UN Inter-agency Research Articles

Disaster Management and Early Warning System: Human Rights Perspective

The origins of a disaster lie in nature and as well as in various human activities. Economically well-off and technologically advanced countries have failed in discovering proper solutions to disasters. The mere presence of hazard does not lead to disaster, there must be vulnerability also. Disaster plus vulnerability leads to damage. Making high probabilities from an undesirable event to low probabilities is disaster management. Risk analysis plays an important role in disaster management. Disaster management means the organization, planning and indication of measures preparing for, responding to and, initial recovery from disasters. Geographic Information System (GIS) and Remote Sensing play a very important role in disaster management and risk reduction. Early warning system is very useful in taking care of measures relating to pre-disaster mitigation and preparedness measures, emergency relief and reconstruction efforts. The problems and multiple human rights challenges posed by natural disasters are mainly of humanitarian nature and it is observed that the human rights of disaster victims are not sufficiently taken care of. In June 2006, the UN Inter-Agency Standing Committee (IASC) adopted Operational Guidelines on Human Rights and Natural Disasters, which are aimed at protecting the rights of persons affected by natural disasters. Human rights-based approach should be considered as one of the measures to increase accountability for warning and it must be ensured that warnings should reach the each and one who are residing in disaster prone areas.

Spatiotemporal analysis of the effect of global development indicators on child mortality

BackgroundChild mortality continue to be a major public health issue in most developing countries; albeit there has been a decline in global under-five deaths. The differences in child mortality can best be explained by socioeconomic and environmental inequalities among countries. In this study, we explore the effect of country-level development indicators on under-five mortality rates. Specifically, we examine potential spatio-temporal heterogeneity in the association between major world development indicators on under-five mortality, as well as, visualize the global differential time trend of under-five mortality rates.MethodsThe data from 195 countries were curated from the World Bank’s World Development Indicators (WDI) spanning from 2000 to 2017 and national estimates for under-five mortality from the UN Inter-agency Group for Child Mortality Estimation (UN IGME).We built parametric and non-parametric Bayesian space-time interaction models to examine the effect of development indicators on under-five mortality rates. We also used employed Bayesian spatio-temporal varying coefficient models to assess the spatial and temporal variations in the effect of development indicators on under-five mortality rates.ResultsIn both parametric and non-parametric models, the results show indicators of good socioeconomic development were associated with a reduction in under-five mortality rates while poor indicators were associated with an increase in under-five mortality rates. For instance, the parametric model shows that gross domestic product (GDP) (β = − 1.26, [CI − 1.51; − 1.01]), current healthcare expenditure (β = − 0.40, [CI − 0.55; − 0.26]) and access to basic sanitation (β = − 0.03, [CI − 0.05; − 0.01]) were associated with a reduction under-five mortality. An increase in the proportion practising open defecation (β = 0.14, [CI 0.08; 0.20]) an increase under-five mortality rate. The result of the spatial components spatial variation in the effect of the development indicators on under-five mortality rates. The spatial patterns of the effect also change over time for some indicators, such as PM2.5.ConclusionThe findings show that the burden of under-five mortality rates was considerably higher among sub-Saharan African countries and some southern Asian countries. The findings also reveal the trend in reduction in the sub-Saharan African region has been slower than the global trend.

Sentience, Harmony and the Value of Nature.

Concern for nature and for animal sentience are important public and political moral concerns. Using frameworks such as Harmony for Nature and One Health and the recent IPBES report on the Diverse Values of Nature, this paper considers how the two issues interrelate, in terms of our concepts of sentience and nature, and sentience-based values' importance in relation to nature-based values. Animals' sentience is part of nature, and part of its diversity, harmony, health and value. Sentient animals' feelings represent animals' evaluations of nature that go beyond valuing nature for solely for market-based and anthropocentric interests. Sentience is therefore relevant for measurement, leveraging and embedding sentience-based values in environmental concerns, including in environmental impact assessments, science-based UN policy-making, interdisciplinary and interagency collaboration, and to strengthen transformative and system-based action for nature.

Estimating the stillbirth rate for 195 countries using a Bayesian sparse regression model with temporal smoothing

Estimation of stillbirth rates globally is complicated because of the paucity of reliable data from countries where most stillbirths occur. We compiled data and developed a Bayesian hierarchical temporal sparse regression model for estimating stillbirth rates for 195 countries from 2000 to 2019. The model combines covariates with a temporal smoothing process so that estimates are data-driven in country-periods with high-quality data and determined by covariates for country-periods with limited or no data. Horseshoe priors are used to encourage sparseness. The model adjusts observations with alternative stillbirth definitions and accounts for various sources of uncertainty. In-sample goodness of fit and out-of-sample validation results suggest that the model is reasonably well calibrated. The model is used by the UN Interagency Group for Child Mortality Estimation to monitor the stillbirth rate for 195 countries.

Investing in the health workforce, protecting mental health: policy and action taken by WHO

Abstract Background The COVID-19 pandemic and the current war in Ukraine have presented opportunities to increase national leadership on mental health, including support health and care workers. Member States across the region have worked closely with the WHO to strengthen their policy levers to support the mental health and occupational safety policies for the workforce at various levels including government, organization and local service levels. To complement these policies, the WHO will launch the WHO Global Health and Care Compact at the Seventy-fifth World Health Assembly in May 2022. Methods The WHO has convened Member States to discuss the policy levers that can support the mental health of health and care workers. These include online multistakeholder webinar series, national policy dialogs, ministerial discussions during the Regional Committee, preparatory consultations for the World Health Assembly to discuss priority areas and policy. More recently with the crisis in Ukraine, the WHO has been working closely with the UN Interagency Steering Committee (IASC) Reference Group on Mental Health and Psychosocial Support in Emergency Settings rolling out services for refugees, including health workers in these settings. Results A number of important policy recommendations are emerging from this work: (1) strengthening national and political leadership; (2) adopting stepped approaches; (3) facilitating collaboration across professions, sectors and levels of syste for more effective responses; (4) strengthening capacity and expertise; (5) monitoring effectiveness for continuous improvement; (6) ensuring acceptability and accessibility. Conclusions Promoting health and well-being and mental health support to the health and care workforce has become a key priority for health systems to enable sustainable national health workforces. WHO will prioritize country support on this area and the development of regional guidance.

Global, regional, and national trends in under-5 mortality between 1990 and 2019 with scenario-based projections until 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation

SummaryBackgroundThe Sustainable Development Goals (SDGs), set in 2015 by the UN General Assembly, call for all countries to reach an under-5 mortality rate (U5MR) of at least as low as 25 deaths per 1000 livebirths and a neonatal mortality rate (NMR) of at least as low as 12 deaths per 1000 livebirths by 2030. We estimated levels and trends in under-5 mortality for 195 countries from 1990 to 2019, and conducted scenario-based projections of the U5MR and NMR from 2020 to 2030 to assess country progress in, and potential for, reaching SDG targets on child survival and the potential under-5 and neonatal deaths over the next decade.MethodsLevels and trends in under-5 mortality are based on the UN Inter-agency Group for Child Mortality Estimation (UN IGME) database on under-5 mortality, which contains around 18 000 country-year datapoints for 195 countries—nearly 10 000 of those datapoints since 1990. The database includes nationally representative mortality data from vital registration systems, sample registration systems, population censuses, and household surveys. As with previous sets of national UN IGME estimates, a Bayesian B-spline bias-reduction model (B3) that considers the systematic biases associated with the different data source types was fitted to these data to generate estimates of under-5 (age 0–4 years) mortality with uncertainty intervals for 1990–2019 for all countries. Levels and trends in the neonatal mortality rate (0–27 days) are modelled separately as the log ratio of the neonatal mortality rate to the under-5 mortality rate using a Bayesian model. Estimated mortality rates are combined with livebirths data to calculate the number of under-5 and neonatal deaths. To assess the regional and global burden of under-5 deaths in the present decade and progress towards SDG targets, we constructed several scenario-based projections of under-5 mortality from 2020 to 2030 and estimated national, regional, and global under-5 mortality trends up to 2030 for each scenario.FindingsThe global U5MR decreased by 59% (90% uncertainty interval [UI] 56–61) from 93·0 (91·7–94·5) deaths per 1000 livebirths in 1990 to 37·7 (36·1–40·8) in 2019, while the annual number of global under-5 deaths declined from 12·5 (12·3–12·7) million in 1990 to 5·2 (5·0–5·6) million in 2019—a 58% (55–60) reduction. The global NMR decreased by 52% (90% UI 48–55) from 36·6 (35·6–37·8) deaths per 1000 livebirths in 1990, to 17·5 (16·6–19·0) in 2019, and the annual number of global neonatal deaths declined from 5·0 (4·9–5·2) million in 1990, to 2·4 (2·3–2·7) million in 2019, a 51% (47–54) reduction. As of 2019, 122 of 195 countries have achieved the SDG U5MR target, and 20 countries are on track to achieve the target by 2030, while 53 will need to accelerate progress to meet the target by 2030. 116 countries have reached the SDG NMR target with 16 on track, leaving 63 at risk of missing the target. If current trends continue, 48·1 million under-5 deaths are projected to occur between 2020 and 2030, almost half of them projected to occur during the neonatal period. If all countries met the SDG target on under-5 mortality, 11 million under-5 deaths could be averted between 2020 and 2030.InterpretationAs a result of effective global health initiatives, millions of child deaths have been prevented since 1990. However, the task of ending all preventable child deaths is not done and millions more deaths could be averted by meeting international targets. Geographical and economic variation demonstrate the possibility of even lower mortality rates for children under age 5 years and point to the regions and countries with highest mortality rates and in greatest need of resources and action.FundingBill & Melinda Gates Foundation, US Agency for International Development.

Inadequate evidence on stillbirths: rethinking public health

Rates of stillbirths are an indicator of the quality of care around pregnancy and birth. They are increasingly a matter of global health concern, falling within the remit of the Sustainable Development Goal 3 (maternal health), which aims to end preventable deaths of newborn babies and children younger than 5 years by 2030. However, stillbirths continue to be a particular challenge in most low-income and middle-income countries (LMICs), especially in sub-Saharan Africa, 1 Kiguli J Munabi IG Ssegujja E et al. Stillbirths in sub-Saharan Africa: unspoken grief. Lancet. 2016; 387: e16-18 Summary Full Text Full Text PDF PubMed Scopus (22) Google Scholar where more than 0·8 million deaths have been estimated to occur annually. 2 Hug L You D Blencowe H et al. Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessment. Lancet. 2021; 398: 772-785 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar Researchers have regularly brought attention to stillbirths and urged for maternal and newborn health policies. 3 UN Inter-agency Group for Child Mortality EstimationLevels and trends in child mortality: report 2018, estimates developed by United Nations Inter-agency Group for Child Mortality Estimation. United Nations International Children's Emergency Fund, New York, NY2020 Google Scholar , 4 Lawn JE Blencowe H Waiswa P et al. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet. 2016; 387: 587-603 Summary Full Text Full Text PDF PubMed Scopus (669) Google Scholar , 5 Waiswa P Akuze J Moyer C et al. Status of birth and pregnancy outcome capture in health demographic surveillance sites in 13 countries. Int J Public Health. 2019; 64: 909-920 Crossref PubMed Scopus (6) Google Scholar Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessmentProgress in reducing the rate of stillbirths has been slow compared with decreases in the mortality rate of children younger than 5 years. Accelerated improvements are most needed in the regions and countries with high stillbirth rates, particularly in sub-Saharan Africa. Future prevention of stillbirths needs increased efforts to raise public awareness, improve data collection, assess progress, and understand public health priorities locally, all of which require investment. Full-Text PDF Open Access

Potentially Avertable Child Mortality Associated with Surgical Workforce Scale-up in Low- and Middle-Income Countries: A Global Study.

Expansion of access to surgical care can improve health outcomes, although the impact that scale-up of the surgical workforce will have on child mortality is poorly defined. In this study, we estimate the number of child deaths potentially avertable by increasing the surgical workforce globally to meet targets proposed by the Lancet Commission on Global Surgery. To estimate the number of deaths potentially avertable through increases in the surgical workforce, we used log-linear regression to model the association between surgeon, anesthetist and obstetrician workforce (SAO) density and surgically amenable under-5 mortality rate (U5MR), infant mortality rate (IMR), and neonatal mortality rate (NMR) for 192 countries adjusting for potential confounders of childhood mortality, including the non-surgical workforce (physicians, nurses/midwives, community health workers), gross national income per capita, poverty rate, female literacy rate, health expenditure per capita, percentage of urban population, number of surgical operations, and hospital bed density. Surgically amenable mortality was determined using mortality estimates from the UN Inter-agency Group for Child Mortality Estimation adjusted by the proportion of deaths in each country due to communicable causes unlikely to be amenable to surgical care. Estimates of mortality reduction due to upscaling surgical care to support the Lancet Commission on Global Surgery (LCoGS) minimum target of 20-40 SAO/100,000 were calculated accounting for potential increases in surgical volume associated with surgical workforce expansion. Increasing SAO workforce density was independently associated with lower surgically amenable U5MR as well as NMR (p < 0.01 for each model). When accounting for concomitant increases in surgical volume, scale-up of the surgical workforce to 20-40 SAO/100,000 could potentially prevent between 262,709 (95% CI 229,643-295,434) and 519,629 (465,046-573,919) under 5 deaths annually. The majority (61%) of deaths averted would be neonatal deaths. Scale up of surgical workforce may substantially decrease childhood mortality rates around the world. Our analysis suggests that scale-up of surgical delivery through increase in the SAO workforce could prevent over 500,000 children from dying before the age of 5 annually. This would represent significant progress toward meeting global child mortality reduction targets.

Immunopeptidomics for next-generation bacterial vaccine development.

Antimicrobial resistance is an increasing global threat and alternative treatments substituting failing antibiotics are urgently needed. Vaccines are recognized as highly effective tools to mitigate antimicrobial resistance; however, the selection of bacterial antigens as vaccine candidates remains challenging. In recent years, advances in mass spectrometry-based proteomics have led to the development of so-called immunopeptidomics approaches that allow the untargeted discovery of bacterial epitopes that are presented on the surface of infected cells. Especially for intracellular bacterial pathogens, immunopeptidomics holds great promise to uncover antigens that can be encoded in viral vector- or nucleic acid-based vaccines. This review provides an overview of immunopeptidomics studies on intracellular bacterial pathogens and considers future directions and challenges in advancing towards next-generation vaccines.

Mexican mortality 1990‒2016: Comparison of unadjusted and adjusted estimates

Background: Vital statistics registration and census counts for Mexico may be incomplete, resulting in unreliable mortality indicators. Objective: We evaluate unadjusted mortality estimates for Mexico during 1990‒2016 and compare them with other published estimates for Mexico and with the historical mortality patterns observed among the 41 Human Mortality Database (HMD) populations. Finally, we investigate the effect of various adjustments on estimated life expectancy. Methods: We apply the HMD methodology to the official vital statistics and census counts to construct unadjusted life table series for Mexico. Then we make adjustments by substituting revised estimates for child mortality and by fitting a log-quadratic model. Results: Adjusted estimates of mortality below age 5 derived by the UN Inter-agency Group for Child Mortality Estimation (IGME) are up to 48% higher than our unadjusted estimates. Even in 2015, the IGME-adjusted estimates of child mortality remain at least 10% higher than our unadjusted estimates. Our analysis suggests that there may also be underestimation of mortality at both prime adult ages and the oldest ages. The log-quadratic model produced the lowest estimates of life expectancy at birth (3.8‒4.4 years lower than the unadjusted values in 1995). Conclusions: Unadjusted estimates are likely to underestimate mortality in Mexico, even in recent years. Adjustments may improve the accuracy of the mortality estimates, but we cannot adjudicate which set of adjusted estimates is closest to reality. Contribution: This is the first time the HMD methodology has been applied to the Mexican data.

Global, regional, and national mortality trends in youth aged 15–24 years between 1990 and 2019: a systematic analysis

SummaryBackgroundThe global health community is devoting considerable attention to adolescents and young people, but risk of death in this population is poorly measured. We aimed to reconstruct global, regional, and national mortality trends for youths aged 15–24 years between 1990 and 2019.MethodsIn this systematic analysis, we used all publicly available data on mortality in the age group 15–24 years for 195 countries, as compiled by the UN Inter-agency Group for Child Mortality Estimation. We used nationally representative vital registration data, estimated the completeness of death registration, and extracted mortality rates from surveys with sibling histories, household deaths reported in censuses, and sample registration systems. We used a Bayesian B-spline bias-reduction model to generate trends in 10q15, the probability that an adolescent aged 15 years would die before reaching age 25 years. This model treats observations of the 10q15 probability as the product of the actual risk of death and an error multiplier that varies depending on the data source. The main outcome that we assessed was the levels of and trends in youth mortality and the global and regional mortality rates from 1990 to 2019.FindingsGlobally, the probability of an individual dying between age 15 years and 24 years was 11·2 deaths (90% uncertainty interval [UI] 10·7–12·5) per 1000 youths aged 15 in 2019, which is about 2·5 times less than infant mortality (28·2 deaths [27·2–30·0] by age 1 year per 1000 live births) but is higher than the risk of dying from age 1 to 5 (9·7 deaths [9·1–11·1] per 1000 children aged 1 year). The probability of dying between age 15 years and 24 years declined by 1·4% per year (90% UI 1·1–1·8) between 1990 and 2019, from 17·1 deaths (16·5–18·9) per 1000 in 1990; by contrast with this total decrease of 34% (27–41), under-5 mortality declined by 59% (56–61) in this period. The annual number of deaths declined from 1·7 million (90% UI 1·7–1·9) in 1990 to 1·4 million (1·3–1·5) in 2019. In sub-Saharan Africa, the number of deaths increased by 20·8% from 1990 to 2019. Although 18·3% of the population aged 15–24 years were living in sub-Saharan Africa in 2019, the region accounted for 37·9% (90% UI 34·8–41·9) of all worldwide deaths in youth.InterpretationIt is urgent to accelerate progress in reducing youth mortality. Efforts are particularly needed in sub-Saharan Africa, where the burden of mortality is increasingly concentrated. In the future, a growing number of countries will see youth mortality exceeding under-5 mortality if current trends continue.FundingUN Children's Fund, Bill & Melinda Gates Foundation, United States Agency for International Development.

Health workforce and health-related sustainable development goals from 1990 to 2018 in China: a retrospective study based on national statistical data

BackgroundThe health workforce has vital roles in protecting and promoting the health of the population, given that it is a prerequisite of health care. Reducing maternal mortality, neonatal mortality, and under-5 mortality are three important health-related sustainable development goals (SDGs). To my knowledge, no study has yet analysed the importance of the health workforce for health-related SDGs in China on the basis of multiple-year national statistical data. I aimed to achieve this with the present study. MethodsUnivariate linear regression analyses were done with maternal mortality ratios, neonatal mortality, and under-five mortality as dependent variables. Aggregate density of health technicians was an independent variable in one set of regressions. Doctor and nurse densities were separately used in two other sets. All variables were transformed into natural logarithms. Statistical data for these variables covered 1990–2018 and were extracted from the China Health Statistics Yearbook 2019, WHO, and the UN Inter-agency Group for Child Mortality Estimation. The study was approved by the ethics committee of the School of Medicine of Xi’an Jiaotong University (number 2014189). FindingsDensity of health technicians was significant in accounting for maternal mortality ratio, neonatal mortality, and under-5 mortality (with elasticities ranging from –1·219 to –2·400, all p-values <0·0001). The elasticities of the three types of mortality with respect to doctor and nurse densities ranged from –1·643 to –3·227 (p=0·00012 for maternal mortality ratio, p<0·0001 for neonatal mortality, and p<0·0001 for under-5 mortality) and from –0·766 to –1·471 (all p-values <0·0001). InterpretationThe density of the health workforce is important in accounting for variation in maternal mortality ratio, neonatal mortality, and under-5 mortality in China. The effect of this density in reducing child mortality is greater than it is in reducing maternal mortality in China, possibly because qualified health technicians can better address the illnesses that put children at risk. Doctor density has a greater effect than nurse density in reducing all the three mortality types, possibly because of a greater of specialisation of doctors. Investment in the health workforce should always be part of a strategy to achieve health-related SDGs in China. FundingMajor Programme of National Social Science Fund of China: Research on Disease Prevention and Healthy China Construction (17ZDA079).

History of global burden of disease assessment at the World Health Organization

BackgroundThe World Health Organization collaborated in the first Global Burden of Disease Study (GBD), published in the 1993 World Development Report. This paper summarizes the substantial methodological improvements and expanding scope of GBD work carried out by WHO over the next 25 years.MethodsThis review is based on a review of WHO and UN interagency work relating to Global Burden of Disease over the last 20 years, supplemented by a literature review of published papers and commentaries on global burden of disease activities and the production of global health statistics.ResultsWHO development of global burden of disease work in the Millenium Development Goal era resulted in regular publication of time series estimates of deaths by cause, age and sex at country level, consistent with UN population and life table estimates, and with cause-specific statistics produced across UN agencies and interagency collaborations. This positioned WHO as the lead agency to monitor many of the 43 health-related indicators for the UN Sustainable Development Goals.In 2007, the Institute of Health Metrics and Evaluation (IHME) was established to conduct new global burden of disease and related work, funded by the Bill and Melinda Gates Foundation (BMGF). WHO was a core collaborator in its first GBD2010 study, but withdrew prior to publication as it was unable to obtain full access input data and methods. The publication of global health statistics by IHME resulted in user confusion and in debate over differences and the reasons for them. The new WHO administration of Director General Dr. Tedros Ghebreyesus has sought to make greater use of IHME outputs for its global health statistics and SDG monitoring.ConclusionsWHO work on global burden of disease has positioned it to be the lead agency for monitoring many of the UN Sustainable Development Goals. Current moves to use IHME analyses raises a number of issues for WHO and for Member States in relation to WHO’s constitutional mandate, its accountability to Member States, the consistency of WHO and UN demographic and health statistics, and the ability of Member States to engage with the results of the complex and computer-intensive modelling procedures used by IHME. As new global health actors and funders have arisen in recent decades, and funding to carry out WHO’s expanding mandate has declined, it is unclear whether WHO has the ability or desire to continue as the lead agency for global health statistics.

Role of Sports in Peace-Building: Insights from NCAA Community

Role of Sports in Peace-Building: Insights from NCAA Community

Recommendation for Reforms of the Co-ordination in the UN System

Within the conceptual framework of the "financial co-ordination", in the present article, we analyzes approach to the problem of program(s) and budget co-ordination within the UN system, we have proposed a new model for co-ordination which has the potential of elimination of negative effects of the present mechanism of co-ordination in the UN system. This model is based on the idea of introducing a budgetary control mechanism into the UN inter-agency system by providing the UN General Assembly with a legal power to approve the regular (administrative) budgets of UN-related agencies (by amending paragraph 3, article 17 of the UN Charter). This amendment induces greater de jure and de facto binding power in all decisions relating to the program(s) and budget co-ordination within the UN system.

The investment case as a mechanism for addressing the NCD burden: Evaluating the NCD institutional context in Jamaica, and the return on investment of select interventions.

Noncommunicable diseases (NCDs) are a broad challenge for decision-makers. NCDs account for seven out of every 10 deaths globally, with 42 percent occurring prematurely in individuals under age 70. Despite their heavy toll, NCDs are underfunded, with only around two percent of global funding dedicated to the disease set. Country governments are responsible for funding targeted actions to reduce the NCD burden, but among other priorities, many have yet to invest in the health-system interventions and policy measures that can reduce the burden. This article examines “investment cases” as a potential mechanism for catalyzing attention to—and funding for—NCDs. In Jamaica, using the UN inter-agency OneHealth Tool, we conducted an economic analysis to estimate the return-on-investment from scaling up strategic clinical interventions, and from implementing or intensifying policy measures that target NCD risk factors. In addition, we conducted an institutional and context (ICA) analysis, interviewing stakeholders across sectors to take stock of promising policy pathways (e.g., areas of general consensus, political appetite and opportunity) as well as challenges to implementation. The economic analysis found that scaling up clinical interventions that target CVD, diabetes, and mental health disorders, and policy measures that target tobacco and alcohol use, would save over 6,600 lives between 2017–2032, and avert JMD 81.3 billion (USD 640 million) in direct and indirect economic costs that result from mortality and morbidity linked to NCDs. The ICA uncovered government economic growth targets and social priorities that would be aided by increased attention to NCDs, and it linked these targets and priorities to the economic analysis.

Offline: The false narrative of “tremendous progress”

Offline: The false narrative of “tremendous progress”

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.

Infant Mortality in India and its Contributing Risk Factors: A Systematic Analysis

Infant mortality rate (IMR) data can be used as a statistical measure to identify the changing dynamics of children health, which can be an indicator of the welfare and progress of a society. However, these data are usually collected by authorized bodies or Government organizations on a large scale, with very little local stratification. For implementing correct policies for medical intervention, the knowledge about patterns of the cause-specific mortality is necessary. Studies included in this article were identified through a systematic analysis search of the scientific literature published between 2018 & 2019. Secondary data was extracted from vital records, sample Registration system 2019, database from “UN inter-agency” group of infant mortality estimates. The data between 2009–2019 (on or before June 2019) were collected. The infant mortality rate was calculated based for every death per 1000 live birth in the year. The data for each year was evaluated based on the information collected from secondary records. Further, the IMR data from the “Indian Sample Registration System (ISRS)”. Estimated NMR for 2019 was based on assumption and data collected on or before May 2019. For the purpose analysis all publicly available data on infant mortality was used.