Interagency Group Research Articles

National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis

SummaryBackgroundReducing neonatal mortality is an essential part of the third Sustainable Development Goal (SDG), to end preventable child deaths. To achieve this aim will require an understanding of the levels of and trends in neonatal mortality. We therefore aimed to estimate the levels of and trends in neonatal mortality by use of a statistical model that can be used to assess progress in the SDG era. With these estimates of neonatal mortality between 1990 and 2017, we then aimed to assess how different targets for neonatal mortality could affect the burden of neonatal mortality from 2018 to 2030.MethodsIn this systematic analysis, we used nationally-representative empirical data related to neonatal mortality, including data from vital registration systems, sample registration systems, and household surveys, to estimate country-specific neonatal mortality rates (NMR; the probability of dying during the first 28 days of life) for all countries between 1990 (or the earliest year of available data) and 2017. For our analysis, we used all publicly available data on neonatal mortality from databases compiled annually by the UN Inter-agency Group for Child Mortality Estimation, which were extracted on or before July 31, 2018, for data relating to the period between 1950 and 2017. All nationally representative data were assessed. We used a Bayesian hierarchical penalised B-splines regression model, which allowed for data from different sources to be weighted differently, to account for variable biases and for the uncertainty in NMR to be assessed. The model simultaneously estimated a global association between NMR and under-5 mortality rate and country-specific and time-specific effects, which enabled us to identify countries with an NMR that was higher or lower than expected. Scenario-based projections were made at the county level by use of current levels of and trends in neonatal mortality and historic or annual rates of reduction that would be required to achieve national targets. The main outcome that we assessed was the levels of and trends in neonatal mortality and the global and regional NMRs from 1990 to 2017.FindingsBetween 1990 and 2017, the global NMR decreased by 51% (90% uncertainty interval [UI] 46–54), from 36·6 deaths per 1000 livebirths (35·5–37·8) in 1990, to 18·0 deaths per 1000 livebirths (17·0–19·9) in 2017. The estimated number of neonatal deaths during the same period decreased from 5·0 million (4·9 million–5·2 million) to 2·5 million (2·4 million–2·8 million). Annual NMRs vary widely across the world, but west and central Africa and south Asia had the highest NMRs in 2017. All regions have reported reductions in NMRs since 1990, and most regions accelerated progress in reducing neonatal mortality in 2000–17 versus 1990–2000. Between 2018 and 2030, we project that 27·8 million children will die in their first month of life if each country maintains its current rate of reduction in NMR. If each country achieves the SDG neonatal mortality target of 12 deaths per 1000 livebirths or fewer by 2030, we project 22·7 million cumulative neonatal deaths by 2030. More than 60 countries need to accelerate their progress to reach the neonatal mortality SDG target by 2030.InterpretationAlthough substantial progress has been made in reducing neonatal mortality since 1990, increased efforts to improve progress are still needed to achieve the SDG target by 2030. Accelerated improvements are most needed in the regions and countries with high NMR, particularly in sub-Saharan Africa and south Asia.FundingBill & Melinda Gates Foundation, United States Agency for International Development.

A workflow for Sustainable Development Goals indicators assessment based on high-resolution satellite data

ABSTRACTFor evaluating the progresses towards achieving the Sustainable Development Goals (SDGs), a global indicator framework was developed by the UN Inter-Agency and Expert Group on Sustainable Development Goals Indicators. In this paper, we propose an improved methodology and a set of workflows for calculating SDGs indicators. The main improvements consist of using moderate and high spatial resolution satellite data and state-of-the-art deep learning methodology for land cover classification and for assessing land productivity. Within the European Network for Observing our Changing Planet (ERA-PLANET), three SDGs indicators are calculated. In this research, harmonized Landsat and Sentinel-2 data are analyzed and used for land productivity analysis and yield assessment, as well as Landsat 8, Sentinel-2 and Sentinel-1 time series are utilized for crop mapping. We calculate for the whole territory of Ukraine SDG indicators: 15.1.1 – ‘Forest area as proportion of total land area’; 15.3.1 – ‘Proportion of land that is degraded over total land area’; and 2.4.1 – ‘Proportion of agricultural area under productive and sustainable agriculture’. Workflows for calculating these indicators were implemented in a Virtual Laboratory Platform. We conclude that newly available high-resolution remote sensing products can significantly improve our capacity to assess several SDGs indicators through dedicated workflows.

Age distribution, trends, and forecasts of under-5 mortality in 31 sub-Saharan African countries: A modeling study.

BackgroundDespite the sharp decline in global under-5 deaths since 1990, uneven progress has been achieved across and within countries. In sub-Saharan Africa (SSA), the Millennium Development Goals (MDGs) for child mortality were met only by a few countries. Valid concerns exist as to whether the region would meet new Sustainable Development Goals (SDGs) for under-5 mortality. We therefore examine further sources of variation by assessing age patterns, trends, and forecasts of mortality rates.Methods and findingsData came from 106 nationally representative Demographic and Health Surveys (DHSs) with full birth histories from 31 SSA countries from 1990 to 2017 (a total of 524 country-years of data). We assessed the distribution of age at death through the following new demographic analyses. First, we used a direct method and full birth histories to estimate under-5 mortality rates (U5MRs) on a monthly basis. Second, we smoothed raw estimates of death rates by age and time by using a two-dimensional P-Spline approach. Third, a variant of the Lee–Carter (LC) model, designed for populations with limited data, was used to fit and forecast age profiles of mortality. We used mortality estimates from the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) to adjust, validate, and minimize the risk of bias in survival, truncation, and recall in mortality estimation. Our mortality model revealed substantive declines of death rates at every age in most countries but with notable differences in the age patterns over time. U5MRs declined from 3.3% (annual rate of reduction [ARR] 0.1%) in Lesotho to 76.4% (ARR 5.2%) in Malawi, and the pace of decline was faster on average (ARR 3.2%) than that observed for infant (IMRs) (ARR 2.7%) and neonatal (NMRs) (ARR 2.0%) mortality rates. We predict that 5 countries (Kenya, Rwanda, Senegal, Tanzania, and Uganda) are on track to achieve the under-5 sustainable development target by 2030 (25 deaths per 1,000 live births), but only Rwanda and Tanzania would meet both the neonatal (12 deaths per 1,000 live births) and under-5 targets simultaneously. Our predicted NMRs and U5MRs were in line with those estimated by the UN IGME by 2030 and 2050 (they overlapped in 27/31 countries for NMRs and 22 for U5MRs) and by the Institute for Health Metrics and Evaluation (IHME) by 2030 (26/31 and 23/31, respectively). This study has a number of limitations, including poor data quality issues that reflected bias in the report of births and deaths, preventing reliable estimates and predictions from a few countries.ConclusionsTo our knowledge, this study is the first to combine full birth histories and mortality estimates from external reliable sources to model age patterns of under-5 mortality across time in SSA. We demonstrate that countries with a rapid pace of mortality reduction (ARR ≥ 3.2%) across ages would be more likely to achieve the SDG mortality targets. However, the lower pace of neonatal mortality reduction would prevent most countries from achieving those targets: 2 countries would reach them by 2030, 13 between 2030 and 2050, and 13 after 2050.

A gap analysis of SDG 3 and MDG 4/5mortality health targets in the six Arabic countries of North Africa: Egypt, Libya, Tunisia, Algeria, Morocco, and Mauritania

ABSTRACTBackground: The United Nations Assembly adopted the Sustainable Development Goals to succeed the Millennium Development Goals in September 2015. From a European perspective, the development of health in the countries of North Africa are of special interest as a critical factor of overall social development in Europe’s Mediterranean partners. In this paper, we address the mortality related SDG-3 targets, the likelihood to achieve them until 2030 and analyze how they are defined.Methods: We projected mortality trends from 2000–2015 to 2030, based on mortality estimates by inter-agency groups and the WHO in mother and child health, non-communicable diseases, and road traffic mortality. The gap analysis compares the time remaining until 2030 to the time needed to complete the target assuming a linear trend of the respective indicator. A delay of not more than 3.75 years is considered likely to achieve the target.Results: The SDG-3 targets of a Maternal Mortality Ratio below 70 per 100 000 live births and an U5MR below 25 per 1 000 live births have been achieved by Egypt, Libya, and Tunisia. Libya and Tunisia have also achieved the target for Newborn Mortality with Egypt close to achieving it as well. Algeria and Morocco are generally on track for most of the indicators, including deaths from non-communicable diseases and suicide rates; however, all of the countries are lagging when it comes to deadly Road Traffic Injuries for 2030. Mauritania is the only North African country which is not likely to reach the 2030 targets for any of the mortality indicators.Conclusions: Although mortality statistics may be incomplete there is an impressive gradient from East to West showing Mauritania and deadly road traffic injuries as the most problematic areas. Given the large differences between countries baselines, we consider it preferable to set realistic targets to be achieved until 2030.

Abstract 17059: Re-Use of Clinical Trial Data From the NHLBI Data Repository (BioLINCC) for Patient-Level Meta-Analyses of Cardiovascular Outcomes: Challenges and Opportunities

Introduction: An objective of the Meta-AnalyTical Interagency Group (MATIG) is to conduct patient-level meta-analyses of cardiovascular outcomes using data from publicly available repositories. We describe challenges with data re-use from a seminal trial, provide a systematic approach to identify and curate data elements for hypothesis generation, and establish stackable trials to support these analyses. Methods: We used data from the ACCORD trial to assess risk factors and their gender specific differences for the event of hospitalization or death due to heart failure (hdHF), in patients with type 2 diabetes*. We identified the data elements needed to answer the research questions, reviewed the trial protocol to verify definitions, extracted patient-level data, performed quality assessment and statistical analysis. The results showed a gender difference in the effect of intensive vs. standard glucose-lowering therapy on hdHF. To validate the findings, we sought additional trials in BioLINCC to develop a compendium for meta-analysis, and repeated these steps for each trial. Results: Challenges for reusing the ACCORD trial included access to complete patient-level data and metadata. The compendium, developed to evaluate the stackability** of data across trials, identified differences in trial designs, patient populations, study interventions, and data elements that may impact the feasibility and interpretation of meta-analysis. An example of compendium components is shown in Table 1. Conclusion: High-quality metadata facilitate re-use of trial repository data. This compendium standardizes common data elements for gender, racial and age-group specific outcome assessment in major clinical trials. It provides the framework to assess the fitness of trials for patient-level meta-analyses. Efforts are underway by MATIG to expand the compendium to include risk factors and major cardiovascular outcomes across multiple large trials for meta-analysis.

Framing an agenda for children thriving in the SDG era: a WHO–UNICEF–Lancet Commission on Child Health and Wellbeing

Framing an agenda for children thriving in the SDG era : a WHO-UNICEF-Lancet Commission on Child Health and Wellbeing.

Global, regional, and national mortality trends in older children and young adolescents (5-14 years) from 1990 to 2016: an analysis of empirical data.

SummaryBackgroundFrom 1990 to 2016, the mortality of children younger than 5 years decreased by more than half, and there are plentiful data regarding mortality in this age group through which we can track global progress in reducing the under-5 mortality rate. By contrast, little is known on how the mortality risk among older children (5–9 years) and young adolescents (10–14 years) has changed in this time. We aimed to estimate levels and trends in mortality of children aged 5–14 years in 195 countries from 1990 to 2016.MethodsIn this analysis of empirical data, we expanded the United Nations Inter-agency Group for Child Mortality Estimation database containing data on children younger than 5 years with 5530 data points regarding children aged 5–14 years. Mortality rates from 1990 to 2016 were obtained from nationally representative birth histories, data on household deaths reported in population censuses, and nationwide systems of civil registration and vital statistics. These data were used in a Bayesian B-spline bias-reduction model to generate smoothed trends with 90% uncertainty intervals, to determine the probability of a child aged 5 years dying before reaching age 15 years.FindingsGlobally, the probability of a child dying between the ages 5 years and 15 years was 7·5 deaths (90% uncertainty interval 7·2–8·3) per 1000 children in 2016, which was less than a fifth of the risk of dying between birth and age 5 years, which was 41 deaths (39–44) per 1000 children. The mortality risk in children aged 5–14 years decreased by 51% (46–54) between 1990 and 2016, despite not being specifically targeted by health interventions. The annual number of deaths in this age group decreased from 1·7 million (1·7 million–1·8 million) to 1 million (0·9 million–1·1 million) in 1990–2016. In 1990–2000, mortality rates in children aged 5–14 years decreased faster than among children aged 0–4 years. However, since 2000, mortality rates in children younger than 5 years have decreased faster than mortality rates in children aged 5–14 years. The annual rate of reduction in mortality among children younger than 5 years has been 4·0% (3·6–4·3) since 2000, versus 2·7% (2·3–3·0) in children aged 5–14 years. Older children and young adolescents in sub-Saharan Africa are disproportionately more likely to die than those in other regions; 55% (51–58) of deaths of children of this age occur in sub-Saharan Africa, despite having only 21% of the global population of children aged 5–14 years. In 2016, 98% (98–99) of all deaths of children aged 5–14 years occurred in low-income and middle-income countries, and seven countries alone accounted for more than half of the total number of deaths of these children.InterpretationIncreased efforts are required to accelerate reductions in mortality among older children and to ensure that they benefit from health policies and interventions as much as younger children.FundingUN Children's Fund, Bill & Melinda Gates Foundation, United States Agency for International Development.

Measuring Transboundary Water Cooperation within the Framework of Agenda 2030: A Proposal for a Revision of SDG Indicator 6.5.2

Resolution A/RES/70/1 entitled Transforming our world: the 2030 Agenda for Sustainable was adopted by the United Nations General Assembly (UNGA) on 25 September 2015 and included a set of 17 Sustainable Development Goals (SDGs), developed to replace the previous 8 Millennium Developments Goals (MDGs), their timeframe having just ended. One of the focuses of these SDGs was to address certain shortcomings of the past MDGs, by adopting a more comprehensive, governance and peace-building oriented, approach. It is noteworthy that for the first time a water and sanitation-dedicated Goal (SDG 6) was adopted, aimed at ensuring availability and sustainable management of water and sanitation for all. It is even more remarkable that one of its Targets (Target 6.5) is specifically dedicated to implementing integrated water resources management (IWRM) at all levels, including through transboundary as appropriate. Progress towards Target 6.5 is to be measured through two Indicators defined as the degree of IWRM implementation (0-100) (Indicator 6.5.1), and the proportion of transboundary basin area with an operational arrangement for water cooperation (Indicator 6.5.2). SDG Indicator 6.5.2 emphasizes the importance of the law of international watercourses, by using arrangements as a measurement of transboundary and therefore acknowledging the role legal instruments play in the protection, preservation and management of transboundary freshwater resources. While the establishment of an indicator on transboundary water is most opportune and promising, its formulation and calculation raises some technical, scientific and legal questions. It is the legal questions that I am attempting to address in this paper. After an overview and preliminary assessment of SDG Indicator 6.5.2's reporting mechanism, this article will provide supporting arguments for an adaptation of Indicator 6.5.2 and will offer a proposal for an adjustment of Indicator 6.5.2, ahead of the upcoming 2020 revision of the SDG Indicators conducted by the Inter-agency and Expert Group on SDG Indicators (IAEG-SDG).

TASK AND PROGRESS OF IAEG-SDGS: WGGI IN MONITORING SDGS THROUGH A ‘GEOGRAPHIC LOCATION’ LENS

Abstract. In September 2015, the 193 Member States of the United Nations (UN) unanimously adopted the 2030 Agenda for Sustainable Development and its 17 Sustainable Development Goals (SDGs), aiming to transform the world over the next 15 years (ESDN, 2016). To meet the ambitions and demands of the 2030 Agenda, it is necessary for the global indicator framework to adequately and systematically address the issue of alternative data sources and methodologies, including geospatial information and Earth observations in the context of geographic location (UN-GGIM, 2016). For this purpose, the Inter-Agency and Expert Group on Sustainable Development Goals Indicator (IAEG-SDGs) created the Working Group on Geospatial Information (IAEG-SDGs: WGGI) to give full play to the role of geospatial data in SDGs measurement and monitoring. The Working Group reviewed global indicators through a ‘geographic location’ lens to pick out those which geospatial information can significantly support the production, and analyzed the methodological and measurements issues. This paper has discussed the progress in monitoring SDGs ever since the establishment of IAEG-SDGs: WGGI, as well as the existing problems, appropriate solutions and plans for the next stage of work.

Localization of SDGs through Disaggregation of KPIs

The United Nation’s Agenda 2030 and Sustainable Development Goals (SDGs) pick up where the Millennium Development Goals (MDGs) left off. The SDGs set forth a formidable task for the global community and international sustainable development over the next 15 years. Learning from the successes and failures of the MDGs, government officials, development experts, and many other groups understood that localization is necessary to accomplish the SDGs but how and what to localize remain as questions to be answered. The UN Inter-Agency and Expert Group on Sustainable Development Goals (UN IAEG-SDGs) sought to answer these questions through development of metadata behind the 17 goals, 169 associated targets and corresponding indicators of the SDGs. Data management is key to understanding how and what to localize, but, to do it properly, the data and metadata needs to be properly disaggregated. This paper reviews the utilization of disaggregation analysis for localization and demonstrates the process of identifying opportunities for subnational interventions to achieve multiple targets and indicators through the formation of new integrated key performance indicators. A case study on SDG 6: Clean Water and Sanitation is used to elucidate these points. The examples presented here are only illustrative—future research and the development of an analytical framework for localization and disaggregation of the SDGs would be a valuable tool for national and local governments, implementing partners and other interested parties.

Global estimation of neonatal mortality using a Bayesian hierarchical splines regression model

In recent years, much of the focus in monitoring child mortality has been on assessing changes in the under-five mortality rate (U5MR). However, as the U5MR decreases, the share of neonatal deaths (within the first month) tends to increase, warranting increased efforts in monitoring this indicator in addition to the U5MR. A Bayesian splines regression model is presented for estimating neonatal mortality rates (NMR) for all countries. In the model, the relationship between NMR and U5MR is assessed and used to inform estimates, and spline regression models are used to capture country-specific trends. As such, the resulting NMR estimates incorporate trends in overall child mortality while also capturing data-driven trends. The model is fitted to 195 countries using the database from the United Nations Interagency Group for Child Mortality Estimation, producing estimates from 1990, or earlier if data are available, until 2015. The results suggest that, above a U5MR of 34 deaths per 1000 live births, at the global level, a 1 per cent increase in the U5MR leads to a 0.6 per cent decrease in the ratio of NMR to U5MR. Below a U5MR of 34 deaths per 1000 live births, the proportion of deaths under-five that are neonatal is constant at around 54 per cent. However, the relationship between U5MR and NMR varies across countries. The model has now been adopted by the United Nations Inter-agency Group for Child Mortality Estimation.

Enhancing Capacity for Evidence-Based Policymaking: the Role of Economic Evaluation Standards.

This commentary will describe some ongoing activities that are moving the federal government toward stronger use of evidence in decision-making. In particular, the work of the Commission on Evidence-Based Policymaking points to directions that have implications for capacity building and the institutionalization of economic evaluation, as well as mechanisms and resources that could make economic evaluation more feasible. Bipartisan legislation incorporates many of the recommendations of the Commission and reinforces efforts already underway at individual agencies as well as among interagency groups. Understanding the current context of evidence-based policymaking in the federal government can enable economic researchers to better influence the processes of capacity building, shape the designs of evaluations, and inform decision-making. The commentary highlights areas where further elaboration of economic evaluation principles could be useful to support evidence building, implementation, and program improvement.

Health system reforms in five sub-Saharan African countries that experienced major armed conflicts (wars) during 1990–2015: a literature review

ABSTRACTBackground: Sub-Saharan Africa (SSA) has had more major armed conflicts (wars) in the past two decades – including 13 wars during 1990–2015 – than any other part of the world, and this has had an adverse effect on health systems in the region.Objective: To understand the best health system practices in five SSA countries that experienced wars during 1990–2015, and yet managed to achieve a maternal mortality reduction – equal to or greater than 50% during the same period – according to the Maternal Mortality Estimation Inter-Agency Group (MMEIG). Maternal mortality is a death of a woman during pregnancy, or within 42 days after childbirth – measured as maternal mortality ratio (MMR) per 100,000 live births.Design: We conducted a selective literature review based on a framework that drew upon the World Health Organisation’s (WHO) six health system building blocks. We searched seven databases, Google Scholar as well as conducting a manual search of sources in articles’ reference lists – restricting our search to articles published in English. We searched for terms related to maternal healthcare, the WHO six health system building blocks, and names of the five countries.Results: Our study showed three general health system reforms across all five countries that could explain MMR reduction: health systems decentralisation, the innovation related to the WHO workforce health system building block such as training of community healthcare workers, and governments-financing reforms.Conclusion: Restoring health systems after disasters is an urgent concern, especially in countries that have experienced wars. Our findings provide insight from five war-affected SSA countries which could inform policy. However, since few studies have been conducted concerning this topic, our findings require further research to inform policy, and to help countries rebuild and maintain their health systems resilience.

Sustainable Development Goals (SDGs), and their implementation: A national global framework for health, development and equity needs a systems approach at every level.

The Sustainable Development Goals (SDGs) are a set of global goals for fair and sustainable health at every level: from planetary biosphere to local community. The aim is to end poverty, protect the planet and ensure that all people enjoy peace and prosperity, now and in the future. The UN has established web-sites to inform the implementation of the SDGs and an Inter-Agency and Expert Group on an Indicator Framework. We have searched for independent commentaries and analysis. The goals represent a framework that is scientifically robust, and widely intuitive intended to build upon the progress established by the Millennium Development Goals (MDGs). There is a need for system wide strategic planning to integrate the economic, social and environmental dimensions into policy and actions. Many countries have yet to understand the difference between the MDGs and the SDGs, particularly their universality, the huge potential of new data methods to help with their implementation, and the systems thinking that is needed to deliver the vision. The danger is that individual goals may be prioritized without an understanding of the potential positive interactions between goals. There is an increasing understanding that sustainable development needs a paradigm shift in our understanding of the interaction between the real economy and quality of life. There would be many social, environmental and economic benefits in changing our current model. We need to develop systems wide understanding of what supports a healthy environment and the art and science of making change.

Interagency physical activity and lifestyle education programmes

To help address the disability burden and growing financial impact of chronic diseases, interagency group programmes targeting a socio-economically deprived population offer opportunities to exercise in a gym and receive education on healthier lifestyle matters. Set up to engage and support people with persistent lower back pain (LBP) and multimorbidity (2 or more chronic diseases) to become more active, they are implemented by Health Service Executive (HSE) primary care physiotherapy and Dublin City Council (DCC) fitness instructor services. Based on a bio-psycho-social model and motivational interviewing, the programmes support experiential learning to improve self efficacy. Existing Interagency services have been reconfigured without additional resources. An interagency vision has facilitated sharing of facilities, knowledge and manpower. Both programmes offered participants six free 60 minute sessions in a gym led by a fitness instructor using equipment that suit preferences and needs, followed by a 30 minute education session led by a physiotherapist encouraging healthier lifestyle choices and goal setting around 8 key areas. These are exercise, pacing, pain, stress, sleep, nutrition, medications and signposting to relevant psychological and physical supports. Ongoing participant feedback has led to the introduction of discounted memberships similar to the DCC 'passport for leisure' scheme on programme completion and free swimming pool access after each session. A texting system between participants and physiotherapist facilitates group time reminders and rescheduling. Outcomes: In 2013 the 'Back on Track' programme started for adults with persistent LBP, and in 2016 this model was adapted as the ‘Activ8’ programme to suit people with multimorbidity. In its first three years the ‘Back on Track’ programme received 203 referrals, 164 started and 101 completed the 6 weeks. 90% showed reduced fear avoidance behaviours and 98% showed improved physical function. Withdrawal reasons included family commitments, pain 'flare up' and 'not for me' attitude. 39 'graduates' availed of discounted memberships. A self directed peer support group commenced in 2015. With interagency trust, alliances and good communication channels it is envisaged both programmes are transferable to other community based sports and recreation facilities. A feasibility study was conducted in late 2016 on ‘Activ8’ and in early 2017 it will be replicated in a different socio-economic area. Lessons learnt include better engagement when physical activities are less prescriptive and more self directed. Internet sites offer opportunities for online learning. The Back on Track programme is enhanced by a physiotherapist with specialist skills in pain management or with direct psychologist input. Using a community based state supported leisure centre for the programmes promotes accessibility, sustainability and is a cost effective model for an overstretched healthcare system.

A Bayesian approach to the global estimation of maternal mortality

The maternal mortality ratio (MMR) is defined as the number of maternal deaths in a population per 100,000 live births. Country-specific MMR estimates are published on a regular basis by the United Nations Maternal Mortality Estimation Inter-agency Group (UN MMEIG) to track progress in reducing maternal deaths and were used to evaluate regional and national performance related to Millennium Development Goal (MDG) 5, which called for a 75% reduction in the MMR between 1990 and 2015. Until 2014, the UN MMEIG used a multilevel regression model for producing estimates for countries without sufficient data from vital registration systems. While this model worked well in the past to assess MMR levels for countries with limited data, it was deemed unsatisfactory for final MDG 5 reporting for countries where longer time series of observations had become available because, by construction, estimated trends in the MMR were covariate-driven only and did not necessarily track data-driven trends. We developed a Bayesian maternal mortality estimation model, which extends upon the UN MMEIG multilevel regression model. The new model assesses data-driven trends through the inclusion of an ARIMA time series model that captures accelerations and decelerations in the rate of change in the MMR. Varying reporting and data quality issues are accounted for in source-specific data models. The revised model provides data-driven estimates of MMR levels and trends and was used for MDG 5 reporting for all countries.

SDG’s Indicators Framework and Disability in India

The post-2015 development framework endorsed disability as an issue of social rights that is in accordance with the guidelines of United Nations Convention on the Rights of Persons with Disabilities. The United Nations Statistical Commission has worked through the Inter-agency and Expert Group and the High-level Group in the formation of the indicators framework to measure the progress made by the disabled persons in the implementation of the Sustainable Development Goals (SDGs). The main objective of this article is to assess the disability prevalence in India and subsequently examine its preparedness towards developing the disability indicators. We consider the Census 2011 data to provide an account of disability situations along with information on state-wise composition, types, age distribution, literacy and employment aspects. We then explain as to how the indicators framework would result in data and information demands on India’s part, which are essential for monitoring the progress of disability inclusion in the country.

Progress and priorities for reproductive, maternal, newborn, and child health in Kenya: a Countdown to 2015 country case study.

SummaryBackgroundProgress in reproductive, maternal, newborn, and child health (RMNCH) in Kenya has been inconsistent over the past two decades, despite the global push to foster accountability, reduce child mortality, and improve maternal health in an equitable manner. Although several cross-sectional assessments have been done, a systematic analysis of RMNCH in Kenya was needed to better understand the push and pull factors that govern intervention coverage and influence mortality trends. As such, we aimed to determine coverage and impact of key RMNCH interventions between 1990 and 2015.MethodsWe did a comprehensive, systematic assessment of RMNCH in Kenya from 1990 to 2015, using data from nationally representative Demographic Health Surveys done between 1989 and 2014. For comparison, we used modelled mortality estimates from the UN Inter-Agency Groups for Child and Maternal Mortality Estimation. We estimated time trends for key RMNCH indicators, as defined by Countdown to 2015, at both the national and the subnational level, and used linear regression methods to understand the determinants of change in intervention coverage during the past decade. Finally, we used the Lives Saved Tool (LiST) to model the effect of intervention scale-up by 2030.FindingsAfter an increase in mortality between 1990 and 2003, there was a reversal in all mortality trends from 2003 onwards, although progress was not substantial enough for Kenya to achieve Millennium Development Goal targets 4 or 5. Between 1990 and 2015, maternal mortality declined at half the rate of under-5 mortality, and changes in neonatal mortality were even slower. National-level trends in intervention coverage have improved, although some geographical inequities remain, especially for counties comprising the northeastern, eastern, and northern Rift Valley regions. Disaggregation of intervention coverage by wealth quintile also revealed wide inequities for several health-systems-based interventions, such as skilled birth assistance. Multivariable analyses of predictors of change in family planning, skilled birth assistance, and full vaccination suggested that maternal literacy and family size are important drivers of positive change in key interventions across the continuum of care. LiST analyses clearly showed the importance of quality of care around birth for maternal and newborn survival.InterpretationIntensified and focused efforts are needed for Kenya to achieve the RMNCH targets for 2030. Kenya must build on its previous progress to further reduce mortality through the widespread implementation of key preventive and curative interventions, especially those pertaining to labour, delivery, and the first day of life. Deliberate targeting of the poor, least educated, and rural women, through the scale-up of community-level interventions, is needed to improve equity and accelerate progress.FundingUS Fund for UNICEF, Bill & Melinda Gates Foundation.

Systematic Review of Recent Social Indicator Efforts in US Coastal and Ocean Ecosystems (2000-2016)

After Hurricanes Sandy and Katrina, governmental organizations have placed the development of metrics to quantify social impacts, resilience, and community adaptation at the center of their agendas. Following the premise that social indicators provide valuable information to help decision makers address complex interactions between people and the environment, several interagency groups in the United States have undertaken the task of embedding social metrics into policy and management. While this task has illuminated important opportunities for consolidating social and behavioral disciplines at the core of the federal government, there are still significant risks and challenges as quantification approaches move forward. In this article, we discuss the major rationale underpinning these efforts, as well as the limitations and conflicts encountered in transitioning research to policy and application. We draw from a comprehensive literature review to explore major initiatives in institutional scenarios addressing community well-being, vulnerability, and resilience in coastal and ocean resource management agencies.

How Much Will a Data Revolution in Development Cost?

The UN High Level Panel has called for a data revolution. The world’s population should be counted, measured, weighed, and evaluated. This information should be collected, compiled, aggregated, and presented in such a form that it can usefully inform policy-makers and citizens in aggregated forms, and disaggregated according to region, village, gender, and population group. It is tempting to think that having more and better information will improve policy choices, but this is not automatic. Moreover, demanding more information may lead to a deteriorating supply of information if demand outstrips supply. This article therefore focuses on the cost of the data revolution rather than its possible benefits. The simple starting point is that data do have a cost. The cost of the data revolution will be considerable. The costs include the sheer financial cost of monitoring, but importantly extend to include the opportunity cost of competing demands on survey capacity. Particular indicators also influence behavior by skewing activities in favor of completing goals with quantifiable targets. More data are only better data if they contain meaningful information that clearly outweighs the opportunity cost related to its gathering. However, funding available for sustainable development goal (SDG) measurement is limited and there are also institutional capacity limits to be reckoned with. On 11 March 2016, the United Nations Statistical Commission’s Interagency and Expert Group on SDG Indicators (IAEG-SDGs) agreed on 230 individual indicators to monitor the 17 goals and 169 targets. Because the final list of 230 indicators has been a moving target, the research for this article took as the starting point of what a reasonable level of measurement of the millennium development goals would have cost to raise a debate and to give a crude estimate over the cost of the introduction of the SDGs, with their exponential increased demand for data. This is done by bringing together and reconciles the existing information on the costs measurement as a reference for scholars concerned with SDG feasibility and operationalization.