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  1. 26
    351815
    Peer Reviewed

    Global cost of child survival: estimates from country-level validation.

    van Ekdom L; Stenberg K; Scherpbier RW; Niessen LW

    Bulletin of the World Health Organization. 2011 Apr 1; 89(4):267-77.

    OBJECTIVE: To cross-validate the global cost of scaling up child survival interventions to achieve the fourth Millennium Development Goal (MDG4) as estimated by the World Health Organization (WHO) in 2007 by using the latest country-provided data and new assumptions. METHODS: After the main cost categories for each country were identified, validation questionnaires were sent to 32 countries with high child mortality. Publicly available estimates for disease incidence, intervention coverage, prices and resources for individual-level and programme-level activities were validated against local data. Nine updates to the 2007 WHO model were generated using revised assumptions. Finally, estimates were extrapolated to 75 countries and combined with cost estimates for immunization and malaria programmes and for programmes for the prevention of mother-to-child transmission of the human immunodeficiency virus (HIV). FINDINGS: Twenty-six countries responded. Adjustments were largest for system- and programme-level data and smallest for patient data. Country-level validation caused a 53% increase in original cost estimates (i.e. 9 billion 2004 United States dollars [US$]) for 26 countries owing to revised system and programme assumptions, especially surrounding community health worker costs. The additional effect of updated population figures was small; updated epidemiologic figures increased costs by US$ 4 billion (+15%). New unit prices in the 26 countries that provided data increased estimates by US$ 4.3 billion (+16%). Extrapolation to 75 countries increased the original price estimate by US$ 33 billion (+80%) for 2010-2015. CONCLUSION: Country-level validation had a significant effect on the cost estimate. Price adaptations and programme-related assumptions contributed substantially. An additional 74 billion US$ 2005 (representing a 12% increase in total health expenditure) would be needed between 2010 and 2015. Given resource constraints, countries will need to prioritize health activities within their national resource envelope.
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  2. 27
    350915
    Peer Reviewed

    Effects of the World Bank's maternal and child health intervention on Indonesia's poor: evaluating the safe motherhood project.

    Baird J; Ma S; Ruger JP

    Social Science and Medicine. 2011 Jun; 72(12):1948-55.

    This article examines the impact of the World Bank's Safe Motherhood Project (SMP) on health outcomes for Indonesia's poor. Provincial data from 1990 to 2005 was analyzed combining a difference-in-differences approach in multivariate regression analysis with matching of intervention (SMP) and control group provinces and adjusting for possible confounders. Our results indicated that, after taking into account the impact of two other concurrent development projects, SMP was statistically significantly associated with a net beneficial change in under-five mortality, but not with infant mortality, total fertility rate, teenage pregnancy, unmet contraceptive need or percentage of deliveries overseen by trained health personnel. Unemployment and the pupil-teacher ratio were statistically significantly associated with infant mortality and percentage deliveries overseen by trained personnel, while pupil-teacher ratio and female education level were statistically significantly associated with under-five mortality. Clinically relevant changes (52-68% increase in the percentage of deliveries overseen by trained personnel, 25-33% decrease in infant mortality rate, and 8-14% decrease in under-five mortality rate) were found in both the intervention (SMP) and control groups. Copyright (c) 2010 Elsevier Ltd. All rights reserved.
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  3. 28
    345857
    Peer Reviewed

    HIV/AIDS. Universal access in the fight against HIV/AIDS.

    Girard F; Ford N; Montaner J; Cahn P; Katabira E

    Science. 2010 Jul 9; 329(5988):147-9.

    This article focuses on the United Nations' goal of universal access to comprehensive programs for HIV prevention, treatment, care, and support by 2010, which has failed to deliver. It discusses how universal access can benefit other health programs such as progress towards universal access has directly advanced efforts to achieve several of the U.N. Millennium Development Goals (MDGs) but also includes why some criticize HIV-specific programs.
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  4. 29
    345609
    Peer Reviewed

    Use of new World Health Organization child growth standards to assess how infant malnutrition relates to breastfeeding and mortality.

    Vesel L; Bahl R; Martines J; Penny M; Bhandari N; Kirkwood BR

    Bulletin of the World Health Organization. 2010 Jan; 88(1):39-48.

    OBJECTIVE: To compare the estimated prevalence of malnutrition using the World Health Organization's (WHO) child growth standards versus the National Center for Health Statistics' (NCHS) growth reference, to examine the relationship between exclusive breastfeeding and malnutrition, and to determine the sensitivity and specificity of nutritional status indicators for predicting death during infancy. METHODS: A secondary analysis of data on 9424 mother-infant pairs in Ghana, India and Peru was conducted. Mothers and infants were enrolled in a trial of vitamin A supplementation during which the infants' weight, length and feeding practices were assessed regularly. Malnutrition indicators were determined using WHO and NCHS growth standards. FINDINGS: The prevalence of stunting, wasting and underweight in infants aged < 6 months was higher with WHO than NCHS standards. However, the prevalence of underweight in infants aged 6-12 months was much lower with WHO standards. The duration of exclusive breastfeeding was not associated with malnutrition in the first 6 months of life. In infants aged < 6 months, severe underweight at the first immunization visit as determined using WHO standards had the highest sensitivity (70.2%) and specificity (85.8%) for predicting mortality in India. No indicator was a good predictor in Ghana or Peru. In infants aged 6-12 months, underweight at 6 months had the highest sensitivity and specificity for predicting mortality in Ghana (37.0% and 82.2%, respectively) and Peru (33.3% and 97.9% respectively), while wasting was the best predictor in India (sensitivity: 54.6%; specificity: 85.5%). CONCLUSION: Malnutrition indicators determined using WHO standards were better predictors of mortality than those determined using NCHS standards. No association was found between breastfeeding duration and malnutrition at 6 months. Use of WHO child growth standards highlighted the importance of malnutrition in the first 6 months of life.
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  5. 30
    332634

    Progress for children. Achieving the MDGs with equity.

    UNICEF

    New York, New York, UNICEF, 2010 Sep. [92] p. (Progress for Children No. 9)

    ‘Achieving the MDGs with Equity’ is the focus of this ninth edition of Progress for Children, UNICEF’s report card series that monitors progress towards the MDGs. This data compendium presents a clear picture of disparities in children’s survival, development and protection among the world’s developing regions and within countries. While gaps remain in the data, this report provides compelling evidence to support a stronger focus on equity for children in the push to achieve the MDGs and beyond. (Excerpt)
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  6. 31
    344704

    [Crisis in human resources for health: millennium development goals for maternal and child health threatened] Tekort aan gezondheidswerkers in Afrika: millenniumdoelstellingen voor moeder- en kindzorg in gevaar.

    Beltman JJ; Stekelenburg J; van Roosmalen J

    Nederlands Tijdschrift Voor Geneeskunde. 2010; 154(5):A1159.

    International migration of health care workers from low-income countries to the West has increased considerably in recent years, thereby jeopardizing the achievements of The Millennium Development Goals, especially number 4 (reduction of child mortality) and 5 (improvement of maternal health).This migration, as well as the HIV/AIDS epidemic, lack of training of health care personnel and poverty, are mainly responsible for this health care personnel deficit. It is essential that awareness be raised amongst donors and local governments so that staffing increases, and that infection prevention measures be in place for their health care personnel. Western countries should conduct a more ethical recruitment of health care workers, otherwise a new millennium development goal will have to be created: to reduce the human resources for health crisis.
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  7. 32
    332061

    Child mortality decreases globally and immunization coverage increases, despite unequal access.

    Zuehlke E

    Washington, D.C., Population Reference Bureau [PRB], 2009 Dec. [2] 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.
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  8. 33
    332020

    Last chance for the world to live up to its promises? Why decisive action is needed now on child health and the MDGs. A World Vision policy briefing.

    World Vision

    Milton Keynes, United Kingdom, World Vision International Policy and Advocacy, 2008 Sep. 15 p. (World Vision Policy Briefing)

    Now is the window of opportunity to ensure that 2015 will be remembered as the year the world lived up to its promise to the world's poorest and most vulnerable people. This short briefing paper considers child health in the context of the three health-focused MDGs, identifies concrete steps needed in the coming months to put the MDGs back on track, and summarises World Vision's own efforts to contribute to their achievement. (Excerpt)
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  9. 34
    331941

    Diarrhoea: Why children are still dying and what can be done.

    Johansson EW; Wardlaw T; Binkin N; Brocklehurst C; Dooley T

    New York, New York, UNICEF, 2009. [65] p.

    This report sets out a 7-point strategy for comprehensive diarrhoea control that includes a treatment package to reduce child deaths, and a prevention package to reduce the number of diarrhoea cases for years to come. The report looks at treatment options such as low-osmolarity ORS and zinc tablets, as well as prevention measures such as the promotion of breastfeeding, vitamin A supplementation, immunization against rotavirus -- a leading cause of diarrhoea -- and proven methods of improving water, sanitation and hygiene practices. Diarrhoea's status as the second leading killer of children under five is an alarming reminder of the exceptional vulnerability of children in developing countries. Saving the lives of millions of children at risk of death from diarrhoea is possible with a comprehensive strategy that ensures all children in need receive critical prevention and treatment measures. (Excerpt)
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  10. 35
    331304
    Peer Reviewed

    Are the goals set by the Millennium Declaration and the Programme of Action of the International Conference on Population and Development within reach by 2015?

    Concepcion MB

    Asia Pacific Population Journal. 2008 Aug; 23(2):3-9.

    This article discusses the likelihood of countries in Asia and the Pacific in reaching their 2015 Millennium Development Goals (MGDs). It touches on malnourishment, the reduction of child mortality, and the improvement of maternal health and stresses that the benefits of development must serve everyone, and not just favor the wealthy.
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  11. 36
    328891
    Peer Reviewed

    Child health and mortality.

    El Arifeen S

    Journal of Health, Population, and Nutrition. 2008 Sep; 26(3):273-9.

    Bangladesh is currently one of the very few countries in the world, which is on target for achieving the Millennium Development Goal (MDG) 4 relating to child mortality. There have been very rapid reductions in mortality, especially in recent years and among children aged over one month. However, this rate of reduction may be difficult to sustain and may impede the achievement of MDG 4. Neonatal deaths now contribute substantially (57%) to overall mortality of children aged less than five years, and reductions in neonatal mortality are difficult to achieve and have been slow in Bangladesh. There are some interesting attributes of the mortality decline in Bangladesh. Mortality has declined faster among girls than among boys, but the poorest have not benefited from the reduction in mortality. There has also been a relative absence of a decline in mortality in urban areas. The age and cause of death pattern of under-five mortality indicate certain interventions that need to be scaled up rapidly and reach high coverage to achieve MDG 4 in Bangladesh. These include skilled attendance at delivery, postnatal care for the newborn, appropriate feeding of the young infant and child, and prevention and management of childhood infections. The latest (2007) Bangladesh Demographic and Health Survey shows that Bangladesh has made sustained and remarkable progress in many areas of child health. More than 80% of children are receiving all vaccines. The use of oral rehydration solution for diarrhoea is high, and the coverage of vitamin A among children aged 9-59 months has been consistently increasing. However, poor quality of care, misperceptions regarding the need for care, and other social barriers contribute to low levels of care-seeking for illnesses of the newborns and children. Improvements in the health system are essential for removing these barriers, as are effective strategies to reach families and communities with targeted messages and information. Finally, there are substantial health-system challenges relating to the design and implementation, at scale, of interventions to reduce neonatal mortality.
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  12. 37
    328434

    Child survival: India and China's challenges [editorial]

    Lancet. 2008 Aug 16; 372(9638):508.

    Last week, UNICEF published The State of Asia-Pacific's Children 2008-its first annual report on maternal, newborn, and child survival in the region. The report has a particular focus on the challenges for India and China, since, with their huge populations, achievements in these countries can make a substantial difference to child survival in the region and worldwide. China has made good investments in health (10% of gross domestic product) and is on track to reach Millennium Development Goal (MDG) 4 on child survival. However, UNICEF notes that the country's progress has slowed down in the past 10 years and the coverage of essential interventions remains low in rural areas. The report singles out India. It states that the global attainment of the health-related MDGs will largely depend on the country's progress in improving health and addressing the social determinants of health. A fifth of all deaths (2.1 million) in children younger than 5 years occurred in India in 2006. Huge disparities in infant mortality rates exist-within cities and between urban and rural areas, and between the sexes, socioeconomic groups, and different castes. The privatisation of health care in India and China is set to widen the gaps between rich and poor people. Without progress on reducing disparities, efforts to provide primary health care to women and children could founder, says UNICEF. But there are reasons for optimism in India. The government launched the National Rural Health Mission in 2005 to tackle deepening disparities in the country, with the reduction of the infant mortality rate as a primary goal. Interventions, such as cash transfers for expectant mothers living below the poverty line, neonatal services, and the Integrated Management of Neonatal and Childhood Illness, are gradually being rolled out. Such initiatives show there is political will in India to address child survival. But this commitment is not backed-up by serious financial investment. The Indian Government spends less on health (3% of gross domestic product) than several other countries in the Asia-Pacific region, despite a gross domestic product growth rate of 9% in 2007. India can, and must, spend more on health if its mothers and children are to prosper. (full text)
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  13. 38
    327633

    The Millennium Development Goals report 2007.

    United Nations

    New York, New York, United Nations, Department of Economic and Social Affairs, 2007 Jun. 36 p.

    Since their adoption by all United Nations Member States in 2000, the Millennium Declaration and the Millennium Development Goals have become a universal framework for development and a means for developing countries and their development partners to work together in pursuit of a shared future for all. The Millennium Declaration set 2015 as the target date for achieving most of the Goals. As we approach the midway point of this 15-year period, data are now becoming available that provide an indication of progress during the first third of this 15-year period. This report presents the most comprehensive global assessment of progress to date, based on a set of data prepared by a large number of international organizations within and outside the United Nations system. The results are, predictably, uneven. The years since 2000, when world leaders endorsed the Millennium Declaration, have seen some visible and widespread gains. Encouragingly, the report suggests that some progress is being made even inthose regions where the challenges are greatest. These accomplishments testify to the unprecedented degree of commitment by developing countries and their development partners to the Millennium Declaration and to some success in building the global partnership embodied in the Declaration. The results achieved in the more successful cases demonstrate that success is possible in most countries, but that the MDGs will be attained only if concerted additional action is taken immediately and sustained until 2015. All stakeholders need to fulfil, in their entirety, the commitments they made in the Millennium Declaration and subsequent pronouncements. (excerpt)
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  14. 39
    327008

    The state of Africa's children 2008. Child survival.

    UNICEF

    New York, New York, UNICEF, 2008 May. 54 p.

    Every year, the United Nations Children's Fund (UNICEF) publishes The State of the World's Children, the most comprehensive and authoritative report on the world's youngest citizens. The State of the World's Children 2008, published in January 2008, examines the global realities of maternal and child survival and the prospects for meeting the health-related Millennium Development Goals (MDGs) - the targets set by the world community in 2000 for eradicating poverty, reducing child and maternal mortality, combating disease, ensuring environmental sustainability and providing access to affordable medicines in developing countries. This year, UNICEF is also publishing the inaugural edition of The State of Africa's Children. This volume and other forthcoming regional editions complement The State of the World's Children 2008, sharpening from a worldwide to a regional perspective the global report's focus on trends in child survival and health, and outlining possible solutions - by means of programmes, policies and partnerships - to accelerate progress in meeting the Millennium Development Goals. (excerpt)
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  15. 40
    326748

    Child and Adolescent Health and Development progress report 2006-2007. Highlights.

    World Health Organization [WHO]. Department of Child and Adolescent Health and Development

    Geneva, Switzerland, WHO, Department of Child and Adolescent Health and Development, 2008. 20 p.

    The first few days and weeks of life are among the most critical for child survival. Every year, an estimated 4 million children die during the first month of life. Almost all of these deaths (98%) occur in developing countries. Most neonatal deaths are due to ore-term birth, asphyxia and infections such as sepsis, tetanus and pneumonia. In 2006-2007, to support efforts by countries and regions to reduce newborn deaths, we worked to build capacity for the planning and delivery of improved newborn care services in health facilities and communities, to provide tools and guidance for extending population coverage, and to evaluate the impact of all those actions. (excerpt)
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  16. 41
    323732

    The state of the world's children 2008. Child survival.

    UNICEF

    New York, New York, UNICEF, 2007 Dec. [160] p.

    Child mortality is a sensitive indicator of a country's development and telling evidence of its priorities and values. Investing in the health of children and their mothers is not only a human rights imperative, it is a sound economic decision and one of the surest ways for a country to set its course towards a better future. Impressive progress has been made in improving the survival rates and health of children, even in some of the poorest countries, since 1990. Nonetheless, achieving Millennium Development Goal 4 (MDG 4), which aims to reduce the global under-five mortality rate by two thirds between 1990 and 2015, will require additional effort. Attaining the goal is still possible, but the challenge is formidable. Reaching the target means reducing the number of child deaths from 9.7 million in 2006 to around 4 million by 2015. Accomplishing this will require accelerated action on multiple fronts: reducing poverty and hunger (MDG 1), improving maternal health (MDG 5), combating HIV and AIDS, malaria and other major diseases (MDG 6), increasing the usage of improved water and sanitation (MDG 7) and providing affordable essential drugs on a sustainable basis (MDG 8). It will also require a re-examination of strategies to reach the poorest, most marginalized communities. Every child has the right to live a healthy life. A group of children at a community child centre, Malawi. The remarkable advances in reducing child deaths achieved by many developing countries in recent decades provide reason for optimism. The causes of and solutions to child deaths are well known. Simple, reliable and affordable interventions with the potential to save the lives of millions of children are readily available. The challenge is to ensure that these remedies - provided through a continuum of maternal, newborn and child health care - reach the millions of children and families who, so far, have been passed by. (excerpt)
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  17. 42
    321986
    Peer Reviewed

    The role of family planning in poverty reduction.

    Allen RH

    Obstetrics and Gynecology. 2007 Nov; 110(5):999-1002.

    Family planning plays a pivotal role in population growth, poverty reduction, and human development. Evidence from the United Nations and other governmental and nongovernmental organizations supports this conclusion. Failure to sustain family planning programs, both domestically and abroad, will lead to increased population growth and poorer health worldwide, especially among the poor. However, robust family planning services have a range of benefits, including maternal and infant survival, nutrition, educational attainment, the status of girls and women at home and in society, human immunodeficiency virus (HIV) prevention, and environmental conservation efforts. Family planning is a prerequisite for achievement of the United Nations' Millennium Development Goals and for realizing the human right of reproductive choice. Despite this well-documented need, the U.S. contribution to global family planning has declined in recent years. (author's)
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  18. 43
    321885

    New estimates of global under-5 mortality [letter]

    Wardlaw T

    Lancet. 2007 Oct 20; 370(9596):1413.

    Christopher Murray and colleagues publish the results of an analysis of under-5 mortality data. They note several issues they believe limit the quality and usefulness of evidence on child mortality estimates produced by the Inter-agency Child Mortality Estimation Group (IACMEG), which includes WHO, UNICEF, the World Bank, the UN Population Division, Harvard University, the US Bureau of the Census, and others. Developing the best possible method is important, and we repeat the invitation previously extended to Murray to join the Inter-agency group. However, we wish to note that many of the issues raised have already been recognised by the IACMEG and incorporated into its work plan. Additionally, we take issue with several of the technical arguments and conclusions of the article. First, UNICEF and members of the IACMEG have recognised the issue of the completeness of databases and significant work has already been completed in the development of a new and updated database, which will go live in thecoming months. This public-access database will allow ready access to the IACMEG child mortality estimates, in addition to information on how they are calculated and the data sources used. (excerpt)
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  19. 44
    321141

    Adolescent pregnancy -- unmet needs and undone deeds. A review of the literature and programmes.

    Neelofur-Khan D

    Geneva, Switzerland, World Health Organization [WHO], 2007. [109] p. (WHO Discussion Papers on Adolescence; Issues in Adolescent Health and Development)

    The World Health Organization (WHO) has been contributing to meeting the Millennium Development Goals (MDGs) by according priority attention to issues pertaining to the management of adolescent pregnancy. Three of the aims of the MDGs - empowerment of women, promotion of maternal health, and reduction of child mortality - embody WHO's key priorities and its policy framework for poverty reduction. The UN Special Session on Children has focused on some of the key issues affecting adolescents' rights, including early marriage, access to sexual and reproductive health services, and care for pregnant adolescents. This review of the literature was conducted to identify (1) the major factors affecting the pregnancy outcome among adolescents, related to their physical immaturity and inappropriate or inadequate healthcare-seeking behaviour, and (2) the socioeconomic and political barriers that influence their access to health-care services and information. The review also presents programmatic evidence of feasible measures that can be taken at the household, community and national levels to improve pregnancy outcomes among adolescents. (excerpt)
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  20. 45
    320507

    Child and adolescent health and development in a European perspective --- a new WHO strategy.

    Ostergren MM; Barnekow V

    Danish Medical Bulletin. 2007 May; 54:150-152.

    In general, children and adolescents in the WHO European Region today have better nutrition, health and development than ever before. There are striking inequalities in health status across the 52 countries in the Region, however, with over ten-fold differences in infant and child mortality rates. Inequalities are also growing within countries, and several health threats are emerging. Against this background, the WHO Regional Office for Europe has developed a European strategy for child and adolescent health and development. The purpose of the Strategy, together with a tool kit for implementation, is to assist member states in formulating their own policies and programmes. (author's)
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  21. 46
    319153

    Focusing on malnutrition management to improve child survival in India [editorial]

    Ashworth A; Jackson A; Uauy R

    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)
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  22. 47
    315425
    Peer Reviewed

    Research challenges to improve maternal and child survival.

    Costello A; Filippi V; Kubba T; Horton R

    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)
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  23. 48
    315420
    Peer Reviewed

    Human resources in developing countries.

    Lanata CF

    Lancet. 2007 Apr 14; 369(9569):1238-1239.

    More than 10 million children are dying every year, mainly in developing countries, from causes that could be mostly prevented by available cost-effective interventions. Governments worldwide have committed themselves to improve this reality by adopting the Millennium Declaration, in which one of the ten Millennium Development Goals (MDGs) calls for a two-thirds reduction in the number of deaths for children younger than 5 years from the 1990 baseline. From a group of 20 proven interventions that could reduce child mortality by more than 60% (if their coverage could be improved from estimates made in 2000 to 99% of those who need them), three include vaccines: Haemophilus influenzae type B vaccine, measles vaccine, and tetanus toxoid. However, these effective interventions, including vaccines, were not delivered in a way that could reach children who need them most,4 and when delivered, they usually tend to serve the rich and privileged first, leaving the poor to the end. (excerpt)
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  24. 49
    314493
    Peer Reviewed

    A response to criticism of our estimates of under-5 mortality in Iraq, 1980 -- 98.

    Blacker J; Ali MM; Jones G

    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)
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  25. 50
    307068
    Peer Reviewed

    Weaning practices of the Makushi of Guyana and their relationship to infant and child mortality: A preliminary assessment of international recommendations.

    Wilson W; Milner J; Bulkan J; Ehlers P

    American Journal of Human Biology. 2006 May-Jun; 18(3):312-324.

    The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) for the first 6 months of life, primarily because of potential immunological benefits which are deemed to outweigh nutritive costs for infants. This recommendation is controversial, as studies of the relationship between the term of EBF and infant and child health have produced conflicting results. The purpose of this paper is to evaluate the relationship between the term of EBF and infant and child mortality among a group of swidden-horticulturalists in lowland South America. Consistent with the WHO, we hypothesized that EBF < 6 months will compromise the survival of the infant or child. This relationship was assessed via recall data generated in 2001 in structured interviews with 60 Makushi Amerindian women in Guyana's North Rupununi region. The data were analyzed with t-tests, Fisher's exact test, and logistic regression. The results do not support our hypothesis; the term of EBF is not found to be related to infant or child mortality. This is surprising given the potential for contamination in nonbreast-milk foods in this environment. Notably, this is occurring among mothers who are not energetically stressed. We propose that the apparent lack of benefit of EBF = 6 months is due to insufficient energy supply from breast milk alone, which may predispose the child to morbidity when subsequently stressed. This study concurs with others which revealed no significant benefits to the infant of EBF > 6 months, and the recognition that universal recommendations must be situated within local ecological contexts. (author's)
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