Progress toward Global Reduction in Under-Five Mortality: A Bootstrap Analysis of Uncertainty in Millennium Development Goal 4 Estimates

Background

Millennium Development Goal 4 calls for an annual rate of reduction (ARR) of the under-five mortality rate (U5MR) of 4.4% between 1990 and 2015. Progress is measured through the point estimates of the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). To facilitate evidence-based conclusions about progress toward the goal, we assessed the uncertainty in the estimates arising from sampling errors and biases in data series and the inferior quality of specific data series.

Methods and Findings

We implemented a bootstrap procedure to construct 90% uncertainty intervals (UIs) for the U5MR and ARR to complement the UN IGME estimates. We constructed the bounds for all countries without a generalized HIV epidemic, where a standard estimation approach is carried out (174 countries). In the bootstrap procedure, potential biases in levels and trends of data series of different source types were accounted for. There is considerable uncertainty about the U5MR, particularly for high mortality countries and in recent years. Among 86 countries with a U5MR of at least 40 deaths per 1,000 live births in 1990, the median width of the UI, relative to the U5MR level, was 19% for 1990 and 48% for 2011, with the increase in uncertainty due to more limited data availability. The median absolute width of the 90% UI for the ARR from 1990 to 2011 was 2.2%. Although the ARR point estimate for all high mortality countries was greater than zero, for eight of them uncertainty included the possibility of no improvement between 1990 and 2011. For 13 countries, it is deemed likely that the ARR from 1990 to 2011 exceeded 4.4%.

Conclusions

In light of the upcoming evaluation of Millennium Development Goal 4 in 2015, uncertainty assessments need to be taken into account to avoid unwarranted conclusions about countries'' progress based on limited data. Please see later in the article for the Editors'' Summary     

Millennium Development Goal Four and Child Health Inequities in Indonesia: A Systematic Review of the Literature

Introduction

Millennium Development Goal (MDG) 4 calls for reducing mortality of children under-five years by two-thirds by 2015. Indonesia is on track to officially meet the MDG 4 targets by 2015 but progress has been far from universal. It has been argued that national level statistics, on which MDG 4 relies, obscure persistent health inequities within the country. Particularly inequities in child health are a major global public health challenge both for achieving MDG 4 in 2015 and beyond. This review aims to map out the situation of MDG 4 with respect to disadvantaged populations in Indonesia applying the Social Determinants of Health (SDH) framework. The specific objectives are to answer: Who are the disadvantaged populations? Where do they live? And why and how is the inequitable distribution of health explained in terms of the SDH framework?

Methods and Findings

We retrieved studies through a systematic review of peer-reviewed and gray literature published in 1995-2014. The PRISMA-Equity 2012 statement was adapted to guide the methods of this review. The dependent variables were MDG 4-related indicators; the independent variable “disadvantaged populations” was defined by different categories of social differentiation using PROGRESS. Included texts were analyzed following the guidelines for deductive content analysis operationalized on the basis of the SDH framework. We identified 83 studies establishing evidence on more than 40 different determinants hindering an equitable distribution of child health in Indonesia. The most prominent determinants arise from the shortcomings within the rural health care system, the repercussions of food poverty coupled with low health literacy among parents, the impact of low household decision-making power of mothers, and the consequences of high persistent use of traditional birth attendants among ethnic minorities.

Conclusion

This review calls for enhanced understanding of the determinants and pathways that create, detain, and overcome inequities in child health in resource constraint settings like Indonesia and the promotion of actionable health policy recommendations and tailored investments.     

Plant-made vaccines in support of the Millennium Development Goals

Vaccines are one of the most successful public health achievements of the last century. Systematic immunisation programs have reduced the burden of infectious diseases on a global scale. However, there are limitations to the current technology, which often requires costly infrastructure and long lead times for production. Furthermore, the requirement to keep vaccines within the cold-chain throughout manufacture, transport and storage is often impractical and prohibitively expensive in developing countries—the very regions where vaccines are most needed. In contrast, plant-made vaccines (PMVs) can be produced at a lower cost using basic greenhouse agricultural methods, and do not need to be kept within such narrow temperature ranges. This increases the feasibility of developing countries producing vaccines locally at a small-scale to target the specific needs of the region. Additionally, the ability of plant-production technologies to rapidly produce large quantities of strain-specific vaccine demonstrates their potential use in combating pandemics. PMVs are a proven technology that has the potential to play an important role in increasing global health, both in the context of the 2015 Millennium Development Goals and beyond.     

The Inequality Footprints of Nations: A Novel Approach to Quantitative Accounting of Income Inequality

In this study we use economic input-output analysis to calculate the inequality footprint of nations. An inequality footprint shows the link that each country''s domestic economic activity has to income distribution elsewhere in the world. To this end we use employment and household income accounts for 187 countries and an historical time series dating back to 1990. Our results show that in 2010, most developed countries had an inequality footprint that was higher than their within-country inequality, meaning that in order to support domestic lifestyles, these countries source imports from more unequal economies. Amongst exceptions are the United States and United Kingdom, which placed them on a par with many developing countries. Russia has a high within-country inequality nevertheless it has the lowest inequality footprint in the world, which is because of its trade connections with the Commonwealth of Independent States and Europe. Our findings show that the commodities that are inequality-intensive, such as electronic components, chemicals, fertilizers, minerals, and agricultural products often originate in developing countries characterized by high levels of inequality. Consumption of these commodities may implicate within-country inequality in both developing and developed countries.     

Parasites, people and policy: infectious diseases and the Millennium Development Goals

Here, I briefly review past history and present patterns in the interactions between parasites (defined broadly to include viruses and bacteria along with protozoan, helminth and arthropod parasites) and human populations in developed and developing countries. Against this background, I offer thoughts on current public health initiatives at national and international levels, with particular reference to the Millennium Development Goals. The news is both good and bad: mortality and morbidity from infectious diseases in the developing world are significantly lower than they were 50 years ago, but we should and could be doing better, particularly in relation to neglected tropical diseases.     

Multilevel Anthropogenic Cycles of Copper and Zinc: A Comparative Statistical Analysis

Contemporary cycles for copper and zinc are coanalyzed with the tools of exploratory data analysis. One-year analyses (circa 1994) are performed at three discrete spatial levels-country (52 countries that comprise essentially all anthropogenic stocks and flows of the two metals), eight world regions, and the planet as a whole-and are completed both in absolute magnitude and in per capita terms. This work constitutes, to our knowledge, the first multiscale, multilevel analysis of anthropogenic resources throughout their life cycles. The results demonstrate that (1) A high degree of correlation exists between country-level copper and country-level zinc rates of fabrication and manufacturing, entry into use, net addition to in-use stocks, discard, and landfilling; (2) Regional-level rates for copper and zinc cycle parameters show the same correlations as exist at country level; (3) On a per capita basis, countries add to in-use stock almost 50% more copper than zinc; (4) The predominant discard streams for copper and zinc at the global level are different for the two metals, and relative rates of different loss processes differ geographically, so that resource recovery policies must be designed from metalspecific and location-specific perspectives; (5)When absolute magnitudes of life-cycle flows are considered, the standard deviations of the data sets decrease from country level to regional level for both copper and zinc, which is not the case for the per capita data sets, where the statistical properties of the data sets for both metals approach being independent of spatial level, thus providing a basis for predicting unmeasured per capita metal flow behavior.     

Inequality and antibiotic resistance: A contractualist perspective

There are substantial inequalities associated with antibiotics and the determinants of their effectiveness, including the risk of exposure to antibiotic‐resistant microbes, access to relevant treatment advice, diagnostic facilities, risk of life‐threatening infectious disease, and access to antibiotics. Current arrangements (social, political, economic) allow inequalities in the distribution of antibiotic benefits and burdens. This article focuses on the justification of relevant inequalities from a contractualist perspective.     

The potential impact of plant biotechnology on the Millennium Development Goals

The eight Millennium Development Goals (MDGs) are international development targets for the year 2015 that aim to achieve relative improvements in the standards of health, socioeconomic status and education in the world's poorest countries. Many of the challenges addressed by the MDGs reflect the direct or indirect consequences of subsistence agriculture in the developing world, and hence, plant biotechnology has an important role to play in helping to achieve MDG targets. In this opinion article, we discuss each of the MDGs in turn, provide examples to show how plant biotechnology may be able to accelerate progress towards the stated MDG objectives, and offer our opinion on the likelihood of such technology being implemented. In combination with other strategies, plant biotechnology can make a contribution towards sustainable development in the future although the extent to which progress can be made in today's political climate depends on how we deal with current barriers to adoption.     

Childhood Diarrhea Exhibits Spatiotemporal Variation in Northwest Ethiopia: A SaTScan Spatial Statistical Analysis

Background

Childhood diarrhea continues to be a public health problem in developing countries, including Ethiopia. Detecting clusters and trends of childhood diarrhea is important to designing effective interventions. Therefore, this study aimed to investigate spatiotemporal clustering and seasonal variability of childhood diarrhea in northwest Ethiopia.

Methods

Retrospective record review of childhood diarrhea was conducted using quarterly reported data to the district health office for the seven years period beginning July 1, 2007. Thirty three districts were included and geo-coded in this study. Spatial, temporal and space-time scan spatial statistics were employed to identify clusters of childhood diarrhea. Smoothing using a moving average was applied to visualize the trends and seasonal pattern of childhood diarrhea. Statistical analyses were performed using Excel^® and SaTScan programs. The maps were plotted using ArcGIS 10.0.

Results

Childhood diarrhea in northwest Ethiopia exhibits statistical evidence of spatial, temporal, and spatiotemporal clustering, with seasonal patterns and decreasing temporal trends observed in the study area. A most likely purely spatial cluster was found in the East Gojjam administrative zone of Gozamin district (LLR = 7123.89, p <0.001). The most likely spatiotemporal cluster was detected in all districts of East Gojjam zone and a few districts of the West Gojjam zone (LLR = 24929.90, p<0.001), appearing from July 1, 2009 to June 30, 2011. One high risk period from July 1, 2008 to June 30, 2010 (LLR = 9655.86, p = 0.001) was observed in all districts. Peak childhood diarrhea cases showed a seasonal trend, occurring more frequently from January to March and April to June.

Conclusion

Childhood diarrhea did not occur at random. It has spatiotemporal variation and seasonal patterns with a decreasing temporal trend. Accounting for the spatiotemporal variation identified in the study areas is advised for the prevention and control of diarrhea.     

p-SAGE: 基因集合的参数统计分析方法

肿瘤的发生与发展通常是由重要的细胞通路表达水平的反常导致的．尽管目前已经有很多工作利用基因表达谱数据以及一些其他的先验知识来寻找那些与肿瘤相关的基因集合,但还是没有一个恰当的基因集合的统计学方法．大多数研究都是直接将单基因的检验方法直接应用到基因集合上来．提出了基因集合的参数统计分析方法( p-SAGE ),这个方法应用到大脑肿瘤的实验中,识别了许多显著的基因集合．一些新发现的基因集合是与信号转导和免疫相关的．这个简便有效的方法可以得出有生物学意义的结果．     

Merit and Justice: An Experimental Analysis of Attitude to Inequality

Merit and justice play a crucial role in ethical theory and political philosophy. Some theories view justice as allocation according to merit; others view justice as based on criteria of its own, and take merit and justice as two independent values. We study experimentally how these views are perceived. In our experiment subjects played two games (both against the computer): a game of skill and a game of luck. After each game they observed the earnings of all the subjects in the session, and thus the differences in outcomes. Each subject could reduce the winnings of one other person at a cost. The majority of the subjects used the option to subtract. The decision to subtract and the amount subtracted depended on whether the game was one of skill or luck, and on the distance between the earnings of the subject and those of others. Everything else being equal, subjects subtracted more in luck than in skill. In skill game, but not in luck, the subtraction becomes more likely, and the amount larger, as the distance increases. The results show that individuals considered favorable outcomes in luck to be undeserved, and thus felt more justified in subtracting. In the skill game instead, they considered more favorable outcomes (their own as well as others'') as signal of ability and perhaps effort, which thus deserved merit; hence, they felt less motivated to subtract. However, a larger size of the unfavorable gap from the others increased the unpleasantness of poor performance, which in turn motivated larger subtraction. In conclusion, merit is attributed if and only if effort or skill significantly affect the outcome. An inequality of outcomes is viewed differently depending on whether merit causes the difference or not. Thus, merit and justice are strongly linked in the human perception of social order.