Yoko Akachi, Maria Steenland and Günther Fink
Reducing child mortality remains one of the key objectives of the Sustainable Development Goals. Remarkable progress has been made over the past 25 years, with the global number of deaths of children aged under 5 falling from 13 million in 1990 to six million in 2015. Yet little is known about the relative contributions of specific public health interventions and general improvements in socioeconomic status and educational attainment over the same period.
Continue reading “What has contributed to the reduction in mortality rate for children aged under 5 in sub-Saharan Africa?”
Tanja AJ Houweling, David Osrin, Kishwar Azad, Dharma S Manandhar, Prasanta Tripathy, Tambosi Phiri, Joanna Morrison and Anthony Costello
In low- and middle-income countries, the odds of surviving the first 28 days of life are grossly unequal between infants born in deprived and better-off families, even among children living in the same community. In our study, recently published in the IJE, we have shown that women’s groups are able to address this problem. Under the guidance of a facilitator, women came together every month to discuss problems during pregnancy, delivery and the newborn period, and then designed and implemented strategies to overcome these problems with the help of the entire community.
- Ekjut women’s group in rural India
Continue reading “Can women talking save lives? Reducing inequalities in newborn mortality in India, Nepal, Bangladesh and Malawi”
Rheumatic Heart Disease (RHD) is caused by a bacterial (streptococcal) throat infection acquired in childhood. Although this type of infection is common and widespread, a small proportion of children so affected go on to develop an inflammatory condition that leads to scarring and narrowing of the heart valves and, in time, heart failure. Early on in the course of the disease the joints may be affected – hence the term “rheumatic”.
Still an important disease
At one time Rheumatic Heart Disease was common throughout the UK, Europe and the US; it was the most important cause of heart disease among young adults in Victorian Britain and probably caused the death of Mozart. Although rare now in most developed countries, it remains an important public health problem in many low and middle income countries. The disease is widespread in the Middle East and Asia, and the the poor indigenous populations of some wealthy countries, for example among Australian Aboriginees and New Zealand Maoris. It is particularly prevalent in sub-Saharan Africa, where it is one of the commonest causes of heart disease, typically affecting children or young adults. There it carries a grim prognosis because of the lack of specialised treatment. Continue reading “Smoke exposure in early life and Rheumatic Heart Disease”
Eileen Lee and Tim Bruckner
Since the start of the Mexican Drug War in December 2006, over 100,000 people have been murdered and over 20,000 are still missing. The escalation of violence has led to questions regarding the legitimacy and ability of political institutions, including law enforcement, to protect the public. A yet unmeasured cost of the drug war, related to living in an insecure environment, is the increased risk of dying from a heart attack.
We recently found that heart attack deaths among the elderly rose in months when Mexico’s homicide rate also rose. Our study adds to the growing literature on the collateral consequences of violence among persons who do not directly know the perpetrators or the victims. We believe that a threat, or perceived threat, to security from Mexico’s rising homicides, and the attendant media coverage, may have induced a stress response that triggered an excess of heart attacks. Given the high homicide rate in Mexico, the country provided a reasonable setting for us to test how population health responds to threats to security. Continue reading “Increased risk of heart attacks – An unmeasured cost of the war on drugs in Mexico”
Mahesh Karra, Günther Fink, David Canning
Over the past two decades, low- and middle-income countries (LMICs) have made considerable progress towards reducing child mortality. In spite of these achievements, almost six million children under the age of five are estimated to have died in 2015. Many of these deaths could likely be avoided if high quality antenatal care and delivery at health facilities were available to mothers and their children. Yet access to high quality health services remains low in many settings.
Distance to health care facilities has been identified as one of the main potential barriers to health service access. However, while there is strong evidence that long distances to facilities lead to lower utilization of health services, the evidence is less clear about whether long distances to facilities are linked to poor health outcomes. Continue reading “Are We There Yet? Assessing the Burden of Travel on Maternal Health Care Utilization and Child Mortality in Developing Countries”
Elina Dale, Anubhav Agarwal, Cyrus Engineer
Significant resources in global health are spent on pay-for-performance (P4P), also known under a more general term as results-based financing (RBF). Originating in the UK and USA, P4P has now become – to borrow a phrase from Cheryl Cashin – the new “it-girl” in health financing. However, as recent experience from Afghanistan shows, implementation is not always easy and P4P interventions must be better designed if they are to achieve real population health gains.
From 2010 to 2012 a P4P programme in Afghanistan provided quarterly bonus payments to health-care providers for increases in the use of maternal and child health (MCH) services, adjusted by a quality of care score. Our study, a large-scale cluster randomized trial, demonstrates that the programme did not produce the intended results. There were no observable improvements in any of the five key MCH coverage indicators measuring contraceptive prevalence, skilled birth attendances, vaccinations, and antenatal and postnatal check-ups. No changes were observed in the equity of care. While the programme appeared to increase time spent with patients, resulting in more complete histories and physical examinations, and improved patient counselling, other measures of quality, such as availability of medicines and supplies, did not substantially change. Continue reading “Lessons from the recent trial of a pay-for-performance programme in Afghanistan”