SDG indicator 3.b.3 - an analysis of its robustness and challenges for measuring access to medicines for children.

BACKGROUND: Sustainable Development Goal (SDG) indicator 3.b.3 monitors progress in medicines' accessibility for adults and has significant limitations when applying to medicines for children. An adapted indicator methodology was developed to fill this gap, but no proof of its robustness exists. We provide this evidence through sensitivity analyses. METHODS: Data on availability and prices of child medicines from ten historical datasets were combined to create datasets for analysis: Dataset 1 (medicines selected at random) and Dataset 2 (preference given to available medicines, to better capture affordability of medicines). A base case scenario and univariate sensitivity analyses were performed to test critical components of the methodology, including the new variable of number of units needed for treatment (NUNT), disease burden (DB) weighting, and the National Poverty Line (NPL) limits. Additional analyses were run on a continuously smaller basket of medicines to explore the minimum number of medicines required. Mean facility scores for access were calculated and compared. RESULTS: The mean facility score for Dataset 1 and Dataset 2 within the base case scenario was 35.5% (range 8.0-58.8%) and 76.3% (range 57.2-90.6%). Different NUNT scenarios led to limited variations in mean facility scores of + 0.1% and -0.2%, or differences of + 4.4% and -2.1% at the more critical NPL of $5.50 (Dataset 1). For Dataset 2, variations to the NUNT generated differences of + 0.0% and -0.6%, at an NPL of $5.50 the differences were + 5.0 and -2.0%. Different approaches for weighting for DB induced considerable fluctuations of 9.0% and 11.2% respectively. Stable outcomes with less than 5% change in mean facility score were observed for a medicine basket down to 12 medicines. For smaller baskets, scores increased more rapidly with a widening range. CONCLUSION: This study has confirmed that the proposed adaptations to make SDG indicator 3.b.3 appropriate for children are robust, indicating that they could be an important addition to the official Global Indicator Framework. At least 12 child-appropriate medicines should be surveyed to obtain meaningful outcomes. General concerns that remain about the weighting of medicines for DB and the NPL should be considered at the 2025 planned review of this framework.

Factors associated with occurrence and recovery of nonambulatory dairy cows in the United States.

The primary objective of this study was to compare characteristics of US dairy operations that had one or more nonambulatory cows (unable to rise for any period of time) (cases) with operations that had no nonambulatory cows (controls) during 2004. A secondary objective was to describe factors associated with recovery of the last nonambulatory cow on the operation during 2004. Case dairy operations (n = 1,822) more often fed a total mixed ration [odds ratio (OR) = 2.0; confidence interval (CI): 1.1-3.4], produced more than 9,090 kg of milk (OR = 2.8; CI: 1.8-4.5), and were more likely to be of medium to large herd size (100 or more head of adult cows, OR = 3.7; CI: 2.2-6.2) compared with control dairies (n = 151). Compared with operations where the predominant flooring surface on which lactating cows stood or walked in winter was pasture, operations where pasture was not the predominant surface were at increased risk of having nonambulatory cows (OR = 4.7; CI: 2.2-10.2). Cows nonambulatory for less than 24 h were more likely to recover compared with cows nonambulatory for 24 h or more (OR = 3.0; CI: 2.0-4.4). Cows that received calcium, phosphorus, or potassium while non-ambulatory were more likely to recover (OR = 3.6; CI: 2.1-6.1) than cattle that did not receive these treatments. Cattle that were not repositioned periodically were more likely to recover (OR = 2.1; CI: 1.4-3.1), as were cattle that were not treated by a veterinarian before becoming nonambulatory (OR = 1.9; CI: 1.1-3.3). These findings are consistent with prolonged recumbency and prior history of health issues, respectively. Nonambulatory cattle with hypocalcemia were more likely to recover (OR = 6.0; CI: 3.4-10.7) compared with nonambulatory cows with all other causes of a nonambulatory condition (analyzed collectively as a single variable but including cancer, clinical mastitis, digestive conditions, metabolic imbalances, neurological problems, respiratory disease, other, unknown). The results of this study reveal that the majority of US dairy operations have at least one nonambulatory dairy cow over the course of a year. Additionally, individual animal factors associated with being nonambulatory may lead to improved identification and treatment of animals that are nonambulatory for a prolonged period. From the perspective of recovery, considering euthanasia is appropriate for cows that have been nonambulatory for more than 24 h.

Herd-level economic losses associated with Johne's disease on US dairy operations.

Johne's disease ('paratuberculosis') is a chronic, infectious, wasting disease that affects dairy cattle. Estimation of its impact on herd productivity and corresponding economic loss on US dairy operations was part of the USDA National Animal Health Monitoring System's (NAHMS) 1996 national dairy study. Johne's-positive herds experience an economic loss of almost US$ 100 per cow when compared to Johne's-negative herds due to reduced milk production and increased cow-replacement costs. For Johne's-positive herds that reported at least 10% of their cull cows as having clinical signs consistent with Johne's disease, economic losses were over US$ 200 per cow. These high-prevalence herds experienced reduced milk production of over 700 kg per cow, culled more cows but had lower cull-cow revenues, and had greater cow mortality than Johne's-negative herds. Averaged across all herds, Johne's disease costs the US dairy industry, in reduced productivity, US$ 22 to US$ 27 per cow or US$ 200 to US$ 250 million annually.