World Health Statistics Research Articles

National HIV/AIDS mortality, prevalence, and incidence rates are associated with the Human Development Index

HIV/AIDS is a worldwide threat to human health with mortality, prevalence, and incidence rates varying widely. We evaluated the association between the global HIV/AIDS epidemic and national socioeconomic development. We obtained global age-standardized HIV/AIDS mortality, prevalence, and incidence rates from World Health Statistics Report of the World Health Organization. The human development indexes (HDIs) of 141 countries were obtained from a Human Development Report. Countries were divided into 4 groups according to the HDI distribution. We explored the association between HIV/AIDS epidemic and HDI information using Spearman correlation analysis, regression analysis, and the Kruskal-Wallis test. HIV/AIDS mortality, prevalence, and incidence rates were inversely correlated with national HDI (r = -0.675, -0.519, and -0.398, respectively; P < .001), as well as the 4 indicators of HDI (ie, life expectancy at birth, mean years of schooling, expected years of schooling, and gross national income per capita). Low HDI countries had higher HIV/AIDS mortality, prevalence, and incidence rates than that of medium, high, and very high HDI countries. Quantile regression results indicated that HDI had a greater negative effect on the HIV/AIDS epidemic in countries with more severe HIV/AIDS epidemic. Less-developed countries are likely to have more severe HIV/AIDS epidemic. There is a need to pay more attention to HIV/AIDS control in less-developed countries, where lower socioeconomic status might have accelerated the HIV/AIDS epidemic more rapidly.

Authors' Response to: Mortality estimates for South East Asia, and INDEPTH mortality surveillance: necessary, but not sufficient

In his commentary on our paper ‘Mortality estimates for South East Asia, and INDEPTH mortality surveillance: necessary, but not sufficient,’1 Rao rightly points out the limitations of using mortality estimates based either on: (i) statistical modelling from a fraction of the population with inaccurate assumptions; or (ii) on small, unrepresentative population clusters with surveillance systems and accurate measures. When used for describing disease burden, driving evidence-based policy decisions, evaluating the targets of the Millennium Development Goals project, or making international comparisons, mortality estimates should be adequately qualified with uncertainty intervals and a discussion of data limitations. By contrasting the data-collection systems, statistical assumptions, and modelling used in two studies described in the June issue of IJE,1,2 and contrasting these studies’ representativeness, Rao highlights the inherent strengths and weaknesses of different approaches to disseminating population-level estimates in countries that may have incomplete or may lack registration systems for vital data or census or sample registration data. With the example of Vietnam, he points out the variation in estimates of cause-specific mortality based on these approaches, and the misrepresentation for countries that do not mirror similar disease patterns as their reference populations. The strength of each of the two approaches named above for estimating mortality drives its utility. In the first approach, the utility lies in comparisons over time and across regions of the world, for purposes such as prioritizing health needs, designing programmes, and financing health systems. Our paper is part of a series on the status of epidemiology in six regions of the world defined by the World Health Organization (WHO),3 and hence the need for comparable data. In our overview of the South East Asia region, we described the limitations of the mortality data, and in Table 2 of our paper we provided both official estimates by member states and WHO-based best estimates from available evidence. However, more specific details on modelling assumptions could have been provided, in addition to uncertainty intervals (UIs) to capture the uncertainty based on insufficient data and resulting from the specifications given for a model.4 Table 1 of our paper compares male and female life expectancy estimates from WHO5 and from the Global Burden of Disease Study series published in Lancet in 2010, with uncertainty intervals.6 The differences vary, and as indicated by WHO are subject to considerable uncertainty, particularly for countries with health-information systems that are weak, unreliable. or of low quality,5 underlying the need for uncertainty estimates6 or qualifiers, as suggested by Rao. Table 1 Life expectancy and healthy life expectancy estimates from the WHO World Health Statistics 2011 and the 2010 Global Burden of Disease series (with uncertainty intervals) The utility of the second approach and efforts of estimates based on statistical modelling should not be underestimated. The recent Global Burden of Disease projections in 187 countries are based on such estimates, utilizing methods that have been developed over the past 60 years (including a modification of previous methods that used under-5 mortality rates to predict adult mortality, as pointed out by Rao) and involving more than 500 researchers from 300 institutions in 50 countries. Margaret Chan, the director of WHO, states that such efforts also highlight ‘the need to close the data gaps’ and understand the discrepancies in estimates, particularly in low- and middle-income countries.7 This ‘unprecedented’ exercise that drives researchers towards more comprehensive and more accurate use of methods, both in primary data collection and in statistical modelling, is in stark contrast to the ‘potential to remain complacent’ suggested by Rao.7 Lastly, we are grateful for Rao’s commentary for informing an important debate, and are in complete agreement that capacity building in the collection and utilization of high-quality local mortality data needs to be strengthened, in conjunction with work done by government offices, to provide nationally representative estimates of mortality with better accuracy.

Universal Coverage for Primary Health Care Is a Wise Investment

We aimed to provide systemic, empirical evidence on the coverage expansion of primary health care (PHC) linking to good health in low- and middle-income countries. We conducted a pooled, cross-sectional analysis using the 2011 World Health Statistics for World Health Organization Member States at low- and middle-income levels (n = 102). With life expectancy, infant mortality, and under-5 mortality as health indicators, we examined the effect of service coverage rate using variables under 2 domains: health expenditure and PHC (public health provision, primary care access). Our results indicated that after controlling for gross national income per capita, higher total health expenditure as share of gross domestic product was associated with shorter life expectancy (β = -0.99; P = .014), higher infant mortality (β = 1.65; P = .155), and under-5 mortality (β = 4.82; P = .020). Multivariate analysis showed higher coverage of public health services was significantly associated with improved population health. Making public health and primary care services accessible and be used by everyone is the wise means toward improved health.

‘Out of Pocket Expenditure’ of Health Care Services in India: Factors, Consequences and Solution

Financing is the most crucial part of the of the health care service delivery system and health care finance is one of the most critical factor contributing in the poverty scenario of any country. In developing countries like India where the health system should be more equitable and cost effective, the soaring problem of ‘out of pocket expenditure’ on Health System has shown a gloomy face and raises question on health equity. Evidences from several studies In India show that out of pocket expenditures on health care services intensify poverty.  In the World Health Survey of 2011, India was ranked 42nd in the list of countries with highest average of out of pocket expenditure. The survey found that 74.4 per cent of private expenditure on health was paid out of pocket. The article discusses the triggering factors which lead to the inequitable out of pocket health expenditure. Secondary Data from World Health Statistics 2010, NSSO 52nd and 60th round have been used here as evidence.

Socio-cultural aspects of diabetes mellitus in Nigeria

AbstractUndoubtedly, Nigeria is the most populous country in Africa with about 400 ethnic groups and languages. There is a double burden of disease with rising incidence and prevalence of diabetes mellitus. World Health statistics indicate that Nigeria has the highest number of diabetics in sub-Saharan Africa. In spite of advances in diabetes care and facilities, desired outcomes are not good and linked to this, patient satisfaction is not optimal. Reasons include inadequate attention to biological aspects of diabetes, inadequate or inappropriate pharmacology and psycho-socio-cultural factors. In this review, crucial socio-cultural factors in Nigeria include traditional medicine, religion, diet, physical activity patterns, foot care, awareness, and stress management. Diabetes programs in Nigeria should adopt the principles of education and psycho-social support highlighted by the DAWN study, integrating our socio-cultural heritage, empowering individuals to take charge of their diabetes and achieve desired health outcomes. Religion should be explored as a potential tool to reach out on facts whilst doing away with erroneous beliefs about diabetes mellitus.

Epidemiology of hypertension

Abstract Hypertension is an epidemic affecting one billion people and is the commonest risk factor for death throughout the world. World health statistics 2012 has estimated the prevalence of hypertension to be 29.2% in males and 24.8% in females. Approximately 90 percent for men and women who are non hypertensive at 55 or 65 years will develop hypertension by the age of 80–85. Hypertension is not limited to rich population and affects countries across all income groups. Out of total 58.8 million deaths worldwide in year 2004, high blood pressure was responsible for 12.8% (7.5 million deaths). World over hypertension is responsible for 51% of cerebrovascular disease and 45% of ischemic heart disease deaths. Unlike the popular belief that hypertension is more important for high-income countries, people in low- and middle-income countries have more than double the risk of dying of hypertension. Understanding epidemiology of hypertension will significantly help in decreasing the burden of associated morbidity and mortality. In America, with the help of programs such as National High Blood Pressure Education Program (NHBPEP), the awareness about hypertension has improved from 51 percent in the period 1976–1980 to 70 percent in 1999–2000 and as a result hypertension related morbidity and mortality has substantially improved. Since 1972, age-adjusted death rates from stroke have decreased by about 60% and that by coronary heart disease has decreased by about 50 percent. Recent WHO initiative on non communicable diseases is expected to decrease hypertension related mortality and morbidity globally.

World Health Statistics 2011: How does Bangladesh compare with other South-East Asian countries?

The World Health Statistics 2011 compiles the health and related data of its member states including a summary of the progress made towards achieving the health-related Millennium Development Goals (MDGs) and associated targets. This analysis examined data for Bangladesh and compares with the other ten member states of the WHO South-East Asia region. From the analysis, it is evident that considerable progress is being made to improve the health of the people of Bangladesh. Nevertheless, there remain many areas of concern over health development and provision of healthcare delivery and financing. In Bangladesh, annual population growth rate and adolescent fertility rate are higher than regional averages. Life expectancy and mortality rates are not impressive in comparison to other regional countries. Overall burden of cause-specific mortality and morbidity is higher; however reported cases of selected infectious diseases are lower than regional average. In terms of health service coverage, in one hand some real concerns were noted (e.g. poor antenatal coverage and availability of skilled health personnel etc.) and on the other hand some achievements were accomplished (e.g. vaccination of measles, DTP3 etc.). Increasing number of underweight children and smoking among male adults are also the key areas of concerns. Bangladesh ranks in the bottom quartile of healthcare spending in the region; the percentage of GDP allocation for health is 3.3% which is far below the level needed to scale up essential health interventions. The country has also relatively few healthcare personnel and hospital beds, and health inequality is observed in the provision of health care delivery which is most prominent in lower socio-economic groups. With regards to health-related MDGs, except child mortality, other target may not be met. Findings from these cross-national comparisons can inform national policy, highlight areas where Bangladesh could improve, and yield benchmarks for improved healthcare performance.DOI: http://dx.doi.org/10.3329/seajph.v1i1.13206 South East Asia Journal of Public Health 2011:1(1)

Global Health Donor Presence, Variations in HIV/AIDS Prevalence, and External Resources for Health in Developing Countries in Africa and Asia

The presence of multiple global health aid organizations in donor recipient countries at any point in time has led to arguments for and against aid coordination and aid pluralism. Little data, however, exist to empirically demonstrate the relationship between donor presence and longitudinal disease outcomes in donor-recipient countries. We examined the association between global health donor presence and changes in HIV/AIDS prevalence in 14 developing countries: 12 in Africa (Ethiopia, Kenya, Tanzania, Malawi, Zimbabwe, Mozambique, Rwanda, South Africa, Uganda, Zambia, Burkina Faso and Mali) and compared them with two developing countries in Asia (India and Vietnam). To conduct our analyses, we conceptualized a framework for examining global health donor presence and disease outcomes. Donor presence data were derived from Mapping the Donor Landscape in Global Health: HIV/AIDS, a report published by the Kaiser Family Foundation, Washington, DC, USA. HIV/AIDS prevalence data were obtained and analyzed from the World Health Statistics and the Demographic and Health Surveys. Percent changes in national HIV/AIDS prevalence between 2009 and 2011 in the 14 developing countries were computed and correlation coefficients between donor presence and prevalence changes were calculated. Between 2009 and 2011, HIV/AIDS prevalence decreased in all but one of the 14 developing countries with the presence of 21 or more global health donors. There was about 40% overall reduction in HIV/AIDS prevalence across the 14 countries in our analyses. South Africa recorded the most reduction in HIV/AIDS prevalence (-6.7%) followed by Zambia (-6.3, %), and Mozambique (-5.7%). Ethiopia was the only country without a reduction in HIV/AIDS prevalence (+0.1%). A correlation coefficient of 0.43 implied greater reductions in HIV/AIDS prevalence associated with increased donor presence. Our study shows a correlation between donor presence and HIV/AIDS disease burden in 14 donor-recipient countries. Our findings indicate that increased donor presence yields quantifiable reduction in global health disease burden. Further research is needed to demonstrate whether these gains can be observed in other global health disease outcomes.

Growth of neural engineering and neuro-mechanics in India: physically challenged looking towards a bright future

Neural engineering is an emerging field, information and research relating to it is comparatively limited. However, awareness regarding its potential scope is spreading globally nowadays. The reason for growing interest of the scientific community worldwide is due to high incidence of neurological and neuromuscular diseases affecting different age groups in recent years. As per WHO Mental Health Report, 2012, mental and neurological disorders are highly prevalent worldwide accounting for almost 11% and are priority health problems globally. A UN survey (2010) showed around 400 million people with disabilities and 414 million people aged > 60 years exist in Asia (World Health and Disability Statistics: Facts Country and State Population with Disabilities, 2011). With global and national health statistics predicting steady increase of health issues in elderly and disabled population, the need of the hour is for focusing on research-oriented technology in interdisciplinary fields like neuromechanics and trained healthcare personnel are required to serve this growing need.

Health financing in the African Region: 2000-2009 data analysis.

BackgroundIn order to raise African countries probability of achieving the United Nations Millennium Development Goals by 2015, there is need to increase and more efficiently use domestic and external funding to strengthen health systems infrastructure in order to ensure universal access to quality health care. The objective of this paper is to examine the changes that have occurred in African countries on health financing, taking into account the main sources of funding over the period 2000 to 2009.MethodsOur analysis is based on the National Health Accounts (NHA) data for the 46 countries of the WHO African Region. The data were obtained from the WHO World Health Statistics Report 2012. Data for Zimbabwe was not available. The analysis was done using Excel software.ResultsBetween 2000 and 2009, number of countries spending less than 5% of their GDP on health decreased from 24 to 17; government spending on health as a percentage of total health expenditure increased in 31 countries and decreased in 13 countries; number of countries allocating at least 15% of national budgets on health increased from 2 to 4; number of countries partially financing health through social security increased from 19 to 21; number of countries where private spending was 50% and above of total health expenditure decreased from 29 (64%) to 23 (51%); over 70% of private expenditure on health came from household out-of-pocket payments (OOPS) in 32 (71%) countries and in 27 (60%) countries; number of countries with private prepaid plans increased from 29 to 31; number of countries financing more than 20% of their total health expenditure from external sources increased from 14 to 19; number of countries achieving the Commission for Macroeconomics and Health recommendation of spending at least US$34 per person per year increased from 11 to 29; number of countries achieving the International Taskforce on Innovative Financing recommendation of spending at least US$44 per person per year increased from 11 to 24; average per capita total expenditure on health increased from US$35 to US$82; and average per capita government expenditure on health grew from US$ 15 to US$ 41.ConclusionWhilst the African Region (AFR) average government expenditure on health as a per cent of THE increased by 5.4 per cent, the average private health expenditure decreased by the same percentage between 2000 and 2009. The regional average OOPS as a per cent of private expenditure on health increased by 4.9 per cent. The average external resources for health as a percentage of THE increased by 3.7 per cent. Even though on average the quantity of health funds have increased, we cannot judge from the current study the extent to which financial risk protection, equity and efficiency has progressed or regressed.In 2009 OOPS made up over 20% of total expenditure on health in 34 countries. Evidence shows that where OOPS as a percentage of total health expenditure is less than 20%, the risk of catastrophic expenditure is negligible. Therefore, there is urgent need for countries to develop health policies that address inequities and health financing models that optimize the use of health resources and strengthen health infrastructure. Increased coverage of prepaid health-financing mechanisms would reduce over-reliance on potentially catastrophic and impoverishing out-of-pocket payments.

A Role for Government: An Observation on Federal Healthcare Efforts in Prevention

A Role for Government: An Observation on Federal Healthcare Efforts in Prevention

A comparative study of mortality data for all causes and unintentional injuries between Japan and other developed countries

BackgroundIt is true that Japan is one of the lowest infant mortality countries in the world. However unintentional injury is the leading cause of death, as in other developed countries....

The national perinatal mortality rate in the State of Qatar during 2011; trends since 1990 and comparative analysis with selected high-income countries: The PEARL Study Project*

To prospectively ascertain Qatar’s national perinatal mortality rate (PMR) during 2011, compare it with recent data from selected high-income countries, and analyze trends in Qatar’s PMR between 1990 and 2011 using historical data. A national prospective cohort study. National data on live births, stillbirths, and early neonatal mortality (day 0–6) were collected from all public and private maternity units in Qatar (1st January–December 31st 2011) and compared with historical perinatal mortality data (1990–2010) ascertained from the database of maternity and neonatal units of Women’s Hospital and annual reports of Hamad Medical Corporation (HMC). For inter-country comparison, country data were extracted from the World Health Statistics published by WHO in 2011 and from the European Perinatal Health Report published by the Europeristat project in 2008. A total of 20,725 births (20,583 live births plus 142 stillbirths) were recorded during the study period. Qatar’s national PMR during 2011 was 9.55 [early neonatal mortality rate (ENMR) 2.7 and stillbirth rate (SBR) 6.85], which was a significant improvement from a PMR of 13.2 in 1990 [risk ratio (RR) 0.72, 95% confidence interval 0.58–0.89, P=0.002]. This improvement in PMR was more significant in ENMR (P<0.001) than in SBR (P=0.019). The stillbirths constituted 55% of PMR in 1990, which increased to 71.72% of PMR during 2011. The RR of PMR had a significant downwards trend between 1990 and 2011 (P=0.016). Qatar’s 2011 PMR, SBR, and ENMR are comparable to those of selected high-income counties. Qatar’s PMR, ENMR, and SBR have significantly improved between 1990 and 2011, and are currently comparable to those of selected high-income countries. An in-depth research to assess the correlates and determinants of stillbirth and perinatal mortality in Qatar is indicated.

Non-Communicable Disease: A Welcome and Long Needed Addition to the WHO’s 2012 World Heath Statistics

The World Health Organization's annual report World Health Statistics 2012 was recently published. In addition to annually published indicators of health, this year's report contains a highlighted new section on non-communicable diseases and their impact on world health. The section gives particular attention to hypertension and obesity. Interestingly, despite worldwide increases in obesity and metabolic syndrome, hypertension rates have actually improved in wealthy nations since 1980, while rates have greatly increased in developing regions and particularly in Africa. Potential contributors to these disparities likely include access to screening and treatment, and the rise of high sodium and low potassium processed foods in poorer nations. It will be imperative in years to come to identify and employ the success seen in wealthy nations worldwide to improve outcomes and productivity in the developing world.

Hypertension and C-reactive protein

The recently released World Health Statistics report revealed that one in every 3–4 adults aged 25 worldwide has hypertension.1 According to this report, hypertension is singlehandedly responsible for 13% of all global deaths, 51% of stroke deaths, and 45% of coronary heart disease deaths. Hypertension therefore remains a major public health concern that is associated with substantial healthcare costs. The majority of hypertension (with the exception of secondary hypertension) has no direct identifiable cause. The discovery of novel causal factors of hypertension, or its downstream effects, can lead to more effective therapeutic interventions, which has the potential to translate into millions of lives and money saved. Despite the frequently used but misleading terms of ‘essential’ and ‘idiopathic’ hypertension, much is known about its pathophysiology. Vascular inflammation indeed has an important role in the genesis and progression of hypertension as recently reviewed by Androulakis et al.2

World health statistics

Introduction::Part 1. Ten highlights in health statistics::Part 2. Global health indicators::Mortality and burden of disease::Health service coverage::Risk factors::Health workforce and hospital beds::Demographic and socioeconomic statistics::Footnotes and explanatory notes

Evaluation of the efficiency of national health systems of the members of World Health Organization

PurposeThe importance of health care is growing worldwide, and the health sector receives a good proportion of GDP. As health care costs are increasing, it is important to assess the performance of health care facilities across countries. Therefore, this paper aims to examine the effectiveness of data envelopment analysis, which is one of the most important techniques currently available to model and measure the efficiency of national health care systems across the world.Design/methodology/approachIn this paper, the effectiveness of the operation of 180 countries is evaluated using data envelopment analysis (DEA). The countries selected are the members of the World Health Organization. Efficiency measures are calculated with respect to two groups of indicators, namely health status and health service coverage. In the health status group, four outputs representing mortality rates and one input representing the total expenditure on health is used in the analysis. In the health service coverage group, two outputs representing immunisation coverage and one input representing the total expenditure on health are used in the analysis.FindingsUsing data for the year 2008 from World Health Statistics (WHO), 45 countries are found to be efficient.Originality/valueThe value of the paper lies in the fact that it is one of the few studies to examine the robustness of data envelopment analysis to evaluate the performance of health care systems across countries.

Volunteering as a midwife educator in Sierra Leone: A personal account

British Journal of MidwiferyVol. 20, No. 3 CommentVolunteering as a midwife educator in Sierra Leone: A personal accountAlice WatermanAlice WatermanSearch for more papers by this authorAlice WatermanPublished Online:16 Aug 2013https://doi.org/10.12968/bjom.2012.20.3.216AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References World Health Organization (2010) World Health Statistics 2010. www.who.int/whosis/whostat/EN_WHS10_Full.pdf (accessed 17 February 2012) Google Scholar FiguresReferencesRelatedDetails 1 March 2012Volume 20Issue 3ISSN (print): 0969-4900ISSN (online): 2052-4307 Metrics History Published online 16 August 2013 Published in print 1 March 2012 Information© MA Healthcare LimitedPDF download

A pearl study analysis of national neonatal, early neonatal, late neonatal, and corrected Neonatal Mortality Rates in the state of Qatar during 2011: A comparison with World Health Statistics 2011 and Qatar′s historic data over a period of 36 years (1975-2011)

Objective:To prospectively ascertain Qatar's national Neonatal Mortality Rate (NMR), Early Neonatal Mortality Rate (ENMR), and Late Neonatal Mortality Rate (LNMR) during 2011, compare it with recent data from high-income countries, and analyze trends in Qatar's NMR's between 1975 and 2011 using historic data.Study Design:A National prospective cohort-study.Materials and Methods:National data on live births and neonatal mortality was collected from all public and private maternity facilities in Qatar (1st January-December 31st 2011) and compared with historical neonatal mortality data (1975-2010) ascertained from the database of maternity and neonatal units of Women's Hospital and annual reports of Hamad Medical Corporation. For inter country comparison, country data of 2009 was extracted from World Health Statistics 2011 (WHO) and the European Perinatal Health report (2008).Results:A total of 20583 live births were recorded during the study period. Qatar's national NMR during 2011 was 4.95, ENMR 2.7, LNMR 2.2, and cNMR 3.33. Between 1975 and 2011, Qatar's population increased by 10-fold, number of deliveries by 7.2 folds while relative risk of NMR decreased by 87% (RR 0.13, 95% CI 0.10-0.18, P<0.001), ENMR by 91% (RR 0.09, 95% CI 0.06-0.12, P<0.001) and LNMR by 58% (RR 0.42, 95% CI 0.23-0.74, P=0.002). The comparable ranges of neonatal mortality rates from selected high-income West European countries are: NMR: 2-5.7, ENMR 1.5-3.8, and LNMR 0.5-1.9.Conclusions:The neonatal survival in the State of Qatar has significantly improved between 1975 and 2011. The improvement has been more marked in ENMR than LNMR. Qatar's current neonatal mortality rates are comparable to most high-income West European countries. An in-depth research to assess the correlates and determinants of neonatal mortality in Qatar is indicated.

Getting the numbers right in Africa -- a tribal solution

It often seems that the health care numbers and vital statistics in Africa are as hazy as the sun on the horizon. Medical statistics, for example, can come with staggering margins of error. The World Health Organization notes in “2011 World Health Statistics” that “there are considerable