United Nations Inter-agency Group Research Articles

Levels, trends and inequalities in mortality among 5-19-year-olds in Tanzania: Magu Health and Demographic Surveillance Study (1995-2022).

For the past two decades, health priorities in Tanzania have focussed on children under-five, leaving behind the older children and adolescents (5-19 years). Understanding mortality patterns beyond 5 years is important in bridging a healthy gap between childhood to adulthood. We aimed to estimate mortality levels, trends, and inequalities among 5-19-year-olds using population data from the Magu Health and Demographic Surveillance Site (HDSS) in Tanzania and further compare the population level estimates with global estimates. Using data from the Magu HDSS from 1995 to 2022, from Kaplan Meir survival probabilities, we computed annual mortality probabilities for ages 5-9, 10-14 and 15-19 and determined the average annual rate of change in mortality by fitting the variance weighted least square regression on annual mortality probabilities. We compared 5-19 trends with younger children aged 1-4 years. We further disaggregated mortality by sex, area of residence and wealth tertiles, and we computed age-stratified risk ratios with respective 95% confidence intervals (CIs) using Cox proportional hazard model to determine inequalities. We further compared population-level estimates in all-cause mortality with global estimates from the United Nations Inter-agency Group for Child Mortality Estimation and the Global Burden of Disease study by computing the relative differences to the estimates. Mortality declined steadily among the three age groups from 1995 to 2022, whereby the average annual rate of decline increased with age (2.2%, 2.7%, and 2.9% for 5-9-, 10-14-, and 15-19-year-old age groups, respectively). The pace of this decline was lower than that of younger children aged 1-4 years (4.8% decline). We observed significant mortality inequalities with boys, those residing in rural areas, and those from poorest wealth tertiles lagging behind. While Magu estimates were close to global estimates for the 5-9-year-old age group, we observed divergent results for adolescents (10-19 years), with Magu estimates lying between the global estimates. The pace of mortality decline was lower for the 5-19-year-old age group compared to younger children, with observable inequalities by socio-demographic characteristics. Determining the burden of disease across different strata is important in the development of evidence-based targeted interventions to address the mortality burden and inequalities in this age group, as it is an important transition period to adulthood.

Income inequality as a determinant of neonatal mortality in the Americas during 2000–2019: implications for the attainment of Sustainable Development Goal target 3.2

BackgroundThe work of the WHO Commission on the Social Determinants of Health has been fundamental to provide a conceptual framework of the social determinants of health. Based on this framework, this study assesses the relationship of income inequality as a determinant of neonatal mortality in the Americas and relates it to the achievement of the Sustainable Development Goal target 3.2 (reduce neonatal mortality to at least as low as 12 deaths per 1,000 live births). The rationale is to evaluate if income inequality may be considered a social factor that influences neonatal mortality in the Americas.MethodsYearly data from 35 countries in the Americas during 2000–2019 was collected. Data sources include the United Nations Inter-agency Group for Child Mortality Estimation for the neonatal mortality rate (measured as neonatal deaths per 1,000 live births) and the United Nations University World Institute for Development Economics Research for the Gini index (measured in a scale from 0 to 100). This is an ecological study that employs a linear regression model that relates the neonatal mortality rate (dependent variable) to the Gini index (independent variable), while controlling for other factors that influence neonatal mortality. Coefficient estimates and their robust standard errors were obtained using panel data techniques.ResultsA positive relationship between income inequality and neonatal mortality is found in countries in the Americas during the period studied. In particular, the analysis suggests that a unit increase in a country’s Gini index during 2000–2019 is associated with a 0.27 (95% CI [− 0.04, 0.57], P =.09) increase in the neonatal mortality rate.ConclusionThe analysis suggests that income inequality may be positively associated with the neonatal mortality rate in the Americas. Nonetheless, given the modest magnitude of the estimates and Gini values and trends during 2000–2019, the findings suggest a potential limited scope for redistributive policies to support reductions in neonatal mortality in the region. Thus, policies and interventions that address higher coverage and quality of services provided by national health systems and reductions in socio-economic inequalities in health are of utmost importance.

International progress on stillbirth reduction: Changes in Stillbirth Rates in Selected Low and Middle-Income Countries from 2000 to 2021

In this paper, we attempted to determine if there were reductions in low and middle – income country stillbirth rates since 2000 - focusing on sub-Saharan Africa, Asia and Latin America and the Caribbean. We used data made available by the United Nations Inter-agency Group for Child Mortality Estimation and the World Health Organization as well as the National Institute of Child Health and Human Development Global Network for Women's and Children's Health Research.. Overall, nearly every country evaluated had at least a small reduction in stillbirth rate from the year 2000 to 2021, but the reductions varied substantially between regions. Asia and Latin America/Caribbean had similar levels of reductions with a number of countries in each of those regions having rates in 2021 that were 40 % or more lower than those documented in 2000. No country in Africa documented a reduction in stillbirths of 40 % and many had stillbirth reductions of less than 15 %.

Microbial antigen in human milk: a natural vaccine?

Microbial antigen in human milk: a natural vaccine?

Cooperation among intergovernmental organizations in global cultural governance: Towards an actor-centered constructivist approach

ABSTRACT This article provides an empirical investigation of the cooperation among intergovernmental organisations (IOs) in global cultural governance. The existing scientific literature has not yet taken up the inter-organisational cooperation as a serious topic of research and the present contribution aims to fill this gap. Based on an actor-centred constructivism, the article seeks to address inter-organisational cooperation as an observable empirical phenomenon, to explore when and why the cooperation between IOs risks not lasting and to understand why the dynamics of inter-organisational cooperation in cultural affairs have a specific-time limit. The focus will be on two cases: the European Union-Mercosur audiovisual programme and the United Nations interagency group on creative industries. As such, the article is more concerned with analysing the political micro-foundations through which the cooperation among IOs takes place and with exploring the factors, which contribute to not establish sustainable cooperative arrangements.

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

Cherish your children: socio-economic and demographic characteristics associated with child mortality

BackgroundThe United Nations Interagency Group for Child Mortality Estimation (UNIGME) indicates that child mortality is the death rate of children between age zero to five. The importance of this area of research is high where worldwide a number of studies have been led on infant and child mortality, despite limited research discoveries with regards to Sri Lanka. The aim of this study is to investigate the socio-economic and demographic characteristics associated with child mortality in Sri Lanka.MethodsUsing the context of Sri Lanka as a case study, this study carried out based on data gathered from the micro level national survey. Using the logit regression model through the step-wise technique, the study investigate the socio-economic and demographic characteristics associated with child mortality in Sri Lanka.ResultsAccording to the generated results, place of residence province-wise, household head’s education level and source of drinking water have negative effect (lower risk) on child mortality in Sri Lanka. Exceptionally, the Western province has the highest negative effect on child mortality which demonstrates it as the least harmful region in Sri Lanka in child endurance. Household heads who owns private entities and Sri Lankan Moors has a positive effect on child mortality as well.ConclusionThis study is helpful to address the population health of local arena and results can be supportive to the government and policymakers to gain an overview of physical health status of the country and able to uplift their policies based on the new findings.

Correlation of Caesarean Section Rates to Maternal and Neonatal Mortality in the Eastern Mediterranean Region; A Population-Based Ecological Study

Purpose: This study aims to explore the relationship between population-level caesarean section rates (CSRs) with maternal and neonatal mortality rates (MMR, NMR) in the Eastern Mediterranean Region (EMR). Design: A populationbased ecological study was performed with data obtained from the World Health Organization, Global Health Observatory database, 2015, United Nations Inter-agency Group for Child Mortality Estimation (UN-IGME) and the United Nations Maternal Mortality Estimation Inter-Agency Group (UN-MMEIG) 2015). Mean ± standard deviation (SD), range, median and Interquartile range (IQR) were used to describe the quantitative data. We performed multivariate logistic regression analysis to explore the effect (a) of (a) Antenatal clinic visits (ANC %), (b), Skilled Birth Attendance (SBA) rate (% of deliveries attended by SBA), (c) Total Health Expenditure (THE) per capita and (d) Female Literacy Rate (FLR%) on the studied relationship. Spline linear regression was used to find the most predictive variable for MMR, and the NMR. Statistical significance was accepted at P<0.05. Results: The mean CSR was 21.20±13.38, (1.8-52). The CSR of <10% was linked with the highest NMR and MMR, 33.0 (24.0-39.0) and 390.5(329.5-648.0) respectively. The most predictable variables for NMR and MMR were SBA % [B=-0.875; p< .001; R2=0.766 and adjusted R2=0.754] and FLR (F=15-24) [B=0.877; P<0.001; R2=0.77 and adjusted R2=0.758] respectively. Conclusions: We found a statistically significant inverse relationship between CSRs and maternal and neonatal mortality in MSs with <10% of CSR. The improved mortality rates in MSs with >15% of CSR were significantly linked with better socioeconomic and healthcare variables than higher CSRs. Keywords: Caesarean Section, Maternal and Neonatal Mortality, Eastern Mediterranean Region.

Patterns and trends in causes of child and adolescent mortality 2000–2016: setting the scene for child health redesign

The under-5 mortality rate has declined from 93 deaths per 1000 live births in 1990 to 39 per 1000 live births in 2018. This improvement in child survival warrants an...

Antibiotic resistance - Netflix, HAL 9000 and the $100 billion question

With Yuval Noah Harari’s ‘I told you so’ still ringing in our ears and the battlefield still ablaze, one cannot help but wonder what the next microorganism assault on humankind is going to involve.1 While we are still fully engaged on our main front, another old enemy is gathering strength on our flanks. Bacterial resistance has been described as the single most important threat to public health in the 21st century.2 The United Nations interagency group on bacterial resistance estimates that drug-resistant disease could rise from a current figure of around 700 000 deaths per annum to around 10 million a year by 2050, if we don’t act.3 The six most common bacterial pathogens in orthopaedics are currently all on the CDC (Centers for Disease Control and Prevention) ‘Urgent’ or ‘Serious’ threat list.4 A meta-analysis estimated that 39% to 51% of surgical site infection in the USA was caused by bacteria that are resistant to the standard prophylactic antibiotics.5 Our primary tool against resistance is antibiotic stewardship programmes. But wil it solve the problem?

Vitamin A supplementation and estimated number of averted child deaths in Ethiopia: 15 years in practice (2005-2019).

Vitamin A supplementation (VAS), started as a short‐term strategy pending dietary improvements, has been implemented in Ethiopia for the last 15 years. We aimed to describe the trends in VAS coverage and estimated the associated reductions in child mortality. VAS coverage data obtained from the District Health Information System and the Demographic and Health Surveys were linked to child mortality data from the United Nations Interagency Group for Child Mortality Estimation (UN IGME). The number of child deaths averted was modelled assuming 12% and 24% reductions in all‐cause mortality. From 2006 to 2011, VAS was delivered through campaigns, and coverage was above 85%. However, from 2011 onwards, VAS delivery was integrated to the routine health system, and the coverage declined to <60% with significant disparities by wealth quintile and rural–urban residence. VAS has saved between 167,563 to 376,030 child lives (2005–2019), but additional lives (>42,000) could have been saved with a universal coverage (95%). Inconsistent supply of vitamin A capsules, but more importantly, low access to health care, and the limited contact opportunities for children after 24 months may have contributed to the declining VAS coverage. Any changes in target or scale‐up should thus consider these spatial and socioeconomic variations. Increasing the coverage of VAS and closing the equity gap in access to nutrition services is critical. However, with alternative programmes like vitamin A fortification being set‐up, the benefits and safety of VAS need to be closely monitored, particularly in areas where there will be overlap.

Monitoring the status of selected health related sustainable development goals: methods and projections to 2030

ABSTRACT Background: Monitoring Sustainable Development Goal indicators (SDGs) and their targets plays an important role in understanding and advocating for improved health outcomes for all countries. We present the United Nations (UN) Inter-agency groups’ efforts to support countries to report on SDG health indicators, project progress towards 2030 targets and build country accountability for action. Objective: We highlight common principles and practices of each Inter-agency group and the progress made towards SDG 3 targets using seven health indicators as examples. The indicators used provide examples of best practice for modelling estimates and projections using standard methods, transparentdata collection and country consultations. Methods: Practices common to the UN agencies include multi-UN agency participation, expert groups to advise on estimation methods, transparent publication of methods and data inputs, use of UN-derived population estimates, country consultations, and a common reporting platform to present results. Our seven examples illustrate how estimates, using mostly Bayesian models, make use of country data to track progress towards SDG targets for 2030. Results: Progress has been made over the past decade. However, none of the seven indicators are on track to achieve their respective SDG targets by 2030. Accelerated efforts are needed, especially in low- and middle-income countries, to reduce the burden of maternal, child, communicable and noncommunicable disease mortality, and to provide access to modern methods of family planning to all women. Conclusion: Our analysis shows the benefit of UN interagency monitoring which prioritizes transparent country data sources, UN population estimates and life tables, and rigorous but replicable modelling methods. Countries are supported to build capacity for data collection, analysis and reporting. Through these monitoring efforts we support countries to tackle even the most intransient health issues, including the pandemic caused by SARS-CoV-2 that is reversing the hard-earned gains of all countries.

Leveraging the COVID-19 response to end preventable child deaths from pneumonia

Leveraging the COVID-19 response to end preventable child deaths from pneumonia

Child Mortality Transition in the Arabian Gulf: Wealth, Health System Reforms, and Development Goals.

Background: Child mortality is the most crucial indicator of national progress and a reflection of not only the health system performance but also the wealth (budget) utilization and goal achievements. Many developing nations have recorded progress in this dimension but those of the Arabian Gulf (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates) show remarkable progress and achievements.Methods: Using the latest update of United Nations Inter-agency Group for Child Mortality Estimation 2017, an attempt is made here to review and appraise their achievements in child mortality reduction since 1950s taking into account Under 5 mortality, infant mortality, and neonatal mortality.Results: This review finds a rapid decline in child mortality in the Arabian Gulf in a short span of 50 years, which is in line with the achievement of Sustainable Development Goals.Conclusions: There is a remarkable budget allocation and investment in health system building, improving the other contributing sectors like water, sanitation, hygiene, nutrition, and life style modifications apart from the usual health care interventions.

Further Analyses of Trends in Malaria Diagnoses and Incidence Rates (2014-2018) in Edo State, Nigeria

Background: The United Nations Inter-Agency and Expert Group on Millennium Development Goals (MDGs), established incidence rate as one of the indicators for monitoring progress on Malaria control. Data on malaria incidence rates in Edo State, Nigeria, 2006-2013 were published in 2015. The current study focused on incidence rates, 2014-2018. In addition, trends in malaria diagnoses were also investigated.&#x0D; Methods: Records of numbers of patients from the 18 Local Government Areas (LGAs) complaining of malaria, at LGA Health Centres, State Hospitals, etc. were obtained from the Department of Disease Control, State Ministry of Health, Benin City. Patients were placed in 3 categories: Fever, without malaria confirmation, confirmed uncomplicated, confirmed severe. Human population records over the 5-year period were obtained from the Nigeria Population Commission, Benin City. Incidence rates were calculated and relative proportions of patients in the 3 categories determined.&#x0D; Results: The numbers of fever cases, without malaria confirmation, varied across LGAs and constituted 58.00-68.00% of all fever cases annually. In confirmed cases of malaria, most were uncomplicated. The highest numbers of confirmed cases were in Egor and Oredo LGAs. The pattern was similar in uncomplicated and severe cases. The ratios of uncomplicated and severe cases of malaria varied significantly (p&lt;0.05) annually. Malaria incidence rates varied among LGAs in each of the years: 2014 (0.75-5.48%), in 2015 (0.24-2.55%), in 2016 (1.44-5.21%), in 2017 (1.17-9.69%), in 2018 (0.63-4.03%). However, these differences were not significant (p&gt;0.05). In the period 2014-2018, malaria incidence rates of 5.00% and above were recorded only 5times across LGAs: Egor, 2014 (5.48%); Esan Central, 2016 (5.14%; Ovia southwest, 2016 (5.21%), 2017 (9.69%); Uhunmwnde, 2017 (5.05%).&#x0D; Conclusion: The decline in malaria incidence rates, 2014-2018, over the 2006-2013 data indicates progress. However, there are still daunting challenges which have been detailed in the text. These results also highlight the need for malaria test confirmation rather than utilizing fever as the exclusive symptom for malaria. All stakeholders must intensify efforts to ensure that this downward trend in malaria incidence rates is sustained.

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

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

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

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

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

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

Overall and abortion-related maternal mortality rates in Uruguay over the past 25 years and their association with policies and actions aimed at protecting women’s rights

ObjectiveTo evaluate changes in maternal mortality rates in Uruguay over the past 25years, as well as their distribution by cause, and their temporal relationship with social changes and Human Development Index (HDI) indicators. MethodsData on maternal mortality obtained directly from the Uruguayan Ministry of Public Health for the 2001 to 2015 period were analyzed together with data from the United Nations Inter-Agency Group for Child Mortality Estimation for the 1990 to 2015 period. The swiftness of the decrease in maternal mortality per five-year period, the variation in the percentage of abortion-related deaths, and the correlation with HDI indicators were evaluated. ResultsMaternal mortality decreased significantly, basically due to a reduction in the number of deaths from unsafe abortion, which was the principal cause of maternal mortality in the 1990s. The reduction in maternal mortality over the past 10years also coincides with a reduction in poverty and an improvement in the HDI. ConclusionA rapid reduction occurred in maternal mortality in Uruguay, particularly in maternal mortality resulting from unsafe abortion. This coincided with the application of a model for reducing the risk and harm of unsafe abortions, which finally led to the decriminalization of abortion.

Trends in differences between births and surviving infants reported for immunization program planning and external data sources in Eastern and Southern Africa 2000–2013

To inform our WHO team's support for immunization programs in Member States in Eastern and Southern Africa, we compared annual trends from 2000 to 2013 in target populations reported by Member States through the WHO-UNICEF joint reporting form with United Nations (UN) population projections and modeled infant mortality estimates from the UN Inter-agency Group for Child Mortality Estimation. Our findings indicated a tendency of underestimating births and surviving infants used by Member States as denominators for administrative immunization coverage rates, resulting in or contributing to overestimation of coverage. The difference with UN estimates appeared to be more pronounced for surviving infants than births. Measures of central tendency for individual country differences indicated that those differences decreased over time. Comparing trends of births and surviving infants with external sources can help monitoring progress in efforts to provide accurate and reliable target population estimates and sampling frames.