UN Population Division Research Articles

Demographic challenges in the context of the state policy of the Russian Federation in the sphere of maternity and childhood protection

The article examines current demographic trends in Russia in comparison with population changes based on data from the Federal State Statistics Service of Russia (Rosstat) and the UN Population Division. The specifi cs of the age structure of the population of Russia, formed by a number of demographic waves, are such that changes in the number of births and the size of age groups occur in waves; this trend will continue in the coming decades. The state policy of the Russian Federation in the fi eld of family support, aimed at increasing the total fertility rate from 1.3 to 1.6 by 2030 and to 1.8 by 2036, should provide for the introduction of new health-preserving and reproductive health protection technologies, the development of childhood infrastructure, antenatal clinics and perinatal centers for high-quality and aff ordable medical care for mothers and children.

Nowcasting and forecasting global aging and cancer burden: analysis of data from the GLOBOCAN and Global Burden of Disease Study

ObjectiveTo analyze the impact of global population aging on cancer epidemiology, with a focus on the incidence and mortality rates among individuals aged 60 years and above. MethodsWe utilized open-source data, retrieving population age estimates from the United Nations Population Division website. The GLOBOCAN 2020 database provided estimates for cancer cases and deaths in 2020 and 2040, while the Global Burden of Disease 2019 database supplied estimates of new cancer cases worldwide from 2000 to 2019. Inclusion criteria considered individuals aged 60 years and over, focusing on the top five deadliest cancers. The cohort-component method was employed for population prediction, with age-specific incidence and mortality rates estimated for 2020 used to forecast the cancer burden. ResultsIn 2021, the global population aged over 60 years accounted for 13.7%, with Europe/North America and Australia/New Zealand having the highest proportions. The older population is predicted to reach 19.2% by 2040. In 2020, of the 19.3 million new cancer cases worldwide, 64% occurred in individuals aged 60 and above, contributing to 71.3% of cancer-related deaths. The five most common cancer sites were the lung, colorectum, prostate, breast, and stomach. Cancer incidence and deaths are projected to rise significantly among older individuals, reaching 20.7 million new cases and 12.7 million deaths by 2040. Older age, tobacco use, dietary factors, alcohol consumption, and high body mass index (BMI) were identified as major risk factors for various cancers in this demographic. ConclusionsThis study reveals a significant rise in cancer incidence and mortality among the elderly due to global population aging. The urgency for targeted interventions in cancer prevention, screening, and treatment for older individuals is emphasized. Despite acknowledged limitations, these findings contribute valuable insights to inform strategies for managing cancer in the elderly amidst evolving demographic trends.

A study about the prediction of population growth and demographic transition in Bangladesh

AbstractBangladesh is the smallest nation in South Asia, with the eighth-largest and tenth-largest population density globally. The main goal of this article is to find the population growth and demographic transition (DT) in Bangladesh. The time series data used in this paper were gathered from population surveys, national censuses, and UN Population division, population projections and estimates. There are numerous variations in the population's size and age distribution due to Bangladesh's continuing demographic transition, which creates possibilities for the economy and society and difficulties for policy. It must be successfully controlled to develop this population into stronger and more stable economic and social development. Bangladesh's population and policymakers observe increasing population growth concerns, as the country's economy and policies heavily depend on both the population's size and growth rate. Bangladesh's changing demographics are creating new economic opportunities, and the findings presented in this paper could be useful to planners and policymakers to enhance Bangladesh's population policy. At the end of the pioneering study, we presented graphically what the population of Bangladesh could be in 2000- 2100 and the impact it would have on Bangladesh.

Population Dynamics and Policies in Europe: Analysis of Population Resilience at the Subnational and National Levels

While previous research has focused on the relationship between population dynamics and policies in Europe, there has been scarce attention on dynamics at the NUTS-3 level. By looking at the population measures at subnational regions in Europe we seek to identify average population dynamics since year 2000. We group subnational regions by countries in terms of average population dynamics and assess the connection between population policies in 1996 and average population dynamics in 2000–2017 using data from World Population Policy database, the UN Population Division, the World Bank’s World Development Indicators and Eurostat. We find that urban areas and Western and Northern Europe exhibit population growth whilst rural areas and Central, Eastern, and Southern Europe have more depopulating regions. Our analyses also suggest a negative association between fertility policies and population growth.

Tackling maternal mortality in Pakistan: A perspective and call for systemic improvements

Dear Madam, Pregnancy should be a time of immense hope and a positive experience for all women. This period necessitates significant management and care, as the woman’s body undergoes numerous physiological and psychological adaptations. Thus, establishing an effective management system and a proficient maternal healthcare service is of utmost importance for the mother and the children. However, in developing countries like Pakistan, it is still a shockingly scary experience for millions of pregnant women who lack access to high-quality healthcare systems. For many females, the miracle of childbirth is marred by the tragedy of maternal death. Maternal death is defined as the death of a woman while pregnant or within 42 days of termination of the pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes [1]. Additionally, Pakistan has been ranked as one of the top ten countries expected to contribute 60% of all maternal deaths worldwide [2]. It continues to have the highest maternal deaths in Southeast Asia [3]. Despite Pakistan being officially categorized as a country with high maternal mortality rates, the actual number of cases could be even higher due to under-registration of vital events, particularly in the rural parts of the country [4]. Nevertheless, based on interview survey methods, the maternal mortality ratio in Pakistan is estimated to have declined from 430/10^5 live births in 1990 to 180/10^5 in 2015 [2]. However, the recent report, "Trends in Maternal Mortality", released by WHO, UNICEF, UNFPA, the world bank, and UN Population Division, reveals alarming setbacks for women's health over recent years, as maternal deaths either increased or remained stalled in nearly all regions of the world after 2015 [5]. The report statistics indicate a public health emergency that a woman dies every two minutes due to complications associated with pregnancy or childbirth. It emphasizes that the world must significantly accelerate progress in reducing maternal deathsor risk the lives of over one million more women by 2030 [5]. While the entire global community contends with the maternal mortality, Pakistan shoulders a disproportionate share of its consequences [2]. ---Continue

Population Age Structure and the Vulnerability of States to Coups d’État

Abstract This essay responds to recent critiques of the U.S. State Department’s inconsistent application of congressionally mandated foreign-aid restrictions following several successful coups d’état in countries receiving USAID foreign assistance. This demographic analysis, which conforms to an age-structural modeling and forecasting protocol that was originally developed for U.S. strategic intelligence efforts, finds: (1.) a disproportionately high level of coup vulnerability (the probability of experiencing a successful coup) among youthful countries (median age equal to or less than 25.5 years), particularly among states in the early-youthful segment of this phase (median age equal to or less than 20.5 years); and (2.) a dramatic one-time decline in coup vulnerability among all phases of the age-structural transition following the end of the Cold War. This essay’s two-decade forecast of an expected gradual decline in coups is consistent with the slow and halting pace of age-structural change that is currently projected by the 2022 revision of the UN Population Division’s medium scenario for countries along the equatorial midriff of Africa, and in parts of the Middle East and southcentral Asia. These findings support an alternative criticism – not of the U.S. State Department’s reluctance to restrict foreign assistance to coup perpetrators, but of currently mandated restrictions that neglect to exempt USAID programs known to advance the age-structural transition (i.e. those that extend girls’ educational attainment, improve access to family planning and other reproductive health services, or expand women’s autonomy and rights).

Demographic Factors as Predictors of Revolutionary Situations: Experience in Quantitative Analysis

Although there are plenty of quantitative cross-national analyses on the influence of population age structure on revolutionary risks, there are currently not enough studies that examine its impact on the risks of armed and unarmed revolutions taken separately. Assuming that the dependence of potential political destabilization on the median age will differ for armed and unarmed revolutions, we propose the following hypothesis. High median age and the level of a country’s economic development will negatively correlate with armed revolutions. A moderately young median age will have positive influence on the risks of non-violent rebellions, while the overall dependence of unarmed revolutions on median age will be slightly positive and curvilinear. Relying on materials from NAVCO 1.3 and the UN Population Division databases and by means of utilizing cross-tabulations, correlations and logistic regression, we analyze about 250 revolutionary episodes between 1950 and 2019. All of our hypotheses turn out to be supported. The higher the median age of the population — the less likely the occurrence will be of armed revolutionary instability. On the other hand, as the population ages, the risks of unarmed revolutionary actions first grow, but then decline.

Population Dynamics in Russia in the Context of Global Trends

—The article examines the current demographic trends in Russia as compared to population changes in the world and its major regions based on data from the Russian Federal State Statistics Service (Rosstat), Eurostat, and the UN Population Division. It is shown that in terms of a number of characteristics of population reproduction—low fertility, ageing population structure, natural population decline—Russia is quite similar to the developed countries group. However, Russia is behind many countries in reducing the mortality rate of the middle-aged and older population, especially in men, and, correspondingly, in life expectancy for all age groups, which results in a noticeable increase in natural population decline and in deformation of the sex structure of the population. The specifics of the age structure of the Russian population that have been formed by a number of demographic waves are such that changes in the number of births and in age group sizes come in waves; this trend will continue in the coming decades. The article also analyzes excess mortality in Russia during the COVID-19 pandemic in comparison with similar data for the European Union (EU-27) and compares healthy life expectancy estimates for Russia, the entire world, individual countries, and different groups of countries by income.

The health-adjusted dependency ratio as a new global measure of the burden of ageing: a population-based study

The old-age dependency ratio (OADR), which is the ratio of older people (aged ≥65 years) to working age people (aged 20-64 years), is the most common way to assess and compare the burden of population ageing in different countries. However, the relationship between chronological age and dependency varies widely across countries. We therefore present the health-adjusted dependency ratio (HADR), a new measure of ageing burden based on the ageing-related health of the adult population. In this population-based study we used health data for diseases and injuries for 2017 from the Global Burden of Disease project and population data for 2017 from the UN's Population Division to identify the number of adults (aged >20 years) in each country who have the same or higher ageing-related disease burden as the global average 65-year-old. We then calculated the HADR as the ratio of adults who were less healthy than the average 65-year-old (dependent population) to those in better health (supporting population) and compared the HADR with the OADR for 188 countries. We also used cross-sectional, bivariate regression analysis to investigate whether the HADR is a more powerful predictor of changes in per capita health-care expenditure than the OADR as a measure of predictive validity. Many demographically younger populations have an earlier onset of ageing-related disease, and many demographically older populations have a later onset. For instance, Pakistan has an OADR of 0·09 and an HADR of 0·19, and France has an OADR of 0·35 and an HADR of 0·13. Relative to the OADR, the HADR suggests that Asia, western Europe, and North America have a lower ageing burden, whereas central Asia, southern Asia, and Africa have a greater burden. While Japan and countries in western Europe have the highest OADR, Russia, Papua New Guinea, and countries in southeast Europe have the highest HADR. Relative to the OADR, the HADR suggests that there is much less variation in the burden of ageing across countries than has previously been assumed. HADR was also more closely associated with growth in health spending than the OADR. A 0·1 increase in the HADR was associated with a 2·9 percentage points larger growth rate in per capita spending (p=0·0001), and a 0·1-point increase in the OADR was associated with a 1·8 percentage point larger growth rate. The OADR probably overestimates the burden of population ageing in many demographically older countries and underestimates the ageing burden in many demographically younger countries, which implies that the challenges associated with ageing are more universal than previously thought, and that the world cannot easily be divided in a young and an old groups of nations. None.

Youth Cohort Size, Structural Socioeconomic Conditions, and Youth Protest Behavior in Democratic Societies (1995–2014)

Conventional literature associates large youth cohort size (YCS) with increased risk of political violence in countries with such demographic profiles. Key questions which remain unanswered, however, are whether YCS is also associated with young people’s proclivities toward more peaceful forms of protests, and whether structural socioeconomic conditions influence such a relationship? Using multilevel binary logistic regression techniques on pooled individual level data for 51 democratic countries purposively sampled from World Values Survey Waves 3 to 6, and country level data from World Bank, and UN Population Division, I show that YCS demonstrates a positive relationship with young people’s participation in peaceful demonstrations. This relationship is, however, moderated by structural factors such as education and unemployment, which end up reducing young people’s likelihood of participation. I argue that resource limitation, as predicted by the Civic Voluntarism Model, better explains the relationship between YCS and individual youth protest behavior in democratic societies, more than socioeconomic grievance, as suggested by grievance theory. An important implication of this finding is that participation in elite-challenging behaviors such as peaceful protests, can be expected to be more common among young people in affluent democratic societies, than their peers elsewhere in the democratic world.

The Influx of War Refugees from Ukraine – Recommendations for Poland Based on Turkey’s Experiences

Goal – the presentation of analysis results regarding the numerical comparison of migration crises caused by refugee displacements from Syria and Ukraine and the identification of challenges faced by Poland based on Turkey’s experiences related to the mass influx of refugees. Research methodology – the examination of Poland’s and Turkey’s official state documents, a review of articles and existing studies, the analysis of statistical data on the flows of persons from the following databases: the UNHCR, the UN Population Division, data from the Polish Chancellery of the Prime Minister and the Office for Foreigners. The research methods used also include synthesis and inference. Score/results – although the Syrian and Ukrainian migration crises show various differences, Poland can certainly draw on Turkey’s proven tools and avoid solutions having hindered integration and contributed to the exclusion of Syrian refugees. However, Turkey’s and Poland’s experiences represent evidence for other countries that it is necessary to have a clearly defined migration policy in place. Originality/value – the originality of the article lies in the comparison of the two largest migration crises of recent years and an attempt to identify challenges faced by Poland in connection with the influx of war refugees and possible solutions based on Turkey’s experiences. In addition, the subject has significant research potential due to the imminent economic crisis in Ukraine, which may trigger another wave of migration.

Global estimates of paediatric tuberculosis incidence in 2013–19: a mathematical modelling analysis

SummaryBackgroundMany children who develop tuberculosis are thought to be missed by diagnostic and reporting systems. We aimed to estimate paediatric tuberculosis incidence and underreporting between 2013 and 2019 in countries representing more than 99% of the global tuberculosis burden.MethodsWe developed a mathematical model of paediatric tuberculosis natural history, accounting for key mechanisms and risk factors for infectious exposure (HIV, malnutrition, and BCG non-vaccination), the probability of infection given exposure, and progression to disease among infected individuals. We extracted paediatric population estimates from UN Population Division data, and we used WHO estimates for adult tuberculosis incidence rates. We parameterised this model for 185 countries and calibrated it using data from countries with stronger case detection and reporting systems. Using this model, we estimated trends in paediatric incidence, and the proportion of these cases that are diagnosed and reported (case detection ratio [CDR]) for each country, age group, and year.FindingsFor 2019, we estimated 997 500 (95% credible interval [CrI] 868 700–1 163 100) incident tuberculosis cases among children, with 481 000 cases (398 400–587 400) among those aged 0–4 years and 516 500 cases (442 900–608 000) among those aged 5–14 years. The paediatric CDR was estimated to be lower in children aged 0–4 years (41%, 95% CrI 34–50) than in those aged 5–14 years (63%, 53–75) and varied widely between countries. Estimated CDRs increased substantially over the study period, from 18% (15–20) in 2013 to 53% (45–60) in 2019, with improvements concentrated in the Eastern Mediterranean, South-East Asia, and Western Pacific regions. Over the study period, global incidence was estimated to have declined slowly at an average annual rate of 1·52% (1·42–1·66).InterpretationPaediatric tuberculosis causes substantial morbidity and mortality, and these data indicate that cases (and, thus, probably associated mortality) are currently substantially underreported. These findings reinforce the need to ensure prompt diagnosis and care for children developing tuberculosis, strengthen reporting systems, and invest in research to develop more accurate and easy-to-use diagnostics for paediatric tuberculosis in high-burden settings.FundingNational Institutes of Health.

Characteristics of the reproductive behaviour of the population in Iran and Russia during the Pandemic period COVID-19

Introduction. The urgent issue of the challenges of the COVID-19 pandemic, which negatively affected the demographic development of the world’s countries, is the search for new effective mechanisms for the development of demographic potential, which is not possible without appropriate justification monitoring data. The aim of the study is to analyze trends in demographic processes and assess the reproductive behavior of the population of Russia and Iran, as well as develop recommendations in the field of monitoring demographic processes, taking into account the need to study their changes as a result of the spread of COVID-19, which seems significant for determining effective directions and measures of demographic policy in terms of increasing the birth rate in Russia and Iran in the post-pandemic period. Materials and methods. The article is based on the data of the official national statistics of the countries (the Federal State Statistics Service of the Russian Federation and the Statistical Center of the Islamic Republic of Iran), the international database of the UN Population Division, and sociological information. The general research period is determined by the boundaries from 2000 to 2019. To assess the determination of reproductive behaviour in Russia and Iran, general statistical methods of data analysis were used (for example, indicators of structure, dynamics, implementation of the plan), unique methods of demographic statistics (construction of age and sex pyramids of the population, total fertility rate, and others), methods of sociological research (results are presented as All-Russian sociological research “Demographic well-being of Russians”, conducted with the participation of the authors in 2019-2020 on the territory of 10 constituent entities of Russia). Results. An assessment of fertility trends in Russia and Iran is given, general and specific traits of the character and mechanisms of reproductive behaviour are identified. The substantiation of the improvement of directions and measures of demographic policy is given, taking into account the assessment of its effectiveness. In Russia, it was aimed at increasing the birth rate. In Iran, on the contrary, at decreasing it. In both countries, the policy was very effective - in Russia in 2007-2016. the birth rate for second and subsequent births increased significantly in Iran in the late 1980s-1990s. The decline in fertility was one of the largest in the world. If in Iran the birth rate is now close to the level of simple reproduction of the population (in 2017, the total fertility rate was 2.12), then in Russia, especially after the decline since 2017. In this case, it is far from this level. Conclusion. The article substantiates the need to improve scientific monitoring of the demographic consequences of the COVID-19 pandemic.

7.E. Skills building seminar: (Re)Forming cities due to the COVID challenge: Urban, Environmental & Public Mental Health outcomes

Abstract According to the “Urban Health Rome Declaration” at European meeting “G7 Health” that defines the strategic aspects and actions to improve Urban, Environmental and Public Mental Health into the cities, and referring to the Agenda 2030 in which the 11th SDG argue about “Sustainable Cities and Communities. Make cities and human settlements inclusive, safe, resilient and sustainable”, one of the most expressive syntheses of the challenging relationship between urban planning and Public Health is stated by WHO (2016): “Health is the precondition of urban sustainable development and the first priority for urban planners”. Referring to the Healthy Cities & Urban Health definitions, we can consider Public Health not merely an aspect of individual health protection and promotion, but a collective condition, strongly influenced by the environmental context and by the strategies implemented by local Governments. The “Health in All Policies” strategy, clearly underlines how health depend by the quality of outdoor and indoor living environments. In this scenario, the on-going COVID-19 pandemic is a strong reminder that urbanization has changed the way individuals and communities live, work, and interact, and that it's urgent to make the urban systems and local communities resilient, to prevent the spread of infectious diseases today and tomorrow. Certainly, the on-going urbanization is achieving an increasing attractiveness/appeal, considering that the urban population is expected to rise to the forecasted 70% by 2050 as stated by the UN Population Division Department. The increase in building density will be one of the main global trends, with significant impacts on Public Health and the increase in risk factors affecting the contemporary city, creating a gap between built and green environments, in terms of alarming living conditions. The COVID-19 pandemic is also an accelerator, revelator and amplifier of the on-going urban emergencies in terms of environmental sustainability and Urban Health, with particular reference to the social, environmental and digital issues. Aim of the skills building seminar titled “(re)FORMING CITIES DUE TO THE COVID CHALLENGE”, organized by the three EUPHA Section URB+MEN+ENV, it would like to be to build the capacity and knowledge between participants about the main topics and urban features capable to have relevant Public and Mental Health outcomes, with a specific focus about the COVID-19 pandemic period. For this purpose, after the three presentations, 30 minutes will be used to create a discussion with the audience, using digital systems (like MENTIMETER, SOCRATIVE, etc.) to collect opinions and create a live discussion about a specific set of questions and topics. The qualitative approach of the second part of this skills building seminar is opposed to the first part, in which the three presentations will share scientific-evidences and data; both approaches can be further summarized in the drafting of a Position Paper. Key messages The WP would build the capacity and knowledge between the audience about the main topics and urban features capable to have relevant ENV, URB & MEN outcomes, focusing the COVID-19 pandemic period. The COVID-19 pandemic accelerated the on-going urban emergencies in terms of sustainability, Urban and Public Mental Health, with particular reference to social, environmental and digital issues.

Examining Women Discrimination: By Women in Kashmir

Women constitute 3.82 billion in the world (According to the UN Population Division). Women being a constant contributory to the economic factor are still considered to be anonymous to the world. Women play a significant role in our lives, from being daughter to a mother. Women help to shape the lives of people in an enormous number of ways. Kashmiri women have been prone to many changes throughout their lives. It leaves a great impact on the Kashmiri Society. Women have been discriminated by the same sex since ages but no concern has been raised for the issue till now. It needs to be controlled and curtailed so that it won’t affect the growth of women in our societies. The objective behind the paper is to aware the people of the discrimination happening in our surroundings and to reach to the point where people will be able to raise a voice against it especially women of our society that are being victimized throughout their lives. This paper mainly lays stress on the discrimination against women by women in Kashmir. The paper starts with the introduction to the concept to discrimination with respect to women and includes the instances that are based on research work in Kashmir. The study has been carried out in different regions of Kashmir. In this study, survey method has been used for the collection of the data. The result of the research is not satisfying but enriched with the instances of discrimination. In conclusion, many factors were responsible for the growth of such behavior in our society.

Urbanization in megacities increases the frequency of extreme precipitation events far more than their intensity

More than half of the world’s population lives in urban areas (UN Population Division 2018 The World’s cities in 2018 (UN: New York)), which are especially vulnerable to climate extremes (Field et al 2012 Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation: Special Report of the Intergovernmental Panel on Climate Change (Cambridge: Cambridge University Press)). Urbanization itself is known to increase surface temperatures, but its quantitative effect on extreme precipitation remains very uncertain. Using decadal convection-permitting climate simulations in four midlatitude megacities (Paris, France; New York City, USA; Tokyo, Japan; Shanghai, China), we show that urbanization can strongly increase the frequency and intensity of extreme urban precipitation. Frequency increases far more than intensity, by +16% (11%–22%) (95% confidence interval) for 1 year daily extremes, and +26% (11%–41%) for 1 year hourly extremes, downwind of city centers. Intensities of the same events increase by +5% (3.2%–6.4%) (daily extremes) and +6% (3.2%–9.8%) (hourly extremes), respectively. The intensity and frequency of extremes increases more for the rarest, most extreme events considered, and there is some indication that hourly extremes increase more than daily extremes. Our simulations also show that direct urban anthropogenic emissions of heat could be an important factor driving these changes. Urbanization is expected to continue in the future, and our results indicate that these effects should be considered in urban planning decisions to make cities more resilient to extreme precipitation.

Geographical patterns of population aging in Russia

The paper investigates the geographical features of demographic ageing using the age of retirement as the main definition for the old age boundary. The study is based on demographic statistics of Rosstat and the UN Population Division. The possible interdependence between population ageing and the implementation of social policies in the field of pension regulation is studied. The hypothesis about the relationship between low levels and a high pace of population ageing for countries of the world and regions of the Russian Federation was tested.
 A cartographic and statistical analysis of spatial data at the level of regions and municipalities made it possible to identify and describe the main geographical factors of population ageing differentiation. The ‘ethnic’ subjects of the Russian Federation, as well as the Northern regions of new development (autonomous okrugs), where a minimum proportion of the elderly of retirement age is observed, are growing older the most rapidly. At the same time, the echo of social сrises that took place during the 20th century still plays a significant part in the pace of ageing. However, over the course of this century its influence will increasingly weaken.
 At the local level, ethnic and rural-urban differentiation is becoming a less significant factor of population ageing in comparison with migration: the working-age population continues to concentrate in the largest urbanised areas. The main territories of the “young” population concentration are the administrative centres of Russia’s regions and areas with a high proportion of non-Russian ethnic groups with a high total fertility rate (TFR), as well as some other ‘azonic’ municipalities.

National, regional, and global burdens of disease from 2000 to 2016 attributable to alcohol use: a comparative risk assessment study

Alcohol use has increased globally, with varying trends in different parts of the world. This study investigates gender, age, and geographical differences in the alcohol-attributable burden of disease from 2000 to 2016. This comparative risk assessment study estimated the alcohol-attributable burden of disease. Population-attributable fractions (PAFs) were estimated by combining alcohol exposure data obtained from production and taxation statistics and from national surveys with corresponding relative risks obtained from meta-analyses and cohort studies. Mortality and morbidity data were obtained from the WHO Global Health Estimates, population data were obtained from the UN Population Division, and human development index (HDI) data were obtained from the UN Development Programme. Uncertainty intervals (UIs) were estimated using a Monte Carlo-like approach. Globally, we estimated that there were 3·0 million (95% UI 2·6-3·6) alcohol-attributable deaths and 131·4 million (119·4-154·4) disability-adjusted life-years (DALYs) in 2016, corresponding to 5·3% (4·6-6·3) of all deaths and 5·0% (4·6-5·9) of all DALYs. Alcohol use was a major risk factor for communicable, maternal, perinatal, and nutritional diseases (PAF of 3·3% [1·9-5·6]), non-communicable diseases (4·3% [3·6-5·1]), and injury (17·7% [14·3-23·0]) deaths. The alcohol-attributable burden of disease was higher among men than among women, and the alcohol-attributable age-standardised burden of disease was highest in the eastern Europe and western, southern, and central sub-Saharan Africa regions, and in countries with low HDIs. 52·4% of all alcohol-attributable deaths occurred in people younger than 60 years. As a leading risk factor for the burden of disease, alcohol use disproportionately affects people in low HDI countries and young people. Given the variations in the alcohol-attributable burden of disease, cost-effective local and national policy measures that can reduce alcohol use and the resulting burden of disease are needed, especially in low-income and middle-income countries. None.

Time trends in facility-based and private-sector childbirth care: analysis of Demographic and Health Surveys from 25 sub-Saharan African countries from 2000 to 2016.

BackgroundAfrica, and sub-Saharan Africa in particular, remains one of the regions with modest improvements to maternal and newborn survival and morbidity. Good quality intrapartum and early postpartum care in a health facility as well as delivery under the supervision of trained personnel is associated with improved maternal and newborn health outcomes and decreased mortality. We describe and contrast recent time trends in the scale and socio-economic inequalities in facility-based and private facility-based childbirth in sub-Saharan Africa.MethodsWe used Demographic and Health Surveys in two time periods (2000-2007 and 2008-2016) to analyse levels and time trends in facility-based and private facility-based deliveries for all live births in the five-year survey recall period to women aged 15-49. Household wealth quintiles were used for equity analysis. Absolute numbers of births by facility sector were calculated applying UN Population Division crude birth rates to the total country population.ResultsThe percentage of all live births occurring in health facilities varied across countries (5%-85%) in 2000-2007. In 2008-2016, this ranged from 22% to 92%. The lowest percentage of all births occurring in private facilities in 2000-2007 period was in Ethiopia (0.3%) and the highest in the Democratic Republic of Congo at 20.5%. By 2008-2016, this ranged from 0.6% in Niger to 22.3% in Gabon. Overall, the growth in the absolute numbers of births in facilities outpaced the growth in the percentage of births in facilities. The largest increases in absolute numbers of births occurred in public sector facilities in all countries. Overall, the percentage of births occurring in facilities was significantly lower for poorest compared to wealthiest women. As the percentage of facility births increased in all countries over time, the extent of wealth-based differences had reduced between the two time periods in most countries (median risk ratio in 2008-2016 was 2.02). The majority of countries saw a narrowing in both the absolute and relative difference in facility-based deliveries between poorest and wealthiest.ConclusionsThe growth in facility-based deliveries, which was largely driven by the public sector, calls for increased investments in effective interventions to improve service delivery and quality of life for the mother and newborn. The goal of universal health coverage to provide better quality services can be achieved by deploying interventions that are holistic in managing and regulating the private sector to enhance performance of the health care system in its entirety rather than interventions that only target service delivery in one sector.

Estimates of the global population of children who are HIV-exposed and uninfected, 2000–18: a modelling study

Children who are HIV-exposed uninfected (HEU) have higher morbidity and mortality than children who are HIV-unexposed and uninfected despite safer breastfeeding and improved maternal health with maternal antiretroviral therapy. We present the first global estimates of the population of children who are HEU (aged 0-14 years) and the geographical and temporal trends in HIV high-burden countries between 2000 and 2018. The Spectrum AIDS Impact Module developed by Avenir Health, UNAIDS, and partners is used to estimate key HIV epidemic indicators from mathematical models. We used 2019 UNAIDS global estimates of children (aged 0-14 years) who are HEU generated by Spectrum and 2017 UN Population Division estimates of the number of all children in each region or country to estimate the regional or national prevalence of children who were HEU, the regional or national contribution of children who were HEU to the global population of children who were HEU, and the proportion of children who were HEU and exposed to antiretrovirals for six UNAIDS regions and 21 HIV high-burden countries in 2018. We also estimated the percentage change in the global population of children who were HEU between 2000 and 2018. In 2018, there were an estimated 14·8 million (lower estimate 11·1-upper estimate 18·3) children who were HEU, 13·2 million (9·8-16·3; 90%) of whom resided in sub-Saharan Africa and 760 000 (640 000-970 000; 5%) of whom resided in the Asia and Pacific region. Five countries accounted for 50% of all 14·8 million children who were HEU globally: South Africa (3·5 million [23·8%]), Uganda (1·1 million [7·5%]), Mozambique (1·0 million [6·6%]), Tanzania (910 000 [6·1%]); and Nigeria (880 000 [6·0%]). In five southern African countries, the prevalence of children who were HEU exceeded 15% of the general child population: eSwatini (32·4%), Botswana (27·4%), South Africa (21·6%), Lesotho (21·1%), and Namibia (16·4%). The global population of children who are HEU is substantial, requiring a coordinated strategy to reduce HIV exposure in children and ensure optimal health and wellbeing of children who are HEU and their families. Future research and programmatic funding investments must be aligned with the geographical distribution of children who are HEU. National Institutes of Health, International AIDS Society.