National coverage gains were accelerated by important increases among poor and rural mothers and children. Despite progress, important inequalities persist, and need to be addressed to achieve the Sustainable Development Goals.
Author Archives: Lancet Global Health
As a result of several studies, a coherent view of reproductive, newborn, maternal, and child health inequalities has begun to emerge.1–7 Overall, and in most countries, inequalities have been decreasing. However, inequalities have been growing in a small but substantial proportion of countries, and in many of these countries, a decline in health status and health-service coverage among poor populations is part of the cause. In The Lancet Global Health, Cesar Victora8 and colleagues present the findings of the latest study of these trends.
Most maternal and child health indicators significantly declined during the Ebola virus disease outbreak in 2014. Despite a reduction in this negative trend in the post-outbreak period, the use of essential maternal and child health services have not recovered to their pre-outbreak levels, nor are they all on a course that suggests that they will recover without targeted interventions.
The response to the west African Ebola virus disease epidemic in 2016 illustrated the stark dichotomy of both the failings and the remarkable potential of global public health architecture. A stuttering, uncoordinated early response, which exposed the overwhelmed public health capacity of the region and claimed the lives of thousands,1 was followed by one of the most successful global partnerships between foreign and local governments and multinational aid organisations to stem an international health crisis.
Most patients with ESKD starting dialysis in sub-Saharan Africa discontinue treatment and die. Further work is needed to develop equitable and sustainable strategies to manage individuals with ESKD in sub-Saharan Africa.
A few years ago, my group published an article entitled Nephrology in Africa—not yet uhuru.1 Uhuru is the Swahili word for “freedom”. The idea was to highlight the plight of patients with end-stage kidney disease (ESKD) and the challenges and frustrations of their nephrologists in sub-Saharan Africa amidst health-care authorities that had not done enough to alleviate the problem. The absence of uhuru referred to in that article is not peculiar to nephrology; other medical specialties in sub-Saharan Africa have similar problems associated with a reduced size of and inadequately experienced workforce, diagnostic facilities, and access to treatment, often resulting in poor patient outcomes.
Typhoid fever and iNTS disease are major causes of invasive bacterial febrile illness in the sampled locations, most commonly affecting children in both low and high population density settings. The development of iNTS vaccines and the introduction of S Typhi conjugate vaccines should be considered for high-incidence settings, such as those identified in this study.
Despite significant heterogeneity in exposure and outcome measures, clear evidence shows that the burden of behavioural risk factors is affected by socioeconomic position within LLMICs. Governments seeking to meet Sustainable Development Goal (SDG) 3.4—reducing premature non-communicable disease mortality by a third by 2030—should leverage their development budgets to address the poverty-health nexus in these settings. Our findings also have significance for health workers serving these populations and policy makers tasked with preventing and controlling the rise of non-communicable diseases.
Pillay-van Wyk V, Msemburi W, Laubscher R, et al. Mortality trends and differentials in South Africa from 1997 to 2012: second National Burden of Disease Study. Lancet Glob Health 2016; 4: e642–53—In figure 8, some of the data and rankings were incorrect. Figure 8 has now been replaced with a corrected version.
The studies1,2 of Russian-backbone live attenuated influenza vaccine (LAIV) in children from Senegal and Bangladesh in The Lancet Global Health are welcome, in view of the high burden of influenza-associated morbidity and mortality in resource-limited settings. Although the lack of immunogenicity data is highlighted as a limitation by the authors, we feel that the importance of generating such data in future studies is underplayed. With the exception of one study3 including children from South Africa, to our knowledge, no paediatric immunogenicity data exist from sub-Saharan Africa for the Ann Arbor-based LAIV.
Significant progress has been made in reducing maternal and neonatal mortality in the past 15 years, but additional improvements will require a comprehensive approach that targets all causes of maternal and newborn mortality.1 Further reduction of maternal and newborn deaths is a priority for achieving the Sustainable Development Goals and for implementing the UN Global Strategy for Women’s, Children’s and Adolescents’ Health, and is also critical for two strategic plans—Every Newborn: An Action Plan to End Preventable Deaths (ENAP) and the Strategies toward Ending Preventable Maternal Mortality (EPMM).
Stephen Hodgins says that cord application of chlorhexidine protects infants against omphalitis equally after birth at home or in hospital, and that we were incorrect to say that it was not effective for infants born in hospital.