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Children. 2018 May 4; 5(5)Pakistan has one of the highest prevalences of child malnutrition as compared to other developing countries. This narrative review was accomplished to examine the published empirical literature on children’s nutritional status in Pakistan. The objectives of this review were to know about the methodological approaches used in previous studies, to assess the overall situation of childhood malnutrition, and to identify the areas that have not yet been studied. This study was carried out to collect and synthesize the relevant data from previously published papers through different scholarly database search engines. The most relevant and current published papers between 2000(-)2016 were included in this study. The research papers that contain the data related to child malnutrition in Pakistan were assessed. A total of 28 articles was reviewed and almost similar methodologies were used in all of them. Most of the researchers conducted the cross sectional quantitative and descriptive studies, through structured interviews for identifying the causes of child malnutrition. Only one study used the mix method technique for acquiring data from the respondents. For the assessment of malnutrition among children, out of 28 papers, 20 used the World Health Organization (WHO) weight for age, age for height, and height for weight Z-score method. Early marriages, large family size, high fertility rates with a lack of birth spacing, low income, the lack of breast feeding, and exclusive breastfeeding were found to be the themes that repeatedly emerged in the reviewed literature. There is a dire need of qualitative and mixed method researches to understand and have an insight into the underlying factors of child malnutrition in Pakistan.
New York, New York, UNICEF, 2017 Jul. 32 p.This report provides compelling new evidence that backs up an unconventional prediction UNICEF made in 2010: The higher cost of reaching the poorest children with life-saving, high-impact health interventions would be outweighed by greater results. This new study combines modelling and data from 51 countries. The results indicate that the number of lives saved by investing in the most deprived is almost twice as high as the number saved by equivalent investment in less deprived groups.
Efficacy of World Health Organization guideline in facility-based reduction of mortality in severely malnourished children from low and middle income countries: a systematic review and meta-analysis.
Journal of Paediatrics and Child Health. 2017 May; 53(5):474-479.Aim: Globally more than 19 million under-five children suffer from severe acute malnutrition (SAM). Data on efficacy of World Health Organization's (WHO’s) guideline in reducing SAM mortality are limited. We aimed to assess the efficacy of WHO’s facility-based guideline for the reduction of under-five SAM children mortality from low and middle income countries (LMICs). Methods: A systematic search of literature published in 1980–2015 was conducted using electronic databases. Additional articles were identified from the reference lists and grey literature. Studies from LMICs where SAM children (0–59 months) were managed in facilities according to WHO’s guideline were included. Outcome was reduction in SAM mortality measured by case fatality rate (CFR). The review was reported following the Grading of Recommendations Assessment Development and Evaluation and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and meta-analyses done using RevMan 5.3®. Results: This review identified nine studies, which demonstrated reductions in SAM mortality. CFR ranged from 8 to 16% where WHO guideline applied. High rates of poverty, malnutrition, severe co-morbid condition, lack of resources and differences in treatment practices played a key role in large CFR variation. Most death occurred within 48 h of admission in Asia, between 4 days and 4 weeks in Africa and in Latin America. CFR was reduced by 41% (odds ratio: 0.59; 95% confidence interval: 0.46–0.76) when WHO guideline were applied. A 45% reduction in CFR was achieved after excluding human immunodeficiency virus positive cases. Dietary management also differed among WHO and conventional management. Conclusion: Children receiving SAM inpatient care as per WHO guideline have reduced CFR compared to conventional treatment.
Neglected chronic disease: The WHO framework on non-communicable diseases and implications for the global poor.
Global Public Health. 2017 Apr; 12(4):396-415.The current global framework on noncommunicable disease (NCD), as exemplified by the WHO Action Plan of 2012, neglects the needs of the global poor. The current framework is rooted in an outdated pseudo-evolutionary theory of epidemiologic transition, which weds NCDs to modernity, and relies on global aggregate data. It is oriented around a simplistic causal model of behavior, risk and disease, which implicitly locates ‘risk’ within individuals, conveniently drawing attention away from important global drivers of the NCD epidemic. In fact, the epidemiologic realities of the bottom billion reveal a burden of neglected chronic diseases that are associated with ‘alternative’ environmental and infectious risks that are largely structurally determined. In addition, the vertical orientation of the framework fails to centralize health systems and delivery issues that are essential to chronic disease prevention and treatment. A new framework oriented around a global health equity perspective would be able to correct some of the failures of the current model by bringing the needs of the global poor to the forefront, and centralizing health systems and delivery. In addition, core social science concepts such as Bordieu's habitus may be useful to re-conceptualizing strategies that may address both behavioral and structural determinants of health.
Synthetic evaluation of the effect of health promotion: impact of a UNICEF project in 40 poor western counties of China.
Public Health. 2010 Jul; 124(7):376-91.OBJECTIVE: To synthetically evaluate the effects of a health promotion project launched by the Ministry of Health of China and the United Nations Children's Fund (UNICEF) in 40 poor western counties of China. STUDY DESIGN: The two surveys were cross-sectional studies. Stratified multistage random sampling was used to recruit subjects. METHODS: Data were collected through two surveys conducted in the 40 'UNICEF project counties' in 1999 and 2000. After categorizing the 27 evaluation indicators into four aspects, a hybrid of the Analytic Hierarchy Process, the Technique for Order Preference by Similarity to Ideal Solution, and linear weighting were used to analyse the changes. The 40 counties were classified into three different levels according to differences in the synthetic indicator derived. Comparing the synthetic evaluation indicators of these two surveys, issues for implementation of the project were identified and discussed. RESULTS: The values of the synthetic indicators were significantly higher in 2000 than in 1999 (P=0.02); this indicated that the projects were effective. Among the 40 counties, 11 counties were at a higher level in 2000, 10 counties were at a lower level, and others were in the middle level. Comparative analysis showed that 36% of village clinics were not licensed to practice medicine, nearly 50% of village clinics had no records of medicine purchases, nearly 20% of village clinics had no pressure cooker for disinfection, and 20% of pregnant women did not receive any prenatal care. CONCLUSIONS: The health promotion projects in the 40 counties were effective. Health management, medical treatment conditions, maternal health and child health care have improved to some extent. However, much remains to be done to improve health care in these 40 poor counties. The findings of this study can help decision makers to improve the implementation of such improvements. Copyright 2010 The Royal Society for Public Health. All rights reserved.
Improving effectiveness and outcomes for the poor in health, nutrition, and population: an evaluation of World Bank Group support since 1997.
Washington, D.C., World Bank, Independent Evaluation Group, 2009.  p.The World Bank Group’s support for health, nutrition, and population (HNP) has been sustained since 1997 -- totaling $17 billion in country-level support by the World Bank and $873 million in private health and pharmaceutical investments by the International Finance Corporation (IFC) through mid-2008. This report evaluates the efficacy of the Bank Group’s direct support for HNP to developing countries since 1997 and draws lessons to help improve the effectiveness of this support.
Putting young people into national poverty reduction strategies: a guide to statistics on young people in poverty.
New York, New York, United Nations Population Fund [UNFPA], . 35 p.Many national poverty reduction strategies overlook the needs of young people. Even where national strategies do have a youth focus, the analysis of their situation is limited because little or no reference is made to readily available data. For those advocating on behalf of young people in poverty, considerable scope exists to make use of simple but reputable statistics to mount a strong case for Governments and civil society to allocate more resources in addressing poverty among this major population group. The purpose of this guide is to show how relevant statistics on young people in poverty can be easily sourced for use in developing national poverty reduction strategies. The guide shows how to use accessible databases on the Internet to provide individual countries with sophisticated statistical profile of young people in poverty. (excerpt)
Africa Renewal. 2007 Oct; 21(3):7.Until six years ago, Eugenia Uwamahoro and several of her eight children had to trek 2 kilometres each day to a river to get about 140 litres of water for drinking, cooking, washing and feeding her four cows. There was a water pump in her village, Nyakabingo, in Rwanda's Gicumbi district, but it hardly functioned. Then the Rwandan government, with financial support from the UN Children's Fund (UNICEF), repaired the pump, and the community contracted a private manager to maintain it. "It has improved my life," Ms. Uwamahoro told African Renewal. "Now we can rest." Not only has the pump saved her considerable time and effort, but she also gets her household's daily water supply at lower cost than she would have from the private village water carriers who cart it up from the river. Many villagers "are happy to pay for the improved service," says Kamaru Tstoneste, who operates the pump. But some villagers cannot afford the cost. So community leaders compiled a list of the neediest households, and review it from time to time. "This group gets an agreed quantity of free supply," Mr. Tstoneste told Africa Renewal. Still, he adds, "Old habits die hard. There are those who refuse to pay for water and still go to the river." (excerpt)
Washington, D.C., World Bank, Development Economics Prospects Group, 2007 Nov. 20 p. (Policy Research Working Paper No. 4383)This paper summarizes the policy lessons from applications of the Maquette for MDG Simulations (MAMS) model to two low income countries: Ghana and Honduras. Results show that costs of MDGs achievement could reach 10-13 percent of GDP by 2015, although, given the observed low productivity in the provision of social services, significant savings may be realized by improving efficiency. Sources of financing also matter: foreign aid inflows can reduce international competitiveness through real exchange appreciation, while domestic financing can crowd out the private sector and slow poverty reduction. Spending a large share of a fixed budget on growth-enhancing infrastructure may mean sacrificing some human development, even if higher growth is usually associated with lower costs of social services. The pursuit of MDGs increases demand for skills: while this encourages higher educational attainments, in the short term this could lead to increased income inequality and a lower poverty elasticity of growth. (author's)
The practice of charging user fees at the point of service delivery for HIV / AIDS treatment and care.
Geneva, Switzerland, WHO, 2005 Dec.  p. (WHO Discussion Paper; WHO/HIV/2005.11)The global movement to expand access to antiretroviral treatment for people living with HIV/AIDS as part of a comprehensive response to the HIV pandemic is grounded in both the human right to health and in evidence on public-health outcomes. However, for many individuals in poor communities, the cost of treatment remains an insurmountable obstacle. Even with sliding fee scales, cost recovery at the point of service delivery is likely to depress uptake of antiretroviral treatment and decrease adherence by those already receiving it. Therefore, countries are being advised to adopt a policy of free access at the point of service delivery to HIV care and treatment, including antiretroviral therapy. This recommendation is based on the best available evidence and experience in countries. It is warranted as an element of the exceptional response needed to turn back the AIDS epidemic. With the endorsement by G8 leaders in July 2005 and UN Member States in September 2005 of efforts to move towards universal access to HIV treatment and care by 2010, health sector financing strategies must now move to the top of the international agenda. Rapid scale-up of programmes within the framework of the "3 by 5" target has underscored the challenge of equity, particularly for marginalized and rural populations. It is apparent that user charges at the point of service delivery "institutionalize exclusion" and undermine efforts towards universal access to health services. Abolishing them, however, requires prompt, sustained attention to long-term health system financing strategies, at both national and international levels. (excerpt)
Lancet. 2007 Sep 22; 370(9592):1034.The association between domestic violence and the first five Millennium Development Goals is bidirectional. Violence has a negative effect on efforts to alleviate poverty (MDG 1), and poverty has been shown to increase the likelihood of violence. Similarly, education, women's empowerment, child mortality, and maternal health are all linked to domestic violence. Simwaka and colleagues discussed the association between women's empowerment and violence against women and poor access and control over resources, and recommended putting gender issues in the African agenda to achieve MDG 5. Hence, monitoring the progress in preventing violence should not be separated from monitoring the development process in developing countries. Other challenges such as discrimination, inequity, extremism, religious fanaticism, human rights violations, and the faded democracy process have hampered efforts to combat violence in these countries. Ammar stated that "Egypt would be able to combat public violence (eg, terrorism) better if it addresses co-occurrence of spousal and child abuse than by changing its school curriculum". Moreover, we will not be able to estimate properly the magnitude of domestic violence if its economic costs are not investigated. Therefore, the growing political will to take action against violence is not enough in itself, especially when women feel that spousal abuse is justified and when judges and lawyers are part of a culture that tolerates violence against women. (full text)
BMC International Health and Human Rights. 2007 Aug 28; 7(1):7.Achieving sustainable economic and social growth through advances in health is crucial in Latin America within the framework of the United Nations Millennium Development Goals. Health-related Millennium Development Goals need to incorporate a multidimensional approach addressing the specific epidemiologic profile for each region of the globe. In this regard, addressing the cycle of destitution and suffering associated with infection with Trypanosoma cruzi, the causal agent of Chagas disease of American trypanosomiasis, will play a key role to enable the most impoverished populations in Latin America the opportunity to achieve their full potential. Most cases of Chagas disease occur among forgotten populations because these diseases persist exclusively in the poorest and the most marginalized communities in Latin America. Addressing the cycle of destitution and suffering associated with T. cruzi infection will contribute to improve the health of the most impoverished populations in Latin America and will ultimately grant them with the opportunity to achieve their full economic potential. (author's)
Washington, D.C., World Bank, Water Supply and Sanitation Sector Board, 2006 Mar.  p.Over 900,000 people in peri-urban areas (called Ger districts) in Ulaanbaatar, Mongolio lack basic infrastructure services. Since 1997, the World Bank has supported the Government of Mongolia to improve services to Ger dwellers. A 2004 social assessment revealed that on-site sanitation is very high on the list of priorities for residents in the Ger areas. The Government of Mongolia is now addressing this problem supported by a grant from the Japan Social Development Fund (JSDF). As an initial step in advancing sanitation and hygiene in the Ger areas, the World Bank has provided technical assistance to the Mongolian Government through the Sanitation, Hygiene and Wastewater Support Service (SWAT). The technical work and consultations were a first step to pave the way for a more holistic approach to improving sanitation in Ulaanbaatar's urban periphery. (excerpt)
Lancet. 2007 Jul 28; 370(9584):297-298.Several affluent countries have announced donations totalling US$1.5 billion to buy new vaccines that will help eradicate pneumococcal diseases in the world's poorest children. Donations from the UK, Italy, Canada, Russia, and Norway launch what many hope will be a new era to ease the burdens of disease and foster economic growth. Yet only a quarter of the money will be spent on covering the costs of vaccines-three-quarters will go towards extra profits for vaccines that are already profitable. The Advanced Market Commitment (AMC), to which the G8 leaders and the Bill & Melinda Gates Foundation have committed, is the difficulty. An AMC is a heavily promoted but untried idea for inducing major drug companies to invest in research to discover vaccines for neglected diseases by promising to match the revenues that companies earn from developing a product for affluent markets. By committing to buy a large volume of vaccine at a high price, an AMC creates a whole market in one stroke. However, no moneyis spent until a good product is fully developed. (excerpt)
Lancet Infectious Diseases. 2007 Jul; 7(7):439.The 2007 Group of Eight (G8) summit, which took place in Heiligendamm, Germany, on June 6-8, has been described by John Kirton (G8 Research Group, University of Toronto, Canada) as an "emerging centre of democratic global governance". Like many self-appointed elites, the G8 is an idiosyncratic club. The eight started as six in 1975 with a meeting in Rambouillet, France, of the heads of government of France, West Germany, Italy, Japan, the UK, and the USA-the most economically powerful democratic nations. This annual forum for discussion of matters of mutual interest was joined by Canada in 1976, by the European Union in 1977, and by Russia in 1997. Although the G8 nations account for nearly two-thirds of world economic output, the Russian economy is not among the world's top eight, whereas China with the fourth largest economy remains outside the G8 club. (excerpt)
YouandAIDS. 2003 Aug; 2(1):16-17.In September 2000, at the United Nations Millennium Summit world leaders endorsed a set of time-bound and measurable goals and targets to combat poverty, hunger, disease, illiteracy, environmental degradation, discrimination against women and create a global partnership for development. This global compact - now known as the Millennium Development Goals - was endorsed by all members of the United Nations. It sets out a series of time-bound and quantifiable targets ranging from halving extreme poverty to halting the spread of HIV/AIDS by 2015. The Summit's Millennium Declaration also outlined a consensus on how to proceed, with a stronger focus on human rights, good governance and democracy as well as conflict prevention and peace-building. The political framework for achieving the Millennium Development Goals was provided by the new global deal struck in 2002 in Monterrey, Mexico, between North and South. The rich nations represented at the Monterrey "Financing for Development" summit pledged to remove trade barriers and provide more aid and meaningful debt relief to developing countries that undertake tough political and economic reforms. This global compact was reaffirmed at the World Summit for Sustainable Development held in Johannesburg, South Africa, in August 2002. (excerpt)
Africa Renewal. 2007 Jan; 20(4):10-11.In October, more than 23 million people -- some 3.6 million of them in Africa -- set a world record by literally standing up to bring attention to persistent global poverty and to prompt world leaders to act on their promises to eradicate the scourge. The message of the Stand Up Against Poverty campaign, coordinated by the New York--based UN Millennium Campaign, reached people at more than 11,000 events in over 80 countries -- cricket fans in Jaipur, India, music lovers at a concert in Harare, Zimbabwe, children in school in Lebanon and soccer supporters in Mexico. Organizers timed the global campaign to coincide with other events marking the International Day for the Eradication of Poverty. "Together, we sent a clear message to our political leaders that we are going to keep pushing them to deliver on aid, on debt cancellation, on trade justice and to provide good and accountable governments," said Mr. Kumi Naidoo of the Global Call to Action Against Poverty (GCAP). An alliance of community organizations, faith-based groups, trade unions and campaigners in over 100 countries, GCAP was one of the organizations supporting the Stand Up campaign. (excerpt)
Finance and Development. 2007 Mar; 44(1): p.This approach is a bit like setting up a straw man only to knock it down. The aid industry unquestionably provides ample fodder for critics: many cases exist of aid funding poorly conceived, badly executed, unsustainable projects (for example, cement factories built far from sources of gypsum and sand). And some badly managed countries have, indeed, received millions, especially during the Cold War, when aid was extended for geopolitical objectives. At times, aid agencies followed fads that later proved misguided (recall the popular integrated rural development projects of the 1970s). This does not prove that all aid has been, or is, ineffective. It is entirely unsurprising that many economists have found the relationship between aggregate aid and growth to be weak. Evidence suggests a high level of heterogeneity in the effects of aid, which comes on top of the typical statistical problems that arise in cross-country analysis. Multiple markers for development success--income growth, poverty reduction, literacy, access to sanitation, and inoculations--further complicate empirical analysis. Case studies do not solve this problem because of the difficulty of establishing a counterfactual: some argue that aid has not prevented growing numbers of poor in Africa; others argue that the situation would be far worse without aid. Although these findings may make aid seem indefensible, much of the criticism is misguided. This isn't to say the impact of aid is easily known or that we can fine-tune aid to improve results. Even though it will be difficult for some time to come up with adequate evidence, there are strong grounds for believing that aid fosters development. (excerpt)
Strategic and technical meeting on intensified control of neglected tropical diseases: a renewed effort to combat entrenched communicable diseases of the poor. Report of an international workshop, Berlin, 18-20 April 2005.
Geneva, Switzerland, World Health Organization [WHO], Department of Control of Neglected Tropical Diseases, 2006.  p. (WHO/CDS/NTD/2006.1)Throughout the developing world, socioeconomic progress is impeded by ancient and entrenched infectious diseases that permanently diminish human potential in very large populations. These diseases have largely vanished from affluent nations but continue to flourish in tropical and subtropical climates under the living conditions that surround impoverished populations -- the people left behind by socioeconomic development. These neglected tropical diseases thrive in areas where water supply, housing and sanitation are inadequate, nutrition is poor, literacy rates are low, health systems are rudimentary and insects and other disease vectors are constant household and occupational companions. Neglected tropical diseases continue to permanently maim or otherwise impair the lives of millions of people every year, frequently with adverse effects starting early in life. They anchor affected populations in poverty and also compromise the effectiveness of efforts made by other sectors to improve socioeconomic development. For example, there is ample evidence that children heavily infected with intestinal worms will not fully benefit from educational opportunities and are more likely to suffer poor nutritional status. Adults permanently disabled by blindness or limb deformities may be a burden in rural agricultural communities that eke out a living from subsistence farming. In addition, the stigma attached to many of these diseases closes options for a normal family and social life, especially for women. Efforts to control these diseases thus free people to develop their potential unimpeded by disabling disease and, in so doing, increase the chances that efforts in other sectors, such as education and agriculture, will be successful. (excerpt)
Adult literacy programs and socio-economic transformation among the rural poor: Lessons from a local NGO in Arua district, Uganda.
Art'ishake. 2006 Summer; (3):22-25.In this paper, we examine the role of adult literacy programs in transforming the lives of the rural poor in Uganda. Based on the work of a local NGO--the Uganda Rural Literacy and Community Development Association (URLCODA), operating in Arua district--we argue that participating in literacy activities lays a solid foundation for continuing education/training, social development, and active participation in democratic processes. URLCODA's project therefore complements the global efforts to achieve some of the UN's Millennium Development Goals. The challenges faced in maximizing the benefits of literacy to participants and possible remedies are highlighted. (author's)
SHS Views. 2006; (14):8-12.Poverty is not an inevitability. In its effort to fight poverty, UNESCO has mobilized all programme Sectors to work towards the first of the Millennium Development Goals as defined by the United Nations: the eradication of extreme poverty. While the Organization's Member States have yet to decide how this cross-cutting programme should continue, SHS Views takes stock of the programme's first five years. (excerpt)
The Des Moines Declaration: A call for accelerated action in agriculture, food and nutrition to end poverty and hunger.
Food and Nutrition Bulletin. 2005; 26(3):312-314.Agriculture is the main source of income for poor people living in rural areas. As such, a boost in agricultural productivity in the rural areas of developing countries will greatly enhance earning potential as well as produce more food. However, agricultural production increases will not generate adequate gains in employment, and additional steps must also be taken to increase employment in agro based value added rural enterprises. In addition, food productivity must be increased to improve the lives of people and protect biodiversity in our environment. With close to a billion people still suffering from hunger, malnutrition and food insecurity and with the population of our planet projected to grow by 50% by the middle of the 21st century, either we must produce more food on the land and in the water now available to us, or people will be forced to cut down precious forest areas and cultivate marginal lands to grow the food necessary to fuel our escalating demands. It is crucial that new agricultural innovations and technologies be developed. (excerpt)
International Workshop on Multi-Micronutrient Deficiency Control in the Life Cycle, Lima, Peru, May 30-June 1, 2001.
Food and Nutrition Bulletin. 2002; 23(3):309-316.Thirty-one representatives from international organizations, nongovernmental organizations, government agencies, universities, and the private sector participated in a three-day workshop in Lima, Peru, organized by the Universidad Nacional Agraria La Molina and supported by the Ministry of Health Peru, UNICEF, and the World Health Organization. The objective of the workshop was to develop a protocol for a comprehensive micronutrient supplementation program for populations in developing countries that suffer from deficiencies of several micronutrients. The workshop consisted of two components: presentation of preliminary results of the multicenter study on infant supplementation and recommendations on the policy and community, monitoring and impact evaluation, and research aspects of supplementation programs. This paper provides the summary reports of the second component. (author's)
[Sydney], Australia, Youth for a Sustainable Future Pacifika, 2006.  p.The Millennium Development Goals, better known as the MDGs, are a set of goals committed to reducing poverty, illiteracy, inequality and disease in developing countries. In September 2000, leaders from 189 nations including 14 Pacific Island nations, agreed to achieve the MDGs by endorsing the Millennium Declaration. The Declaration is a special documentation because it specifies responsibility for all countries to enhance the global agenda on human development. This means that even developed countries like the United States, Australia and New Zealand, are responsible for assisting developing countries in meeting the goals. (excerpt)
BMJ. British Medical Journal. 2006 Nov 11; 333(7576):986.Unclean water is an "immeasurably greater threat to human security than violent conflict" across the developing world, says the latest annual report from the United Nations Development Programme. The report says, "'Not having access to clean water' is a euphemism for profound deprivation. It means that people walk more than one kilometre to the nearest source of clean water for drinking, that they collect water from drains, ditches or streams that might be infected with pathogens and bacteria that can cause severe illness and death." Each year 1.8 million children die from diarrhoea that could be prevented; 443 million school days are lost to water related illnesses; and almost 50% of all people in poor countries have at any given time a health problem caused by a lack of water and sanitation. (excerpt)