Levels and trends in child mortality : estimates developed by the UN Inter-agency Group for child Mortality Estimation (IGME) – report 2014
Issued by World Bank as Working Paper 90587
pdf: http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2014/09/12/000470435_20140912082625/Rendered/PDF/905870WP0Box380ortality0report02014.pdf
Abstract
The under-five mortality rate is a key indicator of child well-being, including health and nutrition status. It is also a key indicator of the coverage of child survival interventions and, more broadly, of social and economic development. Millennium Development Goal 4 (MDG 4) calls for reducing the under-five mortality rate by two-thirds between 1990 and 2015. The world has made substantial progress, reducing the rate 49 percent, from 90 (89, 92) deaths per 1,000 live births in 1990 to 46 (44, 48) in 2013. Since 1990 almost 100 million children under age five roughly the current populations of the Philippines have been saved. The world is also reducing under-five mortality faster than at any other time during the past two decades. The global annual rate of reduction has steadily accelerated since 1990-1995 more than tripling from 1.2 percent to 4.0 percent in 2005-2013.

Cost Effectiveness and Resource Allocation
(Accessed 20 September 2014)
http://www.resource-allocation.com/

Research
Modelling the cost-effectiveness of a new infant vaccine to prevent tuberculosis disease in children in South Africa
Liezl Channing and Edina Sinanovic*
Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925 Cape Town, South Africa
Abstract
Background
Tuberculosis remains the leading cause of death in South Africa. A number of potential new TB vaccine candidates have been identified and are currently in clinical trials. One such candidate is MVA85A. This study aimed to estimate the cost-effectiveness of adding the MVA85A vaccine as a booster to the BCG vaccine in children from the perspective of the South African government.
Methods
The cost-effectiveness was assessed by employing Decision Analytic Modelling, through the use of a Markov model. The model compared the existing strategy of BCG vaccination to a new strategy in which infants receive BCG and a booster vaccine, MVA85A, at 4 months of age. The costs and outcomes of the two strategies are estimated through modelling the vaccination of a hypothetical cohort of newborns and following them from birth through to 10 years of age, employing 6-monthly cycles.
Results
The results of the cost-effectiveness analysis indicate that the MVA85A strategy is both more costly and more effective – there are fewer TB cases and deaths from TB than BCG alone. The South African government would need to spend an additional USD 1,105 for every additional TB case averted and USD 284,017 for every additional TB death averted. The threshold analysis shows that, if the efficacy of the MVA85A vaccine was 41.3% (instead of the current efficacy of 17.3%), the two strategies would have the same cost but more cases of TB and more deaths from TB would be prevented by adding the MVA85A vaccine to the BCG vaccine. In this case, the government should consider the MVA85A strategy.
Conclusions
At the current level of efficacy, the MVA85A vaccine is neither effective nor cost-effective and, therefore, not a good use of limited resources. Nevertheless, this study contributes to developing a standardized Markov model, which could be used, in the future, to estimate the potential cost-effectiveness of new TB vaccines compared to the BCG vaccine, in children between the ages of 0–10 years. It also provides an indicative threshold of vaccine efficacy, which could guide future development.

JAMA
September 17, 2014, Vol 312, No. 11
http://jama.jamanetwork.com/issue.aspx

Viewpoint | September 17, 2014
The Ebola Epidemic – A Global Health Emergency
Lawrence O. Gostin, JD1; Daniel Lucey, MD, MPH2; Alexandra Phelan, LLM, BBiomedSc/LLB1
Author Affiliations
JAMA. 2014;312(11):1095-1096. doi:10.1001/jama.2014.11176.
Excerpt
On August 8, the World Health Organization (WHO) Director-General Margaret Chan declared the West Africa Ebola crisis a “public health emergency of international concern,”1 triggering powers under the 2005 International Health Regulations (IHR). The IHR requires countries to develop national preparedness capacities, including the duty to report internationally significant events, conduct surveillance, and exercise public health powers, while balancing human rights and international trade. Until last year, the director-general had declared only one such emergency—influenza AH1N1 (in 2009). Earlier this year, she declared poliomyelitis a public health emergency of international concern and now again for Ebola, signaling perhaps a new era of potential WHO leadership in global health security…

The Lancet
Sep 20, 2014 Volume 384 Number 9948 p1071 – 1158 e39 – 46
http://www.thelancet.com/journals/lancet/issue/current

Series – Midwifery
Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care
Mary J Renfrew, Alison McFadden, Maria Helena Bastos, James Campbell, Andrew Amos Channon, Ngai Fen Cheung, Deborah Rachel Audebert Delage Silva, Soo Downe, Holly Powell Kennedy, Address Malata, Felicia McCormick, Laura Wick, Eugene Declercq
Preview |
In this first paper in a series of four papers on midwifery, we aimed to examine, comprehensively and systematically, the contribution midwifery can make to the quality of care of women and infants globally, and the role of midwives and others in providing midwifery care. Drawing on international definitions and current practice, we mapped the scope of midwifery. We then developed a framework for quality maternal and newborn care using a mixed-methods approach including synthesis of findings from systematic reviews of women’s views and experiences, effective practices, and maternal and newborn care providers.

The projected effect of scaling up midwifery
Caroline S E Homer, Ingrid K Friberg, Marcos Augusto Bastos Dias, Petra ten Hoope-Bender, Jane Sandall, Anna Maria Speciale, Linda A Bartlett
Preview |
We used the Lives Saved Tool (LiST) to estimate deaths averted if midwifery was scaled up in 78 countries classified into three tertiles using the Human Development Index (HDI). We selected interventions in LiST to encompass the scope of midwifery practice, including prepregnancy, antenatal, labour, birth, and post-partum care, and family planning. Modest (10%), substantial (25%), or universal (95%) scale-up scenarios from present baseline levels were all found to reduce maternal deaths, stillbirths, and neonatal deaths by 2025 in all countries tested.

PLoS One
[Accessed 20 September 2014]
http://www.plosone.org/

Coverage and Timing of Children’s Vaccination: An Evaluation of the Expanded Programme on Immunisation in The Gambia
Susana Scott, Aderonke Odutola, Grant Mackenzie, Tony Fulford, Muhammed O. Afolabi, Yamundow Lowe Jallow, Momodou Jasseh, David Jeffries, Bai Lamin Dondeh, Stephen R. C. Howie, Umberto D’Alessandro
Research Article | published 18 Sep 2014 | PLOS ONE 10.1371/journal.pone.0107280
Abstract
Objective
To evaluate the coverage and timeliness of the Expanded Programme on Immunisation (EPI) in The Gambia.
Methods
Vaccination data were obtained between January 2005 and December 2012 from the Farafenni Health and Demographic Surveillance System (FHDSS), the Basse Health and Demographic Surveillance System (BHDSS), the Kiang West Demographic surveillance system (KWDSS), a cluster survey in the more urban Western Health Region (WR) and a cross sectional study in four clinics in the semi-urban Greater Banjul area of WR. Kaplan-Meier survival function was used to estimate the proportion vaccinated by age and to assess timeliness to vaccination.
Findings
BCG vaccine uptake was over 95% in all regions. Coverage of DPT1 ranged from 93.2% in BHDSS to 99.8% in the WR. Coverage decreased with increasing number of DPT doses; DPT3 coverage ranged from 81.7% in BHDSS to 99.0% in WR. Measles vaccination coverage ranged from 83.3% in BHDSS to 97.0% in WR. DPT4 booster coverage was low and ranged from 43.9% in the WR to 82.8% in KWDSS. Across all regions, delaying on previous vaccinations increased the likelihood of being delayed for the subsequent vaccination.
Conclusions
The Gambia health system achieves high vaccine coverage in the first year of life. However, there continues to be a delay to vaccination which may impact on the introduction of new vaccines. Examples of effectively functioning EPI programmes such as The Gambia one may well be important models for other low income countries struggling to achieve high routine vaccination coverage.

PLoS Medicine
(Accessed 20 September 2014)
http://www.plosmedicine.org/

WHO Essential Medicines Policies and Use in Developing and Transitional Countries: An Analysis of Reported Policy Implementation and Medicines Use Surveys
Kathleen Anne Holloway, David Henry
Research Article | published 16 Sep 2014 | PLOS Medicine 10.1371/journal.pmed.1001724
Abstract
Background
Suboptimal medicine use is a global public health problem. For 35 years the World Health Organization (WHO) has promoted essential medicines policies to improve quality use of medicines (QUM), but evidence of their effectiveness is lacking, and uptake by countries remains low. Our objective was to determine whether WHO essential medicines policies are associated with better QUM.
Methods and Findings
We compared results from independently conducted medicines use surveys in countries that did versus did not report implementation of WHO essential medicines policies. We extracted survey data on ten validated QUM indicators and 36 self-reported policy implementation variables from WHO databases for 2002–2008. We calculated the average difference (as percent) for the QUM indicators between countries reporting versus not reporting implementation of specific policies. Policies associated with positive effects were included in a regression of a composite QUM score on total numbers of implemented policies. Data were available for 56 countries. Twenty-seven policies were associated with better use of at least two percentage points. Eighteen policies were associated with significantly better use (unadjusted p<0.05), of which four were associated with positive differences of 10% or more: undergraduate training of doctors in standard treatment guidelines, undergraduate training of nurses in standard treatment guidelines, the ministry of health having a unit promoting rational use of medicines, and provision of essential medicines free at point of care to all patients. In regression analyses national wealth was positively associated with the composite QUM score and the number of policies reported as being implemented in that country. There was a positive correlation between the number of policies (out of the 27 policies with an effect size of 2% or more) that countries reported implementing and the composite QUM score (r = 0.39, 95% CI 0.14 to 0.59, p = 0.003). This correlation weakened but remained significant after inclusion of national wealth in multiple linear regression analyses. Multiple policies were more strongly associated with the QUM score in the 28 countries with gross national income per capita below the median value (US$2,333) (r = 0.43, 95% CI 0.06 to 0.69, p = 0.023) than in the 28 countries with values above the median (r = 0.22, 95% CI −0.15 to 0.56, p = 0.261). The main limitations of the study are the reliance on self-report of policy implementation and measures of medicine use from small surveys. While the data can be used to explore the association of essential medicines policies with medicine use, they cannot be used to compare or benchmark individual country performance.
Conclusions
WHO essential medicines policies are associated with improved QUM, particularly in low-income countries.
Editors’ Summary
Background
The widespread availability of effective medicines, particularly those used to treat infectious diseases, has been largely responsible for a doubling in the average global life expectancy over the past century. However, the suboptimal use (overuse and underuse) of medicines is an ongoing global public health problem. The unnecessary use of medicines (for example, the use of antibiotics for sore throats caused by viruses) needlessly consumes scarce resources and has undesirable effects such as encouraging the emergence of antibiotic resistance. Conversely, underuse deprives people of the undisputed benefits of many medicines. Since 1977, to help optimize medicine use, the World Health Organization (WHO) has advocated the concept of “essential medicines” and has developed policies to promote the quality use of medicines (QUM). Essential medicines are drugs that satisfy the priority needs of the human population and that should always be available to communities in adequate amounts of assured quality, in the appropriate dosage forms, and at an affordable price. Policies designed to promote QUM include recommendations that medicines should be free at the point of care and that all health care professionals should be educated about the WHO list of essential medicines (which is revised every two years) throughout their careers.
Why Was This Study Done?
Surveys of WHO member countries undertaken in 2003 and 2007 suggest that the implementation of WHO policies designed to promote QUM is patchy. Moreover, little is known about whether these policies are effective, particularly in middle- and low-income countries. For most of these countries, it is not known whether any of the policies affect validated QUM indicators such as the percentage of patients prescribed antibiotics (a lower percentage indicates better use of medicines) or the percentage of patients treated in compliance with national treatment guidelines (a higher percentage indicates better use of medicines). Here, the researchers analyze data from policy implementation questionnaires and medicine use surveys to determine whether implementation of WHO essential medicines policies is associated with improved QUM in low- and middle-income countries.
What Did the Researchers Do and Find?
The researchers extracted data on ten validated QUM indicators and on implementation of 36 policy variables from WHO databases for 2002–2008 and compared the average differences for the QUM indicators between low- and middle-income countries that did versus did not report implementation of specific WHO policies for QUM. Among 56 countries for which data were available, 27 policies were associated with improved QUM. Four policies were particularly effective, namely, doctors’ undergraduate training in standard treatment guidelines, nurses’ undergraduate training in standard treatment guidelines, the existence of a ministry of health department promoting the rational use of medicines, and the provision of essential medicines free to all patients at point of care. The researchers also analyzed correlations between how many of the 27 effective policies were implemented in a country and a composite QUM score. As national wealth increased, both the composite QUM score of a country and the reported number of policies implemented by the country increased. There was also a positive correlation between the numbers of policies that countries reported implementing and their composite QUM score. Finally, the implementation of multiple policies was more strongly associated with the composite QUM score in countries with a gross national income per capita below the average for the study countries than in countries with a gross national income above the average.
What Do These Findings Mean?
These findings show that between 2002 and 2008, the reported implementation of WHO essential medicines policies was associated with better QUM across low- and middle-income countries. These findings also reveal a positive correlation between the number of policies that countries report implementing and their QUM. Notably, this correlation was strongest in the countries with the lowest per capita national wealth levels, which underscores the importance of essential medicines policies in low-income countries. Because of the nature of the data available to the researchers, these findings do not show that the implementation of WHO policies actually causes improvements in QUM. Moreover, the age of the data, the reliance on self-report of policy implementation, and the small sample sizes of the medicine use surveys may all have introduced some inaccuracies into these findings. Nevertheless, overall, these findings suggest that WHO should continue to develop its medicine policies and to collect data on medicine use as part of its core functions.

PLoS Medicine
(Accessed 20 September 2014)
http://www.plosmedicine.org/

Intimate Partner Violence and Reproductive Coercion: Global Barriers to Women’s Reproductive Control
Jay G. Silverman, Anita Raj
Policy Forum | published 16 Sep 2014 | PLOS Medicine 10.1371/journal.pmed.1001723
Summary Points
:: Intimate partner violence (IPV) is a major contributor to poor reproductive outcomes (e.g., adolescent and unintended pregnancy) among women and girls globally.
:: To improve reproductive health, it is necessary that service provision goes beyond identification of women and girls affected by IPV to include identification of specific behaviors that reduce women and girls’ control over their reproductive health, e.g., reproductive coercion, and assistance to reduce harm caused by these behaviors.
:: In order to assist women and girls to mitigate the risks to their reproductive health caused by IPV and reproductive coercion, access to female-controlled contraceptive methods must be improved.
:: In addition to assisting women and girls to improve their control over their reproductive health, reduction of IPV and reproductive coercion in the longer term requires ongoing and multiple-sector efforts to transform the social norms that maintain men’s entitlement to control of women’s and girls’ bodies and their reproduction.

Science
19 September 2014 vol 345, issue 6203, pages 1417-1536
http://www.sciencemag.org/current.dtl

Infectious Disease
Ebola vaccine: Little and late
Jon Cohen
With the Ebola epidemic in West Africa continuing to spiral out of control, it’s become painfully clear that the tried-and-true strategies to contain outbreaks in the past have failed here. This has spurred hopes that biomedical interventions like vaccines and treatments can help slow the spread and save lives. But the leading biomedical countermeasures, which still are experimental and have just recently gone into humans for the first time, are in short supply. Companies, with help from the U.S. government, are looking at ways to pull out all the stops and ramp up production; but even with an all-out effort and a green light from the early human trials, manufacturers have little hope of having enough doses to make a dent in this epidemic for at least 9 months.

Tropical Medicine and Health
Vol. 42(2014) No. 3
https://www.jstage.jst.go.jp/browse/tmh/42/3/_contents

Scientific Productivity on Research in Ethical Issues over the Past Half Century: A JoinPoint Regression Analysis
Nguyen Phuoc Long, Nguyen Tien Huy, Nguyen Thi Huyen Trang, Nguyen Thien Luan, Nguyen Hoang Anh, Tran Diem Nghi, Mai Van Hieu, Kenji Hirayama, Juntra Karbwang
Released: September 10, 2014
[Advance Publication] Released: July 17, 2014
Abstract
BACKGROUND: Ethics is one of the main pillars in the development of science. We performed a JoinPoint regression analysis to analyze the trends of ethical issue research over the past half century. The question is whether ethical issues are neglected despite their importance in modern research.
METHOD: PubMed electronic library was used to retrieve publications of all fields and ethical issues. JoinPoint regression analysis was used to identify the significant time trends of publications of all fields and ethical issues, as well as the proportion of publications on ethical issues to all fields over the past half century. Annual percent changes (APC) were computed with their 95% confidence intervals, and a p-value < 0.05 was considered statistically significant.
RESULTS: We found that publications of ethical issues increased during the period of 1965–1996 but slightly fell in recent years (from 1996 to 2013). When comparing the absolute number of ethics related articles (APEI) to all publications of all fields (APAF) on PubMed, the results showed that the proportion of APEI to APAF statistically increased during the periods of 1965–1974, 1974–1986, and 1986–1993, with APCs of 11.0, 2.1, and 8.8, respectively. However, the trend has gradually dropped since 1993 and shown a marked decrease from 2002 to 2013 with an annual percent change of –7.4%.
CONCLUSIONS: Scientific productivity in ethical issues research on over the past half century rapidly increased during the first 30-year period but has recently been in decline. Since ethics is an important aspect of scientific research, we suggest that greater attention is needed in order to emphasize the role of ethics in modern research.

Vaccine
Volume 32, Issue 43, Pages 5531-5768 (29 September 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/42

Coverage and acceptability of cholera vaccine among high-risk population of urban Dhaka, Bangladesh
Original Research Article
Pages 5690-5695
Md. Jasim Uddin, Tasnuva Wahed, Nirod Chandra Saha, Sheikh Shah Tanvir Kaukab, Iqbal Ansary Khan, Ashraful Islam Khan, Amit Saha, Fahima Chowdhury, John David Clemens, Firdausi Qadri
Abstract
The oral cholera vaccine (Shanchol), along with other interventions, is a potential new measure to prevent or control cholera. A mass cholera-vaccination programme was launched in urban Dhaka, Bangladesh, during February–April 2011 targeting about 173,041 people who are at high risk of cholera. This cross-sectional, descriptive study assessed the coverage and acceptability of the vaccine. The study used a quantitative household survey and qualitative data-collection techniques comprising focus-group discussions, in-depth interviews, and observations for assessment. The findings revealed that 88% of the target population received the first dose of the vaccine, and 79% received the second dose. Absence of persons at home was a prominent cause of not administering the first (71%) and the second dose (67%). Thirty-three percent of the respondents (n = 9308) did not like the taste of the vaccine. Only 1.3% and 3% recipients of the first dose and the second dose of the vaccine respectively reported adverse effects within 28 days of vaccination, and the adverse effects included vomiting or vomiting tendency and diarrhoea. To improve the coverage of the cholera vaccine, exploration of effective solutions to reach the unvaccinated population is required. The vaccine may be more acceptable to the community through changing its taste.

Value in Health
Volume 17, Issue 6, p661-756 September 2014
http://www.valueinhealthjournal.com/current

Pharmaceutical Portfolio Management: Global Disease Burden and Corporate Performance Metrics
Rutger Daems, Edith Maes, Maneesha Mehra, Benjamin Carroll, Adrian Thomas
p732–738
Abstract
Background
Biopharmaceutical companies face multiple external pressures. Shareholders demand a profitable company while governments, nongovernmental third parties, and the public at large expect a commitment to improving health in developed and, in particular, emerging economies. Current industry commercial models are inadequate for assessing opportunities in emerging economies where disease and market data are highly limited.
Objective
The purpose of this article was to define a conceptual framework and build an analytic decision-making tool to assess and enhance a company’s global portfolio while balancing its business needs with broader social expectations.
Methods
Through a case-study methodology, we explore the relationship between business and social parameters associated with pharmaceutical innovation in three distinct disease areas. The global burden of disease–based theoretical framework using disability-adjusted life-years provides an overview of the burden associated with particular diseases. The social return on investment is expressed as disability-adjusted life-years averted as a result of the particular pharmaceutical innovation. Simultaneously, the business return on investment captures the research and development costs and projects revenues in terms of a profitability index.
Conclusions
The proposed framework can assist companies as they strive to meet the medical needs of populations around the world for decades to come.