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Disclosure of HIV status is an important part of pediatric care. We studied disclosure and clinical outcomes in a multi-country Asian cohort of children and adolescents with HIV. Those 6–19 years of age who initiated combination antiretroviral therapy (cART) between 2008 and 2018, and who had at least one follow-up clinic visit were included. Data up to December 2019 were analyzed. Cox and competing risk regression analyses were used to assess the effect of disclosure on disease progression (WHO clinical stage 3 or 4), loss to follow-up (LTFU; > 12 months), and death. Of 1913 children and adolescents (48% female; median [IQR] age 11.5 [9.2–14.7] years at last clinic visit), 795 (42%) were disclosed to about their HIV status at a median age of 12.9 years (IQR: 11.8–14.1). During follow-up, 207 (11%) experienced disease progression, 75 (3.9%) were LTFU, and 59 (3.1%) died. There were lower hazards of disease progression (adjusted hazard ratio [aHR] 0.43 [0.28–0.66]) and death (aHR 0.36 [0.17–0.79]) for those disclosed to compared with those who were not. Disclosure and its appropriate implementation should be promoted in pediatric HIV clinics in resource-limited settings. [ABSTRACT FROM AUTHOR]

The article discusses the determinants of longevity among people in the East Asian region. Also cited are the significant improvement in the life expectancy (LE) and infant mortality rates (IMR) in the region in the late 20th century, how improved public health infrastructure and medical advancements helped prevent deaths from infectious diseases, and the secular trend of maternal smoking, body mass index (BMI), and gestational age.

Objective: To compare the prognostic value of mid-upper arm circumference (MUAC), weight-for-height Z -score (WHZ) and weight-for-age Z -score (WAZ) for predicting death over periods of 1, 3 and 6 months follow-up in children. Design: Pooled analysis of twelve prospective studies examining survival after anthropometric assessment. Sensitivity and false-positive ratios to predict death within 1, 3 and 6 months were compared for three individual anthropometric indices and their combinations. Setting: Community-based, prospective studies from twelve countries in Africa and Asia. Participants: Children aged 6–59 months living in the study areas. Results: For all anthropometric indices, the receiver operating characteristic curves were higher for shorter than for longer durations of follow-up. Sensitivity was higher for death with 1-month follow-up compared with 6 months by 49 % (95 % CI (30, 69)) for MUAC < 115 mm (P < 0·001), 48 % (95 % CI (9·4, 87)) for WHZ < -3 (P < 0·01) and 28 % (95 % CI (7·6, 42)) for WAZ < -3 (P < 0·005). This was accompanied by an increase in false positives of only 3 % or less. For all durations of follow-up, WAZ < -3 identified more children who died and were not identified by WHZ < -3 or by MUAC < 115 mm, 120 mm or 125 mm, but the use of WAZ < -3 led to an increased false-positive ratio up to 16·4 % (95 % CI (12·0, 20·9)) compared with 3·5 % (95 % CI (0·4, 6·5)) for MUAC < 115 mm alone. Conclusions: Frequent anthropometric measurements significantly improve the identification of malnourished children with a high risk of death without markedly increasing false positives. Combining two indices increases sensitivity but also increases false positives among children meeting case definitions. [ABSTRACT FROM AUTHOR]

Rotavirus remains a leading cause of diarrhoeal morbidity and mortality in young children and rotavirus vaccines are critical for reducing global disease burden. This report addresses the performance of rotavirus vaccines in countries with high child mortality. We performed a sensitivity analysis as part of a systematic review on rotavirus vaccines to inform development of World Health Organization vaccine recommendations. The efficacy of four prequalified vaccines against severe rotavirus gastroenteritis was similar across high mortality settings in Asia and Africa. Within the first year following vaccination, vaccine efficacy for the four vaccines ranged from 48% to 57% while in the second year, efficacy ranged from 29% to 54%. The four vaccines showed no increase in intussusception risk in these settings. All four vaccines appear to prevent significant numbers of severe rotavirus gastroenteritis episodes with no measurable increase in intussusception risk in high mortality settings in Africa and Asia. [ABSTRACT FROM AUTHOR]

This article is aimed to examine the relationship between socioeconomic factors and child mortality in South Asia because the relationship between child mortality and socioeconomic factors cannot be overlooked for better progress. Panel data were obtained from (World Development Indicators) and (Human Development Index) for the period 1990–2017. The data were quantitative. Levin, Lin, and Chu and I'm, Pesaran, and Shin test were used to check the stationarity of data. A cointegration test was applied to check the long-run association. Granger causality test was used to determine the direction of the relationship. Fully modified ordinary least squares and dynamic ordinary least squares techniques were used to examine the long-run and short-run impact of socioeconomic determinants on child mortality. The findings from this study showed the significant impact of education, unemployment, and health expenditure, access to improved water and sanitation facilities, and income inequality on child mortality. Overall results showed that there is a negative association between education and child mortality, access to improved water and access to sanitation facilities and child mortality, and health expenditure and child mortality, but there is a positive association between unemployment and income inequality with child mortality. The rate of child mortality is still very alarming in South Asian countries. [ABSTRACT FROM AUTHOR]

Background: Civil registration and vital statistics (CRVS) systems do not produce comprehensive data on maternal and child deaths in most low- and middle-income countries (LMICs), with most births and deaths which occur outside the formal health system going unreported. Community-based death reporting, investigation and review processes are being used in these settings to augment official registration of maternal and child deaths and to identify death-specific factors and associated barriers to maternal and childcare. This study aims to review how community-based maternal and child death reporting, investigation and review processes are carried out in LMICs. Methods: We conducted a scoping review of the literature published in English from January 2013 to November 2020, searching PubMed, EMBASE, PsycINFO, Joanna Briggs, The Cochrane Library, EBM reviews, Scopus, and Web of Science databases. We used descriptive analysis to outline the scope, design, and distribution of literature included in the study and to present the content extracted from each article. The scoping review is reported following the PRISMA reporting guideline for systematic reviews. Results: Of 3162 screened articles, 43 articles that described community-based maternal and child death review processes across ten countries in Africa and Asia were included. A variety of approaches were used to report and investigate deaths in the community, including identification of deaths by community health workers (CHWs) and other community informants, reproductive age mortality surveys, verbal autopsy, and social autopsy. Community notification of deaths by CHWs complements registration of maternal and child deaths missed by routinely collected sources of information, including the CRVS systems which mostly capture deaths occurring in health facilities. However, the accuracy and completeness of data reported by CHWs are sub-optimal. Conclusions: Community-based death reporting complements formal registration of maternal and child deaths in LMICs. While research shows that community-based maternal and child death reporting was feasible, the accuracy and completeness of data reported by CHWs are sub-optimal but amenable to targeted support and supervision. Studies to further improve the process of engaging communities in the review, as well as collection and investigation of deaths in LMICs, could empower communities to respond more effectively and have a greater impact on reducing maternal and child mortality. [ABSTRACT FROM AUTHOR]

Mother-to-child transmission of hepatitis B virus (HBV) is the main route of transmission in Asia, and characterization of HBV quasispecies is needed to further understand virus evolution and adaptation. To understand changes in HBV during mother-to-child transmission, we enrolled nine pairs of mothers and children in the study, including a set of twins. Three groups were infected with HBV genotype C, and six groups were infected with HBV genotype B. The full-length HBV genome was amplified by PCR from serum samples before antiviral treatment, the whole viral genomes from each pair were sequenced, and the complexity and diversity of the quasispecies were analyzed. The entropy of transmitted HBV in children was found to be lower than their mothers, suggesting that there was a bottleneck effect during HBV transmission from the mother to the child. Selective evolution was shown by calculating πN and πS in the whole genomes, and the highest values were obtained for the X gene, which plays a role in viral replication and immune escape. All genotype C patients and only one genotype B pair had a πN/πS greater than 1 ratio, indicating that positive selection had occurred. In addition, quasispecies were found to be different between the twin children despite having the same mother, indicating that virus evolution is host-specific. [ABSTRACT FROM AUTHOR]

Despite reductions over the past 2 decades, childhood mortality remains high in low- and middle-income countries in sub-Saharan Africa and South Asia. In these settings, children often die at home, without contact with the health system, and are neither accounted for, nor attributed with a cause of death. In addition, when cause of death determinations occur, they often use nonspecific methods. Consequently, findings from models currently utilized to build national and global estimates of causes of death are associated with substantial uncertainty. Higher-quality data would enable stakeholders to effectively target interventions for the leading causes of childhood mortality, a critical component to achieving the Sustainable Development Goals by eliminating preventable perinatal and childhood deaths. The Child Health and Mortality Prevention Surveillance (CHAMPS) Network tracks the causes of under-5 mortality and stillbirths at sites in sub-Saharan Africa and South Asia through comprehensive mortality surveillance, utilizing minimally invasive tissue sampling (MITS), postmortem laboratory and pathology testing, verbal autopsy, and clinical and demographic data. CHAMPS sites have established facility- and community-based mortality notification systems, which aim to report potentially eligible deaths, defined as under-5 deaths and stillbirths within a defined catchment area, within 24–36 hours so that MITS can be conducted quickly after death. Where MITS has been conducted, a final cause of death is determined by an expert review panel. Data on cause of death will be provided to local, national, and global stakeholders to inform strategies to reduce perinatal and childhood mortality in sub-Saharan Africa and South Asia. [ABSTRACT FROM AUTHOR]

Background The Child Health and Mortality Prevention Surveillance (CHAMPS) network aims to generate reliable data on the causes of death among children aged <5 years using all available information, including minimally invasive tissue sampling (MITS). The sensitive nature of MITS inevitably evokes religious, cultural, and ethical questions influencing the feasibility and sustainability of CHAMPS. Methods Due to limited behavioral studies related to child MITS, we developed an innovative qualitative methodology to determine the barriers, facilitators, and other factors that affect the implementation and sustainability of CHAMPS surveillance across 7 diverse locations in sub-Saharan Africa and South Asia. We employed a multimethod grounded theory approach and analytical structure based on culturally specific conceptual frameworks. The methodology guided data interpretation and collective analyses confirming how to define dimensions of CHAMPS feasibility within the cultural context of each site while reducing subjectivity and bias in the process of interpretation and reporting. Results Findings showed that the approach to gain consent to conduct the MITS procedure involves religious factors associated with timing of burial, use of certain terminology, and methods of transporting the body. Community misperceptions and uncertainties resulted in rumor surveillance and consistency in information sharing. Religious pronouncements, recognition of health priorities, attention to pregnancy, and advancement of child health facilitated community acceptability. Conclusions These findings helped formulate program priorities, guided site-specific adaptations in surveillance procedures, and verified inferences drawn from CHAMPS epidemiological and formative research data. Results informed appropriate community sensitization and engagement activities for introducing and sustaining mortality surveillance, including MITS. [ABSTRACT FROM AUTHOR]

We examine the depth and breadth of ongoing demographic transformation in Asia and draw ramifications on future rice farming using long-run time-series data from 17 major rice-growing countries in Asia. We found that Asia is undergoing declining trends in women fertility, child mortality, family size, population growth, the proportion of the agricultural population, and involvement of youth in agriculture. On the other hand, rural out-migration, aging of the farming population, and urbanization show increasing trends. These emerging trends will have far-reaching impacts on future rice farming mediated through labor market, rice market, rice demand, and rice supply. Policymakers and scientists must anticipate more rapid demographic transformation in the future and implement necessary technological, institutional, policy, and strategic solutions to manage or cope with future demographic transformation. [ABSTRACT FROM AUTHOR]

Background: Despite remarkable progress in the improvement of child survival between 1990 and 2015, the Millennium Development Goal (MDG) 4 target of a two-thirds reduction of under-5 mortality rate (U5MR) was not achieved globally. In this paper, we updated our annual estimates of child mortality by cause to 2000-15 to reflect on progress toward the MDG 4 and consider implications for the Sustainable Development Goals (SDG) target for child survival.Methods: We increased the estimation input data for causes of deaths by 43% among neonates and 23% among 1-59-month-olds, respectively. We used adequate vital registration (VR) data where available, and modelled cause-specific mortality fractions applying multinomial logistic regressions using adequate VR for low U5MR countries and verbal autopsy data for high U5MR countries. We updated the estimation to use Plasmodium falciparum parasite rate in place of malaria index in the modelling of malaria deaths; to use adjusted empirical estimates instead of modelled estimates for China; and to consider the effects of pneumococcal conjugate vaccine and rotavirus vaccine in the estimation.Findings: In 2015, among the 5·9 million under-5 deaths, 2·7 million occurred in the neonatal period. The leading under-5 causes were preterm birth complications (1·055 million [95% uncertainty range (UR) 0·935-1·179]), pneumonia (0·921 million [0·812 -1·117]), and intrapartum-related events (0·691 million [0·598 -0·778]). In the two MDG regions with the most under-5 deaths, the leading cause was pneumonia in sub-Saharan Africa and preterm birth complications in southern Asia. Reductions in mortality rates for pneumonia, diarrhoea, neonatal intrapartum-related events, malaria, and measles were responsible for 61% of the total reduction of 35 per 1000 livebirths in U5MR in 2000-15. Stratified by U5MR, pneumonia was the leading cause in countries with very high U5MR. Preterm birth complications and pneumonia were both important in high, medium high, and medium child mortality countries; whereas congenital abnormalities was the most important cause in countries with low and very low U5MR.Interpretation: In the SDG era, countries are advised to prioritise child survival policy and programmes based on their child cause-of-death composition. Continued and enhanced efforts to scale up proven life-saving interventions are needed to achieve the SDG child survival target.Funding: Bill & Melinda Gates Foundation, WHO. [ABSTRACT FROM AUTHOR]

Aims: Poverty kills children. This study assesses the relationship between poverty and child mortality rates (CMRs) in 71 societies from three world regions to determine whether some countries, relative to their region, neglect their children. Methods: Spearman rank order correlations were calculated to determine any association between the CMR and poverty data, including income inequality and gross national income. A current CMR one standard deviation (SD) above or below the regional average and a percentage change between 1988 and 2010 were used as the measures to assess the progress of nations. Results: There were positive significant correlations between higher CMRs and relative poverty measures in all three regions. In Western countries, the current CMRs in the USA, New Zealand and Canada were 1 SD below the Western mean. The narrowest income inequalities, apart from Japan, were seen in the Scandinavian nations alongside low CMRs. In Asia, the current CMRs in Pakistan, Myanmar and India were the highest in their region and were 1 SD below the regional mean. Alongside South Korea, these nations had the lowest percentage reductions in CMRs. In Sub-Saharan Africa, the current CMRs in Somalia, Burkina Faso, Sierra Leone, Chad, Democratic Republic of Congo and Angola were the highest in their region and were 1 SD below the regional mean. Conclusions: Those concerned with the pursuit of social justice need to alert their societies to the corrosive impact of poverty on child mortality. Progress in reducing CMRs provides an indication of how well nations are meeting the needs of their children. Further country-specific research is required to explain regional differences. [ABSTRACT FROM AUTHOR]

Background: Diarrhoea is the second leading cause of mortality in children worldwide, but establishing the cause can be complicated by diverse diagnostic approaches and varying test characteristics. We used quantitative molecular diagnostic methods to reassess causes of diarrhoea in the Global Enteric Multicenter Study (GEMS).Methods: GEMS was a study of moderate to severe diarrhoea in children younger than 5 years in Africa and Asia. We used quantitative real-time PCR (qPCR) to test for 32 enteropathogens in stool samples from cases and matched asymptomatic controls from GEMS, and compared pathogen-specific attributable incidences with those found with the original GEMS microbiological methods, including culture, EIA, and reverse-transcriptase PCR. We calculated revised pathogen-specific burdens of disease and assessed causes in individual children.Findings: We analysed 5304 sample pairs. For most pathogens, incidence was greater with qPCR than with the original methods, particularly for adenovirus 40/41 (around five times), Shigella spp or enteroinvasive Escherichia coli (EIEC) and Campylobactor jejuni o C coli (around two times), and heat-stable enterotoxin-producing E coli ([ST-ETEC] around 1·5 times). The six most attributable pathogens became, in descending order, Shigella spp, rotavirus, adenovirus 40/41, ST-ETEC, Cryptosporidium spp, and Campylobacter spp. Pathogen-attributable diarrhoeal burden was 89·3% (95% CI 83·2-96·0) at the population level, compared with 51·5% (48·0-55·0) in the original GEMS analysis. The top six pathogens accounted for 77·8% (74·6-80·9) of all attributable diarrhoea. With use of model-derived quantitative cutoffs to assess individual diarrhoeal cases, 2254 (42·5%) of 5304 cases had one diarrhoea-associated pathogen detected and 2063 (38·9%) had two or more, with Shigella spp and rotavirus being the pathogens most strongly associated with diarrhoea in children with mixed infections.Interpretation: A quantitative molecular diagnostic approach improved population-level and case-level characterisation of the causes of diarrhoea and indicated a high burden of disease associated with six pathogens, for which targeted treatment should be prioritised.Funding: Bill & Melinda Gates Foundation. [ABSTRACT FROM AUTHOR]

South Asia is home to the largest number of stunted children worldwide: 65 million or 37% of all South Asian children under 5 were stunted in 2014. The costs to society as a result of stunting during childhood are high and include increased mortality, increased morbidity (in childhood and later as adults), decreased cognitive ability, poor educational outcomes, lost earnings and losses to national economic productivity. Conversely, investing in nutrition provides many benefits for poverty reduction and economic growth. This article draws from analyses conducted in four sub ‐ Saharan countries to demonstrate that investments in nutrition can also be very cost ‐ effective in South Asian countries. Specifically, the analyses demonstrate that scaling up a set of 10 critical nutrition ‐ specific interventions is highly cost ‐ effective when considered as a package. Most of the interventions are also very cost ‐ effective when considered individually. By modelling cost ‐ effectiveness of different scale ‐ up scenarios, the analysis offers insights into ways in which the impact of investing in nutrition interventions can be maximized under budget constraints. Rigorous estimations of the costs and benefits of nutrition investments, similar to those reported here for sub ‐ Saharan countries, are an important next step for all South Asian countries in order to drive political commitment and action and to enhance allocative efficiency of nutrition resources. [ABSTRACT FROM AUTHOR]

Background: Malaria continues to be a major cause of infectious disease mortality in tropical regions. However, deaths from malaria are most often not individually documented, and as a result overall understanding of malaria epidemiology is inadequate. INDEPTH Network members maintain population surveillance in Health and Demographic Surveillance System sites across Africa and Asia, in which individual deaths are followed up with verbal autopsies. Objective: To present patterns of malaria mortality determined by verbal autopsy from INDEPTH sites across Africa and Asia, comparing these findings with other relevant information on malaria in the same regions. Design: From a database covering 111,910 deaths over 12,204,043 person-years in 22 sites, in which verbal autopsy data were handled according to the WHO 2012 standard and processed using the InterVA-4 model, over 6,000 deaths were attributed to malaria. The overall period covered was 1992-2012, but two-thirds of the observations related to 2006-2012. These deaths were analysed by site, time period, age group and sex to investigate epidemiological differences in malaria mortality. Results: Rates of malaria mortality varied by 1:10,000 across the sites, with generally low rates in Asia (one site recording no malaria deaths over 0.5 million person-years) and some of the highest rates in West Africa (Nouna, Burkina Faso: 2.47 per 1,000 person-years). Childhood malaria mortality rates were strongly correlated with Malaria Atlas Project estimates of Plasmodium falciparum parasite rates for the same locations. Adult malaria mortality rates, while lower than corresponding childhood rates, were strongly correlated with childhood rates at the site level. Conclusions: The wide variations observed in malaria mortality, which were nevertheless consistent with various other estimates, suggest that population-based registration of deaths using verbal autopsy is a useful approach to understanding the details of malaria epidemiology. [ABSTRACT FROM AUTHOR]

Background: Childhood mortality, particularly in the first 5 years of life, is a major global concern and the target of Millennium Development Goal 4. Although the majority of childhood deaths occur in Africa and Asia, these are also the regions where such deaths are least likely to be registered. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective: To present a description of cause-specific mortality rates and fractions over the first 15 years of life as documented by INDEPTH Network sites in sub-Saharan Africa and south-east Asia. Design: All childhood deaths at INDEPTH sites are routinely registered and followed up with verbal autopsy (VA) interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provided persontime denominators for mortality rates. Cause-specific mortality rates and cause-specific mortality fractions are presented according to WHO 2012 VA cause groups for neonatal, infant, 1-4 year and 5-14 year age groups. Results: A total of 28,751 childhood deaths were documented during 4,387,824 person-years over 18 sites. Infant mortality ranged from 11 to 78 per 1,000 live births, with under-5 mortality from 15 to 152 per 1,000 live births. Sites in Vietnam and Kenya accounted for the lowest and highest mortality rates reported. Conclusions: Many children continue to die from relatively preventable causes, particularly in areas with high rates of malaria and HIV/AIDS. Neonatal mortality persists at relatively high, and perhaps sometimes underdocumented, rates. External causes of death are a significant childhood problem in some settings. [ABSTRACT FROM AUTHOR]

Context: One of the United Nation's Millennium Development Goals (MDGs) is the reduction of maternal and child mortality. The 'green revolution' has increased food supply in Asia, and hunger and under nutrition have been decreasing since 1981. However, instead of having to deal with surplus food grain, South Asia and India are still facing high levels of hunger. Although some south Indian cities are witnessing a technology boom, one in every 11 children die within the first 5 years of their lives either due to malnutrition or due to non availability of even simple technology and health care. Aim: To assess the nutritional status of schoolchildren in Mangalore city. Settings and Design: A cross-sectional study. Materials and Methods: A total 1630 students from 11 schools were enrolled for the study. The sample size was calculated assuming the prevalence of undernourished in Mangalore city as 20% and a relative precision of 10%. Statistical Analysis: The BMI (body mass index), Z-scores, and World Health Organization (WHO) Multicentric Growth Reference Study (MGRS) growth chart was used for analysis. Results: Our study population of 1630 students comprised 830 (50.9%) males and 800 (49.1%) females. On analysis, 82 children (5.03%) were found to be undernourished, 37 (2.3%) were overweight, and 16 (1%) were obese. Undernourishment was more prevalent in boys (6.87%) than in girls (3.12%). Obesity was marginally higher among males (1.2%) as compared to females (0.8%) (P=0.003). A total of 15 boys (1.8%) and 22 girls (2.8%) were found to be overweight. Conclusions: The nutritional status of the students in our study is better than has been found in other studies. However, there are cases of under nourishment that need attention. At the same time, there is a need to deal with obesity and overweight in schoolchildren in order to prevent the impending epidemic of noncommunicable disease. [ABSTRACT FROM AUTHOR]

Globally, pneumonia is the leading cause of death in young children and burden of disease is disproportionately high in South-East Asia Region of WHO. This review article presents the current status of pneumonia disease burden, risk factors and the ability of health infrastructure to deal with the situation. Literature survey was done for the last 20 years and data from country offices were also collected. The estimated incidence of pneumonia in under five children is 0.36 episodes per child, per year. Risk factors are malnutrition (40% in India), Indoor air pollution, non-breast feeding, chronic obstructive pulmonary disease, etc. Strengthening of health care delivery system for early detection and treatment and as well as minimization of preventable risk factors can avert a large proportion of death due to pneumonia. [ABSTRACT FROM AUTHOR]

The article offers information on a study which analyzed patterns and trends in childhood cancer mortality in 24 developed and middle-income countries in America, Asia and Oceania between 1970 and 2007. A review of the related literature on childhood cancer mortality is offered. Data reviewed were from the World Health Organization (WHO) database for all neoplasms, bone and kidney cancer, non-Hodgkin lymphoma (NHL) and leukemias. The findings of the study are presented in detail.

Abstract: The global community has considered several vaccines to reduce pneumonia morbidity and mortality among children <5 years. Recent burden estimates support pneumococcal vaccine introduction, however, influenza vaccine has received only recent attention. The effect of influenza vaccine on early childhood pneumonia has not been adequately explored. As part of an integrated four-stage strategy, both pneumococcal and influenza vaccine impact on pneumonia burden reduction should be evaluated in controlled trials in tropical and sub-tropical Asian and African countries, along with evaluation of new aetiology diagnostics, research into common pneumonia mortality pathways and interventions targeting those pathways. [Copyright &y& Elsevier]

The proportion of child deaths that occurs in the neonatal period (38% in 2000) is increasing, and the Millennium Development Goal for child survival cannot be met without substantial reductions in neonatal mortality. Every year an estimated 4 million babies die in the first 4 weeks of life (the neonatal period). A similar number are stillborn, and 0.5 million mothers die from pregnancy-related causes. Three-quarters of neonatal deaths happen in the first week--the highest risk of death is on the first day of life. Almost all (99%) neonatal deaths arise in low-income and middle-income countries, yet most epidemiological and other research focuses on the 1% of deaths in rich countries. The highest numbers of neonatal deaths are in south-central Asian countries and the highest rates are generally in sub-Saharan Africa. The countries in these regions (with some exceptions) have made little progress in reducing such deaths in the past 10-15 years. Globally, the main direct causes of neonatal death are estimated to be preterm birth (28%), severe infections (26%), and asphyxia (23%). Neonatal tetanus accounts for a smaller proportion of deaths (7%), but is easily preventable. Low birthweight is an important indirect cause of death. Maternal complications in labour carry a high risk of neonatal death, and poverty is strongly associated with an increased risk. Preventing deaths in newborn babies has not been a focus of child survival or safe motherhood programmes. While we neglect these challenges, 450 newborn children die every hour, mainly from preventable causes, which is unconscionable in the 21st century. INSETS: Panel 1: Data inputs and methods used to obtain estimates...;Panel 2: Key messages for neonatal health. [ABSTRACT FROM AUTHOR]

The effects of democracy on living conditions among the poor are disputed. Previous studies have addressed this question by estimating the average effect of democracy on early-life mortality across all countries. We revisit this debate using a research design that distinguishes between the aggregated effects of democracy across all countries and their individual effects within countries. Using Interrupted Time Series methodology and estimating model parameters in a Bayesian framework, we find the average effect of democracy on early-life mortality to be close to zero, but with considerable variation at the country-level. Democratization was followed by fewer child deaths in 21 countries, an increase in deaths in eight, and no measurable changes in the remaining 32 cases. Transitions were usually beneficial in Europe, neutral or beneficial in Africa and Asia, and neutral or harmful in Latin America. The distribution of country-level effects is not consistent with common arguments about the conditional effects of democratic transitions. Our results open a new line of research into the sources of theses heterogeneous effects. • The effects of democracy on early-life mortality are disputed. • Previous studies estimated the average effects across countries. • Our analysis allows the effect of democracy to vary from country to country. • It was followed by fewer deaths in 21 countries, more in 8, and no effects on 32. [ABSTRACT FROM AUTHOR]

The article discusses a study which investigated the relationship between acute kidney injury (AKI) and mortality in critically ill pediatric patients in the intensive care units (ICUs).

The article focuses on the issue of various updates related to women, girls and equality principle. Child marriages are common amongst those who live in rural areas. Researchers have developed a diagnostic testing method for HIV which is more sensitive and less expensive. According to the study, nurses in low-resource settings can effectively determine the completeness of a medication abortion without using an ultrasound.

This article comments on a study in this issue which reported on a trial of oral live-attenuated rotavirus vaccine in European babies. Rotavirus diarrhoea causes half a million deaths per year and vaccines are the only method of controlling the disease. Most cases of the disease occur in developing countries where there are many factors that interfere with the effectiveness of the vaccines. Trials of both vaccines need to be conducted in Africa and Asia before the treatment can be recommended.

Reports that an analysis of 15 Muslim and non-Muslim community pairs in four countries in Asia shows no consistent relationship between differences in levels of female autonomy and child mortality. Indication that in many areas, Muslim women do not have lower levels of autonomy than women of other religions; Observation that indicators of women's autonomy do not have a strong or uniform association with child mortality.

The article reports on the grants announced by philanthropist Bill Gates to fund disease surveillance sites in poor countries in 2015.

The article offers world health news briefs as of December 2013. Global Nurses United (GNU), an activist organization, held rallies worldwide to protest health care cuts and austerity measures and to support full funding for public health care. World Health Organization had reported that 60 percent of public hospitals in Syria have shortages of medicine and elevated risks of infectious diseases. The World Bank Web site provides a series of studies on universal health coverage.

The article reports that the number of children under 5 years old who die each year from malaria in Africa fell by a third between 1990 and 2010. About 12 000 fewer children died every day in 2010 than in 1990. It is stated that mortality in the age group of 0-5 is increasingly concentrated in sub-Saharan Africa and South Asia.

The article focuses on a review which provides reliable estimates on the efficiency of Vitamin A supplements for preventing mortality and morbidity in children age six months to five years. It states that the review has found 43 clinical trials, which were taken in 19 countries such as Asia. It also relates that the review has found that children after one year of taking the Vitamin A were 24% less prone to mortality.

Presents medical news briefs. Two young men who have died from avian flu in Asia bring the death toll 29; Study which found that online health advice for people with diabetes is often too complex for the patient to understand; Advertisement in a German medical journal by junior doctors who are protesting changes in their job conditions; Call for more research into how many children in the UK are affected by lead poisoning; Death rate in the Darfur area of the Sudan which was three times more than expected between mid-June to mid-August.