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Child death review teams (CDRTs) focus on the prevention of child deaths, but a comprehensive understanding of their activities is lacking. This exploratory study addressed this gap through a qualitative analysis of reported CDRT activities using the “spectrum of prevention” framework. We collected state-level CDRT reports published 2006-2015, recorded their activities (n = 193), and coded them using the “spectrum of prevention” framework. The highest percentage (64.2%) of activities was categorized under “fostering coalitions and networks.” We recommend that CDRTs increase their reporting of activities so others can better understand their potential impact on preventing child deaths. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM PUBLISHER]

Objective:Disparities by race and socioeconomic status persist in pediatric asthma morbidity, mortality, and treatment. Improving parent/provider communication and parents' asthma-management confidence may result in better asthma control in vulnerable populations. The Merck Childhood Asthma Network, Inc. funded an initiative to implement medical-social care coordination to improve asthma outcomes at sites in four low-income, urban communities (Los Angeles, CA; Philadelphia, PA; Chicago, IL; and San Juan, PR.) As part of a cross-site evaluation of this effort, pre- post-program changes in parents' reports of asthma care and management were assessed.Methods:Across sites, 805 parents or other caregivers responded to a baseline survey that was repeated one year later following their child's participation in care coordination. Parents' asthma-management confidence, as well as their perceptions of provider access, trust, and communication, were measured with Likert scales. Linear mixed models were used to assess improvement in these variables, across and within sites, adjusting for sociodemographics.Results:Pooled across sites, the adjusted mean estimate for all outcomes showed a significant improvement (p<.05) from baseline to follow-up.KnowledgeandBetween-Provider Communicationimproved significantly (p<.05) within all four sites;Accessimproved significantly in Chicago, Philadelphia, and Puerto Rico;Trustimproved significantly in Chicago, Los Angeles, and Philadelphia; andPatient-Provider Communicationimproved significantly in Philadelphia only.Conclusion:Pediatric asthma care coordination, as implemented variously in diverse settings, was associated with improvement in parents' perceptions of asthma care and self-reported asthma-management knowledge and confidence. This positive impact on parents may help sustain care coordination's impact on children. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including maternal and child health in sub-Saharan Africa; utilisation of antenatal health-care resources; and reproductive health indicators.

This paper examines the impact of the Highly Indebted Poor Countries (HIPC) Initiative on under five mortality rate (U5MR) in Sub-Saharan Africa. The HIPC Initiative involves debt forgiveness and the redirection of funds that were meant to service external debt towards the provision of social services and poverty reduction in eligible countries. The Initiative is akin to a natural experiment since some countries benefited while some did not, and the timing of debt forgiveness varied across countries. We exploit these variations to identify the impact of HIPC Initiative on child mortality using a dynamic panel data estimator. We find that participation in HIPC Initiative is associated with statistically significant decreases in U5MR. On the other hand, the impact of actual debt cancelled is statistically insignificant. [ABSTRACT FROM AUTHOR]

In Nigeria, childhood mortality is very high, with almost a million children dying each year. A fifth of these die from vaccine-preventable diseases. The role of immunisation in preventing childhood morbidity and mortality is widely recognised. Unfortunately little, if any, account has been given of the law’s role in immunisation in legal discourse in Nigeria. Yet recent steps have been taken at both federal and state levels to compel immunisation using the instrument of legislation. For instance, the Child Rights Act, a domestication of the Convention of the Rights of the Child, passed in 2003 includes provisions compelling immunisation. Also, several states in Nigeria like Jigawa, Niger and Katsina States, have recently enacted legislation that makes childhood immunisation compulsory under the law. These pieces of legislation criminalise refusal to immunise children and also public statements that discourage immunisation. I identify the challenges that limit or obstruct uptake of immunisation in Nigeria and ask what role the law can play in providing solutions to these challenges. I examine the ways in which the law has been engaged to promote immunisation, the impact of law and the limits of legislative intervention. I also suggest ways to improve the law’s effectiveness in this essential public health matter. [ABSTRACT FROM PUBLISHER]

In Egypt, diarrhoeal diseases remain the main cause of mortality among young children, although the percentage of households with an “improved” access to water, according to the definition used by the World Health Organisation (WHO), is very high. This article seeks to shed light on this paradox, by better identifying the populations affected by problems of access to water, taking into account three dimensions—the time it takes to access a source of water, daily cut-offs and behaviour with respect to storage—and by applying alternative matching estimators to estimate the effects of defective water access on child diarrhoea. It is found that children whose families are identified as having a water access problem through the use of broader-based definitions have a greater likelihood of contracting diarrhoeal diseases. This article, thus, shows that the mortality of children in Egypt could be further reduced by improving households' access to water. [ABSTRACT FROM PUBLISHER]

Background: Diarrheal diseases are a major cause of child mortality and one of the main causes of medical consultation for children in sub-Saharan countries. This paper attempts to determine the risk factors and neighborhood inequalities of diarrheal morbidity among under-5 children in selected countries in sub-Saharan Africa over the period 1990-2013. Design: Data used come from the Demographic and Health Survey (DHS) waves conducted in Burkina Faso (1992-93, 1998-99, 2003, and 2010), Mali (1995, 2001, 2016, and 2012), Nigeria (1990, 1999, 2003, 2008, and 2013), and Niger (1992, 1998, 2006, and 2012). Bivariate analysis was performed to assess the association between the dependent variable and each of the independent variables. Multilevel logistic regression modelling was used to determine the fixed and random effects of the risk factors associated with diarrheal morbidity. Results: The findings showed that the proportion of diarrheal morbidity among under-5 children varied considerably across the cohorts of birth from 10 to 35%. There were large variations in the proportion of diarrheal morbidity across countries. The proportions of diarrheal morbidity were higher in Niger compared with Burkina Faso, Mali, and Nigeria. The risk factors of diarrheal morbidity varied from one country to another, but the main factors included the child's age, size of the child at birth, the quality of the main floor material, mother's education and her occupation, type of toilet, and place of residence. The analysis shows an increasing trend of diarrheal inequalities according to DHS rounds. In Burkina Faso, the value of the intraclass correlation coefficient (ICC) was 0.04 for 1993 DHS and 0.09 in 2010 DHS; in Mali, the ICC increased from 0.04 in 1995 to 0.16 in 2012; in Nigeria, the ICC increased from 0.13 in 1990 to 0.19 in 2013; and in Niger, the ICC increased from 0.07 in 1992 to 0.11 in 2012. Conclusions: This suggests the need to fight against diarrheal diseases on both the local and community levels across villages. [ABSTRACT FROM AUTHOR]

Background: Several epidemiological studies from low- and middle-income countries have reported a protective effect of maternal antenatal iron/folic acid (IFA) on childhood mortality. Objective: The current study aimed to evaluate the effect of maternal antenatal IFA supplementation on childhood mortality in Pakistan. Design: A propensity score-matched sample of 8,512 infants live-born within the 5 years prior to interview was selected from the pooled data of two Pakistan Demographic and Health Surveys (2006/07 and 2012/13). The primary outcomes were childhood mortality indicators and the main exposure variable was maternal antenatal IFA supplementation. Post-matched analyses used Cox proportional hazards regression and adjusted for 16 potential confounders. Results: Maternal antenatal IFA supplementation significantly reduced the adjusted risk of death on day 0 by 33% [adjusted hazard ratio (aHR) = 0.67, 95% confidence interval (95% CI) 0.48-0.94], during the neonatal period by 29% (aHR = 0.71, 95% CI 0.57-0.88), and for under-fives by 27% (aHR = 0.73, 95% CI 0.60-0.89). When IFA was initiated in the first 4 months of pregnancy, the adjusted risk of neonatal and under-five deaths was significantly reduced by 35 and 33%, respectively. Twenty percent of under-five deaths were attributable to non-initiation of IFA in the first 4 months of pregnancy. With universal initiation of IFA in the first 4 months of pregnancy, 80,300 under-five deaths could be prevented annually in Pakistan. Conclusions: Maternal antenatal IFA supplementation significantly reduced neonatal and under-five deaths in Pakistan. Earlier initiation of supplements in pregnancy was associated with a greater prevention of neonatal and under-five deaths. [ABSTRACT FROM AUTHOR]

Background: Under-five mortality has been a major public health challenge from time immemorial. In response to this challenge, the World Health Organization and the United Nations Children's Fund developed the Integrated Management of Childhood Illnesses (IMCI) strategy and presented it to the whole world as a key approach to reduce child morbidity and mortality. Botswana started to implement the IMCI strategy in 1998. Reductions in the under-five mortality rate (U5MR) have been documented, although the reduction is not on par with the expected Millennium Development Goal 4 predictions. Design: A quantitative study was done to identify the problems IMCI implementers face when tending children under 5 years in the Gaborone Health District of Botswana. The study population was made up of all the IMCI-trained and registered nurses, and systematic sampling was used to randomly select study participants. Questionnaires were used to collect data. Results: The study findings indicated challenges related to low training coverage, health systems, and the unique features of the IMCI strategy. Conclusions: The comprehensive implementation of the IMCI strategy has the potential to significantly influence the U5MR in Botswana. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the authors discuss various reports within the issue including "Evidence Acquisition and Evaluation for Evidence Summit on Population-Level Behavior Change to Enhance Child Survival and Development in Low- and Middle-Income Countries" by Robert Balster, Stephanie Levy, and E. Stammer," "Caregiver Behavior Change for Child Survival and Development in Low- and Middle-Income Countries: An Examination of the Evidence" by J. P. Elder, Willo Pequegnat, and S. Ahmed et al., and "An Evidence Review of Gender-Integrated Interventions in Reproductive and Maternal-Child Health" by J. M. Kraft, K. G. Wilkins, and G. J. Morales et al.

An introduction is presented in which the author discusses various reports within the issue including "Evidence Acquisition and Evaluation for Evidence Summit on Population-Level Behavior Change to Enhance Child Survival and Development in Low- and Middle-Income Countries" by Robert Balster, Stephanie Levy, and E. Stammer," "Caregiver Behavior Change for Child Survival and Development in Low- and Middle-Income Countries: An Examination of the Evidence" by J. P. Elder, Willo Pequegnat, and S. Ahmed et al., and "An Evidence Review of Gender-Integrated Interventions in Reproductive and Maternal-Child Health" by J. M. Kraft, K. G. Wilkins, and G. J. Morales et al.

In June of 2012, representatives from more than 80 countries promulgated a Child Survival Call to Action, which called for reducing child mortality to 20 or fewer child deaths per 1,000 live births in every country by 2035. To address the problem of ending preventable child deaths, the U.S. Agency for International Development and the United Nations Children's Fund convened, on June 3–4, 2013, an Evidence Summit on Enhancing Child Survival and Development in Lower- and Middle-Income Countries by Achieving Population-Level Behavior Change. Six evidence review teams were established on different topics related to child survival and healthy development to identify the relevant evidence-based interventions and to prepare reports. This article was developed by the evidence review team responsible for identifying the research literature on caregiver change for child survival and development. This article is organized into childhood developmental periods and cross-cutting issues that affect child survival and healthy early development across all these periods. On the basis of this review, the authors present evidence-based recommendations for programs focused on caregivers to increase child survival and promote healthy development. Last, promising directions for future research to change caregivers' behaviors are given. [ABSTRACT FROM AUTHOR]

As part of a broader evidence summit, USAID and UNICEF convened a literature review of effective means to empower communities to achieve behavioral and social changes to accelerate reductions in under-5 mortality and optimize early child development. The authors conducted a systematic review of the effectiveness of community mobilization and participation that led to behavioral change and one or more of the following: child health, survival, and development. The level and nature of community engagement was categorized using two internationally recognized models and only studies where the methods of community participation could be categorized as collaborative or shared leadership were eligible for analysis. The authors identified 34 documents from 18 countries that met the eligibility criteria. Studies with shared leadership typically used a comprehensive community action cycle, whereas studies characterized as collaborative showed clear emphasis on collective action but did not undergo an initial process of community dialogue. The review concluded that programs working collaboratively or achieving shared leadership with a community can lead to behavior change and cost-effective sustained transformation to improve critical health behaviors and reduce poor health outcomes in low- and middle-income countries. Overall, community engagement is an understudied component of improving child outcomes. [ABSTRACT FROM AUTHOR]

Evidence-based behavior change interventions addressing health systems must be identified and disseminated to improve child health outcomes. Studies of the efficacy of such interventions were identified from systematic searches of the published literature. Two hundred twenty-nine of the initially identified references were judged to be relevant and were further reviewed for the quality and strength of the evidence. Studies were eligible if an intervention addressed policy or health systems interventions, measured relevant behavioral or health outcomes (e.g., nutrition, childhood immunization, malaria prevention and treatment), used at least a moderate quality research design, and were implemented in low- or middle-income countries. Policy or systems interventions able to produce behavior change reviewed included media (e.g., mass media, social media), community mobilization, educational programs (for caregivers, communities, or providers), social marketing, opinion leadership, economic incentives (for both caregiver and provider), health systems strengthening/policy/legislation, and others. Recommendations for policy, practice, and research are given based on fairly strong data across the areas of health service delivery, health workforce, health financing, governance and leadership, and research. [ABSTRACT FROM AUTHOR]

Given the high morbidity and mortality among children in low- and middle-income countries as a result of preventable causes, the U.S. government and the United Nations Children's Fund convened an Evidence Summit on Enhancing Child Survival and Development in Lower- and Middle-Income Countries by Achieving Population-Level Behavior Change on June 3–4, 2013, in Washington, D.C. This article summarizes evidence for technological advances associated with population-level behavior changes necessary to advance child survival and healthy development in children under 5 years of age in low- and middle-income countries. After a rigorous evidence selection process, the authors assessed science, technology, and innovation papers that used mHealth, social/transmedia, multiplatform media, health literacy, and devices for behavior changes supporting child survival and development. Because of an insufficient number of studies on health literacy and devices that supported causal attribution of interventions to outcomes, the review focused on mHealth, social/transmedia, and multiplatform media. Overall, this review found that some mHealth interventions have sufficient evidence to make topic-specific recommendations for broader implementation, scaling, and next research steps (e.g., adherence to HIV/AIDS antiretroviral therapy, uptake and demand of maternal health service, and compliance with malaria treatment guidelines). While some media evidence demonstrates effectiveness in changing cognitive abilities, knowledge, and attitudes, evidence is minimal on behavioral endpoints linked to child survival. Population level behavior change is necessary to end preventable child deaths. Donors and low- and middle-income countries are encouraged to implement recommendations for informing practice, policy, and research decisions to fully maximize the impact potential of mHealth and multimedia for child survival and development. [ABSTRACT FROM AUTHOR]

Through a systematic review of the literature, this article summarizes and evaluates evidence for the effectiveness of mass media interventions for child survival. To be included, studies had to describe a mass media intervention; address a child survival health topic; present quantitative data from a low- or middle-income country; use an evaluation design that compared outcomes using pre- and postintervention data, treatment versus comparison groups, or postintervention data across levels of exposure; and report a behavioral or health outcome. The 111 campaign evaluations that met the inclusion criteria included 15 diarrheal disease, 8 immunization, 2 malaria, 14 nutrition, 1 preventing mother-to-child transmission of HIV, 4 respiratory disease, and 67 reproductive health interventions. These evaluations were then sorted into weak (n =33), moderate (n = 32), and stronger evaluations (n = 46) on the basis of the sampling method, the evaluation design, and efforts to address threats to inference of mass media effects. The moderate and stronger evaluations provide evidence that mass media-centric campaigns can positively impact a wide range of child survival health behaviors. [ABSTRACT FROM PUBLISHER]

Recognizing the need for evidence to inform public health officials and health care workers in the U.S. government and low- and middle-income country governments on efficient, effective behavior change policies, strategies, and programs for child health and development, the U.S. government convened the Evidence Summit on Enhancing Child Survival and Development in Lower- and Middle-Income Countries by Achieving Population-Level Behavior Change. This article summarizes the background and methods for the acquisition and evaluation of the evidence used to the achieve the goals of the summit that is reviewed in other articles in this special issue of the Journal of Health Communication. The process began by identifying focal questions intended to inform the U.S. and low- and middle-income governments about behavior change interventions that accelerate reductions in under-5 mortality and optimize healthy and protective child development to 5 years of age. Experts were selected representing the research and program communities, academia, relevant nongovernmental organizations, and government agencies and assembled into evidence review teams. This was followed by the systematic gathering of relevant peer-reviewed literature that would inform the focal questions. Members of the evidence review teams were invited to add relevant articles not identified in the initial literature review to complete the bibliographies. Details of the search processes and methods used for screening and quality reviews are described. The evidence review teams were asked to comply with a specific evaluation framework for recommendations on practice and policy on the basis of both expert opinion and the quality of the data reviewed. [ABSTRACT FROM AUTHOR]

Increasing coverage of routine immunisation and new vaccines is key to reaching Millennium Development Goal number four (MDG 4) on reducing child mortality. Malawi, despite a weak health system, is on track to achieve MDG 4, partly because of its high-performing immunisation programme. Among the early adopters of new vaccines, with major support from Global Alliance for Vaccines and Immunisation, Malawi introduced pneumococcal vaccine in 2011 during a time of severe political and economic crisis. This exploratory case study (part of a larger research project on explaining differential immunisation coverage, conducted in 2010 and 2011, using primarily qualitative methods including in-depth interviewing) looks at the decision-making and policy process for vaccine introduction within the broader political–economic context. Based on a framework of benchmarks on preparedness of immunisation systems and assessments of integration with health systems, the study findings suggest that pneumococcal vaccine introduction was more integrated with key health system functions the closer it got to the point of service delivery. Furthermore, although the vaccine introduction succeeded in relation to immunisation targets and prevention of disease, it may have had substantial indirect costs to other targeted health interventions and broader health systems functions at times when basic amenities are in short supply or unavailable. For a donor-dependent country such as Malawi, policy choices are limited to what is on offer – and new vaccines were on offer; other crucial necessities were not. Further research could establish with more certainty the conditions under which vaccine introduction strengthens health systems that are already weak, and when they push systems further into crisis. [ABSTRACT FROM AUTHOR]

Set in 2000, with a completion date of 2015, the deadline for the Millennium Development Goals is approaching, at which time a new global development infrastructure will become operational. Unsurprisingly, the discussions on goals, topics, priorities and monitoring and evaluation are gaining momentum. But this is a critical juncture. Over a decade of development programming offers a unique opportunity to reflect on its structure, function and purpose in a contemporary global context. This article examines the topic from an analytical health perspective and identifies universal health equity as an operational and analytical priority to encourage attention to the root causes of unnecessary and unfair illness and disease from the perspectives of those for whom the issues have most direct relevance. [ABSTRACT FROM AUTHOR]

As with other South Asian countries, injury is becoming a leading cause of death and morbidity among children in Vietnam. In response to the increasing burden of child injury, government and non-government agencies in Vietnam have combined efforts during the last decade to develop and implement various child injury prevention strategies and programmes. This article provides, through a review of relevant documents and interviews with major stakeholders, an overview of these efforts and highlights major challenges to child injury prevention in the country. The findings point to notable achievements in terms of increasing awareness of injury facing children at all levels in the community and developing a sound injury prevention policy framework in a relatively short period of time. However, much needs to be done to implement necessary environmental and legislative changes, strengthen child injury surveillance and injury prevention research; and to improve access to health services. The insight into the experience of Vietnam could benefit other low- and middle-income countries with a high burden of child injury. [ABSTRACT FROM AUTHOR]

The Millennium Development Goal 4 (MDG4) calls for the reduction in under-five mortality by two-thirds between 1990 and 2015. Only 16 of the 68 countries with 97% of the world's child deaths are on track to achieve this. This paper reviews the current evidence regarding proven interventions for reducing child mortality in high-mortality, resource-poor settings. All of these interventions require implementation within communities rather than implementation confined to only those attending health facilities with strong community participation in order to be effective. The evidence strongly suggests that facility-based interventions require a strong community-based component in order to improve child mortality in the surrounding population. We provide specific information about common community-based approaches used in the implementation of interventions with documented improvements in child mortality. A stronger emphasis on community-based approaches will be needed in order to accelerate progress in reaching MDG4. This report arises from an ongoing review of assessments of the effectiveness of community-based primary health care (CBPHC) in improving child health sponsored by the Working Group on CBPHC of the American Public Health Association. [ABSTRACT FROM AUTHOR]

According to a 1999 report by the Institute of Medicine an estimated 44,000 to 98,000 people die annually due to medication errors (MEs) in health care. Medication errors can occur at any point in the continuum of care and the literature suggests that MEs are common in our hospitals today, especially in the complex setting of pediatric medicine. This paper is a survey of reported research over the last decade on MEs in pediatrics and their prevention and reduction strategies. It is difficult to know the prevalence of pediatric MEs due to the lack of consistency in error definitions in past studies. Unlike previous surveys on this topic, this paper reviews several studies and provides a taxonomy chart listing the most common pediatric MEs, as well as contributing factors, severity, and possible prevention strategies. The objective is to provide interested researchers in this field with a resource that aggregates and compares related studies on MEs in pediatrics, and provides a comprehensive taxonomy of errors. Challenges and prevention strategies towards reducing pediatric MEs are also discussed. [ABSTRACT FROM PUBLISHER]

Maternal and child mortality rates, the targets for two of the eight Millennium Development Goals, remain unacceptably high in many countries. Some countries have made significant advances in reducing deaths in pregnancy, childbirth, and childhood at the national level. However, on a sub-national basis most countries show wide disparities in health indices which are not necessarily reflected in national figures. This is a sign of inequitable access to and provision of health services. Yet there has been little attention to health equity in relation to the Millennium Development Goals. Instead, countries have focused on achieving national targets. This has led to an emphasis on utilitarian, as opposed to universalist, approaches to public health, which we discuss here. We recommend a policy of "proportionate universalism". In this approach, universal health care and a universal social policy are the ultimate goal, but in the interim actions are carried out with intensities proportionate to disadvantage. We also briefly describe an initiative that aims to promote evidence-based policy and interventions that will reduce inequity in access to maternal and child health care in China, India, Indonesia and Viet Nam. Les taux de mortalité maternelle et infantile, cibles de deux des huit objectifs du Millénaire pour le développement (OMD), demeurent à des niveaux intolérables dans beaucoup de pays. Quelques pays ont accompli de remarquables progrès pour réduire les décès pendant la grossesse, l'accouchement et l'enfance au niveau national. Néanmoins, à l'échelle sous-nationale, les indices sanitaires de la plupart des pays montrent de larges disparités qui n'apparaissent pas forcément dans les chiffres nationaux. C'est le signe d'une inégalité dans l'accès et le recours aux services de santé. Pourtant, l'équité dans la santé a reçu peu d'attention dans le cadre des OMD. Les pays ont préféré viser les objectifs nationaux. Cela les a conduits à mettre l'accent sur des méthodes utilitaires, plutôt qu'universalistes, de la santé publique, que nous examinons ici. Nous recommandons une politique « d'universalisme proportionné ». Dans cette optique, les soins de santé universels et une politique sociale universelle constituent le but ultime, mais entretemps, des mesures sont prises avec une intensité proportionnelle aux désavantages. Nous décrivons aussi brièvement une initiative qui encouragera la politique à base factuelle et les interventions qui réduiront les inégalités d'accès aux soins de santé maternelle et infantile en Chine, en Inde, en Indonésie et au Viet Nam. Las tasas de mortalidad materna e infantil, cuya reducción es la meta de dos de los ocho Objetivos de Desarrollo del Milenio, continúan siendo inaceptablemente altas en muchos países. Algunos países han realizado importantes avances para disminuir las tasas de muertes relacionadas con el embarazo, el parto y la infancia a nivel nacional. Sin embargo, a nivel sub-nacional, la mayoría de los países muestran grandes disparidades en los índices de salud, que no necesariamente se reflejan en las cifras nacionales. Esto es un signo de desigualdad de accesibilidad y prestación de los servicios de salud. No obstante, se ha prestado poca atención a la equidad en salud con relación a los Objetivos de Desarrollo del Milenio. En vez, los países se han concentrado en lograr las metas nacionales, por lo cual se ha hecho hincapié en enfoques utilitarios en salud pública, y no en enfoques universalistas, que son los que se tratan en este artículo. Recomendamos una política de "universalismo proporcional". En este enfoque, los servicios de salud universal y una política social universal son la meta final, pero en el ínterin, se toman acciones con intensidades proporcionales a las desventajas. Además, resumimos una iniciativa que promoverá una política basada en evidencia e intervenciones que disminuirán la desigualdad de acceso a los servicios de salud materno-infantil en China, India, Indonesia y Vietnam. [ABSTRACT FROM AUTHOR]

With the deadline drawing closer, many question whether the Millennium Development Goals (MDGs) can be met. Some even question their relevance, especially given the financial crisis. The global scorecard shows that half of the road has been covered so far but it has taken three quarters of the time. Thus, are the MDGs a noble but unrealistic aspiration? Not quite. After some false dawns and missed opportunities, it is natural for some to dismiss the MDGs as targets that are ‘easily set but never met’. However, it would be too early and too pessimistic to consider the MDGs as ‘mission impossible’. After exposing the two most pervasive misconceptions about the MDGs, the paper shows that addressing the growing disparities within countries offers the best hope for achieving the MDGs. It shows that only one out of eight countries with recent data in Asia – Indonesia – managed to achieve pro-poor progress in reducing infant and child mortality. Six others witnessed an increase in disparity – especially the Philippines, Vietnam and Cambodia. A little equity and a touch of imagination can yield spectacular outcomes for human well-being. A revisit of the conventional wisdom regarding the MDGs is overdue. Diminishing its intellectual capture on development thinking will serve the MDGs well. [ABSTRACT FROM PUBLISHER]

In order to improve the reliability of children's models, the aim of this study was to determine the subject-specific masses and 3D locations of the centres of mass (CoM) of body segments using biplanar X-rays. Previous methods, validated on upper leg segments, were applied to the whole body. Six children and six adults were studied. The low-dose X-ray system EOS® was used to simultaneously get head-to-foot biplanar X-rays in the upright position. Specific methods were used to get 3D reconstructions of bones and body shape. The densities from the literature were used to define the masses. To assess the accuracy of the reconstructions, a force plate was used to compare the mass and the projection of the CoM. A mean distance of 4.5 mm between the measured and the calculated projections of the CoM was found. The mean error between the estimated and the actual body mass was 2.6%. Such a method will be useful in obtaining the body segment parameters in children, hard to obtain using direct measurement techniques. [ABSTRACT FROM AUTHOR]

Background: Malaria is the leading cause of death among children less than five years of age in sub-Saharan Africa (SSA), however, precise estimates on the burden of malaria are lacking. The aim of this study was to describe temporal trends for malaria and all-cause mortality by combining a series of clinical and intervention studies conducted in Burkina Faso. Methods: Data from a demographic surveillance system was used to follow-up children under five years who participated in five observational and intervention studies between June 1999 and December 2004 in rural north-western Burkina Faso. Mortality data was analyzed with cause-specific mortality ascertained using the verbal autopsy method. Person-years (PY) of observations were computed and age-standardized mortality rates (MR) for all-causes and malaria (adjusted for missing causes of death) were calculated. Rate ratios to investigate mortality variations over years were calculated using multivariate Poisson regression. Results: The study followed 6,387 children aged less than five years (mean follow-up: 2.8 years; 16,099 PY). During the study period, 443 deaths were registered with malaria accounting for 49% of all deaths. All-cause and malaria-specific MRwere 26.7 (95% CI: 24.2-29.2) and 15.8 (95% CI: 14.217.7) per 1,000 PY. All-cause MR declined over years of follow-up (from 31.2 to 16.3 per 1,000 PY in 1999/2000 to 2004, respectively) but malaria MR remained relatively stable (from 15.8 to 12.1 per 1,000 PY in 1999/2000 to 2004, respectively) resulting in an increasing relative effect of malaria on all-cause mortality. Variations in all-cause and malariaspecific mortality were observed with increasing age and across village town clusters. Conclusion: The findings of this study support the continuously decreasing trend of all-cause mortality in most of SSA, but call for more efforts to comprehensively address malaria with existing control tools such as insecticide-treated bed nets and effective first-line combination therapies. [ABSTRACT FROM AUTHOR]

Along with the numerous trauma-related impacts of violence and its effects on other health outcomes, the social toll of violence is further exacerbated by economic costs that represent formidable threats to fiscal growth and development. A companion piece to a review of the scientific literature describing the nature, magnitude and impact of violence on health (Matzopoulos, Bowman, Butchart & Mercy, 2008) in this issue, this paper reviews the current knowledge base on violence and development with a specific focus on low- to middle-income countries. It describes how violence impacts on all eight goals of the Millennium Development Plan and exerts a considerable economic burden on already stressed state systems and social spending. Violence will become an increasingly important threat to development and is receiving growing recognition among the global health community and within health ministries. The near absence of violence prevention within the global development agenda is, however, cause for concern. There is an urgent need to mobilise the international development community to provide financial and technical support for intersectoral collaboration, multilateral research cooperation and the development of research capacity towards addressing violence as a significant threat to development. [ABSTRACT FROM AUTHOR]

The fertility-stimulating effect of high rates of child mortality on reproductive decision making (RDM) is a central tenet of population studies, yet the effects of the HIV/AIDS epidemic on RDM have not been thoroughly explored in the literature. This paper investigates how RDM is articulated in the context of high HIV/AIDS prevalence in Zimbabwe. Using qualitative methods (35 focus groups and 46 in-depth interviews), we found that childbearing is extremely important in the lives of adult Zimbabweans and that children are needed to cement the couple's relationship, whether it is the first or subsequent marriage. Most respondents said that rates of both adult and child mortality were greatly increasing due to the AIDS epidemic. However, contrary to expectations based upon the insurance strategy, most respondents said that they would have fewer children as a result of the perceived increase in child mortality. They were also hesitant to continue childbearing after a child death, indicating only weak replacement motivation. Instead, many respondents expressed the desire to limit family size due to concerns about their own mortality and its negative effects on their children. Furthermore, new reproductive strategies seem to be emerging, which focus upon the health of parents and child and are based upon perceptions of 100 per cent maternal-infant HIV transmission. Adult HIV status is linked to child survival as respondents explained that having a healthy child who survives to age five indicates that the parents are also free of the virus and, at this point, they can safely continue childbearing. Additionally, couples who have experienced the death of a child are hesitant to give birth again because they believe future children would die. Finally, there was some talk of having children early in an attempt to avoid contracting HIV. This study presents evidence that Zimbabweans are altering their reproductive strategies in order to protect both parents and children from the threat of AIDS. [ABSTRACT FROM AUTHOR]

Background: During the Millennium Development Goal (MDG) era, impressive reductions in the under-5 mortality rate (U5MR) have been observed, although the MDG 4 target was not met. So far, cause-specific progress in child mortality has been analyzed and discussed mainly at the global and regional levels. Objectives: We aimed to explore annual changes in cause-specific mortality at the country level, assess which causes contributed the most to child mortality reduction in 2000-2015, and estimate how many child lives were saved. Methods: We used the cause-specific child mortality estimates published by Liu and colleagues. We derived average annual changes in cause-specific child mortality rates and cause-specific contribution to overall child mortality in 2000-2015. We estimated the number of cause-specific child deaths averted during the MDG era, assuming that cause-specific child mortality remained the same as in 2000. We targeted the 75 Countdown countries where 95% of maternal and child deaths occurred during the MDG era. Results: Wide disparities existed across causes within countries, both in neonatal and post-neonatal mortality reduction, except for a few countries such as China, Rwanda, and Cambodia. In 20 of the 45 sub-Saharan African countries, malaria was the main contributor to post-neonatal mortality reduction, and pneumonia was the main contributor in only six countries. A single disease often contributed to a substantial proportion of the child mortality reduction, particularly in west and central African countries. Diarrhea-specific post-neonatal child mortality reduction accounted for 7.1 million averted child deaths (24.5%), while pneumonia accounted for another 6.7 million averted child deaths (23%). Conclusions: This study demonstrates country-specific characteristics with regards to cause-wise child mortality that could not be identified by global or regional analyses. These findings provide the global community with evidence for formulating national policies and strategies to achieve the Sustainable Development Goals in child mortality reduction. [ABSTRACT FROM AUTHOR]

Background: Despite remarkable progress in water coverage improvements, diseases associated with poor water remain a considerable public health problem in many developing countries. Objective: We aimed to estimate the costs and benefits of drilling or rehabilitating boreholes with handpumps in resource-poor settings and hard-to-reach areas. Methods: Diarrheal reduction in the population was predicted on the basis of the empirical findings from a cluster randomized controlled trial. The full investment and estimated annual running costs were used to calculate the intervention costs. Direct economic benefits of avoiding child diarrheal disease, indirect economic benefits related to health improvements, and non-health benefits related to water improvement were estimated. One-way and multi-way sensitivity analyses were performed to determine the robustness of the findings. Results: Our analysis found that the return on a US$ 1 investment was US$ 9.4 for borehole drilling and US$ 14.1 for borehole rehabilitation. Time savings were the main contributor, accounting for 68% of the benefits, followed by the economic benefits of averted child deaths, which contributed to 15% of the benefits. The sensitivity analyses suggested that improving water sources yields high returns under all circumstances, and that borehole rehabilitation is more efficient than borehole drilling. Conclusion: This study explicitly justifies increased investment in water improvement in rural areas and demonstrates the high returns of rehabilitating boreholes. We hope that this study will be used as evidence for informing the policy decisions of governments or international agencies regarding further investments in improved water coverage in rural areas and the selection of appropriately designed interventions. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue including "Population-Level Behavior Change to Enhance Child Survival and Development in Low- and Middle-Income Countries" by Elizabeth Fox, "Systematic Review of the Effectiveness of Mass Media Interventions for Child Survival in Low- and Middle-Income Countries" by D. A. Naugle and R. C. Hornik, and "Evidence Acquisition and Evaluation for Evidence Summit on Population-Level Behavior Change to Enhance Child Survival and Development in Low- and Middle-Income Countries" by Robert L. Balster and colleagues.

South Africa has made substantial progress on child and maternal mortality, yet many avoidable deaths of mothers and children still occur. This analysis identifies priority interventions to be scaled up nationally and projects the potential maternal and child lives saved. We modelled the impact of maternal, newborn and child interventions using the Lives Saved Tools Projections to 2015 and used realistic coverage increases based on expert opinion considering recent policy change, financial and resource inputs, and observed coverage change. A scenario analysis was undertaken to test the impact of increasing intervention coverage to 95%. By 2015, with realistic coverage, the maternal mortality ratio (MMR) can reduce to 153 deaths per 100,000 and child mortality to 34 deaths per 1,000 live births. Fifteen interventions, including labour and delivery management, early HIV treatment in pregnancy, prevention of mother-to-child transmission and handwashing with soap, will save an additional 9,000 newborns and children and 1,000 mothers annually. An additional US$370 million (US$7 per capita) will be required annually to scale up these interventions. When intervention coverage is increased to 95%, breastfeeding promotion becomes the top intervention, the MMR reduces to 116 and the child mortality ratio to 23. The 15 interventions identified were adopted by the National Department of Health, and the Health Minister launched a campaign to encourage Provincial Health Departments to scale up coverage. It is hoped that by focusing on implementing these 15 interventions at high quality, South Africa will reach Millennium Development Goal (MDG) 4 soon after 2015 and MDG 5 several years later. Focus on HIV and TB during early antenatal care is essential. Strategic gains could be realised by targeting vulnerable populations and districts with the worst health outcomes. The analysis demonstrates the usefulness of priority setting tools and the potential for evidence-based decision making in the health sector. [ABSTRACT FROM AUTHOR]