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  • Another key challenge requires special attention in improvin

    2019-04-15

    Another key challenge requires special attention in improving maternal health in western China. On the basis of recent estimates, China has more than 250 million so-called rural-to-urban migrants who move from the countryside to cities to seek better paid jobs. A substantial number of these people come from western China. Their access to affordable maternal care has become a big challenge, because health insurance policies and other maternal health entitlements are not transferrable between provinces or municipalities. However, tackling equity in access to maternal care should not only apply to the disparities between the regions, but also disparities between different social groups within a region. Hence, the development and implementation of a strategy for targeted populations, via precision poverty alleviation, to meet specific unmet needs of maternal health for different poor and vulnerable populations will be crucial for China and other developing countries. Such as strategy would be in line with China\'s commitment to the SDGs that “No one should be left behind”. Finally, although hospital-based delivery was the main mode of skilled birth attendance in China and, as a consequence, around 75% of births occurred in hospitals at the county-level or above, maternal health care in China has not been completely medicalised. As Gao and colleagues report, China has extensively promoted the implementation of Essential Public Health Service programmes, through which, in rural areas, five antenatal care sessions are free of charge at the point of service use. Increasing efforts, including funding and human resources, have been put in place to support and promote health education related to maternal and child care. The central Government of China has emphasised the importance of implementing effective primary health care with a robust referral system, encouraging people to use township or apexbio dilution calculator health centres nearby first, including for maternal and child health care.
    In , Younes Mohammadi and colleagues present an estimate of the change in under-5 child mortality rate (CMR) from 1990 to 2015 in Iran. The dramatic 70% reduction means that Iran as a whole achieved Millennium Development Goal 4 (MDG4) and was one of the best performers in the Middle East and North Africa region in absolute reduction of CMR during the past four decades. The figure is also higher than the worldwide estimate of a 52·0% decrease in CMR as provided by the Global Burden of Disease Study (2015).
    The world stands on the edge of an historic public health success with the imminent eradication of dracunculiasis (guinea-worm disease) and polio. Since the World Health Assembly called for the eradication of dracunculiasis in 1986 and poliomyelitis in 1988, astonishing progress has been made. In 2016, only 25 human cases of dracunculiasis were reported from three countries, transmission of wild poliovirus was found in only three countries, and 37 cases of polio were reported worldwide. In addition to these achievements, there has been progress in the elimination of the little-known disease podoconiosis (endemic non-filarial elephantiasis). Essential to Alu-equivalent family elimination effort is the need to understand the geography of the disease to identify potentially at-risk areas and set a benchmark for evaluating elimination efforts. The global burden of podoconiosis is not at present clearly defined, although available estimates suggest that globally there are 4 million people with podoconiosis, mainly in tropical countries of Africa, Central and South America, and southeast Asia. Tropical African countries bear the highest disease burden. A literature search identifies 32 countries as being either known or suspected to be endemic for podoconiosis. In Africa, the disease has been reported in Angola, Burundi, Cameroon, Cape Verde, Chad, Democratic Republic of Congo, Equatorial Guinea, Ethiopia, Kenya, Madagascar, Mozambique, Niger, Nigeria, Rwanda, São Tomé and Príncipe, Sudan, Tanzania, and Uganda. Podoconiosis has been reported in the Latin American highlands in Brazil, Colombia, Costa Rica, Ecuador, El Salvador, French Guiana, Guatemala, Honduras, Mexico, Peru, and Suriname. In Asia, although filarial elephantiasis predominates in India, podoconiosis has been reported in the northwestern part of the country, as well as in Sri Lanka and Indonesia. However, under-reporting of podoconiosis is possible because of diagnostic challenges and a low index of suspicion. Podoconiosis is an environment-related disease, caused by long-term barefoot exposure to red clay soil. Therefore, environmental factors, such as soil, and other climatic factors that affect the generation of soil, can help predict the occurrence of podoconiosis. An individual\'s vulnerability to the disease is also aggravated by poverty and insufficient access to water for foot hygiene.