Health-related Millennium Development Goals

2015

Part I

Health-related Millennium Development Goals

Table 1. Global and regional progress towards the achievement of the health-related MDGs

Target Global AFR AMR SEAR EUR EMR WPR

Target 1.C: Halve, between 1990 and 2015, the proportion of people who suffer from hunger

Percent reduction in proportion of underweight children under five years of age, 1990?2013

50

40

27

60

43

86

36

79

Target 4.A: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate

Percent reduction in under-five mortality rate, 1990?2013

Measles immunization coverage among 1-year-oldsa (%), 2013

67

49

49

64

60

63

46

71

90

84

74

92

78

95

78

97

Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

Percent reduction in maternal mortality ratio, 1990?2013

Births attended by skilled health personnelb (%), 2007?2014

75

45

49

37

64

59

50

60

90

74

51

96

68

98

67

96

Target 5.B: Achieve, by 2015, universal access to reproductive health

Antenatal care coverage (%): at least one visit, 2007?2014

100

83

77

96

77

...

78

95

Unmet need for family planning (%), 2012

0

12

24

9

13

10

18

6

Target 6.A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS

Percent reduction in HIV incidence, 2001?2013

>0

46

59

24

45

20 < -50 21

Target 6.C: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases

Percent reduction in incidence of malariaa, 2000?2013 75

30

34

76

49

100

39

69

Percent reduction in mortality rate of tuberculosis (among HIV-negative people)a, 1990?2013

50

45

40

69

54

11

15

74

Target 7.C: Halve, by 2015, the proportion of the population without sustainable access to safe drinking-water and basic sanitation

Percent reduction in proportion of population without access to improved drinking-water sources, 1990?2012

50

54

32

60

70

60

13

76

Percent reduction in proportion of population without access to improved sanitation, 1990?2012

50

32

8

40

27

22

32

53

a Target etablished via resolutions of the World Health Assembly or agreed upon by WHO multilateral partnerships. b Target set by the International Conference on Population and Development.

Met or on track Substantial progress

No or limited progress ... Data not available or not applicable

12

Summary of status and trends

2015

2015 represents the target year for the Millennium Development Goals (MDGs). By assessing the progress made based upon data available up to 2014 this report provides a clear indication of whether the regional and global targets set for 2015 are likely to be met. It should be noted, however, that the progress assessments reported below may change for some countries once the 2015 data have been taken into account in upcoming final analyses.

Table 1 summarizes the current estimates of global and regional progress made towards the achievement of health-related MDG indicators with set targets1 for which data are available. For relative target reductions (%) the numbers indicate the overall percent reduction, while for absolute targets (% coverage) the numbers indicate the latest available figure.

For each of the indicators shown in Table 1 the extent of global and regional progress has been classified into one of three categories based upon the following arbitrarily defined criteria:

Met or on track ? indicates that the relative target reduction has already been met or will be achieved by 2015 should the trends observed since 1990 continue. In the case of absolute targets, the criterion used is that the latest observed data are within 5 percentage points of the target value.

Substantial progress ? indicates that for relative target reductions the latest observed data are at least halfway to achieving the target. For the absolute coverage targets, indicates that the difference between the latest observed data and the target is no more than half the gap between the target and the global

1. The targets shown for measles immunization coverage, percent reduction in malaria incidence and percent reduction in mortality due to tuberculosis were established via resolutions of the World Health Assembly or agreed upon by WHO multilateral partnerships. The target shown for births attended by skilled health personnel was set by the International Conference on Population and Development (ICPD+5).

baseline2 but greater than 5 percentage points.

No or limited progress ? indicates that latest observed data are not yet halfway to achieving the relative target reduction. For the absolute coverage targets, indicates that the difference between the latest observed data and the target is more than half of the gap between the target and the global baseline.

Table 1 clearly shows that significant strides have been taken at the global level towards achieving many of the health-related MDGs, with the corresponding targets for HIV and drinking-water having been met. Although not shown in Table 1 the MDG targets for both malaria and tuberculosis were also met. In addition, it can be seen that substantial progress has been made in terms of the proportion of the target achieved in reducing child undernutrition (four fifths), child mortality (two thirds) and maternal mortality (three fifths), and in increasing access to improved sanitation (three fifths). Substantial progress was also made towards achieving the Stop TB Partnership target of halving the tuberculosis mortality rate.

However, it is also clear from Table 1 that the gains made in different regions of the world have been uneven and renewed efforts are now needed if progress is to be made in all countries. In order to sustain and build upon the gains already made new global action plans have therefore emerged or are being prepared with even more ambitious goals set for 2030. This unfinished agenda will need to incorporate new challenges such as the growing impact of noncommunicable diseases, and changing social and environmental determinants. Such an ambitious agenda and its goals will need to be firmly embedded within a sustainable development and implementation framework, and be driven by the crucially important concept of universal health coverage.

2. After rounding to the nearest 5% this leads to the following cutoff values: (a) measles immunization coverage among 1-yearolds ? 80%; (b) births attended by skilled health personnel ? 75%; (c) antenatal care coverage: at least one visit ? 80%; and (d) unmet need for family planning ? 10%.

13

Figure 1. P roportion of children under 5 years of age who are underweight ? globally and by WHO region, 1990?2013

50

1990

2013

40

2015 target

Proportion of children aged < 5 years who are underweight (%)

30

20

10

0 Global

African Region

Region of South-East the Americas Asia Region

European Eastern Western

Region Mediterranean Pacific

Region

Region

Goal 1, Target 1.C: Halve, between 1990 and 2015, the proportion of people who suffer from hunger

Undernutrition1 is the underlying cause of death in an estimated 45% of all deaths among children under 5 years of age.2 Between 1990 and 2013 the proportion of underweight children in developing countries declined from 28% to 17%, and if past trends continue will reach 16% in 2015. This rate of progress is close to, but does not meet, the MDG target for this indicator. As shown in Fig. 1, the proportion of underweight children declined globally from 25% in 1990 to 15% in 2013. At regional level, the MDG target for this indica-

tor was met in the WHO Region of the Americas, the WHO European Region and the WHO Western Pacific Region. Of the remaining regions, some are more likely to reach the target than others (Fig. 1).

Between 1990 and 2013, the number of children affected by stunting declined globally from 257 million to 161 million, representing a decrease of 37%.

1. Including fetal growth restriction, stunting, wasting, and deficiencies of vitamin A and zinc, along with suboptimal breastfeeding.

2. Black RE, Victora CG, Walker SP, Bhutta ZA Christian P, deOnis M et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 3August 2013;382(9890):427?51. doi:10.1016/ S0140-6736(13)60937-X ( science/article/pii/S014067361360937X, accessed 25 March 2015).

14

2015

Table 2. Number of countries according to MDG Target 4.A achievement status, by WHO region, 2013

WHO region African Region (AFR) Region of the Americas (AMR) South-East Asia Region (SEAR) European Region (EUR) Eastern Mediterranean Region (EMR) Western Pacific Region (WPR)

Global

MDG Target 4.A ? achievement status

Achieved On track

At least Less than halfway halfway

6 5 5 23 6 3 48 (25%)

2 3 2 4 2 0 13 (7%)

25 24

4 26 12 18 109 (56%)

14 3 0 0 1 6

24 (12%)

Total

47 35 11 53 21 27 194 (100%)

Goal 4, Target 4.A: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate

Progress in child survival worldwide has been described as one of the greatest success stories of international development, with child deaths being almost halved over the last two decades compared to the 1990 MDG baseline. Between 1990 and 2013 under-five mortality rates declined by 49%, falling from an estimated 90 deaths per 1000 live births to 46 deaths per 1000 live births.

More than half of this reduction has taken place in the past decade with the global rate of decline accelerating greatly ? from 1.2% per annum between 1990 and 1995 to 4.0% per annum between 2005 and 2013. As a result, an estimated 17000 fewer children died every day in 2013 than in 1990. Nevertheless, such a rate of decline remains insufficient to reach the target of a two thirds reduction in the 1990 mortality levels by the year 2015.

Worldwide, the total number of neonatal deaths decreased from 4.7 million in 1990 to 2.8 million in 2013. Neonatal mortality rates per 1000 live births declined

from 33 to 20 over the same period ? a reduction of 39%. This rate of decline is slower than that for child mortality overall with the proportion of deaths in children aged < 5 years that occurred in the neonatal period increasing from 37% in 1990 to 44% in 2013.

Despite remarkable progress at the global level, the MDG Target 4.A will not be achieved in most countries by 2015. Table 2 shows the number of countries that: (a) have achieved this target; (b) are on track to meet the target by 2015 if the current rate of progress is maintained; (c) are at least halfway to achieving a two thirds reduction in the 1990 level of mortality but are unlikely to achieve it by 2015 at the current rate of progress; and (d) are less than halfway to meeting the target. As shown in Table 2, less than one third of all countries have either achieved or are on track to meet the MDG target by 2015.

Improved understanding of cause-specific trends will now be an essential element in accelerating further

15

Deaths per 1000 live births Pneumonia

Diarrhoea Measles Malaria

Intrapartum-related complications Prematurity

Other postneonatal conditions Meningitis

Neonatal sepsis & other infections Injuries HIV/AIDS Tetanus Congenital Other neonatal conditions

Figure 2. Global trends in cause-specific mortality rates among children under 5 years of age, 2000?2013

80

77

6

> 30% decline from 2000 to 2013

6 70

20?30% decline from 2000 to 2013 < 20% decline from 2000 to 2013

3

60

50 // 0

2000

3 3

2

2

2

1

1

1

1

1

0

46

2013

change. As the MDG era draws to a close, analysis indicates that preterm birth complications are now the leading cause of under-five deaths globally, accounting for 17% of all such deaths, not just deaths in the neonatal period. This finding underlines the major transition which has taken place in the patterns of child survival. Pneumonia is now the second leading cause of death among the under-fives (15%) with birth asphyxia third (11%), diarrhoea (which was the third leading cause in 2010) fourth (9%) followed by malaria (7%), congenital anomalies (7%) and neonatal infections (7%).

Despite an increase in the global number of live births from 127.7 million in 2000 to 137.7 million in 2013, the total number of deaths in children aged < 5 years decreased from 9.9 million to 6.3 million respectively, with under-five mortality rates falling from 77 to 46 per 1000 live births over the same period. In absolute terms, deaths from pneumonia, diarrhoeal diseases, measles and malaria were associated with the largest

reductions (Fig. 2). Taken together, these reductions accounted for more than half (58%) of the gains made in under-five survival rates between 2000 and 2013.

The first 28 days of life ? the "neonatal period" ? represent the most vulnerable time for a child's survival. In 2013, around 44% of under-five deaths occurred during this period, up from 37% in 1990.

In 2010 the World Health Assembly established the following three milestones for 2015: (a) at least 90% routine coverage with the first dose of measles-containing vaccine for children aged 1 year; (b) a reduced and maintained global annual measles incidence of less than 5 cases per million; and (c) a 95% reduction in the 2000 global measles mortality estimate.

a. During the period 2000?2009, estimated measles immunization coverage increased globally from 73% to 83% and remained at 83?84% through 2013. As of 2013, 66% of WHO Member States had reached

16

2015

Maternal mortality ratio (per 100 000 live births)

Figure 3. Maternal mortality ratio ? globally and by WHO region, 1990?2013

1000 800 600

Global AFR AMR SEAR EUR EMR WPR

400

200

0

1990

1995

2000

2005

2010

2013

Goal 5, Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

at least 90% coverage, compared with only 44% in 2000.

b. During the period 2000?2013, the incidence of measles decreased by 72%, from 146 to 40 cases per million population. However, following outbreaks in a number of countries, the figure for 2013 was an increase on the figure for 2012.

c. Between 2000 and 2013, the estimated global number of measles deaths in children aged < 5 years decreased by 74% from 481000 to 124000. This decrease was one of three main contributors to the observed decline in overall under-five mortality.

The maternal mortality ratio ? the number of maternal deaths per 100 000 live births ? decreased globally by around 45% between 1990 and 2013, with reductions observed in all WHO regions (Fig. 3). Although large, this rate of decrease is unlikely to lead to the achievement of the targeted 75% reduction by 2015. In addition, of the 89 countries with the highest maternal mortality ratio in 1990 (100 or more maternal deaths per 100 000 live births) 13 have made insufficient or no progress at all, with an average annual decline of less than 2% between 1990 and 2013.

The absolute number of women dying due to complications during pregnancy and childbirth has decreased by 45% from an estimated 523000 in 1990 to 289000 in 2013. Direct obstetric causes, notably haemorrhage (27%), hypertensive diseases of pregnancy (14%) and sepsis (11%), continue to be the leading causes of maternal deaths. Increasingly, however, deaths during pregnancy are attributed to other medical conditions.

17

Figure 4. Contraceptive prevalence, unmet need and total demand for family planning ? globally and by WHO region, 2012

100

Unmet need for family

planning

Contraceptive prevalence

80

(any method)

Demand for family planning among women aged 15?49 who are married or in union (%)

60

40

20

0 Global

African Region

Region of South-East the Americas Asia Region

European Eastern Region Mediterranean

Region

The sum of contraceptive prevalence and unmet need represents total demand for family planning.

Western Pacific Region

Goal 5, Target 5.B: Achieve, by 2015, universal access to reproductive health

In order to reduce maternal mortality rates and improve maternal health women need access to effective interventions and high-quality reproductive health care. Many countries have implemented programmes to expand access to interventions in order to reduce the level of unmet need for contraception, provide antenatal care during pregnancy and ensure delivery by a skilled birth attendant.

The prevalence of contraceptive use among women aged 15?49 years who were married or in a consensual union increased globally from 55% in 1990 to 64% in 2012. Unmet need ? defined as the proportion of women who are married or in a union who want to stop or postpone childbearing but are not using contraception ? declined from 15% in 1990 to 12% in 2012. Although the WHO African Region had the lowest total demand for family planning in 2012 it also had the highest level of unmet need at 24% (Fig. 4).

Worldwide, the proportion of women receiving antenatal care at least once during pregnancy was 83% for the period 2007?2014. However, only 64% of pregnant women received the recommended minimum of four antenatal care visits or more, suggesting that large expansions in antenatal care coverage are still needed. In addition, despite increasing coverage of delivery by a skilled birth attendant both globally and in several regions, coverage is still only 51% in the WHO African Region and in low-income countries.

18

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download