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Background: The COVID-19 virus pandemic has caused a significant number of deaths worldwide. If the prevalence of the infection continues to grow, this could impact life expectancy. This paper provides first estimates of the potential direct impact of the COVID-19 pandemic on period life expectancy. Methods: From the estimates of bias-adjusted age-specific infection fatality rates in Hubei (China) and a range of six prevalence rate assumptions ranging from 1% to 70%, we built a discrete-time microsimulation model that simulates the number of people infected by COVID-19, the number dying from it, and the number of deaths from all causes week by week for a period of one year. We applied our simulation to four broad regions: North America and Europe; Latin America and the Caribbean; Southeastern Asia; and sub-Saharan African. For each region, 100,000 individuals per each 5-year age group are simulated. Results: At a 10% COVID-19 prevalence rate, the loss in life expectancy at birth is likely above 1 year in North America and Europe and in Latin America and the Caribbean. In Southeastern Asia and sub-Saharan Africa, one year lost in life expectancy corresponds to an infection prevalence of about 15% and 25%, respectively. Given the uncertainty in fatality rates, with a 50% prevalence of COVID-19 infections under 95% prediction intervals, life expectancy would drop by 3 to 9 years in North America and Europe, by 3 to 8 years in Latin America and the Caribbean, by 2 to 7 years in Southeastern Asia, and by 1 to 4 years in sub-Saharan Africa. In all prevalence scenarios, as long as the COVID-19 infection prevalence rate remains below 1 or 2%, COVID-19 would not affect life expectancy in a substantial manner. Interpretation: In regions with relatively high life expectancy, if the infection prevalence threshold exceeds 1 or 2%, the COVID-19 pandemic will break the secular trend of increasing life expectancy, resulting in a decline in period life expectancy. With life expectancy being a key indicator of human development, mortality increase, especially among the vulnerable subgroups of populations, would set a country back on its path of human development. [ABSTRACT FROM AUTHOR]

Objective: To characterize the impact of widespread inventory management policies on stock-outs of essential drugs in Zambia’s health clinics and develop related recommendations. Methods: Daily clinic storeroom stock levels of artemether-lumefantrine (AL) products in 2009–2010 were captured in 145 facilities through photography and manual transcription of paper forms, then used to determine historical stock-out levels and estimate demand patterns. Delivery lead-times and estimates of monthly facility accessibility were obtained through worker surveys. A simulation model was constructed and validated for predictive accuracy against historical stock-outs, then used to evaluate various changes potentially affecting product availability. Findings: While almost no stock-outs of AL products were observed during Q4 2009 consistent with primary analysis, up to 30% of surveyed facilities stocked out of some AL product during Q1 2010 despite ample inventory being simultaneously available at the national warehouse. Simulation experiments closely reproduced these results and linked them to the use of average past monthly issues and failure to capture lead-time variability in current inventory control policies. Several inventory policy enhancements currently recommended by USAID | DELIVER were found to have limited impact on product availability. Conclusions: Inventory control policies widely recommended and used for distributing medicines in sub-Saharan Africa directly account for a substantial fraction of stock-outs observed in common situations involving demand seasonality and facility access interruptions. Developing central capabilities in peripheral demand forecasting and inventory control is critical. More rigorous independent peer-reviewed research on pharmaceutical supply chain management in low-income countries is needed. [ABSTRACT FROM AUTHOR]

Background: A woman's ability to achieve her preferred family size is critical in addressing issues of high fertility in sub-Saharan Africa. The socio-cultural context in sub-Saharan Africa presents some difficulty for the attainment of preferred fertility for many women. Few studies in sub-Saharan Africa have examined the extent to which women are unable to achieve their preferred family sizes. This study, therefore, examines the factors that are associated with the non-attainment of women's preferred fertility by the end of their reproductive years. Data and methods: The study analyzed pooled cross-sectional data with a sub-sample of 1,888 currently married women aged 45–49 years from five rounds of the Ghana Demographic and Health Survey, 1993 to 2014. Test of associations and multinomial logistic regression analysis were used to examine the predictors of underachieved and overachieved fertility relative to achieved fertility. Results: The results indicate that 44 per cent of the women recorded overachieved fertility while about 36 per cent underachieved their fertility. Partner wants more, experiencing child loss and married more than once were significantly associated with overachieved fertility. Nonetheless, increased years of a woman's education and delaying her at first birth were negatively associated with overachieved fertility. On the other hand, underachieved fertility was significantly associated with having a partner with fewer fertility preference, being of the Islamic faith and ever use of modern contraception. Conclusion: Partner's fertility preference, child loss experience, marrying more than once and ever use of modern contraception were important predictors of a woman's inability to achieve her fertility preference. Policies to regulate men's fertility behaviour, delaying age at first birth, use of modern contraception, encouraging longer years of education, and reducing infant and child mortality are important strategies to achieve fertility preference in Ghana. [ABSTRACT FROM AUTHOR]