Search

Women and children bear substantial morbidity and mortality as a result of armed conflicts. This Series paper focuses on the direct (due to violence) and indirect health effects of armed conflict on women and children (including adolescents) worldwide. We estimate that nearly 36 million children and 16 million women were displaced in 2017, on the basis of international databases of refugees and internally displaced populations. From geospatial analyses we estimate that the number of non-displaced women and children living dangerously close to armed conflict (within 50 km) increased from 185 million women and 250 million children in 2000, to 265 million women and 368 million children in 2017. Women's and children's mortality risk from non-violent causes increases substantially in response to nearby conflict, with more intense and more chronic conflicts leading to greater mortality increases. More than 10 million deaths in children younger than 5 years can be attributed to conflict between 1995 and 2015 globally. Women of reproductive ages living near high intensity conflicts have three times higher mortality than do women in peaceful settings. Current research provides fragmentary evidence about how armed conflict indirectly affects the survival chances of women and children through malnutrition, physical injuries, infectious diseases, poor mental health, and poor sexual and reproductive health, but major systematic evidence is sparse, hampering the design and implementation of essential interventions for mitigating the harms of armed conflicts. [ABSTRACT FROM AUTHOR]

In this Series paper, we describe the frequency of, trends in, determinants of, and inequalities in caesarean section (CS) use, globally, regionally, and in selected countries. On the basis of data from 169 countries that include 98·4% of the world's births, we estimate that 29·7 million (21·1%, 95% uncertainty interval 19·9-22·4) births occurred through CS in 2015, which was almost double the number of births by this method in 2000 (16·0 million [12·1%, 10·9-13·3] births). CS use in 2015 was up to ten times more frequent in the Latin America and Caribbean region, where it was used in 44·3% (41·3-47·4) of births, than in the west and central Africa region, where it was used in 4·1% (3·6-4·6) of births. The global and regional increases in CS use were driven both by an increasing proportion of births occurring in health facilities (accounting for 66·5% of the global increase) and increases in CS use within health facilities (33·5%), with considerable variation between regions. Based on the most recent data available for each country, 15% of births in 106 (63%) of 169 countries were by CS, whereas 47 (28%) countries showed CS use in less than 10% of births. National CS use varied from 0·6% in South Sudan to 58·1% in the Dominican Republic. Within-country disparities in CS use were also very large: CS use was almost five times more frequent in births in the richest versus the poorest quintiles in low-income and middle-income countries; markedly high CS use was observed among low obstetric risk births, especially among more educated women in, for example, Brazil and China; and CS use was 1·6 times more frequent in private facilities than in public facilities. [ABSTRACT FROM AUTHOR]

The article presents author's comments on key health indicators. It mentions that United Nation (UN) agencies, including World Health Organization (WHO) and UNICEF, and Global Burden of Disease (GBD) work of the Institute of Health Metrics and Evaluation (IHME), have participated in the global health estimates. It mentions that funding agencies, from the Bill and Melinda Gates Foundation, are making investments in global health estimation.

Pakistan has undergone massive changes in its federal structure under the 18th Constitutional Amendment. To gain insights that will inform reform plans, we assessed several aspects of health-systems performance in Pakistan. Some improvements were noted in health-systems performance during the past 65 years but key health indicators lag behind those in peer countries. 78.08% of the population pay out of pocket at the point of health care. The private sector provides three-quarters of the health services, and physicians outnumber nurses and midwives by a ratio of about 2:1. Complex governance challenges and underinvestment in health have hampered progress. With devolution of the health mandate, an opportunity has arisen to reform health. The federal government has constitutional responsibility of health information, interprovincial coordination, global health, and health regulation. All other health responsibilities are a provincial mandate. With appropriate policy, institutional, and legislative action within and outside the health system, the existing challenges could be overcome. [ABSTRACT FROM AUTHOR]

The article discusses the effective large-scale evaluations in global heath. It notes that large-scale evaluations and initiatives are important for accountability and learning in global health. It mentions that there is a little evidence to support the effective of large-scale programmes to HIV transmission.

A letter to the editor is presented related to revision of the book "International Statistical Classification of Diseases and Related Health Problems" concerning explaining the World Health Organization's approach toward death statistics.

The article focuses on controversies surrounding health statistics. Since disagreements over health statistics can originate in technical complexities as well as provide cover for hidden agendas and political maneuvering, the enforcement of standards and transparency is required. Monitoring in health projects like the Millennium Declaration of the United Nations and global health initiatives like the Global Fund to Fight AIDS, Tuberculosis and Malaria is designed to ensure accountability and transparency. Several health statistic support initiatives aimed at reducing the gap between the demand for and supply of health statistics are presented, including UNICEF's Multiple Indicator Cluster Surveys.

The article offers the authors' insights on the efforts of the journal "The Lancet" in improving the health and development of children and adolescents. They mention the Series of papers published in the journal since 2004 on child survival and the launch of the Millennium Development Goals (MDGs), which brought about increased accountability and actions. Also discussed is the journal's plan to release a new Series in mid-2020 on structural solutions for promoting child and adolescent health.

In high-income countries, life expectancy at age 60 years has increased in recent decades. Falling tobacco use (for men only) and cardiovascular disease mortality (for both men and women) are the main factors contributing to this rise. In high-income countries, avoidable male mortality has fallen since 1980 because of decreases in avoidable cardiovascular deaths. For men in Latin America, the Caribbean, Europe, and central Asia, and for women in all regions, avoidable mortality has changed little or increased since 1980. As yet, no evidence exists that the rate of improvement in older age mortality (60 years and older) is slowing down or that older age deaths are being compressed into a narrow age band as they approach a hypothesised upper limit to longevity. [ABSTRACT FROM AUTHOR]

The authors present their views about the ageing of populations as a public health challenge. Topics discussed include the need for health systems to find effective approaches to extend health care and to respond to the needs of older adults, the economic implications of an ageing population, and the shortage of research about the effectiveness of interventions in low-income and middle-income countries.

A 2017 Lancet Health in Humanitarian Crises Series paper declared that the international "humanitarian system is not just broke, but broken"[1] and called for action to prioritise protection; integrate affected and displaced people into national health systems; scale up efficient, effective, and sustainable interventions in humanitarian settings; and renew global leadership and coordination. The Lancet Series on Women's and Children's Health in Conflict Settings[[2]] was informed by insights from the BRANCH Consortium, along with humanitarian health actors and civil society organisations operating in conflict settings. The global health community has a responsibility to support the capacities of populations affected by conflict and displacement and improve the health and nutrition of women and children in these settings. [Extracted from the article]

Conceived in 2003 and born in 2005 with the launch of its first report and country profiles, the Countdown to 2015 for Maternal, Newborn, and Child Survival has reached its originally proposed lifespan. Major reductions in the deaths of mothers and children have occurred since Countdown's inception, even though most of the 75 priority countries failed to achieve Millennium Development Goals 4 and 5. The coverage of life-saving interventions tracked in Countdown increased steadily over time, but wide inequalities persist between and within countries. Key drivers of coverage such as financing, human resources, commodities, and conducive health policies also showed important, yet insufficient increases. As a multistakeholder initiative of more than 40 academic, international, bilateral, and civil society institutions, Countdown was successful in monitoring progress and raising the visibility of the health of mothers, newborns, and children. Lessons learned from this initiative have direct bearing on monitoring progress during the Sustainable Development Goals era. [ABSTRACT FROM AUTHOR]

Background: Millennium Development Goal 5 calls for a 75% reduction in the maternal mortality ratio (MMR) between 1990 and 2015. We estimated levels and trends in maternal mortality for 183 countries to assess progress made. Based on MMR estimates for 2015, we constructed projections to show the requirements for the Sustainable Development Goal (SDG) of less than 70 maternal deaths per 100,000 livebirths globally by 2030.Methods: We updated the UN Maternal Mortality Estimation Inter-Agency Group (MMEIG) database with more than 200 additional records (vital statistics from civil registration systems, surveys, studies, or reports). We generated estimates of maternal mortality and related indicators with 80% uncertainty intervals (UIs) using a Bayesian model. The model combines the rate of change implied by a multilevel regression model with a time-series model to capture data-driven changes in country-specific MMRs, and includes a data model to adjust for systematic and random errors associated with different data sources.Results: We had data for 171 of 183 countries. The global MMR fell from 385 deaths per 100,000 livebirths (80% UI 359-427) in 1990, to 216 (207-249) in 2015, corresponding to a relative decline of 43·9% (34·0-48·7), with 303,000 (291,000-349,000) maternal deaths worldwide in 2015. Regional progress in reducing the MMR since 1990 ranged from an annual rate of reduction of 1·8% (0·0-3·1) in the Caribbean to 5·0% (4·0-6·0) in eastern Asia. Regional MMRs for 2015 ranged from 12 deaths per 100,000 livebirths (11-14) for high-income regions to 546 (511-652) for sub-Saharan Africa. Accelerated progress will be needed to achieve the SDG goal; countries will need to reduce their MMRs at an annual rate of reduction of at least 7·5%.Interpretation: Despite global progress in reducing maternal mortality, immediate action is needed to meet the ambitious SDG 2030 target, and ultimately eliminate preventable maternal mortality. Although the rates of reduction that are needed to achieve country-specific SDG targets are ambitious for most high mortality countries, countries that made a concerted effort to reduce maternal mortality between 2000 and 2010 provide inspiration and guidance on how to accomplish the acceleration necessary to substantially reduce preventable maternal deaths.Funding: National University of Singapore, National Institute of Child Health and Human Development, USAID, and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. [ABSTRACT FROM AUTHOR]

The author calls for a sustained and improved data system to measure interventions in reducing maternal, newborn and child mortality. Topics he covered include the importance for robust interconnected system of data collection and use for health workers, programme managers, and global actors, examples of household survey programmes which are considered indicators of progress in data collection and the key principles of an envisioned measurement system.

Background Model-based estimates of the global proportions of maternal deaths that are in HIV-infected women range from 7% to 21%, and the effects of HIV on the risk of maternal death is highly uncertain. We used longitudinal data from the Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA) network to estimate the excess mortality associated with HIV during pregnancy and the post-partum period in sub-Saharan Africa. Methods The ALPHA network pooled data gathered between June, 1989 and April, 2012 in six community-based studies in eastern and southern Africa with HIV serological surveillance and verbal-autopsy reporting. Deaths occurring during pregnancy and up to 42 days post partum were defined as pregnancy related. Pregnant or post-partum person-years were calculated for HIV-infected and HIV-uninfected women, and HIV-infected to HIV-uninfected mortality rate ratios and HIV-attributable rates were compared between pregnant or post-partum women and women who were not pregnant or post partum. Findings 138074 women aged 15-49 years contributed 636213 person-years of observation. 49568 women had 86963 pregnancies. 6760 of these women died, 235 of them during pregnancy or the post-partum period. Mean prevalence of HIV infection across all person-years in the pooled data was 17.2% (95% CI 17.0-17.3), but 60 of 118 (50.8%) of the women of known HIV status who died during pregnancy or post partum were HIV infected. The mortality rate ratio of HIV-infected to HIV-uninfected women was 20.5 (18.9-22.4) in women who were not pregnant or post partum and 8.2 (5.7-11.8) in pregnant or post-partum women. Excess mortality attributable to HIV was 51.8 (47.8-53.8) per 1000 person-years in women who were not pregnant or post partum and 11.8 (8.4-15.3) per 1000 person-years in pregnant or post-partum women. Interpretation HIV-infected pregnant or post-partum women had around eight times higher mortality than did their HIV-uninfected counterparts. On the basis of this estimate, we predict that roughly 24% of deaths in pregnant or post-partum women are attributable to HIV in sub-Saharan Africa, suggesting that safe motherhood programmes should pay special attention to the needs of HIV-infected pregnant or post-partum women. Funding Wellcome Trust, Health Metrics Network (WHO). [ABSTRACT FROM AUTHOR]

The article looks at the progress of the Countdown to 2015 for Maternal, Newborn, and Child Survival between 1990 and 2010. Countdown to 2015 for Maternal, Newborn, and Child Survival monitors priority intervention coverage to attain the Millennium Development Goals (MDGs) for child mortality and maternal health. It included 68 countries and 26 key interventions. According to the authors, progress toward reducing mortality in children younger than five years is slow and maternal mortality remains high in the countries. They also reveal that despite the increase in overall overseas assistance for maternal, newborn and child health, funding in such sectors only accounted for 31 percent of all health assistance in 2007.

This article focuses on a study conducted to assess yearly changes in mortality rates of children under the age of 5 in Tanzania. The article aimed to explain the drop in child mortality rates in Tanzania and examine the possibility of meeting the Millennium Development Goal 4 set forth by the United Nations. The article includes background information, methods, findings, interpretations, and funding for the study as well as charts and graphs. The study found improvements in the health care system in Tanzania between 1999 and 2004 which may have contributed to improved rates of child survival.

The article indicates that investments in health research and development (R&D) are still insufficiently aligned with global public health demands and needs. Topics discussed include three processes from World Health Organisation (WHO) drawing attention to the neglected areas of health R&D. Also mentioned are the creation of a Global Observatory on Health R&D at WHO and its functions as well as the critical element of its success.