework to guide TB treatment programmes. An overview of TB in Zambia is provided. Data related to TB cases at the county's main referral hospital, the University Teaching Hospital (UTH), is discussed. Treatment policies and barriers are described. Zambian nurses have been greatly affected by the rise in the morbidity and mortality of nurses with TB. This article explains the impact of TB on the Zambian nursing workforce. Review of Zambian government programmes designed to address this health crisis and targeted interventions to reduce TB among nurses are offered. (author's)
Bulletin of the World Health Organization. 1956; 15:5-41.The author reviews that mortality statistics from cancer of the breast in females and from malignant neoplasms of the uterus and of the other female genital organs for nineteen countries over the years 1920-53, first considering the general trend of the mortality series for each group of diseases for all ages and then analysing for each sector of mortality the changes which have occurred in the age-specific death-rates in some pivotal years during the same period. Considerable differences in the levels of total mortality from each group of tumours for various countries are noted. The important variations among age-specific death-rates for cancer of the breast in females and for uterine neoplasms in various countries are examined and their significance is commented upon. (excerpt)
Zhonghua Liu Xing Bing Xue Za Zhi / Chinese Journal of Epidemiology. 1997 Oct; 18(5):309-311.Global HIV infection and AIDS: according to WHO estimates, by mid 1996 there were 7 million cumulative AIDS cases. Today the number of people infected with HIV is even more alarming: roughly 21.8 million, of those 42% are women. By the year 2000 there will be between 40 and 50 million cases. Each day about 8,500 additional people are infected with AIDS; one can say the situation is grim. Currently, the AIDS and HIV epidemic regions are shifting, they have gradually moved from the original sites of North America and West Europe toward the mass populations of developing countries in Asia, Africa, and Latin America. In the Asian region which contains about 60% of the world's population, beginning in 1988, with Thailand and India at the center, an exploding epidemic has taken shape. Recent materials indicate, those infected with HIV in Thailand exceed 700,000, over 2 million in India, and the HIV epidemic has already spread to the near neighbors Burma, southern China, Cambodia, Malaysia and Vietnam. With the accumulation of molecular epidemiology research materials, the complete picture of the causes and characteristics of this massive epidemic happening in the Asian region is gradually becoming clear. (excerpt)
American Journal of Tropical Medicine and Hygiene. 2006 Feb; 74(2):187-188.Accurate measurement of malaria incidence is of great importance to malaria control, but it is very hard to achieve in most circumstances. Robert Snow and colleagues recently reported the results of a method to determine the case incidences of Plasmodium falciparum malaria around the world. For non-African P. falciparum malaria, they estimated three times more cases than in recent WHO figures. They suggested that the WHO estimates were lower due to the use of passively reported national malaria records. We, who prepared the WHO estimates of non-African malaria cases and published the method used to derive them, discuss here the suggestion by Snow and colleagues that, because of the data and methods used, the WHO estimates must be an under-representation of the true incidence of malaria cases. (excerpt)
UN Chronicle. 2002 Dec; 39(4): p..Almost 5 million children die each year from preventable causes. Environmental hazards kill the equivalent of a jumbo jet full of children every 45 minutes. These scary statistics have spurred the World Health Organization (WHO) to launch a new -- movement to try and tackle the crisis and reduce by two thirds the number of deaths of under-five-year-olds by 2015. Under WHO Director-General Dr. Gro Harlem Brundtland, the movement is busy mobilizing partners, such as key organizations and Governments, to achieve results in six areas: household water quality and availability; hygiene and sanitation; indoor and outdoor air pollution; disease vectors such as mosquitoes; chemicals; and accidents. According to Dr. Brundtland, the provision of healthy environments for children would be one of the highest social and political priorities of the decade. "Our top priority must be in investing in the future of children, a group that is particularly vulnerable to environmental hazards." She identified "hazards" as being dangers present in the environment in which children live, learn and play. She added that increased industrialization, explosive urban population growth and lack of pollution control were just a few added factors that affect children's lives. (excerpt)
UN Chronicle. 2005 Jun-Aug; 42(2): p..The battle against tuberculosis (TB) is being successfully fought in most areas of the world, but in Africa the disease has reached alarming proportions with an increasing number of cases and deaths linked to HIV, said the World Health Organization in its WHO Report 2005, Global Tuberculosis Control: Surveillance, Planning, Financing, released on 24 March to coincide with World TB Day. The WHO Report focuses on five principal indicators: incidence, prevalence, deaths, case detection and treatment success. It finds that its prevalence has declined worldwide by more than 20 per cent since 1990 and that incidence rates are falling or stable in all regions except in Africa, where TB rates have tripled since 1990 in countries with high HIV prevalence and continue to rise at 3 to 4 per cent annually. (excerpt)
How does progress towards the child mortality Millennium Development Goal affect inequalities between the poorest and least poor? Analysis of Demographic and Health Survey data.
BMJ. British Medical Journal. 2005 Nov 19; 331(7526):1180-1182.The millennium development goals (MDGs) have been widely accepted as a framework for improving health and welfare worldwide. Child mortality is one of the most crucial and avoidable global health concerns. In many low income countries, 10-20% of children die before reaching 5 years (compared with, for example, 0.7% in England and Wales). The child mortality MDG (to reduce the under 5 mortality rate by two thirds between 1990 and 2015) is formulated as a national average. The World Health Report 2003 posed an important question: how does progress towards the MDGs affect equity? We investigated this by examining, across a range of settings, how inequality in the under 5 mortality of the poorest and least poor changes as progress is made towards the MDG. (excerpt)