The number of women dying due to complications during pregnancy and childbirth has decreased by 34% from an estimated 546,000 in 1990 to 358,000 in 2008, according to this report. Despite the progress, the report notes that the annual rate of decline is less than half of what is needed to achieve the Millennium Development Goal (MDG) target of reducing the maternal mortality ratio by 75 between 1990 and 2015. This will require an annual decline of 5.5%. The 34% decline since 1990 translates into an average annual decline of just 2.3%. In the period from 1990 to 2008, ten out of 87 countries with maternal mortality ratios equal to or over 100 per 100,000 live births in 1990 are on track with an annual decline of 5.5% between 1990 and 2008. At the other extreme, 30 made insufficient or no progress since 1990. The study shows progress in sub-Saharan Africa, where maternal mortality decreased by 26%. Ninety-nine per cent of all maternal deaths in 2008 occurred in developing regions, with sub-Saharan Africa and South Asia accounting for 57% and 30% of all deaths, respectively.
Equity in Health
The 2016 Dar Es Salaam Call to Action on Diabetes and Other non-communicable diseases (NCDs) advocates national multi-sectoral NCD strategies and action plans based on available data and information from countries of sub-Saharan Africa and beyond. The authors estimated trends from 1980 to 2014 in age-standardised mean body mass index (BMI) and diabetes prevalence in these countries, in order to assess the co-progression and assist policy formulation. They pooled data from African and worldwide population-based studies which measured height, weight and biomarkers to assess diabetes status in adults aged ≥ 18 years. African data came from 245 population-based surveys (1.2 million participants) for BMI and 76 surveys (182 000 participants) for diabetes prevalence estimates. The age-standardised mean BMI increased from 21.0 kg/m2 to 23.0 kg/m2 in men, and from 21.9 kg/m2 to 24.9 kg/m2 in women. The age-standardised prevalence of diabetes increased from 3.4% to 8.5% in men, and from 4.1% to 8.9% in women. Estimates in northern and southern regions were mostly higher than the global average; those in central, eastern and western regions were lower than global averages. A positive association was observed between mean BMI and diabetes prevalence in both sexes in 1980 and 2014. These estimates, based on limited data sources, confirm the rapidly increasing burden of diabetes in Africa. This rise is being driven, at least in part, by increasing adiposity, with regional variations in observed trends. African countries’ efforts to prevent and control diabetes and obesity should integrate the setting up of reliable monitoring systems, consistent with the World Health Organisation’s Global Monitoring System Framework.
This study explored trends in socioeconomic disparities and under-five mortality rates in rural parts of the United Republic of Tanzania between 2000 and 2011. The authors used longitudinal data on births, deaths, migrations, maternal educational attainment and household characteristics from the Ifakara and Rufiji health and demographic surveillance systems. They estimated hazard ratios (HR) for associations between mortality and maternal educational attainment or relative household wealth, using Cox hazard regression models. The under-five mortality rate declined in Ifakara from 132.7 deaths per 1000 live births in 2000 to 66.2 in 2011 and in Rufiji from 118.4 deaths per 1000 live births in 2000 to 76.2 in 2011. Combining both sites, in 2000–2001, the risk of dying for children of uneducated mothers was 1.44 times higher than for children of mothers who had received education beyond primary school and in 2010–2011, the HR was 1.18. In contrast, mortality disparities between richest and poorest quintiles worsened in Rufiji, from 1.20 in 2000–2001 to 1.48 in 2010–2011, while in Ifakara, disparities narrowed from 1.30 to 1.15 in the same period. While childhood survival has improved, mortality disparities still persist. The authors thus argue for policies and programmes that both reduce child mortality and address socioeconomic disparities.
Tuberculosis remains the single greatest public health challenge associated with HIV worldwide. Despite widespread recognition of this fact, and clinical trials showing that interventions can help few programmes exist to implement such measures, according to a view presented at the International Aids Society Conference in Paris in July.
Nobel Peace Prize Laureate, Desmond Tutu, the former Anglican Archbishop of Cape Town, has warned it is not possible to win the war on terror as long as conditions that drive people to desperation continue to persist. "There is no way anybody is going to win the war on terror as long as there are conditions in so many parts of the world that drive people to acts of desperation because of poverty, disease and ignorance," said Tutu. Some people attending the forum in the past have questioned whether it has made a difference, but church leaders say it has brought the concerns of poor communities onto the global agenda.
The authors present a repeated cross-sectional study using four Uganda Demographic and Health Surveys of evidence on births with ANC, facility delivery, caesarean sections and complete maternal care. The authors assessed socio-economic differentials in these indicators by wealth, education, urban/rural residence, and geographic zone in the 1995 and 2011 surveys. ANC coverage with remained high over the study period but < 50% of women who received any ANC reported 4+ visits. Facility-based delivery care increased slowly, reaching 58% in 2011. While significant inequalities in coverage by wealth, education, residence and geographic zone remained, coverage improved for all indicators among the lowest socio-economic groups of women over time. The private sector market share declined over time to 14% of ANC and 25% of delivery care in 2011. Only 10% of women with 4+ ANC visits and 13% of women delivering in facilities received all measured care components. The Ugandan health system had to cope with more than 30,000 additional births annually between 1991 and 2011. The majority of women in Uganda accessed ANC, but this contact did not result in care of sufficient frequency, content, and continuum of care. Providers in both sectors require quality improvements. The authors suggest that achieving universal health coverage and maternal/newborn SDGs in Uganda requires prioritising poor, less educated and rural women, despite competing priorities for financial and human resources.
Following Monday's long day of debate over draft language that included references to specific HIV "vulnerable groups," such as sex workers, homosexuals and intravenous drug users, a finalized version of the United Nations' Declaration of Commitment for fighting HIV/AIDS on a global scale was submitted last night to delegates of the U.N. General Assembly special session on HIV/AIDS, who are expected to vote to adopt the document this afternoon at the conference's closing session, the Washington Post reports. Islamic groups and the Vatican had objected to the inclusion of such groups in the 20-page document, saying it would be "difficult" for them to endorse a plan that referred to behavior that is "illegal and against religious norms" in their countries. The language was removed after a lengthy debate that threatened to "overshadow" the conference's achievements and replaced with references to "risk behaviors, including sexual activity and drug use," the Post reports.
An October report released by the U.N. Population Division of the Department of Economic and Social Affairs said HIV/AIDS will continue to have devastating consequences for decades to come for virtually every sector of society and that in many countries the disease is undermining achievements of the U.N. Millennium Development Goals.
Life-saving medicines are not available to one-third of the world's population despite a long international campaign for wider access to essential drugs, the World Health Organization have said. In the 25 years since WHO drew up its essential drugs and medicines list, the number of people able to obtain those medicines has doubled, but there remains "a huge unfinished agenda," said Jonathan Quick, the head of the U.N. agency's project.
U.N. Special Envoy for HIV/AIDS in Africa Stephen Lewis, during a speech at the Global Health Council's annual conference in Washington, D.C., said that he was "aghast" at the way in which "AIDS was deepening hunger and hunger was deepening AIDS" in Southern Africa. According to Lewis, Africa "reaps what the world sows, and with a vengeance."