DHS Further Analysis Reports No. 107 - This report, based largely on the 2014-15 national survey in Rwanda, focuses on changes and trends in reproductive behavior since 2010. In the 4-5 years after the 2010 survey, fertility continued its decline to 4.2 births per woman as contraceptive prevalence i...ncreased slightly. However, the earlier downward trend in number of children desired appears stalled. This is clearly evident from an increase in the proportions of married women and men who say they want more children. Child mortality has significantly declined and remains strongly related to fertility; while age at marriage has continued to increase. The demographic goals specified in the 1998-99 plan for development, Rwanda Vision 2020, appear on track, but the annual rate of population growth remains high, currently 2.5%, because fertility is high. Furthermore, large numbers of young people are now entering their child-bearing years. Although most trends seem encouraging, especially compared with other countries in sub-Saharan Africa, significant population growth is expected in Rwanda, from 12 to 16 million people by 2030, and to 22 million people by mid-century, even with assumed reductions of fertility.
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Long-term exposure of humans to air pollution enhances the risk of cardiovascular and respiratory diseases. A novel Global Exposure Mortality Model (GEMM) has been derived from many cohort studies, providing much-improved coverage of the exposure to fine particulate matter (PM2.5). We applied the GE...MM to assess excess mortality attributable to ambient air pollution on a global scale and compare to other risk factors.
Methods and results
We used a data-informed atmospheric model to calculate worldwide exposure to PM2.5 and ozone pollution, which was combined with the GEMM to estimate disease-specific excess mortality and loss of life expectancy (LLE) in 2015. Using this model, we investigated the effects of different pollution sources, distinguishing between natural (wildfires, aeolian dust) and anthropogenic emissions, including fossil fuel use. Global excess mortality from all ambient air pollution is estimated at 8.8 (7.11–10.41) million/year, with an LLE of 2.9 (2.3–3.5) years, being a factor of two higher than earlier estimates, and exceeding that of tobacco smoking. The global mean mortality rate of about 120 per 100 000 people/year is much exceeded in East Asia (196 per 100 000/year) and Europe (133 per 100 000/year). Without fossil fuel emissions, the global mean life expectancy would increase by 1.1 (0.9–1.2) years and 1.7 (1.4–2.0) years by removing all potentially controllable anthropogenic emissions. Because aeolian dust and wildfire emission control is impracticable, significant LLE is unavoidable.
Conclusion
Ambient air pollution is one of the main global health risks, causing significant excess mortality and LLE, especially through cardiovascular diseases. It causes an LLE that rivals that of tobacco smoking. The global mean LLE from air pollution strongly exceeds that by violence (all forms together), i.e. by an order of magnitude (LLE being 2.9 and 0.3 years, respectively).
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DHS Further Analysis Reports No. 90 - In Rwanda, between 2005 and 2010, there have been radical declines in the desired number of children, actual fertility, and child mortality along with a large increase in contraceptive prevalence. This study reviews trends in some of these measures. Multivariate... analyses evaluate the relative importance for
the desired number of children of years of schooling, wealth, urban residence, media exposure, child mortality, and attitudes toward gender equality. Variations in reproductive preferences, the total fertility rate, and unmet need for family planning are mapped for the 30 districts of Rwanda. The explanations for the rapid changes in reproductive attitudes and behavior are clearly related to the concerns of the country, the rapid rate of population growth, and its implications for economic development and reproductive health.
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The document outlines comprehensive guidelines for managing cholera outbreaks in South Africa, focusing on prevention, diagnosis, treatment, and public health measures. It emphasizes the importance of rehydration therapy, sanitation, clean water access, and community involvement to control the sprea...d of the disease. It also provides protocols for handling outbreaks, including case identification, laboratory confirmation, and multi-sectoral coordination to reduce morbidity and mortality rates.
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In the European Union, over 20 million people suffer from asthma. During the 1990s there was a rapid decrease in asthma mortality, probably related to the increased use of inhaled corticosteroids (ICS). However, during the last decade, asthma mortality rates have plateaued, and a consistently high p...roportion of patients have uncontrolled asthma. As a result, many patients with asthma still have impaired quality of life and suffer from chronic respiratory symptoms, often including night-time symptoms, causing sleep disturbance, excessive daytime sleepiness and decreased work productivity.
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The article investigates the global burden and risk factors of chronic obstructive pulmonary disease (COPD). It emphasizes that COPD is a leading cause of morbidity and mortality worldwide, with significant health and economic impacts. The study identifies smoking as the primary risk factor, but als...o highlights other contributors such as occupational exposure, air pollution, and respiratory infections. The authors discuss variations in COPD prevalence and mortality rates across different regions, influenced by socioeconomic and environmental factors. The article calls for comprehensive public health strategies to reduce exposure to risk factors and improve early diagnosis and management to curb the global impact of COPD.
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The current guidelines on Integrated Management of Acute Malnutrition (IMAM), addresses the issue of improved management of severe acute malnutrition (SAM), particularly in children under 5 years of age. In the absence of standard protocols, mortality in children admitted to hospital with SAM can ra...nge between 20 -30% with the highest levels of 50-60% among those with oedematous malnutrition. With modern treatment regimens and improved access to treatment, case-fatality rates can be reduced to less than 5%. These provincial guidelines on IMAM in KZN, includes inpatient care protocols on the management of SAM, and outpatient and community outreach components to manage moderate acute malnutrition (MAM) and prevent deterioration to SAM.
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The article "The burden of chronic obstructive pulmonary disease and its attributable risk factors in the Middle East and North Africa region, 1990–2019" provides an analysis of the prevalence, mortality, and disability-adjusted life-years (DALYs) due to COPD in the MENA region from 1990 to 2019. ...The study uses data from the Global Burden of Disease (GBD) 2019 and shows that while age-standardized death and DALY rates have decreased over 30 years, COPD remains a significant health issue, especially among older populations. The main risk factors identified are smoking, ambient particulate pollution, and occupational exposure. The research underscores the impact of socioeconomic factors and recommends targeted public health initiatives to reduce the burden.
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The WHO Global Health Estimates show that nearly half a million deaths (493 471) occurred in the WHO European Region due to violence and injuries in 2016. This represents a decline of 29% from 2000. Injuries account for 5.3% of all deaths and 9.6 of all years of life lost. They are a leading cause o...f death in people aged 15–29 years and the second leading cause of death for young people aged 5–14. The three leading causes of injury deaths are self-directed violence (141 089), falls (83 325) and road-traffic injuries (78 198). Inequalities in injury deaths exist in the Region, with mortality rates 2.4 times higher in males than in females and 1.5 times higher in middle-income compared to high-income countries.
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Nearly 800 women die every day from preventable maternal causes, and in 2022 alone, an estimated 2.3 million newborns died. For every maternal death, countless more women endure life-altering injuries, infections, and disabilities related to childbirth.
Maternal deaths are concentrated in the poo...rest regions and conflict-affected areas. In 2020, sub-Saharan Africa accounted for nearly 70% of all maternal deaths, with just 22 countries responsible for 81% of the global total. Humanitarian crises and fragile health systems exacerbate these challenges, with maternal mortality rates in crisis-affected areas often double the global average. The barriers to progress are multifaceted, including inadequate funding, poor-quality healthcare, harmful gender and social norms, and critical gaps in data and accountability.
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UNICEF analysis indicates that:
- Investments that increase access to high-impact health and nutrition interventions by poor groups have saved almost twice as many lives as equivalent investments in non-poor groups.
- Access to high-impact health and nutrition interventions has improved ra...pidly among poor groups in recent years, leading to substantial improvements in equity.
- During the period studied, absolute reductions in under-five mortality rates associated with improvements in intervention coverage were three times faster among poor groups than non-poor groups.
- Because birth rates were higher among the poor, the reduction in the under-five mortality rate translated into 4.2 times more lives saved for every 1 million people. Indeed, of the 1.1 million lives saved across the 51 countries during the final year studied for each country, nearly 85 per cent were among the poor.
- Intensified focus on equity-enhancing policies and investments can help countries achieve the Sustainable Development Goal newborn and child mortality targets (SDG3.2).
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This Plan envisions a future with the elimination of cervical cancer as a public health problem as a result of universal access to sexual health and STI prevention services, HPV vaccines, effective screening and precancer treatment services, treatment of invasive cervical cancer, and palliative care.... It foresees that all women and girls, regardless of age, race, ethnicity, socioeconomic status, HIV status, or disability will have timely access to quality cervical cancer prevention, care, and treatment so that they can live in good health throughout the life course and enjoy the health-related human rights.
The goal is to accelerate progress toward the elimination of cervical cancer as a public health problem in the Americas by reducing incidence and mortality rates by one-third by 2030.
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Maternal and Neonatal health update: by the Nepal government, Health and population ministry, Health protection unit, Family health department, created in 2010 (English) 2067 (Nepali). Compiled together by: UNICEF, WHO, UNFPA, NHSSP, Nepal medical college hospital and other government health departm...ents.
This is a training directory and reference guideline, very useful for physicians, students and for training purposes of medical staff. Majority of the content is for medical personnel. It gives detailed descriptions regarding procedures and how to perform them, and also regarding the statistics in Nepal, prevalence rates, morbidity and mortality rates.
Contents:
1) Nepal health status
2) Post Partum Hemorrhage (PPH)
3) Partograph
4) Hypertension during pregnancy
5) Status of Neonatal Health
6) Neonatal Resuscitation
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Key questions
What is already known?
Critical illness is common throughout the world and COVID-19 has caused a global surge of critically ill patients.
There are large gaps in the quality of care for critically ill patients, especially in low-staffed and low-resourced settings, and mortal...ity rates are high.
Essential Emergency and Critical Care (EECC) is the effective lifesaving care of low-cost and low-complexity that all critically ill patients should receive in all wards in all hospitals in the world.
What are the new findings?
The clinical processes that comprise EECC and the essential care of critically ill patients with COVID-19 have been specified in a large consensus among clinical experts worldwide.
The resource requirements for hospitals to be ready to provide this care has been described.
What do the new findings imply?
The findings can be used across medical specialties in hospitals worldwide to prioritise and implement essential care for reducing preventable deaths.
Inclusion of the EEEC processes could increase the impact of pandemic preparedness and response programmes and policies for health systems strengthening.
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The objective of this concept note and the framework it outlines is the elimination of a group of CDs and the negative health effects they generate, which together create a tangible burden on affected individuals, their families and communities, and on health care systems throughout the Region. Thou...gh there is no unified consensus on the best measures to use for the public’s health and a nation’s epidemiologic situation, it is common for the disease burden to be measured by disease rates (incidence, prevalence, etc.), disease-specific death rates, comparative morbidity and mortality rates, geographic distribution, and disability-adjusted life years (DALYs). The current epidemiological situation, including data on disease rates or geographic distribution for the diseases in Table 1, is discussed below in Section 4. Hotez et al. (2008) were the first to review and compare the burden of DALYs in Latin America and the Caribbean—for NTDs, HIV/AIDS, malaria, and TB—as it existed about 10 years ago. Though the regional burden of TB, malaria, and neglected infectious diseases (NIDs) is somewhat less than it was 10 years ago, work (and schooling) continue to be lost to illness and premature death or disability, and the need for stepping up disease elimination efforts is evident in all communities living in vulnerable conditions....
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Ethiopia has been repeatedly affected by conflict, flooding, drought, and disease outbreaks in the past years. As of January 2024, the country is actively responding to the longest recorded cholera outbreak which started in August 2022, recurrent measles outbreaks which started in August 2021, and t...he highest number of malaria cases reported since 2017. The El Niño phenomenon is expected to cause further havoc up to July 2024, by causing drought in some parts of the country, and flooding in others. Food insecurity due to lost harvest and livestock is aggravating already high malnutrition rates, negatively impacting morbidity and mortality.
The Health Cluster is closely collaborating with the Ministry of Health (MOH) to prepare for, prevent, and respond to public health emergencies by mobilizing resources to enable health partners to provide life-saving health services to vulnerable populations.
In an environment with ever-increasing needs and decreased funding, the below priorities for 2024 and 2025 have been identified: 1 Strengthen advocacy for longer-term, development funding to address root causes of recurrent disease outbreaks, including through the Humanitarian-Development-Peace Nexus 2 Advocate for increased access to quality health services, with a strong focus on:
sexual and reproductive health services (including for survivors of sexual and gender-based violence)
inclusion of people with disabilities, older people, and people living with HIV
remote populations through inclusion of Mobile Health Teams (MHT) as part of the health system 3 Standardize health services provided by Health Cluster partners through the implementation of Essential Health Care packages, aligned with existing MOH guidance, aimed at ensuring quality service delivery for affected populations, especially at community level 4 Strengthen quality of, and access to data for needs analysis and informed decision-making 5 Strengthen subnational coordination, with increased focus on zones and local health partners
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Cervical cancer is the second most common cancer among women worldwide and causes a significant number of deaths in the South-East Asia Region. Nearly 200 000 new cases of cervical cancer occurred in SEA Region Member States in 2008, giving an incidence of almost 25 per 100... 000 and a mortality rate of almost 14 per 100 000. Cervical cancer can be prevented by early screening and vaccination. However, due to poor access to screening and treatment services, the vast majority of these deaths occur in women from nine Member States of the South-East Asia Region which account for more than one third of the global burden of cervical cancer.
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Health Policy and Planning, Volume 35, Issue 1, February 2020, Pages 47–57, https://doi.org/10.1093/heapol/czz122
Colombia has an underreporting of 30% of the total cases, according to World Health Organization (WHO) estimations. In 2016, successful tuberculosis (TB) treatment rate was 70%, and t...he mortality rate ranged between 3.5% and 10%. In 2015, Colombia adopted and adapted the End TB strategy and set a target of 50% reduction in incidence and mortality by 2035 compared with 2015.
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The World Health Organization (WHO) is releasing the second edition of its Global Accelerated Action for the Health of Adolescents (AA-HA!) guidance. The document aims to equip governments to respond to the health and well-being challenges, opportunities and needs of adolescents.
The guidance pro...vides the latest available data on adolescent health and well-being. It also outlines an updated list of core indicators that data should be collected on. Globally, road injury was the top cause of death for adolescent males in 2019. Among female adolescents, the leading causes of death were diarrhoeal diseases among the younger group (10-14 years) and tuberculosis (TB) in the older group (15-19 years).
Over the last 20 years, mortality rates have declined among adolescents globally, with the largest decline in older (15–19 years) adolescent girls. For non-fatal diseases, the burden has not improved over the past two decades, with the main causes of ill health in this category being: mental health conditions (depressive and anxiety disorders, childhood behavioural disorders), iron deficiency anaemia, skin diseases and migraine.
Adolescent well-being depends on a range of factors, including healthy food, education, life skills and employability, connectedness, feeling valued by society, safe and supportive environments, resilience, and the freedom to make choices. To take an appropriately holistic approach, the guidance outlines how to take crosscutting action to support adolescent health and well-being, with mutually reinforcing interventions across sectors, such as health, education, social protection, and telecommunications. Targeted efforts are also required to engage adolescents, as they trust health systems less than adults do and are especially vulnerable to modern-day trends, like online bullying and gaming.
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Non-communicable diseases (NCDs) are the second common cause of death in sub-Saharan Africa (SSA) accounting for about 35% of all deaths, after a composite of communicable, maternal, neonatal, and nutritional diseases. Despite prior perception of low NCDs mortality rates, current evidence suggests t...hat SSA is now at the dawn of the epidemiological transition with contemporary double burden of disease from NCDs and communicable diseases. In SSA, cardiovascular diseases (CVDs) are the most frequent causes of NCDs deaths, responsible for approximately 13% of all deaths and 37% of all NCDs deaths. Although ischemic heart disease (IHD) has been identified as the leading cause of CVDs mortality in SSA followed by stroke and hypertensive heart disease from statistical models, real field data suggest IHD rates are still relatively low. The neglected endemic CVDs of SSA such as endomyocardial fibrosis and rheumatic heart disease as well as congenital heart diseases remain unconquered. While the underlying aetiology of heart failure among adults in high-income countries (HIC) is IHD, in SSA the leading causes are hypertensive heart disease, cardiomyopathy, rheumatic heart disease, and congenital heart diseases. Of concern is the tendency of CVDs to occur at younger ages in SSA populations, approximately two decades earlier compared to HIC. Obstacles hampering primary and secondary prevention of CVDs in SSA include insufficient health care systems and infrastructure, scarcity of cardiac professionals, skewed budget allocation and disproportionate prioritization away from NCDs, high cost of cardiac treatments and interventions coupled with rarity of health insurance systems. This review gives an overview of the descriptive epidemiology of CVDs in SSA, while contrasting with the HIC and highlighting impediments to their management and making recommendations.
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