New data show child mortality rates falling

New data released 16 September 2014 by the United Nations show that under-five mortality rates have dropped by 49% between 1990 and 2013. The average annual reduction has accelerated – in some countries it has even tripled – but overall progress is still short of meeting the global target of a two-thirds decrease in underfive mortality by 2015.

New estimates in the ‘Levels and Trends in Child Mortality 2014’ report show that in 2013, 6.3 million children under five died from mostly preventable causes, around 200,000 fewer than in 2012, but still equal to nearly 17,000 child deaths each day. “There has been dramatic and accelerating progress in reducing mortality among children, and the data prove that success is possible even for poorly resourced countries,” said Mickey Chopra, head UNICEF’s of global health programmes.

“There is now a gathering momentum from countries in every part of the world to make sure proven, costeffective interventions are applied where they will save the most lives.”

In 2013, 2.8 million babies died within the first month of life, which represents about 44% of all under-five deaths. About two-thirds of these deaths occurred in just 10 countries.

While the number of neo-natal deaths have declined, progress has been slower than for the overall under-five mortality rate. In June this year, WHO, UNICEF and partners issued the first-ever global plan to end preventable newborn deaths and stillbirths by 2035. The Every Newborn Action Plan calls for all countries to take steps to provide basic, cost-effective health services – in particular around the time of childbirth, as well as for small and sick babies – and to improve the quality of care.

“The global community is poised to end preventable maternal, newborn and child deaths within a generation,” said Dr Flavia Bustreo, Assistant Director General at WHO. “We know what to do and we know how to do it. The challenge now is to move from plan to action – we are pleased to see countries like India beginning to lead the way.” Among the report’s other major findings:

- Eight of the 60 countries identified as ‘high mortality countries’ – with at least 40 under-five deaths for every 1000 live births – have already reached or surpassed the MDG target (67% reduction). The countries are Malawi (72%), Bangladesh (71%), Liberia (71%), Tanzania (69%), Ethiopia (69%), Timor-Leste (68%), Niger (68%) and Eritrea (67%).

- Eastern Asia, Latin America and the Caribbean and Northern Africa, have already reduced the under-five mortality rate by more than two-thirds since 1990.

- Two countries, India (21%) and Nigeria (13%), together account for more than one-third of deaths among children below 5 years of age.

- While Sub-Saharan Africa has cut under- five mortality rates by 48% since 1990, it still has the world’s highest rate – 92 deaths per 1000 live births – nearly 15 times the average in high-income countries.

The leading causes of under-five deaths are pre-term birth complications (17%); pneumonia (15%); complications during labour and delivery (11%); diarrhoea (9%); and malaria (7%). Under-nutrition contributes to nearly half of all under-five deaths. “For continued progress, it is essential to invest more in health systems that deliver high-quality, affordable services to all women and children who need them,” said Olusoji Adeyi, Director of Health, Nutrition and Population at the World Bank Group.

The report notes that major improvements in child survival are in part due to affordable, evidence-based interventions against the leading infectious diseases, such as immunization, insecticide-treated mosquito nets, rehydration treatment for diarrhoea, nutritional supplements and therapeutic foods. The major causes of neonatal mortality – pre-term birth complications (35%) or problems during delivery or birth (24%) – require health interventions closely linked with protecting maternal health.

GAVI introduces Inactivated Polio Vaccine for Endgame Strategic Plan

Nepal has becomes the first country in the world to use support from Gavi, the Vaccine Alliance to begin protecting its children with Inactivated Polio Vaccine (IPV). The introduction is part of a plan to ensure that IPV will be available to millions of children in Gavi-supported countries through the introduction of the vaccine into routine immunisation systems.

Inactivated Polio Vaccine (IPV) was licensed in 1955 and underwent early reformulations to enhance potency and ensure safety in standalone and combination vaccines. According to the WHO, IPV is one of the safest vaccines in humans, whether used alone or in combination vaccines. No serious adverse events have been reported.

While the oral polio vaccine has successfully reduced polio cases by 99% worldwide, adding IPV to routine immunisation programmes will improve immunity and help prevent new vaccineassociated outbreaks from emerging. In May 2013, the World Health Assembly endorsed the Polio Eradication & Endgame Strategic Plan 2013-2018, calling on countries to strengthen routine immunisation programmes and introduce at least one dose of IPV as a lead up to the phased removal of oral polio vaccines.

Children in Afghanistan and Pakistan – two of the final three countries where polio remains endemic – are also set to begin receiving inactivated polio vaccine (IPV) by the end of next year as part of the planned ‘endgame’ for eradicating the crippling disease. Nigeria, the third country where polio remains endemic, has also applied to introduce IPV, with approval expected shortly.

Afghanistan, Nepal and Pakistan are among 25 countries who have received approval to begin using IPV with support from Gavi, while gradually phasing out the oral polio vaccine (OPV) which is currently used in most developing countries.

“Nepal’s introduction of IPV with Gavi support marks an important moment in the global effort to secure a polio-free future,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “Gavi is working with partners to ensure that millions of children in the world’s poorest countries are protected with IPV through routine immunisation as an important step towards achieving global polio eradication.”

Last year more than 400 cases of wild polio virus were recorded, mostly in endemic countries and since the beginning of this year more than 150 cases have been reported, mainly in Pakistan but also in non-endemic countries such as Equatorial Guinea, Iraq, Cameroon, Syria and Ethiopia.

Ban Ki-moon says improving health of women, children a ‘moral imperative’

Lauding the gains made in improving the health of women and children worldwide, UN Secretary-General Ban Ki-moon called for renewed commitment and action to sustain the unprecedented progress made in this area in partnership with governments, civil society, the private sector, philanthropists and international organizations.

“For the first time ever, we have the opportunity to end all preventable deaths of women and children within a generation,” Ban said at the ‘Every Woman Every Child’ event held 25 September 2014 at UN Headquarters on the margins of the General Assembly’s high-level debate.

“Let us seize this historic opportunity as a moral imperative. It is also one of the smartest investments we can make.” Launched by the Secretary-General in September 2010, Every Woman Every Child aims to save the lives of 16 million women and children by 2015.

The initiative has catalysed unprecedented progress in reducing maternal and child mortality, doing so through a pioneering model of multi-stakeholder partnership involving governments, civil society, the private sector, philanthropists and international organizations.

To date, over 400 partners have made commitments under Every Woman Every Child. Ban noted that efforts have led to the reduction in deaths of children under the age of five faster than at any time in the past two decades.

Each day, some 17,000 more children survive. Deaths of mothers have been cut by almost half since 1990.

“These are impressive numbers in conference rooms in New York. They are even more meaningful in hospitals, health posts and homes,” he noted.

“In today’s troubled world, our progress in this area shines brightly. It demonstrates what can be achieved when we come together as a community in partnership.

“As we advance, we will have to protect these fragile gains – and cope with emerging challenges. Climate change, water, education, sanitation, nutrition and human rights all affect women and children’s health.” “I call on all of you to renew your commitments, boost financing, keep insisting on accountability for resources and results, and reach every woman and every child,” said the Secretary- General.

“Together, we can make history.”

IBA, Philips join forces to advance diagnosis, treatment of cancer

IBA (Ion Beam Applications S.A.), a leading provider of proton therapy and radiopharmacy solutions, and Royal Philips have signed of a global collaboration agreement to provide advanced diagnostic and therapeutic solutions for the treatment of cancer.

The collaboration covers sales, marketing, research and development (R&D) of imaging and therapy solutions in oncology.

In a joint statement, the companies said that leveraging high quality imaging and proton therapy offers the potential to increase confidence in the diagnosis and treatment of cancer, reduce shortand long-term side-effects and potentially enhance the quality of life of the patient before, during and after treatment, while reducing the cost of treatment for the healthcare system.

IBA will benefit from Philips diagnostic imaging products offered to oncology care centres, while Philips will leverage IBA proton therapy solutions within its offering for customers in select markets around the world. The commercial collaboration also includes an integrated offering for Molecular Imaging Centres, combining IBA’s expertise in PET radioisotope production centres with Philips imaging and diagnostics expertise.

Commenting on the collaboration, Olivier Legrain, Chief Executive Officer of IBA, said: “This is an exciting and important step for IBA. A closer collaboration with a company of Philips’ caliber and global reach, where we are able to combine both companies’ expertise and excellence in oncology care, will accelerate innovation and provide more efficient and effective solutions in molecular imaging and treatment solutions. This collaboration is an important step toward adaptive treatment of cancer and a personalized treatment approach to enable the best possible result for cancer patients across the globe.”

Gene Saragnese, Executive Vice President and CEO, Imaging Systems, Philips added: “Proton therapy is one of the most exciting technological advancements in the oncology field. We look forward to collaborating with IBA to enhance access to bestin- class technology for both Proton Centres and Molecular Imaging Centres, as well as to accelerate the development of our informed therapy guidance vision in ways that can change the future of care, and improve the quality of life for patients.”

IBA’s Proton Therapy Specific Cone Beam CT successfully used for the first time

IBA (Ion Beam Applications SA), a leading provider of proton therapy solutions for the treatment of cancer, and Université Catholique de Louvain announced September 15 that the first patient treatment with IBA’s Proton Therapy Specific Cone Beam CT (CBCT) was successfully completed at Penn Medicine’s Roberts Proton Therapy Center.

As a component of IBA’s Image Guided Proton Therapy (IGPT) solution, CBCT provides 3D imaging for increased accuracy in patient treatment. It is fully integrated with IBA’s imaging platform adaPTinsight, developed in partnership with the Université catholique de Louvain (UCL), to offer fast 6D corrections of patient positioning for IBA’s ProteusPLUS and ProteusONE proton therapy solutions.

Dr. James M. Metz, MD, Professor and Vice Chair, Radiation Oncology, Penn Medicine commented: “CBCT is a great tool for highly accurate patient positioning. It also enables the clinicians to assess the patient anatomical change over the treatment course regularly and to adapt the treatment plan whenever needed. The end results significantly benefit the patients, with enhanced precision and accuracy of the proton therapy delivery. We believe that this is another significant step in improving our ability to help patients achieve their goals of beating their cancer with as few side effects as possible.”

Frederic Genin, Executive VP Product Management at IBA added: “IBA’s significant experience and successful collaborations with key users make it possible to achieve this important milestone in the development of specific imaging solutions for proton therapy. The applications of image guidance and image monitoring are of paramount importance to benefit from the superior dose distribution of proton therapy. By adding Cone Beam CT as one of IBA’s Image Guided Proton Therapy solutions, we are accelerating the development of Adaptive Proton Therapy.”

WHO calls on countries to implement salt reduction measures

On World Heart Day, 29 September, the World Health Organization (WHO) called on countries to implement population salt reduction measures, on communities to support public health efforts to reduce salt intake, and on individuals to consume less salt to avoid high blood pressure and heart disease.

High salt intake is a key contributor to the increase in noncommunicable diseases (NCDs) worldwide. NCDs account for over 2.2 million deaths, or over 57% of mortality, in the Eastern Mediterranean Region annually. Cardiovascular diseases alone, in which high salt intake plays a major role, cause almost half of these deaths.

The scientific evidence linking high blood pressure to high salt intake, and conversely reduced salt intake to improve health outcomes, is conclusive. In countries where salt intake was reduced by 1 gram per person per day, deaths from stroke and heart attack are expected to be reduced by more than 7%.

“Data from the Eastern Mediterranean Region shows that the average salt consumption in most countries is around 10 grams per person per day,” said Dr Ala Alwan, the WHO Regional Director for the Eastern Mediterranean. “This is double the amount recommended by WHO.”

Dr Alwan added: “Reducing salt intake to less than 5 grams per person per day can prevent cardiovascular disease, which is the number one killer in the Eastern Mediterranean Region and in the world.

“Salt reduction is one of the strategic interventions in the regional framework for action on noncommunicable diseases , endorsed by ministers of health in this region,” explained Dr Alwan. “Implementing salt reduction programmes can help countries achieve the global target for salt reduction,” he said, referring to the global voluntary target, endorsed by the World Health Assembly in May 2013, to reduce salt intake by 30% by the year 2025.

Salt reduction is a proven measure “best buy” for combating noncommunicable diseases, with a cost of about US$ 0.40-0.50 per person per year. Best buys are interventions that are very cost-effective, cheap, culturally acceptable and feasible to implement in all countries.

This World Heart Day, governments, the food industry, civil society groups, families and individuals are urged to take action to reduce salt intake and improve heart-health.

In consultation with Member States and international experts, WHO has developed policy guidance and recommended actions to reduce salt intake; several countries are in the process of implementing this guidance. A key measure is setting national standards for the amount of salt in various food items. Bread is the first priority for action since more than 25% of people’s salt intake in the region comes from salt in bread. Cheese, processed tomato products and meats, and the salt added during cooking or at the table are the next targets.

WHO calls for stronger action on climate-related health risks

“The evidence is overwhelming: climate change endangers human health. Solutions exist and we need to act decisively to change this trajectory,” Dr Margaret Chan, WHO Director-General said at the first-ever global conference on health and climate, held late August in Geneva.

Previously unrecognized health benefits could be realized from fast action to reduce climate change and its consequences. For example, changes in energy and transport policies could save millions of lives annually from diseases caused by high levels of air pollution. The right energy and transport policies could also reduce the burden of disease associated with physical inactivity and traffic injury.

Measures to adapt to climate change could also save lives around the world by ensuring that communities are better prepared to deal with the impact of heat, extreme weather, infectious disease and food insecurity.

These are two key messages discussed at the conference. The health sector needs to act quickly and assertively to promote climate-smart strategies, climate and health experts warned.

WHO and its partners highlighted the importance of acting now to help protect health in the present as well as the future. The health community is working hard to improve its capacity for surveillance and control of infectious diseases such as cholera, malaria and dengue, which are highly sensitive to weather and climate.

Climate change is already causing tens of thousands of deaths every year from shifting patterns of disease, from extreme weather events, such as heat-waves and floods, and from the degradation of water supplies, sanitation, and impacts on agriculture, according to the most recent WHO data. “Vulnerable populations, the poor, the disadvantaged and children are among those suffering the greatest burden of climate- related impacts and consequent diseases, such as malaria, diarrhoea and malnutrition, which already kill millions every year,” noted Dr Flavia Bustreo, WHO Assistant Director-General, Family, Women’s and Children’s Health.

“Without effective action to mitigate and adapt to the adverse effects of climate change on health, society will face one of its most serious health challenges,” she said.

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