Researchers in this study systematically collected all available data for malaria mortality for the period 1980–2010, correcting for misclassification bias. They found that global malaria deaths increased from 995,000 in 1980 to a peak of 1,817,000 in 2004, decreasing to 1,238,000 in 2010. In Africa, malaria deaths increased from 493,000 in 1980 to 1,613,000 in 2004, decreasing by about 30% to 1,133,000 in 2010. The researchers estimated more deaths in individuals aged 5 years or older than has been estimated in previous studies: 435,000 deaths in Africa and 89,000 deaths outside of Africa in 2010. In conclusion, the researchers assert that the malaria mortality burden is larger than previously estimated, especially in adults. There has been a rapid decrease in malaria mortality in Africa because of the scaling up of control activities supported by international funders. They argue that external funder support needs to be increased if malaria elimination and eradication and broader health and development goals are to be met.
Equity in Health
Most data on mortality and prognostic factors in patients with heart failure come from North America and Europe, with little information from other regions. Here, in the International Congestive Heart Failure (INTER-CHF) study, the authors aimed to measure mortality at 1 year in patients with heart failure in Africa, China, India, the Middle East, southeast Asia and South America and to explore demographic, clinical, and socioeconomic variables associated with mortality. The authors enrolled 5823 patients within 1 year with a 98% follow-up. Mortality was highest in Africa (34%) and India (23%), compared to an overall average of 16%. Regional differences persisted after multivariable adjustment. Independent predictors of mortality included cardiac variables and non-cardiac variables (body-mass index, chronic kidney disease, and chronic obstructive pulmonary disease). 46% of mortality risk was explained by multivariable modelling with these variables; however, the remainder was unexplained. Marked regional differences in mortality in patients with heart failure persisted after multivariable adjustment for cardiac and non-cardiac factors. Therefore, variations in mortality between regions could be the result of health-care infrastructure, quality and access, or environmental and genetic factors. Further studies in large, global cohorts are suggested to be needed.
In 1987, the World Health Organization (WHO) estimated that vitamin A deficiency was endemic in 39 countries based on the ocular manifestations of xerophthalmia or deficient serum (plasma) retinol concentrations. In 1995, WHO updated these estimates and reported that vitamin A deficiency was of public health significance in 60 countries, and was likely to be a problem in an additional 13 countries. The current estimates reflect the time period between 1995 and 2005, and indicate that 45 and 122 countries have vitamin A deficiency of public health significance based on the prevalence of night blindness and biochemical vitamin A deficiency, respectively, in preschool-age children.
Diabetes prevalence is steadily increasing everywhere, most markedly in the world's middle-income countries. In many settings the environments and services do not enable the prevention and management of diabetes. As part of the 2030 Agenda for Sustainable Development, Member States have set an ambitious target to reduce premature mortality from non communicable diseases - including diabetes – by one third. This report presents trends in diabetes prevalence, in the contribution of high blood glucose (including diabetes) to premature mortality, and outlines actions governments are taking to prevent and control diabetes. From the analysis it is clear that stronger responses are needed not only from different sectors of government, but also from civil society and people with diabetes themselves, and also producers of food and manufacturers of medicines and medical technologies.
Non-communicable diseases (NCD) occur more commonly among people in lower socioeconomic groups. NCDs and poverty are in a vicious cycle, where poverty exposes people to behavioural risk factors for NCDs and, in turn, the resulting NCDs may become an important driver of poverty. Since in poorer countries most health-care costs must be paid by patients out-of-pocket, the cost of health care for NCDs create significant strain on household budgets, particularly for lower-income families. Treatment for diabetes, cancer, cardiovascular diseases and chronic respiratory diseases can be protracted and therefore extremely expensive. Such costs can force families into catastrophic spending and impoverishment. Household spending on NCDs, and on the behavioural risk factors that cause them, translates into less money for necessities such as food and shelter, and for the basic requirement for escaping poverty – education. Each year, an estimated 100 million people are pushed into poverty because they have to pay directly for health services.
The Global strategy for women’s and children’s health sets out the key areas where action is urgently required to enhance health financing, strengthen policy and improve service delivery. It argues that investing in women’s and children’s health reduces poverty, stimulates economic productivity and growth, is cost-effective and helps women and children realise their human rights. The report makes a number of recommendations. First, it urges governments and the global community to support country-led health plans, emphasising life-saving interventions and ensuring that women and their children can access prevention, treatment and care when and where they need it. The report also advocates for stronger health systems, with sufficient skilled health workers at their core and innovative approaches to financing, product development and the efficient delivery of health services. The over-reaching aim of the report is to help reach the goal of saving the lives of 16 million women and children by 2015.
The international humanitarian medical organisation Médecins Sans Frontières (MSF) has said that the battle against tuberculosis (TB) is being lost because of reliance on archaic diagnostic tests and drugs. "The HIV/AIDS pandemic has magnified this problem as TB often coincides with, and is made harder to treat by, HIV/AIDS. MSF calls for an urgent increase in worldwide investment in TB research and development," the organisation said.
Tuberculosis (TB) is a major cause of illness and death worldwide, especially in Asia and Africa. Globally, 9.2 million new cases and 1.7 million deaths from TB occurred in 2006, of which 0.7 million cases and 0.2 million deaths were in HIV-positive people. Population growth has boosted these numbers compared with those reported by the World Health Organization (WHO) for previous years. More positively, and reinforcing a finding first reported in 2007, the number of new cases per capita appears to have been falling globally since 2003, and in all six WHO regions except the European Region where rates are approximately stable. If this trend is sustained, Millennium Development Goal 6, to have halted and begun to reverse the incidence of TB, will be achieved well before the target date of 2015. Four regions are also on track to halve prevalence and death rates by 2015 compared with 1990 levels, in line with targets set by the Stop TB Partnership. Africa and Europe are not on track to reach these targets, following large increases in the incidence of TB during the 1990s. At current rates of progress these regions will prevent the targets being achieved globally.
The Global Tuberculosis Control Report is compiled annually by the World Health Organization, and this edition documents the success and challenges in tuberculosis (TB) treatment worldwide during 2009/2010. Some successes are highlighted, such as a 35% drop in the TB death rate since 1990, with a slow decline in TB incidence. It indicates that the world is on track to reach the Millennium Development Goal for TB incidence, and the Stop TB Partnership 2015 target for TB mortality. There has also been major progress in improving access to diagnosis and treatment, and also in the scale up of TB/HIV intervention and strengthening of laboratory services. However, major challenges still exist. In 2009, 1.7 million died from TB, and although incidence levels are falling, they are falling too slowly, the report has revealed. It predicts that, under the current rate of decline, TB will not be eliminated within the next generation. Also, the response to multi-drug resistant TB is still insufficient and more efforts are needed to scale up and strengthen programmes, especially with 440,000 new cases emerging each year. Less than 5% of those cases are being properly treated, the report notes.
The Global Tuberculosis Report provides a comprehensive and up-to-date assessment of the TB epidemic, and of progress in prevention, diagnosis and treatment of the disease at global, regional and country levels. This global TB report provides an assessment of the TB epidemic and progress in TB diagnosis, treatment and prevention reports, as well as an overview of TB-specific financing and research. It also discusses the broader agenda of universal health coverage, social protection and other SDGs that have an impact on health. Data were available for 202 countries and territories that account for over 99% of the world’s population and TB cases. Six countries accounted for 60% of the new cases: India, Indonesia, China, Nigeria, Pakistan and South Africa. Global progress is argued to depend on major advances in TB prevention and care in these countries. Worldwide, the rate of decline in TB incidence remained at only 1.5% from 2014 to 2015. This needs to accelerate to a 4–5% annual decline by 2020 to reach the first milestones of the End TB Strategy. TB treatment averted 49 million deaths globally between 2000 and 2015, but important diagnostic and treatment gaps persist. US$ 6.6 billion was available for TB care and prevention in low and middle-income countries in 2016, of which 84% was from domestic sources. Nonetheless, national TB programmes in low-income countries continue to rely on international funders for almost 90% of their financing. The report notes that investments in low and middle-income countries fall almost US$ 2 billion short of the US$ 8.3 billion needed in 2016. This annual gap will widen to US$ 6 billion in 2020 if current funding levels do not increase. Despite some progress in the pipeline for new diagnostics, drugs and regimens, and vaccines, TB research and development is also argued to remain severely underfunded.