According to the World Health Organisation malnutrition is associated with about 60 percent of deaths in children under five years old in the developing world. The WHO has developed guidelines to improve the quality of hospital care for malnourished children in order to reduce deaths. The guidelines suggest ten steps for routine management of severe malnourishment. These will require most hospitals to make substantial changes.
Equity in Health
Treating severe malnutrition: implementing clinical guidelines in South African hospitals
Treatment Action Campaign on the 12th National Antenatal Survey
The Treatment Action Campaign (TAC) welcomes the publication of the 12th antenatal survey on HIV and syphilis sero-prevalence in South Africa. The survey is an important scientific instrument for measuring HIV prevalence and thereby testing the efficacy of South Africa's prevention programmes. TAC notes the marginal increase in HIV prevalence from 24,5% to 24,8% between 2000 and 2001, but welcomes the drop in HIV prevalence that appears to be taking place amongst people under the age of 20. We also welcome the survey's finding of a continued decline in national syphilis prevalence. Despite these promising signs, TAC believes that no comfort can be drawn from the results.
Further details: /newsletter/id/29230
Treatment Action Campaign Threatens Court Action
The Treatment Action Campaign (TAC) on Monday threatened to challenge the Medicines Control Council (MCC) in court if it decided to ban the anti-Aids drug, nevirapine. "We haven't decided on an exact legal route yet but we will make sure that any reverse decision is heard. We're not going to quietly sit by if this is a serious threat," the TAC's Mark Heywood told reporters in Johannesburg. He was reacting to newspaper reports at the weekend that the MCC was reviewing its approval of nevirapine because it had concerns about its effectiveness and toxicity.
Treatment preparedness summit closes
At the closing of the first International Treatment Preparedness Summit (ITPS) in Cape Town, South Africa, last month, participants detailed a number of priority actions to address the inequalities that prevent millions of people living with HIV/AIDS from securing access to treatment. At the end of the four-day meeting attended by over 120 representatives of treatment advocacy groups from 67 countries across the world, delegates agreed that current treatment efforts were insufficient. One of the things they called for was for national governments to develop treatment plans detailing how they intend to implement the World Health Organisation's goal of ensuring ARV treatment for at least 3 million people in the developing world by 2005.
Further details: /newsletter/id/29651
Trends and risk factors for childhood diarrhoea in Sub-Saharan countries (1990 - 2013): Assessing the neighbourhood inequalities.
Bado A; Susuman A; Nebie E: Global Health Action 9(30166), May 2016,
This paper assesses the risk factors of and neighborhood inequalities in diarrhoeal morbidity among under-5 year old children in selected countries in sub-Saharan Africa over the period 1990–2013, using DHS data from selected countries. The findings showed that the proportion of diarrhoeal morbidity among under-5 children varied considerably across the cohorts of birth from 10% to 35%, with increasing inequalities across DHS rounds. The main risk factors were 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.
Trends in Between-Country Health Equity in Sub-Saharan Africa from 1990 to 2011: Improvement, Convergence and Reversal
Jin J; Liang D; Shi L; Huang J: International Journal of Environmental Research and Public Health 13(6), 620; 2016
It is not clear whether between-country health inequity in Sub-Saharan Africa has been reduced over time due to economic development and increased foreign investments. The authors used the World Health Organization’s data about 46 nations in Sub-Saharan Africa to test if under-5 mortality rate (U5MR) and life expectancy (LE) converged or diverged from 1990 to 2011. The authors explored whether the standard deviation of selected health indicators decreased over time (i.e., sigma convergence), and whether the less developed countries moved toward the average level in the group (i.e., beta convergence). The variation of U5MR between countries became smaller from 1990 to 2001. Yet this trend did not continue after 2002. Life expectancy in Africa from 1990–2011 demonstrated a consistent convergence trend, even after controlling for initial differences of country-level factors. The lack of consistent convergence in U5MR partially resulted from the fact that countries with higher U5MR in 1990 eventually performed better than those countries with lower U5MRs in 1990, constituting a reversal in between-country health inequity.
Trends in human development
Rodríguez FR: United Nations Development Programme, 15 March 2010
According to this report, the past four decades have, by and large, been a time of substantial progress in human development for the world as a whole. The world’s average Human Development Index (HDI) grew by 29% in this period. Only one of the 111 countries in the dataset saw a decline in its HDI since 1970 – Zambia. Strikingly, the improvements in the HDI come from improvements in education and health. But the author warns that one cannot assume that free-market globalisation has brought these benefits to people in the developing world. Instead, he points to current evidence that shows that the massive increases in education and health achieved over the past 40 years had little if anything to do with globalisation but rather with the decision by states to expand their educational and health systems, coupled by initiatives of the international community to enable access to vaccines and antibiotics. He refers to research that shows that the correlation between economic growth and changes in the non-income components of human development is nearly zero. These results, he suggests, indicate that the oft-repeated dictum that economic growth is a necessary condition for increasing human development is simply not true.
Trends in Life Expectancy and the Macroeconomy in Malawi
Matchaya GC: Malawi Medical Journal 19(4):154-158, 2007
In this paper, authors present the trends in life expectancy in Malawi since independence and offer possible explanations regarding inter-temporal variations. Descriptive analysis reveals that the life expectancy in Malawi has trailed below the Sub Saharan African average. From the 1960s through to the early 1980s life expectancy improved driven mainly by rising incomes and the absence of HIV/AIDS. In the mid 1980s life expectancy declined tremendously and never improved due to the spread of HIV/AIDS, the economic slump that followed the World Bank's Structural Adjustment programmes (SAP) and widespread corruption and poor governance in the era of democracy. At the turn of the new millennium, Malawians were no healthier than their ancestors at the dawn of independence though this improved after 2004. If Malawi is to meet its health Millennium Development Goals by 2015, good governance, improved agricultural performance and an increase in health expenditure should be at the heart of its development policies.
Trends in lung cancer mortality in South Africa: 1995-2006
Bello B, Fadahun O, Kielkowski D and Nelson G: BMC Public Health 11(209), 4 April 2011
Using South Africa's annual mortality and population estimates data, the authors of this study calculated lung cancer age-standardised mortality rates for the period 1995 to 2006. Lung cancer caused 52,217 deaths during the study period. There were 4,525 deaths for the most recent year (2006), with men accounting for 67% of deaths. For the entire South African population, the age-standardised mortality rate of 24.3 per 100,000 persons in 1995 was similar to the rate of 23.8 per 100,000 persons in 2006. Overall, there was no significant decline in lung cancer mortality in South Africa from 1995 to 2006. In men, there was a statistically non-significant annual decline of 0.21 deaths per 100,000 persons. Despite this promising trend, the authors caution that the increasing rate in women is a public health concern that warrants intervention. Smoking intervention policies and programmes need to be strengthened to further reduce lung cancer mortality in men and to address the increasing rates in women.
Trends in maternal mortality: 1990 to 2008
World Health Organization, United Nations Children’s Fund, United Nations Population Fund and the World Bank: September 2010
This review uses Millennium Development Goal 5 (reducing the maternal mortality ratio by three quarters and achieving universal access to reproductive health by 2015) to assess global progress in improving maternal health. The main study limitation was a lack of reliable and accurate data on maternal mortality, particularly in developing-country settings where maternal mortality is high. An estimated 358,000 maternal deaths occurred worldwide in 2008, a 34% decline from the levels of 1990. Despite this decline, developing countries continued to account for 99% (355,000) of the deaths, with sub-Saharan Africa and South Asia accounting for 87% (313,000). Overall, it was estimated that there were 42,000 deaths due to AIDS among pregnant women in 2008. About half of those were assumed to be maternal. The contribution of AIDS was highest in sub-Saharan Africa where 9% of all maternal deaths were due to AIDS. These estimates provide an up-to-date indication of the extent of the maternal mortality problem globally. They reflect the efforts by countries, which have increasingly been engaged in studies to measure maternal mortality and strengthen systems to obtain better information about maternal deaths. The modest and encouraging progress in reducing maternal mortality, the review argues, is likely due to increased attention to developing and implementing policies and strategies targeting increased access to effective interventions. Such efforts need to be expanded and intensified, to accelerate progress towards reducing the still very wide disparities between developing and developed worlds.