The Lancet Global Health
Dec 2014 Volume 2 Number 12 e672 – 736
http://www.thelancet.com/journals/langlo/issue/current

Comment
Prevention of neonatal pneumonia and sepsis via maternal immunisation
Amy Sarah Ginsburg, Ajoke Sobanjo-ter Meulen, Keith P Klugman
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Pneumonia is the leading killer of children younger than 5 years, and the greatest risk of mortality from pneumonia in childhood is in the neonatal period.1 Substantial reductions in childhood pneumonia deaths have been hindered by a lack of progress in addressing neonatal mortality. Deaths in the neonatal period constitute 41•6% of the 6•3 million children who die annually before their fifth birthday.2 In 2010, there were an estimated 1•7 million cases of neonatal sepsis and 510 000 cases of neonatal pneumonia.

Comment
Political economy analysis for nutrition policy
Michael R Reich, Yarlini Balarajan
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The past decade has seen increasing global policy attention to nutrition. Concrete steps have been taken to construct a global governance architecture for nutrition and also to mobilise resources for action.1 Efficacious, low-cost interventions exist,2 and there is greater consensus around technical issues, including the role of nutrition-specific and nutrition-sensitive interventions in addressing malnutrition in different settings.3 The economic argument to invest in nutrition is well developed, supported by cost-benefit analyses and studies that quantify the cost to scale up interventions.

Article
Annual rates of decline in child, maternal, HIV, and tuberculosis mortality across 109 countries of low and middle income from 1990 to 2013: an assessment of the feasibility of post-2015 goals
Dr Stéphane Verguet PhD a, Prof Ole Frithjof Norheim PhD b, Zachary D Olson MA a, Gavin Yamey MD c, Prof Dean T Jamison PhD c
Summary
Background
Measuring a country’s health performance has focused mostly on estimating levels of mortality. An alternative is to measure rates of decline in mortality, which are more sensitive to changes in health policy than are mortality levels. Historical rates of decline in mortality can also help test the feasibility of future health goals (eg, post-2015). We aimed to assess the annual rates of decline in under-5, maternal, tuberculosis, and HIV mortality over the past two decades for 109 low-income and middle-income countries.
Methods
For the period 1990—2013, we estimated annual rates of decline in under-5 mortality (deaths per 1000 livebirths), the maternal mortality ratio (deaths per 100 000 livebirths), and tuberculosis and HIV mortality (deaths per 100 000 population per year) using published data from UNICEF and WHO. For every 5-year interval (eg, 1990—95), we defined performance as the size of the annual rate of decline for every mortality indicator. Subsequently, we tested the feasibility of post-2015 goals by estimating the year by which countries would achieve 2030 targets proposed by The Lancet’s Commission on Investing in Health (ie, 20 deaths per 1000 for under-5 mortality, 94 deaths per 100 000 for maternal mortality, four deaths per 100 000 for tuberculosis mortality, and eight deaths per 100 000 for HIV mortality) at observed country and aspirational best-performer (90th percentile) rates.
Findings
From 2005 to 2013, the mean annual rate of decline in under-5 mortality was 4•3% (95% uncertainty interval [UI] 3•9—4•6), for maternal mortality it was 3•3% (2•5—4•1), for tuberculosis mortality 4•1% (2•8—5•4), and for HIV mortality 2•2% (0•1—4•3); aspirational best-performer rates per year were 7•1% (6•8—7•5), 6•3% (5•5—7•1), 12•8% (11•5—14•1), and 15•3% (13•2—17•4), respectively. The top two country performers were Macedonia and South Africa for under-5 mortality, Belarus and Bulgaria for maternal mortality, Uzbekistan and Macedonia for tuberculosis mortality, and Namibia and Rwanda for HIV mortality. At aspirational rates of decline, The Lancet’s Commission on Investing in Health target for under-5 mortality would be achieved by 50—64% of countries, 35—41% of countries would achieve the 2030 target for maternal mortality, 74—90% of countries would meet the goal for tuberculosis mortality, and 66—82% of countries would achieve the target for HIV mortality.
Interpretation
Historical rates of decline can help define realistic targets for Sustainable Development Goals. The gap between targets and projected achievement based on recent trends suggests that countries and the international community must seek further acceleration of progress in mortality.
Funding
Bill & Melinda Gates Foundation, NORAD.

Tuberculosis in pregnancy: an estimate of the global burden of disease
Jordan Sugarman BSc a, Charlotte Colvin PhD b, Allisyn C Moran PhD b, Dr Olivia Oxlade PhD a
Summary
Background
The estimated number of maternal deaths in 2013 worldwide was 289 000, a 45% reduction from 1990. Non-obstetric causes such as infectious diseases including tuberculosis now account for 28% of maternal deaths. In 2013, 3•3 million cases of tuberculosis were estimated to occur in women globally. During pregnancy, tuberculosis is associated with poor outcomes, including increased mortality in both the neonate and the pregnant woman. The aim of our study was to estimate the burden of tuberculosis disease among pregnant women, and to describe how maternal care services could be used as a platform to improve case detection.
Methods
We used publicly accessible country-level estimates of the total population, distribution of the total population by age and sex, crude birth rate, estimated prevalence of active tuberculosis, and case notification data by age and sex to estimate the number of pregnant women with active tuberculosis for 217 countries. We then used indicators of health system access and tuberculosis diagnostic test performance obtained from published literature to determine how many of these cases could ultimately be detected.
Findings
We estimated that 216 500 (95% uncertainty range 192 100—247 000) active tuberculosis cases existed in pregnant women globally in 2011. The greatest burdens were in the WHO African region with 89 400 cases and the WHO South East Asian region with 67 500 cases in pregnant women. Chest radiography or Xpert RIF/MTB, delivered through maternal care services, were estimated to detect as many as 114 100 and 120 300 tuberculosis cases, respectively.
Interpretation
The burden of tuberculosis disease in pregnant women is substantial. Maternal care services could provide an important platform for tuberculosis detection, treatment initiation, and subsequent follow-up.
Funding
United States Agency for International Development.