Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Comparative evaluation of antimicrobial activity of three types of materials (reinforced zinc oxide eugenol, MTA and Cem cement) used in primary teeth pulpotomy

Background and Aim: One of the major purposes of pediatric dentistry is to maintain deciduous teeth in anatomical and functional conditions up to their physiological exfoliation and eruption of permanent teeth. Whenever pulp gets involved or exposed to mouth area and microorganisms penetrate into pulp, deciduous teeth needs pulp therapy. In the sterile environment, the exposed pulp tissue is able to repair itself and also to create a dentin bridge, but in the presence of bacteria, development of disease and ultimately death of the pulp will be inevitable. The ideal pulpotomy cement should have good physical and biological properties such as sealing of the remaining pulp tissue, being biocompatible and possessing antibacterial activity. The aim of this study was to compare the antibacterial effect of some usual materials used for pulpotomy in deciduous teeth.   Materials and Methods: In this study, we evaluated the antibacterial activity of materials used in deciduous teeth pulpotomy including Zoliran, Sina Zonalin, Kemdent Zonalin, MTA (OrthoMTA) and CEM Cement against Streptococcus mutans and Lactobacillus acidophilus. Well diffusion test and disk diffusion test and time kill curve were used for antibacterial activity assay. Also, we evaluated stability of antibacterial activity of the materials. The antibacterial activity in disk diffusion and well diffusion test was measured based on the diameter of the zone of inhibition, whereas in time kill curve the optical density of the bacterial suspension was measured. We used analysis of variance (ANOVA) and Tukey’s test at the significance level of 5% . Results: In well diffussion and disk diffussion tests all of the materials except CEM Cement showed antibacterial activity against Streptococcus mutans and Lactobacillus acidophilus. The largest and smallest zones of inhibition belonged to zoliran and MTA respectively. The results of time kill curve revealed a similar pattern, so that during the experiment period Zoliran, Sina Zonalin, Kemdent Zonalin, MTA and CEM Cement showed the greatest effects in both groups of bacteria respectively. Conclusion: Reinforced ZOE groups had the greatest effect in inhibition of growth of S.mutans and L.acidophilus compared to MTA and CEM Cement. Thus, use of Zoliran, Sina and Kemdent Zonalin cements in pulpotomy of deciduous teeth can be useful in controlling bacterial growth and achieving success in pulpotomy

Preparation of CdO Rhombus-like Nanostructure and Its Photocatalytic Degradation of Azo Dyes from Aqueous Solution

In this work, a special rhombus-like structure of CdO composed of particles at the nanometre scale was successfully synthesized for the first time. A facile hydrothermal process with a post-reaction calcination was employed to prepare this nanomaterial. Scanning electron microscopy (SEM) images showed that the obtained rhombus-like structure consists of nanoparticles with an average size of 29 nm. The band gap energy of 1.9 eV based on a diffuse reflectance spectroscopy (DRS) showed that the product can be favourable to photoactivity in the visible region of sunlight. The prepared sample was employed to destruct carcinogenic azo dyes, such as Congo Red (CR), Malachite Green (MG) and Crystal Violet (CV). The obtained results showed that the CdO with the special morphology was able to effectively catalyse the degradation of these pollutants. The related decolourization efficiencies were obtained by up to 100% after various lengths of time of light irradiation. It was concluded that the photodegradation of the mentioned organic dyes under visible light irradiation by a CdO rhombus-like nanostructure follows the first-order reaction kinetics. The effect of the initial pH and contact time on the percentage of the decolourization of these organic dyes was also studied

MAPPING LOCAL PATTERNS OF CHILDHOOD OVERWEIGHT AND WASTING IN LOW- AND MIDDLE-INCOME COUNTRIES BETWEEN 2000 AND 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Mapping routine measles vaccination in low- and middle-income countries

The safe, highly effective measles vaccine has been recommended globally since 1974, yet in 2017 there were more than 17 million cases of measles and 83,400 deaths in children under 5 years old, and more than 99% of both occurred in low- and middle-income countries (LMICs)1–4. Globally comparable, annual, local estimates of routine first-dose measles-containing vaccine (MCV1) coverage are critical for understanding geographically precise immunity patterns, progress towards the targets of the Global Vaccine Action Plan (GVAP), and high-risk areas amid disruptions to vaccination programmes caused by coronavirus disease 2019 (COVID-19)5–8. Here we generated annual estimates of routine childhood MCV1 coverage at 5 × 5-km2 pixel and second administrative levels from 2000 to 2019 in 101 LMICs, quantified geographical inequality and assessed vaccination status by geographical remoteness. After widespread MCV1 gains from 2000 to 2010, coverage regressed in more than half of the districts between 2010 and 2019, leaving many LMICs far from the GVAP goal of 80% coverage in all districts by 2019. MCV1 coverage was lower in rural than in urban locations, although a larger proportion of unvaccinated children overall lived in urban locations; strategies to provide essential vaccination services should address both geographical contexts. These results provide a tool for decision-makers to strengthen routine MCV1 immunization programmes and provide equitable disease protection for all children

Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000–17

Abstract Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000–17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000–7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910–68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers’ understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage