Average Annual Rate Of Reduction Research Articles

Under-five Mortality in Developing Countries: Will the Millennium Development Goal Be Achieved?

High levels of child mortality in the developing countries led the United Nations to include a significant reduction of under-five mortality rates among the eight Millennium Development Goals (MDGs) to be reached before 2015. In particular, the target of MDG 4 is to reduce the under-five mortality rates in every developing country by two thirds with respect to the levels reached in 1990. This article contributes to the debate on whether the target of MDG 4 will be reached by 2015; it also offers policy recommendations. We observe 110 countries defined by United Nations as “less” or “least” developed. The time-series-macro data used in the study come mainly from the United Nations “MDGInfo” database. Additional data come from WHO, UNICEF, UNDP and World Bank databases. The availability of a large amount of comparable data at the national level makes the quantitative cross-country approach particularly suitable for describing and comparing the intensity and main features of child mortality in different regions and countries. In our article, we: 1) provide an overview of the general context of developing countries; 2) analyze (using principal component analysis and cluster analysis) aspects of child mortality to highlight its different patterns and group together the considered countries in homogeneous clusters; 3) apply and update a methodology used by international agencies to monitor the outcomes obtained by each country in the reduction of child mortality and to estimate the chance each country has to reach MDG 4 (taking into account the trends shown since 1990); and 4) utilize linear regression models to identify the main social and economic determinants of the gaps that exist for each country in 2010 between the observed under-five mortality rates levels and those required to achieve the target. Our study shows that in 50 of 110 countries, mostly in sub-Saharan Africa, the average annual rate of reduction in under-five mortality rates observed so far will not be sufficient to meet MDG 4.

Reducing infant (0–11 months) and child (0–4 years) mortality in India: a disposition from the Sample Registration System

Despite major advances in maternal and child health care initiatives in India, the Millennium Development Goal (MDG)-4 targeting a two-third reduction in under-five mortality appears to be unattainable by 2015. This paper assesses India’s feasibility towards averting infant (0–11 months) and child (0–4 years) mortality by 2015 across regions and major states. Using statewise estimates on infant mortality rate (IMR) during 1990–2009 and child mortality rate (CMR) during 1990–2008 from the Sample Registration System of India, this paper estimates average annual rate of reduction (AARR) in IMR and CMR across regions and major states. The estimates are also provided for the shortfall in IMR and CMR from the projected estimates of 2015 and the required AARR for the successive years up to 2015. Estimated figures suggest that India has experienced a substantial decline in the IMR and CMR since 1990. However, an AARR of around 10 and 8 % is required for reducing infant (during 2010–2015) and child mortality (during 2009–2015), respectively, in order to achieve a two-third reduction in the IMR and CMR from the level of 1990. Although the MDG-4 target is based on U5MR in totality, this study draws attention towards the progress in major components of the U5MR separately, and advocates for disaggregation of MDG target at national level in terms of focus (region-specific) towards achieving required reduction in separate components of under-five mortality.

Mapping biomass change after forest disturbance: Applying LiDAR footprint-derived models at key map scales

Accurate estimate of biomass and its changes at local to regional scales are important for a better understanding of ecosystem function, biodiversity and sustainability. In this study we explored the forest biomass prediction and dynamic monitoring from Light detection and ranging (LiDAR) waveform metrics at different key map scales. NASA's Laser Vegetation Imaging Sensor (LVIS) data were acquired in Penobscot County, Maine, USA, during August 2003 and 2009 airborne campaigns in the New England region. Field data were collected in 2003, and 2009 to 2011. Regression models developed at the scale of footprint were applied to all LVIS waveforms within the two study sites: Howland Forest (HF) and Penobscot Experiment Forest (PEF). The effect of forest disturbances on LVIS biomass prediction models was investigated. Two types of models, i. e. combined model without consideration of disturbances and disturbance-specific models were developed and compared. Field data from nested field plots of 0.25ha, 0.5ha and 1.0ha were used to evaluate the averaged, footprint-level (~0.03ha, 20m diameter) estimates in these plots. The results demonstrate that: 1) prediction model at the scale of individual LVIS footprints is reliable when the geolocations of the measured footprints were determined by DGPS with a best accuracy of 0.5–1.0m. 2) The differences between biomass prediction models for disturbed and undisturbed forests were statistically significant (p<0.001) at the scale of footprint, and the disturbance-specific models performed slightly better (R2=0.89, RMSE=27.9Mg·ha−1, and relative error of 22.6%) than the combined model (R2=0.86, RMSE=31.0Mg·ha−1, 25.1%). 3) The evaluation using field plot data showed that the predictions of biomass were improved markedly with the increase of plot sizes from 0.25ha to 1.0ha and that the effect of disturbance was not strong. At 1.0ha plot-level, both disturbance-specific and combined models agreed well with field estimates (R2=0.91, 23.1Mg∙ha−1, 16.1%; and R2=0.91, 22.4Mg·ha−1, 15.6%). 4) Sensitivity analysis on levels of variation and error to footprint density suggests that a certain density of LVIS footprints is required for biomass mapping. The errors were minimized when footprint coverage approached about 50% of the area of 1.0ha plots (16 footprints). 5) By applying the footprint-level models developed from 2009 LVIS data to both 2009 and 2003 LVIS data, the change of biomass from 2003 to 2009 could be assessed. The average annual biomass reduction rate from forest disturbance at two sites is −7.0Mg·ha−1 and −6.2Mg·ha−1, the average annual biomass accumulation from regrowth is +4.4Mg·ha−1 and +5.2Mg·ha−1, respectively.

Has the Rate of Reduction in Infant Mortality Increased in India Since the Launch of National Rural Health Mission? Analysis of Time Trends 2000-2009 with Projection to 2015.

National Rural Health Mission (NRHM) - India was launched in 2005 to tackle urban-rural health inequalities, especially in maternal and child health. We examined national and state level trends in Infant Mortality Rates (IMR) from 2000 through 2009 to: 1) assess whether the NRHM had increased the average annual reduction rate (AARR) of IMR 2) evaluate state-wise progress towards Millennium Development Goals (MDG4) and estimate required AARRs for 'off track' states. Log-linear regression models were applied to national and state IMR data collated from the Sample Registration System (SRS)-India to estimate average annual reduction rates and compare AAARs before and after introduction of NRHM. The log-linear trend of infant mortality rates was also projected forward to 2015. The infant mortality rate in rural India declined from 74 to 55/1000 live births between 2000 and 2009, with AARR of 3.0% (95% CI=2.6%-3.4%) and the urban-rural gap in infant mortality narrowed (p =0.036). However there was no evidence (p=0.49) that AARR in rural India increased post NRHM (3.4%, 95% CI 2.0-4.7%) compared to pre NRHM (2.8%, 95% CI 2.1%-3.5%). States varied widely in rates of infant mortality reduction. Projections of infant mortality rates suggested that only eight states might be on track to help India achieve MDG4 by 2015. Despite a narrowing urban-rural gap and high AARRs in some states, there was no evidence that the rate of reduction in infant mortality has increased in rural India post NRHM introduction. India appears unlikely to achieve child survival-related NRHM and millennium development goals. Government should revisit the child survival related NRHM strategies and ensure equitable access to health services. More robust monitoring and evaluation mechanisms must be inbuilt for following years.

Newborn survival: a multi-country analysis of a decade of change

Neonatal deaths account for 40% of global under-five mortality and are ever more important if we are to achieve the Millennium Development Goal 4 (MDG 4) on child survival. We applied a results framework to evaluate global and national changes for neonatal mortality rates (NMR), healthy behaviours, intervention coverage, health system change, and inputs including funding, while considering contextual changes. The average annual rate of reduction of NMR globally accelerated between 2000 and 2010 (2.1% per year) compared with the 1990s, but was slower than the reduction in mortality of children aged 1-59 months (2.9% per year) and maternal mortality (4.2% per year). Regional variation of NMR change ranged from 3.0% per year in developed countries to 1.5% per year in sub-Saharan Africa. Some countries have made remarkable progress despite major challenges. Our statistical analysis identifies inter-country predictors of NMR reduction including high baseline NMR, and changes in income or fertility. Changes in intervention or package coverage did not appear to be important predictors in any region, but coverage data are lacking for several neonatal-specific interventions. Mortality due to neonatal infection deaths, notably tetanus, decreased, and deaths from complications of preterm birth are increasingly important. Official development assistance for maternal, newborn and child health doubled from 2003 to 2008, yet by 2008 only 6% of this aid mentioned newborns, and a mere 0.1% (US$4.56m) exclusively targeted newborn care. The amount of newborn survival data and the evidence based increased, as did recognition in donor funding. Over this decade, NMR reduction seems more related to change in context, such as socio-economic factors, than to increasing intervention coverage. High impact cost-effective interventions hold great potential to save newborn lives especially in the highest burden countries. Accelerating progress requires data-driven investments and addressing context-specific implementation realities.

Understanding socio-economic determinants of childhood mortality: a retrospective analysis in Uganda.

BackgroundTeso sub-region of Eastern Uganda had superior indices of childhood survival during the period 1959 to 1969 compared to the national average. We analysed the reasons that could explain this situation with a view of suggesting strategies for reducing childhood mortality.MethodsWe compared the childhood mortalities and their average annual reduction rate (AARR) of Teso sub-region with those of Uganda for the period 1959 to 1969. We also compared indicators of social economic well being (such as livestock per capita and per capita intake of protein/energy). In addition data was compared on other important determinants of child survival such as level of education and rate of urbanisation.FindingsIn 1969 the infant mortality rate (IMR) for Teso was 94 per 1000 live births compared to the 120 for Uganda. Between 1959 and 1969 the AARR for IMR for Teso was 4.57% compared to 3% for Uganda. It was interesting that the AARR for Teso was higher than that that of 4.4.% required to achieve millennium development goal number four (MDG4). The rate of urbanisation and the level of education were higher in Uganda compared to Teso during the same period. Teso had a per capita ownership of cattle of 1.12 compared to Uganda's 0.44. Teso sub region had about 3 times the amount of protein and about 2 times the amount of calories compared to Uganda.ConclusionsWe surmise that higher ownership of cattle and growing of high protein and energy foods might have been responsible for better childhood survival in Teso compared to Uganda.

Trends of maternal mortality ratio during 1996-2010 in China

To analyze time trend and regional disparities in maternal mortality ratio (MMR) and major causes of maternal death in China from 1996 to 2010. Data used in this study were based on national maternal mortality surveillance system. From 1996 to 2005, it included 176 monitoring districts (countries) in 31 provinces, autonomous regions and municipalities in the inner land. From 2006 to the present, it covered 336 districts (countries). MMR, major causes of maternal death and their reduction margin, average annual reduction rate in different times and regions from 1996 to 2010 were analyzed. The trend and regional differences in MMRs and major causes of mortality were analyzed using Cochran-Armitage trend and Poisson Test. From 1996 to 2010, Chinese MMR has decreased by 53.2% from 64.7 in 1996 to 30.0 per 100 000 live births in 2010. MMR was higher in rural areas (30.1/100 000) than in urban areas (29.7/100 000), and highest in the west region (46.1/100 000) followed by the middle region (29.1/100 000) and the east region (17.8/100 000) in 2010. MMR in east, middle and west regions have decreased by 37.76%, 57.02% and 66.27% respectively from 1996 to 2010. The disparities between different regions were decreasing. From 2006 to 2010, MMR in rural areas has dropped to 1.82 times of the city, and that in the west was 3 times of the east. Obstetric hemorrhage was still the leading cause of maternal death, responsible for 47.9% maternal deaths in 1996 and 27.8% in 2010. The risk of death due to obstetric hemorrhage was decreasing. The MMR in China showed the decreasing trends. Although the regional disparities were still remarkable, they demonstrated narrowing trends. Interventions on maternal death should be focused in rural areas and west regions.

RW1-2.3 Reducing neonatal mortality: the Bangladesh experience

Bangladesh experienced a dramatic decline in infant and under-5 mortality from 133 to 65 and 87 to 52 respectively whereas neonatal deaths only 52 to 37 deaths per 1000 live...

Countdown to 2015: tracking intervention coverage for child survival

The fourth Millennium Development Goal (MDG) calls for a two-thirds' reduction between 1990 and 2015 in deaths of children younger than five years; achieving this will require widespread use of effective interventions, especially in poor countries. We present the first report of the Child Survival Countdown, a worldwide effort to monitor coverage of key child-survival interventions in 60 countries with the world's highest numbers or rates of child mortality. In 2005, we developed a profile for each of the 60 countries to summarise information on coverage with essential child survival interventions. The profiles also present information on demographics, nutritional status, major causes of death in children under 5 years of age, and the status of selected health policies. Progress toward the fourth MDG is summarised by comparing the average annual rate of reduction in under-5 mortality in each country with that needed to achieve the goal. The profiles also include a comparison of the proportions of children in the poorest and richest quintiles of the population who received six or more essential prevention interventions. Each country's progress (as measured by defined indicators of intervention coverage) was put into one of three groups created on the basis of international targets: "on track"; "watch and act"; and "high alert". For indicators without targets, arbitrary thresholds for high, middle, and low performance across the 60 countries were used as a basis for categorisation. Only seven countries are on track to met MDG-4, 39 countries are making some progress, although they need to accelerate the speed, and 14 countries are cause for serious concern. Coverage of the key child survival interventions remains critically low, although some countries have made substantial improvements in increasing the proportion of mothers and children with access to life saving interventions by as much as ten percentage points in 2 years. Children from the poorest families were less likely than those from wealthier families to have received at least six essential prevention interventions. Our results show that tremendous efforts are urgently needed to achieve the MDG for child survival. Profiles for each country show where efforts need to be intensified, and highlight the extent to which prevention interventions are being delivered equitably and reaching poor families. This first report also shows country-specific improvements in coverage and highlights missed opportunities. The "Countdown to 2015" will report on progress every 2 years as a strategy for increasing accountability worldwide for progress in child survival.

Indicadores nutricionais e políticas públicas

Durante a realização da Conferência Mundial sobre Alimentação, em 1974, os governos participantes defenderam o direito inalienável de todo homem, mulher ou criança estar livre do risco da fome e da desnutrição para o desenvolvimento de suas faculdades físicas e mentais. Quase trinta anos depois, os presentes ao Segundo Fórum Mundial de Alimentação, realizado em 1996, comprometeram-se com o conceito de Segurança Alimentar para todos e com a erradicação da fome, reduzindo-se o número de desnutridos à metade até 2015. Apesar dos esforços dispendidos, a persistir a atual taxa de redução, esta meta não será atingida, a menos que se estabeleça a Segurança Alimentar e Nutricional como política pública, especialmente em regiões com pobreza. A escolha do método mais adequado para medida de consumo de alimentos e de estado nutricional, e a avaliação dos indicadores mais adequados só será viabilizada por meio da abordagem ampla da questão. Os indicadores adotados em saúde pública podem mascarar realidades particulares atrás de valores médios, especialmente em regiões de pobreza, levando à falsas interpretações sobre estado nutricional e consumo de alimentos. Com este entendimento, o estabelecimento de políticas públicas para a Segurança Alimentar e Nutricional depende de uma ação coordenada entre estado, sociedade, academia e o setor produtivo, a fim de que estabeleça um plano efetivo de transformação da realidade.

Values for the Free to Total Prostate-Specific Antigen Ratio as a Function of Age: Necessity of Reference Range Validation

Objective: To measure the levels of free prostate-specific antigen (PSA), total PSA, and free to total PSA ratio in a population of men with no known prostate pathology aged from 20 to 70 years. Patients and Methods: Serum total PSA and free PSA values were determined in 1,502 patients due for a systematic health examination. The digital rectal examination was only proposed for those over 50 years of age. The assays were determined on the AsXYM apparatus, from Abbott laboratories, by MEIA technology with monoclonal antibodies. Results: 1,274 men were available for study. The mean age was 43.6 ± 11 years (range 20–69 years). The total PSA level was stable up to 40 years. Beyond that, it increased with age. There was a linear regression between the age and the logarithm of the total PSA rate (r = 0.26, p < 0.0001) from 40 to 70 years. The upper limit of the normal value (95th percentile) increased from 1.07 for the 20- to 30-year age range to 2.82 for the 60- to 70-year range. The free PSA level was stable up to 50 years of age. It then significantly increased. The upper limit of the normal value was measured as 0.42 in the range of 20–30 years and as 0.53 in the range of 60–70 years with an annual average increase rate of roughly 0.5%. Overall there was a linear regression between age and the free PSA rate (r = 0.12, p < 0.0001). The upper limit of the free to total PSA ratio, measured as being 0.68 in the range of 20–29 years, dropped towards 60–69 years with an upper limit of the normal of 0.48. The average annual reduction rate was around 0.70%. There was a linear regression between the age and the free to total PSA ratio (r = 0.17, p < 0.0001). Conclusion: These total PSA levels are lower than the ones measured in other studies with other assay methods. These variations stress the importance of validating reference values of total PSA and free PSA as a function of the assay method and the population to which they are applied before using them as an aid in the diagnosis of prostate cancer.

A Growth Accounting Analysis of Cost Efficiency in Milk Production for Six Northern States in the United States

This paper reports on the use of a growth accounting approach to calculate and decompose cost efficiency indices into technical change, regional competitive advantage stemming from spatial effects, and economies of size. Dairy farm data for Connecticut, Maine, Vermont, Michigan, New York and Pennsylvania for the years 1968, 1970, 1977, 1980 and 1988 are utilized in the analysis. The results show that technological change yielded a 1.8% average annual rate of cost reduction over the period studied. In addition, medium and large farms were, on average, 12% to 20% more efficient than small farms. Pennsylvania had a distinct competitive advantage (13.8%), while Maine exhibited a clear competitive disadvantage (−18.2%) in producing milk relative to New York.

Treatment of multidrug-resistant tuberculosis in China.

During the past decade the number and gravity of tuberculosis (TB) cases has continued to increase, both in developing and industrialized nations. Coupled with the recent emergence of multidrug-resistant tuberculosis (MDR-TB), the possibility that untreatable forms of the disease may become widespread has arisen. In China, the prevalence rate of smear-positive cases from three national surveys in 1979, 1984-1985 and 1990 was 187, 156 and 134/100,000, respectively, thus giving an annual average reduction rate of only 3.0%. This may be due to the accumulation of chronic cases, which is not surprising given that as many as 84.3% of new smear-positive cases received non-organized chemotherapy. To counteract this situation, a strategy was developed in Beijing to practice fully supervised chemotherapy for all new smear-positive cases. This is now 90% with a cure rate also of 90%. As a result, the prevalence rate of smear-positive cases has dropped, with an average annual reduction of 17%. Building upon this success, the World Bank Loan TB Control Project in China has been carried out in 12 provinces with 550 million people since 1992. The main objective of this project is to provide fully supervised, 6-month short-course chemotherapy for all newly detected smear-positive cases. The cure rate based on cohort analysis was 88% in 1993. Complete data are not available on resistance although the initial and acquired resistance rates were 28.1 and 41.1%, respectively. MDR-TB treated with ofloxacin has been increasing since 1992, with 317 cases reported during the period 1992-1995, of which 77% showed sputum conversion.

Tuberculosis control programme in Beijing

Since 1978 a new tuberculosis control programme based on modern concepts has been started in Beijing. The main goals of the programme were: (1) To prioritize the control of sources of infection; (2) to instigate fully supervised treatment (FST) for new smear-positive patients; (3) to extend services to the rural areas. A four-level network of tuberculosis control services has been organized both in urban and rural areas. Tuberculosis control has been integrated into rural primary health care. Coverage of FST among new smear-positive cases increased to 93% in 1990. A standard regimen, 1HS/11H 2S 2 has been used for initial treatment. A reserve regimen of RFP and EMB was added to those who failed to convert in 6 months. Since 1988 a 6-month intermittent short-course regimen has been introduced as standard regimen. Case-finding has been intensified since 1980 through symptomatics. Control of chronic excreters was achieved through FST of new smear-positive cases and fully supervised retreatment of old chronic cases. The new tuberculosis control programme has proved highly successful in controlling sources of infection. The prevalence of smear-positive pulmonary tuberculosis in Beijing during the national surveys in 1979,1984–1985 and 1990 was 127, 56 and 16 per 100 000 respectively. The average annual reduction rate was 17%. This successful experiment has been recognized as a model for the whole country.