1
|
Hazlett C, Ramos AP, Smith S. Better individual-level risk models can improve the targeting and life-saving potential of early-mortality interventions. Sci Rep 2023; 13:21706. [PMID: 38066048 PMCID: PMC10709389 DOI: 10.1038/s41598-023-48888-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Infant mortality remains high and uneven in much of sub-Saharan Africa. Even low-cost, highly effective therapies can only save lives in proportion to how successfully they can be targeted to those children who, absent the treatment, would have died. This places great value on maximizing the accuracy of any targeting or means-testing algorithm. Yet, the interventions that countries deploy in hopes of reducing mortality are often targeted based on simple models of wealth or income or a few additional variables. Examining 22 countries in sub-Saharan Africa, we illustrate the use of flexible (machine learning) risk models employing up to 25 generally available pre-birth variables from the Demographic and Health Surveys. Using these models, we construct risk scores such that the 10 percent of the population at highest risk account for 15-30 percent of infant mortality, depending on the country. Successful targeting in these models turned on several variables other than wealth, while models that employ only wealth data perform little or no better than chance. Consequently, employing such data and models to predict high-risk births in the countries studied flexibly could substantially improve the targeting and thus the life-saving potential of existing interventions.
Collapse
Affiliation(s)
- Chad Hazlett
- Professor, Department of Political Science and Department of Statistics and Data Science, University of California Los Angeles, Los Angeles, USA
- PhD Candidate, Department of Statistics and Data Science, University of California Los Angeles, Los Angeles, USA
| | - Antonio P Ramos
- Research Scientist, Califonia Center for Population Research, University of California, Los Angeles, USA.
- Principal Research Scientist, José Luiz Egydio Setúbal Foundation, São Paulo, Brazil.
| | - Stephen Smith
- PhD Candidate, Department of Statistics and Data Science, University of California Los Angeles, Los Angeles, USA
| |
Collapse
|
2
|
Atif M, Farooq M, Shafiq M, Ayub G, Ilyas M. The impact of partner's behaviour on pregnancy related outcomes and safe child-birth in Pakistan. BMC Pregnancy Childbirth 2023; 23:516. [PMID: 37452293 PMCID: PMC10349400 DOI: 10.1186/s12884-023-05814-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Pakistan is one of the nations with the worst statistics for pregnancy-related outcomes. Health programmes in underdeveloped nations frequently ignore the role of partners in maternal health, which is a crucial contributing factor in these worst situations. This research study aims to explore the role of husbands in maternity care and safe childbirth in Pakistan. METHODS The data for this study comes from the Pakistan Maternal Mortality Survey 2019. The k-Modes clustering algorithm was implemented to generate clusters from the dataset. Cluster profiling was used to identify the problems in pregnancy-related outcomes in cases where women live away from their partners. The chi-square test and logistic regression model were fitted to identify the significant factors associated with women's health and safe childbirth. RESULTS The finding of the study reveals that the partner's support during and after pregnancy plays a vital role in maternal health and safe child-birth. It was revealed that the women living away from their partners have certain health problems during pregnancy. These problems include Vaginal bleeding, Excessive vomiting, Chest pain, Cough, High B.P, Excessive weight gain, Body aches, Swelling of feet, and Swelling of the face. This also leads to complications and health problems in the postpartum period. Due to a lack of antenatal care from the spouse during pregnancy, the women who lived away from their partners lost their pregnancies. CONCLUSION The study concludes that the husband's emotional and financial support substantially impacts the overall health of expecting mothers and the safety of delivery in Pakistan. Given its potential advantages for mother and child health outcomes, male engagement in health education must be acknowledged and addressed. The finding of the study is of immense importance, as it guides the policymakers to arrange various awareness programs for the male partners to support their pregnant spouse and provide proper antenatal care.
Collapse
Affiliation(s)
- Muhammad Atif
- Department of Statistics, University of Peshawar, Peshawar, Pakistan.
| | - Muhammad Farooq
- Department of Statistics, University of Peshawar, Peshawar, Pakistan
| | - Muhammad Shafiq
- Institute of Numerical Sciences, Kohat University of Science and Technology, Kohat, Pakistan
| | - Gohar Ayub
- Department of Mathematics and Statistics, University of Swat, Mingora, Pakistan
| | - Muhammad Ilyas
- Department of Statistics, University of Malakand, Chakdara, Pakistan
| |
Collapse
|
3
|
Wells JCK. An Evolutionary Model of “Sexual Conflict” Over Women's Age at Marriage: Implications for Child Mortality and Undernutrition. Front Public Health 2022; 10:653433. [PMID: 35784199 PMCID: PMC9247288 DOI: 10.3389/fpubh.2022.653433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEarly women's marriage is associated with adverse outcomes for mothers and their offspring, including reduced human capital and increased child undernutrition and mortality. Despite preventive efforts, it remains common in many populations and is often favored by cultural norms. A key question is why it remains common, given such penalties. Using an evolutionary perspective, a simple mathematical model was developed to explore women's optimal marriage age under different circumstances, if the sole aim were to maximize maternal or paternal lifetime reproductive fitness (surviving offspring).MethodsThe model was based on several assumptions, supported by empirical evidence, regarding relationships between women's marital age and parental and offspring outcomes. It assumes that later marriage promotes women's autonomy, enhancing control over fertility and childcare, but increases paternity uncertainty. Given these assumptions, optimal marriage ages for maximizing maternal and paternal fitness were calculated. The basic model was then used to simulate environmental changes or public health interventions, including shifts in child mortality, suppression of women's autonomy, or promoting women's contraception or education.ResultsIn the basic model, paternal fitness is maximized at lower women's marriage age than is maternal fitness, with the paternal optimum worsening child undernutrition and mortality. A family planning intervention delays marriage age and reduces child mortality and undernutrition, at a cost to paternal but not maternal fitness. Reductions in child mortality favor earlier marriage but increase child undernutrition, whereas ecological shocks that increase child mortality favor later marriage but reduce fitness of both parents. An education intervention favors later marriage and reduces child mortality and undernutrition, but at a cost to paternal fitness. Efforts to suppress maternal autonomy substantially increase fitness of both parents, but only if other members of the household provide compensatory childcare.ConclusionEarly women's marriage maximizes paternal fitness despite relatively high child mortality and undernutrition, by increasing fertility and reducing paternity uncertainty. This tension between the sexes over the optimal marriage age is sensitive to ecological stresses or interventions. Education interventions seem most likely to improve maternal and child outcomes, but may be resisted by males and their kin as they may reduce paternal fitness.
Collapse
|
4
|
Mlambo C, Sibanda K, Ntshangase B, Mvuyana B. ICT and Women's Health: An Examination of the Impact of ICT on Maternal Health in SADC States. Healthcare (Basel) 2022; 10:802. [PMID: 35627939 PMCID: PMC9141576 DOI: 10.3390/healthcare10050802] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 11/25/2022] Open
Abstract
Attainment of sexual and reproductive health is regarded as a human rights matter. Notwithstanding this, maternal mortality continues to be a major public health concern in low-income countries, especially those in sub-Saharan Africa. Maternal mortality remains high in Africa, yet there are information communication technologies (ICTs) (such as the internet, mobile communication, social media, and community radios) that have the potential to make a difference. Making effective use of all of these ICTs can considerably decrease preventable maternal deaths. ICTs, particularly mobile devices, offer a platform for access to health information and services that can bring change in areas where health infrastructure and resources are often limited. However, for Southern Africa, maternal mortality remains high despite the presence of ICT tools that have transformative potential to improve maternal health. In light of this, this study sought to examine the impact of ICT on maternal health. The study was quantitative in nature, and it used panel data that covered the period from 2000-2018. The Mean Group and Pooled Mean Group cointegration techniques and a generalised method of moments panel technique were used for estimation purposes. Results showed that ICT has a negative effect on maternal health. This shows that ICT tools contribute positively to maternal health. The study gave a number of recommendations. The mobile gender gap should be closed (digital inclusion), mobile network connectivity boosted, and digital platforms must be created in order to enhance the transformative potential of ICT in improving health outcomes.
Collapse
Affiliation(s)
- Courage Mlambo
- Public Administration and Economics, Faculty of Management Sciences, Mangosuthu University, Umlazi 4031, South Africa; (B.N.); (B.M.)
| | - Kin Sibanda
- Department of Economics, Faculty of Management Sciences, Walter Sisulu University, Mthatha 5099, South Africa;
| | - Bhekabantu Ntshangase
- Public Administration and Economics, Faculty of Management Sciences, Mangosuthu University, Umlazi 4031, South Africa; (B.N.); (B.M.)
| | - Bongekile Mvuyana
- Public Administration and Economics, Faculty of Management Sciences, Mangosuthu University, Umlazi 4031, South Africa; (B.N.); (B.M.)
| |
Collapse
|
5
|
Thompson DM, Booth L, Moore D, Mathers J. Peer support for people with chronic conditions: a systematic review of reviews. BMC Health Serv Res 2022; 22:427. [PMID: 35361215 PMCID: PMC8973527 DOI: 10.1186/s12913-022-07816-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/08/2022] [Indexed: 01/23/2023] Open
Abstract
Background People with chronic conditions experience functional impairment, lower quality of life, and greater economic hardship and poverty. Social isolation and loneliness are common for people with chronic conditions, with multiple co-occurring chronic conditions predicting an increased risk of loneliness. Peer support is a socially driven intervention involving people with lived experience of a condition helping others to manage the same condition, potentially offering a sense of connectedness and purpose, and experiential knowledge to manage disease. However, it is unclear what outcomes are important to patients across the spectrum of chronic conditions, what works and for whom. The aims of this review were to (1) collate peer support intervention components, (2) collate the outcome domains used to evaluate peer support, (3) synthesise evidence of effectiveness, and (4) identify the mechanisms of effect, for people with chronic conditions. Methods A systematic review of reviews was conducted. Reviews were included if they reported on formal peer support between adults or children with one or more chronic condition. Data were analysed using narrative synthesis. Results The search identified 6222 unique publications. Thirty-one publications were eligible for inclusion. Components of peer support were organised into nine categories: social support, psychological support, practical support, empowerment, condition monitoring and treatment adherence, informational support, behavioural change, encouragement and motivation, and physical training. Fifty-five outcome domains were identified. Quality of life, and self-efficacy were the most measured outcome domains identified. Most reviews reported positive but non-significant effects. Conclusions The effectiveness of peer support is unclear and there are inconsistencies in how peers are defined, a lack of clarity in research design and intervention reporting, and widely variable outcome measurement. This review presents a range of components of peer support interventions that may be of interest to clinicians developing new support programmes. However, it is unclear precisely what components to use and with whom. Therefore, implementation of support in different clinical settings may benefit from participatory action research so that services may reflect local need. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07816-7.
Collapse
Affiliation(s)
- Dean M Thompson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | | | - David Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
6
|
Behera S, Pradhan J. Uneven economic burden of non-communicable diseases among Indian households: A comparative analysis. PLoS One 2021; 16:e0260628. [PMID: 34890400 PMCID: PMC8664228 DOI: 10.1371/journal.pone.0260628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/14/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are the leading global cause of death and disproportionately concentrate among those living in low-income and middle-income countries. However, its economic impact on households remains less well known in the Indian context. This study aims to assess the economic impact of NCDs in terms of out-of-pocket expenditure (OOPE) and its catastrophic impact on NCDs affected households in India. MATERIALS AND METHODS Data were collected from the 75th round of the National Sample Survey Office, Government of India, conducted in the year 2017-18. This is the latest round of data available on health, which constitutes a sample of 113,823 households. The collection of data is based on a stratified multi-stage sampling method. Generalised Linear Regression model was employed to identify the socio-economic covariates associated with the catastrophic health expenditure (CHE) on hospitalisation. RESULTS The result shows a higher burden of OOPE on NCDs affected households. The mean expenditure by NCDs households in public hospitals is INR 13,170 which is more than twice as compared to the non-NCDs households INR 6,245. Particularly, the proportion of total medical expenditure incurred on medicines (0.39) and diagnostics (0.15) is troublesome for households with NCDs, treated in public hospitals. Moreover, results from the generalised linear regression model confirm the significant relationship between CHE with residence, caste, religion, household size, and economic status of households. The intensity of CHE is more for the households who are poor, drinking unsafe water, using firewood as cooking fuel, and household size of 1-5 members. CONCLUSION Therefore, an urgent need for a prevention strategy should be made by the government to protect households from the economic burden of NCDs. Specifically, to reduce the burden of CHE associated with NCDs, a customised disease-specific health insurance package should be introduced by the government of India in both public and private facilities.
Collapse
Affiliation(s)
- Sasmita Behera
- Department of Humanities and Social Sciences, National Institute of Technology, Rourkela, India
| | - Jalandhar Pradhan
- Department of Humanities and Social Sciences, National Institute of Technology, Rourkela, India
| |
Collapse
|
7
|
Brand ÉM, Rossetto M, Hentges B, Winkler GB, Duarte ERM, da Silva LC, Leal AF, Knauth DR, Silva DL, Mantese GHA, Volpato TF, Bobek PR, Dellanhese APF, Teixeira LB. Survival and predictors of death in tuberculosis/HIV coinfection cases in Porto Alegre, Brazil: A historical cohort from 2009 to 2013. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000051. [PMID: 36962094 PMCID: PMC10021355 DOI: 10.1371/journal.pgph.0000051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Tuberculosis is a curable disease, which remains the leading cause of death among infectious diseases worldwide, and it is the leading cause of death in people living with HIV. The purpose is to examine survival and predictors of death in Tuberculosis/HIV coinfection cases from 2009 to 2013. METHODS We estimated the survival of 2,417 TB/HIV coinfection cases in Porto Alegre, from diagnosis up to 85 months of follow-up. We estimated hazard ratios and survival curves. RESULTS The adjusted risk ratio (aRR) for death, by age, hospitalization, and Directly Observed Treatment was 4.58 for new cases (95% CI: 1.14-18.4), 4.51 for recurrence (95% CI: 1.11-18.4) and 4.53 for return after abandonment (95% CI: 1.12-18.4). The average survival time was 72.56 ± 1.57 months for those who underwent Directly Observed Treatment and 62.61 ± 0.77 for those who did not. CONCLUSIONS Case classification, age, and hospitalization are predictors of death. The occurrence of Directly Observed Treatment was a protective factor that increased the probability of survival. Policies aimed at reducing the mortality of patients with TB/HIV coinfection are needed.
Collapse
Affiliation(s)
- Évelin Maria Brand
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maíra Rossetto
- Department of Medicine, Universidade Federal da Fronteira Sul, Chapecó, Santa Catarina, Brazil
| | - Bruna Hentges
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gerson Barreto Winkler
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Erica Rosalba Mallmann Duarte
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Lucas Cardoso da Silva
- European Master in Health Economics and Management, Erasmus University Rotterdam, ERASMUS, Rotterdam, Netherlands
| | - Andrea Fachel Leal
- Programa de Pós-Graduação em Políticas Públicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Daniela Riva Knauth
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Danielle Lodi Silva
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - George Henrique Aliatti Mantese
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Tiane Farias Volpato
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Paulo Ricardo Bobek
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Luciana Barcellos Teixeira
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Public Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| |
Collapse
|
8
|
Aziz A, Saleem S, Nolen TL, Pradhan NA, McClure EM, Jessani S, Garces AL, Hibberd PL, Moore JL, Goudar SS, Dhaded SM, Esamai F, Tenge C, Patel AB, Chomba E, Mwenechanya M, Bose CL, Liechty EA, Krebs NF, Derman RJ, Carlo WA, Tshefu A, Koso-Thomas M, Siddiqi S, Goldenberg RL. Why are the Pakistani maternal, fetal and newborn outcomes so poor compared to other low and middle-income countries? Reprod Health 2020; 17:190. [PMID: 33334329 PMCID: PMC7745345 DOI: 10.1186/s12978-020-01023-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pakistan has among the poorest pregnancy outcomes worldwide, significantly worse than many other low-resource countries. The reasons for these differences are not clear. In this study, we compared pregnancy outcomes in Pakistan to other low-resource countries and explored factors that might help explain these differences. METHODS The Global Network (GN) Maternal Newborn Health Registry (MNHR) is a prospective, population-based observational study that includes all pregnant women and their pregnancy outcomes in defined geographic communities in six low-middle income countries (India, Pakistan, Democratic Republic of Congo, Guatemala, Kenya, Zambia). Study staff enroll women in early pregnancy and follow-up soon after delivery and at 42 days to ascertain delivery, neonatal, and maternal outcomes. We analyzed the maternal mortality ratios (MMR), neonatal mortality rates (NMR), stillbirth rates, and potential explanatory factors from 2010 to 2018 across the GN sites. RESULTS From 2010 to 2018, there were 91,076 births in Pakistan and 456,276 births in the other GN sites combined. The MMR in Pakistan was 319 per 100,000 live births compared to an average of 124 in the other sites, while the Pakistan NMR was 49.4 per 1,000 live births compared to 20.4 in the other sites. The stillbirth rate in Pakistan was 53.5 per 1000 births compared to 23.2 for the other sites. Preterm birth and low birthweight rates were also substantially higher than the other sites combined. Within weight ranges, the Pakistani site generally had significantly higher rates of stillbirth and neonatal mortality than the other sites combined, with differences increasing as birthweights increased. By nearly every measure, medical care for pregnant women and their newborns in the Pakistan sites was worse than at the other sites combined. CONCLUSION The Pakistani pregnancy outcomes are much worse than those in the other GN sites. Reasons for these poorer outcomes likely include that the Pakistani sites' reproductive-aged women are largely poorly educated, undernourished, anemic, and deliver a high percentage of preterm and low-birthweight babies in settings of often inadequate maternal and newborn care. By addressing the issues highlighted in this paper there appears to be substantial room for improvements in Pakistan's pregnancy outcomes.
Collapse
Affiliation(s)
- Aleha Aziz
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA.
| | | | | | | | | | | | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala, Guatemala
| | | | | | - Shivaprasad S Goudar
- J N Medical College, KLE Academy Higher Education and Research, Belagavi, Karnataka, India
| | - Sangappa M Dhaded
- J N Medical College, KLE Academy Higher Education and Research, Belagavi, Karnataka, India
| | | | | | | | | | | | - Carl L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| |
Collapse
|
9
|
Ramos AP, Flores MJ, Weiss RE. Leave no child behind: Using data from 1.7 million children from 67 developing countries to measure inequality within and between groups of births and to identify left behind populations. PLoS One 2020; 15:e0238847. [PMID: 33052926 PMCID: PMC7556530 DOI: 10.1371/journal.pone.0238847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 08/25/2020] [Indexed: 11/25/2022] Open
Abstract
Background Goal 3.2 from the Sustainable Development Goals (SDG) calls for reductions in national averages of Under-5 Mortality. However, it is well known that within countries these reductions can coexist with left behind populations that have mortality rates higher than national averages. To measure inequality in under-5 mortality and to identify left behind populations, mortality rates are often disaggregated by socioeconomic status within countries. While socioeconomic disparities are important, this approach does not quantify within group variability since births from the same socioeconomic group may have different mortality risks. This is the case because mortality risk depends on several risk factors and their interactions and births from the same socioeconomic group may have different risk factor combinations. Therefore mortality risk can be highly variable within socioeconomic groups. We develop a comprehensive approach using information from multiple risk factors simultaneously to measure inequality in mortality and to identify left behind populations. Methods We use Demographic and Health Surveys (DHS) data on 1,691,039 births from 182 different surveys from 67 low and middle income countries, 51 of which had at least two surveys. We estimate mortality risk for each child in the data using a Bayesian hierarchical logistic regression model. We include commonly used risk factors for monitoring inequality in early life mortality for the SDG as well as their interactions. We quantify variability in mortality risk within and between socioeconomic groups and describe the highest risk sub-populations. Findings For all countries there is more variability in mortality within socioeconomic groups than between them. Within countries, socioeconomic membership usually explains less than 20% of the total variation in mortality risk. In contrast, country of birth explains 19% of the total variance in mortality risk. Targeting the 20% highest risk children based on our model better identifies under-5 deaths than targeting the 20% poorest. For all surveys, we report efficiency gains from 26% in Mali to 578% in Guyana. High risk births tend to be births from mothers who are in the lowest socioeconomic group, live in rural areas and/or have already experienced a prior death of a child. Interpretation While important, differences in under-5 mortality across socioeconomic groups do not explain most of overall inequality in mortality risk because births from the same socioeconomic groups have different mortality risks. Similarly, policy makers can reach the highest risk children by targeting births based on several risk factors (socioeconomic status, residing in rural areas, having a previous death of a child and more) instead of using a single risk factor such as socioeconomic status. We suggest that researchers and policy makers monitor inequality in under-5 mortality using multiple risk factors simultaneously, quantifying inequality as a function of several risk factors to identify left behind populations in need of policy interventions and to help monitor progress toward the SDG.
Collapse
Affiliation(s)
- Antonio P. Ramos
- Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, CA, United States of America
- California Center for Population Research, UCLA, Los Angeles, CA, United States of America
- * E-mail:
| | - Martin J. Flores
- Department of General Internal Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, United States of America
| | - Robert E. Weiss
- Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, CA, United States of America
- California Center for Population Research, UCLA, Los Angeles, CA, United States of America
| |
Collapse
|
10
|
Wells N, Chappuis F, Beran D. Spotlight on experiences of medicine unavailability: access to medicines challenges for NCDs and NTDs - the contrasting cases of insulin and praziquantel. Expert Rev Clin Pharmacol 2020; 13:341-353. [DOI: 10.1080/17512433.2020.1740589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Nadya Wells
- Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
11
|
Musango L, Timol M, Burhoo P, Shaikh F, Donnen P, Kirigia JM. Assessing health system challenges and opportunities for better noncommunicable disease outcomes: the case of Mauritius. BMC Health Serv Res 2020; 20:184. [PMID: 32143648 PMCID: PMC7059264 DOI: 10.1186/s12913-020-5039-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 02/26/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The objectives of the study reported in this paper were: (a) to score the coverage of core NCD population-based interventions and individual services in Mauritius; (b) to analyse and score the presence of 15 common health system challenges that impede delivery of core NCD interventions and services in Mauritius; and (c) to provide policy recommendations for Mauritius to address health system barriers to delivery of NCD interventions and services. METHODS The Mauritius country assessment applied the guidelines developed by the World Health Organization Regional Office for Europe for systematically scoring coverage of NCD interventions and assessing health system challenges for improving NCD outcomes. The assessment used qualitative research design approach. RESULTS Of the 24 core population-based interventions for addressing key NCD risk factors, 16.7% were rated extensive, 37.5% moderate and 45.8% limited. Three (20%), 8 (53%) and 4 (27%) of the 15 individual/personal CVD, diabetes and cancer services were rated extensive, moderate and limited respectively. The top five health system challenges hampering scale-up of coverage of population-based NCD interventions in Mauritius were inadequate interagency cooperation; limited application of explicit priority setting approaches; inadequate change management; sub-optimal distribution and mix human resources; insufficient population empowerment; and insufficient political commitment. The top five challenges had average scores of between 3.1 (interagency cooperation) and 2.4 (distribution and mix of human resources). The top five health system challenges constraining expansion in coverage of individual NCD services were limited integration of evidence into practice; limited use of explicit priority-setting approaches; inadequate application of information and technology solutions; insufficient population empowerment; and sub-optimal distribution and mix of human resources. The top five challenges for individual interventions had mean scores varying between 2.6 (integration of evidence into practice) and 1.7 (distribution and mix of human resources). CONCLUSIONS Mauritius needs to increase its domestic general government investments into the national health system and requisite multi-sectoral action to address the priority health system challenges with a view of bridging the existing gaps in coverage of NCD population-based interventions and individual services.
Collapse
Affiliation(s)
- Laurent Musango
- World Health Organization, Country Office for Mauritius, P.O. Box 1194, Port Louis, Mauritius
| | - Maryam Timol
- Ministry of Health and Quality of Life (MOHQL), Port Louis, Mauritius
| | | | - Faisal Shaikh
- World Health Organization, Country Office for Mauritius, P.O. Box 1194, Port Louis, Mauritius
| | | | | |
Collapse
|
12
|
Huang J, Zhang T, Wang L, Guo D, Liu S, Lu W, Liang H, Zhang Y, Liu C. The effect of family doctor-contracted services on noncommunicable disease self-management in Shanghai, China. Int J Health Plann Manage 2019; 34:935-946. [PMID: 31373079 DOI: 10.1002/hpm.2865] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Noncommunicable diseases (NCDs) are a major threat to population health worldwide. In Shanghai, China, a new pattern of NCD management-self-management-has been developed in community health service centres (CHSCs). OBJECTIVE To clarify how contracting with CHSC-based family doctors (FDs) influences the engagement in and effectiveness of self-management behaviour among NCD patients. METHOD We conducted two waves of a questionnaire survey (in 2013 and 2016) to collect data on patients with NCDs. Separate logistic regression models and longitudinal analysis were performed to examine the effect of contracting with an FD on NCD self-management and the effectiveness of this self-management. RESULTS Nearly all contracted patients (80.79%) had implemented NCD self-management, while only 55.57% of non-contracted patients did so. The self-management effectiveness rate was also higher among contracted patients than among non-contracted ones (86.66% vs. 54.79%). In the population-averaged models, contracted patients had 2.25 and 2.91 times greater odds of implementing self-management and reporting that the self-management was effective, respectively, after controlling for all related variables. Additionally, awareness of FD-contracted services, satisfaction with CHSCs, and experiencing first contact at CHSCs had positive impacts on the implementation and effectiveness of self-management. CONCLUSIONS FDs were important for ensuring that NCD patients engaged in self-management behaviour, the most common form of which was focus group. Participation in NCD focus groups may be key for attaining the effects of self-management, including improved health knowledge, greater health awareness, more frequent engagement in health behaviour, and, most importantly, greater practice of self-monitoring. Self-management might help to achieve greater NCD control.
Collapse
Affiliation(s)
- Jiaoling Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Tao Zhang
- Jinyang Community Health Service Center of Pudong New Area, Shanghai, China
| | - Luan Wang
- Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Dongfeng Guo
- Department of General Medicine, Gongli Hospital, the Second Military Medical University, Shanghai, China
| | - Shanshan Liu
- Pudong Institute for Health Development, Shanghai, China
| | - Wei Lu
- School of Economics and Management, Hainan Normal University, Hainan, China
| | - Hong Liang
- School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Yimin Zhang
- Pudong Institute for Health Development, Shanghai, China
| | - Chengjun Liu
- School of Social Development and Public Policy, Fudan University, Shanghai, China.,Eye and Dental Diseases Prevention and Treatment of Pudong New Area, Shanghai, China
| |
Collapse
|
13
|
Morberg D, Alzate López Y, Moreira S, Prata N, Riley L, Burroughs Peña M. The rheumatic heart disease healthcare paradox: disease persistence in slums despite universal healthcare coverage—a provider perspective qualitative study. Public Health 2019; 171:15-23. [DOI: 10.1016/j.puhe.2019.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 03/16/2019] [Accepted: 03/20/2019] [Indexed: 01/19/2023]
|
14
|
Biadgilign S, Ayenew HY, Shumetie A, Chitekwe S, Tolla A, Haile D, Gebreyesus SH, Deribew A, Gebre B. Good governance, public health expenditures, urbanization and child undernutrition Nexus in Ethiopia: an ecological analysis. BMC Health Serv Res 2019; 19:40. [PMID: 30646917 PMCID: PMC6334413 DOI: 10.1186/s12913-018-3822-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/16/2018] [Indexed: 11/20/2022] Open
Abstract
Background Child undernutrition remains the major public health problem in low and middle-income countries including Ethiopia. The effects of good governance, urbanization and public health expenditure on childhood undernutrition are not well studied in developing countries. The objective of the study is to examine the relationship between quality of governance, public health expenditures, urbanization and child undernutrition in Ethiopia. Methods This is pooled data analysis with ecological design. We obtained data on childhood undernutrition from the Ethiopian Demographic and Health Surveys (EDHS) that were conducted in 2000, 2005, 2011 and 2016. Additionally, data on quality of governance for Ethiopia were extracted from the World Governance Indicators (WGI) and public health spending and urbanization were obtained from the World Development Indicators and United Nations’ World Population Prospects (WPP) respectively. Univariate and multivariate analysis were done to assess the relationship between governance, public health expenditure and urbanization with childhood undernutrition. Result Government effectiveness (adjusted odd ratio (AOR) = 20.7; p = 0.046), regulatory quality (AOR = 0.0077; p = 0.026) and control of corruption (AOR = 0.0019; p = 0.000) were associated with stunting. Similarly, government effectiveness (AOR = 72.2; p = 0.007), regulatory quality (AOR = 0.0015; p = 0.004) and control of corruption (AOR = 0.0005; p = 0.000) were associated with underweight. None of the governance indicators were associated with wasting. On the other hand, there is no statistically significant association observed between public health spending and urbanization with childhood undernutrition. However, other socio-demographic variables play a significant effect on reducing of child undernutrition. Conclusion This study indicates that good governance in the country plays a significant role for reducing childhood undernutrition along with other socio-demographic factors. Concerned bodies should focus on improving governance and producing a quality policy and at the same time monitor its implementation and adherence. Electronic supplementary material The online version of this article (10.1186/s12913-018-3822-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sibhatu Biadgilign
- Public Health Nutrition Research Consultant, P.O. Box 24414, Addis Ababa, Ethiopia.
| | | | - Arega Shumetie
- Department of Economics, Haramaya University of Ethiopia, Dire Dawa, Ethiopia
| | - Stanley Chitekwe
- United Nations Children's Fund (UNICEF), Nepal Country Office UN House, New York, USA
| | - Assaye Tolla
- United Nations Children's Fund (UNICEF), Nigeria Country Office, UN House, Plot 617/618 Central Area District Diplomatic Zone, Garki, P M, Abuja, B 2851, Nigeria
| | - Demewoz Haile
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Seifu Hagos Gebreyesus
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amare Deribew
- St. Paul Millennium Medical College, Addis Ababa, Ethiopia.,Nutrition International (former Micronutrient Initiative), Ottawa, Ethiopia
| | | |
Collapse
|
15
|
Carrillo-Larco RM, Ruiz-Alejos A, Bernabé-Ortiz A, Gilman RH, Smeeth L, Miranda JJ. Cohort Profile: The PERU MIGRANT Study-A prospective cohort study of rural dwellers, urban dwellers and rural-to-urban migrants in Peru. Int J Epidemiol 2018; 46:1752-1752f. [PMID: 29040556 PMCID: PMC5837622 DOI: 10.1093/ije/dyx116] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- Rodrigo M Carrillo-Larco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Andrea Ruiz-Alejos
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Robert H Gilman
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|
16
|
Ramos AP, Weiss RE, Heymann JS. Improving program targeting to combat early-life mortality by identifying high-risk births: an application to India. Popul Health Metr 2018; 16:15. [PMID: 30139376 PMCID: PMC6108144 DOI: 10.1186/s12963-018-0172-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/10/2018] [Indexed: 11/25/2022] Open
Abstract
Background It is widely recognized that there are multiple risk factors for early-life mortality. In practice most interventions to curb early-life mortality target births based on a single risk factor, such as poverty. However, most premature deaths are not from the targeted group. Thus interventions target many births that are at not at high risk and miss many births at high risk. Methods Using data from the second wave of Demographic and Health Surveys from India and a hierarchical Bayesian model, we estimate infant mortality risk for 73.320 infants in India as a function of 4 risk factors. We show how this information can be used to improve program targeting. We compare our novel approach against common programs that target groups based on a single risk factor. Results A conventional approach that targets mothers in the lowest quintile of income correctly identifies only 30% of infant deaths. By contrast, using four risk factors simultaneously we identify a group of births of the same size that includes 57% of all deaths. Using the 2012 census to translate these percentages into numbers, there were 25.642.200 births in 2012 and 4.4% died before the age of one. Our approach correctly identifies 643.106 of 1.128.257 infant deaths while poverty only identifies 338.477 infant deaths. Conclusion Our approach considerably improves program targeting by identifying more infant deaths than the usual approach that targets births based on a single risk factor. This leads to more efficient program targeting. This is particularly useful in developing countries, where resources are lacking and needs are high. Electronic supplementary material The online version of this article (10.1186/s12963-018-0172-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Antonio P Ramos
- Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, CA, USA.
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | - Jody S Heymann
- WORLD Policy Analysis Center, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| |
Collapse
|
17
|
Franco Blanco CA, Estrada Montoya JH. Impacto macroeconómico generado por la pandemia del VIH/SIDA informado por la literatura internacional desde 1990 a 2013. ACTA ODONTOLÓGICA COLOMBIANA 2018. [DOI: 10.15446/aoc.v8n2.73885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción: en 2013, ONUSIDA reportó más de 62 millones de personas infectadas por el VIH desde el inicio de la pandemia; de estos, tres millones se infectaron durante el último año. El impacto del VIH/SIDA a nivel individual ha sido bien documentado, mas los efectos de la pandemia a nivel macroeconómico mundial han sido menos estudiados. Objetivo: determinar el impacto a nivel macroeconómico del VIH/SIDA. Materiales y métodos: estudio hermenéutico sobre fuentes secundarias de información que mediante la triangulación de esta con la teoría económica, se proyectaron posibles consecuencias en los países más afectados por la pandemia. Resultados: la pandemia del VIH/SIDA impacta la oferta de trabajo, mediante el aumento de la morbilidad y mortalidad. El SIDA reduce la productividad laboral, creando así crisis fiscales. El gasto público relacionado con el VIH/SIDA aumentará dentro del rango de 0,2% y 3,5% del presupuesto del gobierno. La baja productividad del sector primario nacional aumenta la importación de alimentos. En Sudáfrica para el año 2010 el PIB sería un 17% menor a un escenario sin VIH/SIDA. Conclusiones: se estima que el VIH/SIDA aumentará los costos de mantenimiento de la fuerza de trabajo, alterará la balanza comercial, induciendo déficit fiscal, así como una caída de la productividad cercana al 75% y del crecimiento económico de 5% del PIB en los próximos diez años. Aunque se realizó una búsqueda a nivel mundial, los resultados obtenidos se concentran en África.
Collapse
|
18
|
Niessen LW, Mohan D, Akuoku JK, Mirelman AJ, Ahmed S, Koehlmoos TP, Trujillo A, Khan J, Peters DH. Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the Sustainable Development agenda. Lancet 2018; 391:2036-2046. [PMID: 29627160 DOI: 10.1016/s0140-6736(18)30482-3] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 07/24/2017] [Accepted: 01/17/2018] [Indexed: 12/01/2022]
Abstract
Five Sustainable Development Goals (SDGs) set targets that relate to the reduction of health inequalities nationally and worldwide. These targets are poverty reduction, health and wellbeing for all, equitable education, gender equality, and reduction of inequalities within and between countries. The interaction between inequalities and health is complex: better economic and educational outcomes for households enhance health, low socioeconomic status leads to chronic ill health, and non-communicable diseases (NCDs) reduce income status of households. NCDs account for most causes of early death and disability worldwide, so it is alarming that strong scientific evidence suggests an increase in the clustering of non-communicable conditions with low socioeconomic status in low-income and middle-income countries since 2000, as previously seen in high-income settings. These conditions include tobacco use, obesity, hypertension, cancer, and diabetes. Strong evidence from 283 studies overwhelmingly supports a positive association between low-income, low socioeconomic status, or low educational status and NCDs. The associations have been differentiated by sex in only four studies. Health is a key driver in the SDGs, and reduction of health inequalities and NCDs should become key in the promotion of the overall SDG agenda. A sustained reduction of general inequalities in income status, education, and gender within and between countries would enhance worldwide equality in health. To end poverty through elimination of its causes, NCD programmes should be included in the development agenda. National programmes should mitigate social and health shocks to protect the poor from events that worsen their frail socioeconomic condition and health status. Programmes related to universal health coverage of NCDs should specifically target susceptible populations, such as elderly people, who are most at risk. Growing inequalities in access to resources for prevention and treatment need to be addressed through improved international regulations across jurisdictions that eliminate the legal and practical barriers in the implementation of non-communicable disease control.
Collapse
Affiliation(s)
- Louis W Niessen
- Department of International Public Health and Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jonathan K Akuoku
- Department of Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | | | - Sayem Ahmed
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh; Health Economics and Policy Research Group, Department of Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Tracey P Koehlmoos
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh; Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Antonio Trujillo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jahangir Khan
- Department of International Public Health and Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Health Economics and Policy Research Group, Department of Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - David H Peters
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
19
|
Levi J, Pozniak A, Heath K, Hill A. The impact of HIV prevalence, conflict, corruption, and GDP/capita on treatment cascades: data from 137 countries. J Virus Erad 2018; 4:80-90. [PMID: 29682299 PMCID: PMC5892682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE In 2014, UNAIDS and partners set the 90-90-90 targets for the HIV treatment cascade. Multiple social, political and structural factors might influence progress towards these targets. We assessed how close countries and regions are to reaching these targets, and compared cascade outcomes with HIV prevalence, gross domestic product (GDP)/capita, conflict and corruption. METHODS Country-level HIV cascade data on diagnosis, ART coverage and viral suppression, from 2010 to 2016 were extracted from national reports, published papers and the www.AIDSinfoOnline database, and analysed. Weighted least-squares regression was used to assess predictors of cascade achievement: region, HIV prevalence, GDP/capita, the 2016 Corruption Perceptions Index (CPI), which is an international ranking system, and the 2016 Global Peace Index (GPI), which ranks all countries based on three main categories: societal safety, militarisation and conflict. RESULTS Data were available for diagnosis for 84 countries, ART coverage for 137 countries, and viral suppression for 94 countries. Regions with the lowest ART coverage were South-east Asia and Pacific (36%), Eastern Europe and Central Asia (17%), and Middle East and North Africa (13%). Lower HIV prevalence was associated with poorer cascade results. Countries with higher GDP/capita achieved higher ART coverage (P<0.001). Furthermore, countries with lower levels of peace and higher corruption had lower ART coverage (P<0.001). Countries with a GPI >2.5 all had ART coverage of <40%. CONCLUSION Only one country has reached the UNAIDS 90-90-90 targets. International comparison remains difficult due to heterogeneous data reporting. Difficulty meeting UNAIDS targets is associated with lower GDP/capita, lower HIV prevalence, higher corruption and conflict levels.
Collapse
Affiliation(s)
- Jacob Levi
- Imperial College London,
UK,Corresponding author: Jacob Levi,
Imperial College London Medical School,
St Mary's Hospital,
Praed Street,
LondonW2 1NY,
UK.
| | - Anton Pozniak
- Chelsea and Westminster NHS Foundation Trust,
London,
UK
| | | | - Andrew Hill
- Chelsea and Westminster NHS Foundation Trust,
London,
UK
| |
Collapse
|
20
|
Levi J, Pozniak A, Heath K, Hill A. The impact of HIV prevalence, conflict, corruption, and GDP/capita on treatment cascades: data from 137 countries. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30249-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
21
|
Sherr K, Fernandes Q, Kanté AM, Bawah A, Condo J, Mutale W. Measuring health systems strength and its impact: experiences from the African Health Initiative. BMC Health Serv Res 2017; 17:827. [PMID: 29297341 PMCID: PMC5763472 DOI: 10.1186/s12913-017-2658-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Health systems are essential platforms for accessible, quality health services, and population health improvements. Global health initiatives have dramatically increased health resources; however, funding to strengthen health systems has not increased commensurately, partially due to concerns about health system complexity and evidence gaps demonstrating health outcome improvements. In 2009, the African Health Initiative of the Doris Duke Charitable Foundation began supporting Population Health Implementation and Training Partnership projects in five sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to catalyze significant advances in strengthening health systems. This manuscript reflects on the experience of establishing an evaluation framework to measure health systems strength, and associate measures with health outcomes, as part of this Initiative. Methods Using the World Health Organization’s health systems building block framework, the Partnerships present novel approaches to measure health systems building blocks and summarize data across and within building blocks to facilitate analytic procedures. Three Partnerships developed summary measures spanning the building blocks using principal component analysis (Ghana and Tanzania) or the balanced scorecard (Zambia). Other Partnerships developed summary measures to simplify multiple indicators within individual building blocks, including health information systems (Mozambique), and service delivery (Rwanda). At the end of the project intervention period, one to two key informants from each Partnership’s leadership team were asked to list – in rank order – the importance of the six building blocks in relation to their intervention. Results Though there were differences across Partnerships, service delivery and information systems were reported to be the most common focus of interventions, followed by health workforce and leadership and governance. Medical products, vaccines and technologies, and health financing, were the building blocks reported to be of lower focus. Conclusion The African Health Initiative experience furthers the science of evaluation for health systems strengthening, highlighting areas for further methodological development – including the development of valid, feasible measures sensitive to interventions in multiple contexts (particularly in leadership and governance) and describing interactions across building blocks; in developing summary statistics to facilitate testing intervention effects on health systems and associations with health status; and designing appropriate analytic models for complex, multi-level open health systems.
Collapse
Affiliation(s)
- Kenneth Sherr
- Department of Global Health, University of Washington, 1959 NE Pacific St, Seattle, WA, USA. .,Health Alliance International, Seattle, WA, USA.
| | | | - Almamy M Kanté
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ayaga Bawah
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Jeanine Condo
- School of Public Health, University of Rwanda, Kigali, Rwanda
| | - Wilbroad Mutale
- Department of Public Health, University of Zambia School of Medicine, Lusaka, Zambia
| | | |
Collapse
|
22
|
Njuguna B, Vedanthan R. Find and Plug the Leak: Improving Adherence to Anti-Hypertensive Medicines : Editorial to: "Assessing Adherence to Antihypertensive Therapy in Primary Health Care in Namibia: Findings and Implications" by M.M. Nashilongo et al. Cardiovasc Drugs Ther 2017; 31:485-487. [PMID: 28965235 DOI: 10.1007/s10557-017-6753-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Benson Njuguna
- Moi Teaching and Referral Hospital, Department of Pharmacy, Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Department of Medicine, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA.
| |
Collapse
|
23
|
Do TC, Boettiger D, Law M, Pujari S, Zhang F, Chaiwarith R, Kiertiburanakul S, Lee MP, Ditangco R, Wong WW, Nguyen KV, Merati TP, Pham TT, Kamarulzaman A, Oka S, Yunihastuti E, Kumarasamy N, Kantipong P, Choi JY, Ng OT, Durier N, Ruxrungtham K. Smoking and projected cardiovascular risk in an HIV-positive Asian regional cohort. HIV Med 2017; 17:542-9. [PMID: 27430354 DOI: 10.1111/hiv.12358] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the study was to assess the prevalence and characteristics associated with current smoking in an Asian HIV-positive cohort, to calculate the predictive risks of cardiovascular disease (CVD), coronary heart disease (CHD) and myocardial infarction (MI), and to identify the impact that simulated interventions may have. METHODS Logistic regression analysis was used to distinguish associated current smoking characteristics. Five-year predictive risks of CVD, CHD and MI and the impact of simulated interventions were calculated utilizing the Data Collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D) algorithm. RESULTS Smoking status data were collected from 4274 participants and 1496 of these had sufficient data for simulated intervention calculations. Current smoking prevalence in these two groups was similar (23.2% vs. 19.9%, respectively). Characteristics associated with current smoking included age > 50 years compared with 30-39 years [odds ratio (OR) 0.65; 95% confidence interval (CI) 0.51-0.83], HIV exposure through injecting drug use compared with heterosexual exposure (OR 3.03; 95% CI 2.25-4.07), and receiving antiretroviral therapy (ART) at study sites in Singapore, South Korea, Malaysia, Japan and Vietnam in comparison to Thailand (all OR > 2). Women were less likely to smoke than men (OR 0.11; 95% CI 0.08-0.14). In simulated interventions, smoking cessation demonstrated the greatest impact in reducing CVD and CHD risk and closely approximated the impact of switching from abacavir to an alternate antiretroviral in the reduction of 5-year MI risk. CONCLUSIONS Multiple interventions could reduce CVD, CHD and MI risk in Asian HIV-positive patients, with smoking cessation potentially being the most influential.
Collapse
Affiliation(s)
- T C Do
- HIVNAT/Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | - D Boettiger
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | - M Law
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | - S Pujari
- Institute of Infectious Diseases, Pune, India
| | - F Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - R Chaiwarith
- Research Institute for Health Sciences, Chiang Mai, Thailand
| | - S Kiertiburanakul
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - M P Lee
- Queen Elizabeth Hospital, Hong Kong, China
| | - R Ditangco
- Research Institute for Tropical Medicine, Manila, Philippines
| | - W W Wong
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - K V Nguyen
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - T P Merati
- Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia
| | - T T Pham
- Bach Mai Hospital, Hanoi, Vietnam
| | - A Kamarulzaman
- University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - S Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - E Yunihastuti
- Working Group on AIDS Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - N Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), YRGCARE Medical Centre, VHS, Chennai, India
| | - P Kantipong
- Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - J Y Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - O T Ng
- Tan Tock Seng Hospital, Singapore
| | - N Durier
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - K Ruxrungtham
- HIVNAT/Thai Red Cross AIDS Research Center, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
24
|
Biswas RK, Kabir E. Influence of distance between residence and health facilities on non-communicable diseases: An assessment over hypertension and diabetes in Bangladesh. PLoS One 2017; 12:e0177027. [PMID: 28545074 PMCID: PMC5436657 DOI: 10.1371/journal.pone.0177027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 04/20/2017] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE This paper reflected on the prevalence of hypertension and diabetes in Bangladesh, which is spreading rapidly in low-income countries. The rationale of constructing more health centers for addressing NCDs was assessed in this paper by determining the relationship between prevalence of NCDs, particularly hypertension and diabetes, and distance to health facilities. METHODS From BDHS (Bangladesh Health and Demographic Survey) 2011 data set, 7544 samples were analyzed to demonstrate association between Non-communicable diseases (NCD) and distance from respondents' home to health facilities like hospitals, community clinics, pharmacies or doctors' chambers, and community facilities like market, post office or cinema hall. Bivariate analysis was conducted between accessibility to health facilities and prevalence of the diseases. The causal relationship between the spatial effects and the prevalence of the diseases were analyzed by applying Generalized Linear Mixed Model (GLMM) was fitted. RESULTS Fitting linear mixed effect models, we found that hypertension and diabetes react differently with various spatial effects. Distance from home to hospital had significant effect (P < 0.001) on hypertension showing people living further from the facilities or town centers seemed to be less hypertensive, whereas diabetes showed no such affiliation. CONCLUSION Higher prevalence of diabetes (40.9%) over hypertension (26.5%) in people aging 35 or higher, have appeared to have caused the difference, which concluded that each non-communicable disease should be dealt to its own merit for policy making instead considering as a group of diseases.
Collapse
Affiliation(s)
- Raaj Kishore Biswas
- School of Agricultural, Computational and Environmental Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Enamul Kabir
- School of Agricultural, Computational and Environmental Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia
| |
Collapse
|
25
|
Abstract
Introduction Laser photocoagulation has been the standard treatment for diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) for several decades. The discovery of vascular endothelial growth factor (VEGF) and the subsequent determination of its critical role in the development DME and PDR has led to the development of VEGF inhibitory drugs. Ranibizumab was the first anti-VEGF drug approved for the treatment of both DME and diabetic retinopathy in eyes with DME. Methods Medline searches with the keywords "ranibizumab," "diabetic macular edema," and "proliferative diabetic retinopathy" were performed to identify pertinent pre-clinical studies and clinical trials. Top-line data, with emphasis on pivotal trials, was identified and incorporated into this manuscript. Findings from small uncontrolled trials were generally not used unless they filled important gaps in our understanding of anti-VEGF therapy. Results Ranibizumab is a recombinant humanized antibody fragment that binds all isoforms of VEGF-A with high affinity. Three parallel lines of clinical research have produced level I evidence supporting the superiority of ranibizumab over laser photocoagulation for the treatment of DME. Regular injections also lead to improvement in diabetic retinopathy severity scores in a large minority of eyes. Ranibizumab is effective for PDR and produces less visual field loss than laser photocoagulation. It has an excellent safety profile, with low incidence of ocular and systemic adverse events. Conclusions Ranibizumab has become a frequently used first-line therapy for the treatment of DME. Emerging data suggest that it may become an important treatment for DR and PDR.
Collapse
|
26
|
Zeltner T, Riahi F, Huber J. Acute and Chronic Health Challenges in Sub-Saharan Africa: An Unfinished Agenda. AFRICA'S POPULATION: IN SEARCH OF A DEMOGRAPHIC DIVIDEND 2017. [PMCID: PMC7122485 DOI: 10.1007/978-3-319-46889-1_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
The concept of a “Double Burden of Disease” conceived in the second half of the last century has by now turned into a success story in sub-Saharan Africa. It has been instrumental in creating the regional and global political momentum to address the “unfinished agenda of infectious diseases” and to fight against HIV/AIDS, Tuberculosis and Malaria in a concerted and sustainably financed action. An estimated three million children under the age of five have been saved from malaria, and the incidence of new HIV cases in sub-Saharan Africa has fallen by more than half between 2001 and 2012. The concept also created an awareness of the rising epidemic of non-communicable diseases (NCDs) in this part of the world. It is too early to predict whether or not this success in the area of infectious disease will repeat itself in the domain of non-communicable diseases. There are some obstacles to overcome. The countries of SSA have to integrate the two separately conceived policies and their different funding into one and to avoid competition in resource allocation between the two areas. They need to develop integrated strategies that begin in the primary health care sector and finally they need to define strategies on how to engage constructively with the private sector.
Collapse
|
27
|
Achieving universal health coverage in South Africa through a district health system approach: conflicting ideologies of health care provision. BMC Health Serv Res 2016; 16:558. [PMID: 27717353 PMCID: PMC5054620 DOI: 10.1186/s12913-016-1797-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/24/2016] [Indexed: 11/25/2022] Open
Abstract
Background Universal Health Coverage (UHC) has emerged as a major goal for health care delivery in the post-2015 development agenda. It is viewed as a solution to health care needs in low and middle countries with growing enthusiasm at both national and global levels. Throughout the world, however, the paths of countries to UHC have differed. South Africa is currently reforming its health system with UHC through developing a national health insurance (NHI) program. This will be practically achieved through a decentralized approach, the district health system, the main vehicle for delivering services since democracy. Methods We utilize a review of relevant documents, conducted between September 2014 and December 2015 of district health systems (DHS) and UHC and their ideological underpinnings, to explore the opportunities and challenges, of the district health system in achieving UHC in South Africa. Results Review of data from the NHI pilot districts suggests that as South Africa embarks on reforms toward UHC, there is a need for a minimal universal coverage and emphasis on district particularity and positive discrimination so as to bridge health inequities. The disparities across districts in relation to health profiles/demographics, health delivery performance, management of health institutions or district management capacity, income levels/socio-economic status and social determinants of health, compliance with quality standards and above all the burden of disease can only be minimised through positive discrimination by paying more attention to underserved and disadavantaged communities. Conclusions We conclude that in South Africa the DHS is pivotal to health reform and UHC may be best achieved through minimal universal coverage with positive discrimination to ensure disparities across districts in relation to disease burden, human resources, financing and investment, administration and management capacity, service readiness and availability and the health access inequalities are consciously implicated. Yet ideological and practical issues make its achievement problematic.
Collapse
|
28
|
Shrivastava R, Gadde R, Nkengasong JN. Importance of Public-Private Partnerships: Strengthening Laboratory Medicine Systems and Clinical Practice in Africa. J Infect Dis 2016; 213 Suppl 2:S35-40. [PMID: 27025696 DOI: 10.1093/infdis/jiv574] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
After the launch of the US President's Emergency Plan for AIDS Relief in 2003, it became evident that inadequate laboratory systems and services would severely limit the scale-up of human immunodeficiency virus infection prevention, care, and treatment programs. Thus, the Office of the US Global AIDS Coordinator, Centers for Disease Control and Prevention, and Becton, Dickinson and Company developed a public-private partnership (PPP). Between October 2007 and July 2012, the PPP combined the competencies of the public and private sectors to boost sustainable laboratory systems and develop workforce skills in 4 African countries. Key accomplishments of the initiative include measurable and scalable outcomes to strengthen national capacities to build technical skills, develop sample referral networks, map disease prevalence, support evidence-based health programming, and drive continuous quality improvement in laboratories. This report details lessons learned from our experience and a series of recommendations on how to achieve successful PPPs.
Collapse
Affiliation(s)
- Ritu Shrivastava
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Renuka Gadde
- Becton, Dickinson, and Company, Franklin Lakes, New Jersey
| | - John N Nkengasong
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
29
|
Abstract
Sub-Saharan Africa (SSA) lagged furthest behind in achieving targets for the millennium development goals (MDG). We investigate the hypothesis that its slow progress is influenced by political factors. Longitudinal data on three health MDG indicators: under-five mortality, maternal mortality and HIV prevalence rates were collated from 1990 to 2012 in 48 countries. Countries were grouped into geo-political and eco-political groups. Groupings were based on conflict trends in geographical regions and the International Monetary Fund's classification of SSA countries based on gross national income and development assistance respectively. Cumulative progress in each group was derived and main effects tested using ANOVA. Correlation analysis was conducted between political variables - POLITY 2, fragile state index (FSI), voter turnout rates, civil liberty scores (CLS) and the health variables. Our results suggest a significant main effect of eco-political and geo-political groups on some of the health variables. Political conflict as measured by FSI and political participation as measured by CLS were stronger predictors of slow progress in reducing under-five mortality rates and maternal mortality ratios. Our findings highlight the need for further research on political determinants of mortality in SSA. Cohesive effort should focus on strengthening countries' political, economic and social capacities in order to achieve sustainable goals beyond 2015.
Collapse
Affiliation(s)
- Emma Atti
- a Unit for Health Promotion Research , University of Southern Denmark , Esbjerg , Denmark
| | - Gabriel Gulis
- a Unit for Health Promotion Research , University of Southern Denmark , Esbjerg , Denmark
| |
Collapse
|
30
|
Associations of gender inequality with child malnutrition and mortality across 96 countries. GLOBAL HEALTH EPIDEMIOLOGY AND GENOMICS 2016; 1:e6. [PMID: 29868199 PMCID: PMC5870432 DOI: 10.1017/gheg.2016.1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/16/2016] [Accepted: 01/19/2016] [Indexed: 12/11/2022]
Abstract
National efforts to reduce low birth weight (LBW) and child malnutrition and mortality prioritise economic growth. However, this may be ineffective, while rising gross domestic product (GDP) also imposes health costs, such as obesity and non-communicable disease. There is a need to identify other potential routes for improving child health. We investigated associations of the Gender Inequality Index (GII), a national marker of women's disadvantages in reproductive health, empowerment and labour market participation, with the prevalence of LBW, child malnutrition (stunting and wasting) and mortality under 5 years in 96 countries, adjusting for national GDP. The GII displaced GDP as a predictor of LBW, explaining 36% of the variance. Independent of GDP, the GII explained 10% of the variance in wasting and stunting and 41% of the variance in child mortality. Simulations indicated that reducing GII could lead to major reductions in LBW, child malnutrition and mortality in low- and middle-income countries. Independent of national wealth, reducing women's disempowerment relative to men may reduce LBW and promote child nutritional status and survival. Longitudinal studies are now needed to evaluate the impact of efforts to reduce societal gender inequality.
Collapse
|
31
|
Ali MK, Bhaskarapillai B, Shivashankar R, Mohan D, Fatmi ZA, Pradeepa R, Masood Kadir M, Mohan V, Tandon N, Narayan KMV, Prabhakaran D. Socioeconomic status and cardiovascular risk in urban South Asia: The CARRS Study. Eur J Prev Cardiol 2016; 23:408-19. [PMID: 25917221 PMCID: PMC5560768 DOI: 10.1177/2047487315580891] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/18/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although South Asians experience cardiovascular disease (CVD) and risk factors at an early age, the distribution of CVD risks across the socioeconomic spectrum remains unclear. METHODS We analysed the 2011 Centre for Cardiometabolic Risk Reduction in South Asia survey data including 16,288 non-pregnant adults (≥20 years) that are representative of Chennai and Delhi, India, and Karachi, Pakistan. Socioeconomic status (SES) was defined by highest education (primary schooling, high/secondary schooling, college graduate or greater); wealth tertiles (low, middle, high household assets) and occupation (not working outside home, semi/unskilled, skilled, white-collar work). We estimated age and sex-standardized prevalence of behavioural (daily fruit/vegetables; tobacco use), weight (body mass index; waist-to-height ratio) and metabolic risk factors (diabetes, hypertension, hypercholesterolaemia; hypo-HDL; and hypertriglyceridaemia) by each SES category. RESULTS Across cities, 61.2% and 16.1% completed secondary and college educations, respectively; 52.8% reported not working, 22.9% were unskilled; 21.3% were skilled and 3.1% were white-collar workers. For behavioural risk factors, low fruit/vegetable intake, smoked and smokeless tobacco use were more prevalent in lowest education, wealthy and occupation (for men only) groups compared to higher SES counterparts, while weight-related risks (body mass index 25.0-29.9 and ≥30 kg/m(2); waist-to-height ratio ≥0.5) were more common in higher educated and wealthy groups, and technical/professional men. For metabolic risks, a higher prevalence of diabetes, hypertension and dyslipidaemias was observed in more educated and affluent groups, with unclear patterns across occupation groups. CONCLUSIONS SES-CVD patterns are heterogeneous, suggesting customized interventions for different SES groups may be warranted. Different behavioural, weight, and metabolic risk factor prevalence patterns across SES indicators may signal on-going epidemiological transition in South Asia.
Collapse
|
32
|
Current recommendations on managing tuberculosis patients with diabetes & its epidemiology. Microb Pathog 2016; 92:43-45. [PMID: 26743535 DOI: 10.1016/j.micpath.2015.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 12/08/2015] [Accepted: 12/18/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND & OBJECTIVE Tuberculosis (TB) & Diabetes Mellitus (DM) are common diseases globally & both are mutually on rising trend, and co-existing together. To analyze the effect of TB on diabetes by causing hyperglycemia and causing impaired glucose tolerance. Impaired glucose tolerance that is one of the major risk factor for developing diabetes. STUDY DESIGN Literature study regarding co-association of TB & DM with its complications and management through published articles. The drugs used to treat tuberculosis especially rifampicin and isoniazid interacts with oral anti-diabetic drugs and can lead to suboptimal glycemic control. Therefore the interaction of diabetes and tuberculosis is at multiple levels exacerbating each other. DM is also well recognized as an independent risk factor for lower respiratory tract infection. Infection with, staphylococcus aureus, gram negative bacteria, and fungi occur more frequently in diabetics. RESULT & CONCLUSION The prevalence of diabetes globally is projected to rise from the current estimate of 150 million to 200 million in 2010 and to 300 million (5.4%) in 2025. The potential for increase in the number of cases of diabetes is greatest in Asia. It is an emerging public health problem leading in an associated significant proportion. This article reviews the association between diabetes and tuberculosis and suggests appropriate management for these conditions.
Collapse
|
33
|
Colagiuri R, Boylan S, Morrice E. Research Priorities for NCD Prevention and Climate Change: An International Delphi Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:12941-57. [PMID: 26501301 PMCID: PMC4627009 DOI: 10.3390/ijerph121012941] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/01/2015] [Accepted: 10/13/2015] [Indexed: 11/23/2022]
Abstract
Climate change and non-communicable diseases (NCDs) are arguably the greatest global challenges of the 21st Century. However, the confluence between them remains under-examined and there is little evidence of a comprehensive, systematic approach to identifying research priorities to mitigate their joint impact. Consequently, we: (i) convened a workshop of academics (n = 25) from the Worldwide Universities Network to identify priority areas at the interface between NCDs and climate change; (ii) conducted a Delphi survey of international opinion leaders in public health and relevant other disciplines; and (iii) convened an expert panel to review and advise on final priorities. Three research areas (water security; transport; conceptualising NCD harms to support policy formation) were listed among the top 10 priorities by >90% of Delphi respondents, and ranked among the top 12 priorities by >60% of respondents who ranked the order of priority. A fourth area (reducing the carbon footprint of cities) was ranked highest by the same >60% of respondents. Our results are consistent with existing frameworks on health and climate change, and extends them by focusing specifically on NCDs. Researching these priorities could progress understanding of climate change and NCDs, and inform global and national policy decisions for mitigating associated harms.
Collapse
Affiliation(s)
- Ruth Colagiuri
- Menzies Centre for Health Policy, School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Sinead Boylan
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Emily Morrice
- Menzies Centre for Health Policy, School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia.
| |
Collapse
|
34
|
Yeates K, Lohfeld L, Sleeth J, Morales F, Rajkotia Y, Ogedegbe O. A Global Perspective on Cardiovascular Disease in Vulnerable Populations. Can J Cardiol 2015; 31:1081-93. [PMID: 26321432 DOI: 10.1016/j.cjca.2015.06.035] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/29/2015] [Accepted: 06/29/2015] [Indexed: 12/24/2022] Open
Abstract
Cardiovascular disease (CVD) is a major contributor to the growing public health epidemic in chronic diseases. Much of the disease and disability burden from CVDs are in people younger than the age of 70 years in low- and middle-income countries, formerly "the developing world." The risk of CVD is heavily influenced by environmental conditions and lifestyle variables. In this article we review the scope of the CVD problem in low- and middle-income countries, including economic factors, risk factors, at-risk groups, and explanatory frameworks that hypothesize the multifactorial drivers. Finally, we discuss current and potential interventions to reduce the burden of CVD in vulnerable populations including research needed to evaluate and implement promising solutions for those most at risk.
Collapse
Affiliation(s)
- Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Lynne Lohfeld
- McMaster University, Department of Clinical Epidemiology and Biostatistics, Hamilton, Ontario, Canada
| | - Jessica Sleeth
- Office of Global Health, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Fernando Morales
- ICAP at Columbia University, Mailman School of Public Health, New York, New York
| | | | - Olugbenga Ogedegbe
- Division of Health an Behavior, Center for Healthful Behavior Change, College of Global Public Health, Center for Healthful Behavior Change, New York University, Langone Medical Center, New York, New York
| |
Collapse
|
35
|
Ku GMV, Kegels G. Adapting chronic care models for diabetes care delivery in low-and-middle-income countries: A review. World J Diabetes 2015; 6:566-75. [PMID: 25987954 PMCID: PMC4434077 DOI: 10.4239/wjd.v6.i4.566] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 01/27/2015] [Accepted: 02/09/2015] [Indexed: 02/05/2023] Open
Abstract
A contextual review of models for chronic care was done to develop a context-adapted chronic care model-based service delivery model for chronic conditions including diabetes. The Philippines was used as the setting of a low-to-middle-income country. A context-based narrative review of existing models for chronic care was conducted. A situational analysis was done at the grassroots level, involving the leaders and members of the community, the patients, the local health system and the healthcare providers. A second analysis making use of certain organizational theories was done to explore on improving feasibility and acceptability of organizing care for chronic conditions. The analyses indicated that care for chronic conditions may be introduced, considering the needs of people with diabetes in particular and the community in general as recipients of care, and the issues and factors that may affect the healthcare workers and the health system as providers of this care. The context-adapted chronic care model-based service delivery model was constructed accordingly. Key features are: incorporation of chronic care in the health system's services; assimilation of chronic care delivery with the other responsibilities of the healthcare workers but with redistribution of certain tasks; and ensuring that the recipients of care experience the whole spectrum of basic chronic care that includes education and promotion in the general population, risk identification, screening, counseling including self-care development, and clinical management of the chronic condition and any co-morbidities, regardless of level of control of the condition. This way, low-to-middle income countries can introduce and improve care for chronic conditions without entailing much additional demand on their limited resources.
Collapse
|
36
|
Reeves A, Basu S, McKee M, Sandgren A, Stuckler D, Semenza JC. Tuberculosis control and economic recession: longitudinal study of data from 21 European countries, 1991-2012. Bull World Health Organ 2015; 93:369-79. [PMID: 26240458 PMCID: PMC4450704 DOI: 10.2471/blt.14.142356] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 01/26/2015] [Accepted: 02/09/2015] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate whether the economic recession affected the control of tuberculosis in the European Union. Methods Multivariate regression models were used to quantify the association between gross domestic product, public health expenditure and tuberculosis case detection rates, using data from 21 European Union member states (1991–2012). The estimated changes in case detection attributable to the recession were combined with mathematical models of tuberculosis transmission, to project the potential influence of the recession on tuberculosis epidemiology until 2030. Findings Between 1991 and 2007, detection rates for sputum-smear-positive tuberculosis in the European Union were stable at approximately 85%. During the economic recession (2008–2011) detection rates declined by a mean of 5.22% (95% confidence interval, CI: 2.54–7.90) but treatment success rates showed no significant change (P = 0.62). A fall in economic output of 100 United States dollars per capita was associated with a 0.22% (95% CI: 0.05–0.39) mean reduction in the tuberculosis case detection rate. An equivalent fall in spending on public health services was associated with a 2.74% (95% CI: 0.31–5.16) mean reduction in the detection rate. Mathematical models suggest that the recession and consequent austerity policies will lead to increases in tuberculosis prevalence and tuberculosis-attributable mortality that are projected to persist for over a decade. Conclusion Across the European Union, reductions in spending on public health services appear to have reduced tuberculosis case detection and to have increased the long-term risk of a resurgence in the disease.
Collapse
Affiliation(s)
- Aaron Reeves
- Manor Road Building, Department of Sociology, University of Oxford, Oxford, OX1 3UQ, England
| | - Sanjay Basu
- School of Medicine, Stanford University, Palo Alto, United States of America
| | - Martin McKee
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, England
| | - Andreas Sandgren
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - David Stuckler
- Manor Road Building, Department of Sociology, University of Oxford, Oxford, OX1 3UQ, England
| | - Jan C Semenza
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| |
Collapse
|
37
|
Menon J, Vijayakumar N, Joseph JK, David PC, Menon MN, Mukundan S, Dorphy PD, Banerjee A. Below the poverty line and non-communicable diseases in Kerala: The Epidemiology of Non-communicable Diseases in Rural Areas (ENDIRA) study. Int J Cardiol 2015; 187:519-24. [PMID: 25846664 DOI: 10.1016/j.ijcard.2015.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/01/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION India carries the greatest burden of global non-communicable diseases (NCDs). Poverty is strongly associated with NCDs but there are few prevalence studies which have measured poverty in India, particularly in rural settings. METHODS In Kerala, India, a population of 113,462 individuals was identified. The "Epidemiology of Non-communicable Diseases in Rural Areas" (ENDIRA) study was conducted via ASHAs (Accredited Social Health Activists). Standardised questionnaires were used in household interviews of individuals ≥18years during 2012 to gather sociodemographic, lifestyle and medical data for this population. The Government of Kerala definition of "the poverty line" was used. The association between below poverty line (BPL) status, NCDs and risk factors was analysed in multivariable regression models. RESULTS 84,456 adults were included in the analyses (25.4% below the poverty line). The prevalence of NCDs was relatively common: myocardial infarction (MI) 1.4%, stroke 0.3%, respiratory diseases 5.0%, and cancer 1.1%. BPL status was not associated with age (p=0.96) or gender (p=0.26). Compared with those above the poverty line (APL), the BPL group was less likely to have diabetes, hypertension or dyslipidaemia (p<0.0001), and more likely to smoke (p<0.0001). Compared with APL, BPL was associated with stroke (OR 1.33, 1.04-1.69; p=0.02) and respiratory disease (OR 1.23, 1.15-1.32; p<0.0001) in multivariable analyses, but not MI or cancer. CONCLUSIONS In rural Kerala, BPL status was associated with stroke and respiratory diseases, but not with MI and cancer although it was associated with smoking status, compared with above poverty line status.
Collapse
Affiliation(s)
- Jaideep Menon
- Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala, India.
| | - N Vijayakumar
- Blood Bank & Dialysis Unit, Aluva Taluk Hospital, Kochi, Kerala, India.
| | | | - P C David
- MAGJ Hospital, Mookkannoor, Kerala, India.
| | - M N Menon
- Aiswarya Clinic, Sree Moolanagaram, Kerala, India.
| | | | - P D Dorphy
- Deva Matha Hospital, Koratty, Kerala, India.
| | - Amitava Banerjee
- University of Birmingham Centre for Cardiovascular Sciences, Birmingham, UK.
| |
Collapse
|
38
|
Colson KE, Dwyer-Lindgren L, Achoki T, Fullman N, Schneider M, Mulenga P, Hangoma P, Ng M, Masiye F, Gakidou E. Benchmarking health system performance across districts in Zambia: a systematic analysis of levels and trends in key maternal and child health interventions from 1990 to 2010. BMC Med 2015; 13:69. [PMID: 25889124 PMCID: PMC4382853 DOI: 10.1186/s12916-015-0308-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/02/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Achieving universal health coverage and reducing health inequalities are primary goals for an increasing number of health systems worldwide. Timely and accurate measurements of levels and trends in key health indicators at local levels are crucial to assess progress and identify drivers of success and areas that may be lagging behind. METHODS We generated estimates of 17 key maternal and child health indicators for Zambia's 72 districts from 1990 to 2010 using surveys, censuses, and administrative data. We used a three-step statistical model involving spatial-temporal smoothing and Gaussian process regression. We generated estimates at the national level for each indicator by calculating the population-weighted mean of the district values and calculated composite coverage as the average of 10 priority interventions. RESULTS National estimates masked substantial variation across districts in the levels and trends of all indicators. Overall, composite coverage increased from 46% in 1990 to 73% in 2010, and most of this gain was attributable to the scale-up of malaria control interventions, pentavalent immunization, and exclusive breastfeeding. The scale-up of these interventions was relatively equitable across districts. In contrast, progress in routine services, including polio immunization, antenatal care, and skilled birth attendance, stagnated or declined and exhibited large disparities across districts. The absolute difference in composite coverage between the highest-performing and lowest-performing districts declined from 37 to 26 percentage points between 1990 and 2010, although considerable variation in composite coverage across districts persisted. CONCLUSIONS Zambia has made marked progress in delivering maternal and child health interventions between 1990 and 2010; nevertheless, substantial variations across districts and interventions remained. Subnational benchmarking is important to identify these disparities, allowing policymakers to prioritize areas of greatest need. Analyses such as this one should be conducted regularly and feed directly into policy decisions in order to increase accountability at the local, regional, and national levels.
Collapse
Affiliation(s)
| | - Laura Dwyer-Lindgren
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - Tom Achoki
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Ministry of Health of Botswana, Gaborone, Botswana.
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | | | | | - Peter Hangoma
- Department of Economics, University of Bergen, Bergen, Norway.
- Department of Economics, University of Zambia, Lusaka, Zambia.
| | - Marie Ng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - Felix Masiye
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Economics, University of Zambia, Lusaka, Zambia.
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| |
Collapse
|
39
|
Colagiuri R, Dain K, Moylan J. The global response to diabetes: action or apathy? Med J Aust 2015; 201:581-3. [PMID: 25390263 DOI: 10.5694/mja14.01135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/27/2014] [Indexed: 11/17/2022]
Abstract
Diabetes and related non-communicable diseases (NCDs) account for over 60% of the world's annual deaths, untold personal suffering, and an economically crippling burden of lost productivity. Despite the body of evidence and various calls to action, historically, the global response has bordered on apathy. Although diabetes and related NCDs remain disproportionately underfunded, the United Nations now recognises them as a major challenge to human and economic development, resulting in an action-oriented policy, frameworks and monitoring requirements that are being driven by the UN and the World Health Organization. Australia is at the forefront of many of these initiatives and is currently developing a new national diabetes strategy.
Collapse
Affiliation(s)
- Ruth Colagiuri
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia.
| | | | - Judi Moylan
- Diabetes Australia, Canberra, ACT, Australia
| |
Collapse
|
40
|
Garenne M. The Difficult Task of Evaluating MDG-4. Glob Pediatr Health 2015; 2:2333794X15584622. [PMID: 27335957 PMCID: PMC4784596 DOI: 10.1177/2333794x15584622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background. The fourth Millennium Development Goal (MDG-4) proposed to reduce under-5 mortality rates (U5MR) by two thirds within 25 years. The article discusses changes in U5MR for 35 sub-Saharan African countries, for which DHS surveys are available. Methods. Analysis of DHS data, reconstruction of time series of U5MR, and comparison with other series. Findings. Few countries were able to achieve MDG-4 from 1985 to 2010, and the few who did seem to have achieved the goal apparently either because of abnormally high baseline or a surprisingly low endpoint. If all countries experienced significant mortality decline, only a minority had a steady decline, and many had periods of rising and falling mortality, for a variety of reasons. Interpretation. Discussion focuses on data quality, on methods for estimating levels and trends in under-5 mortality, and on the circumstances explaining rises and falls in mortality. MDG-4 appeared overambitious for Africa, given high mortality levels, political instability, economic crises, and above all emerging diseases, in particular HIV/AIDS. The last 10 years from 2000 to 2010 appeared as the most favorable period since 1960 in African countries, with the exception of countries with widespread HIV/AIDS.
Collapse
Affiliation(s)
- Michel Garenne
- Institut Pasteur, Epidémiologie des Maladies Emergentes, Paris, France
- Institut de Recherche pour le Développement, UMI Résiliences, Bondy, France
- Witwatersrand University, Johannesburg, South Africa
| |
Collapse
|
41
|
Mehta N, Zhang C, Hua X, Redmon P, Eriksen M, Koplan J, Ali M. Tobacco smoking among government employees in six cities in China. HEART ASIA 2014; 6:179-83. [DOI: 10.1136/heartasia-2014-010557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 10/24/2014] [Accepted: 11/20/2014] [Indexed: 11/04/2022]
|
42
|
Cohen RL, Alfonso YN, Adam T, Kuruvilla S, Schweitzer J, Bishai D. Country progress towards the Millennium Development Goals: adjusting for socioeconomic factors reveals greater progress and new challenges. Global Health 2014; 10:67. [PMID: 25270882 PMCID: PMC4197219 DOI: 10.1186/s12992-014-0067-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The health Millennium Development Goals (4, 5, 6) impose the same ambitious 2015 targets on every country. Few low-income countries are on track to reach them. Some authors have proposed country-specific targets as a more informative method by which countries can measure their progress against their potential. METHODS This paper demonstrates a supplementary approach to assess individual country progress that complements the global goals by adjusting for socioeconomic resources and prior time trends. A minimum performance target adjusts for time and national GDP. Fast-track targets, based on best-performing countries' progress within regional and income groups, adjust for health and non-health sector factors known to affect maternal and child health. RESULTS Measuring by the minimum performance target, 74% and 59% of low- and middle-income countries are on track for reducing child mortality and maternal mortality, respectively, compared with 69% and 22% using global MDGs. Only 20% and 7% of low- and middle-income countries are on track for the child and maternal mortality fast-track targets. CONCLUSIONS Supplementary targets in maternal and child health, adjusted for each country's resources and policy performance can help countries know if they are truly underperforming relative to their potential. Adjusted targets can also flag countries that have surpassed their potential, and open opportunities for learning from success. FUNDING Partnership for Maternal, Newborn & Child Health and the Alliance for Health Policy and Systems Research, as part of the Success Factors Study on reducing maternal and child mortality.
Collapse
Affiliation(s)
- Robert L Cohen
- />Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E4622, Baltimore, MD 21205 USA
| | - Yira Natalia Alfonso
- />Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E4622, Baltimore, MD 21205 USA
| | - Taghreed Adam
- />Alliance for Health Policy and Systems Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Shyama Kuruvilla
- />Partnership for Maternal, Newborn & Child Health, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | | | - David Bishai
- />Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E4622, Baltimore, MD 21205 USA
| |
Collapse
|
43
|
Murray CJL, Ortblad KF, Guinovart C, Lim SS, Wolock TM, Roberts DA, Dansereau EA, Graetz N, Barber RM, Brown JC, Wang H, Duber HC, Naghavi M, Dicker D, Dandona L, Salomon JA, Heuton KR, Foreman K, Phillips DE, Fleming TD, Flaxman AD, Phillips BK, Johnson EK, Coggeshall MS, Abd-Allah F, Abera SF, Abraham JP, Abubakar I, Abu-Raddad LJ, Abu-Rmeileh NM, Achoki T, Adeyemo AO, Adou AK, Adsuar JC, Agardh EE, Akena D, Al Kahbouri MJ, Alasfoor D, Albittar MI, Alcalá-Cerra G, Alegretti MA, Alemu ZA, Alfonso-Cristancho R, Alhabib S, Ali R, Alla F, Allen PJ, Alsharif U, Alvarez E, Alvis-Guzman N, Amankwaa AA, Amare AT, Amini H, Ammar W, Anderson BO, Antonio CAT, Anwari P, Arnlöv J, Arsenijevic VSA, Artaman A, Asghar RJ, Assadi R, Atkins LS, Badawi A, Balakrishnan K, Banerjee A, Basu S, Beardsley J, Bekele T, Bell ML, Bernabe E, Beyene TJ, Bhala N, Bhalla A, Bhutta ZA, Abdulhak AB, Binagwaho A, Blore JD, Basara BB, Bose D, Brainin M, Breitborde N, Castañeda-Orjuela CA, Catalá-López F, Chadha VK, Chang JC, Chiang PPC, Chuang TW, Colomar M, Cooper LT, Cooper C, Courville KJ, Cowie BC, Criqui MH, Dandona R, Dayama A, De Leo D, Degenhardt L, Del Pozo-Cruz B, Deribe K, Des Jarlais DC, Dessalegn M, Dharmaratne SD, Dilmen U, Ding EL, Driscoll TR, Durrani AM, Ellenbogen RG, Ermakov SP, Esteghamati A, Faraon EJA, Farzadfar F, Fereshtehnejad SM, Fijabi DO, Forouzanfar MH, Fra Paleo U, Gaffikin L, Gamkrelidze A, Gankpé FG, Geleijnse JM, Gessner BD, Gibney KB, Ginawi IAM, Glaser EL, Gona P, Goto A, Gouda HN, Gugnani HC, Gupta R, Gupta R, Hafezi-Nejad N, Hamadeh RR, Hammami M, Hankey GJ, Harb HL, Haro JM, Havmoeller R, Hay SI, Hedayati MT, Pi IBH, Hoek HW, Hornberger JC, Hosgood HD, Hotez PJ, Hoy DG, Huang JJ, Iburg KM, Idrisov BT, Innos K, Jacobsen KH, Jeemon P, Jensen PN, Jha V, Jiang G, Jonas JB, Juel K, Kan H, Kankindi I, Karam NE, Karch A, Karema CK, Kaul A, Kawakami N, Kazi DS, Kemp AH, Kengne AP, Keren A, Kereselidze M, Khader YS, Khalifa SEAH, Khan EA, Khang YH, Khonelidze I, Kinfu Y, Kinge JM, Knibbs L, Kokubo Y, Kosen S, Defo BK, Kulkarni VS, Kulkarni C, Kumar K, Kumar RB, Kumar GA, Kwan GF, Lai T, Balaji AL, Lam H, Lan Q, Lansingh VC, Larson HJ, Larsson A, Lee JT, Leigh J, Leinsalu M, Leung R, Li Y, Li Y, De Lima GMF, Lin HH, Lipshultz SE, Liu S, Liu Y, Lloyd BK, Lotufo PA, Machado VMP, Maclachlan JH, Magis-Rodriguez C, Majdan M, Mapoma CC, Marcenes W, Marzan MB, Masci JR, Mashal MT, Mason-Jones AJ, Mayosi BM, Mazorodze TT, Mckay AC, Meaney PA, Mehndiratta MM, Mejia-Rodriguez F, Melaku YA, Memish ZA, Mendoza W, Miller TR, Mills EJ, Mohammad KA, Mokdad AH, Mola GL, Monasta L, Montico M, Moore AR, Mori R, Moturi WN, Mukaigawara M, Murthy KS, Naheed A, Naidoo KS, Naldi L, Nangia V, Narayan KMV, Nash D, Nejjari C, Nelson RG, Neupane SP, Newton CR, Ng M, Nisar MI, Nolte S, Norheim OF, Nowaseb V, Nyakarahuka L, Oh IH, Ohkubo T, Olusanya BO, Omer SB, Opio JN, Orisakwe OE, Pandian JD, Papachristou C, Caicedo AJP, Patten SB, Paul VK, Pavlin BI, Pearce N, Pereira DM, Pervaiz A, Pesudovs K, Petzold M, Pourmalek F, Qato D, Quezada AD, Quistberg DA, Rafay A, Rahimi K, Rahimi-Movaghar V, Ur Rahman S, Raju M, Rana SM, Razavi H, Reilly RQ, Remuzzi G, Richardus JH, Ronfani L, Roy N, Sabin N, Saeedi MY, Sahraian MA, Samonte GMJ, Sawhney M, Schneider IJC, Schwebel DC, Seedat S, Sepanlou SG, Servan-Mori EE, Sheikhbahaei S, Shibuya K, Shin HH, Shiue I, Shivakoti R, Sigfusdottir ID, Silberberg DH, Silva AP, Simard EP, Singh JA, Skirbekk V, Sliwa K, Soneji S, Soshnikov SS, Sreeramareddy CT, Stathopoulou VK, Stroumpoulis K, Swaminathan S, Sykes BL, Tabb KM, Talongwa RT, Tenkorang EY, Terkawi AS, Thomson AJ, Thorne-Lyman AL, Towbin JA, Traebert J, Tran BX, Dimbuene ZT, Tsilimbaris M, Uchendu US, Ukwaja KN, Uzun SB, Vallely AJ, Vasankari TJ, Venketasubramanian N, Violante FS, Vlassov VV, Vollset SE, Waller S, Wallin MT, Wang L, Wang X, Wang Y, Weichenthal S, Weiderpass E, Weintraub RG, Westerman R, White RA, Wilkinson JD, Williams TN, Woldeyohannes SM, Wong JQ, Xu G, Yang YC, Yano Y, Yentur GK, Yip P, Yonemoto N, Yoon SJ, Younis M, Yu C, Jin KY, El Sayed Zaki M, Zhao Y, Zheng Y, Zhou M, Zhu J, Zou XN, Lopez AD, Vos T. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384:1005-70. [PMID: 25059949 PMCID: PMC4202387 DOI: 10.1016/s0140-6736(14)60844-8] [Citation(s) in RCA: 668] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration. METHODS To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets. FINDINGS Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990. INTERPRETATION Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action. FUNDING Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
| | | | | | - Stephen S Lim
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - D Allen Roberts
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Nicholas Graetz
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Ryan M Barber
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Haidong Wang
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Herbert C Duber
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Daniel Dicker
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Lalit Dandona
- Institute for Health Metrics and Evaluation, Seattle, WA, USA; Public Health Foundation of India, New Delhi, India
| | | | - Kyle R Heuton
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | | | | | | | | | | | | | | | | | - Jerry P Abraham
- University of Texas School of Medicine San Antonio, San Antonio, TX, USA
| | | | | | - Niveen Me Abu-Rmeileh
- Institute of Community and Public Health-Birzeti University, Ramallah, West Bank, Occupied Palestinian Territory
| | | | | | | | | | | | | | | | | | | | - Gabriel Alcalá-Cerra
- Grupo de Investigación en Ciencias de la Salud y Neurociencias (CISNEURO), Cartagena de Indias, Colombia
| | - Miguel Angel Alegretti
- Facultad de Medicina, Departamento de Medicina Preventiva y Social, Universidad de la República, Montevideo, Uruguay
| | | | | | | | | | - Francois Alla
- School of Public Health, University of Lorraine, Nancy, France
| | | | | | | | | | | | - Azmeraw T Amare
- Department of Epidemiology, University of Groningen, Groningen, The Netherlands; College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Hassan Amini
- Kurdistan Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Kurdistan, Iran
| | | | | | | | | | | | | | | | - Rana J Asghar
- South Asian Public Health Forum, Islamabad, Pakistan
| | - Reza Assadi
- Mashhad University of Medical Sciences, Mashhad, Iran
| | - Lydia S Atkins
- Ministry of Health, Wellness, Human Services and Gender Relations, Castries, St. Lucia
| | - Alaa Badawi
- Public Health Agency of Canada, Toronto, ON, Canada
| | | | | | | | | | | | | | | | | | | | - Ashish Bhalla
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | - Jed D Blore
- University of Melbourne, Melbourne, VIC, Australia
| | | | | | | | | | | | - Ferrán Catalá-López
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Medicines and Healthcare Products Agency (AEMPS), Ministry of Health, Madrid, Spain
| | | | | | | | - Ting-Wu Chuang
- Department of Parasitology, College of Medicine, Taipei Medical University, Taipei, Taiwan; Center for International Tropical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | | | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | - Benjamin C Cowie
- Victorian Infectious Diseases Reference Laboratory, North Melbourne, VIC, Australia
| | | | | | - Anand Dayama
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | | | | | - Muluken Dessalegn
- Africa Medical and Research Foundation in Ethiopia, Addis Ababa, Ethiopia
| | | | | | - Eric L Ding
- Harvard School of Public Health, Cambridge, MA, USA
| | | | | | | | - Sergey Petrovich Ermakov
- The Institute of Social and Economic Studies of Population at the Russian Academy of Sciences, Moscow, Russia
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | | - Lynne Gaffikin
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | | | | | | | - Philimon Gona
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Atsushi Goto
- Department of Diabetes Research, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hebe N Gouda
- University of Queensland, Brisbane, QLD, Australia
| | | | | | - Rahul Gupta
- Kanawha Charleston Health Department, Charleston, WV, USA
| | - Nima Hafezi-Nejad
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mouhanad Hammami
- Wayne County Department of Health and Human Services, Detroit, MI, USA
| | - Graeme J Hankey
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | | | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, University of Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | | | | | | | | | - Hans W Hoek
- Parnassia Psychiatric Institute, The Hague, Netherlands
| | | | | | | | - Damian G Hoy
- School of Population Health, Brisbane, QLD, Australia; Public Health Division, Secretariat of the Pacific Community, Noumea, New Caledonia
| | | | | | | | - Kaire Innos
- National Institute for Health Development, Tallinn, Estonia
| | | | | | | | - Vivekanand Jha
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Guohong Jiang
- Tianjin Centers for Diseases Control and Prevention, Tianjin, China
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Knud Juel
- The National Institute of Public Health, Copenhagen, Denmark
| | | | | | | | - André Karch
- Helmholtz Centre for Infection Research, Braunschweig, Germany; German Center for Infection Research (DZIF), Hannover-Braunschweig site, Germany
| | | | - Anil Kaul
- Oklahoma State University, Tulsa, OK, USA
| | | | - Dhruv S Kazi
- University of California San Francisco, San Francisco, CA, USA
| | | | - Andre Pascal Kengne
- South African Medical Research Council, Cape Town, Western Cape, South Africa
| | - Andre Keren
- Cardiology, Hadassah Ein Kerem University Hospital, Jerusalem, Israel
| | - Maia Kereselidze
- National Centre for Disease Control and Public Health, Tbilisi, Georgia
| | | | | | | | - Young-Ho Khang
- Institute of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
| | - Irma Khonelidze
- National Centre for Disease Control and Public Health, Tbilisi, Georgia
| | | | | | - Luke Knibbs
- University of Queensland, Brisbane, QLD, Australia
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - S Kosen
- Center for Community Empowerment, Health Policy & Humanities, NIHRD, Jakarta, Indonesia
| | | | | | - Chanda Kulkarni
- Rajrajeshwari Medical College & Hospital, Bangalore, Karnataka, India
| | - Kaushalendra Kumar
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Ravi B Kumar
- Indian Institute of Public Health, Public Health Foundation of India, Gurgaon, Haryana, India
| | - G Anil Kumar
- Public Health Foundation of India, New Delhi, India
| | | | - Taavi Lai
- Fourth View Consulting, Tallinn, Estonia
| | | | - Hilton Lam
- Institute of Health Policy and Development Studies, National Institutes of Health, Manila, Philippines
| | - Qing Lan
- National Cancer Institute, Rockville, MD, USA
| | | | - Heidi J Larson
- London School of Hygiene and Tropical Medicine, Bloomsbury, UK
| | | | | | - James Leigh
- University of Sydney, Sydney, NSW, Australia
| | - Mall Leinsalu
- National Institute for Health Development, Tallinn, Estonia
| | - Ricky Leung
- University at Albany, The State University of New York, Rensselaer, NY, USA
| | - Yichong Li
- Genentech, Inc, South San Francisco, CA, USA
| | - Yongmei Li
- Genentech, Inc, South San Francisco, CA, USA
| | | | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, Taipei, Taiwan
| | | | - Shiwei Liu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yang Liu
- Emory University, Atlanta, GA, USA
| | - Belinda K Lloyd
- Eastern Health Clinical School, VIC, Australia; Turning Point, Eastern Health, Fitzroy, VIC, Australia
| | | | | | | | | | - Marek Majdan
- Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
| | | | | | | | - Joseph R Masci
- Elmhurst Hospital Center, Mount Sinai Services, Elmhurst, NY, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Ted R Miller
- Pacific Institute for Research & Evaluation, Calverton MD, USA; Centre for Population Health Research, Curtin University, Perth, WA, Australia
| | | | | | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Lorenzo Monasta
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Marcella Montico
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | | | - Rintaro Mori
- National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | | | | | | | - Aliya Naheed
- International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Kovin S Naidoo
- University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Luigi Naldi
- Azienda Ospedaliera papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Denis Nash
- School of Public Health, City University of New York, New York, NY, USA
| | | | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Sudan Prasad Neupane
- Norwegian Center for Addiction Research (SERAF), University of Oslo, Oslo, Norway
| | - Charles R Newton
- Kenya Medical Research Institute Wellcome Trust Programme, Kilifi, Kenya
| | - Marie Ng
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Sandra Nolte
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | | | | | | | - John Nelson Opio
- Lira District Local Government, Lira Municipal Council, Northern Uganda, Uganda
| | - Orish Ebere Orisakwe
- Toxicology Unit, Faculty of Pharmacy, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
| | | | | | | | | | | | | | - Neil Pearce
- London School of Hygiene and Tropical Medicine, Bloomsbury, UK
| | - David M Pereira
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine and ICVS/3B's-PT Government Associate Laboratory, Braga, Portugal
| | - Aslam Pervaiz
- Postgraduate Medical Institute, Lahore, Punjab, Pakistan
| | | | - Max Petzold
- Centre for Applied Biostatistics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Dima Qato
- College of Pharmacy, University of Illinois, Chicago, IL, USA
| | - Amado D Quezada
- National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico
| | | | | | | | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Saleem M Rana
- Department of Public Health, University of the Punjab, Lahore, Punjab, Pakistan
| | - Homie Razavi
- Center for Disease Analysis, Louisville, CO, USA
| | | | - Giuseppe Remuzzi
- IRCCS Mario Negri Institute for Pharmacological Research, Centro Anna Maria Astori, Bergamo, Italy
| | | | - Luca Ronfani
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | | | | | | | | | - Genesis May J Samonte
- National HIV/AIDS & STI Surveillance and Strategic Information Unit, National Epidemiology Center, Department of Health, Manila, National Capital Region, Philippines
| | | | | | | | - Soraya Seedat
- Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Sadaf G Sepanlou
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sara Sheikhbahaei
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Ivy Shiue
- Heriot-Watt University, Edinburgh, UK
| | - Rupak Shivakoti
- Center for Clinical Global Health Education, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Andrea P Silva
- Instituto Nacional de Epidemiología Dr Juan H Jara, Mar del Plata, Buenos Aires, Argentina
| | - Edgar P Simard
- Surveillance and Health Services Research Program American Cancer Society, Atlanta, GA, USA
| | | | | | - Karen Sliwa
- Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, Cape Town, Western Cape, South Africa
| | | | - Sergey S Soshnikov
- Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow, Russia
| | | | | | - Konstantinos Stroumpoulis
- KEELPNO (Centre for Disease Control, Greece, dispatched to "Alexandra" General Hospital of Athens), Athens, Greece
| | - Soumya Swaminathan
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Bryan L Sykes
- Department of Criminology, Law and Society (and Sociology), University of California-Irvine, Chicago, IL, USA
| | | | | | | | - Abdullah Sulieman Terkawi
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA; Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | | | - Jeffrey A Towbin
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Bach X Tran
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Zacharie Tsala Dimbuene
- Department of Population Sciences and Development, Faculty of Economics and Management, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | - Kingsley N Ukwaja
- Department of Internal Medicine, Federal Teaching Hospital Abakaliki, Abakailiki, Ebonyi State, Nigeria
| | | | | | | | | | | | | | - Stein Emil Vollset
- Norwegian Institute of Public Health, Oslo, Norway; University of Bergen, Bergen, Norway
| | - Stephen Waller
- Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Mitchell T Wallin
- VA Medical Center and Georgetown University Neurology Department, Washington, DC, USA
| | - Linhong Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - XiaoRong Wang
- Shandong University Affiliated Jinan Central Hospital, Jinan, China
| | - Yanping Wang
- National Office for Maternal and Child Health Surveillance, Chengdu, China
| | | | | | - Robert G Weintraub
- University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | | | - Richard A White
- Department of Infectious Disease Epidemiology, Division of Infectious Disease Control and Department of Health Statistics, Division of Epidemiology, Oslo, Norway
| | | | | | | | - John Q Wong
- Ateneo School of Medicine and Public Health, Pasig City, Metro Manila, Philippines
| | - Gelin Xu
- Nanjing University School of Medicine, Jinling Hospital, Nanjing, China
| | - Yang C Yang
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yuichiro Yano
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | | | - Paul Yip
- The University of Hong Kong, Hong Kong, Hong Kong
| | - Naohiro Yonemoto
- National Center of Neurology and Psychiatry, Kodira, Tokyo, Japan
| | | | | | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health and Global Health Institute, Wuhan University, Wuhan, China
| | - Kim Yun Jin
- TCM MEDICAL TK SDN BHD, Nusajaya, Johor Bahru, Malaysia
| | | | - Yong Zhao
- Chongqing Medical University, Chongqing, China
| | - Yingfeng Zheng
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Maigeng Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance, Chengdu, China
| | - Xiao Nong Zou
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Alan D Lopez
- University of Melbourne, Melbourne, VIC, Australia
| | - Theo Vos
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| |
Collapse
|
44
|
Narayan KMV, Miotti PG, Anand NP, Kline LM, Harmston C, Gulakowski R, Vermund SH. HIV and noncommunicable disease comorbidities in the era of antiretroviral therapy: a vital agenda for research in low- and middle-income country settings. J Acquir Immune Defic Syndr 2014; 67 Suppl 1:S2-S7. [PMID: 25117958 DOI: 10.1097/qai.0000000000000267] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In this special 2014 issue of JAIDS, international investigator teams review a host of noncommunicable diseases (NCDs) that are often reported among people living and aging with HIV in sub-Saharan Africa. With the longer lifespans that antiretroviral therapy programs have made possible, NCDs are occurring due to a mix of chronic immune activation, medication side effects, coinfections, and the aging process itself. Cancer; cardiovascular and pulmonary diseases; metabolic, body, and bone disorders; gastrointestinal, hepatic, and nutritional aspects; mental, neurological, and substance use disorders; and renal and genitourinary diseases are discussed. Cost-effectiveness, key research methods, and issues of special importance in Asia, Latin America, and the Caribbean are also addressed. In this introduction, we present some of the challenges and opportunities for addressing HIV and NCD comorbidities in low- and middle-income countries, and preview the research agenda that emerges from the articles that follow.
Collapse
Affiliation(s)
- K M Venkat Narayan
- *Departments of Global Health and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; †Hubert Department of Global Health, Office of AIDS Research, Bethesda, MD; ‡Fogarty International Center, National Institutes of Health, Bethesda, MD; and §Department of Pediatrics, Vanderbilt Institute for Global Health, School of Medicine, Vanderbilt University, Nashville, TN
| | | | | | | | | | | | | |
Collapse
|
45
|
Fernandes QF, Wagenaar BH, Anselmi L, Pfeiffer J, Gloyd S, Sherr K. Effects of health-system strengthening on under-5, infant, and neonatal mortality: 11-year provincial-level time-series analyses in Mozambique. Lancet Glob Health 2014; 2:e468-77. [PMID: 25103520 PMCID: PMC4158849 DOI: 10.1016/s2214-109x(14)70276-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Knowledge of the relation between health-system factors and child mortality could help to inform health policy in low-income and middle-income countries. We aimed to quantify modifiable health-system factors and their relation with provincial-level heterogeneity in under-5, infant, and neonatal mortality over time in Mozambique. METHODS Using Demographic and Health Survey (2003 and 2011) and Multiple Indicator Cluster Survey (2008) data, we generated provincial-level time-series of child mortality in under-5 (ages 0-4 years), infant (younger than 1 year), and neonatal (younger than 1 month) age groups for 2000-10. We built negative binomial mixed models to examine health-system factors associated with changes in child mortality. FINDINGS Under-5 mortality rate was heterogeneous across provinces, with yearly decreases ranging from 11·1% (Nampula) to 1·9% (Maputo Province). Heterogeneity was greater for neonatal mortality rate, with only seven of 11 provinces showing significant yearly decreases, ranging from 13·6% (Nampula) to 4·2% (Zambezia). Health workforce density (adjusted rate ratio 0·94, 95% CI 0·90-0·98) and maternal and child health nurse density (0·96, 0·92-0·99) were both associated with reduced under-5 mortality rate, as were institutional birth coverage (0·94, 0·90-0·98) and government financing per head (0·80, 0·65-0·98). Higher population per health facility was associated with increased under-5 mortality rate (1·14, 1·02-1·28). Neonatal mortality rate was most strongly associated with institutional birth attendance, maternal and child nurse density, and overall health workforce density. Infant mortality rate was most strongly associated with institutional birth attendance and population per health facility. INTERPRETATION The large decreases in child mortality seen in Mozambique between 2000 and 2010 could have been partly caused by improvements in the public-sector health workforce, institutional birth coverage, and government health financing. Increased attention should be paid to service availability, because population per health facility is increasing across Mozambique and is associated with increased under-5 mortality. Investments in health information systems and new methods to track potentially increasing subnational health disparities are urgently needed. FUNDING Doris Duke Charitable Foundation and Mozambican National Institute of Health.
Collapse
Affiliation(s)
- Quinhas F Fernandes
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Bradley H Wagenaar
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Health Alliance International, Seattle, WA, USA.
| | - Laura Anselmi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - James Pfeiffer
- Department of Global Health, University of Washington, Seattle, WA, USA; Health Alliance International, Seattle, WA, USA
| | - Stephen Gloyd
- Department of Global Health, University of Washington, Seattle, WA, USA; Health Alliance International, Seattle, WA, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, USA; Health Alliance International, Seattle, WA, USA
| |
Collapse
|
46
|
Kuate Defo B. Demographic, epidemiological, and health transitions: are they relevant to population health patterns in Africa? Glob Health Action 2014; 7:22443. [PMID: 24848648 PMCID: PMC4028929 DOI: 10.3402/gha.v7.22443] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 04/20/2014] [Accepted: 04/20/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Studies of trends in population changes and epidemiological profiles in the developing world have overwhelmingly relied upon the concepts of demographic, epidemiological, and health transitions, even though their usefulness in describing and understanding population and health trends in developing countries has been repeatedly called into question. The issue is particularly relevant for the study of population health patterns in Africa and sub-Saharan Africa, as the history and experience there differs substantially from that of Western Europe and North America, for which these concepts were originally developed. OBJECTIVE The aim of this study is two-fold: to review and clarify any distinction between the concepts of demographic transition, epidemiological transition and health transition and to identify summary indicators of population health to test how well these concepts apply in Africa. RESULTS Notwithstanding the characteristically diverse African context, Africa is a continent of uncertainties and emergencies where discontinuities and interruptions of health, disease, and mortality trends reflect the enduring fragility and instability of countries and the vulnerabilities of individuals and populations in the continent. Africa as a whole remains the furthest behind the world's regions in terms of health improvements and longevity, as do its sub-Saharan African regions and societies specifically. This study documents: 1) theoretically and empirically the similarities and differences between the demographic transition, epidemiological transition, and health transition; 2) simple summary indicators that can be used to evaluate their descriptive and predictive features; 3) marked disparities in the onset and pace of variations and divergent trends in health, disease, and mortality patterns as well as fertility and life expectancy trajectories among African countries and regions over the past 60 years; 4) the rapid decline in infant mortality and gains in life expectancy from the 1950s through the 1990s in a context of preponderant communicable diseases in all African countries; 5) the salient role of adult mortality, mostly ascribed to HIV/AIDS and co-morbidities, since the 1990s in reversing trends in mortality decline, its interruption of life expectancy improvements, and its reversal of gender differences in life expectancies disadvantaging women in several countries with the highest prevalence of HIV/AIDS; 6) the huge impact of wars in reversing the trends in under-five mortality decline in sub-Saharan countries in the 1990s and beyond. These assessments of these transition frameworks and these phenomena were not well documented to date for all five regions and 57 countries of Africa. CONCLUSION Prevailing frameworks of demographic, epidemiological, and health transitions as descriptive and predictive models are incomplete or irrelevant for charting the population and health experiences and prospects of national populations in the African context.
Collapse
Affiliation(s)
- Barthélémy Kuate Defo
- Public Health Research Institute and Department of Demography, University of Montreal, Montreal, Quebec, Canada;
| |
Collapse
|
47
|
Theron G, Zijenah L, Chanda D, Clowes P, Rachow A, Lesosky M, Bara W, Mungofa S, Pai M, Hoelscher M, Dowdy D, Pym A, Mwaba P, Mason P, Peter J, Dheda K. Feasibility, accuracy, and clinical effect of point-of-care Xpert MTB/RIF testing for tuberculosis in primary-care settings in Africa: a multicentre, randomised, controlled trial. Lancet 2014; 383:424-35. [PMID: 24176144 DOI: 10.1016/s0140-6736(13)62073-5] [Citation(s) in RCA: 322] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Xpert MTB/RIF test for tuberculosis is being rolled out in many countries, but evidence is lacking regarding its implementation outside laboratories, ability to inform same-day treatment decisions at the point of care, and clinical effect on tuberculosis-related morbidity. We aimed to assess the feasibility, accuracy, and clinical effect of point-of-care Xpert MTB/RIF testing at primary-care health-care facilities in southern Africa. METHODS In this pragmatic, randomised, parallel-group, multicentre trial, we recruited adults with symptoms suggestive of active tuberculosis from five primary-care health-care facilities in South Africa, Zimbabwe, Zambia, and Tanzania. Eligible patients were randomly assigned using pregenerated tables to nurse-performed Xpert MTB/RIF at the clinic or sputum smear microscopy. Participants with a negative test result were empirically managed according to local WHO-compliant guidelines. Our primary outcome was tuberculosis-related morbidity (measured with the TBscore and Karnofsky performance score [KPS]) in culture-positive patients who had begun anti-tuberculosis treatment, measured at 2 months and 6 months after randomisation, analysed by intention to treat. This trial is registered with Clinicaltrials.gov, number NCT01554384. FINDINGS Between April 12, 2011, and March 30, 2012, we randomly assigned 758 patients to smear microscopy (182 culture positive) and 744 to Xpert MTB/RIF (185 culture positive). Median TBscore in culture-positive patients did not differ between groups at 2 months (2 [IQR 0-3] in the smear microscopy group vs 2 [0·25-3] in the MTB/RIF group; p=0·85) or 6 months (1 [0-3] vs 1 [0-3]; p=0·35), nor did median KPS at 2 months (80 [70-90] vs 90 [80-90]; p=0·23) or 6 months (100 [90-100] vs 100 [90-100]; p=0·85). Point-of-care MTB/RIF had higher sensitivity than microscopy (154 [83%] of 185 vs 91 [50%] of 182; p=0·0001) but similar specificity (517 [95%] 544 vs 540 [96%] of 560; p=0·25), and had similar sensitivity to laboratory-based MTB/RIF (292 [83%] of 351; p=0·99) but higher specificity (952 [92%] of 1037; p=0·0173). 34 (5%) of 744 tests with point-of-care MTB/RIF and 82 (6%) of 1411 with laboratory-based MTB/RIF failed (p=0·22). Compared with the microscopy group, more patients in the MTB/RIF group had a same-day diagnosis (178 [24%] of 744 vs 99 [13%] of 758; p<0·0001) and same-day treatment initiation (168 [23%] of 744 vs 115 [15%] of 758; p=0·0002). Although, by end of the study, more culture-positive patients in the MTB/RIF group were on treatment due to reduced dropout (15 [8%] of 185 in the MTB/RIF group did not receive treatment vs 28 [15%] of 182 in the microscopy group; p=0·0302), the proportions of all patients on treatment in each group by day 56 were similar (320 [43%] of 744 in the MTB/RIF group vs 317 [42%] of 758 in the microscopy group; p=0·6408). INTERPRETATION Xpert MTB/RIF can be accurately administered by a nurse in primary-care clinics, resulting in more patients starting same-day treatment, more culture-positive patients starting therapy, and a shorter time to treatment. However, the benefits did not translate into lower tuberculosis-related morbidity, partly because of high levels of empirical-evidence-based treatment in smear-negative patients. FUNDING European and Developing Countries Clinical Trials Partnership, National Research Foundation, and Claude Leon Foundation.
Collapse
Affiliation(s)
- Grant Theron
- Lung Infection and Immunity Unit, Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lynn Zijenah
- Department of Immunology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | - Petra Clowes
- National Institute of Medical Research, Mbeya Medical Research Centre, Mbeya, Tanzania; Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | - Andrea Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany; German Centre for Infection Research (DZIF), Munich, Germany
| | - Maia Lesosky
- Lung Infection and Immunity Unit, Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Wilbert Bara
- City of Harare Health Services, Rowan Martin Building, Harare, Zimbabwe
| | - Stanley Mungofa
- City of Harare Health Services, Rowan Martin Building, Harare, Zimbabwe
| | - Madhukar Pai
- McGill International TB Centre and Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany; German Centre for Infection Research (DZIF), Munich, Germany
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alex Pym
- South African Medical Research Council, Durban, South Africa; KwaZulu Research Institute for Tuberculosis and HIV (K-RITH), Durban, South Africa
| | - Peter Mwaba
- University Teaching Hospital, Lusaka, Zambia
| | - Peter Mason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Jonny Peter
- Lung Infection and Immunity Unit, Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Keertan Dheda
- Lung Infection and Immunity Unit, Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa; University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa; Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
| |
Collapse
|
48
|
Banchani E, Tenkorang EY. Implementation challenges of maternal health care in Ghana: the case of health care providers in the Tamale Metropolis. BMC Health Serv Res 2014; 14:7. [PMID: 24393358 PMCID: PMC3893381 DOI: 10.1186/1472-6963-14-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 01/03/2014] [Indexed: 11/12/2022] Open
Abstract
Background Achieving the Millennium Development Goal (MDG) of improving maternal health has become a focus in recent times for the majority of countries in sub-Saharan Africa. Ghana’s maternal mortality is still high indicating that there are challenges in the provision of quality maternal health care at the facility level. This study examined the implementation challenges of maternal health care services in the Tamale Metropolis of Ghana. Methods Purposive sampling was used to select study participants and qualitative strategies, including in-depth interviews, focus group discussions and review of documents employed for data collection. The study participants included midwives (24) and health managers (4) at the facility level. Results The study revealed inadequate in-service training, limited knowledge of health policies by midwives, increased workload, risks of infection, low motivation, inadequate labour wards, problems with transportation, and difficulties in following the procurement act, among others as some of the challenges confronting the successful implementation of the MDGs targeting maternal and child health in the Tamale Metropolis. Conclusions Implementation of maternal health interventions should take into consideration the environment or the context under which the interventions are implemented by health care providers to ensure they are successful. The study recommends involving midwives in the health policy development process to secure their support and commitment towards successful implementation of maternal health interventions.
Collapse
Affiliation(s)
- Emmanuel Banchani
- Department of Sociology, Memorial University of Newfoundland, St, John's A1C 5S7, Canada.
| | | |
Collapse
|
49
|
Rabbani F, Perveen S, Wasim S, Toure K, Nurse-Findlay S, Mobeen N. Evaluating regional workshops on strengthening the capacity of healthcare professional associations to achieve Millennium Development Goals 4 and 5. Int J Gynaecol Obstet 2013; 124:265-9. [PMID: 24355246 DOI: 10.1016/j.ijgo.2013.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 08/07/2013] [Accepted: 11/19/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In 2007-2008, the Partnership for Maternal, Newborn and Child Health (PMNCH), Geneva, organized capacity-building workshops in Malawi, Burkina Faso, and Bangladesh. Their aim was to strengthen the role of healthcare professional associations (HCPAs) in national reproductive, maternal, newborn, and child health (RMNCH) planning and programs. The present cross-sectional study evaluated the outcomes of these regional workshops. METHODS In 2010, a structured survey, telephone interviews of workshop participants, and a document review were used to analyze the impact of these workshops. RESULTS Overall, HCPAs in only 2 of the 17 participating countries (11.8%) were able to increase their impact on RMNCH planning. Although all countries developed action plans, 15 (88.2%) were unable to fully implement them despite increased interactions among HCPAs and with the Ministry of Health (MOH). Nine countries (52.9%) implemented their action plans partly. Engagement of the MOH emerged as a strong indicator of HCPA contribution toward RMNCH planning. CONCLUSION Strong and sustained follow-up by PMNCH, a clear sense of ownership by HCPAs, designated staff, and financial resources emerged as important determinants for the implementation of action plans. These workshops were generally successful in both encouraging HCPA collaboration and marching toward Millennium Development Goals 4 and 5.
Collapse
Affiliation(s)
- Fauziah Rabbani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
| | - Shagufta Perveen
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Saba Wasim
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Kadi Toure
- Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland
| | | | - Naushaba Mobeen
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
50
|
Sreeramareddy CT, Harsha Kumar HN, Sathian B. Time trends and inequalities of under-five mortality in Nepal: a secondary data analysis of four demographic and health surveys between 1996 and 2011. PLoS One 2013; 8:e79818. [PMID: 24224010 PMCID: PMC3817106 DOI: 10.1371/journal.pone.0079818] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 10/03/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Inequalities in progress towards achievement of Millennium Development Goal four (MDG-4) reflect unequal access to child health services. OBJECTIVE To examine the time trends, socio-economic and regional inequalities of under-five mortality rate (U5MR) in Nepal. METHODS We analyzed the data from complete birth histories of four Nepal Demographic and Health Surveys (NDHS) done in the years 1996, 2001, 2006 and 2011. For each livebirth, we computed survival period from birth until either fifth birthday or the survey date. Using direct methods i.e. by constructing life tables, we calculated yearly U5MRs from 1991 to 2010. Projections were made for the years 2011 to 2015. For each NDHS, U5MRs were calculated according to child's sex, mother's education, household wealth index, rural/urban residence, development regions and ecological zones. Inequalities were calculated as rate difference, rate ratio, population attributable risk and hazard ratio. RESULTS Yearly U5MR (per 1000 live births) had decreased from 157.3 (95% CIs 178.0-138.9) in 1991 to 43.2 (95% CIs 59.1-31.5) in 2010 i.e. 114.1 reduction in absolute risk. Projected U5MR for the year 2015 was 54.33. U5MRs had decreased in absolute terms in all sub groups but relative inequalities had reduced for gender and rural/urban residence only. Wide inequalities existed by wealth and education and increased between 1996 and 2011. For lowest wealth quintile (as compared to highest quintile) hazard ratio (HR) increased from 1.37 (95% CIs 1.27, 1.49) to 2.54 ( 95% CIs 2.25, 2.86) and for mothers having no education (as compared to higher education) HR increased from 2.55 (95% CIs 1.95, 3.33) to 3.75 (95% CIs 3.17, 4.44). Changes in regional inequities were marginal and irregular. CONCLUSIONS Nepal is most likely to achieve MDG-4 but eductional and wealth inequalities may widen further. National health policies should address to reduce inequalities in U5MR through 'inclusive policies'.
Collapse
Affiliation(s)
- Chandrashekhar T. Sreeramareddy
- Department of Population Medicine, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Bandar Sungai Long, Selangor, Malaysia
| | - H. N. Harsha Kumar
- Department of Community Medicine, Kasturba Medical College, Mangalore, Karnataka, India
| | - Brijesh Sathian
- Department of Community Medicine, Manipal College of Medical Sciences, Pokhara, Western Development Region, Nepal
| |
Collapse
|