Slowing the stork : better health for women through family planning

Each year 500,000 women die from causes related to pregnancy - 99 percent of them in developing countries. While many of those pregnancies are unwanted and could have been prevented by family planning, only a minority of developing country couples use effective contraceptive methods. For some women, pregnancy represents a major health risk. Others, of lower risk, do not want any more children. This paper discusses the factors which determine women's use of contraceptives, and how family planning programs reach the large numbers of women at risk from further pregnancies. The most successful family planning policies offer women a variety of contraceptive methods tailored to specific age groups and educational levels. Much program experience suggests that family planning is one of, if not the most cost-effective means of averting maternal deaths. The savings generated by family planning services could be invested in saving the lives and health of women who do want to have more children.Health Monitoring&Evaluation,Adolescent Health,Reproductive Health,Early Child and Children's Health,Gender and Health

Competition: A Missing Component of Fruit Fly (Diptera: Tephritidae) Risk Assessment and Planning

Tephritid fruit flies are internationally significant pests of horticulture. Because they are also highly invasive and of major quarantine concern, significant effort is placed in developing full or partial pest risk assessments (PRAs) for fruit flies, while large investments can be made for their control. Competition between fruit fly species, driven by the need to access and utilise fruit for larval development, has long been recognised by researchers as a fundamental component of fruit fly biology, but is entirely absent from the fruit fly PRA literature and appears not be considered in major initiative planning. First presenting a summary of the research data which documents fruit fly competition, this paper then identifies four major effects of fruit fly competition that could impact a PRA or large-scale initiative: (i) numerical reduction of an existing fruit fly pest species following competitive displacement by an invasive fruit fly; (ii) displacement of a less competitive fruit fly pest species in space, time or host; (iii) ecological resistance to fruit fly invasion in regions already with competitively dominant fruit fly species; and (iv) lesser-pest fruit fly resurgence following control of a competitively superior species. From these four major topics, six more detailed issues are identified, with each of these illustrated by hypothetical, but realistic biosecurity scenarios from Australia/New Zealand and Europe. The scenarios identify that the effects of fruit fly competition might both positively or negatively affect the predicted impacts of an invasive fruit fly or targeted fruit fly control initiative. Competition as a modifier of fruit fly risk needs to be recognised by policy makers and incorporated into fruit fly PRAs and major investment initiatives

The Fallacy of Year-Round Breeding in Polyphagous Tropical Fruit Flies (Diptera: Tephritidae): Evidence for a Seasonal Reproductive Arrestment in Bactrocera Species

Bactrocera fruit flies are major pests of horticulture in tropical parts of the world and are highly invasive. Able to breed in many different fruit types, and living in hot to warm climates where temperature is not limiting, it is assumed that these flies breed continuously in their native environment. However, Bactrocera are native to monsoonal rainforests, where the mature fruit needed for breeding is largely absent for four to five months a year during the dry season. Reviewing literature and published population graphs of these flies, we argue that there is evidence to suggest that these flies undergo a reproductive arrest during the dry season when breeding hosts are scarce. We believe females stop or limit reproduction through a diapause or quiescence mechanism, so extending their life-span during the unfavourable breeding period. Once through that period they then switch their life-history strategy to focus on reproduction. Evidence is that this behaviour continues in invaded and agricultural systems and is not just restricted to rainforests. We cannot confirm this hypothesis with the information available, but because of its potential significance in managing these pests we urge that targeted research be carried out to confirm or deny the hypothesis

Diseases Control Priorities in Developing Countries

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Advancement of global health: key messages from the Disease Control Priorities Project.

The Disease Control Priorities Project (DCPP), a joint project of the Fogarty International Center of the US National Institutes of Health, the WHO, and The World Bank, was launched in 2001 to identify policy changes and intervention strategies for the health problems of low-income and middle-income countries. Nearly 500 experts worldwide compiled and reviewed the scientific research on a broad range of diseases and conditions, the results of which are published this week. A major product of DCPP, Disease Control Priorities in Developing Countries, 2nd edition (DCP2), focuses on the assessment of the cost-effectiveness of health-improving strategies (or interventions) for the conditions responsible for the greatest burden of disease. DCP2 also examines crosscutting issues crucial to the delivery of quality health services, including the organisation, financial support, and capacity of health systems. Here, we summarise the key messages of the project

Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition

The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions. 71 intersectoral prevention policies were identified in total, 29 of which are priorities for early introduction. Interventions within the health sector were grouped onto five platforms (population based, community level, health centre, first-level hospital, and referral hospital). DCP3 defines a model concept of essential universal health coverage (EUHC) with 218 interventions that provides a starting point for country-specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4·2 million per year. Estimated total costs prove substantial: about 9·1% of (current) gross national income (GNI) in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing provision of continuing intervention against chronic conditions accounts for about half of estimated incremental costs. For lower-middle-income countries, the mortality reduction from implementing the EUHC can only reach about half the mortality reduction in non-communicable diseases called for by the Sustainable Development Goals. Full achievement will require increased investment or sustained intersectoral action, and actions by finance ministries to tax smoking and polluting emissions and to reduce or eliminate (often large) subsidies on fossil fuels appear of central importance. DCP3 is intended to be a model starting point for analyses at the country level, but country-specific cost structures, epidemiological needs, and national priorities will generally lead to definitions of EUHC that differ from country to country and from the model in this Review. DCP3 is particularly relevant as achievement of EUHC relies increasingly on greater domestic finance, with global developmental assistance in health focusing more on global public goods. In addition to assessing effects on mortality, DCP3 looked at outcomes of EUHC not encompassed by the disability-adjusted life-year metric and related cost-effectiveness analyses. The other objectives included financial protection (potentially better provided upstream by keeping people out of the hospital rather than downstream by paying their hospital bills for them), stillbirths averted, palliative care, contraception, and child physical and intellectual growth. The first 1000 days after conception are highly important for child development, but the next 7000 days are likewise important and often neglected

Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition

The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions. 71 intersectoral prevention policies were identified in total, 29 of which are priorities for early introduction. Interventions within the health sector were grouped onto five platforms (population based, community level, health centre, first-level hospital, and referral hospital). DCP3 defines a model concept of essential universal health coverage (EUHC) with 218 interventions that provides a starting point for country-specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4·2 million per year. Estimated total costs prove substantial: about 9·1% of (current) gross national income (GNI) in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing provision of continuing intervention against chronic conditions accounts for about half of estimated incremental costs. For lower-middle-income countries, the mortality reduction from implementing the EUHC can only reach about half the mortality reduction in non-communicable diseases called for by the Sustainable Development Goals. Full achievement will require increased investment or sustained intersectoral action, and actions by finance ministries to tax smoking and polluting emissions and to reduce or eliminate (often large) subsidies on fossil fuels appear of central importance. DCP3 is intended to be a model starting point for analyses at the country level, but country-specific cost structures, epidemiological needs, and national priorities will generally lead to definitions of EUHC that differ from country to country and from the model in this Review. DCP3 is particularly relevant as achievement of EUHC relies increasingly on greater domestic finance, with global developmental assistance in health focusing more on global public goods. In addition to assessing effects on mortality, DCP3 looked at outcomes of EUHC not encompassed by the disability-adjusted life-year metric and related cost-effectiveness analyses. The other objectives included financial protection (potentially better provided upstream by keeping people out of the hospital rather than downstream by paying their hospital bills for them), stillbirths averted, palliative care, contraception, and child physical and intellectual growth. The first 1000 days after conception are highly important for child development, but the next 7000 days are likewise important and often neglected