"Fewer children, better life" or "as many as God wants"? Family planning among low-income Iranian and Afghan refugee families in Isfahan, Iran

In the West it is often assumed that religion (esp. Islam) and contraception are mutually exclusive. Yet, the Islamic Republic of Iran has one of the most successful family-planning programs in the developing world, and is often looked to as a potential model for other Muslim countries. Although Iran's family-planning program has been extremely successful among Iranians, it has been far less successful among Afghan refugees and other ethnic groups. Afghans and Iranians both seek services in Iran's public health sector for family health care, treatment of infectious disease, and childhood vaccinations. On these occasions, all adult married patients are strongly encouraged to use family planning to reduce the number of offspring. In this article, we explore how Iran's family-planning program is differentially perceived and utilized among low-income Iranian and Afghan refugee families in rural and urban locations. Particular attention is given to how different interpretations of Islam may or may not influence reproductive health-related behaviors and how cultural factors influence reproductive strategies.     

The Value of Forests to World Food Security

We assembled information on the contribution and value of forests to world food security. An assessment was made of the role of forests and non-timber products in the food system of developing countries. We estimated that upwards of 300 million people annually earn part or all of their livelihood and food from forests. A total of about $90 billion in non-timber products are harvested each year. Forests also help to protect land, water, and biological resources, and they play an important role in maintaining the productivity of agricultural and environmental systems.     

Scaling Up Family Planning to Reduce Maternal and Child Mortality: The Potential Costs and Benefits of Modern Contraceptive Use in South Africa

Introduction

Family planning contributes significantly to the prevention of maternal and child mortality. However, many women still do not use modern contraception and the numbers of unintended pregnancies, abortions and subsequent deaths are high. In this paper, we estimate the service delivery costs of scaling up modern contraception, and the potential impact on maternal, newborn and child survival in South Africa.

Methods

The Family Planning model in Spectrum was used to project the impact of modern contraception on pregnancies, abortions and births in South Africa (2015-2030). The contraceptive prevalence rate (CPR) was increased annually by 0.68 percentage points. The Lives Saved Tool was used to estimate maternal and child deaths, with coverage of essential maternal and child health interventions increasing by 5% annually. A scenario analysis was done to test impacts when: the change in CPR was 0.1% annually; and intervention coverage increased linearly to 99% in 2030.

Results

If CPR increased by 0.68% annually, the number of pregnancies would reduce from 1.3 million in 2014 to one million in 2030. Unintended pregnancies, abortions and births decrease by approximately 20%. Family planning can avert approximately 7,000 newborn and child and 600 maternal deaths. The total annual costs of providing modern contraception in 2030 are estimated to be US$33 million and the cost per user of modern contraception is US$7 per year. The incremental cost per life year gained is US$40 for children and US$1,000 for mothers.

Conclusion

Maternal and child mortality remain high in South Africa, and scaling up family planning together with optimal maternal, newborn and child care is crucial. A huge impact can be made on maternal and child mortality, with a minimal investment per user of modern contraception.     

Costs associated with gunshot wounds in Canada in 1991.

OBJECTIVE: To estimate the costs (in 1993 dollars) associated with gunshot wounds in Canada in 1991. DESIGN: Cost analysis using separate estimates of gunshot incidence rates and costs per incident for victims who died, those who survived and were admitted to hospital and those who survived and were treated and released from emergency departments. Estimates were based on costs for medical care, mental health care, public services (i.e., police investigation), productivity losses, funeral expenses, and individual and family pain, suffering and lost quality of life. SETTING: Canada. OUTCOME MEASURES: Costs per case, costs by type of incident (e.g., assault, suicide or unintentional shooting) and costs per capita. RESULTS: The total estimated cost associated with gunshot wounds was $6.6 billion. Of this, approximately $63 million was spent on medical and mental health care and $10 million on public services. Productivity losses exceeded $1.5 billion. The remaining cost represented the value attributed to pain, suffering and lost quality of life. Suicides and attempted suicides accounted for the bulk of the costs ($4.7 billion); homicides and assaults were the next most costly ($1.1 billion). The cost per survivor admitted to hospital was approximately $300,000; this amount included just over $29,000 for medical and mental health care. CONCLUSION: Costs associated with gunshot wounds were $235 per capita in Canada in 1991, as compared with $595 in the United States in 1992. The differences in these costs may be due to differences in gun availability in the two countries. This suggests that increased gun control may reduce Canada''s costs, especially those related to suicide.     

Long-term costs and health impact of continued global fund support for antiretroviral therapy

Background

By the end of 2011 Global Fund investments will be supporting 3.5 million people on antiretroviral therapy (ART) in 104 low- and middle-income countries. We estimated the cost and health impact of continuing treatment for these patients through 2020.

Methods and Findings

Survival on first-line and second-line ART regimens is estimated based on annual retention rates reported by national AIDS programs. Costs per patient-year were calculated from country-reported ARV procurement prices, and expenditures on laboratory tests, health care utilization and end-of-life care from in-depth costing studies. Of the 3.5 million ART patients in 2011, 2.3 million will still need treatment in 2020. The annual cost of maintaining ART falls from $1.9 billion in 2011 to $1.7 billion in 2020, as a result of a declining number of surviving patients partially offset by increasing costs as more patients migrate to second-line therapy. The Global Fund is expected to continue being a major contributor to meeting this financial need, alongside other international funders and domestic resources. Costs would be $150 million less in 2020 with an annual 5% decline in first-line ARV prices and $150–370 million less with a 5%–12% annual decline in second-line prices, but $200 million higher in 2020 with phase out of stavudine (d4T), or $200 million higher with increased migration to second-line regimens expected if all countries routinely adopted viral load monitoring. Deaths postponed by ART correspond to 830,000 life-years saved in 2011, increasing to around 2.3 million life-years every year between 2015 and 2020.

Conclusions

Annual patient-level direct costs of supporting a patient cohort remain fairly stable over 2011–2020, if current antiretroviral prices and delivery costs are maintained. Second-line antiretroviral prices are a major cost driver, underscoring the importance of investing in treatment quality to improve retention on first-line regimens.     

The Potato—Its origin,cytogenetic relationships,production, uses and food value

About eight billion bushels of potatoes are produced annually throughout the world, 400 million of them in the United States. In the United States and England they are used principally for human consumption; in other European countries as livestock food and as raw material for the manufacture of starch, alcohol and other by-products.     

Prevention of diabetes complications in developing countries: time to intensify self-management education

The IDF report has indicated that about 80% of four million diabetes-related deaths that occur every year comes from the developing world. The IDF report suggests the need to focus more on preventing diabetes complications in poor countries. Thus, considering the economic constraints in combating the explosion of diabetes complications in the developing regions of the world, it appears that exploring culturally adaptable educational intervention programmes for specific regions would be the appropriate strategy. We believe that diabetes-related deaths could be reduced in developing countries through intensified diabetes self-management education.     

The value of decreasing the duration of the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection

Finding medications or vaccines that may decrease the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could potentially reduce transmission in the broader population. We developed a computational model of the U.S. simulating the spread of SARS-CoV-2 and the potential clinical and economic impact of reducing the infectious period duration. Simulation experiments found that reducing the average infectious period duration could avert a median of 442,852 [treating 25% of symptomatic cases, reducing by 0.5 days, reproductive number (R₀) 3.5, and starting treatment when 15% of the population has been exposed] to 44.4 million SARS-CoV-2 cases (treating 75% of all infected cases, reducing by 3.5 days, R₀ 2.0). With R₀ 2.5, reducing the average infectious period duration by 0.5 days for 25% of symptomatic cases averted 1.4 million cases and 99,398 hospitalizations; increasing to 75% of symptomatic cases averted 2.8 million cases. At $500/person, treating 25% of symptomatic cases saved $209.5 billion (societal perspective). Further reducing the average infectious period duration by 3.5 days averted 7.4 million cases (treating 25% of symptomatic cases). Expanding treatment to 75% of all infected cases, including asymptomatic infections (R₀ 2.5), averted 35.9 million cases and 4 million hospitalizations, saving $48.8 billion (societal perspective and starting treatment after 5% of the population has been exposed). Our study quantifies the potential effects of reducing the SARS-CoV-2 infectious period duration.     

Nowadays which emergency contraception? Comparison between past and present: latest news in terms of clinical efficacy, side effects and contraindications

Despite many highly effective methods of contraception are available nowadays, many pregnancies are unintended. Emergency contraception (EC) is the use of drug or device after unprotected intercourse to prevent an unwanted pregnancy. It is a woman's last chance to prevent unintended pregnancy. Nevertheless the confusion about mechanisms of action, side effects, clinical efficacy and controindications makes the intervention underused in every setting investigated. So far levonorgestrel (LNG) has been considered the gold standard for oral EC. Today, a new type of second generation progesterone receptor modulator, ulipristal acetate (UPA) has been proposed as a more effective drug than LNG in prevention of unwanted pregnancies by delaying or inhibiting ovulation; even if many other devices are disposable in commerce. We revised the literature to concern most of the data available on the role of EC and moreover clarifying the available methods, the action windows of the accessible devices, the adverse events and the controindications.     

Agroterrorism in the U.S.: key security challenge for the 21st century

Agriculture is one of the easiest sectors of the U.S. economy to disrupt, and its disruption could have catastrophic consequences for the U.S. and world economies. Agriculture in the U.S. accounts for 13% of the current Gross Domestic Product (GDP) and provides employment for 15% of the population. It produces high-quality, cheap, plentiful food for domestic consumption and accounts for more than $50 billion in exports. The likelihood of terrorist acts interrupting the production, processing, and distribution of agricultural products is high: A number of different possible plant or animal pathogens could cause harm or loss of production, and even an act of agroterrorism that did not result in the destruction of foodstuffs or interruptions in the food supply could have a psychological impact. A number of recent unintentional events and epidemics have prompted the U.S. and other countries to provide resources to counteract contagious diseases and contain their impact, including increased funding to federal agencies that are responsible for protecting domestic agriculture. This article presents recommendations to protect agriculture, including changing the way agriculture is viewed on the federal level and increasing the resources to protect agriculture from terrorist attack.     

WHO's special programmes: undermining from above.

Despite the World Health Organisation''s spoken commitment to developing integrated primary health care, its most visible and successful activities are not integrated within countries; they are its disease specific intervention programmes, such as the Global Programme on AIDS and the programmes for the control of diarrhoeal and acute respiratory diseases. The 10 or so special programmes, all but one of which (the onchocerciasis control programme) are based in Geneva, have found increasing favour among donors, but critics say that they undermine WHO''s attempts to integrate its activities at country level and discourage countries from developing their own capacity.     

Determinants of human population growth

The 20th century has seen unprecedented growth of the human population on this planet. While at the beginning of the century the Earth had an estimated 1.6 billion inhabitants, this number grew to 6.1 billion by the end of the century, and further significant growth is a near certainty. This paper tries to summarize what factors lie behind this extraordinary expansion of the human population and what population growth we can expect for the future. It discusses the concept of demographic transition and the preconditions for a lasting secular fertility decline. Recent fertility declines in all parts of the world now make it likely that human population growth will come to an end over the course of this century, but in parts of the developing world significant population growth is still to be expected over the coming decades. The slowing of population growth through declining birth rates, together with still increasing life expectancy, will result in a strong ageing of population age structure. Finally, this paper presents a global level systematic analysis of the relationship between population density on the one hand, and growth and fertility rates on the other. This analysis indicates that in addition to the well-studied social and economic determinants, population density also presents a significant factor for the levels and trends of human birth rates.     

Economic returns to investment in AIDS treatment in low and middle income countries

Since the early 2000s, aid organizations and developing country governments have invested heavily in AIDS treatment. By 2010, more than five million people began receiving antiretroviral therapy (ART)--yet each year, 2.7 million people are becoming newly infected and another two million are dying without ever having received treatment. As the need for treatment grows without commensurate increase in the amount of available resources, it is critical to assess the health and economic gains being realized from increasingly large investments in ART. This study estimates total program costs and compares them with selected economic benefits of ART, for the current cohort of patients whose treatment is cofinanced by the Global Fund to Fight AIDS, Tuberculosis and Malaria. At end 2011, 3.5 million patients in low and middle income countries will be receiving ART through treatment programs cofinanced by the Global Fund. Using 2009 ART prices and program costs, we estimate that the discounted resource needs required for maintaining this cohort are $14.2 billion for the period 2011-2020. This investment is expected to save 18.5 million life-years and return $12 to $34 billion through increased labor productivity, averted orphan care, and deferred medical treatment for opportunistic infections and end-of-life care. Under alternative assumptions regarding the labor productivity effects of HIV infection, AIDS disease, and ART, the monetary benefits range from 81 percent to 287 percent of program costs over the same period. These results suggest that, in addition to the large health gains generated, the economic benefits of treatment will substantially offset, and likely exceed, program costs within 10 years of investment.     

Human population growth and the demographic transition

The world and most regions and countries are experiencing unprecedentedly rapid demographic change. The most obvious example of this change is the huge expansion of human numbers: four billion have been added since 1950. Projections for the next half century expect a highly divergent world, with stagnation or potential decline in parts of the developed world and continued rapid growth in the least developed regions. Other demographic processes are also undergoing extraordinary change: women''s fertility has dropped rapidly and life expectancy has risen to new highs. Past trends in fertility and mortality have led to very young populations in high fertility countries in the developing world and to increasingly older populations in the developed world. Contemporary societies are now at very different stages of their demographic transitions. This paper summarizes key trends in population size, fertility and mortality, and age structures during these transitions. The focus is on the century from 1950 to 2050, which covers the period of most rapid global demographic transformation.     

Optimizing coffee cultivation and its impact on economic growth and export earnings of the producing countries: The case of Saudi Arabia

Coffee is one of the historical socioeconomic crops. It has received an increasing attention at the global level, due to its positive interlinkage with the economic growth and on the gross domestic product for most of the producing countries, particularly, developing and least developed countries. Saudi Arabia is one of the coffee producing countries that has a relative comparative advantage of coffee cultivation. Yet, coffee cultivation has not received as much attention in Saudi Arabia as that of producing countries around the world. This study aims to assess the current state of coffee cultivation in Saudi Arabia and to investigate the potential to optimize coffee cultivation in Saudi Arabia that maximizes the net national economic return and export earnings, given limitation of cultivated areas, local market activities, and international trade activities. The study statistically analyzed primary data collected from around (65) coffee farms and traders in the study regions at the south and southwest Saudi Arabia, and optimized coffee cultivation in Saudi Arabia using LINGO optimization software. Empirical results of the study revealed the great potential of Saudi Arabia to expand coffee cultivation at south and southwest regions to meet the escalating local demand and to increase its share at the world market up to 2%. Optimization of coffee cultivation in Saudi Arabia showed a high potential to meet the local demand for coffee by producing 80.07 thousand tons grown over 2861.78 hectares and to generate a net return equivalent to $395.72 million a year, which is equivalent to $138.28 thousand per hectare and $4.94 thousand per ton of coffee. Optimizing coffee cultivation will play a substantial role to increase market share of Saudi Arabia to about 1–2% of the world market by increasing its export volume, respectively, to about 69.66 and 112.56 thousand tons, the national net economic return by about $395.86 and $395.95 million a year, and the export earnings of coffee by about $219.43–354.57 million a year, which in turns, will serve the national strategic trend to diversify the economic base and lower the dependency of incomes generated from oil exportation.     

Plant Nutrition--Roots of Life for Fundamental Biology and Better Crop Production

The world's population reached 6.7 billion in 2008 and continuesto grow. 2008 was also a year marked by high food prices, andindeed food crises have arisen in developing countries. Giventhe increase in population and decrease in available arableland, the public expects us, the plant science community, toprovide technologies that maintain and increase food production.Plants grow in the soil, take up mineral nutrients and generatefood for us. Therefore, the uptake of mineral nutrients by plantsfrom the soil is a critical step, in terms of both food productionand global element cycling. The human body contains about 1.5 kg of nitrogen atoms. Everyhuman eats nearly three times this quantity of nitrogen everyyear in the form of protein, equivalent to 73 g of protein aday. The current world population consumes some 28 million tonnesof protein-nitrogen every year.     

The Global Inventor Gap: Distribution and Equality of World-Wide Inventive Effort, 1990–2010

Applying distance-to-frontier analysis, we have used 2.9 million patents and population data to assess whether the relative capacity of world countries and major regions to create new knowledge and technology has become globally more equal or less equal between 1990 and 2010. We show with the Gini coefficient that the global distribution of inventors has become more equal between major countries and regions. However, this trend has been largely due to the improved performance of only two major countries, China and India. The worst performing regions, totalling a population of almost 2 billion, are actually falling behind. Our results suggest that substantial parts of the global population have fallen further behind countries at the global frontier in their ability to create new knowledge and inventions, and that the catch-up among the least developed and middle-income countries is highly uneven, prompting questions about the nature and future of the global knowledge economy.     

Gates,GAVI, the glorious global funds and more: all you ever wanted to know

Global immunization programmes have achieved some remarkable successes. In 1977, Frank Fenner's Commission declared smallpox to have been eradicated by an 11-year-long intensive campaign. The Expanded Programme on Immunization encompassed six important childhood vaccines and reached over three-quarters of the world's children. Polio eradication has gone remarkably well, with only 10 out of 200 countries reporting residual cases. But amidst all the good news, there is also bad news. Coverage is variable; infrastructure is crumbling; and newer vaccines are not being incorporated in many country programmes. The Bill and Melinda Gates Foundation has introduced a new dynamic here. From their initial gift of $100 million in December 1998, their commitment to date is US$1.5 billion - and rising. At the centre is a Global Children's Vaccine Fund which permitted the launch, in January 2000, of the Global Alliance for Vaccines and Immunization. This is targeted to the 74 poorest countries of the world and is designed to improve vaccination infrastructure, to purchase newer vaccines and to support research and development. Even before we know how successful this programme will be, it has had its imitators. The Global Fund to Fight AIDS, TB and Malaria borrowed many concepts from GAVI. The Global Alliance for Improved Nutrition announced in May 2002 does so as well, and is heavily supported by Gates. Highly effective parasite control programmes antedate all this but will be much strengthened. However, we still face a sizeable budgetary gap both for research and for bringing the best advances to all people who need them.     

The value of undiscovered pharmaceuticals in tropical forests

Previous estimates of the potential value of higher plants in tropical forests for Pharmaceuticals are too high because analysts mistakenly used gross revenues to value drugs instead of net revenues. Correcting this error, we estimate each new drug is worth an average $94 million to a private drug company and $449 million to society as a whole. Given recent experience searching for new drugs, we estimate that the higher plants in the world’s tropical forests contain about 375 potential pharmaceuticals of which 48 (about one in eight) have already been discovered. Multiplying these values by the number of potential new drugs suggests that a complete collection and screening of all tropical plant species should be worth about $3–4 billion to a private pharmaceutical company and as much as $147 billion to society as a whole.     

Fermented foods, feeds, and beverages

World population reached 5 billion people in 1986 and is expected to rise to 6 particularly severe in parts of Africa, particularly Ethiopia. Hunger and malnutrition accompany the poverty that is characteristic of the masses of the people in the developing world. Even in the United States, one of the most affluent countries, there has been a considerable increase in the number of homeless people including mothers and children living in the streets or in substandard housing. The indigenous fermented foods and beverages already consumed for centuries by hundreds of millions of the world's masses can be used in many cases to improve and extend the world's food and nutrition supply at a relatively low cost. Fermented foods, feeds and beverages are getting ever increasing attention particularly in the developing world and also in the developed world. This paper summarizes activities and advances related to fermented foods, feeds, and beverages over the past several years.