Foreign Office Research Articles

The didactic features of James Summers’s (1828–1891) research on Chinese*

Abstract James Summers (1828–1891) is distinguished as the first professor of Chinese in Britain to conduct systematic research on the Chinese language. During his tenure as a Chinese professor, Summers’s research on the Chinese language demonstrated a pronounced didactic emphasis. This was evident in his departure from rigidly following linguistic theories, his adoption of diverse linguistic ideas and methodologies from scholars of varied backgrounds, and his inclusion of multiple varieties of Chinese as target languages, particularly Nanjing Mandarin. Summers’s early missionary work in China, along with his role at King’s College London, where he trained student interpreters for the British Foreign Office, greatly shaped his pedagogical focus. The didactic feature of his works aligns with the broader pragmatic approach of British sinology, reflecting the trend of recruiting retired missionaries and diplomats with experience in China into European university faculties after the mid-19th century.

Prevention of corruption in the acts of the national police of Ukraine: administrative and legal dimension

The relevance of the research lies in the fact that the existing issue of preventing corruption among police officers is not only a problem of the Ministry of Internal Affairs of Ukraine, but also a national issue, in particular. The purpose of the article is to analyze the typology of corruption in the bodies of the National Police of Ukraine. In the context of scientific intelligence, a number of general scientific and sectoral methods are applied, in particular, the method of analysis, synthesis, historical and logical, dialectical, historical and synergistic, systemic methods. It is noted that corruption in police bodies is a phenomenon that poses a risk not only to established members of the structural divisions of law enforcement agencies, but also to one that, in its individual content, exerts a negative influence on the breakdown of social relations, the breakdown of the state, which presents individual rights as such on the dominance of the doctrines of the rule of law, equality of all before the law, which are characteristic of a democratic legal state. The article states that the prevention of corruption in the ranks of law enforcement officers is a component of the state’s general anti-corruption policy, which correlates with the state’s intentions to prevent this negative phenomenon, includes its own strategy for the development of public and legal relations regarding the neutralization or localization of the actions of officials of the NP of Ukraine (factors ) corruption and consequential influence with the support of the congruence of the legal toolkit in order to achieve the set goal, which is established in the field of implementation of the tasks set before it by the National Police of Ukraine. At the same time, an important factor in preventing corruption offenses among police officers is the growth of their civic consciousness. Attention was drawn to the fact that corruption offenses among police officers are an extremely dangerous phenomenon, which, unfortunately, is characteristic of foreign police officers as well. It is noted that corruption can be overcome under circumstances when each police officer will feel a direct responsibility for the fulfillment of a common desire - the formation of a police that is actually independent from corruption. It is noted that a significant number of foreign countries managed to form a modern effective mechanism for preventing corruption offenses among police officers. Considering the European choice of our state, there is a definite need to develop and implement an innovative anti­corruption policy taking into account the positive factors of the existing international experience.

Occupational well-being of diplomatic personnel: a qualitative study.

Diplomatic personnel face unique job demands due to their frequent relocations. There is some evidence that occupational stress contributes to poor well-being in this occupational group, but little research on the aspects of the job that are perceived to be particularly challenging. This study aimed to explore diplomatic personnel's perceptions of their organization and their roles and to identify aspects of the job, which could cause stress and potentially affect well-being. Semi-structured interviews were carried out with 24 employees of the Foreign, Commonwealth and Development Office between September 2021 and February 2022. Participants were asked to reflect on their experiences before the coronavirus disease 2019 pandemic. Thematic analysis was used to analyse data. Participants enjoyed many aspects of their work including the variety, travel opportunities and feeling that they made a difference. They also identified several stressors relating to job demands, overseas postings, family needs, frequent relocation, hardship posts, workplace relationships, (lack of) appreciation and acknowledgement, and organizational culture. Good relationships with colleagues and managers were perceived to be very important. Findings suggest various ways in which diplomatic organizations can better support their personnel, highlighting workload management; cross-cultural training; providing appropriate support to both accompanying families and unaccompanied staff members; practical and psychological preparation for those in high-risk locations; encouraging positive workplace relationships; good management; increased autonomy and increased recognition for good work.

Globalization or Empire? Revolution, the State, and the Geopolitics of Chinese Debt, 1895–1914

Via an investigation of the collaboration between banks and foreign offices, this article demonstrates that the restructuring of China’s state debt before and after the revolution of 1911 was not simply a part of Chinese globalisation undertaken under the benign stewardship of foreign banks. Rather, the contest for Chinese loans reflected a power struggle for regional hegemony between expansionist states that hinged on both competition and cooperation, as well as Chinese attempts to preserve their economic and territorial sovereignty. It further shows that the notion that financial institutions operated independently of the state does not reflect the clear record of close coordination between states and financial institutions during loan negotiations.

Modeling the relative influence of socio-demographic variables on post-acute COVID-19 quality of life.

Post-acute sequelae of SARS-CoV-2, referred to as "long COVID", are a globally pervasive threat. While their many clinical determinants are commonly considered, their plausible social correlates are often overlooked. To compare social and clinical predictors of differences in quality of life (QoL) with long COVID. Additionally, to measure how much adjusted associations between social factors and long COVID-associated quality of life are unexplained by important clinical intermediates. Data from the ISARIC long COVID multi-country prospective cohort study. Subjects from Norway, the United Kingdom (UK), and Russia, aged 16 and above, with confirmed acute SARS-CoV-2 infection reporting >= 1 long COVID-associated symptoms 1+ month following infection. The social exposures considered were educational attainment (Norway), employment status (UK and Russia), and female vs male sex (all countries). Quality of life-adjusted days, or QALDs, with long COVID. This cohort study included a total of 3891 participants. In all three countries, educational attainment, employment status, and female sex were important predictors of long COVID QALDs. Furthermore, a majority of the estimated relationships between each of these social correlates and long COVID QALDs could not be attributed to key long COVID-predicting comorbidities. In Norway, 90% (95% CI: 77%, 100%) of the adjusted association between the top two quintiles of educational attainment and long COVID QALDs was not explained by clinical intermediates. The same was true for 86% (73%, 100%) and 93% (80%,100%) of the adjusted associations between full-time employment and long COVID QALDs in the United Kingdom (UK) and Russia. Additionally, 77% (46%,100%) and 73% (52%, 94%) of the adjusted associations between female sex and long COVID QALDs in Norway and the UK were unexplained by the clinical mediators. This study highlights the role of socio-economic status indicators and female sex, in line with or beyond commonly cited clinical conditions, as predictors of long COVID-associated QoL, and further reveal that other (non-clinical) mechanisms likely drive their observed relationships. Our findings point to the importance of COVID interventions which go further than an exclusive focus on comorbidity management in order to help redress inequalities in experiences with this chronic disease.

Portrait of a UK-Africa Capacity Building Initiative Consortium 2015-2022: the Cameroon, Ghana, South Africa and United Kingdom Materials Initiative (CaGSUMI) for developing materials for solar cells.

The CaGSUMI consortium was funded by the Royal Society-Department for International Development (later the Foreign, Commonwealth & Development Office) on the Africa Capacity Building Initiative programme between the years 2015 and 2022 and involved three Sub-Saharan African universities: Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, University of Yaoundé I, Cameroon, and the University of Zululand, South Africa; and the University of Manchester in the United Kingdom. The project was used to cement an emergent UK-Africa network in the areas of materials chemistry related to renewable energy generation with both thin films and nanomaterials. The consortium's outputs led to numerous publications of African science in international journals, a number of graduated PhDs who went on to permanent academic positions and prestigious fellowships, the establishment of a capacity-building plan relevant to the chemistry departments in each of the African countries, and the installation of a number of first-in-kind pieces of kit for African laboratories that will keep them on a competitive footing at an international level for the next decade and more.

Doctoral training to support sustainable soil geochemistry research in Africa.

Africa's potential for scientific research is not yet being realized, for various reasons including a lack of researchers in many fields and insufficient funding. Strengthened research capacity through doctoral training programmes in higher education institutes (HEIs) in Africa, to include collaboration with national, regional and international research institutions, can facilitate self-reliant and sustainable research to support socio-economic development. In 2012, the Royal Society and the UK's Department for International Development (now the Foreign, Commonwealth and Development Office) launched the Africa Capacity Building Initiative (ACBI) Doctoral Training Network which aimed to strengthen research capacity and training across sub-Saharan Africa. The ACBI supported 30 core PhD scholarships, all registered/supervised within African HEIs with advisory support from the UK-based institutes. Our 'Soil geochemistry to inform agriculture and health policies' consortium project, which was part of the ACBI doctoral training programme network, was implemented in Malawi, Zambia and Zimbabwe between 2014 and 2020. The aims of our consortium were to explore linkages between soil geochemistry, agriculture and public health for increased crop productivity, nutrition and safety of food systems and support wider training and research activities in soil science. Highlights from our consortium included: (i) the generation of new scientific evidence on linkages between soils, crops and human nutrition; (ii) securing new projects to translate science into policy and practice; and (iii) maintaining sustainable collaborative learning across the consortium. Our consortium delivered high-quality science outputs and secured new research and doctoral training funding from a variety of sources to ensure the continuation of research and training activities. For example, follow-on Global Challenges Research Funded Translation Award provided a strong evidence base on the prevalence of deficiencies in children under 5 years of age and women of reproductive age in Zimbabwe. This new evidence will contribute towards the design and implementation of a nationally representative micronutrient survey as an integral part of the Zimbabwe Demographic and Health Surveys conducted by the Ministry of Health and Child Care. The award also generated new evidence and a road map for creating quality innovative doctorates through a doctoral training landscape activity led by the Zimbabwe Council for Higher Education. Although our project and the wider ACBI has contributed to increasing the self-reliance and sustainability of research within the region, many challenges remain and ongoing investment is required.

“LORD” OF STARA RAŠKA: WAR BIOGRAPHY OF SS-STANDARTENFÜHRER KARL VON KREMPLER (1939–1945)

The paper chronicles the life of Karl von Krempler, a war criminal who was a Yugoslav “Volksdeutscher”. The emphasis is on the period of the Second World War, when he attained high positions within the structure of SS and police in the occupied Serbia. Besides his pre-war, war and post-war career, the attention is devoted to the analysis of Krempler’s intriguing personality. The paper is prepared on the basis of the archival documentation preserved at: the Archives of Yugoslavia, The State Archives of Serbia, Historical Archives of Belgrade, the Military Archives, Historical Archives “Ras” in Novi Pazar, Historical Museum of Bosnia and Herzegovina, The Political Archive of the Federal Foreign Office of Germany and Federal Archives in Berlin.

Intimate partner violence against adolescent girls: regional and national prevalence estimates and associated country-level factors

Intimate partner violence is a serious public health problem and negatively affects short-term and long-term health, development, and wellbeing of adolescent girls. Global estimates from WHO have shown that adolescent girls aged 15-19 years experience high rates of intimate partner violence. We aimed to estimate the lifetime and past-year prevalence and patterns of physical or sexual intimate partner violence against adolescent girls by male partners across 161 countries and areas, and to examine the country-level factors, including the prevalence of child marriage, associated with the lifetime and past-year prevalence of intimate partner violence in this age group. These analyses used the 2018 global, regional, and country estimates on intimate partner violence published by WHO and economic, social, and political metadata from subject-specific databases. Drawing on data from the WHO Global Database on Prevalence of Violence Against Women, we used hierarchical Bayesian modelling techniques to estimate lifetime and past-year prevalence of physical or sexual (or both) intimate partner violence against adolescent girls aged 15-19 years by country. Linear regression methods were used to examine contextual social, economic, and political factors associated with intimate partner violence against adolescent girls in the 101 countries (lifetime prevalence) and 105 countries (past-year prevalence) for which these metadata were available. The estimated global prevalence of physical or sexual intimate partner violence against ever-partnered adolescent girls aged 15-19 years was 24% (95% uncertainty interval 21-28) in their lifetime and 16% (14-19) in the past year. Prevalence varied greatly across countries and regions, with lifetime prevalence ranging from 6% (3-11) in Georgia to 49% (35-64) in Papua New Guinea. Overall, the prevalence of both lifetime (154 countries) and past-year (157 countries) intimate partner violence against adolescent girls was higher in low-income and lower-middle-income countries and regions than in high-income countries and regions. Countries with higher rates of female secondary school enrolment and those with inheritance laws that are more gender-equal had lower prevalence of intimate partner violence against adolescent girls. Lower-income countries and societies with a high prevalence of child marriage had higher prevalence of physical or sexual intimate partner violence against adolescent girls. Our findings highlight the widespread prevalence of intimate partner violence against adolescent girls across the globe and its relationship with country-level contextual factors. They emphasise the need for promoting and ensuring policies and programmes that increase and ensure gender equality. Countries should strive to provide secondary education for all girls, ensure equal property rights for women, eliminate discriminatory gender norms, and address harmful practices such as child marriage. UN Women-WHO Joint Programme on Strengthening Violence Against Women Data funded by the UK Foreign and Commonwealth Development Office and the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development, and Research Training in Human Reproduction.

Dollar reserves and U.S. yields: Identifying the price impact of official flows

By exploiting changes in the volatility of U.S. Treasury yields and foreign official (FO) flows into U.S. Treasuries after the 2008 Global Financial Crisis, we identify a FO flow shock via heteroskedasticity in a structural VAR. We estimate that a $100B FO flow shock moves 5 and 10-year U.S. yields by about 100 basis points within a month. An event study of the intraday U.S. Treasury yield curve response to Japan’s FX intervention in September 2022 validates our VAR estimates. Our findings imply that a 1% reduction in the Dollar share of China’s reserves could raise long-term U.S. yields by about 20 basis points.

Allen Leeper, the Foreign Office and the Diplomacy of Air Disarmament, 1932-1934

ABSTRACT As the resident Foreign Office expert on air disarmament during the World Disarmament Conference, Allen Leeper was at the forefront of a campaign for the elimination of military aircraft as a radical bid to address German claims to equality and French demands for security. His motivations derived from a deep-seated fear that legitimising a German air force posed an unacceptable risk to European stability by provoking an all-out arms race, heightening continental tensions and raising the spectre of war. But Leeper’s sweeping solution for military aircraft, with its intertwined repercussions for civil aviation, fell victim to an increasingly truculent government in Berlin that refused to delay equality, claimed substantial increases in German military strength and boosted defence spending while surreptitiously rearming behind the scenes. In these altered circumstances, Leeper abandoned disarmament as a diplomatic tool for treating the Franco-German question and, instead, resorted to other traditional methods for ensuring continental stability. In doing so, he displayed the strengths of the ‘world leadership’ school of foreign-policy making that placed a premium on Britain’s active engagement in great power politics to uphold its position as the pre-eminent global power.

Socio-cultural and Didactic Aspects of M. M. Speransky’s Personal Correspondence with his Daughter and British Relatives of his Wife

This article explores the connections that M. M. Speransky had with the relatives of his prematurely deceased wife, Elizabeth Jane Stephens. Her mother came from the Swiss family of Planta, who had moved to England in 1752. Methodologically, this research is based on the “new biographical history” or “new biography”, the methods of microhistory and the gender principle in biographical research. The author reconstructs the nature of Speransky’s interaction with the Planta family on the basis of correspondence preserved in his collection in the Department of Manuscripts of the Russian National Library with Joseph Planta the Elder (1744–1827), Director of the British Museum, and with his son, Joseph Planta the Younger (1787–1847), who held a post in the Foreign Office. Joseph Planta the Elder was a prominent intellectual of his time, and his son was directly connected with the British Foreign Office during one of the most turbulent periods in European history, and such connections could not but leave their mark on Speransky’s own life. The author concludes that the maintenance of long-term links with his wife’s family, with whom Speransky was not personally acquainted, testifies to the importance of these family ties, both for Speransky himself and for his daughter. Speransky actively encouraged and supported his daughter’s correspondence with Barbara Planta, her grandmother’s sister, and sought to provide his daughter with a European education, with an emphasis on the study of foreign languages, including English. It is concluded that the correspondence with the Planta family allowed Speransky himself to feel involved in both British and European culture, and to raise his daughter in this paradigm, instilling in her a European identity.

Women and Children in Foreign Mercenary Regiments During the Smolensk War

This article discusses the presence of women and children in early modern military communities with reference to the foreign regiments in Russian service during the Smolensk War of 1632–1634. While gender history has been extensively researched in the context of Western European military history, it has not yet received much attention in studies of seventeenth-century Russian warfare. The article explores possible avenues for such research, drawing primarily on Russian-language archival records of the semi-autonomous regiments for which all non-Russians (mostly Germans, Englishmen, and Scots) were recruited abroad. Other sources include the surviving wills of English mercenary officers, the church records of the Lutheran parish in Moscow, and the accounts of foreign travellers to Russia. The article systematises evidence on the wives, mistresses, and children of foreign soldiers and officers who came to Russia as members of their families or in some other status. These data prove the constant presence of women and children in the foreign regiments during the siege of Smolensk. The article examines the legal situation of these persons and the policy of the Russian authorities towards them. It also discusses their property situation, inheritance issues, and women’s participation in legal and informal conflicts within the military communities, as well as corruption cases related to the illegal service of minors in the regiments. It also examines the social tensions created by marriages between mercenaries and the daughters and widows of foreigners living permanently in Russia. Documentary evidence of any contact between mercenaries and Russian women is almost entirely lacking.

Strong isolation by distance and evidence of population microstructure reflect ongoing Plasmodium falciparum transmission in Zanzibar.

The Zanzibar archipelago of Tanzania has become a low-transmission area for Plasmodium falciparum. Despite being considered an area of pre-elimination for years, achieving elimination has been difficult, likely due to a combination of imported infections from mainland Tanzania and continued local transmission. To shed light on these sources of transmission, we applied highly multiplexed genotyping utilizing molecular inversion probes to characterize the genetic relatedness of 282 P. falciparum isolates collected across Zanzibar and in Bagamoyo district on the coastal mainland from 2016 to 2018. Overall, parasite populations on the coastal mainland and Zanzibar archipelago remain highly related. However, parasite isolates from Zanzibar exhibit population microstructure due to the rapid decay of parasite relatedness over very short distances. This, along with highly related pairs within shehias, suggests ongoing low-level local transmission. We also identified highly related parasites across shehias that reflect human mobility on the main island of Unguja and identified a cluster of highly related parasites, suggestive of an outbreak, in the Micheweni district on Pemba island. Parasites in asymptomatic infections demonstrated higher complexity of infection than those in symptomatic infections, but have similar core genomes. Our data support importation as a main source of genetic diversity and contribution to the parasite population in Zanzibar, but they also show local outbreak clusters where targeted interventions are essential to block local transmission. These results highlight the need for preventive measures against imported malaria and enhanced control measures in areas that remain receptive to malaria reemergence due to susceptible hosts and competent vectors. This research was funded by the National Institutes of Health, grants R01AI121558, R01AI137395, R01AI155730, F30AI143172, and K24AI134990. Funding was also contributed from the Swedish Research Council, Erling-Persson Family Foundation, and the Yang Fund. RV acknowledges funding from the MRC Centre for Global Infectious Disease Analysis (reference MR/R015600/1), jointly funded by the UK Medical Research Council (MRC) and the UK Foreign, Commonwealth & Development Office (FCDO), under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 program supported by the European Union. RV also acknowledges funding by Community Jameel.

Enhancing Export Performance through Marketing Capability: An Empirical Study of Ethiopian Leather Industry

This study aimed to gain insight into export promotion programs (EPPs) and their effects on export performance (EP). Also, the mediating role of marketing implementation capability is examined. The target respondents were leather and leather product export manufacturing firms in Ethiopia. Convenience and snowball sampling techniques were used. Owners and managers responsible for exporting leather and leather products were identified and selected to participate in the survey. A total of 178 valid responses were analyzed using the Smart PLS Software (version 4.0). The results show that the use of export promotion programs has a significant impact on export performance. Trade fairs, trade missions, foreign offices, and education and training have significant impacts on export performance. Also, marketing implementation capability mediates between government offered EPPs and export performance. However, ownership and experience doesn’t have moderation impact. This study contributes to the literature on export performance in emerging nations, where search is scant. In addition, we focused on debate on export promotion programs, marketing implementation capability, and export performance.

Role of the foreign bank representative office to encourage foreign direct investment inflow increasement in Indonesia

Role of the foreign bank representative office to encourage foreign direct investment inflow increasement in Indonesia

Diplomatic Identity in Postwar Britain: The Deconstruction of the Foreign Office ‘Type’, 1945–1997 By James Southern

Diplomatic Identity in Postwar Britain: The Deconstruction of the Foreign Office ‘Type’, 1945–1997 By James Southern

Utilization of social franchising in family planning services: a Pakistan perspective.

Pakistan's private sector caters to around 65% of family planning users. Private sector family planning was promoted in the Delivering Accelerated Family Planning in Pakistan (DAFPAK) program by UK's Foreign, Commonwealth & Development Office (FCDO) in 2019. We use data from DAFPAK to analyze the clientele and products distributed by two major NGOs, Marie Stopes Society (MSS) and DKT Pakistan, that support private providers in Pakistan. We also examined the effect of COVID-19 on client visits and contraceptives uptake at private facilities in Pakistan. DAFPAK used field validation surveys to analyze the volume of clients and products of 639 private facilities across three provinces (Punjab, KPK and Balochistan) of Pakistan. The data was collected in two phases (February 2020 and 2021) using multi-stage cluster sampling at 95% confidence level. Using a generalized negative binomial regression, facility-level characteristics and impact of COVID-19 was analyzed with the volume of clients and products given out at 95% confidence interval alongside descriptive analysis. DKT facilities covered 53% of the sample while MSS covered 47%, with 72% facilities in the rural areas. Average facility existence duration is 87 months (7.25 years). While the average experience of the facility staff is 52 months (4.33 years). MSS is serving more clients as compared to DKT during both phase 1 (IRR: 3.15; 95% CI: 2.74, 3.61) and phase 2 (IRR: 2.11; 95% CI: 1.79, 2.49). Similarly, MSS had a greater volume of products given out in both phases 1 (IRR: 1.89; 95% CI: 1.51, 2.38) and phase 2 (IRR: 2.57; 95% CI: 2.09, 3.14). In both phases, client visits and product distribution decreased when client privacy is invaded (IRR: 0.74; 95% CI: 0.67, 0.82 - phase 1) and (IRR: 0.83; 95% CI: 0.72, 0.97 - phase 2). Lastly, during COVID-19, products distribution decreased by a factor of 0.84 (IRR: 0.84; 95% CI: 0.72, 0.97) but client visits remain unaffected. Overall, clientele is low for all facilities. At a facility, privacy is a determinant of client visits and products given out per visit. Transiently, during COVID-19, client volumes decreased, with a shift from oral pills to condoms and emergency contraceptive pills.

Effectiveness of kangaroo mother care before clinical stabilisation versus standard care among neonates at five hospitals in Uganda (OMWaNA): a parallel-group, individually randomised controlled trial and economic evaluation

Preterm birth is the leading cause of death in children younger than 5 years worldwide. WHO recommends kangaroo mother care (KMC); however, its effects on mortality in sub-Saharan Africa and its relative costs remain unclear. We aimed to compare the effectiveness, safety, costs, and cost-effectiveness of KMC initiated before clinical stabilisation versus standard care in neonates weighing up to 2000 g. We conducted a parallel-group, individually randomised controlled trial in five hospitals across Uganda. Singleton or twin neonates aged younger than 48 h weighing 700-2000 g without life-threatening clinical instability were eligible for inclusion. We randomly assigned (1:1) neonates to either KMC initiated before stabilisation (intervention group) or standard care (control group) via a computer-generated random allocation sequence with permuted blocks of varying sizes, stratified by birthweight and recruitment site. Parents, caregivers, and health-care workers were unmasked to treatment allocation; however, the independent statistician who conducted the analyses was masked. After randomisation, neonates in the intervention group were placed prone and skin-to-skin on the caregiver's chest, secured with a KMC wrap. Neonates in the control group were cared for in an incubator or radiant heater, as per hospital practice; KMC was not initiated until stability criteria were met. The primary outcome was all-cause neonatal mortality at 7 days, analysed by intention to treat. The economic evaluation assessed incremental costs and cost-effectiveness from a disaggregated societal perspective. This trial is registered with ClinicalTrials.gov, NCT02811432. Between Oct 9, 2019, and July 31, 2022, 2221 neonates were randomly assigned: 1110 (50·0%) neonates to the intervention group and 1111 (50·0%) neonates to the control group. From randomisation to age 7 days, 81 (7·5%) of 1083 neonates in the intervention group and 83 (7·5%) of 1102 neonates in the control group died (adjusted relative risk [RR] 0·97 [95% CI 0·74-1·28]; p=0·85). From randomisation to 28 days, 119 (11·3%) of 1051 neonates in the intervention group and 134 (12·8%) of 1049 neonates in the control group died (RR 0·88 [0·71-1·09]; p=0·23). Even if policy makers place no value on averting neonatal deaths, the intervention would have 97% probability from the provider perspective and 84% probability from the societal perspective of being more cost-effective than standard care. KMC initiated before stabilisation did not reduce early neonatal mortality; however, it was cost-effective from the societal and provider perspectives compared with standard care. Additional investment in neonatal care is needed for increased impact, particularly in sub-Saharan Africa. Joint Global Health Trials scheme of the Department of Health and Social Care, Foreign, Commonwealth and Development Office, UKRI Medical Research Council, and Wellcome Trust; Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The association between disability and mortality: a mixed-methods study

Globally, 1·3 billion people have a disability and are more likely to experience poor health than the general population. However, little is known about the mortality or life expectancy gaps experienced by people with disabilities. We aimed to undertake a systematic review and meta-analysis of the association between disability and mortality, compare these findings to the evidence on the association of impairment types and mortality, and model the estimated life expectancy gap experienced by people with disabilities. We did a mixed-methods study, which included a systematic review and meta-analysis, umbrella review, and life expectancy modelling. For the systematic review and meta-analysis, we searched MEDLINE, Global Health, PsycINFO, and Embase for studies published in English between Jan 1, 2007, and June 7, 2023, investigating the association of mortality and disability. We included prospective and retrospective cohort studies and randomised controlled trials with a baseline assessment of disability and a longitudinal assessment of all-cause mortality or cause-specific mortality. Two reviewers independently assessed study eligibility, extracted the data, and assessed risk of bias. We did a random-effects meta-analysis to calculate a pooled estimate of the mortality rate ratio for people with disabilities compared with those without disabilities. We did an umbrella review of meta-analyses examining the association between different impairment types and mortality. We used life table modelling to translate the mortality rate ratio into an estimate of the life expectancy gap between people with disabilities and the general population. The systematic review and meta-analysis is registered with PROSPERO, CRD42023433374. Our search identified 3731 articles, of which 42 studies were included in the systematic review. The meta-analysis included 31 studies. Pooled estimates showed that all-cause mortality was 2·24 times (95% CI 1·84-2·72) higher in people with disabilities than among people without disabilities, although heterogeneity between the studies was high (τ2=0·28, I2=100%). Modelling indicated a median gap in life expectancy of 13·8 years (95% CI 13·1-14·5) by disability status. Cause-specific mortality was also higher for people with disabilities, including for cancer, COVID-19, cardiovascular disease, and suicide. The umbrella review identified nine meta-analyses, which showed consistently elevated mortality rates among people with different impairment types. Mortality inequities experienced by people with disabilities necessitate health system changes and efforts to address inclusion and the social determinants of health. National Institute for Health and Care Research, Rhodes Scholarship, Indonesia Endowment Funds for Education, Foreign, Commonwealth and Development Office (Programme for Evidence to Inform Disability Action), and the Arts and Humanities Research Council.