Lecture 1 Notes

The regions with the lowest proportions of skilled

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Unformatted text preview: auses include: ectopic pregnancy, embolism, other direct, indirect or unclassified causes. Efforts to reduce maternal mortality need to be tailored to local conditions, since the causes of death vary across developing regions and countries. In Africa and Asia, haemorrhage is the leading cause of maternal death, while in Latin America and the Caribbean, hypertensive disorders during pregnancy and childbirth pose the greatest threat. Obstructed labour and abortion account for 13 and 12 per cent, respectively, of maternal mortality in Latin America and the Caribbean. In Asia, anaemia is a major contributor to maternal deaths, but is a less important cause in Africa and a negligible factor in Latin America. In Africa, particularly parts of Southern Africa, HIV and AIDS are frequently involved in deaths during pregnancy and childbirth. Preventing unplanned pregnancies alone could avert around one quarter of maternal deaths, including those that result from unsafe abortion. Still, an estimated 137 million women have an unmet need for family planning. An additional 64 million women are using traditional methods of contraception with high failure rates. Contraceptive prevalence increased slowly from 55 per cent in 1990 to 64 per cent in 2005, but remains very low in subSaharan Africa, at 21 per cent. In addition, in regions where the adolescent birth rate remains high, a large number of young women, particularly very young women, and their children face increased risk of death and disability. In sub-Saharan Africa, Southern Asia and Latin America and the Caribbean, the high adolescent birth rates prevailing in 1990 have not declined significantly, despite continued reductions in total fertility in those regions. 98 Developi ng regio ns 43 57 0 16 10 20 30 40 50 60 70 80 90 100 110 17 Goal 6 - Combat HIV/AIDS, malaria and other diseases HIV prevalence has leveled off in the developing world (excluding SubSaharan Africa) deaths from AIDS continue to rise in Sub-Saharan Africa In the hardest hit areas more than half of those living with HIV are women Male to female death rates from HIV/AIDS: Developed regions: 4 to 1 Sub-Saharan Africa: 1 to 2.3 (for age group 15-29) 19 Diseases that are eradicated in the developed world like tuberculosis are still killing substantial populations in developing countries 20 22 Disease sSAfrica India China Dev 1. Communicable, Maternal, Perinatal, Nutritional 72 40 12 7 A. Infectious and parasitic 53 20 5 2 1. 2. 3. 4. 5. 3 20 7 7 10 4 3 4 2 0 3 0 1 0 0 0 0 0 0 0 B. Respiratory Infections C. Maternal D. Perinatal 10 2 5 10 1 7 3 0 3 5 0 0 2. Noncommunicable 21 50 77 87 A. Malignant neoplasms B. Cardiovascular C. Respiratory D. Digestive 4 10 2 2 7 27 6 3 19 33 16 4 26 38 6 4 7 10 11 6 Tuberculosis HIV/AIDS Diarrhoeal Childhood Clusters Malaria 3. Injuries Table 5. Deaths by Disease, 2000 (%). Source: Global Burden of Disease (2002). To be sure, the process is far from entirely linear. It is true that in many ways, China has almost completed its epidemiological transition. The pre-revolutionary health situation was very poor in China. Since then, there have been remarkable improvements. By the 1990s, life expectancy had doubled. In particular, during the Deng era 1960–1980, China moved through the late stages of the transition utilising advances in public health care and medicine (Cook and Dummer (2004)). Yet it is possible to argue that China’s rapid economic growth in the last two decades has come at a heavy environmental price, with serious implications for the incidence of respiratory disease. This is apparent in the table above where close to 20% of deaths in China may be attributed to respiratory problems. It is safe to say that India will exhibit no di↵erent a pattern as it continues to urbanize. Of the noncommunicable diseases, heart problems are the leading cause of death in all regions of the world. But recent research emphasizes that heart disease is quickly becoming a burden in developing countries even before they have rid themselves of infectious diseases (Reddy and Yusuf (1998)). This is evident from Table 5 in the case of India, where heart disease far outstrips cancer as a cause of death compared to the developed world. Improvements in nutrition and health status as well as the successful eradication of major killer diseases have contributed to the ongoing epidemiological transition in India (Gupte et. al. (2001)). Nevertheless, as observed by the World Health Organization, the burden of disease as measured by “premature death” there is second only to sub-Saharan Africa. Indeed, it is worth nothing from Table 5 that a main di↵erence between the patterns of THE MILLENNIUM DEVELOPMENT GOALS REPORT 2007 UNITED NATIONS Prevention measures are failing to keep pace with the spread of HIV Slight declines in HIV prevalence among young people since 2000/2001 were reported in eight of the 11 African countries where sufficient information was available to assess trends. Improvements were most evident in Kenya, in urban areas of Côte d’Ivoire, Malawi and Zimbabwe, and in rural parts of Botswana. In general, however, prevention measures are failing to keep pace with the growth of the epidemic. In sub-Saharan Africa, less than a third of young men and just over a fifth of young women demonstrated a compr...
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