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    • Using the finding of a

    2019-04-20

    Using the finding of a 12% reduction in neonatal mortality, Pitt and colleagues show that, even though the reduction in neonatal mortality was relatively modest, the intervention would still be cost-effective. With further statistical modelling they calculate that such an intervention is likely to be cost-effective across a wide range of neonatal mortality rates—namely, 20–60 deaths per 1000 livebirths. The conclusions of the study support the WHO recommendation that a newborn home-visiting programme should be implemented in low-income and middle-income countries.
    Tim Colbourn and colleagues\' study from Malawi is remarkable in scale. A dataset of 113 154 cases of severe pneumonia in young children, which led to 6903 hospital deaths over a zolmitriptan of more than 10 years, makes this a truly big-data study from Africa. The information system was set up by the International Union Against TB and Lung Disease and the Malawian Ministry of Health and was supported by funding from the Bill & Melinda Gates Foundation and the Scottish Government. The study included most government and non-governmental organisation hospitals in Malawi and aimed to give a national picture of the effect of child pneumonia over time on hospital inpatient services. At a time when child pneumonia mortality has fallen substantially in almost all low-income and middle-income countries, any remaining national inequities, such as disadvantaged communities in which progress has lagged behind, must be identified. Much of our understanding of childhood pneumonia in these countries comes from a relatively limited number of hospitals and research centres. These centres often do not represent the highest mortality settings and the most disadvantaged communities. Routine data collection has to be scaled up to better understand child pneumonia in these settings. In addition to documenting the decrease in case-fatality rate with time (both in children who are HIV-positive and HIV-negative), Colbourn and colleagues point to a number zolmitriptan of ongoing challenges: almost half of all deaths occurred within the first 24 h after hospital admission; and the case-fatality rate in children with very severe pneumonia is still very high. If these large-scale data were compared with published or population-based estimates by the Ministry of Health, further important questions could be addressed: (1) what percentage of all cases of severe pneumonia (by age group) were admitted to hospital, (2) what percentage of all child deaths (by age group) from pneumonia happened in hospital, and (3) what percentage of the decrease in child pneumonia mortality was due to the decrease in in-hospital pneumonia deaths?
    On World AIDS Day, Dec 1, we commemorate those who have died, reflect on the state of the epidemic, and reunite for the struggle ahead. The AIDS movement has much to celebrate—new infections are down from 3·1 million to 2·0 million since 2000 and AIDS-related deaths have fallen by more than 40% since 2005. Over 15 million people now access treatment. Yet AIDS remains the leading cause of death among women of reproductive age and the leading cause of death in Africa—including among young people. 17 million people lack access to treatment, and 19 million do not know that Nuclear lamina live with the virus.
    Universal health coverage (UHC)—the availability of quality, affordable health services for all when needed without financial impoverishment—can be a vehicle for improving equity, health outcomes, and financial wellbeing. It can also contribute to economic development. In its report, the Commission on Investing in Health (CIH) set forth an ambitious investment framework for transforming global health through UHC. The CIH endorsed pro-poor pathways to UHC that provide access to services and financial protection to poor people from the beginning and that include people with low income in the design and development of UHC health financing and service provision mechanisms. The CIH argued that pro-poor UHC offers the most efficient way to provide health and financial protection, and proposed pathways through which pro-poor UHC could be achieved.