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Lancet. 2007 Apr 14; 369(9569):1240-1243.Every year, 11 million mothers and newborn infants die, and a further 4 million infants are stillborn. Much is known about the efficacy of single interventions to increase survival under well-managed conditions, much less about how to integrate programmes at scale in poor populations. Funds for maternal, neonatal, and child health are limited, and research is needed to clarify the most cost-effective solutions. In 2003, the Bill & Melinda Gates Foundation?s grand challenges in global health focused on scientific and technological solutions to prevent, treat, and cure diseases of the developing world. The disappointing progress towards the Millennium Development Goals (MDGs) 4 and 5 to reduce child and maternal mortality led us to do a similar exercise to engage creative minds from development and health professionals-ie, those who work in the front line-about how research might accelerate progress towards meeting these MDGs. (excerpt)
Lancet. 2006 Apr 8; 367(9517):1137.Francisco Songane, a former Mozambican health minister who took over as Director of the new Partnership for Maternal, Newborn and Child Health on Feb 1, 2006, is a man with a mission. His goal is to capitalise on emerging political will--after years of neglect by the international community-- to reduce the unacceptably high toll of 11 million women, infants, and children under the age of 5 years who die every year from largely preventable diseases. "Children are dying and mothers are dying", he told The Lancet. "It is not normal to die in childbirth. It is not normal to die as a newborn", he says, commenting that in some countries, such as Mozambique, many women do not name their children for the first month because so many babies die. "We have to change that kind of fatalism. We cannot accept that people who make up two thirds of the world's population are dying silently without anyone helping", Songane asserts. (excerpt)
In: War and public health, edited by Barry S. Levy, Victor W. Sidel. Washington, D.C., American Public Health Association [APHA], 2000. 254-278.War has always been disastrous for civilians, and the Persian Gulf War was no exception. Yet the image that has been perpetuated in the West is that the Gulf War was somehow "clean" and fought with "surgical precision" in a manner that minimized civilian casualties. However, massive wartime damage to Iraq's civilian infrastructure led to a breakdown in virtually all sectors of society. Economic sanctions further paralyzed Iraq's economy and made any meaningful post-war reconstruction all but impossible. Furthermore, the invasion of Kuwait and the subsequent Gulf War unleashed internal political events that have been responsible for further suffering and countless human fights violations. The human impact of these events is incalculable. In 1996, more than five years after the end of the war, the vast majority of Iraqi civilians still subsist in a state of extreme hardship, in which health care, nutrition, education, water, sanitation, and other basic services are minimal. As many as 500,000 children are believed to have died since the beginning of the Persian Gulf War, largely due to malnutrition and a resurgence of diarrheal and vaccine- preventable diseases. Health services are barely functioning due to shortages of supplies and equipment. Medicines, including insulin, antibiotics, and anesthetics, are in short supply. The psychological impact of the war has had a damaging and lasting effect on many of Iraq's estimated eight million children. (excerpt)
Child mortality associated with reasons for non-breastfeeding and weaning: Is breastfeeding best for HIV-positive mothers?
AIDS. 2003 Apr 11; 17(6):879-885.Objective: To estimate child mortality associated with reasons for the non-initiation of breastfeeding and weaning caused by preceding morbidity, compared with voluntary weaning as a result of maternal choice. Methods: Demographic and Health Surveys were analysed from 14 developing countries. Women reported whether they initiated lactation or weaned, and if so, their reasons for non-initiation or stopping breastfeeding were classified as voluntary choice or as a result of preceding maternal/infant illness. Rates of child mortality and survival analyses were estimated, by reasons for non-breastfeeding or weaning. Results: Mortality was highest among never-breastfed children. Child mortality among women who never initiated breastfeeding was significantly higher than among women who weaned. Preceding maternal/infant morbidity was the most common reason for not breastfeeding (63.9%), and the mortality of children never breastfed because of preceding morbidity was higher than in children not breastfed as a result of maternal choice; 326.8 per 1000 versus 34.8 per 1000, respectively. Mortality among breastfed children who were weaned because of preceding morbidity was higher than among those weaned voluntarily; 19.2 per 1000 versus 9.3 per 1000, respectively. Failure to initiate lactation was significantly more frequent among women reporting complications of delivery and with low birthweight infants. Conclusion: Child mortality as a result of the voluntary non-initiation of breastfeeding or voluntary weaning was lower than previously estimated, and this should be used as a benchmark when counselling HIV-positive mothers on the risks of non-breastfeeding or weaning to prevent mother-to-child transmission of HIV. (author's)
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.
CENTRAL AFRICAN JOURNAL OF MEDICINE. 1992 Jul; 38(7):314-5.Participants at a 1992 WHO/UNICEF consultation meeting on HIV transmission and breast feeding weigh the risk of death from AIDS with the risk of death from other causes. Breast feeding reduces the risk of death from diarrhea, pneumonia, and other infections. Artificial or inappropriate feeding contributes the most to the more than 3 million annual childhood deaths from diarrhea. The rising prevalence of HIV infection among women worldwide results in more and more cases of HIV-infected newborns. About 33% of infants born to HIV-infected. Some HIV transmission occurs through breast feeding, but breast feeding does not transmit HIV to most infants HIV-infected mothers. Participants recommend that, in areas where infectious diseases and malnutrition are the leading causes of death and infant mortality is high, health workers should advise all pregnant women, regardless of their HIV status, to breast feed. The infant's risk of HIV infection via breast milk tends to be lower than its risk of death from other causes and from not being breast fed. HIV-infected women who do have access to alternative feeding should talk to their health care providers to learn how to feed their infants safely. In areas where the leading cause of death is not infectious disease and infant mortality is low, participants recommend that health workers advise HIV-infected pregnant women to use a safe feeding alternative, e.g., bottle feeding. Yet, the women and their providers should not be influenced by commercial pressures to choose an alternative feeding method. Health care services in these areas should provide voluntary and confidential HIV testing and counseling. Participants stress the need to prevent women from becoming HIV-infected by providing them information about AIDS and how to protect themselves, increasing their participation in decision-making in sexual relationships, and improving their status in society.
Washington, D.C., World Bank, 1992. 36 p.This atlas presents social, economic, and environmental statistics for 200 economies throughout the world, including statistics for 15 economies throughout the world, including statistics for 15 economies of the former Soviet Union. The following social/demographic indices are presented: population growth rate, 1980-1991; under-5 mortality rate, 1991; daily calorie supply/capita, 1989; illiteracy rate, 1990; and female labor force, 1991. GNP/capita, 1991; GNP/capita growth rate, 1980-91; and shares of agriculture, exports, and investment in GDP in 1991 comprise the economic data. Finally, GDP output/kilogram energy used, 1990; annual water use and annual water use/capita, 1970-87; forest coverage, 1989; and change in forest coverage, 1980-89, are presented as economic indicators. All figures are reported in color graphic format. Technical notes and World Bank structure and functions are discussed in closing sections. The text also cautions that the differing statistical systems and data collection methods and capabilities employed internationally demand that caution be taken against directly comparing statistical coverages and definitions.
[Unpublished] 1991. Presented at the 119th Annual Meeting of the American Public Health Association [APHA], Atlanta, Georgia, November 11-14, 1991. 7,  p.Maternal health affects child survival in many ways. For example, and infant in Bangladesh whose mother has died during childbirth has a 95% chance of dying in the 1st year. Further children <10 years old in Bangladesh, especially girls, who have lost their mother are 4 times as likely to also die. In addition, there is a relationship between protein energy malnutrition in mothers and low prepregnancy weight and meager wait gain during pregnancy which retards fetal growth resulting in a low birth weight (LBW) infant, LBW infants die at a rate 30 times that of adequate weight infants. In fact, child survival depends on maternal health even before the mother is able to conceive. Daughter as well as mothers in developing countries often eat last and smaller amounts of food than male family members. Females who remain poorly nourished often experience obstructed labor which causes several complications for the infant such as respiratory failure. Maternal infections such as malaria and sexually transmitted diseases are also closely linked to LBW. Some can also bring about preterm birth and congenital infections. Pregnancy and labor complications are responsible for about 500,000 maternal deaths annually. Hemorrhage, sepsis, eclampsia, and obstructed labor cause most of these deaths. A woman's fertility pattern also contributes to child survival. The high risk birth categories include too young, too old, too many children, and too closely spaced. In fact, the median mortality rate for infants born <2 years after the older sibling is 71% greater than that for those born 2-3 years apart. The World Bank recommends improved community based health care, improved referral facilities, and an alarm and transport system to improve maternal health. The World Bank, UNDP, UNFPA, UNICEF, WHO, IPPF, and the Population Council support the Safe Motherhood Initiative which aims to reduce maternal morbidity and death by 50% by 2000.
Socio-economic development and fertility decline: an application of the Easterlin synthesis approach to data from the World Fertility Survey: Colombia, Costa Rica, Sri Lanka and Tunisia.
New York, New York, United Nations, 1991. ix, 115 p. (ST/ESA/SER.R/101)The relationship between fertility decline and development is explored for Colombia, Costa Rica, Sri Lanka, and Tunisia. The study applies Richard Easterlin and Eileen Crimmins; theoretical and empirical approach to analyzing World Fertility Survey (WFS) data in a comparative context. The paper specifically questions the strengths and weaknesses of the Easterlin-Crimmins framework when applied to developing country data, and what the framework implies about comparative fertility in these countries. 3 stages in all, an analyst 1st decomposes a couple's final number of children ever born through an intermediate variables framework. Stage 2 emphasized understanding the determinants of contraceptive use, while stage 3 explains the remaining stage-1 and stage-2 variables. A model linking the supply of children, the demand for children, and the cost of contraceptive regulation results. Stage 1 results were promising, stage 2 results were less encouraging, while stage 3 revealed a theoretically incomplete approach employing empirically weak WFS data. While the Easterlin-Crimmins approach may be promising, econometric, theoretical, and data quality and collection improvements are necessary. Among stage-3 variables open to manipulation, higher socioeconomic status was associated with delayed age at 1st marriage, lower infant and child death rates, lower numbers of children desired, increased knowledge of contraception, and reduced levels of breastfeeding. Apart from regional differences, the educational and occupational roles of women in the countries studied were of primary importance in understanding differential fertility.
BULLETIN OF THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE. 1990 Dec; 65(4):75.WHO estimates of pediatric AIDS cases are 400,000 by September 1990, not including 300,000 who have already died. WHO projects that 10 million or more infants and children will have HIV infections by 2000, in addition to 25-30 million adults. The primary mode of transmission in most countries is heterosexual contact, resulting in a rapidly increasing prevalence in women of childbearing age. WHO predicts that pediatric AIDS will be a major, and in some countries the predominant, cause of death in children in the 1990s. Even though child survival programs have made progress recently, by immunization and diarrhea control, the fruits of these efforts are expected to be reversed. The world's cumulative total of HIV infected women is about 3 million. In the U.S., 20,000 infants have been born to infected mothers. In contrast, in Eastern Europe, about 1000 children are infected, mostly from unscreened blood transfusions and unsterilized needles and syringes. The impact of childhood AIDS is expected to be an increase in child mortality by 50% in many developing countries. Serious social repercussions for children also stem from projected 10 million uninfected children orphaned by AIDS, mostly in sub-Saharan Africa. The only way to lessen this tragedy is for people to protect themselves by practicing safe sex and having sexually transmitted diseases treated.
In: Issues in contemporary international health, edited by Thomas A. Lambo and Stacey B. Day. New York, New York, Plenum Medical Book Company, 1990. 113-33.The causes of mortality and disability in the world are reviewed, and the 4 most important mechanisms for promoting maternal and child health are proposed: female literacy, family planning, community-based efforts and global strategies for international cooperation. The health needs of women, children and adolescents, who make up the majority and the most vulnerable segment of the population, must be met. Malnutrition is the single most important cause of health problems through adult life, and affects 20 million children in Africa alone. Statistics are cited for infant mortality, vaccine-preventable diseases, diarrheal diseases and respiratory infections, infant mortality and maternal mortality. The key determinant of infant survival is female literacy. Existing scientific cooperation is the closet thing we have to a global international community. An example of applied scientific solutions to health care is the risk approach in maternal health care. 2 strategies of scientific cooperation have emerged: the international center model in a country or region to address a specific problem, and the task force model, as used effectively by WHO, UNICEF, and the Task Force for Child Survival. Research topics on health in developing countries are listed that could be tackled by universities and scientific networks, e.g. scientific research is lacking on how to make household hygiene effective in poor countries. A concerted global research effort and surveillance effort is needed for AIDS.
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.
JOURNAL OF BIOSOCIAL SCIENCE. 1990 Jul; 22(3):365-72.Data from a 1985 survey in 2 urban centers in Sudan, Juba and Wau, were analyzed to assess childhood mortality levels and the effect of UNICEF's health care program. A sample of 5120 mothers (Juba, 3061 and Wau, 2059) with 21,509 children were collected from the towns. Logistic regression analysis was used to delineate determinants of child survival. The child mortality measures denote continued high infant and child mortality levels for Southern Sudan. 3 components of the UNICEF program were significantly associated with child survival: oral rehydration therapy, maternal education and immunization. The study concludes that maternal education is the most important determinant of child survival, affecting both the cure and prevention of child ill- health. (Author's modified).
In: Infant and childhood mortality and socio-economic factors in Africa. (Analysis of national World Fertility Survey data) / Mortalite infantile et juvenile et facteurs socio-economiques en Afrique. (Analyse des donnees nationales de l'Enquete Mondiale sur la Fecondite), [compiled by] United Nations. Economic Commission for Africa [ECA]. Addis Ababa, Ethiopia, United Nations, ECA, 1987. 1-4. (RAF/84/P07)After completion of the World Fertility Survey, the UN Economic Commission for Africa (ECA) held a workshop for representatives from 15 African countries to utilize the SPSS program for demographic data analysis to prepare reports on their own countries' infant and child mortality trends. The introduction to the report on the workshop highlights findings which include infant mortality rates around 90/1000 births in Kenya, Nigeria and Cameroon, and 100 or more in Benin, Ivory Coast, and Senegal. Mortality was less than 80 in Sudan and Mauritania, possibly reflecting serious deficiencies in the data. Childhood mortality was over 100/1000 in Benin, and lowest in Kenya and Ivory Coast, around 70. There were clear indications of decline in mortality in the last 20 years in Cameroon, Ivory Coast, Kenya, Nigeria and Senegal. Among the variables examined for their influence on mortality, maternal education and birth intervals clearly were the strongest, suggesting directions for policy.
[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.
[New York, United Nations, 1986.] 27 p.The ongoing crisis confronting women and children in the Third World--where disease and hunger are taking millions of lives of young children every year and where population growth still proceeds at an unacceptably high rate--is actually worsening in some areas. The European Parliamentarians' Forum on Child Survival, Women, and Population: Integrated Strategies was held under the auspices of The Netherlands government and organized in cooperation with 3 UN organizations: the World Health Organization, UNICEF, and the UN Fund for Population Activities. It is critical that the world regain the momentum of past decades in reducing appalling child mortality rates, improving the health and status of women, and slowing population growth. Development programs from health education to agriculture are hampered or crippled by the inability of development planners to recognize the centrality of the woman's role. Maternal and child health is the logical entry point for primary health care. Education is the springboard for rescuing women in the Third World from poverty, illness,endless childbearing, and lowly social status. One should educate women to save children. Women in the developing world must be given access to basic information to be able to take advantage of new, improved or rediscovered technologies such as 1) oral rehydration therapy, 2) vaccines, 3) growth monitoring through frequent charting to detect early signs of malnutrition, 4) breast feeding, and 5) birth spacing. Education is the single most documented factor affecting birth rate, status of women, and infant and child health. The presentations at The Hague threw into sharp relief the close links, the cause and effect chains, and the synergisms associated with all the factors connected, directly or indirectly, with child survival, women's status, and population--factors such as education, economic opportunities, and overall development questions. A 4-point agenda includes 1) encouraging UN agencies and organizations concerned with social development to work closely together and to enhance the effectiveness of their programs, 2) seeking greater support for the UN's social development programs, 3) focusing public attention on the interrelatedness of health, maternal and child survival and care, women's status, and freedom of choice in family matters, and 4) maintaining and strengthening commitment through the dialogue of parliamentarians.
New York, UNFPA, 1978 Jun. 53 p. (Report No 3)The present report presents the findings of the Mission which visited Afghanistan from October 3-16, 1977 for the purpose of assessing the country's needs for population assistance. Report focus is on the following: the national setting (geographical, cultural, and administrative features; salient demographic, social, and economic characteristics of the population; and economic development and national planning); basic population data; population dynamics and policy formulation; implementing population policies (family health and family planning and education, communication, and information); and external assistance (multilateral and bilateral). The final section presents the recommendations of the Mission in detail. For the past 25 years Afghanistan has been working to inject new life into its economy. Per capita income, as estimated for 1975, was $U.S. 150, a relatively low figure and heavily skewed in favor of a very small proportion of the population. The country is still predominantly rural (85%) and agricultural (75%). In the absence of reliable data, population figures must be accepted tentatively. According to the 7-year plan, the population in 1975 was 16.7 million and the rate of growth around 2.5% per annum. The crude birth rate is near 50/1000 and the crude death rate possibly 25/1000. The Mission endorses the priority given by the government to the population census and recommends continued support on the part of the United Nations Fund for Population Activities (UNFPA) to help the Central Statistical Office in the present effort and in building up capacity for future work. The Mission recommends that efforts be concentrated on the reduction of infant, child, and maternal mortality levels and that assistance be continued to the family health services and to programs of population education. Emphasis should be on services to men and women in rural areas. The Mission also recommends a training program for traditional birth attendants.