Top health issues of 2012 13


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As the world’s climate continues to change, hazards to human health are increasing.This eBook illustrates some of the most pressing current and emerging challenges related to health.

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Top health issues of 2012 13

  1. 1. Top Health Issues of 2012-13 EBook Developed ByA site for Current Affairs & General Studies
  2. 2. Table of ContentsHealth .................................................................................................................................................... 2Pre-term Birth.................................................................................................................................... 11New Cancer Therapy ....................................................................................................................... 13Malaria Vaccine ................................................................................................................................ 14HIV Infections .................................................................................................................................... 17HIV Vaccine ........................................................................................................................................ 21Malnutrition........................................................................................................................................ 22Global Burden Of Disease ............................................................................................................. 26Child Survival .................................................................................................................................... 29Free eBook Free Sharing
  3. 3. HealthAtlas Of Health And ClimateAs the world’s climate continues to change, hazards to human health are increasing. TheAtlas of Health and Climate, published jointly by the World Health Organisation (WHO) andthe World Meteorological Organization (WMO), illustrates some of the most pressing currentand emerging challenges.Droughts, floods and cyclones affect the health of millions of people each year. Climatevariability and extreme conditions such as floods can also trigger epidemics of diseases suchas diarrhoea, malaria, dengue and meningitis, which cause death and suffering for manymillions more. The Atlas gives practical examples of how the use of weather and climateinformation can protect public health.The Report has been divided into three sections:Section 1: Infectionsa) Malariab) Diarrhoeac) Meningitisd) Dengue FeverSection 2: Emergenciesa) Floods And Cyclonesb) Droughtc) Airborne Dispersion Of Hazardous MaterialsSection 3: Emerging Environmental Challengesa) Heat Stressb) UV Radiationc) Pollensd) Air Pollution Section 1: InfectionsFree eBook Free Sharing
  4. 4. Infectious diseases take a heavy toll on populations around the world. Some of the mostvirulent infections are also highly sensitive to climate conditions. For example, temperature,precipitation and humidity have a strong influence on the reproduction, survival and bitingrates of the mosquitoes that transmit malaria and dengue fever, and temperature affects thelife-cycles of the infectious agents themselves.The same meteorological factors also influence the transmission of water and food-bornediseases such as cholera, and other forms of diarrhoeal disease. Hot, dry conditions favourmeningococcal meningitis – a major cause of disease across much of Africa. All of thesediseases are major health problems.Diarrhoea kills over two million people annually, and malaria almost one million. Meningitiskills thousands, blights lives and hampers economic development in the poorest countries.Some 50 million people around the world suffer from dengue fever each year.MalariaMalaria is a parasitic disease spread by the bites of infected Anopheles mosquitoes. There aremany species of malaria parasites but, of the five affecting humans, the greatest threat tohealth comes from the Plasmodium vivax and Plasmodium falciparum.Malaria remains a disease of global importance despite much progress in recent years. It is apersistent threat to health in developing nations where it represents a major constraint toeconomic development measures and reduces the likelihood of living a healthy life,especially among women, children and the rural poor.According to the World Malaria Report in 2011, malaria remains prevalent in 106 countriesof the tropical and semi-tropical world. Thirty-five countries in central Africa bear the highestburden of cases, more than 80 per cent, and deaths, more than 90 per cent. This is due to aFree eBook Free Sharing
  5. 5. number of factors: most deadly parasite species, most efficient mosquito vectors and poorrural infrastructure.Prevention: Where malarial control is inadequate, the climate can provide valuableinformation about the potential distribution of the disease in both time and space. Climatevariables – rainfall, humidity and temperature – are fundamental to the propagation of themosquito vector and to parasite dynamics.Rainfall produces mosquito-breeding sites, humidity increases mosquito survival andtemperature affects parasite development rates. Mapping, forecasting and monitoring thesevariables, and unusual conditions that may trigger epidemics such as cyclones or the breakingof a drought in a region, enable health services to better understand the onset, intensity andlength of the transmission season.DiarrhoeaAround two million people die every year due to diarrhoeal disease – 80 per cent are childrenunder 5. Cholera is one of the most severe forms of waterborne diarrhoeal disease. There aresporadic incidences of the disease in the developed world, but it is a major public healthconcern for developing countries, where outbreaks occur seasonally and are associated withpoverty and use of poor sanitation and unsafe water.Extreme weather events, such as hurricanes, typhoons, or earthquakes, cause a disruption inwater systems resulting in the mixing of drinking and waste waters, which increase the risk ofcontracting cholera.Free eBook Free Sharing
  6. 6. In 1995 a combined average of 65 per cent of the world’s population had access to improveddrinking water sources and sanitation facilities. That left two billion people relying ondrinking water that could potentially contain pathogens, including Vibrio cholerae, thecausative organism of cholera.There is a definite correlation between disease outbreaks and inadequate access to safe waterand lack of proper sanitation. Therefore people in the least developed regions of the worldwho only have access to unsafe water and poor sanitation also have the greatest burden ofrelated diseases, like cholera or other diarrhoeal diseases.Extreme weather-related events such as increased precipitation and flooding furthercontaminate water sources, contributing to an oral-faecal contamination pathway that isdifficult to manage and which increases the cases of disease and fatalities.Prevention: We are still badly off track to meet the Millennium Develop Goal on sanitation.Access to water and sanitation improved from 1995 to 2010, but not substantially in the partsof the world where cholera is recurring. Cases of cholera continue to rise in parts of poverty-stricken Africa and Asia where access to water and sanitation are already poor and progresstowards improving such services is slow or stagnant.MeningitisMeningococcal meningitis is a severe infectious disease of the meninges, a thin layer aroundthe brain and spinal cord. Several micro-organisms can cause meningitis. The bacterium withthe greatest epidemic potential is Neisseria meningitidis.Although meningitis is a ubiquitous problem, most of the burden of disease lies in sub-Saharan Africa in an area called the “Meningitis Belt”. The Meningitis Belt is regularly hit byepidemics that occur only during the dry season, from December to May. Over the past 10years, more than 250 000 cases and an estimated 25 000 deaths have been reported.Prevention: There is a clear seasonal pattern of meningitis cases that corresponds to theperiod of the year when there are increases in dust concentrations as well as reductions inhumidity levels linked to the movement of the Inter Tropical Convergence Zone. While thetemporal association between climate and meningitis is evident, what triggers or ends anepidemic is as yet unknown. One hypothesis is that dry, hot and dusty air irritates therespiratory mucosa thus facilitating invasion of the bacteria.The public health strategy to control meningitis epidemics relies on the implementation oflarge-scale vaccination campaigns in a timely manner to prevent further cases.Dengue FeverTransmitted by Aedes mosquitoes, dengue is the most rapidly spreading mosquito-borne viraldisease in the world. It is estimated to cause over 50 million infections, and around 15,000deaths every year across approximately 100 countries.Dengue is now increasing in many parts of the world, driven by development andglobalization – the combination of rapid and unplanned urbanization, movement of goods andFree eBook Free Sharing
  7. 7. infected people, dispersal of mosquitoes to newer territories, spread and mixing of strains ofthe virus, and more favourable climatic conditions.Prevention: There is currently no effective vaccine or drugs for dengue. Control programmesrely on environmental or chemical control of the vectors, rapid case detection and casemanagement in hospitals for severe dengue.But these interventions are challenging, and there has been only very limited success indisease outbreak control within the most suitable transmission zones. Future initiatives arelikely to depend not just on development of better interventions, but also on more effectivetargeting of control in time and space. In such scenarios, meteorological information canmake an important contribution to understanding where and when dengue cases are likely tooccur. Section 2: EmergenciesEvery year, emergencies caused by weather-, climate- and water-related hazards impactcommunities around the world, leading to loss of life, destruction of social and economicinfrastructure and degradation of already fragile ecosystems. Between 80 and 90 per cent ofall documented disasters from natural hazards during the last ten years have resulted fromfloods, droughts, tropical cyclones, heat waves and severe storms. Statistics And The Hidden ImpactIn 2011, 332 disasters from natural hazards were recorded in 101 countries, causing morethan 30 770 deaths, and affecting over 244 million people. Recorded damages amounted tomore than US$ 366.1 billion.But statistics cannot reflect the full health impact or the depths of human suffering felt duringsuch emergencies. Millions of people have suffered injuries, disease and long-termdisabilities as well as emotional anguish from the loss of loved ones and the memories oftraumatic events.Over the past 30 years the proportion of the world’s population living in flood-prone riverbasins has increased by 114 per cent and those living on cyclone-exposed coastlines by 192per cent.Reports of extreme weather events and disasters have more than tripled since the 1960s andscientists expect such events to become more frequent and severe in the future due to climatechange in many parts of the world. There is also growing evidence that links escalations inviolence and conflict over access to food and water resources to climate. Climate Services And Health EmergenciesAdopted by 168 Member States at the World Disaster Reduction Conference in Kobe, Japanin 2005, the Hyogo Framework For Action describes the work that is required from alldifferent sectors and actors, including health and climate communities, to reduce disasterlosses.Free eBook Free Sharing
  8. 8. The Global Framework for Climate Services will contribute to the implementation of theHyogo Framework by making tailored science-based climate-related information available tosupport informed investment and planning at all levels as a critical step in disaster riskmanagement.Climate services support health and other sectors to save lives and reduce illness and injury inemergencies by:  Assisting health emergency response operations, for example, by providing early warnings of extreme hot and cold temperatures  Providing seasonal forecasting and early warning systems to enable planning and action  Determining which populations and health care facilities are at risk of hydrometeorological hazards using risk assessment tools  Applying climate change models to forecast the long-term effects of climate change, information which could be used, for example, to decide where to locate new health facilities away from high risk areas  Providing real-time meteorological and hydrological data, properly integrated with related health services data and information, to support local and national decision-makingFloods And CyclonesFloods and cyclones may directly and indirectly affect health in many ways, for example by:  Increasing cases of drowning and other physical trauma  Increasing risks of water- and vector-borne infectious diseases  Increasing mental health effects associated with emergency situationsFree eBook Free Sharing
  9. 9.  Disrupting health systems, facilities and services, leaving communities without access to health care when they are needed most  Damaging basic infrastructure such as food and water supplies and safe shelterDroughtDrought may have acute and chronic health effects:  Malnutrition due to the decreased availability of food  Increased risk of communicable diseases due to acute malnutrition, inadequate or unsafe water for consumption and sanitation, and increased crowding among displaced populations  Psycho-social stress and mental health disorders  Overall increase of population displacement  Disruption of local health services due to a lack of water supplies and/or health care workers being forced to leave local areaAirborne Dispersion Of Hazardous MaterialsWildfires and forest fires occur in all vegetation zones. Caused by natural phenomena or byhuman activity, emissions from fires contain gas and particle pollutants that can cause diversehealth problems, as well as disrupt transportation, tourism and agriculture. Extreme radiantheat and smoke inhalation may cause injury and death to people directly exposed to the fires.The occurrence of wildfires is strongly determined by the incidence of drought and heatwaves. Climatologists believe that climate change will increase in the incidence of wildfiresas the associated droughts and heat waves are expected to increase in frequency and intensity.Free eBook Free Sharing
  10. 10. Section 3: Emerging Environmental ChallengesCurrent development patterns, and individual behavioural choices, are bringing a range ofnew challenges to public health. Many of the most important relate to environmental changes.Heat StressExcessive heat is a growing public health threat – for every degree Centigrade above athreshold level, deaths can increase by 2 – 5 per cent. Prolonged, intense heat waves heightenthe risks. Elderly, chronically-ill and socially-isolated individuals, people working in exposedenvironments and children are particularly vulnerable.While extreme heat affects populations around the world in both developing and developedcountries, some of the most dramatic heat waves have occurred in relatively wealthy regionsof the world with cooler average temperatures and mid-latitude climates.Climate change – which is expected to increase the intensity and frequency of such extremes– will worsen the hazards to human health. By the 2050s, heat events that would currentlyoccur only once every 20 years will be experienced on average every 2 – 5 years.Population growth, ageing and urbanization are also expected to increase the numbers ofpeople at high risk. By 2050, it is estimated that there will be at least 3 times as many peopleaged over 65 living in cities around the world, with developing regions seeing the greatestincreases.The combined effects of escalating hazards and growing vulnerable populations will makeheat stress a health priority for the coming decades.Protection: Protection from extreme heat requires a range of actions, from providing earlywarning, surveillance and treatment for vulnerable populations through to long-term urbanplanning to reduce the heat-island effect as well as initiatives to reduce greenhouse gasemissions to limit the severity of global climate change.UV RadiationWhile small doses of ultraviolet (UV) radiation from the sun help the body produce vitaminD, excessive exposure is damaging to human health. Excessive exposure may haveconsequences ranging from premature ageing of the skin to skin cancer. The number of casesof malignant melanoma has doubled every 7 to 8 years over the last 40 years – mostly due toa marked increase in the incidence of skin cancers in fair-skinned populations since the early1970s.UV radiation can also severely damage the cornea, lens and retina of the human eye – longexposures can result in photo keratitis and a lifetime of cumulative exposure contributes tothe risk of cataracts and other forms of ocular damage.In addition to the above risks, a growing body of evidence suggests that levels of UVradiation in the environment may enhance the risk of infectious diseases and limit theefficacy of vaccinations.Free eBook Free Sharing
  11. 11. PollensWHO estimates that around 235 million people currently suffer from asthma worldwide. It isthe most prevalent chronic childhood disease. Asthma can be caused by many factors,including poor air quality and the presence of strong airborne allergens.The reasons for the increase in susceptibility to allergens, in particular to pollen allergens,remain elusive; however, environment and life-style factors appear to be the driving forces.Evidence shows that chemical air pollutants and anthropogenic aerosols can alter the impactof allergenic pollen by changing the amount and features of the allergens therebysimultaneously increasing human susceptibility to them. Climate change is also affectingnatural allergens in several ways.Air PollutionAir pollution and climate change are closely linked. The greenhouse gas CO2 is the majorcause of human-induced climate change, and is emitted from the use of carbon-based fuelsfor power generation, transport, building and industry, and from household cooking andheating. Additional climate change is caused by some of the air pollutants arising frominefficient use of these fuels. These include methane and carbon monoxide, which interactwith other volatile organic pollutants in the environment to form ozone, as well as variousforms of particulate matter such as black carbon. It is these non-CO2 air pollutants that alsohave direct and sometimes severe consequences for health.Air pollution in and around the home carries an even heavier disease burden. Close to twomillion premature deaths annually, mostly in women and children in developing countries,are attributed to household air pollution due to the inefficient use of solid fuels for cooking.Controlling air pollution through improvements in both the efficiency and renewability ofenergy supplies and use, as well as monitoring and modelling air quality, holds substantialbenefits now and in the future for both health and climate.Better use of available technologies, policies and measures to reduce short-lived air pollutantscould generate immediate, significant benefits in human well-being, the climate system andthe environment.Free eBook Free Sharing
  12. 12. Pre-term BirthBorn Too Soon: The Global Action Report on Preterm Birth, published jointly by theWorld Health Organization and Save the Children, provides the first-ever national, regionaland global estimates of preterm birth. The report shows the extent to which preterm birth ison the rise in most countries, and is now the second leading cause of death globally forchildren under five, after pneumonia.Addressing preterm birth is now an urgent priority for reaching Millennium DevelopmentGoal 4, which calls for the reduction of child deaths by two-thirds by 2015. This report showsthat rapid change is possible and identifies priority actions for everyone. Born Too Soonproposes actions for policy, programs and research by all partners – from governments toNGOs to the business community — that if acted upon, will substantially reduce the toll ofpreterm birth, especially in high-burden countries.According to the report published recently, India has the highest number of deaths due topremature births, and ranks 36th in the list of pre-term births globally. The ranking included199 countries.Of the 27 million babies born in India annually (2010 figure), 3.6 million are bornprematurely, of which 303,600 don’t survive due to complications. The deaths due to pre-term births are second only to pneumonia, it notes.In terms of deaths due to pre-term birth, India is at the top (indicating it fares the worst),while in terms of the rate of pre-term births, it is ranked 36th, after Malawi (ranked first),Pakistan (ranked eighth), Nepal (20th), and Bangladesh (24th), says the report.Highlights  Pre-term was defined as 37 weeks of completed gestation or less  Each year, 15 million babies, making up more than one in 10 births globally, are born too early  More than 60 per cent of pre-term births occur in Africa and South Asia.  In terms of the rate of pre-term births, India is ranked 36thIn terms of deaths due to pre-term birth, India is at the top.For the report, pre-term was defined as 37 weeks of completed gestation or less, which is thestandard WHO definition. Each year, 15 million babies, making up more than one in 10 birthsglobally, are born too early, says the report. More than one million of those babies die shortlyafter birth; countless more suffer some type of lifelong physical, neurological, or educationaldisability, often at great cost to families.An estimated three quarters of the pre-term babies who die can survive without expensivecare, if a few proven and inexpensive treatments and preventions are available globally,according to more than 100 experts who contributed to the report, representing almost 40U.N. agencies, universities, and organisations.Free eBook Free Sharing
  13. 13. Top 10 CountriesMore than 60 per cent of pre-term births occur in Africa and South Asia. The countries withthe greatest numbers of preterm births are 1.) India (3,519,100); 2. China (1,172,300); 3.Nigeria (773,600); 4. Pakistan (748,100); 5. Indonesia (675,700); 6. United States (517,400);7. Bangladesh (424,100); 8. Philippines (348,900); 9. Democratic Republic of the Congo(341,400); and 10. Brazil (279,300).Why Do Preterm Births Matter?Urgent action is needed to address the estimated 15 million babies born too soon, especiallyas preterm birth rates are increasing each year. This is essential in order to progress on theMillennium Development Goal (MDG) for child survival by 2015 and beyond, since 40 percent of under-five deaths are in newborns, and it will also give added value to maternal health(MDG 5) investments. For babies who survive, there is an increased risk of disability, whichexacts a heavy load on families and health systems.Why Does Preterm Birth Happen?Preterm birth occurs for a variety of reasons. Some preterm births result from early inductionof labor or cesarean birth whether for medical or non-medical reasons. Most preterm birthshappen spontaneously. Common causes include multiple pregnancies, infections and chronicconditions, such as diabetes and high blood pressure; however, often no cause is identified.There is also a genetic influence. Better understanding of the causes and mechanisms willadvance the development of prevention solutions.Goal By 2025Since prematurity contributes significantly to child mortality, Born Too Soon presents a newgoal for the reduction of deaths due to complications of preterm birth:  For countries with a current neonatal mortality rate level of more than or equal to 5 per 1,000 live births, the goal is to reduce the mortality due to preterm birth by 50% between 2010 and 2025.  For countries with a current neonatal mortality rate level of less than 5 per 1,000 live births, the goal is to eliminate remaining preventable preterm deaths, focusing on equitable care for all and quality of care to minimize long-term impairment.Free eBook Free Sharing
  14. 14. New Cancer TherapyNano Bubbles: To Kill CancerNano Bubbles, a new therapy is being developed to kill cancer cells and improve the way thedisease is treated.The goal has been set to develop microscopic bubbles or nano bubbles,which are 10,000 times smaller than human hair.It is hoped that when this technology will go to the clinic in years to come, it will improvepatients’ survival rate. It will improve patients’ quality of life and make the treatment muchshorter and much more comfortable.Major hospitals in Texas, including Rice University, Baylor College of Medicine, TexasChildren’s Hospital and MD Anderson Cancer Centre are working together to develop nanobubbles.According to developers, the new therapy has as high survival rates. The standard treatmentsof surgery and chemotherapy have often been costly and physically stressful.A year of treatment using the chemo-drug Doxil could cost patients $100,000. Nanotreatment can run just fraction of that.These Gold nano particles will be injected into patients, which penetrate only cancer cells andonce activated by a laser, create tiny explosions that will kill individual cancer cells withoutharming nearby healthy ones.This new nano medicine has already shown success in treating head and neck cancers andprostate cancer in animals. It is hoped that testing on human cells will begin in near future.Free eBook Free Sharing
  15. 15. Malaria VaccineMalaria is a life-threatening disease caused by parasites that are transmitted to people throughthe bites of infected mosquitoes. According to the WHO estimates, it killed more than sixlakh people in 2010. Most of the people killed were from African children. Despite itswidespread prevalence in underdeveloped countries, we don’t have an effective vaccine todeal with this menace. In the absence of an effective vaccine, prevention and controlmeasures are only options to contain the spread of disease.However, many research projects are in clinical trial stage, and some of which hold promiseto achieve breakthrough in developing effective vaccines. Recently, two studies have beenpublished, one by Australian researchers, another by the US scientists which claim to gettingcloser in the development of vaccines to fight the disease.Researchers at the Burnet Institute, Australia’s largest virology and communicable diseasecentre, have made a major breakthrough in quest for a vaccine against malaria. Thir findingsshow that people who develop immunity to malaria develop antibodies that primarily target aprotein known as PfEMP1, which is produced by Plasmodium falciparum, causing most casesof malaria.These findings unlock the mystery of which malaria proteins, known as variant surfaceantigens (VSAs), could be targeted by an effective vaccine to achieve immunity to malaria.The new findings support the idea that a vaccine could be developed that stimulates theimmune system so that it specifically mounts a strong response (or attack) against thePfEMP1 protein that malaria produces.The findings also show that when the immune system attacks other proteins that malariaproduces, this is not as effective in protecting people. This emphasises that the immunesystem has to ‘get it right’ in order to fight malaria infection effectively.In another development, Scientists at the New York University’s Centre for Genomics andSystems Biology, have found a genome of malaria parasite. The study puts light onplasmodium vivax (P. vivax). P. vivax is a species of malaria that causes problems to humansand is known to be the most prevalent human malaria outside of Africa.India’s the National Institute of Malaria Research also participated in this study. Incidentally,65% of malaria cases in India are caused by P. Vivax.The researchers did the study by analysing the P. vivax strains from different locations, suchas West Africa, Asia and South America. This provided the researchers with the firstgenome-wide perspective of the existence of a global variety of the species. The study foundthat P. Vivax has twice the genetic diversity worldwide than Plasmodium Falciparum strains,thereby revealing an unexpected ability to evolve and present new challenges in the lookoutfor better treatments.Free eBook Free Sharing
  16. 16. The study found that there was significant amount of genetic variation in P. Vivax comparedwith wed thought, which can make the diseases adept at evading any drug or vaccine.Scientists claim that they can move ahead with deeper analysis of the genomic variation topursue better and more effective methods.Types Of Malaria VirusMalaria is caused by Plasmodium parasites. The parasites are spread to people through thebites of infected Anopheles mosquitoes, called “malaria vectors”, which bite mainly betweendusk and dawn.There are four parasite species that cause malaria in humans: Plasmodium falciparum Plasmodium vivax Plasmodium malariae Plasmodium ovalePlasmodium falciparum and Plasmodium vivax are the most common. Plasmodiumfalciparum is the most deadly.Best Treatment Against MalariaMalaria is caused by parasites. In most parts of the world, Plasmodium falciparum, the mostlethal type of human malaria, has become resistant to conventional treatment. This is the useof a single drug (or monotherapy) of chloroquine, sulfadoxine-pyrimethamine, or anotherantimalarial medicine to fight malaria. WHO recommends that countries use a combinationof antimalarial medicines to reduce the risk of drug resistance.WHO recommends combinations that contain derivatives of artemisinin — a substanceextracted from the plant Artemisia annua — along with another effective antimalarial drug.These combinations are called artemisinin-based combination therapies (ACTs). ACTs arecurrently the most effective treatment for malaria, with a 95% cure rateagainst falciparum malaria.Over the past five years, ACTs have been deployed on an increasingly large scale. ACTsproduce a rapid clinical cure and are well tolerated by patients. In addition, ACTs have thepotential to reduce transmission of malaria.Do All Mosquitoes Transmit Malaria?Only certain species of mosquitoes of the Anopheles genus—and only females of thosespecies—can transmit malaria.Malaria is caused by a one-celled parasite called a Plasmodium. FemaleAnopheles mosquitoes pick up the parasite from infected people when they bite to obtainblood needed to nurture their eggs. Inside the mosquito the parasites develop and reproduce.When the mosquito bites again, the parasites mix with its saliva and pass into the blood of theperson being bitten.Free eBook Free Sharing
  17. 17. Present StatusIn 2010, about 3.3 billion people — almost half of the world’s population — were at risk ofmalaria. Every year, this leads to about 216 million malaria cases and an estimated 6,55,000deaths. People living in the poorest countries are the most vulnerable.In Africa, malaria deaths have been cut by one third within the last decade; outside of Africa,35 out of the 53 countries, affected by malaria, have reduced cases by 50 per cent in the sametime period. In countries where access to malaria control interventions has improved mostsignificantly, overall child mortality rates have fallen by approximately 20 per cent.World Malaria DayWorld Malaria Day is commemorated on April 25, the date in 2000 when 44 African leadersmet in Abuja, Nigeria, and committed their countries to cutting malaria-related deaths in halfby 2010.World Malaria Day was instituted by the World Health Assembly at its 60th session in May2007. It is a day for recognising the global effort to provide effective control of malaria. Thetheme for World Malaria Day 2012 is ”Sustain Gains, Save Lives: Invest in Malaria”Free eBook Free Sharing
  18. 18. HIV InfectionsUNAIDS Reports: More Than 50% Drop In New HIV InfectionsLatest data show that a 50% reduction in the rate of new HIV infections (HIV incidence) hasbeen achieved in 25 low- and middle-income countries between 2001 and 2011. more thanhalf of these countries are in subSaharan Africa where the majority of the new HIV infectionsoccur. In a further nine countries the rate of new HIV infections fell steeply—by at least onethird between 2001 and 2011. World AIDS Day report: ResultsA new World AIDS Day report: Results, by the Joint United Nations Programme onHIV/AIDS (UNAIDS), shows that unprecedented acceleration in the AIDS response isproducing results for people. The report shows that a more than 50% reduction in the rate ofnew HIV infections has been achieved across 25 low- and middle-income countries––morethan half in Africa, the region most affected by HIV.In some of the countries which have the highest HIV prevalence in the world, rates of newHIV infections have been cut dramatically since 2001; by 73% in Malawi, 71% in Botswana,68% in Namibia, 58% in Zambia, 50% in Zimbabwe and 41% in South Africa andSwaziland.In addition to welcome results in HIV prevention, sub-Saharan Africa has reduced AIDS-related deaths by one third in the last six years and increased the number of people onantiretroviral treatment by 59% in the last two years alone.“The pace of progress is quickening—what used to take a decade is now being achieved in 24months,” said Michel Sidibé, Executive Director of UNAIDS. “We are scaling up faster andsmarter than ever before. It is the proof that with political will and follow through we canreach our shared goals by 2015.”For example, South Africa increased its scale up of HIV treatment by 75% in the last twoyears—ensuring 1.7 million people had access to the lifesaving treatment—and new HIVinfections have fallen by more than 50 000 in just two years. During this period, South Africaalso increased its domestic investments on AIDS to US$ 1.6 billion, the highest by any low-and middle-income country.The report also shows that countries are assuming shared responsibility by increasingdomestic investments. More than 81 countries increased domestic investments by 50%between 2001 and 2011. The new results come as the AIDS response is in a 1000 day push toreach the Millennium Development Goals and the 2015 targets of the UN PoliticalDeclaration on HIV/AIDS.Declining new HIV infections in childrenThe area where perhaps most progress is being made is in reducing new HIV infections inchildren. Half of the global reductions in new HIV infections in the last two years have beenamong newborn children. “It is becoming evident that achieving zero new HIV infections inchildren is possible,” said Mr Sidibé. “I am excited that far fewer babies are being born withHIV. We are moving from despair to hope.”Free eBook Free Sharing
  19. 19. In the last two years, new HIV infections in children decreased by 24%. In six countries––Burundi, Kenya, Namibia, South Africa, Togo and Zambia––the number of children newlyinfected with HIV fell by at least 40% between 2009 and 2011.Fewer AIDS-related deathsThe report shows that antiretroviral therapy has emerged as a powerful force for saving lives.In the last 24 months the numbers of people accessing treatment has increased by 63%globally. In sub-Saharan Africa, a record 2.3 million people had access to treatment. Chinahas increased the number of people on HIV treatment by nearly 50% in the last year alone.There were more than half a million fewer deaths in 2011 than in 2005. The largest drops inAIDS-related deaths are being seen in countries where HIV has the strongest grip. SouthAfrica saw 100 000 fewer deaths, Zimbabwe nearly 90 000, Kenya 71 000 and Ethiopia 48000 than in 2005.Impressive gains were also made in reducing tuberculosis (TB) related AIDS deaths in peopleliving with HIV. In the last 24 months, a 13% decrease in TB-related AIDS deaths wasobserved. This accomplishment is due to record numbers of people with HIV/TB co-infectionaccessing antiretroviral treatment—a 45% increase. The report recognizes the need to domore to reduce TB-related AIDS deaths.More investmentsThe report shows that countries are increasing investments in the AIDS response despite adifficult economic climate. The global gap in resources needed annually by 2015 is now at30%. In 2011, US$ 16.8 billion was available and the need for 2015 is between US$ 22-24 billion.In 2011, for the first time ever, domestic investments from low- and middle-income countriessurpassed global giving for HIV. However, international assistance, which has been stable inFree eBook Free Sharing
  20. 20. the past few years, remains a critical lifeline for many countries. In 26 of 33 countries in sub-Saharan Africa, donor support accounts for more than half of HIV investments. The UnitedStates accounts for 48% of all international assistance for HIV and together with the GlobalFund for AIDS, Tuberculosis and Malaria provide the lion’s share of investments in HIVtreatment. However, countries must take steps to reduce the high dependency on internationalassistance for HIV treatment programmes.1000 days to goAn estimated 6.8 million people are eligible for treatment and do not have access. UNAIDSalso estimates that an additional 4 million discordant couples (where one partner is livingwith HIV) would benefit from HIV treatment to protect their partners from HIV infection.Of the 34 million people living with HIV, about half do not know their HIV status. The reportstates that if more people knew their status, they could come forward for HIV services.In addition, there is an urgent need to improve HIV treatment retention rates; reduce the costof second- and third-line treatment; and explore new ways of expanding and sustainingaccess to treatment, including domestic production of medicines and innovative financing.Despite the encouraging progress in stopping new HIV infections, the total number of newHIV infections remains high—2.5 million in 2011. The report outlines that to reduce newHIV infections globally combination HIV prevention services need to be brought to scale.For example, scaling up voluntary medical male circumcision has the potential to prevent anestimated one in five new HIV infections in Eastern and Southern Africa by 2025.The report shows that HIV continues to have a disproportionate impact on sex workers, menwho have sex with men and people who inject drugs. HIV prevention and treatmentprogrammes are largely failing to reach these key populations. “UNAIDS will focus on supporting countries to accelerate access to HIV testing andtreatment. Now that we know that rapid and massive scale up is possible, we need to do more to reach key populations with crucial HIV services,” said Mr. Sidibé.Free eBook Free Sharing
  21. 21. HIV VaccinesOxford University scientists have discovered a compound that greatly boosts the effect ofvaccines against viruses like flu, HIV and herpes in mice. The research, published in thejournal Nature Biotechnology, claims to have discovered a potent adjuvant for test vaccinesagainst these deadly viruses. The adjuvant is a type of polymer called polyethyleneimine(PEI). It was discovered through an experiment on mice.Mice given a single dose of a flu vaccine including PEI via a nasal droplet were completelyprotected against a lethal dose of flu. This was a marked improvement over mice given theflu vaccine without an adjuvant or in formulations with other adjuvants.The Oxford researchers now intend to test the PEI adjuvant in ferrets, a better animal modelfor studying flu. They also want to understand how long the protection lasts for. It is likely tobe a couple of years before a flu vaccine using the adjuvant could be tested in clinical trials inhumans, the researchers say.What Is Adjuvant?An ‘adjuvant’ is a substance added to a vaccine to enhance the immune response and offerbetter protection against infection. When added to a vaccine, adjuvant irritates the tissue,which results in a more robust response from the immune system. The stronger the responsefrom the immune system, the more antibodies will be created and, theoretically, the betterprotected the individual will be from contracting the disease vaccinated against.Most vaccines include an adjuvant. The main ingredient of the vaccine — whether it is a deador disabled pathogen, or just a part of the virus or bacteria causing the disease — primes thebody’s immune system so it knows what to attack in case of infection. But the adjuvant isneeded as well to stimulate this process.While the need for adjuvants in vaccines has been recognised for nearly 100 years, the wayadjuvants work has only recently been understood. The result has been that only a small setof adjuvants is used in current vaccines, often for historical reasons.Progress Towards HIV VaccinationAlthough the development of an effective vaccine to prevent HIV infection has provedenormously challenging, researchers have made remarkable progress toward that goal inrecent years.In 2009, a clinical trial in Thailand demonstrated for the first time that a vaccine can preventHIV infection. Though the protection it provided was too modest to support licensure,subsequent analysis of the immune responses induced by the vaccine regimen has providedinformation that will be applied to the design and clinical evaluation of future HIV vaccinecandidates.There also has been considerable progress in research to tackle some of the most challengingproblems faced by HIV vaccinologists. Scientists have isolated and closely analysed dozensof exceptionally potent antibodies that neutralize a broad spectrum of HIV variantscirculating around the world.Free eBook Free Sharing
  22. 22. In addition, several preclinical studies of novel vectors for HIV vaccine have producedpromising results, far exceeding the performance in similar studies of candidates that aretoday in clinical trials. We expect that these vectors will prove capable of provoking stronger,better sustained responses against HIV. These novel vectors include three that have advancedto Phase I trials: Ad35 + Ad26; DNA + Ad5; and electorporated DNA/IL12/Ad35.These and other advances in HIV vaccine development—including the design of new toolsand technologies for vaccine delivery—have boosted optimism in the field about theprospects for the development of a safe and effective AIDS vaccine.Source: International AIDS Vaccine InitiativeInternational AIDS Vaccine Initiative (IAVI)The International AIDS Vaccine Initiative (IAVI) is a global not-for-profit organisationwhose mission is to ensure the development of safe, effective, accessible, preventive HIVvaccines for use throughout the world. Founded in 1996, IAVI works with partners in 25countries to research, design and develop AIDS vaccine candidates.HIV Vaccine Effort By IndiaThe Translational Health Sciences and Technology Institute (THSTI), an autonomousinstitute of the Indian government’s Department of Biotechnology, and the InternationalAIDS Vaccine Initiative(IAVI) announced in March, 2011 to jointly establish, operate andfund an HIV Vaccine Design Programme in India.The program will include the establishment of a new laboratory on the campus of THSTI inthe National Capital Region of New Delhi. The program will primarily focus on one of thegreatest scientific challenges of AIDS vaccine design and development: the elicitation ofantibodies capable of neutralizing a broad spectrum of circulating HIV variants, a problemthat stems in large part from the almost unparalleled mutability of HIV.Read More At THSTI & IAVI Announce New HIV vaccine Design Programme in India THSTI-IAVI HIV Vaccine Design Program Related Readings From Web Homing in on the target Needle of hope Hunt for HIV Slayers AIDS InfoFree eBook Free Sharing
  23. 23. MalnutritionHUNGaMA Report on MalnutritionThe Prime Minister, Dr Manmohan Singh released the HUNGaMA (Hunger andMalnutrition) Report-2011 on January 10. The report reveals that despite India’s remarkableeconomic growth over the last decade, many children still struggle to meet their most basicneeds, including access to sufficient food and health care.The results of this survey are both worrying and encouraging. The HUNGaMA Survey showsthat positive change for child nutrition in India is happening. However, rates of childmalnutrition are still unacceptably high.The survey reports high levels of malnutrition, but it also indicates that one child in five hasreached an acceptable healthy weight during the last 7 years in 100 focus districts. This 20per cent decline in malnourishment in the last seven years is better than the rate of declinereported in National Family Health Survey – 3. However, 42 per cent of Indian children arestill underweight. This is an unacceptably high occurrence.Highlights:  HUNGaMA Survey shows a recent set of district level data on nutrition status of children below 5 years old  It presents underweight, stunting and wasting data at the district level  Survey conducted across 112 rural districts of India in 2011  Of the 112 districts surveyed, 100 were selected from the bottom of a child development district index  In the 100 Focus Districts, 42 per cent of children under five are underweight and 59 per cent are stuntedAccording to the 2005-06 National Family Health Survey (NFHS-3), 20 per cent of Indianchildren under five years old were wasted (acutely malnourished) and 48 per cent werestunted (chronicallymalnourished). Importantly, with 43 per cent of children underweight (with a weight deficitfor their age) rates of child underweight in India are twice higher than the average figure insub-Saharan Africa (22 per cent). The consequences of this nutrition crisis are enormous; inaddition to being the attributable cause of one third to one half of child deaths, malnutritioncauses stunted physical growth and cognitive development that last a lifetime; the economiclosses associated with malnutrition are estimated at 3 per cent of India’s GDP annually. Inthis context, it was important to get a more recent set of data on child nutrition in India—thecountry has no data since 2006—to understand the current situation and plan focused action.The HUNGaMA (Hunger and Malnutrition) Survey conducted across 112 rural districts ofIndia in 2011 provides reliable estimates of child nutrition covering nearly 20 per cent ofIndian children. Of the 112 districts surveyed, 100 were selected from the bottom of a childdevelopment district index developed for UNICEF India in 2009, referred to as the 100 FocusFree eBook Free Sharing
  24. 24. Districts in this report. These 100 districts are located in 6 states, namely Bihar, Jharkhand,Madhya Pradesh, Orissa, Rajasthan and Uttar Pradesh.Having the largest sample size for a child nutrition survey since 2004, the HUNGaMASurvey captured nutrition status of 1 09,093 children under five years of age. Data collectiontook place between October 2010 and February 2011 in 3,360 villages across 9 states.Coordinated by the Naandi Foundation , the HUNGaMA survey presents underweight,stunting and wasting data at the district level (this was last done in 2004 by DLHS-2 , whichreported only underweight estimates). The HUNGaMA Survey was conducted with theobjective of presenting to the nation a recent set of district level data on nutrition status ofchildren below 5 years old.HUNGaMA survey was triggered as an idea by the Citizen’s Alliance against Malnutrition, agroup that includes MPs across party lines and many other prominent personalities.About 100 districtsThe 100 focus districts come from six states: Bihar, Jharkhand, Madhya Pradesh, Orissa,Rajasthan, and Uttar Pradesh. These states have, in many ways, become “usual suspects” –they encompass the BIMARU states (Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh),are a subset of the Empowered Action Group (EAG) states (Bihar, Jharkhand, Uttar Pradesh,Uttaranchal, Rajasthan, Orissa, Madhya Pradesh, Chhattisgarh), and have substantial overlapwith the “backward” districts identified for early rollout of the National Rural EmploymentGuarantee Act (NREGA) in 2005. All of these groupings have been the focus for urgentaction by the Indian government and other actors because they have lagged behind in variousdevelopment indicators. The HUNGaMA Survey results provide new data to guide policyand programme action for maternal and child nutrition.Key FindingsThe HUNGaMA Survey shows that positive change for child nutrition in India is happening,including in the 1 00 Focus Districts. However rates of child malnutrition are stillunacceptably high particularly in these Focus Districts where over 40 per cent of children areunderweight and almost 60 per cent are stunted. The key findings of the HUNGaMA Surveyare as follows:  Child malnutrition is widespread across states and districts: In the 100 Focus Districts, 42 per cent of children under five are underweight and 59 per cent are stunted. Of the children suffering from stunting, about half are severely stunted. In the best district in each of these states, the rates of child underweight and stunting are significantly lower — 33 and 43 per cent respectively;  A reduction in the prevalence of child malnutrition is observed: In the 100 Focus Districts, the prevalence of child underweight has decreased from 53 per cent (District Level Health Survey (DLHS), 2004) to 42 per cent (HUNGaMA 2011); this represents a 20.3 per cent decrease over a 7 year period with an average annual rate of reduction of 2.9 per cent.  Child malnutrition starts very early in life: By age 24 months, 42 per cent of children are underweight and 58 per cent are stunted in the 100 Focus Districts; birth weight seems to be an important risk-factor as the prevalence of underweight inFree eBook Free Sharing
  25. 25. children born with a weight below 2.5 kg is 5 0 per cent while that among children born with a weight above 2.5 kg is 34 per cent; the corresponding figures for stunting are 62 and 50 per cent respectively;  Household socio-economic status has a significant effect on children’s nutrition status: The prevalence of malnutrition is significantly higher among children from low-income families, although rates of child malnutrition are significant among middle and high income families. Children from households identifying as Muslim or belonging to Scheduled Castes or Schedule Tribes generally have worse nutrition;  Girls’ nutrition advantage over boys fades away with time: Girls seem to have a nutrition advantage over boys in the first months of life; however this advantage seems to be reversed over time as girls and boys grow older, potentially indicating feeding and care neglect vis-à-vis girls in infancy and early childhood;  Mothers’ education level determines children’s nutrition: In the 100 Focus Districts, 66 per cent mothers did not attend school; rates of child underweight and stunting are significantly higher among mothers with low levels of education; the prevalence of child underweight among mothers who cannot read is 45 per cent while that among mothers with 10 or more years of education is 27 per cent. The corresponding figures for child stunting are 63 and 43 per cent respectively. It was also found that 92 per cent mothers had never heard the word “malnutrition”;  Giving colostrum to the newborn and exclusive breastfeeding for first 6 months of a child’s life are not commonly practised: In the 100 Focus Districts 51 per cent mothers did not give colostrum to the newborn soon after birth and 58 per cent mothers fed water to their infants before 6 months.  Hand washing with soap is not a common practice: In the 100 Focus Districts 11 per cent mothers said they used soap to wash hands before a meal and 19 per cent do so after a visit to the toilet;  Anganwadi Centres are widespread but not always efficient: There is an Anganwadi centre in 96 per cent of the villages in the 1 00 Focus Districts, 61 per cent of them in pucca buildings; the Anganwadi service accessed by the largest proportion of mothers (86 per cent) is immunization; 61 per cent of Anganwadi Centres had dried rations available and 50 per cent provided food on the day of survey; only 19 per cent of the mothers reported that the Anganwadi Centre provides nutrition counseling to parents.How to Measure MalnutritionThe most common measures of malnutrition require only three key pieces of information: theperson’s age, weight, and height. From these three, it’s possible to determine if a person is:  Stunted, meaning the person has a low height for her age – an indication of chronic malnutrition over a long period of time  Wasted, meaning the person has a low weight for her height – an indication of acute malnutrition in the child at present  Underweight, meaning the person has a low weight for her age – a indication of general malnutritionThe HUNGaMA survey includes weight, height, age, and a fourth measure called mid-upperarm circumference to provide a comprehensive picture of nutrition.Free eBook Free Sharing
  26. 26. The above measures are taken in reference to a normal, healthy growth path for children, asdefined by the World Health Organization (WHO) Child Growth Standards. WHO developedthe standard by measuring healthy children from many countries, including India.When a child is below a normal, healthy growth path (more than two “standard deviations”below average, in statistical terms) the child is considered to be malnourished. If the child isvery far below the normal, healthy growth path (by more than three standard deviations) thechild is considered to be severely malnourished.Another metric to assessing malnutrition is the mid-upper arm circumference (MUAC). Thecircumference of the child’s upper arm half way between their shoulder and elbow providesan indication of acute malnutrition independent of the child’s age. If the child’s arm is lessthan 11.5cm in circumference, she is severely malnourished; if the child’s arm is between11.5 and 12.5cm in circumference, she is moderately malnourished. These values areappropriate for children from 6 months to 60 months.Malnutrition: A national Shame“The problem of malnutrition is a matter of national shame. Despite impressive growth in ourGDP, the level of under-nutrition in the country is unacceptably high,” Prime Minister Dr.Manmohan Singh said after releasing the report . Pointing out that India had not succeeded inreducing the levels of malnutrition fast enough, he said, “Though the Integrated ChildDevelopment Scheme continues to be our most important tool to fight malnutrition, we canno longer rely solely on it.In 2011, National Council on India’s Nutrition Challenges had decided upon four things:  To launch a strengthened and restructured ICDS  To start a multi-sectoral programme for 200 high-burden districts  To initiate a nationwide communication campaign against malnutrition  And to bring nutrition focus to key programmes of agricultural development, research and development in agriculture, the Public Distribution System, the mid-day-meals programme, drinking water, sanitation, health.(Food Security Bill has been included on the list).Policy makers and programme implementers need to clearly understand many linkages—between education and health, sanitation and hygiene, drinking water and nutrition—and thenshape their responses accordingly.Related Readings From Web:  Malnutrition  Malnutrition and India by UNICEF  Our stunted futureFree eBook Free Sharing
  27. 27. Global Burden Of DiseaseA study published in The Lancet says that people around the world are living longer but withhigher levels of sickness. The study, Global Burden of Diseases, Injuries, and Risk FactorsStudy 2010, is the vast collaborative effort, which claims to be the largest ever study of theglobal burden of disease.The effort includes papers by nearly 500 authors in 50 countries. Spanning four decades ofdata, it represents the most comprehensive analysis ever undertaken of health problemsaround the world.The GBD 2010 is significantly broader in scope than previous versions, including:  291 diseases and injuries  67 risk factors  1,160 sequelae (nonfatal health consequences)  Estimates for 21 regions  Estimates for 20 age groups  Improved methods for the estimation of health state severity weightsKey Activities 1. Produced valid, unbiased, and comparable estimates of prevalence of disease and injury cases or episodes and relevant disabling sequelae at the population level for the GBD regions 2. Produced cause-specific mortality by region that collectively sums to all-cause mortality estimates globally 3. Revised the health state severity weight system, a highly debated component of past GBD studies that seeks to measure health state severity 4. Produced estimates of years lived with disability( YLDs), years of life loss (YLLs), death, and disability-adjusted life years (DALYs) for diseases, injuries, and risk factors for 21 regions for 20 age groups and both sexes, for 1990, 2005, and 2010CollaboratorsThe GBD 2010 is a collaboration of hundreds of researchers around the world, led by theInstitute for Health Metrics and Evaluation at the University of Washington and a consortiumof several other institutions including:  Harvard University  Imperial College London  Johns Hopkins University  University of Queensland  University of Tokyo  World Health Organization (WHO)Free eBook Free Sharing
  28. 28. History Of The GBD StudyThe original Global Burden of Disease Study (GBD 1990) was commissioned by the WorldBank in 1991 to provide a comprehensive assessment of the burden of 107 diseases andinjuries and 10 selected risk factors for the world and eight major regions. The methodsestablished by that study created a common metric to estimate the health loss associated withmorbidity and mortality.Good News  We’re living longer. Average life expectancy has risen globally since 1970 and has increased in all but eight of the world’s countries within the past decade  Both men and women are gaining years. From 1970 to 2010, the average lifespan rose from 56.4 years to 67.5 years for men, and from 61.2 years to 73.3 years for women  Efforts to combat childhood diseases and malnutrition have been very successful. Deaths in children under five years old declined almost 60 per cent in the past four decades  Developing countries have made huge strides in public health. In the Maldives, Bangladesh, Bhutan, Iran, and Peru, life expectancy has increased by more than 20 years since 1970.  Within the past two decades, gains of 12 to 15 years have occurred in Angola, Ethiopia, Niger, and Rwanda, an indication of successful strategies for curbing HIV, malaria, and nutritional deficiencies  We’re beating many communicable diseases. Thanks to improvements in sanitation and vaccination, the death rate for diarrheal diseases, lower respiratory infections, meningitis, and other common infectious diseases has dropped by 42 per cent since 1990.And the bad News  Non-infectious diseases are on the rise, accounting for two of every three deaths globally in 2010. Heart disease and stroke are the primary culprits.  Deaths in the 15 to 49 age bracket have increased globally in the past 20 years. The reasons vary by region, but diabetes, smoking, alcohol, HIV/AIDS, and malaria all play a role.  The HIV/AIDS epidemic is taking a toll in sub-Saharan Africa. Life expectancy has declined overall by one to seven years in Zimbabwe and Lesotho, and young adult deaths have surged by more than 500 per cent since 1970 in South Africa, Botswana, Zambia, and Zimbabwe.  Alcohol overconsumption is a growing problem in the developed world, especially in Eastern Europe, where it accounts for almost a quarter of the total disease burden. Worldwide, it has become the top risk factor for people ages 15 to 49.  Deaths attributable to obesity are on the rise, with 3.4 million in 2010 compared to 2 million in 1990. Similarly, deaths attributable to dietary risk factors and physical inactivity have increased by 50 per cent (4 million) in the past 20 years.  Overall, we’re consuming too much sodium, trans fat, processed meat, and sugar- sweetened beverages, and not enough fruits, vegetables, whole grains, nuts, fiber, calcium, and omega-3 fatty acids.  Smoking is a lingering problem. Tobacco smoking, including second-hand smoke, is still the top risk factor for disease in North America and Western Europe, just as itFree eBook Free Sharing
  29. 29. was in 1990. Globally, it’s risen in rank from the third to second leading cause of disease.Read More:  A comparative risk assessment of burden of disease and injury  Years lived with disability (YLDs)  Age‐specific and sex‐specific mortality  Healthy life expectancy for 187 countries  Global and regional mortality  Common values in assessing health outcomes  Disability‐adjusted life years (DALYs)  VisualizationsFree eBook Free Sharing
  30. 30. Child SurvivalUNICEF Progress Report: Committing To Child SurvivalTo advance Every Woman Every Child, a strategy launched by United Nations Secretary-General Ban Ki-moon, UNICEF and other UN organisations are joining partners from thepublic, private and civil society sectors in a global movement to accelerate reductions inpreventable maternal, newborn and child deaths.The Child Survival Call to Action was convened in June 2012 by the Governments ofEthiopia, India and the United States, together with UNICEF, to examine ways to spurprogress on child survival. A modelling exercise presented at this event demonstrated that allcountries can lower child mortality rates to 20 or fewer deaths per 1,000 live births by 2035.A Promise RenewedPartners emerged from the Call to Action with a revitalised commitment to child survivalunder the banner of A Promise Renewed. Since June, more than 100 governments and manycivil society and private sector organisations have signed a pledge to redouble their efforts,and many more are expected to follow suit in the days and months to come.To meet the goals of A Promise Renewed, efforts must focus on scaling up essentialinterventions through the following three priority actions: 1. Evidence-based country plans 2. Transparency and mutual accountability 3. Global communication and social mobilisationAnnual ReportsIn support of A Promise Renewed, UNICEF is publishing yearly reports on child survival tostimulate public dialogue and help sustain political commitment. This year’s report,‘Committing to Child Survival – A Promise Renewed’, released in conjunction with theannual review of the child mortality estimates of the UN Inter-Agency Group on MortalityEstimation, presents:  Trends and levels in under-five mortality over the past two decades.  Causes of and interventions against child deaths.  Brief examples of countries that have made radical reductions in child deaths over the past two decades.  A summary of the strategies for meeting the goals of A Promised Renewed.  Statistical tables of child mortality and causes of under-five deaths by country and UNICEF regional classification.Trends In Child Mortality  The number of under-five deaths worldwide has decreased from nearly 12 million in 1990 to less than 7 million in 2011Free eBook Free Sharing
  31. 31.  The rate of decline in under-five mortality has drastically accelerated in the last decade — from 1.8 per cent per year during the 1990s to 3.2 per cent per year between 2000 and 2011  Under-five deaths are increasingly concentrated in sub-Saharan Africa and South Asia. In 2011, 82 per cent of under-five deaths occurred in these two regions, up from 68 per cent in 1990The ProgressMortality rates among children under 5 years of age fell globally by 41% between 1990 —the base year for the Millennium Development Goals (MDGs) — and 2011, lowering theglobal rate from 87 deaths per 1,000 live births to 51. Importantly, the bulk of the progress inthe past two decades has taken place since the MDGs were set in the year 2000, with theglobal rate of decline in under-five mortality accelerating to 3.2 per cent annually in 2000-2011, compared with 1.8 per cent for the 1990-2000 period.Free eBook Free Sharing
  32. 32. Regional ProgressThe most pronounced falls in under-five mortality rates have occurred in four regions: LatinAmerica and the Caribbean; East Asia and the Pacific; Central and Eastern Europe and theCommonwealth of Independent States (CEE/CIS); and the Middle East and North Africa.All have more than halved their regional rates of under-five mortality since 1990. Thecorresponding decline for South Asia was 48 per cent, which in absolute terms translates intoaround 2 million fewer under-five deaths in 2011 than in 1990 — by far the highest absolutereduction among all regions.Sub-Saharan Africa, though lagging behind the other regions, has also registered a 39%decline in the under-five mortality rate. Moreover, the region has seen a doubling in itsannual rate of reduction to 3.1 per cent during 2000-2011, up from 1.5% during 1990-2000.In particular, there has been a dramatic acceleration in the rate of decline in Eastern andSouthern Africa, which coincided with a substantial scale-up of effective interventions tocombat major diseases and conditions, most notably HIV, but also measles and malaria.Free eBook Free Sharing
  33. 33. National Progress  Many countries have witnessed marked falls in mortality during the last two decades — including some with very high rates of mortality in 1990.  Four — Lao People’s Democratic Republic, Timor-Leste, Liberia and Bangladesh — achieved a reduction of at least two-thirds over the period.  Over the past decade, momentum on lowering under-five deaths has strengthened in many high-mortality countries  45 out of 66 such countries have accelerated their rates of reduction compared with the previous decade.  Eight of the top 10 high mortality countries with the highest increases in the annual rate of reduction between 1990-2000 and 2000-2011 are in Eastern and Southern AfricaSources Of ProgressThe progress is attributable not to improvements in just one or two areas, but rather to a broadconfluence of gains — in medical technology, development programming, new ways ofdelivering health services, strategies to overcome bottlenecks and innovation in householdsurvey data analysis, along with improvements in education, child protection, respect forhuman rights and economic gains in developing countries.The Challenge  There are worrying caveats to this progress. At 2.5 per cent, the annual rate of reduction in under-five mortality is insufficient to meet the MDG 4 target.  Almost 19,000 children under 5 still die each day, amounting to roughly 1.2 million under-five deaths from mostly preventable causes every two monthsA Concentrated Burden  A look at how the burden of under-five deaths is distributed among regions reveals an increasing concentration of mortality in sub-Saharan Africa and South Asia  In 2011, more than four-fifths of all global under-five deaths occurred in these two regions alone  Sub-Saharan Africa accounted for almost half (49%) of the global total in 2011  Despite rapid gains in reducing under-five mortality, South Asia’s share of global under-five deaths remains second highest, at 33 per cent in 2011  In contrast, the rest of the world’s regions have seen their share fall from 32 per cent in 1990 to 18 per cent two decades laterFree eBook Free Sharing
  34. 34. Gaps In ProgressIn 2011, about half of global under-five deaths occurred in just five countries: India, Nigeria,the Democratic Republic of the Congo, Pakistan and ChinaFour of these (all but the Democratic Republic of the Congo) are populous middle-incomecountries India and Nigeria together accounted for more than one-third of the total number ofunder-five deaths worldwideIndia contributes to 24% of total global child deaths and ranks 49th in descendingorder of under 5 mortality in the world.Low Mortality LevelsFor the purposes of this report, low-mortality countries are defined as those with under-five mortality of 10-20 deaths per 1,000 live births in 2011.Free eBook Free Sharing
  35. 35.  Many of the 41 countries in the low mortality category are commonly thought of as middle-income, and the majority only reached this threshold in the current millennium.  Populous members of this group include Brazil, China, Mexico, the Russian Federation and Turkey, among others.  As a group, the low-mortality countries have demonstrated continued progress in recent years, with an annual rate of reduction of 5.6 per cent in the past two decades.  This has resulted in a near-70 per cent reduction in their overall under-five mortality from 47 deaths per 1,000 live births in 1990 to 15 in 2011.  Twenty-two of the 41 low-mortality countries have more than halved their mortality rates since 1990.Free eBook Free Sharing
  36. 36. Very Low Mortality LevelsVery-low-mortality countries have rates below 10 per 1,000 live births  By 2011, 57 countries had managed to lower their national under-five mortality rate below 10 per 1,000 live births.  The burden of under-five deaths in very-low-mortality countries stood at around 83,000 in 2011, representing just over 1 per cent of the global total.  The United States accounted for nearly 40 per cent of the under-five deaths in very- low mortality countries in 2011.  This group includes mostly high-income countries in Europe and North America, joined by a small number of high-income and middle-income countries in East Asia and South America.  The Nordic countries — Denmark, Iceland, Finland, Norway and Sweden — and the Netherlands were the earliest to attain under-five mortality rates below 20 per 1,000 live births.  Sweden achieved this landmark first, in 1959; the other four, along with the Netherlands, had all achieved this level by 1966.  Next were France, Japan and Switzerland, all in 1968, followed by Australia, Canada, Luxembourg, New Zealand and the United Kingdom in 1972, and Belgium, Singapore and the United States in 1974.  Oman was the last country to reach this threshold, in 2002.Free eBook Free Sharing
  37. 37. Thank You For downloading this eBook Developed byA site for Current Affairs & General StudiesEkalavvya is the Online Learning Platform For Career And Competition. It provides a balancedoutlook, in-depth and insightful information towards General Studies and Current affairs for yourcompetitive exams. It helps competition oriented youth to spend less time looking for news,information, views and analysis, and more time using them for their career and competitive goals.For more EBooks and Information on Current Affairs & General Studies, visit: