Although global under-five mortality is declining, this paper argues that it is unlikely that Millennium Development Goal 4 will be reached by 2015. The researchers used data about all children born and dead children extracted from 169 Demographic and Health Surveys covering 70 countries to develop four new methods to estimate under-five mortality. Their findings suggest that application of the new methods developed by the researchers could significantly improve the accuracy of estimates of under-five mortality based on summary birth history data. The researchers warn that although their methods can provide accurate estimates of recent under-five mortality, they might not capture rapid fluctuations in mortality such as those that occur during wars. However, they suggest, the two questions needed to generate the data required to apply these new methods could easily be included in existing survey programmes and in routine censuses. Consequently, systematic application of the methods proposed in this study should provide policy makers with the information about levels, recent trends, and inequalities in child mortality that they need to accelerate efforts to reduce the global toll of childhood deaths.
Monitoring equity and research policy
Translating the discoveries of clinical research into practice is vital, as the UK’s Academy of Medical Sciences says in a recent report. But what do doctors in developing countries face in trying to keep up with the task? In this article, the authors say the challenges are legion. Medical academics in the developing world tend to work far from clinics. They often teach huge classes and bear heavy workloads, and struggle with poor salaries and little access to new findings in biomedicine. The research they conduct is all too often underfunded and irrelevant to national needs.
In this paper, the author considers how operational research and management science can improve the design of health systems and the delivery of health care, particularly in low-resource settings. He identifies some gaps in the way operational research is typically used in global health and proposes steps to bridge them, before outlining some analytical tools of operational research and management science and illustrating how their use can inform some typical design and delivery challenges in global health. The paper concludes by considering factors that will increase and improve the contribution of operational research and management science to global health.
The aim of this study was to investigate research priorities in mental health among researchers and other stakeholders in low- and middle-income (LAMI) countries. A two-stage design was used that included identification, through literature searches and snowball technique, of researchers and stakeholders in 114 countries of Africa, Asia, Latin America and the Caribbean; and a mail survey on priorities in research. The study identified broad agreement between researchers and stakeholders and across regions regarding research priorities. Epidemiology (burden and risk factors), health systems and social science ranked highest for type of research. Researchers’ and stakeholders’ priorities were consistent with burden of disease estimates. However, suicide was underprioritised, compared with its burden. Researchers’ and stakeholders’ priorities were also largely congruent with the researchers’ projects. The results of this first-ever conducted survey of researchers and stakeholders regarding research priorities in mental health suggest that it should be possible to develop consensus at regional and international levels regarding the research agenda that is necessary to support health system objectives in LAMI countries.
Globalisation and liberalisation (G&L) are two of the defining features of the last couple of decades. Both have given rise to contentious debate, with views ranging from the most optimistic to the most sceptical. This paper reviews the evidence on how the two trends have affected inequality - and thus poverty - at both the global and domestic levels. The absence of consensus on these effects reflects both the dearth of adequate quantitative information and the lack of and difficulty in the analysis of the causal links among the issues.
Measurement of individuals' costs and outcomes in randomised trials allow uncertainty about cost effectiveness to be quantified. Uncertainty is expressed as probabilities that an intervention is cost effective, and confidence intervals of incremental cost effectiveness ratios. Randomising clusters instead of individuals tends to increase uncertainty but such data are often analysed incorrectly in published studies. The authors used data from a cluster randomized trial to demonstrate five appropriate analytic methods: 1) joint modeling of costs and effects with two-stage non-parametric bootstrap sampling of clusters then individuals, 2) joint modeling of costs and effects with Bayesian hierarchical models and 3) linear regression of net benefits at different willingness to pay levels using a) least squares regression with Huber-White robust adjustment of errors, b) a least squares hierarchical model and c) a Bayesian hierarchical model. All five methods produced similar results, with greater uncertainty than if cluster randomisation was not accounted for. Cost effectiveness analyses alongside cluster randomised trials need to account for study design. Several theoretically coherent methods can be implemented with common statistical software.
The research community has shown increasing interest in developing and using metrics to determine the relationships between urban living and health. In particular, the authors have seen a recent exponential increase in efforts aiming to investigate and apply metrics for urban health, especially the health impacts of the social and built environments as well as air pollution. A greater recognition of the need to investigate the impacts and trends of health inequities is also evident through more recent literature. Data availability and accuracy have improved through new affordable technologies for mapping, geographic information systems and remote sensing. However, less research has been conducted in low- and middle-income countries where quality data are not always available, and capacity for analysing available data may be limited. For this increased interest in research and development of metrics to be meaningful, the best available evidence must be accessible to decision makers to improve health impacts through urban policies.
This report is part of initial findings from an ongoing review of development progress to generate comparative analysis that illustrates relative and absolute progress at national, sub-national and regional levels. The analysis is based on the Millennium Development Goal (MDG) database, household demographic and health surveys and multiple indicator cluster surveys. Two measures are used to evaluate progress: absolute and relative. Both measures are needed to tell the full story of progress, particularly in low-income countries. The report found that most countries are making progress on most of the key MDG indicators. For example, the number of people living in extreme poverty fell from an estimated 1.8 billion in 1990 to 1.4 billion in 2005. The share of children in primary school in low- and middle-income countries has risen from just over 70% to well over 80%. Ninety-five per cent of countries are making progress in reducing child mortality, which overall fell from 101 to 69 per 1000 live births between 1990 and 20071. And, despite wide variation in progress on maternal mortality, access to maternal health services has increased in about 80% of countries. The key message from many years of working towards the MDGs is that progress is possible. In every aspect of development – even in the least successful of the MDGs reviewed here, on maternal health (Goal 5) – a significant number of countries have made real achievements. Although these statistics are encouraging, the challenge for the remaining five years and beyond is to learn from, and build upon, progress made.
Ministers of health, science and technology, and social development have met with scientific researchers and representatives from foundations, the private sector and civil society at the Global Ministerial Forum on Research For Health, held in Bamako, Mali from 17–19 November, an event unique in bringing together high-level leadership in sectors of health research that do not always have the chance to interact. They discussed the future of research for health on diseases disproportionately affecting the developing world. The focus was on collecting and sharing accurate data to demonstrate the demography of disease and to measure the impact of programmes. With sound data, it is possible to convince people, for example, that malaria is a huge problem, and it is a problem which affects some parts of the globe more than others. The final call to action and communiqué are expected to be released shortly at bamako2008.org.
TDR Global has launched a 3-month mobilization initiative on gender equity in health research. The aim is to enhance women’s position in health research and to address the impact of gender on infectious diseases of poverty through research. The initiative will share experience and thoughts on gender equity in health research. Challenge-solving workshops are being planned to identify local challenges, create local teams and offer training. TDR Global talks are opportunities to share best practices and experiences on enhancing gender equity in health research. Working groups on specific issues are options for organizing webinars, training and sharing ideas.