Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015
coBverage of specific reproductive health care services as well as assessment of observed versus expected maternal mortality as a function of Socio-Demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility.
Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographic disparities widened and, in 2015, there were still 24 countries with MMR greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated etiologic profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care (ANC) visit, 78% of four ANC visits, 81% of in-facility delivery (IFD), and 87% of skilled birth attendance (SBA).
Several challenges to improving reproductive health lie ahead in the SDG era. Countries should: a) establish or renew systems for collection and timely dissemination of health data; b) expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; c) invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including emergency obstetric care (EmOC); d) Adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; e) Examine their own performance with respect to their SDI level, using that information to formulate strategies for improving performance and ensuring optimum reproductive health of their population.
Background Timely assessment of HIV/AIDS burden is essential for policy-setting and program evaluation. Based on the Global Burden of Disease study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, ART coverage and mortality for 195 countries and territories from 1980 to 2015. Methods For countries without high quality vital registration data, we estimated prevalence and incidence from antenatal clinic data and population-based sero-prevalence surveys and assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates, on and off antiretroviral therapy mortality (ART), and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. Estimation of incidence, prevalence and death uses GBD versions of the EPP and Spectrum software originally developed by UNAIDS. These versions have been recoded for speed and use updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high quality vital registration data, we developed the Cohort Incidence Bias Adjustment model to estimate HIV incidence and prevalence largely from the number of deaths due to HIV recorded in cause of death statistics. Cause of death statistics have been corrected for garbage coding and HIV misclassification. Findings Globally, HIV incidence reached its peak in 1997 at 3.3 million. Annual incidence has stayed relatively constant at about 2.5 million since 2005 after a period of faster decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38.8 million in 2015. At the same time, mortality due to HIV/AIDS has been declining at a steady pace from its peak at 1.8 million deaths in 2005 to 1.2 million deaths in 2015. There is substantial heterogeneity in the levels and trends of HIV/AIDS across countries. While success stories can be found in many countries with improved mortality due to HIV/AIDS and declines in annual new infections, slowdowns or increases in rate of change in annual new infections has been observed elsewhere. Manuscript Interpretation The global scale-up of ART and PMTCT has been one of the great successes of global health in the last two decades. In the last decade, progress reducing new infections has been very slow, development assistance for health devoted to HIV has stagnated, and low-income country resources for health have grown slowly. New ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90- 90 UNAIDS targets will be hard to achieve
Importance Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health.
Objective To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion.
Evidence Review Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss.
Findings Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries.
Conclusions and Relevance Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.
We describe the methods of diagnostic and vaccine prevention of mumps
Proceedings of the conference "Molecular basis of epidemiology, diagnosis, prevention and treatment of current infections" 4-6 December 2018
In the issue the place of health literacy in the actual Russian and foreign school curricula is discussed. The research focuses on the basics of epidemiology and virology as important areas that help student training to get them prepared for such actual challenges as mass infectious disease outbreaks caused by the specific traits of the nowadays reality. The publication represents an analysis of Russian educational programs and textbooks on biology subject, as well as life safety fundamentals, and social science subjects. On the basis of the research outcomes, the recommendations for updating the content of Russian educational programs in biology and life safety fundamentals were developed.
Several approaches to the concept of fatherhood present in Western sociological tradition are analyzed and compared: biological determinism, social constructivism and biosocial theory. The problematics of fatherhood and men’s parental practices is marginalized in modern Russian social research devoted to family and this fact makes the traditional inequality in family relations, when the father’s role is considered secondary compared to that of mother, even stronger. However, in Western critical men’s studies several stages can be outlined: the development of “sex roles” paradigm (biological determinism), the emergence of the hegemonic masculinity concept, inter-disciplinary stage (biosocial theory). According to the approach of biological determinism, the role of a father is that of the patriarch, he continues the family line and serves as a model for his ascendants. Social constructivism looks into man’s functions in the family from the point of view of masculine pressure and establishing hegemony over a woman and children. Biosocial theory aims to unite the biological determinacy of fatherhood with social, cultural and personal context. It is shown that these approaches are directly connected with the level of the society development, marriage and family perceptions, the level of egality of gender order.
The article is devoted to the study of the authoritarianism prevalent in the mass consciousness of Russians. The article describes a new approach to the consideration of the authoritarian syndrome as the effects of the cultural trauma as a result of political and socio-cultural transformation of society. The article shows the dynamics of the symptoms of the authoritarianism, which appear in the mass consciousness of Russians from 1993 to 2011. This paper proposes a package of measures aimed at reducing the level of the authoritarianism in Russian society.
This work looks at a model of spatial election competition with two candidates who can spend effort in order to increase their popularity through advertisement. It is shown that under certain condition the political programs of the candidates will be different. The work derives the comparative statics of equilibrium policy platform and campaign spending with respect the distribution of voter policy preferences and the proportionality of the electoral system. In particular, it is whown that the equilibrium does not exist if the policy preferences are distributed over too narrow an interval.
The article examines "regulatory requirements" as a subject of state control over business in Russia. The author deliberately does not use the term "the rule of law". The article states that a set of requirements for business is wider than the legislative regulation.
First, the article analyzes the regulatory nature of the requirements, especially in the technical field. The requirements are considered in relation to the rule of law. The article explores approaches to the definition of regulatory requirements in Russian legal science. The author analyzes legislation definitions for a set of requirements for business. The author concludes that regulatory requirements are not always identical to the rule of law. Regulatory requirements are a set of obligatory requirements for entrepreneurs’ economic activity. Validation failure leads to negative consequences.
Second, the article analyzes the problems of the regulatory requirements in practice. Lack of information about the requirements, their irrelevance and inconsistency are problems of the regulatory requirements in Russia.
Many requirements regulating economic activity are not compatible with the current development level of science and technology. The problems are analyzed on the basis of the Russian judicial practice and annual monitoring reports by Higher School of Economics.
Finally, the author provides an approach to the possible solution of the regulatory requirements’ problem. The author proposes to create a nationwide Internet portal about regulatory requirements. The portal should contain full information about all regulatory requirements. The author recommends extending moratorium on the use of the requirements adopted by the bodies and organizations of the former USSR government.