Analyzing the impact of an MDG-Fund program on childhood malnutrition in Timor-Leste.

BACKGROUND: Timor-Leste's food insecurity, propelled by political conflicts, a fragile economy and biophysical limitations that characterize mountainous Small Island Developing States (SIDS), is expressed in a high incidence (50%) of stunted children. Hence, the Millennium Development Goals Achievement Fund's Joint Program's (MDG-F JP) in 2009 was a timely intervention to reduce prevalence of underweight among under-fives. Since the impact of the program remains largely unclear, the current study investigates the contributions of the MDG-F JP on improving children's nutritional status in Timor-Leste, in order to inform policymakers on how to make future programs more effective. METHODS: Using bivariate analyses and multiple linear regression models we analyzed Demographic and Health Survey (DHS) data from under-fives in 2009-2010 and 2016, combined with spatially explicit data from geographic information systems (GIS). The analyses generated trends and factors associated with undernutrition, which were used in a quasi-experimental setting to compare districts that received the MDG-F JP with similar districts that did not receive MDG-F JP interventions. RESULTS: A comprehensive set of factors dependent on seasons, locations, and individuals determine undernutrition in Timor-Leste. A positive impact of the MDG-F JP was found for the average severity of wasting, but not for stunting and underweight. CONCLUSIONS: The findings reinforce the pressing need for integrated and cross-sectoral programs, aimed especially at agricultural workers, mothers, and children. The agricultural challenge is to sustainably select, produce and conserve higher-yield and nutrient-rich crops, and educational enhancement should be aligned with local practices and research.

The HIV paradox: Perinatal mortality is lower in HIV-positive mothers-A field case-control study in Ethiopia.

OBJECTIVE: Sub-Saharan African countries have the highest perinatal mortality rates. Although HIV is a risk factor for perinatal death, antioretroviral therapy (ART) programs have been associated with better outcomes. We aimed to investigate how maternal HIV affects perinatal mortality. METHODS: The authors performed a nested case-control study at Saint Luke Hospital, Wolisso, Ethiopia. Data on sociodemographic characteristics, current maternal conditions, obstetric history, and antenatal care (ANC) services utilization were collected. The association between perinatal mortality and HIV was assessed with logistic regression adjusting for potential confounders. RESULTS: A total of 3525 birthing women were enrolled, including 1175 cases and 2350 controls. Perinatal mortality was lower among HIV-positive women (18.3% vs. 33.6%, P = 0.007). Crude analysis showed a protective effect of HIV (odds ratio, 0.442 [95% confidence interval, 0.241-0.810]), which remained after adjustment (adjusted odds ratio, 0.483 [95% confidence interval, 0.246-0.947]). Among HIV-negative women, access to ANC for women from rural areas was almost half (18.8% vs. 36.2%; P < 0.001), whereas in HIV-positive women, no differences were noted (P = 0.795). CONCLUSION: Among HIV-positive mothers, perinatal mortality was halved and differences in access to ANC services by area were eliminated. These data highlight the benefits of integrating ANC and HIV services in promoting access to the health care system, reducing inequalities and improving neonatal mortality.

Igualdade de gênero dos ODM aos ODS: avaliações feministas / Igualdad de género de los ODM a los ODS: análisis feministas / Gender equality from the MDGs to the SDGs: a feminist analysis

Resumo Há décadas, o feminismo impulsiona uma agenda de igualdade de gênero nas políticas de desenvolvimento. Os feminismos decolonial e interseccional, por exemplo, têm invocado uma agenda antirracista e anticolonial. As demandas das mulheres têm encontrado diferentes graus de incorporação em planos internacionais, como os Objetivos de Desenvolvimento do Milênio (ODM) e os Objetivos de Desenvolvimento Sustentável (ODS). Nesse cenário, este trabalho comparou a igualdade de gênero nos ODM e nos ODS para analisar seus avanços e desafios frente à agenda da transversalidade de gênero e a demandas interseccionais e decoloniais. Para isso, foi realizada pesquisa documental sobre objetivos, metas e resultados dos ODM e objetivos e metas dos ODS. Os resultados indicam que os ODS avançam por serem mais ambiciosos que os ODM e por adotarem abordagem mais abrangente e mais transversal sobre a igualdade de gênero. Entretanto, há importantes lacunas quanto à operacionalização de uma análise das desigualdades de gênero que considere as intersecções das distintas formas de discriminação que afetam os diferentes grupos de mulheres.

Resumen Durante décadas, el feminismo ha impulsado una agenda de igualdad de género en las políticas de desarrollo. Los feminismos decoloniales e interseccionales, por ejemplo, han impulsado una agenda antirracista y anticolonial. Las demandas de las mujeres han encontrado diferentes grados de incorporación en los planes internacionales, como los Objetivos de Desarrollo del Milenio (ODM) y los Objetivos de Desarrollo Sostenible (ODS). En este escenario, este trabajo comparó la igualdad de género en los ODM y los ODS para analizar sus avances y desafíos frente a la agenda de transversalización de género y las demandas interseccionales y decoloniales. Para ello se realizó una investigación documental sobre objetivos, metas y resultados de los ODM y objetivos y metas de los ODS. Los resultados indican que los ODS avanzan por ser más ambiciosos que los ODM y por adoptar un enfoque más amplio y transversal de la igualdad de género. Sin embargo, existen vacíos importantes en la operacionalización de un abordaje de las desigualdades de género que considere las intersecciones de las distintas formas de discriminación que afectan a distintos grupos de mujeres.

Abstract For decades, feminism has driven a gender equality agenda in development policies. Decolonial and intersectional feminisms, for example, have played an anti-racist and anti-colonial agenda. Women's demands have found different degrees of incorporation into international plans, such as the Millennium Development Goals (MDGs) and the Sustainable Development Goals (SDGs). In this scenario, this work compared gender equality in the MDGs and the SDGs to analyze their advances and challenges in the face of the gender mainstreaming agenda and intersectional and decolonial demands. Documental research was carried out on the objectives, targets, and results of the MDGs and the objectives and targets of the SDGs. The results indicate that the SDGs are more ambitious than the MDGs by adopting a broader and more transversal approach to gender equality. However, there are important gaps in operationalizing an approach to gender inequalities that considers the intersections of different forms of discrimination that affect different groups of women.

Re-examining the nexuses of communicable diseases, environmental performance, and dynamics of sustainable Development in OECD countries.

We investigate the determinants of communicable diseases (CDs) and nexus of financial development, economic development, and renewable energy consumption to address the issues of ecological footprint level, the impacts of communicable diseases (CDs), and economic growth of the OECD countries throughout 2000-2019. The results from FMOLS and DOLS reveal that the levels of financial development, energy consumption, and trade volume significantly contribute to overcoming the death toll occurring due to CDs. As regards the growth function, the level of trade in the economy is significantly associated with economic growth. The findings reveal that the improvements and developments in the financial sectors and trading activities cause a reduction in the infection cases represented by COVID-19. In contrast, economic growth does have a negative but insignificant impact upon COVID-19. We conclude that sound financial development combined with economic and environmental regulations could be strategically helpful to cope with CDs.

International and national perspective of disability and policy disconnect in Pakistan: A narrative review.

In the developed societies, supportive environmental, physical and social conditions enable participation of persons with disabilities in the mainstream through actions, like provision of ramps and reserved parking. In contrast, in the developing countries like Pakistan, with focus on visual disability, years lost to disabilities compromise and restrict the productive life span of the disabled. The current narrative review was planned to highlight the perspective of disability in the context of Pakistan to bring to limelight the issues requiring immediate focus of the health authorities and the government through a holistic and sustainable approach. Of the 177 publications found on literature search, 33(%) English-language, full-text studies were reviewed. To address disability issues, long-term sustainable actions, like health reforms, including ensuring availability of rehabilitation professionals in hospitals, legislative reforms to initiate relevant legislations, capacity-building of persons with disabilities, including their mainstreaming, are deemed essential.

As reformas dos sistemas de saúde da América Latina: influências neoliberais e desafios aos Objetivos de Desenvolvimento Sustentável / Health systems reforms in Latin America: neoliberal influences and challenges to the Sustainable Development Goals

Resumo Analisam-se as características das reformas dos sistemas de saúde de países da América Latina e Caribe (ALC), a evolução dos gastos públicos e dos Objetivos de Desenvolvimento do Milênio (ODM). Discutem-se as influências neoliberais nas reformas e as possíveis consequências para os Objetivos de Desenvolvimento Sustentável (ODS) que os sucederam. Estudo comparado de países selecionados. Dados extraídos das plataformas CEPALStat, Global Health Observatory e MDG Indicators e de relatórios Health in the Americas disponíveis no Repositorio Institucional para Compartir Información da Organização Panamericana de Saúde. Revisão não exaustiva de literatura. As reformas foram divididas em três períodos: até 1990 predominou a lógica nacional solidária regulada; de 1990 a 2000 avançou-se para uma lógica concorrencial de mercado; de 2001 a 2015, evoluiu-se para programas de lógica pública, mantendo-se a concorrência entre prestadores de serviços. Os gastos públicos oscilaram e as metas dos ODM analisadas não foram completamente cumpridas. As mudanças dos sistemas de saúde seguiram as configurações dos Estados nacionais apregoadas pelo neoliberalismo, com lógica concorrencial de mercado, fragilizando o sistema de cuidados e o alcance dos ODS.

Abstract This study analyzes the characteristics of health system reforms in Latin American and Caribbean (LAC) countries, the trend of public health spending, and the achievement of the Millennium Development Goals (MDGs). It also discusses the neoliberal influences on public health reforms and the possible consequences for the upcoming Sustainable Development Goals (SDGs). The study is a comparative, non-exhaustive literature review of selected countries, with data extracted from CEPALStat, Global Health Observatory, MDG Indicators platforms, and the Health in the Americas reports available in the Institutional Repository for Information Sharing of the Pan American Health Organization. The reforms were divided into three periods, namely: up to 1990, with a prevailing regulated national solidarity logic; 1990-2000, moving towards a market-oriented competitive logic; 2001-2015, evolving towards public logic programs, maintaining competition between service providers. Public spending fluctuated over time, and the MDG targets analyzed were not completely met. Changes in health systems followed the models prescribed by neoliberalism, with market-oriented competitive logic, weakening the care system and the achievement of the SDGs.

Effectiveness of peer counseling and membership in breastfeeding support groups in promoting optimal breastfeeding behaviors in the Philippines.

BACKGROUND: The prevalence of early initiation of breastfeeding and exclusive breastfeeding (EBF) at 6 months remain low in the Philippines. To help meet the 90% early initiation of breastfeeding target and to improve infant and young child feeding practices in the Philippines, the Millennium Development Goals - Fund 2030 Joint Programme (JP) on Ensuring Food Security and Nutrition for Children 0-24 months old was implemented. We aimed to determine the effectiveness of visits by peer counselors during pregnancy and after delivery, and membership in breastfeeding support groups in promoting these optimal breastfeeding practices. METHODS: We used data from the Endline Survey of the JP to study the effects of prenatal and postnatal peer counselor visits, and membership in breastfeeding support groups, and their possible interactions with initiation of breastfeeding within 1 hour of birth among children aged 0 to 24 months and EBF at 6 months among children aged 6 to 24 months, while adjusting for confounding. We used logistic regression methods for survey data to assess these associations. RESULTS: Of the 2343 mother-infant pairs, only 1500 (63.1%) practiced early initiation of breastfeeding. Of the 1865 children aged 6 months or older, only 621 (34.7%) were exclusively breastfed at 6 months. After adjusting for confounding variables, there was no strong evidence that peer counselor visits were associated with early initiation or EBF at 6 months. However, members of breastfeeding support groups had 1.49 times higher odds of early initiation of breastfeeding (95% CI [Confidence Interval] 1.12, 1.98) and 1.65 times higher odds of EBF (95% CI 1.20, 2.24) compared to those who were not members of breastfeeding support groups. There was no interaction between the different exposure variables and early initiation and EBF at 6 months. CONCLUSIONS: Our findings suggest breastfeeding support groups may be institutionalized to promote both early initiation of breastfeeding and EBF in the Philippines, while the role of peer counselors in promoting optimal breastfeeding behaviors should be further reviewed. Our suggestion to integrate non-healthcare professionals to promote early initiation of breastfeeding and EBF could be tested in future intervention studies.

Predictive Factors for Severe Maternal Morbidity in Brazil: A Case-Control Study.

The maternal mortality or "maternal near miss" ratio in Brazil reflects the socioeconomic indicators as well as the healthcare quality in some areas of this country, pointing out fragile points in the health services. The aim of this study was to estimate the association of diverse variables related to pregnancy and the occurrence of Near Miss in a population of women who were cared in public maternity wards in Brazil. A case-control study was performed. The association between variables and outcomes was verified through a chi-square test. A multiple analysis was carried out, producing odds ratio (OR) estimates with values of p≤0.25 in the univariate model. The results point to the following risk factors for Severe Maternal Morbidity: non-white (<0.001, OR 2.973), family income of up to two minimum wage salaries (<0.001; OR 2.159), not having a partner (<0.001, OR 2.694), obesity (<0.001, OR 20.852), not having received pre-natal care (<0.001, OR 2.843), going to less than six prenatal appointments (<0.001, OR 3.498), undergoing an inter-hospital transfer (<0.001, OR 24.655), and the absence of labor during admission (<0.001, OR 25.205). Although the results vary, the incidence of women with potential life-threatening complications is high in Brazil, which reinforces the need to universalize more complex interventions as well as coverage of primary care. The presence of precarious socio-economic indicators and unqualified obstetric care were risk factors for Severe Maternal Morbidity.

The history of the neglected tropical disease movement.

The history of the neglected tropical disease movement is seen through the lens of authors who worked during the last 4 decades in different roles and in different settings, from Western-based laboratories to clinical roles in endemic countries and in critical policy roles in the World Health Organization (WHO). The authors seek to identify key players from the introduction of the word 'neglected' by the late Kenneth Warren in his Rockefeller Foundation-supported Great Neglected Diseases of Mankind movement through to the more recent developments after the London Declaration of 2012. The role of the various actors-endemic countries, major pharmaceutical companies, the WHO, non-government development organizations, bilateral donors and academia-are discussed. The critical events and decisions are highlighted that were essential enabling factors in creating a viable and successful movement and with a resultant massive global public health and antipoverty impact. The importance of advocacy is emphasized in creating the momentum to establish a globally recognized public health 'brand' as a target in the United Nations Sustainable Development Goals.

Unaligned connections or enlarging engagements? Tertiary education in developing countries and the implementation of the SDGs.

Given that tertiary education (TE) is a sector often associated with exclusion, particularly in low- and middle-income countries (LMICs), where only a small proportion of the population gain access, how well placed is this sector to support the implementation of the SDGs? This article extends our reflections from a recent rigorous review of literature, published from 2010, which looked at the role of tertiary education in low- and lower-middle-income countries. The review noted the sparse literature on a range of development outcomes, with limited attention to some of the key themes of inclusion and sustainability associated with the SDGs. Many studies report on some form of limited connection between TE and development outcomes, also drawing attention to contextual conditions beyond TE that contribute to this. The article considers the reasons for these findings, and some of the difficulties of forming conclusions on a still limited base of research evidence. A second theme in the literature reviewed highlights that where TE establishes partnerships, engagements or cross-institutional alliances, joint and valuable learning in support of the SDGs ensues, enhancing practice and building institutions. Some of the implications of these findings for the positioning of TE in developing countries in the wake of COVID-19 are considered.

"The Actor Is Policy": Application of Elite Theory to Explore Actors' Interests and Power Underlying Maternal Health Policies in Uganda, 2000-2015.

BACKGROUND: The persistence of high maternal mortality and consistent failure in low- and middle-income countries to achieve global targets such as Millennium Development Goal five (MDG 5) is usually explained from epidemiological, interventional and health systems perspectives. The role of policy elites and their interests remains inadequately explored in this debate. This study examined elites and how their interests drove maternal health policies and actions in ways that could explain policy failure for MDG 5 in Uganda. METHODS: We conducted a retrospective qualitative study of Uganda's maternal health policies from 2000 to 2015 (MDG period). Thirty key informant interviews and 2 focus group discussions (FGDs) were conducted with national policy-makers, who directly participated in the formulation of Uganda's maternal health policies during the MDG period. We reviewed 9 National Maternal Health Policy documents. Data were analysed inductively using elite theory. RESULTS: Maternal health policies were mainly driven by a small elite group comprised of Senior Ministry of Health (MoH) officials, some members of cabinet and health development partners (HDPs) who wielded more power than other actors. The resulting policies often appeared to be skewed towards elites' personal political and economic interests, rather than maternal mortality reduction. For a few, however, interests aligned with reducing maternal mortality. Since complying with the government policy-making processes would have exposed elites' personal interests, they mainly drafted policies as service standards and programme documents to bypass the formal policy process. CONCLUSION: Uganda's maternal health policies were mainly influenced by the elites' personal interests rather than by the goal of reducing maternal mortality. This was enabled by the formal guidance for policy-making which gives elites control over the policy process. Accelerating maternal mortality reduction will require re-engineering the policy process to prevent public officials from infusing policies with their interests, and enable percolation of ideas from the public and frontline.

Creating the Nightingale Initiative for Global Health: theoretical reflections to follow in Florence Nightingale's footsteps / Criando a Iniciativa Nightingale para a Saúde Global: reflexões teóricas para seguir os passos de Florence Nightingale / Creación de la Iniciativa Nightingale para la Salud Global: reflexiones teóricas para seguir los pasos de Florence Nightingale

Objective: this paper articulates how three Nightingale scholars applied their theoretical reflections to Florence Nightingale's farreaching anticipation of the year 1999 and to her comprehensive definition of "Health" derived from her 1893 essay "Sick-nursing and Health-nursing." Method: this is a historical narrative paper. With intentions to explore how Nightingale's insights might inform today's nursing culture and enhance nursing practice, these scholars joined a team of civil society activists to craft the Nightingale Declaration for A Healthy World as the founding credo of the Nightingale Initiative for Global Health. To follow in Nightingale's footsteps for more than two decades, these scholars since developed methods to increase public awareness of global health concerns and to engage today's nurses and concerned citizens in this public advocacy. Results: project demonstration results include specific advocacy for the United Nations Millennium Development Goals and Sustainable Development Goals — "Global Goals" targeted to achieve universal outcomes specific to "Health" and across the wider scope of social and environmental health determinants — all anticipated by Nightingale throughout her 40-year career. Conclusion: given today's severe global health concerns, these scholars' theoretical reflections identify challenges to contemporary nursing culture — calling for methods developed to strengthen nursing's voice in the global public arena.

Objetivo: este artigo articula como três estudiosas de Nightingale aplicaram suas reflexões teóricas à antecipação de longo alcance de Florence Nightingale do ano de 1999 e à sua definição abrangente de "Saúde" derivada de seu ensaio de 1893 "Enfermagem de enfermos e enfermagem em saúde". Método: trata-se de um artigo narrativo histórico. Com a intenção de explorar como os insights de Nightingale podem fundamentar a cultura de enfermagem de hoje e aprimorar a prática de enfermagem, essas acadêmicas se juntaram a uma equipe de ativistas da sociedade civil para elaborar a Declaração Nightingale por um Mundo Saudável como o credo fundador da Iniciativa Nightingale para a Saúde Global. Para seguir os passos de Nightingale por mais de duas décadas, essas estudiosas então desenvolveram métodos para aumentar a consciência pública sobre as preocupações com a saúde global e para envolver as enfermeiras e os cidadãos preocupados de hoje nessa defesa pública. Resultados: os resultados da demonstração do projeto incluem a defesa específica dos Objetivos de Desenvolvimento do Milênio e Objetivos de Desenvolvimento Sustentável das Nações Unidas - "Objetivos Globais" direcionados para alcançar resultados universais específicos para "Saúde" e em todo o escopo mais amplo dos determinantes sociais e ambientais de saúde - todos antecipados por Nightingale ao longo de sua carreira de 40 anos. Conclusão: dadas as graves preocupações atuais com a saúde global, as reflexões teóricas dessas estudiosas identificam desafios para a cultura contemporânea da enfermagem - clamando por métodos desenvolvidos para fortalecer a voz da enfermagem na arena pública global.

Objetivo: este artículo articula cómo tres académicas Nightingale aplicaron sus reflexiones teóricas a la gran anticipación proyectiva de Florence Nightingale con respecto al año 1999 y a su definición integral de "Salud" derivada de su ensayo de 1893 de título "Cuidados a los enfermos y cuidados sanitarios". Método: se trata de un artículo narrativo histórico. Con la intención de explorar cómo las ideas de Nightingale podrían fundamentar la cultura de Enfermería actual y mejorar la práctica de la Enfermería, estas académicas se unieron a un equipo de activistas de la sociedad civil para elaborar la Declaración de Nightingale para un mundo saludable como el credo fundador de la Iniciativa Nightingale para la Salud Global. Para seguir los pasos de Nightingale durante más de dos décadas, estas académicas desarrollaron métodos para aumentar la conciencia pública sobre las preocupaciones de salud global e involucrar a las enfermeras y ciudadanos interesados de hoy en esta defensa pública. Resultados: los resultados de la demostración del proyecto incluyen una promoción específica para las Metas de Desarrollo del Milenio y Metas de Desarrollo Sustentable - "Metas Globales" de las Naciones Unidas dirigidas a lograr resultados universales específicos de "Salud" y en el ámbito más amplio de los determinantes de la salud sociales y ambientales, todo anticipado por Nightingale a lo largo de sus 40 años de carrera. Conclusión: dadas las graves preocupaciones de salud mundial de la actualidad, las reflexiones teóricas de estas académicas identifican desafíos a la cultura de la Enfermería contemporánea, y exigen métodos desarrollados para fortalecer la voz de la Enfermería en el ámbito público mundial.

Reporting of the core indicators on drinking water and sanitation from urban slums of Jammu: A cross-sectional study.

INTRODUCTION: Water, sanitation, and hygiene (WASH) play an important role in decreasing the morbidity and mortality associated with poor WASH practices. Poor knowledge and awareness lead to an increase in communicable diseases. OBJECTIVE: To assess and report the core indicators on sanitation and drinking water from urban slums using standardized WHO and UNICEF questionnaires. MATERIALS AND METHODOLOGY: The present observational cross-sectional study was conducted for 2 months i.e., from September 2019 to October 2019 in urban slums of Trikuta Nagar, a field practice area of Department of Community Medicine, GMC Jammu. Information was gathered from the head of the household as well as from other household members. About 50% of the population were selected randomly by lottery method i.e., 450 and consist of 112 households. However, at the time of the study, only 100 households were assessed because of the nonavailability of household members and some houses were locked at the time of the interview. RESULTS: The study revealed that nearly 62% of families were of a joint type and most of the families were headed by male members. Around 82.5% of the slum members used water for drinking from improved source but only 21.5% of the household members used adequate water treatment method i.e., boiling. Besides, about 49.5% of the household members used improved sanitation facilities. CONCLUSION: Local administration needs to accelerate the process of supplying piped water connections to the underserved to improve their drinking water sources and also increase access to basic sanitation services at the household level.

Global mapping of cholera Vibrio and outbreaks in the Pre-Millennium Development Goals (MDG)/Sustainable Development Goals (SDG) and MDGs/SDGs era of 1990-2019.

Vibrio species and cholera outbreak yet remain a frequent health emergency despite progress made in integrated implementation of the MDGs/SDGs/WASH worldwide. Hence, this study aimed at appraising the impacts of MDGs/SDGs/WASH campaigns on the mitigation of cholera outbreak and associated consequences. The study mapped scientific production related to Vibrio outbreak from 1990 to 2019, identified trend, institutional/international concerted efforts toward outbreak research/response and gaps for future preparedness. Relevant documents were identified from the Web of Science database using an optimised title-field specific search Boolean that accommodated all pre-set inclusion criteria for the study. A total of 901 documents were identified including 869 available abstracts were retrieved for content-review of human incidence cases, mortality, culprit Vibrio species, strains, and biotypes. Explanatory analysis showed that the trend of outbreak documents approximately increased in 6th order quadratic relationship (R2 = 0.7948) from 1990 to 2019 with an annual growth rate of 3.21% and a mean value of 30.0 ± 18.0 per year. Other details revealed an increased and undulating case report/mortality rate of cholera outbreaks especially in the MDGs/SDGs era. Decadal comparison of Vibrio outbreak during the period showed significant variation in documents distribution (Kruskal-Wallis p = 0.00077). based on countries' efforts, the USA, ranked first in terms of article numbers (191), publication frequency (24.6(%) and total citations (5962). Four prevailing conceptual frameworks were identified in the outbreak documents with global community interest revealed as the largest topical coverage. All conceptual frameworks consisted in Vibrio characterisation, methodology-related, intervention-related, geographic-related concepts and some replete with health and climate-change depicting concepts. Also, the study observed high mortality in Vibrio outbreaks during 1990-1999 (29080 deaths), and 2010-2019 (386606 deaths) compared to 2000-2009 (7705 deaths) (Kruskal-Wallis, p < 0.05). High number of outbreaks due to V. cholerae and V. parahaemolyticus and a limited outbreaks attributed to emerging strains. In conclusion, vibrio outbreak has not lived up to various investment put into its control from various programme evolutions. The broad spectrum Vibrio vaccines that could cater for outbreak caused by common and emerging strains is inevitable and a significant thrust for future research.

Mapping Collaborations and Partnerships in SDG Research.

Collaboration has become an essential paradigm in sustainable development research and in strategies for meeting the United Nations Sustainable Development Goals (SDGs). This study uses bibliometric methods and network analysis to examine research output and collaboration supporting the SDGs and explores means to detect and analyze research collaboration beyond the traditional definition of multiple, one-time co-authorship. We employed two additional lenses of collaboration: repeat collaboration and collaboration time point to quantify and visualize co-authorship data sourced from Microsoft Academic Graph. Our results show an increased collaboration rate over time at the author and institutional levels; however they also indicate that the majority of collaborations in SDG-related research only happened once. We also found out that on average, repeat collaboration happens more frequently, but after a longer duration, at the institutional level than at the author level. For this reason, we further analyzed institutions and identified core institutions that could help influence more consistent collaboration and sustain or grow the SDG-related research network. Our results have implications for understanding sustainable partnerships in research related to SDGs and other global challenges.

A critical appraisal of the maternal and child health scenario in a metropolitan city in India with reference to achievements of millennium development goals.

BACKGROUND: Post 2015, the Millennium Development Goals (MDGs) will undergo a transition to Sustainable Development Goals (SDGs). Therefore, it becomes necessary to assess the determinants influencing the present status of MDGs. This study was conducted to assess the progress, short comings related to the transition from MDGs to SDGs in a metropolitan city. It provides practical insights for extrapolating need based strategies related to the SDGs. METHODS: Study was conducted in a metropolitan city, Mumbai. Situational analysis of the city was done using monthly and annual performance reports and key informant's interviews at city level. Qualitative analysis was done using thematic analysis. RESULTS: The current infant mortality rate of Mumbai is 26.72 and under-five mortality rate is 38.7/1000 live births. The current MMR of mumbai is 88. The responses from the key informants' spanned three major themes: Concerns and challenges; Good practices and schemes in pipeline; and Opportunities envisioned. Eight major challenging areas were identified. Opportunities are sustainable models of public-private partnership; Involvement of NGOs and AYUSH practitioners; and IT sector involvement, HMIS, e- governance, and Corporate Social Responsibility (CSR). CONCLUSIONS: Significant progress has been made in the field of maternal and child health (MCH), and sustained efforts are required. Maternal mortality figures may be illusive because of the effect of migration and referral cases. Socio-demographic issues of development need to be addressed through governance. Mechanism for intersectoral coordination, IT support, surveillance, and tracking of pregnant mothers needs to be developed. The linkage of MCH services with developmental programs needed.

Governance commitment to reduce maternal mortality. A political determinant beyond the wealth of the countries.

Some countries reached, in 2015, the Millennium Development Goal of reducing maternal mortality to 96 or less maternal deaths per 100,000 live births. Others, however, did not. This paper analyses the strength of the association between maternal mortality and each of the six components of Governance-a political determinant scarcely explored in the literature-in 174 countries. It was found that the greater the governance, the lower maternal mortality, independently of a country's wealth. We used all six indicators of the World Bank's Worldwide Governance Indicators Project in 2015: government effectiveness, regulatory quality, rule of law, control of corruption, voice and accountability, and political stability and absence of violence. Findings were encouraging as maternal mortality in low-income countries with higher government effectiveness and regulatory quality was similar to that of medium-income countries with lower government effectiveness and regulatory quality. To achieve the post-2015 sustainable development goal on preventable maternal mortality-which persists despite economic development-all governance dimensions are essential and represent interdependent cornerstones.

Trends in maternal and neonatal mortality in South Africa: a systematic review.

BACKGROUND: Measuring and monitoring progress towards Millennium Development Goals (MDG) 4 and 5 required valid and reliable estimates of maternal and child mortality. In South Africa, there are conflicting reports on the estimates of maternal and neonatal mortality, derived from both direct and indirect estimation techniques. This study aimed to systematically review the estimates made of maternal and neonatal mortality in the period from 1990 to 2015 in South Africa and determine trends over this period. METHODS: Nationally-representative studies reporting on maternal and neonatal mortality in South Africa were included for synthesis. Literature search for eligible studies was conducted in five electronic databases: Medline, Africa-Wide Information, Scopus, Web of Science and CINAHL. Searches were restricted to articles written in English and presenting data covering the period between 1990 and 2015. Reference lists of retrieved articles were screened for additional publications, and grey literature was searched for relevant documents for the review. Three independent reviewers were involved in study selection, data extractions and achieving consensus. RESULTS: In total, 969 studies were retrieved and 670 screened for eligibility yielding 25 studies reporting data on maternal mortality and 14 studies on neonatal mortality. Most of the studies had a low risk of bias. Estimates from the institutional reporting differed from the international metrics with wide uncertainty/confidence intervals. Moreover, modelled estimates were widely divergent from estimates obtained through empirical methods. In the last two decades, both maternal and neonatal mortality appear to have increased up to 2009, followed by a decrease, more pronounced in the care of maternal mortality. CONCLUSION: Estimates from both global metrics and institutional reporting, although widely divergent, indicate South Africa has not achieved MDG 4a and 5a goals but made a significant progress in reducing maternal and neonatal mortality. To obtain more accurate estimates, there is a need for applying additional estimation techniques which utilise available multiple data sources to correct for underreporting of these outcomes, perhaps the capture-recapture method. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016042769.

Spatio-temporal disparities in maternal health service utilization in Rwanda: What next for SDGs?

The Sustainable Development Goals (SDGs) in part aim to further improve maternal health outcomes by reducing spatial disparities in utilization of critical services such as antenatal and assisted delivery, with emphasis on decentralization and integration of strategies. Yet, our understanding of within country spatial disparities in maternal health services (MHS) utilization over time has been scant. By fitting multiple regression models to a pooled dataset of the 2010/11 and 2014/15 Rwanda Demographic and Health Surveys (n = 12,273), and employing post-estimation margins analysis, we examined spatial differentiation of MHS trends prior to the SDGs in Rwanda. Our study found that women in 2014/15 were more likely to utilize antenatal services and assisted delivery (OR = 1.757, p ≤ 0.001) compared with 2010/11, but with nuanced spatial variations. Compared with Nyarugenge, women in nineteen out of the twenty-nine remaining districts were more likely to report utilization of antenatal services and skilled birth delivery, while the probability of accessing four or more antenatal services in seven districts declined between 2010/11 and 2014/15. Physical, financial and socio-cultural factors were associated with maternal health service utilization over the period. Based on our findings, we present policy suggestions for improving utilization of MHS in Rwanda and in similar contexts in the SDGs period.

Innovative approaches to enhancing maternal and newborn survival: Indonesia's experience in an era of global commitments to reducing mortality.

Globally, countries have made impressive strides toward achieving targets set by the Millennium Development Goals (MDGs) to reduce maternal mortality. The subsequent Sustainable Development Goals (SDGs) have further challenged countries to accelerate these reductions. While Indonesia invested in several initiatives to improve care for mothers and newborns and made large gains in improving skilled care at birth, the country fell short of its MDG target. This paper outlines some of the remaining challenges and highlights the role of the US Agency for International Development-funded Expanding Maternal and Neonatal Survival (EMAS) program in eliminating the barriers to improved care. Achieving the SDGs by 2030 will require strong cross-sectoral collaboration and innovative approaches, such as the recent launch of Indonesia's national health insurance program, which can accelerate reductions in mortality by reaching women most in need of services.