Millennium Development Goals Era Research Articles

Regional determinants of quality of care for sick children: A multilevel analysis in four countries.

The limited impact of increased access to care on improvements in health outcomes during the Millennium Development Goal era has been attributed, in part, to inadequate quality of care. We identified regional factors associated with health service quality for sick child care in low-income countries and examined whether provider factors interact with regional factors to affect the quality of care. We conducted cross-sectional random intercept four-level linear regression using the most recent Service Provision Assessment and Demographic Health Survey data from four countries (467 from the Democratic Republic of Congo 2018, 2425 from Afghanistan 2018, 2072 from Nepal 2015, and 813 from Senegal 2017). The outcome variable was the service quality score for sick child care, which was measured as the percentage of clinically recommended tasks completed in the integrated management of childhood illness (ranging from 0 to 100). Regional factors were selected based on the High-Quality Health System Framework. The service quality score was found to be positively associated with the proportion of large facilities (β = 8.61; P = 0.004) and the proportion of providers ranked in the top fifth for service quality score (β = 30.15; P < 0.001) in the region. We identified significant cross-level interactions between provider qualifications (β = -16.6; P < 0.001) or job descriptions (β = 12.01; P = 0.002) and the proportion of providers in the top fifth for service quality scores within the region. As the proportion of top-performing providers in a region increased, the increase in the service quality score was more pronounced among providers who were nonmedical doctors or did not have job descriptions than among their counterparts. Our findings indicate that the quality of care for sick children in a region improves with a greater proportion of high-performing providers or larger facilities. Providers who are not medical doctors, or those who have specific job descriptions, tend to benefit more from the presence of these top-performing providers.

Stalled Progress in Reducing Maternal Mortality Globally: What Next?

(Lancet. 2023;401(10382):1060–1062. PMID: 36924780) According to a report published by the World Health Organization (WHO) in February 2023, the global maternal mortality rate (MMR) improved considerably from 2000 to 2015 (the Millennium Development Goal era). However, from 2016 to 2020, the first 5 years of the Sustainable Development Goal (SDG) era, MMR stagnated or worsened in most regions of the world. During this period, only 2 regions, Australia and New Zealand and Central and Southern Asia, saw reductions in MMR (34.6% and 15.7%, respectively). The highest MMR was in Sub-Saharan Africa, accounting for ~70% of all maternal deaths in 2020.

Microplastics in aquatic bodies: Assessing the role of governance mechanisms in industrial wastewater management

The purpose of this research is to examine the association between corporate governance mechanisms (board independence, board gender diversity, Chief Executive Officer (CEO) duality, and environmental, social and governance (ESG) linked compensation) and wastewater recycling as a strategy for managing the flow of microplastics into the aquatic environment. The study analysed an international sample of top companies on the Forbes 500 list over a 15-year period during the millennium development goals (MDGs) and sustainable development goals (SDGs) eras. Multiple regression analysis with fixed effect OLS, two-stage least squares regression, propensity score matching, and logistic regression were applied in the data analysis. The results show that, at the aggregate level, board gender diversity is positively associated with wastewater recycling, whilst CEO duality has a significant negative impact. When disaggregated into industries, board gender diversity is positively associated with wastewater recycling in high-polluting and low-polluting industries. In relation to the MDGs/SDGs eras, the impact of board gender diversity is more significant in the MDGs era than in the SDGs era. At the geographical region level, CEO duality has a significant negative impact on wastewater management in the America and Asia Pacific regions, whilst the effect of CEO duality is significantly positive in the Western Europe region. We also find that a minimum of two female directors is required to improve wastewater management practice. The study concludes that whilst board gender diversity is a notable driver of wastewater management, CEO duality diminishes the commitment of multinational entities (MNEs) to addressing wastewater management issues. Our result is robust to (i) alternative measures of wastewater management, (ii) alternate sample composition, (iii) alternate method of data analysis, and (iv) endogeneity checks. The study contributes to the limited literature on waste management and the circular economy, particularly governance mechanisms’ role in wastewater management in an international context.

Hydrogeologic Constraints for Drinking Water Security in Southwest Coastal Bangladesh: Implications for Sustainable Development Goal 6.1

Transitioning from the Millennium Development Goals (MDG) to the Sustainable Development Goals (SDG) is a big challenge, particularly for SDG 6.1, as the effective delivery of drinking water services drops due to more stringent indicators, especially for water quality constraints. Salinity in groundwater has received less attention compared to arsenic and E. Coli in the MDG era, while its presence and widespread variability has considerable implications in larger coastal areas for achieving SDG 6.1 targets. This article analyzes drinking water security in southwest coastal Bangladesh, through an in-depth field investigation. It reveals that the exponential growth of groundwater-based technologies, such as tube wells, does not necessarily indicate the actual safe drinking water coverage in coastal areas, due to complex hydrogeology with the high spatial variability of groundwater salinity risks. The spatial variability of hydrogeologic constraints and groundwater salinity risks also reinforces concerns of access, reliability, and affordability with different water supply technologies. National estimates can be misleading as the presence of salinity substantially lowers the effective drinking water coverage. Infrastructural investments for drinking water supply need to consider a sound knowledge of hydrogeologic heterogeneity, and the monitoring of water quality, if the SDG 6.1 targets are to be met.

Corporate governance and carbon emissions performance: International evidence on curvilinear relationships

This study investigates the impact of corporate governance mechanisms (namely board meeting, board independence, board gender diversity, CEO duality, ESG-based compensation and ESG committee) on carbon emissions performance of multinational entities (MNEs). The study analysed international sample of 336 top MNEs operating in 42 non-financial industries from 32 countries over a 15-year period. Result shows that board gender diversity, CEO duality, and ESG committee are negatively associated with carbon emissions rate, whilst board independence and ESG-based compensation have significant positive impact. Whereas board gender diversity and CEO duality have significant negative impact on carbon emissions rate in carbon-intensive industries, the impact of board meeting, board independence and ESG-based compensation is significant and positive. In the non-carbon-intensive industries, board meeting, board gender diversity and CEO duality have significant negative impact on carbon emissions rate, whilst the impact of ESG-based compensation is positive. Further, there is a negative association between the millennium development goals (MDGs)/sustainable development goals (SDGs) era dichotomy and carbon emissions rate, implying that the United Nations agenda for sustainable development significantly affected carbon emissions performance of MNEs, with the SDGs era generally witnessing better carbon emissions management in comparison to the MDGs era in spite of the higher emissions level in the SDGs era. The study contributes to knowledge in several ways. First, it adds to the limited literature on the determinants of carbon emissions reduction within an international context. Second, the study addresses mixed result reported in prior studies. Third, the study adds to knowledge on the governance factors affecting carbon emissions performance in the MDGs and SDGs periods, thus providing evidence on progress MNEs are making towards addressing climate change challenges through carbon emissions management.

Universal health coverage evolution, ongoing trend, and future challenge: A conceptual and historical policy review.

The goal of universal health coverage (UHC) from the United Nations (UN) has metamorphized from its early phase of primary health care (PHC) to the recent sustainable development goal (SDG). In this context, we aimed to document theoretical and philosophical efforts, historical analysis, financial and political aspects in various eras, and an assessment of coverage during those eras in relation to UHC in a global scenario. Searching with broad keywords circumadjacent to UHC with scope and inter-disciplinary linkages in conceptual analysis, we further narrated the review with the historical development of UHC in different time periods. We proposed, chronologically, these frames as eras of PHC, the millennium development goal (MDG), and the ongoing sustainable development goal (SDG). Literature showed that modern healthcare access and coverage were in extension stages during the PHC era flagshipped with "health for all (HFA)", prolifically achieving vaccination, communicable disease control, and the use of modern contraceptive methods. Following the PHC era, the MDG era markedly reduced maternal, neonatal, and child mortalities mainly in developing countries. Importantly, UHC has shifted its philosophic stand of HFA to a strategic health insurance and its extension. After 2015, the concept of SDG has evolved. The strategy was further reframed as service and financial assurance. Strategies for further resource allocation, integration of health service with social health protection, human resources for health, strategic community participation, and the challenges of financial securities in some global public health concerns like the public health emergency and travelers' and migrants' health are further discussed. Some policy departures such as global partnership, research collaboration, and experience sharing are broadly discussed for recommendation.

Newborn signal functions in Bangladesh: Identification through expert consultation and assessment of readiness among public health facilities

BackgroundThis study aimed to identify a set of newborn signal functions (NSFs) that can categorize health facilities and assist policymakers and health managers in appropriately planning and adequately monitoring the progress and performance of health facilities delivering newborn health care in Bangladesh and similar low-income settings.MethodsA modified Delphi method was used to identify a set of NSFs and a cross-sectional health facility assessment among the randomly selected facilities was conducted to test them in public health facilities in Bangladesh. In the modified Delphi approach, three main steps of listing, prioritizing, and testing were followed to identify the set of NSFs. Then, to finalize the set of NSFs and its variables, a total of five Delphi workshops and three rounds of Delphi surveys were conducted. Finally, 205 public health facilities located in 41 randomly selected districts were assessed for the availability and readiness of finalized NSFs using the updated tool of Bangladesh Health Facility Survey (BHFS) 2017.ResultsTwenty NSFs were identified and finalized, nine of which were categorized as primary NSFs, 13 as basic NSFs, 18 as comprehensive NSFs, and 20 as advanced NSFs. Almost all district hospitals (DHs), Upazila health complexes (UHCs,) and maternal and child welfare centres (MCWCs) performed the primary NSFs in the last three months. However, around one-third of the union health and family welfare centres (UH&FWCs) and very few community clinics (CCs) performed them during the same period. The basic, comprehensive, and advanced NSF readiness was inadequate and inappropriate across all types of facilities, including DHs and UHCs.ConclusionsIn the absence of internationally or nationally agreed-upon NSFs to measure a health facility's service availability and readiness for providing newborn care, this study becomes the first to identify and finalize a set of NSFs and to incorporate relevant variables in the health facility assessment tool which can be used to monitor the availability and readiness of a newborn care facility. The identified NSFs can also be adapted for the countries with similar contexts and can serve as a standard base to determine a global set of NSFs.

The impact of a health systems strengthening initiative on child morbidity: The case of the Ghana Essential Health Interventions Program in rural northern Ghana.

BackgroundImproving child and maternal health remains a core objective of global health priorities, extending from the millennium development goal (MDG) era to the current focus on the Sustainable Development Goals (SGDs). This paper analyses the childhood morbidity effects of the Ghana Essential Heath Interventions Program (GEHIP), a community-based health systems strengthening in rural northern Ghana. GEHIP was a five-year embedded implementation science plausibility trial that implemented a set of health systems strengthening strategies and tested the proposition that their combined effect at the district, subdistrict and community levels could foster effective community engagement and thereby improve maternal and child health outcomes.MethodsA two stage random sample survey of reproductive-aged women residing in treatment and comparison districts at the GEHIP baseline and end line was used for Heckman Difference-in-differences (DiD) regression models for estimating the incremental effect of GEHIP exposure on three child morbidity conditions (diarrhea, fever and cough), as recalled by maternal respondents in the course of survey interviews.ResultsAfter controlling for child age and gender, maternal age, education, marital status, health insurance status, religion, ethnicity, occupation and household wealth index, regression results show that GEHIP had a statistically significant 45% reduction in fever (OR = 0.55, CI = 0.31–0.98) and 47% reduction in cough (OR = 0.53, CI = 0.30–0.94), over and above temporal reductions that prevailed in study districts. Although not significant, GEHIP also had 38% reduction in the incidence of diarrhea.ConclusionPrevious research has shown that GEHIP had a pronounced positive effect with a reduction in mortality. Our results show that household location in GEHIP districts also led to a significant reduction in morbidity due to cough and fever among under-five children. This association is a likely outcome of GEHIP’s impact on the accessibility of primary health care services. Results lend further support to the growing body of evidence that strengthening health systems in rural Africa through the provision of community-based strategies enhances prospects for achieving the United Nations child health SDGs.

Uncertainties in the path to 2030: Increasing trends of under-five mortality in the aftermath of Millennium Development Goal in Eastern Ethiopia.

BackgroundAlthough Ethiopia was applauded for achieving the Millennium Development Goal (MDG) target of reducing child mortality, whether the gains sustained beyond the MDG era was rarely studied. In this study, we reported the trends and determinants of under-five mortality (U5M) from 2015 to 2020 in a population based cohort under the Kersa Health and Demographic Surveillance System (HDSS), eastern Ethiopia.MethodsWe followed pregnant women and their pregnancy outcomes from 2015 to 2020. Each year, data related to death and live births among the follow up population was retrieved. Automated verbal autopsy (InterVA-4) was used to assign the cause of death and Stata 14 was used for analysis. U5M rate was calculated as death among under five children divided by all live births during the study period and described per 1000 live births along with 95% Confidence Interval (CI). A multivariable Cox proportional regression model was used to identify determinant of U5M using adjusted hazard ratio (AHR). Finally, P value <0.05 was considered for declaring statistically significant association.ResultsFrom January 2015 to December 2020, a total of 28 870 live births were registered under the Kersa HDSS, of whom 1335 died before their fifth birthday. The overall U5M rate was 46.3 per 1000 live births (95% confidence interval (CI) = 43.79-48.79), with significant increase from 27.9 in 2015 to 54.7 in 2020 (P < 0.041). Diarrheal diseases, acute respiratory tract infection including pneumonia, meningitis and encephalitis, and HIV related deaths were the leading causes of U5M. The hazard of death was higher among children born to poor household (AHR = 1.52; 95% CI = 1.27-1.81), rural residents (AHR = 6.0; 95% CI = 3.65-9.91), born to adolescent mothers (AHR = 1.41; 95% CI = 1.02-1.95), whose mother didn’t receive antenatal care (AHR = 1.43; 95% CI = 1.21-1.69), were born preterm (AHR = 14.1; 95% CI = 9.96-19.89) and had low birth-weight (AHR = 1.74; 95% CI = 1.39-2.18).ConclusionWe found high level of U5M rate with an increasing trend in the aftermath of the praised MDG4 achievement. Achieving the ambitious U5M of 25 per 1000 live births by 2030 requires addressing diarrheal disease, and respiratory tract infections, and HIV/AIDS. Reasons behind the persistent increase over the study period require further inquiry.

Factors contributing to neonatal mortality reduction in three regions in Ghana: a mixed-methods study using the Lives Saved (LiST) modelling tool

Background Ghana had significant reductions in neonatal mortality during the Millennium Development Goal (MDG) era. Few studies have attempted to identify the interventions, programs and policies that contributed to this progress. To understand the underlying factors which contributed to the reduction in neonatal mortality and to inform strategies to reach the Sustainable Development Goal (SDG) target to end preventable neonatal deaths, we conducted a mixed-methods study in the Northern, Upper West, and Volta Regions of Ghana. Methods The quantitative component consisted of an analysis of trends in coverage of key neonatal health interventions using subnational data from the Ghana Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS). The Lives Saved Tool (LiST) was used to assess the contribution of various neonatal health interventions which resulted in reductions in neonatal mortality. Qualitative in-depth interviews (N=38) were conducted with government health officials, health workers, staff from non-government organizations, and community leaders, including traditional birth attendants and local chiefs from the Northern Region of Ghana. Findings Multiple interventions and contextual factors contributed to declines in the neonatal mortality rate (NMR) in all three regions. The Volta and Upper West Regions improved labor and delivery management practices which accounted for approximately one-third of the decline in NMR. The Northern Region had a substantial decline in NMR; the greatest proportion of the decline was attributed to control and management of infections in newborns (sepsis and pneumonia). Qualitative interviews suggest that improvements in neonatal survival were achieved through the prioritization of neonatal health at community-based health planning (CHPS) compounds and the development of a national-level strategic plan, coupled with neonatal health-related training for health workers. The establishment of neonatal intensive care units and strong partnership with local leaders and women’s groups to increase facility births and promote clean birth practices were also considered important. Conclusions The strategies that supported the reductions span from national-level policy intervention to facility-based quality improvement, to community level engagement. These strategies can be continued, strengthened, and scaled to improve neonatal survival in the SDG era.

Nutrition in Nepal: Three decades of commitment to children and women.

South Asia has made significant progress in reducing child undernutrition. The prevalence of stunting declined by one third between 2000 and 2019; as a result, in 2019, there were 34 million fewer stunted children than in 2000, indicating that progress for child nutrition is possible and is happening at scale. However, no country in South Asia is on track for all nutrition targets of Sustainable Development Goal 2, and the region has the highest prevalence of stunting (33.2%) and wasting (14.8%) in the world. Nepal, the best performing country in the region, narrowly missed the Millennium Development Goal (MDG) target to half the prevalence of child underweight between 1990 and 2015 and achieved the fastest recorded reduction in stunting prevalence in the world between 2001 and 2011. In 2019, UNICEF Nepal completed a series of papers to examine Nepal's progress on maternal and child nutrition during the MDG era. The series explores the trends, distribution and disparities in stunting, micronutrient deficiencies and feeding practices in children under 5 years and anaemia in adolescents and women. Besides, it reviews national micronutrient programmes (vitamin A supplementation, iron and folic acid supplementation and universal salt iodization) and Nepal's first Multi‐Sector Nutrition Plan, to illuminate the success factors and enduring challenges in the policy and programme landscape for nutrition. This overview paper summarizes the evidence from these analyses and examines the implications for the direction of future advocacy, policy and programme actions to improve maternal and child nutrition in Nepal and other similar contexts.

Payment mechanism for institutional births in Nepal

BackgroundSince the Millennium Development Goal era, there have been several efforts to increase institutional births using demand side financing. Since 2005, Government of Nepal has implemented Maternity Incentive Scheme (MIS) to reduce out of pocket expenditure (OOPE) for institutional birth. We aim to assess OOPE among women who had institutional births and coverage of MIS in Nepal.MethodWe conducted a prospective cohort study in 12 hospitals of Nepal for a period of 18 months. All women who were admitted in the hospital for delivery and consented were enrolled into the study. Research nurses conducted pre-discharge interviews with women on costs paid for medical services and non-medical services. We analysed the out of pocket expenditure by mode of delivery, duration of stay and hospitals. We also analysed the coverage of maternal incentive scheme in these hospitals.ResultsAmong the women (n-21,697) reporting OOPE, the average expenditure per birth was 41.5 USD with 36 % attributing to transportation cost. The median OOPE was highest in Bheri hospital (60.3 USD) in comparison with other hospitals. The OOPE increased by 1.5 USD (1.2, 1.8) with each additional day stay in the hospital. There was a difference in the OOPE by mode of delivery, duration of hospital-stay and hospital of birth. The median OOPE was high among the caesarean birth with 43.3 USD in comparison with vaginal birth, 32.6 USD. The median OOPE was 44.7 USD, if the women stayed for 7 days and 33.5 USD if the women stayed for 24 h. The OOPE increased by 1.5 USD with each additional day of hospital stay after 24 h. The coverage of maternal incentive was 96.5 % among the women enrolled in the study.ConclusionsFamilies still make out of pocket expenditure for institutional birth with a large proportion attributed to hospital care. OOPE for institutional births varied by duration of stay and mode of birth. Given the near universal coverage of incentive scheme, there is a need to review the amount of re-imbursement done to women based on duration of stay and mode of birth.

Role of the Global Fund in national HIV/AIDS response in Myanmar: a qualitative study

BackgroundThe Global Fund has been a major funding source for HIV/AIDS programs in Myanmar. In this qualitative study, we aim to understand the impact of Global Fund on national HIV/AIDS response in Myanmar during the era of Millennium Development Goals (MDGs).MethodsWe conducted individual in-depth interviews by recruiting key informants through purposive snowball sampling. The respondents were engaged in the national/subnational response to HIV/AIDS in Myanmar and worked for the United Nations agencies, non-governmental organizations (NGOs), and civil society. Interview questions were organized around the role of Global Fund in strengthening national response to HIV/AIDS in the six building blocks of the Myanmar’s health system. Transcripts from the key informants were synthesized into specific themes through a deductive approach.ResultsWe found that the Global Fund has provided substantial support to (1) finance the national HIV/AIDS response in Myanmar, and (2) strengthen leadership and governance at the central level through improving coordination and collaboration, including more stakeholders (e.g. civil society, NGOs) in decision making process, and catalyzing policy changes on scaling-up key interventions. Yet, its role remains limited in addressing new demands at the township level in terms of capacity building, staffing, and medical supply resulting from rapid scale-up of HIV interventions and decentralization of service delivery in the public sector.ConclusionThere was a missed opportunity for Myanmar to capitalize on the use of the Global Fund’s funding to strengthen the health system. Deliberate planning is required to optimize the use of those scarce resources to provide universal coverage for HIV/AIDS.

Uncertainty in computerised analysis of maternal deaths

Maternal mortality continues to be a major concern for global public health despite commendable progress in reducing maternal deaths during the Millennium Development Goal era. Progress in reducing maternal mortality is largely dependent on the pace of achievements in the low-resource settings where the burden of maternal mortality is concentrated. To test the effectiveness of corrective actions, precise measurement of the appropriate indicator is essential. Vital registration systems in most low-resource settings are poor.

Parental education's role in child survival

The end of the Millennium Development Goals era marked progress in global under-5 mortality, but this was largely inequitable.1 Since the introduction of the Sustainable Development Goals (SDGs) much evidence has indicated the necessity of an integrative and intersectoral approach to the global health agenda.2–4 In recognition of this, education has been considered a core social determinant of health, with SDG 4 focusing on ensuring inclusive and equitable quality education and promoting lifelong learning opportunities for all, with an explicit indicator on better education for girls.

HOME ECONOMICS AND THE ACTUALIZATION OF SUSTAINABLE DEVELOPMENT GOALS VISION 2030

The historical misconception of Home Economics as a female-gender dominated field of academic inquiry is changing. A paradigm shift since the proclamation by International Federation for Home Economics (IFHE) on the 21st of March 1982 in declaring a World Home Economics Day (WHED) allowed Home Economics to be positioned since the 2000's as a strategic academic and professional practical tool to help address issues in family, nations and society at large. This paper begins by understanding the concept of sustainable development by mapping out the global policy focus on international development in the Millennium Development Goals (MDGs) era (2000-2015) and in the Sustainable Development Goals (SDGs) era (2015-2030). By doing so, this paper thematically groups the SDGs under four (4) themes (empowerment, health and wellbeing, sustainable environment and partnerships for development) by anchoring these 4 themes on education and 3 philosophical pillars of Home Economics which include (Food and Nutrition, Clothing and Textiles and, Home Management). This paper therefore conceptualizes Home Economics as: Empowerment through Education; Health and Wellbeing through Nutrition Education; Environmental Sustainability through Clothing and Textiles and; Partnerships for Development through Home Management.

A scoping review of research on policies to address child undernutrition in the Millennium Development Goals era.

The breadth of research on the impact of nutrition-specific policies to address child undernutrition is not well documented. This review maps the evidence base and identifies gaps on such policies. We systematically searched Medline, Embase, PAIS Index for public policy, Scopus and Web of Science databases to identify eligible studies. Key study characteristics, including research design, type of policy, time span of policy before impact assessment, child age at outcome assessment and types of outcomes assessed, were abstracted in duplicate. Low-, middle- and high-income countries. Studies were eligible for inclusion if they aimed to assess the impact of population-level nutrition-specific policies on undernutrition among children under 10 years of age. Of the 5646 abstracts screened, eighty-three studies were included. A range of policies to address child undernutrition were evaluated; the majority were related to micronutrient fortification. Most studies were observational, reported on mandatory regional or sub-national polices, were conducted in high-income countries and evaluated policies within 1 year of implementation. A narrow set of health outcomes were evaluated, most commonly iodine deficiency disorders and neural tube defects. Nutrition policies were commonly associated with improved child nutritional status and health. However, this evidence is primarily based on limited settings and on a limited number of outcomes. Further research is needed to assess the longer-term impact of a broader range of nutrition policies on child health, particularly in low- and middle-income countries.

「ミレニアム開発目標」時代の「開発と平和のためのスポーツ」 ―ホームレスワールドカップ出場国の事例の比較検討―

「ミレニアム開発目標」時代の「開発と平和のためのスポーツ」 ―ホームレスワールドカップ出場国の事例の比較検討―

Does TRIPS (Agreement on Trade-Related Aspects of Intellectual Property Rights) prevent COVID-19 vaccines as a global public good?

The article analyses the global public goods approach to COVID‐19 technologies, embedded in 2020 affirmations by the World Health Assembly (WHA), the UN Human Rights Council and G20 on broad immunization against COVID‐19. After identifying the access to COVID‐19 tools (ACT) Accelerator members, the UN efforts are identified, focusing primarily on the UN human rights bodies, acknowledging how these and the WHA have mutually reinforced each others' efforts. The article finds that the global public goods terminology appeared in UN resolutions in 2020, while wording that included vaccines—on an equal footing as medicines—appeared in 2016, and recognition of generic medicines appeared in 2019. The so‐called Trilateral Cooperation on IP and public health between two UN specialized agencies and the World Trade Organization (WTO) has increased awareness of the flexibilities within WTO's TRIPS Agreement. These flexibilities are explained. With notable exceptions, like India, these flexibilities are not widely applied in domestic legislation. A different emphasis characterizes the millennium development goals era as compared to the sustainable development goals era, and this shift is explained by applying relevant theories. Among pro‐TRIPS developed countries there is an acknowledgment of obstacles created by the IP system, but their overall position has not changed.

A SCIENTOMETRIC ANALYSIS AND VISUALIZATION OF GREEN BUILDING RESEARCH IN AFRICA

ABSTRACTOwing to the adverse impact of the architecture, engineering and construction industry on the human and natural environment, the adoption of green building (GB) has been on the rise globally. The significant rise in the number of global research output on GB is a pointer to its proliferation. In this paper, a novel scientometric analysis of GB research in Africa is presented. This study aims to analyze and visualize GB research output in Africa from the millennium development goals (MDGs) era up to the present sustainable development goals (SDGs) era. A quantitative method (science mapping) was employed to analyze the 156 bibliometric records gathered from the Scopus database. An analysis of the dataset reveals that significant contributions to GB research in Africa originate from Egypt, South Africa, Nigeria, Algeria, Ghana, Morocco, Kenya, Mauritius, Ethiopia and Cameroon. This research provides stakeholders in the built environment with the requisite knowledge and understanding of the trend and state of GB research in Africa, which will help in guiding policymaking, research directions and intervention areas in every sector of the economy.