child mortality

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Visualizing what we know – and don’t know – about child mortality in Africa | 

The significant progress made against child mortality around the world over the last two decades is frequently cited as one of the biggest success stories of international development.

Much more remains to be done, but it’s worth looking at what we know – and don’t know – about this propitious decline in child deaths.

Between 1990 and 2010, death rates among children under 5 decreased by 43% in sub-Saharan Africa, according to the Global Burden of Disease Study 2010 (GBD 2010). The screen grab below shows how deaths from different diseases and injuries in this age group decreased over time. Three major categories of diseases played key roles in driving this decline: diarrhea, lower respiratory infections, and other infectious diseases; neonatal disorders; and neglected tropical diseases and malaria.

Death rates in children under 5 years, sub-Saharan Africa, 1990-2010

Child Mortality Africa What interventions deserve credit for these declines? GBD researchers have not yet done a formal study to pinpoint all the reasons for the drop in child mortality, but a deep dive into the data can reveal likely causes. Continue reading

Think things are bad? Here are 14 Reasons the World is Getting Better | 

Roughly 10% of the whole world lives in extreme poverty, the youngest nation is falling apart and inequality is rising just about everywhere. That is only a sliver of the terrible things happening around the world right now. Thinking about (and reporting on) such topics can get depressing and lead one to think that all is bad.

The fact is, the world is getting better across just about every measure. Extreme poverty is at an all time low, more girls are getting an education and fewer children are dying. There is a long way to go, but progress is being made.

In short: People are living longer, less hungry and better connected than 10 years ago. How awesome is that?

For those of you feeling a bit down, here are a fourteen reasons to be optimistic, according to vlogger and author John Green:

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Visualizing progress on 3 Millennium Development Goals (MDGs) | 

Guest post by Katie Leach-Kemon, a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.

MDGsProgress toward the current Millennium Development Goals (MDGs) and establishing new goals after 2015 are a hot topic of discussion this week at the UN General Assembly in New York City.

In today’s post, we’ll use Global Burden of Disease Study 2010 (GBD 2010) data to explore how much progress countries have made in three key health MDGs, 4, 5 and 6, the first two focused on reducing child mortality and maternal mortality while the latter is on halting the spread of diseases such as HIV/AIDS and malaria.

MDG 6 is arguably the highest-profile goal and one that’s seen tremendous progress – halting or reversing the spread of HIV/AIDS, tuberculosis, and malaria. By 2010, antiretroviral therapy financed by country governments and donors had succeeded in reversing the rise in HIV/AIDS deaths at the global level.

Below is a figure showing donor funding (also known at IHME as development assistance for health, or DAH) for HIV/AIDs from IHME’s report Financing Global Health 2012: The End of the Golden Age?

Funding HIV AIDS

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Child mortality down, but still too many millions of poor children dying | 

That’s the gist of a new report from UNICEF, which celebrates the significant reductions made over the years in reducing the number of children dying mostly in poor countries and mostly from easily preventable causes like hunger, lack of clean water and lack of access to basic health care.

The numbers are, like most global statistics, large and abstract but compelling nevertheless: In 1990, something like 12 million kids were dying before they reached five years old. Today, despite population growth, the estimate is closer to 6 million child deaths under age five.

That’s a major reduction, but it still means 18,000 young children are dying from mostly preventable causes every day.  As UNICEF’s director in the organization’s announcement of the report says:

“Yes, we should celebrate the progress,” said Anthony Lake, UNICEF Executive Director. “But how can we celebrate when there is so much more to do before we reach the goal?  And we can speed up the progress – we know how, but we need to act with a renewed sense of urgency.”

Many are crediting the setting of the Millennium Development Goals, which nearly 15 years ago established reducing global child mortality as one of the eight primary goals of the international community.  But as this graphic from the World Bank illustrates, declining child mortality has been the trend for a long time – well before the MDGs were established.

Under 5 Mortality
World Bank

So why are child deaths on a decline, and what should be done to maintain this trend? Much of the overall progress has been in China, almost certainly due to the health improvements that often accompany economic gains. Yet China, India, Nigeria, Pakistan and DR Congo remain the countries with the highest numbers of premature child deaths.

Many experts contend what’s needed now is less a ranking of mortality country-by-country and more focus on what’s happening to specific populations by various causes. This is due to the fact that many of the poorest people live in middle-income countries and death comes sometimes from political or social drivers as much as from infectious disease.

Martin Drewry, director of London-based Health Poverty Action, said a deeper look reveals to what extent discrimination and ethnic persecution correlates with child death rates. Drewry wants more attention to this:

“The report makes a very brief reference to disparities in mortality within countries, but it is vital that this disparity becomes a driver for deciding development priorities and resource allocations,” he said. Here’s a report from his organization making the case for ‘disaggregating’ the data.

“People from ethnic and cultural minorities frequently have poorer health outcomes than the national average,” contended Drewry. “Health Poverty Action is calling for health data to be broken down by ethnicity. The disparities between different groups within countries needs to be made visible and this information used to drive strategy.”

Other news stories or blog posts on the UNICEF report:

CBS Child deaths down, but many still dying

VOA Child mortality reduced by half

ONE How many children survived to see their 5th birthday?

UN Dispatch Child mortality way down

Data show indoor air pollution a major killer of kids | 

Guest post by Katie Leach-Kemon, a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation, on indoor air pollution and child mortality.

Indian leaders from the public health, environmental, and security sectors have been urging government action to reduce household or indoor air pollution from solid fuels as a major contributor to death early in life.

India slum cooking
Mike Urban

Household air pollution caused 3.5 million deaths worldwide in 2010, many of which were in young children. In India, an estimated 100, 411 children died as a result of household air pollution that same year.

Burning solid fuels such as wood and dung for cooking is a leading risk factor for lower respiratory infections. Lower respiratory infections include deaths caused by influenza, haemophilus influenzae type B, pneumonia, respiratory syncytial virus, and other respiratory infections. A detailed breakdown of deaths caused by these different viruses and bacteria can be found in the published Global Burden of Disease studies.

Household air pollution is attributable to more than 50% of deaths from lower respiratory infections among children under five globally. Continue reading

How a passing comment on an old medical test won a $100K Gates grant | 

Tom Paulson

Gates Grand Challenges award winner Kathleen Bongiovanni demonstrates how a simple idea may save the lives of millions of premature babies

Earlier this week, the Bill & Melinda Gates Foundation announced the latest 100 winners of $100,000 grants from its Grand Challenges Exploration program aimed at supporting high-risk, creative approaches to improving health and fighting poverty in poor countries.

Celebrated for funding “wild” and “wacky” ideas, this year’s batch of Gates Grand Challenge winners included proposals to develop, as the AP reported, unmanned drones to deliver vaccines, tattoos for monitoring pregnancy and a “tuberculosis breathalyzer.”

The Seattle Times followed up with an overview of the three local winners:

  • Kathleen Bongiovanni, a program manager at Seattle Children’s Research Institute, won for proposing a simple test to identify premature babies.
  • Two immunization technology improvement teams at PATH also each won a $100,000 Gates grant. Lauren Franzel of PATH won to do research using bar codes to improve vaccine delivery logistics. PATH’s Shawn McGuire and Nancy Muller got support for work aimed finding better refrigeration techniques during vaccine transport in poor countries.

None of these three local winners’ projects sounded too wacky to me.

PATH has long been a leader in creating new vaccine technologies so not much surprise or wackiness or wildness there.

Bubble check diagnostics

No, the wildest story here is about how Bongiovanni got the idea for her project and applied for the Gates grant despite a bit of skepticism about her chances from more experienced colleagues.

“It was just a passing comment,” she explained. Bongiovanni works in program administration for a project focused on respiratory diseases caused by premature birth at Seattle Children’s Research Institute. She is, in fact, pretty low on the totem pole. Her mentor there, Dr. Tom Hansen, is an expert neonatalogist and, well, an old guy.

During a routine meeting, Bongiovanni overheard Hansen talking about the ‘old days’ and this abandoned method of testing babies for respiratory distress by combining routine amniocentesis fluid with alcohol.

Hansen mentioned it in passing, she said, as he went on to discuss more sophisticated, modern analytical means for diagnosing respiratory distress in newborns.

“Basically, you’re just looking for foam,” Bongiovanni said. “It’s a beautifully simple and cheap test.”

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Will new, positive findings allow Jeffrey Sachs to stop shouting back at the critics? | 

Columbia University

Jeff Sachs

The renowned economist Jeffrey Sachs, now director of Columbia University’s Earth Institute, seems to irritate people — which also seems to prompt his critics to engage in vitriolic attacks of his efforts to combat global poverty and inequity.

The debates centered around Sachs remind me of some of the people I’d meet as a boy attending church, those folks who would argue angrily, endlessly and insultingly over fundamental disagreements about how best to love thy neighbor.

Whatever one may think about Sachs’ methodology or personality, can’t we all at least agree he has done a lot to promote the causes of global health, social justice and equity? For one, Sachs helped craft the Millennium Development Goals — which, if imperfect, gave the world a strategy for improving global health, reducing poverty and improving the lives of the poor worldwide.

One of Sachs’ biggest projects today is known as the Millennium Villages Project. Not surprisingly, it has been pilloried by many aid experts who say there is no evidence the project does any good.

Well, according to The Guardian, there is now evidence of good from Sachs’ Millennium Villages Project:

Death rates among children under five at the Millennium Villages – set up in Africa to demonstrate what is possible if health, education, agriculture and other development needs are tackled simultaneously – have fallen by a third in three years compared with similar communities, according to the project’s first results.

Sachs, in characteristic form, explodes all over the media with these positive findings to announce a breakthrough in the Huffington Post and to suggest, for CNN, that these results show that we can finally achieve “the dream of health for all, even the poorest of the poor… (This) can become a reality because of recent breakthroughs in technology and health systems.”

A bit over the top, yes, but that’s just the way Jeff likes to talk. You need to keep in mind he started on his campaign against poverty and the diseases of poverty back in the days when, well, hardly anybody gave a damn. He had to shout. And he’s still shouting.

So now, finally, he has some data to back his claims up and can maybe stop shouting.

Or maybe not. As Nature News notes, the findings aren’t likely to stop the critics:

“The core of the problem is lack of transparency and careful, independent analysis,” says Michael Clemens, a migration and development researcher at the Center for Global Development, an independent research institution in Washington DC.

The aid blogger Roving Bandit notes that even if child mortality declined in the Millennium Villages, the project itself found no statistical impr0vements in poverty, nutrition, education or other child health indices.

So I guess, no, the answer appears to be the shouting is likely to continue.

Premature births on rise globally (US ranks with Indonesia & Bangladesh) | 

A new report by the World Health Organization has determined that one of every ten babies, 15 million worldwide, is born premature and the numbers are rising.

Disturbingly, if not surprisingly anymore when it comes to health indicators, the United States ranks between Indonesia and Bangladesh on premies.

As the Guardian noted, most of these premature births around the world are preventable if simple, inexpensive treatments were available to all. The rise in premie babies in the rich world was attributed to older mothers, an increased rate of C-section deliveries as well as the use of fertility drugs. In the developing world, comparatively:

In poor countries, where most of the deaths occur, the main causes of premature delivery are infections, malaria, HIV and the high number of adolescent girls getting pregnant. There is a huge difference in survival among the most premature. In rich countries, 90% of babies born before 28 weeks live. In poor countries, only 10% will do so.

Flickr, Mike Blyth

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