This report is part of initial findings from an ongoing review of development progress to generate comparative analysis that illustrates relative and absolute progress at national, sub-national and regional levels. The analysis is based on the Millennium Development Goal (MDG) database, household demographic and health surveys and multiple indicator cluster surveys. Two measures are used to evaluate progress: absolute and relative. Both measures are needed to tell the full story of progress, particularly in low-income countries. The report found that most countries are making progress on most of the key MDG indicators. For example, the number of people living in extreme poverty fell from an estimated 1.8 billion in 1990 to 1.4 billion in 2005. The share of children in primary school in low- and middle-income countries has risen from just over 70% to well over 80%. Ninety-five per cent of countries are making progress in reducing child mortality, which overall fell from 101 to 69 per 1000 live births between 1990 and 20071. And, despite wide variation in progress on maternal mortality, access to maternal health services has increased in about 80% of countries. The key message from many years of working towards the MDGs is that progress is possible. In every aspect of development – even in the least successful of the MDGs reviewed here, on maternal health (Goal 5) – a significant number of countries have made real achievements. Although these statistics are encouraging, the challenge for the remaining five years and beyond is to learn from, and build upon, progress made.
Monitoring equity and research policy
Field trials require extensive data preparation and complex logistics. The use of personal digital assistants (PDAs) can bypass many of the traditional steps that are necessary in a paper-based data entry system. In this study, the authors programmed, designed and supervised the use of PDAs for a large survey enumeration and mass vaccination campaign. The project was implemented in Zanzibar, Tanzania. Zanzibar is composed of two main islands, Unguja and Pemba, where outbreaks of cholera have been reported since the 1970s. PDAs allowed the researchers to digitise information at the initial point of contact with the respondents. Immediate response by the system in case of error helped ensure the quality and reliability of the data. PDAs provided quick data summaries that allowed subsequent research activities to be implemented in a timely fashion. Portability, immediate recording and linking of information was found to enhance structured data collection in the study. The study recommends PDAs as more useful than paper-based systems for data collection in the field, especially in impoverished settings in developing countries.
The 2009 General Household Survey entailed face-to-face interviews with a total of 25,361 households (including multiple households) across all nine provinces. It confirms a number of positive trends related to service delivery as established by previous surveys. However, although access to basic services continues to improve, there is some discontent with the quality of those services. In the case of housing, for example, 16.1% of those occupying state-subsidised housing said that the walls were weak or very weak and 14.9% regard their roofs as weak or very weak. Similarly, although 58% of users of water services said that the quality of such services was good, there has been a steady decline in levels of satisfaction since 2005. The survey also reveals that the number of people living in informal dwellings has dropped. In spite of the resolution to eradicate the use of bucket toilets, it has been found that as soon as bucket toilets were eliminated in a community, other newly formed communities started using the system for a lack of alternatives. Nationwide the percentage of households with no toilets or bucket toilets decreased from 12.6% in 2002 to 6.6% in 2009.
Open collaboration and sharing of information among scientists at scientific meetings can foster innovation and discovery. However, such sharing can be at odds with potential patenting and commercialisation objectives. This tension may be mitigated if certain procedures are followed in the context of scientific meetings. The article first discusses what makes a scientific finding patentable and then sets out four specific patent issues for scientists to consider before attending a scientific meeting and sharing their research. Finally, it provides recommendations on how scientists can best protect their intellectual property rights while sharing information at scientific meetings.
According to this article, epidemiologists and public health researchers are moving very slowly in the data-sharing revolution, and agencies that maintain global health databases are reluctant to share data too. Funders of public health research are beginning to call for change and developing data-sharing policies that are in the public interest. However they are not yet adequately addressing the obstacles that underpin the failure to share data, which include professional structures that reward publication of analysis but not of data, and funding streams and career paths that continue to undervalue critical data management work. Practical issues need to be sorted out too: how and where should data be stored for the long term, who will control access and who will pay for those services? The article offers goals for data sharing and a work plan for reaching them, and challenges respondents to move beyond well-intentioned, but largely aspirational, data-sharing plans.
This report presents findings of a European-Africa consultation on the research agenda for non-communicable diseases. The workshop found that research in Africa can draw from different environmental and genetic characteristics to understand the causes of non-communicable diseases, while economic and social factors are important in developing relevant strategies for prevention and treatment. The suggested research needs include better methods for description and recording, clinical studies, understanding cultural impacts, prevention strategies, and the integrated organisation of care. Specific fields proposed for research are listed in the report. Although the European Union Seventh Framework Research Programme prioritises biomedical and clinical research, it recommends that research for Africa should also address broader social and cultural research and intervention research for greatest impact. Research policy leaders in Africa must engage national governments and international agencies as well as service providers and research communities. None can act effectively alone.
The Bill & Melinda Gates Foundation has announced 78 grants of US$100,000 each in the latest round of Grand Challenges Explorations. Grants have been awarded for the development of a low-cost cell phone microscope to diagnose malaria, the study of the strategic placement of insect-eating plants to reduce insect-borne diseases, and the investigation of nanoparticles to release vaccines when they come in contact with human sweat. The grants support research across 18 countries and six continents. This year’s European grantees are based at universities, research institutes and non-profit organisations. The winners represent groups in Germany, Sweden, Norway and the United Kingdom. Some examples of the projects funded in this round include more effective vaccines, a 'seek-and-destroy' laser vaccine, treating worm infections to improve vaccine effectiveness and new strategies to fight malaria, such as insecticide-treated traditional scarves, using carnivorous plants to control mosquitoes and using cell phone microscope to diagnose malaria. Solutions to promote family health include using ultrasound as a reversible male contraceptive and the use of vitamin A probiotics to combat diarrhoea.
In some areas of the world, one in four people with tuberculosis (TB) becomes ill with a form of the disease that can no longer be treated with standard drugs regimens, according to this report. It estimates that, worldwide, 440,000 people had multi-drug resistant tuberculosis (MDR-TB) worldwide in 2008 and that a third of them died. Of those patients receiving treatment, 60% were reported as cured, yet only an estimated 7% of all MDR-TB patients are diagnosed. These figures point to the urgent need for improvements in laboratory facilities, access to rapid diagnosis and treatment with more effective drugs and regimens shorter than the current two years. In Africa, there is a low percentage of MDR-TB reported among new TB cases, compared with regions such as Eastern Europe and Central Asia, due in part to the limited laboratory capacity to conduct drug resistance surveys. Latest estimates of WHO put the number of MDR-TB cases emerging in 2008 in Africa at 69,000. Previous reports found high levels of mortality among Africans living with HIV and infected with MDR-TB and extensively drug-resistant TB (XDR-TB).
Since 1990, the World Health Organization has used the disability-adjusted life year (DALY) statistic to quantify the burden of diseases. This indicator quantifies both morbidity and mortality due to diseases. This article notes that estimating DALYs is intrinsically problematic since, for some conditions, only limited data is available. For several tropical diseases, especially those affecting people in the poorest countries, it has been argued that DALYs are systematically underestimated. Because it is considered economically unprofitable, virtually no new drugs are being developed for this group of conditions. Being underestimated and lacking targeted drug development programmes, these conditions have been termed neglected tropical diseases (NTDs). Although there may be room for improvement in the calculation of DALYs related to NTDs, the article acknowledges that governments and policy makers use them to determine priorities in prevention and health care and therefore they cannot be ignored. It argues that research efforts targeted at a disease should ideally be in proportion to its global health impact. It considers that NTDs may be neglected twice: once by being attributed an underestimated DALY and again by limited scientific attention.
This article critiques the limitations of gross domestic product (GDP) as a measurement of a nation's success – do individuals living in countries with a high GDP really have a better life than those who don't? It discusses the work of the Stiglitz-Sen-Fitoussi Commission in attempting to find a set of indicators that better represent individuals’ circumstances today, recommending that every country should also apply other indicators to capture what is happening economically, socially and environmentally. Most criticisms of GDP fall into two distinct camps: some maintain that GDP itself needs to be fixed, while others seek to recast the criticism of GDP from an accounting debate to a philosophical one, as our reliance on such a measure suggests that we may still be equating economic growth with progress on a planet that is already overburdened by human consumption and pollution. One measure has succeeded in challenging the hegemony of growth-centric thinking – the Human Development Index (HDI), which turns 20 this year and is still used by the United Nations. The HDI incorporates a nation’s GDP and two other modifying factors: its citizens’ education, based on adult literacy and school-enrolment data, and its citizens’ health, based on life-expectancy statistics. But the HDI has plenty of critics. For example, a slight drop in literacy rates can have a disproportionate effect on a nation's HDI ranking. As a result, researchers are continuing their search for a set of indicators that will reliably measure progress for all nations.