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Trends in Antiretroviral Therapy Eligibility and Coverage Among Children Aged <15 Years with HIV Infection - 20 PEPFAR-Supported Sub-Saharan African Countries, 2012-2016.
MMWR. Morbidity and Mortality Weekly Report. 2018 May 18; 67(19):552-555.Rapid disease progression and associated opportunistic infections contribute to high mortality rates among children aged <15 years with human immunodeficiency virus (HIV) infection (1). Antiretroviral therapy (ART) has decreased childhood HIV-associated morbidity and mortality rates over the past decade (2). As accumulating evidence revealed lower HIV-associated mortality with early ART initiation, the World Health Organization (WHO) guidelines broadened ART eligibility for children with HIV infection (2). Age at ART initiation for children with HIV infection expanded sequentially in the 2010, 2013, and 2016 WHO guidelines to include children aged <2, <5, and <15 years, respectively, regardless of clinical or immunologic status (3-5). The United States President's Emergency Plan for AIDS Relief (PEPFAR) has supported ART for children with HIV infection since 2003 and, informed by the WHO guidelines and a growing evidence base, PEPFAR-supported countries have adjusted their national pediatric guidelines. To understand the lag between guideline development and implementation, as well as the ART coverage gap, CDC assessed national pediatric HIV guidelines and analyzed Joint United Nations Programme on HIV and AIDS (acquired immunodeficiency syndrome; UNAIDS) data on children aged <15 years with HIV infection and the numbers of these children on ART. Timeliness of WHO pediatric ART guideline adoption varied by country; >50% of children with HIV infection are not receiving ART, underscoring the importance of strengthening case finding and linkage to HIV treatment in pediatric ART programs.
Geneva, Switzerland, UNAIDS, 2017. 198 p. (UNAIDS/JC2900E)Since they were launched at the 20th International AIDS Conference in Melbourne, Australia, in 2014, the 90-90-90 targets have become a central pillar of the global quest to end the AIDS epidemic. The targets reflect a fundamental shift in the world’s approach to HIV treatment, moving it away from a focus on the number of people accessing antiretroviral therapy and towards the importance of maximising viral suppression among people living with HIV. This shift was driven by greater understanding of the benefits of viral suppression -- not only does treatment protect people living with HIV from AIDS-related illness, but it also greatly lowers the risk of transmitting the virus to others.
Midwifery. 2016 Feb; 33:7.Add to my documents.
Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.
Geneva, Switzerland, World Health Organization, 2015. 100 p.In 2000, the United Nations (UN) Member States pledged to work towards a series of Millennium Development Goals (MDGs), including the target of a three-quarters reduction in the 1990 maternal mortality ratio (MMR; maternal deaths per 100 000 live births), to be achieved by 2015. This target (MDG 5A) and that of achieving universal access to reproductive health (MDG 5B) together formed the two targets for MDG 5: Improve maternal health. In the five years counting down to the conclusion of the MDGs, a number of initiatives were established to galvanize efforts towards reducing maternal mortality. These included the UN Secretary-General’s Global Strategy for Women’s and Children’s Health, which mobilized efforts towards achieving MDG 4 (Improve child health) as well as MDG 5, and the high-level Commission on Information and Accountability (COIA), which promoted “global reporting, oversight, and accountability on women’s and children’s health”. Now, building on the momentum generated by MDG 5, the Sustainable Development Goals (SDGs) establish a transformative new agenda for maternal health towards ending preventable maternal mortality; target 3.1 of SDG 3 is to reduce the global MMR to less than 70 per 100 000 live births by 2030.
Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group.
Lancet. 2016 Jan 30; 387(10017):462-74.BACKGROUND: Millennium Development Goal 5 calls for a 75% reduction in the maternal mortality ratio (MMR) between 1990 and 2015. We estimated levels and trends in maternal mortality for 183 countries to assess progress made. Based on MMR estimates for 2015, we constructed projections to show the requirements for the Sustainable Development Goal (SDG) of less than 70 maternal deaths per 100,000 livebirths globally by 2030. METHODS: We updated the UN Maternal Mortality Estimation Inter-Agency Group (MMEIG) database with more than 200 additional records (vital statistics from civil registration systems, surveys, studies, or reports). We generated estimates of maternal mortality and related indicators with 80% uncertainty intervals (UIs) using a Bayesian model. The model combines the rate of change implied by a multilevel regression model with a time-series model to capture data-driven changes in country-specific MMRs, and includes a data model to adjust for systematic and random errors associated with different data sources. RESULTS: We had data for 171 of 183 countries. The global MMR fell from 385 deaths per 100,000 livebirths (80% UI 359-427) in 1990, to 216 (207-249) in 2015, corresponding to a relative decline of 43.9% (34.0-48.7), with 303,000 (291,000-349,000) maternal deaths worldwide in 2015. Regional progress in reducing the MMR since 1990 ranged from an annual rate of reduction of 1.8% (0.0-3.1) in the Caribbean to 5.0% (4.0-6.0) in eastern Asia. Regional MMRs for 2015 ranged from 12 deaths per 100,000 livebirths (11-14) for high-income regions to 546 (511-652) for sub-Saharan Africa. Accelerated progress will be needed to achieve the SDG goal; countries will need to reduce their MMRs at an annual rate of reduction of at least 7.5%. INTERPRETATION: Despite global progress in reducing maternal mortality, immediate action is needed to meet the ambitious SDG 2030 target, and ultimately eliminate preventable maternal mortality. Although the rates of reduction that are needed to achieve country-specific SDG targets are ambitious for most high mortality countries, countries that made a concerted effort to reduce maternal mortality between 2000 and 2010 provide inspiration and guidance on how to accomplish the acceleration necessary to substantially reduce preventable maternal deaths. FUNDING: National University of Singapore, National Institute of Child Health and Human Development, USAID, and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. Copyright (c) 2016 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd.. All rights reserved.
Trends in maternal mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division.
Geneva, Switzerland, WHO, 2014.  p.Millennium Development Goal (MDG) 5 Target 5A calls for the reduction of maternal mortality ratio by three quarters between 1990 and 2015. It has been a challenge to assess the extent of progress due to the lack of reliable and accurate maternal mortality data -- particularly in developing-country settings where maternal mortality is high. As part on going efforts, the WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division updated estimates of maternal mortality for the years 1990, 1995, 2000, 2005 and 2013.
International Perspectives On Sexual and Reproductive Health. 2013 Mar; 39(1):32-41.CONTEXT: Despite the fact that most maternal deaths are preventable, maternal mortality remains high in many developing countries. Target A of Millennium Development Goal (MDG) 5 calls for a three-quarters reduction in the maternal mortality ratio (MMR) between 1990 and 2015. METHODS: We derived estimates of maternal mortality for 172 countries over the period 1990-2008. Trends in maternal mortality were estimated either directly from vital registration data or from a hierarchical or multilevel model, depending on the data available for a particular country. RESULTS: The annual number of maternal deaths worldwide declined by 34% between 1990 and 2008, from approximately 546,000 to 358,000 deaths. The estimated MMR for the world as a whole also declined by 34% over this period, falling from 400 to 260 maternal deaths per 100,000 live births. Between 1990 and 2008, the majority of the global burden of maternal deaths shifted from Asia to Sub-Saharan Africa. Differential trends in fertility, the HIV/AIDS epidemic and access to reproductive health are associated with the shift in the burden of maternal deaths from Asia to Sub-Saharan Africa. CONCLUSIONS: Although the estimated annual rate of decline in the global MMR in 1990-2008 (2.3%) fell short of the level needed to meet the MDG 5 target, it was much faster than had been thought previously. Targeted efforts to improve access to quality maternal health care, as well as efforts to decrease unintended pregnancies through family planning, are necessary to further reduce the global burden of maternal mortality.
BMJ. British Medical Journal. 2012; 345:e6229.New figures show that the number of children dying before the age of five has significantly fallen since 2000, but this progress needs to accelerate if the United Nationsâ€™ millennium development goal of reducing child mortality is to be reached. A report released by the UNâ€™s Childrenâ€™s Fund (Unicef), the World Health Organization, the World Bank and the UN Population Division provides statistical analyses of annual child mortality and its global concentrations; the highest rates of child mortality are still in sub-Saharan Africa. The report warns that securing accurate estimates of child mortality is a considerable challenge because many developing countries lack a registration system. It also warns that the decline in neonatal mortality rates has been slower than the decline in mortality rates among children overall.
New York, New York, UNICEF, 2012.  p.Across the world, the number of deaths among children under 5 has been on a continuous decline for over two decades, says the 2012 Progress Report on Committing to Child Survival: A Promise Renewed. Data released today by UNICEF and the United Nations Inter-agency Group for Child Mortality Estimation show that the number of children under the age of 5 dying globally has dropped from nearly 12 million in 1990 to an estimated 6.9 million in 2011. The report combines mortality estimates with insights into the top killers of children under 5 and the high-impact strategies that are needed to accelerate progress. The report shows that all regions of the world have seen a marked decline in under-5 mortality since 1990. Neither a country’s regional affiliation nor economic status need be a barrier to reducing child deaths; low-, medium- and high- income countries all have made tremendous progress in lowering their under-5 mortality rates. But under-5 deaths are increasingly concentrated in sub-Saharan Africa and South Asia. One in every nine children in sub-Saharan Africa dies before reaching the age of 5. And progress in lowering child mortality rates lags behind among disadvantaged and marginalized people, around the world. Undernutrition is a factor in one third of all under-5 child deaths. If disease and undernutrition are to be tackled successfully, broader issues such as water supply, sanitation and hygiene and education will also have to be addressed. The report provides further impetus for a renewed global movement to end preventable child deaths.
PLOS Medicine. 2012 Aug; 9(8):e1001303.Monitoring development indicators has become a central interest of international agencies and countries for tracking progress towards the Millennium Development Goals. In this review, which also provides an introduction to a collection of articles, we describe the methodology used by the United Nations Inter-agency Group for Child Mortality Estimation to track country-specific changes in the key indicator for Millennium Development Goal 4 (MDG 4), the decline of the underfive mortality rate (the probability of dying between birth and age five, also denoted in the literature as U5MR and 5q0). We review how relevant data from civil registration, sample registration, population censuses, and household surveys are compiled and assessed for United Nations member states, and how time series regression models are fitted to all points of acceptable quality to establish the trends in U5MR from which infant and neonatal mortality rates are generally derived. The application of this methodology indicates that, between 1990 and 2010, the global U5MR fell from 88 to 57 deaths per 1,000 live births, and the annual number of under-five deaths fell from 12.0 to 7.6 million. Although the annual rate of reduction in the U5MR accelerated from 1.9% for the period 1990-2000 to 2.5% for the period 2000-2010, it remains well below the 4.4% annual rate of reduction required to achieve the MDG 4 goal of a two-thirds reduction in U5MR from its 1990 value by 2015. Thus, despite progress in reducing child mortality worldwide, and an encouraging increase in the pace of decline over the last two decades, MDG 4 will not be met without greatly increasing efforts to reduce child deaths.
Bulletin of the World Health Organization. 2010 Oct 1; 88(10):718-718A.Add to my documents.
Washington, D.C., Population Reference Bureau [PRB], 2009 Dec.  p.Lack of access to quality health care and clean water and sanitation, undernutrition, and other preventable or treatable causes lead to the deaths of tens of thousands of children worldwide every day. But new estimates from UNICEF, WHO, the World Bank, and the UN Population Division show that under-5 mortality has declined steadily since 1990, and that progress has accelerated this decade. In 1990, nearly 13 million children died before their fifth birthday. By 2008, that number had been cut to 9 million.
JAMA. 2008 Jan 30; 299(4):400-402.The World Health Organization (WHO) and United Nations Children's Fund (UNICEF) comprehensive strategy for measles mortality reduction is focused on 47 priority countries. Components include (1) achieving and maintaining high coverage (greater than 90%) with the first dose of measles vaccine by age 12 months in every district of each priority country through routine immunization services; (2) ensuring that all children receive a second opportunity for measles vaccination; (3) maintaining effective case-based surveillance and monitoring of vaccination coverage; and (4) providing appropriate clinical management, including vitamin A supplementation. In 2005, the World Health Assembly set a goal for global measles control as part of the Global Immunization Vision and Strategy (GIVS): a 90% reduction in measles mortality by 2010, compared with 2000 levels. In January 2007, WHO/UNICEF reported that implementation of measles mortality reduction strategies had reduced measles mortality by 60%, from an estimated 873,000 deaths in 1999 to 345,000 deaths in 2005. This reduction exceeded the goal of 50% measles mortality reduction by 2005 (compared with 1999 levels) that had been set in 2002. This report updates previous reports by detailing (1) measles mortality reduction activities implemented during 2006 and (2) the impact of activities since 2000 on the global burden of measles and progress toward the GIVS mortality reduction goal for 2010. (author's)
New York, New York, United Nations, 2007.  p. (ESA/P/WP.202)The 2006 Revision is the twentieth round of official United Nations population estimates and projections prepared by the Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. These are used throughout the United Nations system as the basis for activities requiring population information. The 2006 Revision builds on the 2004 Revision and incorporates both the results of the 2000 round of national population censuses and of recent specialized surveys carried around the world. These sources provide both demographic and other information to assess the progress made in achieving the internationally agreed development goals, including the Millennium Development Goals (MDGs). The comprehensive review of past worldwide demographic trends and future prospects presented in the 2006 Revision provides the population basis for the assessment of those goals. According to the 2006 Revision, the world population will likely increase by 2.5 billion over the next 43years, passing from the current 6.7 billion to 9.2 billion in 2050. This increase is equivalent to the size the world population had in 1950 and it will be absorbed mostly by the less developed regions, whose population is projected to rise from 5.4 billion in 2007 to 7.9 billion in 2050. In contrast, the population of the more developed regions is expected to remain largely unchanged at 1.2 billion and would have declined were it not for the projected net migration from developing to developed countries, which is expected to average 2.3 million persons annually. (excerpt)
East African Medical Journal. 2006 Jan; 83(1):1-3.At the Millennium Summit in September 2000, world leaders adopted the United Nations Millennium Declaration, which included attainment of the eight Millennium Development Goals (MDGs) by 2015. The first seven MDGs are aimed at reducing poverty and promoting human development while the eighth MDG recognises the essence of global partnership in achieving the first seven. The three MDGs directly related to health (MDGs 4-6) are interdependent so concerted efforts are needed to achieve them. (excerpt)
Seminars in Pediatric Infectious Diseases. 2004 Jul; 15(3):130-136.Since Edward Jenner's discovery of the smallpox vaccine 200 years ago, vaccines have been one of the most lifesaving health interventions for humankind and, conversely, one of the most underused health interventions in developing countries. The implementation of childhood vaccines in the United States and other industrialized countries led to a rapid and large decrease in morbidity and mortality from common childhood diseases. The smallpox eradication program, led by the World Health Organization (WHO) from 1967 to 1977, ended deaths from smallpox, a disease that once killed millions of children and adults each year. Beginning in the early 1980s, the development of routine immunization programs by WHO and UNICEF for children in developing countries led to a sustained program of administration of lifesaving vaccinations as part of primary healthcare systems. Since the launch of these routine immunization programs in most countries, more than 20 million deaths have been prevented from vaccine-preventable diseases (Fig 1). Ongoing initiatives to eradicate polio, reduce measles mortality rates, eliminate measles from discrete regions of the world, and introduce additional vaccines have been remarkably successful. However, more than 1.4 million children died from vaccine-preventable diseases in 2002, 610,000 from measles alone, suggesting that great challenges still exist to fully utilize the potential of lifesaving vaccines (WHO, unpublished data). This article reviews the status of current immunization initiatives, summarizes lessons learned, and makes recommendations for a healthier world through the use of vaccines. (excerpt)
Population 2005. 2004 Dec; 6(4):7-8.In a report issued in November, the Population Division of the UN’s Department of Economic and Social Affairs has estimated that the world’s population may stabilize at about 9 billion by the year 2300. The document, World Population 2300, provides extensive data showing low, medium and high projections for each country of the world. All projected scenarios share the same assumptions about steady decline of mortality after 2050, increase in life expectancy, and zero international migration after 2050. The scenarios are based on assumptions for 2050, which were set out in the UN’s World Population Prospects: The 2002 Revision, Volumes I and II. The following major findings are excerpted from the report. (excerpt)
Inconsistencies between tuberculosis reporting by the Ministry of Health and the World Health Organization. Mexico, 1981-1998. Discrepancias entre los datos ofrecidos por la Secretaría de Salud y la Organización Mundial de la Salud sobre tuberculosis en México, 1981-1998.
Salud Pública de México. 2003 Mar-Apr; 45(2):78-83.The objective was to describe the tuberculosis morbidity and mortality trends in Mexico, by comparing the data reported by the Ministry of Health (MH) and the World Health Organization (WHO) between 1981 and 1998. The number of cases notified in the past few years, their rates, and the trends of the disease in Mexico were analyzed. The incidence of smear-positive pulmonary tuberculosis was estimated for 1997 and 1998 with the annual tuberculosis infection risk (ATIR), to estimate the percentage of bacilliferous cases in 1997-1998. WHO reported more tuberculosis cases for Mexico than the MH. However, this difference has decreased throughout the years. The notification of smear-positive cases remained stable during 1993-1998. The estimated percentages of detection were 66% for 1997 and 26% for 1998 (based on ATIR of 0.5%). Tuberculosis mortality decreased gradually (6.7% per year) between 1990 and 1998, whereas the number of new cases increased, suggesting the persistence of disease transmission in the population. Inconsistencies between case notifications from national data and WHO were considerable, but decreased progressively during the study period. According to ATIR estimations, a considerable number of infectious tuberculosis cases are not detected. (author's)
Lancet. 2004 May 8; 363(9420):1531.Aconcerted immunisation drive, especially in Africa, has helped cut the number of measles deaths to 610 000, down 30% from the benchmark year of 1999, according to WHO and UNICEF. The UN agencies said that almost 260 000 lives had been saved annually since 1999 and the world was on target to achieve the goal of cutting deaths in half by the end of 2005. They attributed the progress to the adoption by high-burden countries of the comprehensive WHO/ UNICEF strategy for sustainable measles mortality reduction. This is aimed at achieving at least 80% routine measles vaccination coverage in every district, and ensuring that all children get a second opportunity for measles immunisation—either through routine services or periodic supplemental immunisation activities (SIAs) every 3–4 years. (excerpt)
Evolution in the recommendations for oral rehydration therapy according to World Health Organisation guidelines: where to go from here?
Journal of the Indian Medical Association. 2003 Jun; 101(6):366-370.Guidelines on the use of oral rehydration salts (ORS) have been revised over the years based on evidence from research studies and clinical experience. This paper charts the evolution in oral rehydration therapy (ORT) in the context of World Health Organisation (WHO) recommendations. Diarrhoeal disease case management, with ORT and ORS as its cornerstone, has had tremendous success in terms of implementation and outcome. To further decrease global diarrhoeal morbidity and mortality, there should be increased efforts to accelerate the introduction of safe, effective, and affordable vaccines against diarrhoeal pathogens such as cholera and rotavirus. (excerpt)
Eastern Mediterranean Health Journal. 2001 Nov; 7(6):956-965.The infant mortality rates for 1978 and 1998 of 16 Arab countries in the Eastern Mediterranean region were studied. The data were extracted from World Health Organization and United Nations Children’s Fund sources. The impact of demographic, social, perinatal care and economic indicators on infant mortality rates in 1998 was studied using Spearman rank coefficient to detect significant correlations. All countries, except Iraq, showed a sharp decline in rates from 1978 to 1998. Infant mortality rates were directly related to population size, annual total births, low birth weight and maternal mortality ratios. Also, infant mortality rates were inversely related to literacy status of both sexes, annual gross national product per capita and access to safe drinking water and adequate sanitation facilities. (author's)
In: An agenda for people: the UNFPA through three decades, edited by Nafis Sadik. New York, New York, New York University Press, 2002. 137-150.This volume chronicles the remarkable success -- indeed, the reproductive revolution -- that has taken place over the last thirty years, in which the United Nations Population Fund (UNFPA) has played such a major role. Our purpose in this chapter is to contrast the situation at the century's end with the one that existed at the time of UNFPA's creation thirty years ago, and to project from the current situation to the new challenges that lie ahead. In many respects, the successful completion of the fertility transition that is now so far advanced will bring an entirely new set of challenges, and these will require a fundamental rethinking about the future mandate, structure, staffing and programme of UNFPA in the twenty-first century. Our purpose here is to identify those challenges and speculate about their implications. (author's)
In: An agenda for people: the UNFPA through three decades, edited by Nafis Sadik. New York, New York, New York University Press, 2002. 2-23.In demographic terms, the last thirty years have been quite distinct from the period that preceded it, or, indeed, from any other period in history. The global fertility level had been almost stable for at least twenty years prior to 1965-1969, with a total fertility rate just under 5 children per woman, and this stability did not hide countervailing forces in different parts of the world. The developed countries, whether they had participated or not in the post-World War II “baby boom,” showed no strong trends in fertility, with a total fertility rate remaining around 2.7. The same lack of change characterized the developing countries, but there the total fertility rate was well over 6, as it may well have been for millennia. (excerpt)
Washington, D.C., Negative Population Growth [NPG], 2003 Jun. 8 p. (NPG Forum)The United Nations Population Division has put the highlights of its new population estimates and projections onto the Web. Present world population is 6.3 billion. It is projected to rise to 8.9 billion by 2050, a number almost identical to the 1998 projection but 400-million-below-the-2000-version and slightly below the U.S. Census Bureau projection of 9.079 billion. The projection reflects (1) the expectation that fertility is heading below 2.1 in all but the poorest less developed countries (LDCs) and (2) the growing seriousness of AIDS. The new report represents an ongoing effort to bring the projections into line with recent experience. That process is still incomplete. Uncertainties internal and external to the calculations raise several questions: Will European fertility rise as anticipated? Will mortality continue to decline, particularly in the least developed countries, or will it rise and thus eventually bring population growth to a stop through the grim process of rising death rates rather than the benign process of reduced fertility? Do the projections still understate U.S. fertility and population growth? The report makes no effort to analyze the external forces that will affect mortality and migration. (excerpt)
Encounter. 2000 Jul-Aug; 3(4):38-52.Accordingly, the broad objective of this paper is twofold (1) To assess the state of progress of GUI country with emphasis on demography, economy and society. (2) To examine the challenges the country is likely to face in coming years. (excerpt)