Top health issues of 2012 13

Top Health Issues of 2012-13

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Table of Contents

Health .................................................................................................................................................... 2

Pre-term Birth.................................................................................................................................... 11

New Cancer Therapy ....................................................................................................................... 13

Malaria Vaccine ................................................................................................................................ 14

HIV Infections .................................................................................................................................... 17

HIV Vaccine ........................................................................................................................................ 21

Malnutrition........................................................................................................................................ 22

Global Burden Of Disease ............................................................................................................. 26

Child Survival .................................................................................................................................... 29

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Health

Atlas Of Health And Climate

As the world’s climate continues to change, hazards to human health are increasing. The
Atlas of Health and Climate, published jointly by the World Health Organisation (WHO) and
the World Meteorological Organization (WMO), illustrates some of the most pressing current
and emerging challenges.

Droughts, floods and cyclones affect the health of millions of people each year. Climate
variability and extreme conditions such as floods can also trigger epidemics of diseases such
as diarrhoea, malaria, dengue and meningitis, which cause death and suffering for many
millions more. The Atlas gives practical examples of how the use of weather and climate
information can protect public health.

The Report has been divided into three sections:

Section 1: Infections

a) Malaria

b) Diarrhoea

c) Meningitis

d) Dengue Fever

Section 2: Emergencies

a) Floods And Cyclones

b) Drought

c) Airborne Dispersion Of Hazardous Materials

Section 3: Emerging Environmental Challenges

a) Heat Stress

b) UV Radiation

c) Pollens

d) Air Pollution

Section 1: Infections


Infectious diseases take a heavy toll on populations around the world. Some of the most
virulent infections are also highly sensitive to climate conditions. For example, temperature,
precipitation and humidity have a strong influence on the reproduction, survival and biting
rates of the mosquitoes that transmit malaria and dengue fever, and temperature affects the
life-cycles of the infectious agents themselves.

The same meteorological factors also influence the transmission of water and food-borne
diseases such as cholera, and other forms of diarrhoeal disease. Hot, dry conditions favour
meningococcal meningitis – a major cause of disease across much of Africa. All of these
diseases are major health problems.

Diarrhoea kills over two million people annually, and malaria almost one million. Meningitis
kills thousands, blights lives and hampers economic development in the poorest countries.
Some 50 million people around the world suffer from dengue fever each year.

Malaria

Malaria is a parasitic disease spread by the bites of infected Anopheles mosquitoes. There are
many species of malaria parasites but, of the five affecting humans, the greatest threat to
health comes from the Plasmodium vivax and Plasmodium falciparum.

Malaria remains a disease of global importance despite much progress in recent years. It is a
persistent threat to health in developing nations where it represents a major constraint to
economic 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 countries
of the tropical and semi-tropical world. Thirty-five countries in central Africa bear the highest
burden of cases, more than 80 per cent, and deaths, more than 90 per cent. This is due to a


number of factors: most deadly parasite species, most efficient mosquito vectors and poor
rural infrastructure.

Prevention: Where malarial control is inadequate, the climate can provide valuable
information about the potential distribution of the disease in both time and space. Climate
variables – rainfall, humidity and temperature – are fundamental to the propagation of the
mosquito vector and to parasite dynamics.

Rainfall produces mosquito-breeding sites, humidity increases mosquito survival and
temperature affects parasite development rates. Mapping, forecasting and monitoring these
variables, and unusual conditions that may trigger epidemics such as cyclones or the breaking
of a drought in a region, enable health services to better understand the onset, intensity and
length of the transmission season.

Diarrhoea

Around two million people die every year due to diarrhoeal disease – 80 per cent are children
under 5. Cholera is one of the most severe forms of waterborne diarrhoeal disease. There are
sporadic incidences of the disease in the developed world, but it is a major public health
concern for developing countries, where outbreaks occur seasonally and are associated with
poverty and use of poor sanitation and unsafe water.

Extreme weather events, such as hurricanes, typhoons, or earthquakes, cause a disruption in
water systems resulting in the mixing of drinking and waste waters, which increase the risk of
contracting cholera.


In 1995 a combined average of 65 per cent of the world’s population had access to improved
drinking water sources and sanitation facilities. That left two billion people relying on
drinking water that could potentially contain pathogens, including Vibrio cholerae, the
causative organism of cholera.

There is a definite correlation between disease outbreaks and inadequate access to safe water
and lack of proper sanitation. Therefore people in the least developed regions of the world
who only have access to unsafe water and poor sanitation also have the greatest burden of
related diseases, like cholera or other diarrhoeal diseases.

Extreme weather-related events such as increased precipitation and flooding further
contaminate water sources, contributing to an oral-faecal contamination pathway that is
difficult 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 parts
of 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 progress
towards improving such services is slow or stagnant.

Meningitis

Meningococcal meningitis is a severe infectious disease of the meninges, a thin layer around
the brain and spinal cord. Several micro-organisms can cause meningitis. The bacterium with
the 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 by
epidemics that occur only during the dry season, from December to May. Over the past 10
years, 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 the
period of the year when there are increases in dust concentrations as well as reductions in
humidity levels linked to the movement of the Inter Tropical Convergence Zone. While the
temporal association between climate and meningitis is evident, what triggers or ends an
epidemic is as yet unknown. One hypothesis is that dry, hot and dusty air irritates the
respiratory mucosa thus facilitating invasion of the bacteria.

The public health strategy to control meningitis epidemics relies on the implementation of
large-scale vaccination campaigns in a timely manner to prevent further cases.

Dengue Fever

Transmitted by Aedes mosquitoes, dengue is the most rapidly spreading mosquito-borne viral
disease in the world. It is estimated to cause over 50 million infections, and around 15,000
deaths every year across approximately 100 countries.

Dengue is now increasing in many parts of the world, driven by development and
globalization – the combination of rapid and unplanned urbanization, movement of goods and


infected people, dispersal of mosquitoes to newer territories, spread and mixing of strains of
the virus, and more favourable climatic conditions.

Prevention: There is currently no effective vaccine or drugs for dengue. Control programmes
rely on environmental or chemical control of the vectors, rapid case detection and case
management in hospitals for severe dengue.

But these interventions are challenging, and there has been only very limited success in
disease outbreak control within the most suitable transmission zones. Future initiatives are
likely to depend not just on development of better interventions, but also on more effective
targeting of control in time and space. In such scenarios, meteorological information can
make an important contribution to understanding where and when dengue cases are likely to
occur.

Section 2: Emergencies

Every year, emergencies caused by weather-, climate- and water-related hazards impact
communities around the world, leading to loss of life, destruction of social and economic
infrastructure and degradation of already fragile ecosystems. Between 80 and 90 per cent of
all documented disasters from natural hazards during the last ten years have resulted from
floods, droughts, tropical cyclones, heat waves and severe storms.

Statistics And The Hidden Impact

In 2011, 332 disasters from natural hazards were recorded in 101 countries, causing more
than 30 770 deaths, and affecting over 244 million people. Recorded damages amounted to
more than US$ 366.1 billion.

But statistics cannot reflect the full health impact or the depths of human suffering felt during
such emergencies. Millions of people have suffered injuries, disease and long-term
disabilities as well as emotional anguish from the loss of loved ones and the memories of
traumatic events.

Over the past 30 years the proportion of the world’s population living in flood-prone river
basins has increased by 114 per cent and those living on cyclone-exposed coastlines by 192
per cent.

Reports of extreme weather events and disasters have more than tripled since the 1960s and
scientists expect such events to become more frequent and severe in the future due to climate
change in many parts of the world. There is also growing evidence that links escalations in
violence and conflict over access to food and water resources to climate.

Climate Services And Health Emergencies

Adopted by 168 Member States at the World Disaster Reduction Conference in Kobe, Japan
in 2005, the Hyogo Framework For Action describes the work that is required from all
different sectors and actors, including health and climate communities, to reduce disaster
losses.


The Global Framework for Climate Services will contribute to the implementation of the
Hyogo Framework by making tailored science-based climate-related information available to
support informed investment and planning at all levels as a critical step in disaster risk
management.

Climate services support health and other sectors to save lives and reduce illness and injury in
emergencies 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-making

Floods And Cyclones

Floods 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 situations


 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 shelter

Drought

Drought 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 area

Airborne Dispersion Of Hazardous Materials

Wildfires and forest fires occur in all vegetation zones. Caused by natural phenomena or by
human activity, emissions from fires contain gas and particle pollutants that can cause diverse
health problems, as well as disrupt transportation, tourism and agriculture. Extreme radiant
heat 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 heat
waves. Climatologists believe that climate change will increase in the incidence of wildfires
as the associated droughts and heat waves are expected to increase in frequency and intensity.


Section 3: Emerging Environmental Challenges

Current development patterns, and individual behavioural choices, are bringing a range of
new challenges to public health. Many of the most important relate to environmental changes.

Heat Stress

Excessive heat is a growing public health threat – for every degree Centigrade above a
threshold level, deaths can increase by 2 – 5 per cent. Prolonged, intense heat waves heighten
the risks. Elderly, chronically-ill and socially-isolated individuals, people working in exposed
environments and children are particularly vulnerable.

While extreme heat affects populations around the world in both developing and developed
countries, some of the most dramatic heat waves have occurred in relatively wealthy regions
of 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 currently
occur 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 of
people at high risk. By 2050, it is estimated that there will be at least 3 times as many people
aged over 65 living in cities around the world, with developing regions seeing the greatest
increases.

The combined effects of escalating hazards and growing vulnerable populations will make
heat stress a health priority for the coming decades.

Protection: Protection from extreme heat requires a range of actions, from providing early
warning, surveillance and treatment for vulnerable populations through to long-term urban
planning to reduce the heat-island effect as well as initiatives to reduce greenhouse gas
emissions to limit the severity of global climate change.

UV Radiation

While small doses of ultraviolet (UV) radiation from the sun help the body produce vitamin
D, excessive exposure is damaging to human health. Excessive exposure may have
consequences ranging from premature ageing of the skin to skin cancer. The number of cases
of malignant melanoma has doubled every 7 to 8 years over the last 40 years – mostly due to
a marked increase in the incidence of skin cancers in fair-skinned populations since the early
1970s.

UV radiation can also severely damage the cornea, lens and retina of the human eye – long
exposures can result in photo keratitis and a lifetime of cumulative exposure contributes to
the risk of cataracts and other forms of ocular damage.

In addition to the above risks, a growing body of evidence suggests that levels of UV
radiation in the environment may enhance the risk of infectious diseases and limit the
efficacy of vaccinations.


Pollens

WHO estimates that around 235 million people currently suffer from asthma worldwide. It is
the 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 impact
of allergenic pollen by changing the amount and features of the allergens thereby
simultaneously increasing human susceptibility to them. Climate change is also affecting
natural allergens in several ways.

Air Pollution

Air pollution and climate change are closely linked. The greenhouse gas CO2 is the major
cause of human-induced climate change, and is emitted from the use of carbon-based fuels
for power generation, transport, building and industry, and from household cooking and
heating. Additional climate change is caused by some of the air pollutants arising from
inefficient use of these fuels. These include methane and carbon monoxide, which interact
with other volatile organic pollutants in the environment to form ozone, as well as various
forms of particulate matter such as black carbon. It is these non-CO2 air pollutants that also
have direct and sometimes severe consequences for health.

Air pollution in and around the home carries an even heavier disease burden. Close to two
million 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 of
energy supplies and use, as well as monitoring and modelling air quality, holds substantial
benefits now and in the future for both health and climate.

Better use of available technologies, policies and measures to reduce short-lived air pollutants
could generate immediate, significant benefits in human well-being, the climate system and
the environment.


Pre-term Birth

Born Too Soon: The Global Action Report on Preterm Birth, published jointly by the
World Health Organization and Save the Children, provides the first-ever national, regional
and global estimates of preterm birth. The report shows the extent to which preterm birth is
on the rise in most countries, and is now the second leading cause of death globally for
children under five, after pneumonia.

Addressing preterm birth is now an urgent priority for reaching Millennium Development
Goal 4, which calls for the reduction of child deaths by two-thirds by 2015. This report shows
that rapid change is possible and identifies priority actions for everyone. Born Too Soon
proposes actions for policy, programs and research by all partners – from governments to
NGOs to the business community — that if acted upon, will substantially reduce the toll of
preterm birth, especially in high-burden countries.

According to the report published recently, India has the highest number of deaths due to
premature births, and ranks 36th in the list of pre-term births globally. The ranking included
199 countries.

Of the 27 million babies born in India annually (2010 figure), 3.6 million are born
prematurely, 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 36th

In 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 the
standard WHO definition. Each year, 15 million babies, making up more than one in 10 births
globally, are born too early, says the report. More than one million of those babies die shortly
after birth; countless more suffer some type of lifelong physical, neurological, or educational
disability, often at great cost to families.

An estimated three quarters of the pre-term babies who die can survive without expensive
care, 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 40
U.N. agencies, universities, and organisations.


Top 10 Countries

More than 60 per cent of pre-term births occur in Africa and South Asia. The countries with
the 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, especially
as preterm birth rates are increasing each year. This is essential in order to progress on the
Millennium Development Goal (MDG) for child survival by 2015 and beyond, since 40 per
cent 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, which
exacts 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 induction
of labor or cesarean birth whether for medical or non-medical reasons. Most preterm births
happen spontaneously. Common causes include multiple pregnancies, infections and chronic
conditions, 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 will
advance the development of prevention solutions.

Goal By 2025

Since prematurity contributes significantly to child mortality, Born Too Soon presents a new
goal 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.


New Cancer Therapy

Nano Bubbles: To Kill Cancer

Nano Bubbles, a new therapy is being developed to kill cancer cells and improve the way the
disease 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 improve
patients’ survival rate. It will improve patients’ quality of life and make the treatment much
shorter and much more comfortable.

Major hospitals in Texas, including Rice University, Baylor College of Medicine, Texas
Children’s Hospital and MD Anderson Cancer Centre are working together to develop nano
bubbles.

According to developers, the new therapy has as high survival rates. The standard treatments
of surgery and chemotherapy have often been costly and physically stressful.

A year of treatment using the chemo-drug Doxil could cost patients $100,000. Nano
treatment can run just fraction of that.

These Gold nano particles will be injected into patients, which penetrate only cancer cells and
once activated by a laser, create tiny explosions that will kill individual cancer cells without
harming nearby healthy ones.

This new nano medicine has already shown success in treating head and neck cancers and
prostate cancer in animals. It is hoped that testing on human cells will begin in near future.


Malaria Vaccine
Malaria is a life-threatening disease caused by parasites that are transmitted to people through
the bites of infected mosquitoes. According to the WHO estimates, it killed more than six
lakh people in 2010. Most of the people killed were from African children. Despite its
widespread prevalence in underdeveloped countries, we don’t have an effective vaccine to
deal with this menace. In the absence of an effective vaccine, prevention and control
measures are only options to contain the spread of disease.

However, many research projects are in clinical trial stage, and some of which hold promise
to achieve breakthrough in developing effective vaccines. Recently, two studies have been
published, one by Australian researchers, another by the US scientists which claim to getting
closer in the development of vaccines to fight the disease.

Researchers at the Burnet Institute, Australia’s largest virology and communicable disease
centre, have made a major breakthrough in quest for a vaccine against malaria. Thir findings
show that people who develop immunity to malaria develop antibodies that primarily target a
protein known as PfEMP1, which is produced by Plasmodium falciparum, causing most cases
of malaria.

These findings unlock the mystery of which malaria proteins, known as variant surface
antigens (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 the
immune system so that it specifically mounts a strong response (or attack) against the
PfEMP1 protein that malaria produces.

The findings also show that when the immune system attacks other proteins that malaria
produces, this is not as effective in protecting people. This emphasises that the immune
system 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 and
Systems Biology, have found a genome of malaria parasite. The study puts light on
plasmodium vivax (P. vivax). P. vivax is a species of malaria that causes problems to humans
and 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, such
as West Africa, Asia and South America. This provided the researchers with the first
genome-wide perspective of the existence of a global variety of the species. The study found
that 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 lookout
for better treatments.


The study found that there was significant amount of genetic variation in P. Vivax compared
with 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 to
pursue better and more effective methods.

Types Of Malaria Virus

Malaria is caused by Plasmodium parasites. The parasites are spread to people through the
bites of infected Anopheles mosquitoes, called “malaria vectors”, which bite mainly between
dusk and dawn.

There are four parasite species that cause malaria in humans:

 Plasmodium falciparum
 Plasmodium vivax
 Plasmodium malariae
 Plasmodium ovale
Plasmodium falciparum and Plasmodium vivax are the most common. Plasmodium
falciparum is the most deadly.

Best Treatment Against Malaria
Malaria is caused by parasites. In most parts of the world, Plasmodium falciparum, the most
lethal type of human malaria, has become resistant to conventional treatment. This is the use
of a single drug (or monotherapy) of chloroquine, sulfadoxine-pyrimethamine, or another
antimalarial medicine to fight malaria. WHO recommends that countries use a combination
of antimalarial medicines to reduce the risk of drug resistance.

WHO recommends combinations that contain derivatives of artemisinin — a substance
extracted from the plant Artemisia annua — along with another effective antimalarial drug.

These combinations are called artemisinin-based combination therapies (ACTs). ACTs are
currently the most effective treatment for malaria, with a 95% cure rate
against falciparum malaria.

Over the past five years, ACTs have been deployed on an increasingly large scale. ACTs
produce a rapid clinical cure and are well tolerated by patients. In addition, ACTs have the
potential to reduce transmission of malaria.

Do All Mosquitoes Transmit Malaria?
Only certain species of mosquitoes of the Anopheles genus—and only females of those
species—can transmit malaria.

Malaria is caused by a one-celled parasite called a Plasmodium. Female
Anopheles mosquitoes pick up the parasite from infected people when they bite to obtain
blood 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 the
person being bitten.


Present Status
In 2010, about 3.3 billion people — almost half of the world’s population — were at risk of
malaria. Every year, this leads to about 216 million malaria cases and an estimated 6,55,000
deaths. 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 same
time period. In countries where access to malaria control interventions has improved most
significantly, overall child mortality rates have fallen by approximately 20 per cent.

World Malaria Day
World Malaria Day is commemorated on April 25, the date in 2000 when 44 African leaders
met in Abuja, Nigeria, and committed their countries to cutting malaria-related deaths in half
by 2010.

World Malaria Day was instituted by the World Health Assembly at its 60th session in May
2007. It is a day for recognising the global effort to provide effective control of malaria. The
theme for World Malaria Day 2012 is ”Sustain Gains, Save Lives: Invest in Malaria”


HIV Infections

UNAIDS Reports: More Than 50% Drop In New HIV Infections

Latest data show that a 50% reduction in the rate of new HIV infections (HIV incidence) has
been achieved in 25 low- and middle-income countries between 2001 and 2011. more than
half of these countries are in subSaharan Africa where the majority of the new HIV infections
occur. In a further nine countries the rate of new HIV infections fell steeply—by at least one
third between 2001 and 2011. World AIDS Day report: Results

A new World AIDS Day report: Results, by the Joint United Nations Programme on
HIV/AIDS (UNAIDS), shows that unprecedented acceleration in the AIDS response is
producing results for people. The report shows that a more than 50% reduction in the rate of
new HIV infections has been achieved across 25 low- and middle-income countries––more
than 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 new
HIV 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 and
Swaziland.

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 on
antiretroviral 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 24
months,” said Michel Sidibé, Executive Director of UNAIDS. “We are scaling up faster and
smarter than ever before. It is the proof that with political will and follow through we can
reach our shared goals by 2015.”

For example, South Africa increased its scale up of HIV treatment by 75% in the last two
years—ensuring 1.7 million people had access to the lifesaving treatment—and new HIV
infections have fallen by more than 50 000 in just two years. During this period, South Africa
also 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 increasing
domestic 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 to
reach the Millennium Development Goals and the 2015 targets of the UN Political
Declaration on HIV/AIDS.

Declining new HIV infections in children

The area where perhaps most progress is being made is in reducing new HIV infections in
children. Half of the global reductions in new HIV infections in the last two years have been
among newborn children. “It is becoming evident that achieving zero new HIV infections in
children is possible,” said Mr Sidibé. “I am excited that far fewer babies are being born with
HIV. We are moving from despair to hope.”


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 newly
infected with HIV fell by at least 40% between 2009 and 2011.

Fewer AIDS-related deaths

The 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. China
has 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 in
AIDS-related deaths are being seen in countries where HIV has the strongest grip. South
Africa saw 100 000 fewer deaths, Zimbabwe nearly 90 000, Kenya 71 000 and Ethiopia 48
000 than in 2005.

Impressive gains were also made in reducing tuberculosis (TB) related AIDS deaths in people
living with HIV. In the last 24 months, a 13% decrease in TB-related AIDS deaths was
observed. This accomplishment is due to record numbers of people with HIV/TB co-infection
accessing antiretroviral treatment—a 45% increase. The report recognizes the need to do
more to reduce TB-related AIDS deaths.

More investments

The report shows that countries are increasing investments in the AIDS response despite a
difficult economic climate. The global gap in resources needed annually by 2015 is now at
30%. 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 countries
surpassed global giving for HIV. However, international assistance, which has been stable in


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 United
States accounts for 48% of all international assistance for HIV and together with the Global
Fund for AIDS, Tuberculosis and Malaria provide the lion’s share of investments in HIV
treatment. However, countries must take steps to reduce the high dependency on international
assistance for HIV treatment programmes.

1000 days to go

An estimated 6.8 million people are eligible for treatment and do not have access. UNAIDS
also estimates that an additional 4 million discordant couples (where one partner is living
with 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 report
states 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 cost
of second- and third-line treatment; and explore new ways of expanding and sustaining
access to treatment, including domestic production of medicines and innovative financing.

Despite the encouraging progress in stopping new HIV infections, the total number of new
HIV infections remains high—2.5 million in 2011. The report outlines that to reduce new
HIV 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 an
estimated 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, men
who have sex with men and people who inject drugs. HIV prevention and treatment
programmes are largely failing to reach these key populations.

“UNAIDS will focus on supporting countries to accelerate access to HIV testing and
treatment. 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.


HIV Vaccines

Oxford University scientists have discovered a compound that greatly boosts the effect of
vaccines against viruses like flu, HIV and herpes in mice. The research, published in the
journal Nature Biotechnology, claims to have discovered a potent adjuvant for test vaccines
against 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 completely
protected against a lethal dose of flu. This was a marked improvement over mice given the
flu 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 model
for studying flu. They also want to understand how long the protection lasts for. It is likely to
be a couple of years before a flu vaccine using the adjuvant could be tested in clinical trials in
humans, the researchers say.

What Is Adjuvant?
An ‘adjuvant’ is a substance added to a vaccine to enhance the immune response and offer
better 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 response
from the immune system, the more antibodies will be created and, theoretically, the better
protected 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 dead
or disabled pathogen, or just a part of the virus or bacteria causing the disease — primes the
body’s immune system so it knows what to attack in case of infection. But the adjuvant is
needed as well to stimulate this process.

While the need for adjuvants in vaccines has been recognised for nearly 100 years, the way
adjuvants work has only recently been understood. The result has been that only a small set
of adjuvants is used in current vaccines, often for historical reasons.

Progress Towards HIV Vaccination
Although the development of an effective vaccine to prevent HIV infection has proved
enormously challenging, researchers have made remarkable progress toward that goal in
recent years.

In 2009, a clinical trial in Thailand demonstrated for the first time that a vaccine can prevent
HIV infection. Though the protection it provided was too modest to support licensure,
subsequent analysis of the immune responses induced by the vaccine regimen has provided
information that will be applied to the design and clinical evaluation of future HIV vaccine
candidates.

There also has been considerable progress in research to tackle some of the most challenging
problems faced by HIV vaccinologists. Scientists have isolated and closely analysed dozens
of exceptionally potent antibodies that neutralize a broad spectrum of HIV variants
circulating around the world.


In addition, several preclinical studies of novel vectors for HIV vaccine have produced
promising results, far exceeding the performance in similar studies of candidates that are
today 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 advanced
to 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 tools
and technologies for vaccine delivery—have boosted optimism in the field about the
prospects for the development of a safe and effective AIDS vaccine.

Source: International AIDS Vaccine Initiative

International AIDS Vaccine Initiative (IAVI)
The International AIDS Vaccine Initiative (IAVI) is a global not-for-profit organisation
whose mission is to ensure the development of safe, effective, accessible, preventive HIV
vaccines for use throughout the world. Founded in 1996, IAVI works with partners in 25
countries to research, design and develop AIDS vaccine candidates.

HIV Vaccine Effort By India
The Translational Health Sciences and Technology Institute (THSTI), an autonomous
institute of the Indian government’s Department of Biotechnology, and the International
AIDS Vaccine Initiative(IAVI) announced in March, 2011 to jointly establish, operate and
fund an HIV Vaccine Design Programme in India.

The program will include the establishment of a new laboratory on the campus of THSTI in
the National Capital Region of New Delhi. The program will primarily focus on one of the
greatest scientific challenges of AIDS vaccine design and development: the elicitation of
antibodies capable of neutralizing a broad spectrum of circulating HIV variants, a problem
that 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 Info


Malnutrition

HUNGaMA Report on Malnutrition

The Prime Minister, Dr Manmohan Singh released the HUNGaMA (Hunger and
Malnutrition) Report-2011 on January 10. The report reveals that despite India’s remarkable
economic growth over the last decade, many children still struggle to meet their most basic
needs, including access to sufficient food and health care.

The results of this survey are both worrying and encouraging. The HUNGaMA Survey shows
that positive change for child nutrition in India is happening. However, rates of child
malnutrition are still unacceptably high.

The survey reports high levels of malnutrition, but it also indicates that one child in five has
reached an acceptable healthy weight during the last 7 years in 100 focus districts. This 20
per cent decline in malnourishment in the last seven years is better than the rate of decline
reported in National Family Health Survey – 3. However, 42 per cent of Indian children are
still 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 stunted

According to the 2005-06 National Family Health Survey (NFHS-3), 20 per cent of Indian
children under five years old were wasted (acutely malnourished) and 48 per cent were
stunted (chronically

malnourished). Importantly, with 43 per cent of children underweight (with a weight deficit
for their age) rates of child underweight in India are twice higher than the average figure in
sub-Saharan Africa (22 per cent). The consequences of this nutrition crisis are enormous; in
addition to being the attributable cause of one third to one half of child deaths, malnutrition
causes stunted physical growth and cognitive development that last a lifetime; the economic
losses associated with malnutrition are estimated at 3 per cent of India’s GDP annually. In
this context, it was important to get a more recent set of data on child nutrition in India—the
country 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 of
India in 2011 provides reliable estimates of child nutrition covering nearly 20 per cent of
Indian children. Of the 112 districts surveyed, 100 were selected from the bottom of a child
development district index developed for UNICEF India in 2009, referred to as the 100 Focus


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 HUNGaMA
Survey captured nutrition status of 1 09,093 children under five years of age. Data collection
took 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 , which
reported only underweight estimates). The HUNGaMA Survey was conducted with the
objective of presenting to the nation a recent set of district level data on nutrition status of
children below 5 years old.

HUNGaMA survey was triggered as an idea by the Citizen’s Alliance against Malnutrition, a
group that includes MPs across party lines and many other prominent personalities.

About 100 districts

The 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 overlap
with the “backward” districts identified for early rollout of the National Rural Employment
Guarantee Act (NREGA) in 2005. All of these groupings have been the focus for urgent
action by the Indian government and other actors because they have lagged behind in various
development indicators. The HUNGaMA Survey results provide new data to guide policy
and programme action for maternal and child nutrition.

Key Findings

The 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 still
unacceptably high particularly in these Focus Districts where over 40 per cent of children are
underweight and almost 60 per cent are stunted. The key findings of the HUNGaMA Survey
are 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 in


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 Malnutrition

The most common measures of malnutrition require only three key pieces of information: the
person’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 malnutrition

The HUNGaMA survey includes weight, height, age, and a fourth measure called mid-upper
arm circumference to provide a comprehensive picture of nutrition.


The above measures are taken in reference to a normal, healthy growth path for children, as
defined by the World Health Organization (WHO) Child Growth Standards. WHO developed
the 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 is
very far below the normal, healthy growth path (by more than three standard deviations) the
child is considered to be severely malnourished.

Another metric to assessing malnutrition is the mid-upper arm circumference (MUAC). The
circumference of the child’s upper arm half way between their shoulder and elbow provides
an indication of acute malnutrition independent of the child’s age. If the child’s arm is less
than 11.5cm in circumference, she is severely malnourished; if the child’s arm is between
11.5 and 12.5cm in circumference, she is moderately malnourished. These values are
appropriate 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 our
GDP, 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 in
reducing the levels of malnutrition fast enough, he said, “Though the Integrated Child
Development Scheme continues to be our most important tool to fight malnutrition, we can
no 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 then
shape their responses accordingly.

Related Readings From Web:

 Malnutrition
 Malnutrition and India by UNICEF
 Our stunted future


Global Burden Of Disease

A study published in The Lancet says that people around the world are living longer but with
higher levels of sickness. The study, Global Burden of Diseases, Injuries, and Risk Factors
Study 2010, is the vast collaborative effort, which claims to be the largest ever study of the
global burden of disease.

The effort includes papers by nearly 500 authors in 50 countries. Spanning four decades of
data, it represents the most comprehensive analysis ever undertaken of health problems
around 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 weights

Key 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 2010

Collaborators

The GBD 2010 is a collaboration of hundreds of researchers around the world, led by the
Institute for Health Metrics and Evaluation at the University of Washington and a consortium
of several other institutions including:

 Harvard University
 Imperial College London
 Johns Hopkins University
 University of Queensland
 University of Tokyo
 World Health Organization (WHO)


History Of The GBD Study

The original Global Burden of Disease Study (GBD 1990) was commissioned by the World
Bank in 1991 to provide a comprehensive assessment of the burden of 107 diseases and
injuries and 10 selected risk factors for the world and eight major regions. The methods
established by that study created a common metric to estimate the health loss associated with
morbidity 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 it


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)
 Visualizations


Child Survival

UNICEF Progress Report: Committing To Child Survival

To 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 the
public, private and civil society sectors in a global movement to accelerate reductions in
preventable maternal, newborn and child deaths.

The Child Survival Call to Action was convened in June 2012 by the Governments of
Ethiopia, India and the United States, together with UNICEF, to examine ways to spur
progress on child survival. A modelling exercise presented at this event demonstrated that all
countries can lower child mortality rates to 20 or fewer deaths per 1,000 live births by 2035.

A Promise Renewed

Partners emerged from the Call to Action with a revitalised commitment to child survival
under the banner of A Promise Renewed. Since June, more than 100 governments and many
civil 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 essential
interventions through the following three priority actions:

1. Evidence-based country plans
2. Transparency and mutual accountability
3. Global communication and social mobilisation

Annual Reports

In support of A Promise Renewed, UNICEF is publishing yearly reports on child survival to
stimulate public dialogue and help sustain political commitment. This year’s report,
‘Committing to Child Survival – A Promise Renewed’, released in conjunction with the
annual review of the child mortality estimates of the UN Inter-Agency Group on Mortality
Estimation, 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 2011


 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 1990

The Progress

Mortality 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 the
global rate from 87 deaths per 1,000 live births to 51. Importantly, the bulk of the progress in
the past two decades has taken place since the MDGs were set in the year 2000, with the
global 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.


Regional Progress

The most pronounced falls in under-five mortality rates have occurred in four regions: Latin
America and the Caribbean; East Asia and the Pacific; Central and Eastern Europe and the
Commonwealth 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. The
corresponding decline for South Asia was 48 per cent, which in absolute terms translates into
around 2 million fewer under-five deaths in 2011 than in 1990 — by far the highest absolute
reduction 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 its
annual 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 and
Southern Africa, which coincided with a substantial scale-up of effective interventions to
combat major diseases and conditions, most notably HIV, but also measles and malaria.


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
Africa

Sources Of Progress

The progress is attributable not to improvements in just one or two areas, but rather to a broad
confluence of gains — in medical technology, development programming, new ways of
delivering health services, strategies to overcome bottlenecks and innovation in household
survey data analysis, along with improvements in education, child protection, respect for
human 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 months

A 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 later


Gaps In Progress

In 2011, about half of global under-five deaths occurred in just five countries: India, Nigeria,
the Democratic Republic of the Congo, Pakistan and China

Four of these (all but the Democratic Republic of the Congo) are populous middle-income
countries India and Nigeria together accounted for more than one-third of the total number of
under-five deaths worldwide

India contributes to 24% of total global child deaths and ranks 49th in descending
order of under 5 mortality in the world.

Low Mortality Levels

For 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.


 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.


Very Low Mortality Levels

Very-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.


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