The leading cause of death in low-income countries worldwide in 2021 was lower respiratory infections, followed by stroke and ischemic heart disease. The death rate from lower respiratory infections that year was 59.4 deaths per 100,000 people. While the death rate from stroke was around 51.6 per 100,000 people. Many low-income countries suffer from health issues not seen in high-income countries, including infectious diseases, malnutrition and neonatal deaths, to name a few. Low-income countries worldwide Low-income countries are defined as those with per gross national incomes (GNI) per capita of 1,045 U.S. dollars or less. A majority of the world’s low-income countries are located in sub-Saharan Africa and South East Asia. Some of the lowest-income countries as of 2023 include Burundi, Sierra Leone, and South Sudan. Low-income countries have different health problems that lead to worse health outcomes. For example, Chad, Lesotho, and Nigeria have some of the lowest life expectancies on the planet. Health issues in low-income countries Low-income countries also tend to have higher rates of HIV/AIDS and other infectious diseases as a consequence of poor health infrastructure and a lack of qualified health workers. Eswatini, Lesotho, and South Africa have some of the highest rates of new HIV infections worldwide. Likewise, tuberculosis, a treatable condition that affects the respiratory system, has high incident rates in lower income countries. Other health issues can be affected by the income of a country as well, including maternal and infant mortality. In 2023, Afghanistan had one of the highest rates of infant mortality rates in the world.

BackgroundGlobal and regional projections of mortality and burden of disease by cause for the years 2000, 2010, and 2030 were published by Murray and Lopez in 1996 as part of the Global Burden of Disease project. These projections, which are based on 1990 data, continue to be widely quoted, although they are substantially outdated; in particular, they substantially underestimated the spread of HIV/AIDS. To address the widespread demand for information on likely future trends in global health, and thereby to support international health policy and priority setting, we have prepared new projections of mortality and burden of disease to 2030 starting from World Health Organization estimates of mortality and burden of disease for 2002. This paper describes the methods, assumptions, input data, and results. Methods and FindingsRelatively simple models were used to project future health trends under three scenarios—baseline, optimistic, and pessimistic—based largely on projections of economic and social development, and using the historically observed relationships of these with cause-specific mortality rates. Data inputs have been updated to take account of the greater availability of death registration data and the latest available projections for HIV/AIDS, income, human capital, tobacco smoking, body mass index, and other inputs. In all three scenarios there is a dramatic shift in the distribution of deaths from younger to older ages and from communicable, maternal, perinatal, and nutritional causes to noncommunicable disease causes. The risk of death for children younger than 5 y is projected to fall by nearly 50% in the baseline scenario between 2002 and 2030. The proportion of deaths due to noncommunicable disease is projected to rise from 59% in 2002 to 69% in 2030. Global HIV/AIDS deaths are projected to rise from 2.8 million in 2002 to 6.5 million in 2030 under the baseline scenario, which assumes coverage with antiretroviral drugs reaches 80% by 2012. Under the optimistic scenario, which also assumes increased prevention activity, HIV/AIDS deaths are projected to drop to 3.7 million in 2030. Total tobacco-attributable deaths are projected to rise from 5.4 million in 2005 to 6.4 million in 2015 and 8.3 million in 2030 under our baseline scenario. Tobacco is projected to kill 50% more people in 2015 than HIV/AIDS, and to be responsible for 10% of all deaths globally. The three leading causes of burden of disease in 2030 are projected to include HIV/AIDS, unipolar depressive disorders, and ischaemic heart disease in the baseline and pessimistic scenarios. Road traffic accidents are the fourth leading cause in the baseline scenario, and the third leading cause ahead of ischaemic heart disease in the optimistic scenario. Under the baseline scenario, HIV/AIDS becomes the leading cause of burden of disease in middle- and low-income countries by 2015. ConclusionsThese projections represent a set of three visions of the future for population health, based on certain explicit assumptions. Despite the wide uncertainty ranges around future projections, they enable us to appreciate better the implications for health and health policy of currently observed trends, and the likely impact of fairly certain future trends, such as the ageing of the population, the continued spread of HIV/AIDS in many regions, and the continuation of the epidemiological transition in developing countries. The results depend strongly on the assumption that future mortality trends in poor countries will have a relationship to economic and social development similar to those that have occurred in the higher-income countries.

This statistic shows the 20 countries* with the highest infant mortality rate in 2024. An estimated 101.3 infants per 1,000 live births died in the first year of life in Afghanistan in 2024. Infant and child mortality Infant mortality usually refers to the death of children younger than one year. Child mortality, which is often used synonymously with infant mortality, is the death of children younger than five. Among the main causes are pneumonia, diarrhea – which causes dehydration – and infections in newborns, with malnutrition also posing a severe problem. As can be seen above, most countries with a high infant mortality rate are developing countries or emerging countries, most of which are located in Africa. Good health care and hygiene are crucial in reducing child mortality; among the countries with the lowest infant mortality rate are exclusively developed countries, whose inhabitants usually have access to clean water and comprehensive health care. Access to vaccinations, antibiotics and a balanced nutrition also help reducing child mortality in these regions. In some countries, infants are killed if they turn out to be of a certain gender. India, for example, is known as a country where a lot of girls are aborted or killed right after birth, as they are considered to be too expensive for poorer families, who traditionally have to pay a costly dowry on the girl’s wedding day. Interestingly, the global mortality rate among boys is higher than that for girls, which could be due to the fact that more male infants are actually born than female ones. Other theories include a stronger immune system in girls, or more premature births among boys.

In 2024, approximately **** million deaths occurred in Brazil. With around ******* deaths that year, diseases of the circulatory system, which include heart and cerebrovascular diseases among other ailments, were the leading cause of death in the South American country. Neoplasms or tumors followed, with over ******* reported deaths. High prevalence of hypertension Circulatory system diseases generally refer to conditions that affect the normal functioning of the heart and blood vessels. Risk factors for developing heart problems such as heart attacks or failures include high blood pressure and smoking. In the last few years, an increasing share of Brazilians have been diagnosed with hypertension, reaching over one quarter of the adult population by 2023, while the share of adults claiming to be smokers has been decreasing in recent years, a habit that has been more common among men than women. Cancer as a major health concern for Brazilians Cancer is an illness characterized by the abnormal growth of body cells, which can then spread to other parts of the body and form tumors. A recent study conducted in 2024 found that over ********* of Brazilian adults considered cancer a top health concern people were facing in their country, ranking second after mental health. Moreover, the estimated number of deaths attributed to cancer reached almost ******* cases in Brazil in 2022, with lung and breast cancer accounting for most of these casualties.

Heart conditions were the most common causes of death in Mexico in 2023. During that period, more than ******* people died in the North American country as a result from said conditions. Diabetes mellitus ranked second, with over ******* deaths registered that year. Obesity in MexicoObesity and being overweight can worsen many risk factors for developing heart conditions, prediabetes, type 2 diabetes, and gestational diabetes, which in the case of a COVID-19 infection can lead to a severe course of the disease. In 2020, Mexico was reported as having one of the largest overweight and/or obese population in Latin America, with ** percent of people in the country having a body mass index higher than 25. In 2022, obesity was announced as being one of the most common illnesses experienced in Mexico, with over ******* cases estimated. In a decade from now, it is predicted that about *** million children in Mexico will suffer from obesity. If estimations are correct, this North American country will belong to the world’s top 10 countries with the most obese children in 2030. Physical activity in MexicoIt is not only a matter of food intake. A 2023 survey found, for instance, that only **** percent of Mexican population practiced sports and physical activities in their free time, a figure that has decreased in comparison to 2013. Less than ** percent of the physically active Mexicans practice sports for fun. However, the vast majority were motivated by health reasons.

Nigeria’s under-five mortality rate is the eighth highest in the world. Identifying the causes of under-five deaths is crucial to achieving Sustainable Development Goal 3 by 2030 and improving child survival. National and international bodies collaborated in this study to provide the first ever direct estimates of the causes of under-five mortality in Nigeria. Verbal autopsy interviews were conducted of a representative sample of 986 neonatal and 2,268 1–59 month old deaths from 2008 to 2013 identified by the 2013 Nigeria Demographic and Health Survey. Cause of death was assigned by physician coding and computerized expert algorithms arranged in a hierarchy. National and regional estimates of age distributions, mortality rates and cause proportions, and zonal- and age-specific mortality fractions and rates for leading causes of death were evaluated. More under-fives and 1–59 month olds in the South, respectively, died as neonates (N = 24.1%, S = 32.5%, p<0.001) and at younger ages (p<0.001) than in the North. The leading causes of neonatal and 1–59 month mortality, respectively, were sepsis, birth injury/asphyxia and neonatal pneumonia, and malaria, diarrhea and pneumonia. The preterm delivery (N = 1.2%, S = 3.7%, p = 0.042), pneumonia (N = 15.0%, S = 21.6%, p = 0.004) and malaria (N = 34.7%, S = 42.2%, p = 0.009) fractions were higher in the South, with pneumonia and malaria focused in the South East and South South; while the diarrhea fraction was elevated in the North (N = 24.8%, S = 13.2%, p<0.001). However, the diarrhea, pneumonia and malaria mortality rates were all higher in the North, respectively, by 222.9% (Z = -10.9, p = 0.000), 27.6% (Z = -2.3, p = 0.020) and 50.6% (Z = -5.7, p = 0.000), with the greatest excesses in older children. The findings support that there is an epidemiological transition ongoing in southern Nigeria, suggest the way forward to a similar transition in the North, and can help guide maternal, neonatal and child health programming and their regional and zonal foci within the country.

BackgroundTuberculosis remains a major public-health problem in the world, despite several efforts to improve case identification and treatment compliance. It is well known cause of ill-health among millions of people each year and ranks as the second leading cause of death from infectious disease worldwide. Despite implementation of the World health organization recommended strategy, the reductions in the incidence of TB have been minimal in high burden countries.Objectives and methodsA case control study was carried out to assess the risk factors of TB, where cases were newly registered bacteriologically confirmed pulmonary TB patients with age greater than 15 years who present at twenty health centres in Addis Ababa. Controls were age and sex matched attendees who presented in the same health centers for non-TB health problems.ResultsA total of 260 cases and 260 controls were enrolled in the study and 45.8% of cases and 46.2% of controls were in the 26–45 years age bracket. According to the multivariable logistic regression analysis, seven variables were found to be independent predictors for the occurrence of TB after controlling possible confounders. Patients who live in house with no window or one window were almost two times more likely to develop tuberculosis compared to people whose house has multiple windows (AOR = 1.81; 95% CI:1.06, 3.07). Previous history of hospital admission was found to pose risk almost more than three times (AOR = 3.39; 95% CI: 1.64–7.03). Having a household member who had TB was shown to increase risk of developing TB by three fold (AOR = 3.00; 95% CI: 1.60, 5.62). The study showed that illiterate TB patients were found to be more than twice more likely to develop TB compared to subjects who can atleast read and write (AOR, 95% CI = 2.15, 1.05, 4.40). Patients with household income of less than 1000 birrs per month were more than two times more likely to develop TB compared to those who had higher income (AOR = 2.2; 95% CI: 1.28, 3.78). Smoking has also been identified as important risk factor for developing TB by four times (AOR = 4.43; 95% CI: 2.10, 9.3). BCG was found to be protective against TB reducing the risk by one-third (AOR = 0.34; 95% CI: 0.22, 0.54).ConclusionThis study showed that TB is more common among the most agile and economically active age group, and number of windows, history of hospital admission, a household member who had TB, illiteracy, low household income and smoking and lack of BCG scar were identified as independent risk factors. Therefore it is imperative that the TB control effort need a strategy to address socio economic issues such as poverty, overcrowding, smoking, and infection control at health care facilities level is an important intervention to prevent transmission of TB within the facilities.

BR: Mortality Rate: Under-5: Male: per 1000 Live Births data was reported at 16.000 Ratio in 2023. This records a decrease from the previous number of 16.200 Ratio for 2022. BR: Mortality Rate: Under-5: Male: per 1000 Live Births data is updated yearly, averaging 64.300 Ratio from Dec 1960 (Median) to 2023, with 64 observations. The data reached an all-time high of 182.300 Ratio in 1960 and a record low of 16.000 Ratio in 2023. BR: Mortality Rate: Under-5: Male: per 1000 Live Births data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Brazil – Table BR.World Bank.WDI: Social: Health Statistics. Under-five mortality rate, male is the probability per 1,000 that a newborn male baby will die before reaching age five, if subject to male age-specific mortality rates of the specified year.;Estimates developed by the UN Inter-agency Group for Child Mortality Estimation (UNICEF, WHO, World Bank, UN DESA Population Division) at www.childmortality.org.;Weighted average;Given that data on the incidence and prevalence of diseases are frequently unavailable, mortality rates are often used to identify vulnerable populations. Moreover, they are among the indicators most frequently used to compare socioeconomic development across countries. Under-five mortality rates are higher for boys than for girls in countries in which parental gender preferences are insignificant. Under-five mortality captures the effect of gender discrimination better than infant mortality does, as malnutrition and medical interventions have more significant impacts to this age group. Where female under-five mortality is higher, girls are likely to have less access to resources than boys. Aggregate data for LIC, UMC, LMC, HIC are computed based on the groupings for the World Bank fiscal year in which the data was released by the UN Inter-agency Group for Child Mortality Estimation. This is a sex-disaggregated indicator for Sustainable Development Goal 3.2.1 [https://unstats.un.org/sdgs/metadata/].

The countries with the lowest life expectancy worldwide include the Nigeria, Chad, and Lesotho. As of 2023, people born in Nigeria could be expected to live only up to ** years. This is almost ** years shorter than the global life expectancy. Life expectancy The global life expectancy has gradually increased over the past couple decades, rising from **** years in 2011 to **** years in 2023. However, the years 2020 and 2021 saw a decrease in global life expectancy due to the COVID-19 pandemic. Furthermore, life expectancy can vary greatly depending on the country and region. For example, all the top 20 countries with the lowest life expectancy worldwide are in Africa. The countries with the highest life expectancy include Liechtenstein, Switzerland, and Japan. Causes of death The countries with the lowest life expectancy worldwide are all low-income or developing countries that lack health care access and treatment that more developed countries can provide. The leading causes of death in these countries therefore differ from those of middle-income and upper-income countries. The leading causes of death in low-income countries include diseases such as HIV/AIDS and malaria, as well as preterm birth complications, which do not cause substantial death in higher income countries.

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According to the research report, the respiratory disease testing market will witness a growth of 8.49 % at a CAGR of 7.01% which is expected to increase by USD 3.52 billion for the forecast period 2020 to 2025.

This market research report provides valuable insights into the post-COVID-19 impact on the market, which will help companies evaluate their business approaches. Furthermore, this report extensively covers market segmentation by type (imaging tests, mechanical tests, and in-vitro diagnostic tests) and geography (North America, Europe, Asia, and ROW). The respiratory disease testing market report also offers information on several market vendors, including Cepheid Inc., COSMED Srl, F. Hoffmann-La Roche Ltd., Koninklijke Philips NV, NDD Medical Technologies, Nihon Kohden Corp., ResMed Inc., Seegene Inc., Smiths Group Plc, and Vyaire Medical Inc. among others.

What will the Respiratory Disease Testing Market Size be During the Forecast Period?

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Parent Market Analysis

Our Technavio Research categorizes the global respiratory disease testing market belonging to Life Sciences Tools & Services industry. Our research report has extensively covered external factors influencing the parent market growth potential in the coming years, which will determine the levels of growth of the market during the forecast period

Respiratory Disease Testing Market: Key Drivers, Trends, and Challenges

Our researcher studied the historical data for years, with 2020 as the base year, and 2021 as the estimated year, and produced drivers, trends and challenges for the market. During the COVID-19 pandemic, the demand for the market has been impacted a lot accelerating but a holistic analysis of drivers will help in exact demands and refining marketing strategies to gain a competitive advantage.

Key Respiratory Disease Testing Market Driver

One of the key factors driving growth in the market is the rising prevalence of COPD. COPD is a chronic, non-communicable, lifestyle-related disease, which progresses continuously in the absence of medical intervention. Several lifestyle-related factors, including smoking, exposure to biomass fuels, and air pollution, increase the risk of developing COPD. Because of the significant presence of these factors in the environment worldwide, COPD has become a leading cause of mortality and morbidity globally. As per WHO, COPD is considered the third-leading cause of death worldwide. Smoking is the leading cause of COPD, especially in developed countries where cigarette smoking is widespread. As per the CDC, in 2019, it was estimated that 34.1 million adults in the US smoked cigarettes. Tobacco smoke from tobacco pipes, cigars, and cigarettes is an irritant that affects the bronchi and the alveoli inside the lungs, leading to COPD.

In addition to tobacco smoke, there are other factors such as occupational exposure to certain hazardous chemicals and materials like asbestos, outdoor pollution, exposure to second-hand or passive smoking, smoke from the burning of biomass, respiratory infections, poor nutritional status, chronic asthma, impaired lung growth, poor socioeconomic status, and dietary factors, which lead directly or indirectly to COPD. Apart from the above-mentioned lifestyle factors, there are factors such as old age and the presence of rare genetic disorders, which contribute to the rising prevalence of COPD. These factors underscore the significant demand for respiratory therapies and devices like those in the US Bilevel Positive Airway Pressure (BiPAP) market, which cater to managing COPD symptoms and improving patient quality of life. The US BiPAP market addresses the diverse needs of COPD patients through innovative technologies and comprehensive care solutions, supporting respiratory health management across different demographic and risk factor profiles.

Key Respiratory Disease Testing Market Challenge

The competitive pricing between global and local vendors will be a major challenge for the market during the forecast period. The global market has the presence of many players, leading to intense competition. Pricing is the main factor driving the competition, which results in lower profit margins. Local vendors offer products at low costs when compared with global vendors, which allows customers to opt for the former. Also, in developing countries, there is a lack of awareness about advanced respiratory monitoring products offered by global vendors. While developing a product, global companies spend a significant amount on R&D, marketing, and promotions. However, local companies sell their products at low-profit margins and at a discounted rate to compete with global companies. This creates an opportunity for local vendors to increase their customer base and sell their produ

Chronic Obstructive Pulmonary Diseases (COPD) Drugs Market Outlook

The global market size for Chronic Obstructive Pulmonary Diseases (COPD) drugs was valued at approximately $15 billion in 2023 and is forecasted to reach around $25 billion by 2032, at a CAGR of approximately 5.5%. The rising prevalence of COPD, coupled with an aging population and increasing pollution levels, are significant growth factors for this market. Advances in drug formulations and delivery systems are also expected to drive market expansion over the forecast period.

One of the primary growth drivers for the COPD drugs market is the aging global population. As people age, the risk of developing chronic respiratory conditions like COPD increases. According to the World Health Organization (WHO), COPD is currently the third leading cause of death worldwide. This alarming statistic underlines the urgent need for effective treatment options, thereby boosting the demand for COPD drugs. Additionally, rising awareness about the disease and its severe complications has led to early diagnosis and treatment, further driving market demand.

Another critical factor contributing to the market's growth is the increasing industrialization and urbanization, particularly in developing countries. The rise in pollution levels, both indoor and outdoor, has significantly escalated the incidence of COPD. Governments and healthcare organizations are focusing on minimizing pollution and improving air quality, but these measures take time to yield results. In the interim, the demand for effective COPD treatments continues to grow, thereby positively impacting the market.

Technological advancements in drug delivery systems, such as inhalers and nebulizers, are also propelling the growth of the COPD drugs market. Improved delivery mechanisms ensure better drug efficacy and patient compliance, making treatments more effective. Furthermore, the development of combination drugs that offer a two-pronged approach to treating COPD symptoms is gaining popularity. These combination drugs not only simplify the treatment regimen but also improve patient outcomes, further driving market expansion.

Pulmonary Drug Delivery Systems have revolutionized the treatment landscape for COPD by enhancing the precision and efficiency of medication delivery directly to the lungs. These systems, which include advanced inhalers and nebulizers, are designed to optimize the therapeutic effects of drugs while minimizing systemic side effects. The development of these delivery systems has been a game-changer, allowing for more targeted treatment approaches that improve patient adherence and outcomes. As the technology continues to evolve, the integration of smart inhalers and digital health solutions is expected to further enhance the management of COPD, providing real-time data and personalized treatment plans for patients.

Regional differences play a significant role in the market's dynamics. North America currently holds the largest market share due to the high prevalence of COPD, robust healthcare infrastructure, and significant investment in research and development. Europe follows closely, driven by similar factors and supportive government policies. Meanwhile, the Asia Pacific region is expected to witness the fastest growth rate during the forecast period. This rapid expansion can be attributed to increasing pollution levels, a large patient pool, and improving healthcare infrastructure. Latin America and the Middle East & Africa are also experiencing gradual growth due to rising awareness and improving healthcare facilities.

Drug Class Analysis

In the COPD drugs market, bronchodilators constitute a significant segment. These drugs are designed to relax the muscles around the airways, making breathing easier for patients. Bronchodilators can be short-acting or long-acting and are often used in combination with other medications to achieve better results. The increasing prevalence of COPD and rising awareness about the benefits of bronchodilators are key drivers for this segment. Additionally, technological advancements in inhaler devices and the development of new bronchodilator formulations are expected to further propel this segment's growth.

Phosphodiesterase-4 (PDE4) inhibitors are another essential drug class in the COPD market. These drugs work by reducing inflammation in the airways, thereby improving lung function and reducing the frequency o

Chronic Obstructive Pulmonary Disease Market Outlook

The global Chronic Obstructive Pulmonary Disease (COPD) market size is projected to experience significant growth, with an expected compound annual growth rate (CAGR) of 5.8% from 2024 to 2032. In 2023, the market was valued at approximately USD 17 billion, and it is anticipated to reach USD 28.7 billion by 2032. The growing prevalence of respiratory diseases, coupled with advancements in medical technology and an aging global population, are pivotal growth factors driving this market. As lifestyle diseases continue to rise, there is an increasing demand for effective COPD management solutions, further accelerating market expansion.

The increasing incidence of COPD, primarily due to factors such as smoking, air pollution, and occupational hazards, is a significant driver of market growth. COPD is a chronic inflammatory lung disease that obstructs airflow from the lungs, and its increasing prevalence is alarming. The World Health Organization (WHO) estimates that COPD will become the third leading cause of death globally by 2030. This dire prediction underscores the urgent need for effective treatments and management strategies, thereby boosting the market for COPD drugs and therapies. Additionally, the healthcare sector's focus on early diagnosis and the development of novel therapeutics is fostering market growth.

Technological advancements in the healthcare sector, particularly in the development of new drugs and therapies, are enhancing the market outlook for COPD. The introduction of novel drug delivery systems, such as inhalers and nebulizers that provide more efficient delivery of medications to the respiratory system, is significantly improving patient outcomes. Furthermore, ongoing research and development (R&D) efforts are leading to the discovery of new drug classes and combination therapies that offer better efficacy and fewer side effects. These innovations are not only improving the quality of life for COPD patients but are also expanding the market by offering a wider range of treatment options.

The aging population is a crucial demographic factor contributing to the growth of the COPD market. As people age, they become more susceptible to respiratory diseases, including COPD. The global population is aging rapidly, with the number of people aged 65 and above projected to exceed 1.5 billion by 2050. This demographic shift is leading to an increased demand for healthcare services and medications tailored to the needs of the elderly, including those for managing chronic conditions like COPD. Consequently, pharmaceutical companies and healthcare providers are focusing on developing products and services to cater to this growing segment, further propelling market growth.

Regionally, the COPD market is witnessing varied growth patterns, with North America and Europe currently leading in terms of market share due to the high prevalence of smoking and well-established healthcare infrastructure. However, Asia Pacific is expected to exhibit the highest growth rate during the forecast period, driven by factors such as increasing pollution levels, rising smoking rates, and improving access to healthcare services. The growing awareness about COPD and its management among both healthcare providers and patients in this region is further supporting market expansion. As developing countries continue to invest in healthcare infrastructure and public health initiatives, the market outlook for COPD in these regions remains positive.

Drug Class Analysis

In the COPD market, bronchodilators are a primary drug class that plays a crucial role in managing symptoms and improving the quality of life for patients. These medications work by relaxing the muscles around the airways, helping to open them and make breathing easier. Bronchodilators are often the first line of treatment and include both short-acting and long-acting formulations. The demand for bronchodilators is driven by their effectiveness in providing quick relief from acute symptoms. Moreover, the development of combination inhalers that contain bronchodilators and other therapeutic agents is gaining traction, offering enhanced patient compliance and outcomes.

Phosphodiesterase-4 (PDE4) inhibitors represent a newer class of drugs in the COPD market, known for their anti-inflammatory properties. These drugs work by inhibiting the PDE4 enzyme, thereby reducing inflammation in the lungs and helping to prevent exacerbations of the disease. The introduction of PDE4 inhibitors has provided an additional therapeutic option for patients who may not respond adeq

Background Cirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories. Methods We used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries. Findings In 2017, cirrhosis caused more than 1·32 million (95% UI 1·27–1·45) deaths (440000 [416000–518000; 33·3%] in females and 883000 [838000–967000; 66·7%] in males) globally, compared with less than 899000 (829000–948000) deaths in 1990. Deaths due to cirrhosis constituted 2·4% (2·3–2·6) of total deaths globally in 2017 compared with 1·9% (1·8–2·0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21·0 (19·2–22·3) per 100000 population in 1990 to 16·5 (15·8–18·1) per 100000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions for all years of the study period (32·2 [25·8–38·6] deaths per 100000 population in 2017), and the high-income super-region had the lowest (10·1 [9·8–10·5] deaths per 100000 population in 2017). The age-standardised death rate decreased or remained constant from 1990 to 2017 in all GBD regions except eastern Europe and central Asia, where the age-standardised death rate increased, primarily due to increases in alcohol-related liver disease prevalence. At the national level, the age-standardised death rate of cirrhosis was lowest in Singapore in 2017 (3·7 [3·3–4·0] per 100000 in 2017) and highest in Egypt in all years since 1990 (103·3 [64·4–133·4] per 100000 in 2017). There were 10·6 million (10·3–10·9) prevalent cases of decompensated cirrhosis and 112 million (107–119) prevalent cases of compensated cirrhosis globally in 2017. There was a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017. Cirrhosis caused by NASH had a steady age-standardised death rate throughout the study period, whereas the other four causes showed declines in age-standardised death rate. The age-standardised prevalence of compensated and decompensated cirrhosis due to NASH increased more than for any other cause of cirrhosis (by 33·2% for compensated cirrhosis and 54·8% for decompensated cirrhosis) over the study period. From 1990 to 2017, the number of prevalent cases more than doubled for compensated cirrhosis due to NASH and more than tripled for decompensated cirrhosis due to NASH. In 2017, age-standardised death and DALY rates were lower among countries and territories with higher SDI. Interpretation Cirrhosis imposes a substantial health burden on many countries and this burden has increased at the global level since 1990, partly due to population growth and ageing. Although the age-standardised death and DALY rates of cirrhosis decreased from 1990 to 2017, numbers of deaths and DALYs and the proportion of all global deaths due to cirrhosis increased. Despite the availability of effective interventions for the prevention and treatment of hepatitis B and C, they were still the main causes of cirrhosis burden worldwide, particularly in low-income countries. The impact of hepatitis B and C is expected to be attenuated and overtaken by that of NASH in the near future. Costeffective interventions are required to continue the prevention and treatment of viral hepatitis, and to achieve early diagnosis and prevention of cirrhosis due to alcohol-related liver disease and NASH.

Abstract

The 1993 National Demographic Survey (NDS) is a nationally representative sample survey of women age 15-49 designed to collect information on fertility; family planning; infant, child and maternal mortality; and maternal and child health. The survey was conducted between April and June 1993. The 1993 NDS was carried out by the National Statistics Office in collaboration with the Department of Health, the University of the Philippines Population Institute, and other agencies concerned with population, health and family planning issues. Funding for the 1993 NDS was provided by the U.S. Agency for International Development through the Demographic and Health Surveys Program.

Close to 13,000 households throughout the country were visited during the survey and more than 15,000 women age 15-49 were interviewed. The results show that fertility in the Philippines continues its gradual decline. At current levels, Filipino women will give birth on average to 4.1 children during their reproductive years, 0.2 children less than that recorded in 1988. However, the total fertility rate in the Philippines remains high in comparison to the level achieved in the neighboring Southeast Asian countries.

The primary objective of the 1993 NDS is to provide up-to-date inform ation on fertility and mortality levels; nuptiality; fertility preferences; awareness, approval, and use of family planning methods; breastfeeding practices; and maternal and child health. This information is intended to assist policymakers and administrators in evaluating and designing programs and strategies for improving health and family planning services in 'the country.

MAIN RESULTS

Fertility varies significantly by region and socioeconomic characteristics. Urban women have on average 1.3 children less than rural women, and uneducated women have one child more than women with college education. Women in Bicol have on average 3 more children than women living in Metropolitan Manila.

Virtually all women know of a family planning method; the pill, female sterilization, IUD and condom are known to over 90 percent of women. Four in 10 married women are currently using contraception. The most popular method is female sterilization ( 12 percent), followed by the piU (9 percent), and natural family planning and withdrawal, both used by 7 percent of married women.

Contraceptive use is highest in Northern Mindanao, Central Visayas and Southern Mindanao, in urban areas, and among women with higher than secondary education. The contraceptive prevalence rate in the Philippines is markedly lower than in the neighboring Southeast Asian countries; the percentage of married women who were using family planning in Thailand was 66 percent in 1987, and 50 percent in Indonesia in 199l.

The majority of contraceptive users obtain their methods from a public service provider (70 percent). Government health facilities mainly provide permanent methods, while barangay health stations or health centers are the main sources for the pill, IUD and condom.

Although Filipino women already marry at a relatively higher age, they continue to delay the age at which they first married. Half of Filipino women marry at age 21.6. Most women have their first sexual intercourse after marriage.

Half of married women say that they want no more children, and 12 percent have been sterilized. An additional 19 percent want to wait at least two years before having another child. Almost two thirds of women in the Philippines express a preference for having 3 or less children. Results from the survey indicate that if all unwanted births were avoided, the total fertility rate would be 2.9 children, which is almost 30 percent less than the observed rate,

More than one quarter of married women in the Philippines are not using any contraceptive method, but want to delay their next birth for two years or more (12 percent), or want to stop childbearing (14 percent). If the potential demand for family planning is satisfied, the contraceptive prevalence rate could increase to 69 percent. The demand for stopping childbearing is about twice the level for spacing (45 and 23 percent, respectively).

Information on various aspects of maternal and child health---antenatal care, vaccination, breastfeeding and food supplementation, and illness was collected in the 1993 NDS on births in the five years preceding the survey. The findings show that 8 in 10 children under five were bom to mothers who received antenatal care from either midwives or nurses (45 percent) or doctors (38 percent). Delivery by a medical personnel is received by more than half of children born in the five years preceding the survey. However, the majority of deliveries occurred at home.

Tetanus, a leading cause of infant deaths, can be prevented by immunization of the mother during pregnancy. In the Philippines, two thirds of bitlhs in the five years preceding the survey were to mothers who received a tetanus toxoid injection during pregnancy.

Based on reports of mothers and information obtained from health cards, 90 percent of children aged 12-23 months have received shots of the BCG as well as the first doses of DPT and polio, and 81 percent have received immunization from measles. Immunization coverage declines with doses; the drop out rate is 3 to 5 percent for children receiving the full dose series of DPT and polio. Overall, 7 in 10 children age 12-23 months have received immunization against the six principal childhood diseases---polio, diphtheria, ~rtussis, tetanus, measles and tuberculosis.

During the two weeks preceding the survey, 1 in 10 children under 5 had diarrhea. Four in ten of these children were not treated. Among those who were treated, 27 percent were given oral rehydration salts, 36 percent were given recommended home solution or increased fluids.

Breasffeeding is less common in the Philippines than in many other developing countries. Overall, a total of 13 percent of children born in the 5 years preceding the survey were not breastfed at all. On the other hand, bottle feeding, a widely discouraged practice, is relatively common in the Philippines. Children are weaned at an early age; one in four children age 2-3 months were exclusively breastfed, and the mean duration of breastfeeding is less than 3 months.

Infant and child mortality in the Philippines have declined significantly in the past two decades. For every 1,000 live births, 34 infants died before their first birthday. Childhood mortality varies significantly by mother's residence and education. The mortality of urban infants is about 40 percent lower than that of rural infants. The probability of dying among infants whose mother had no formal schooling is twice as high as infants whose mother have secondary or higher education. Children of mothers who are too young or too old when they give birth, have too many prior births, or give birth at short intervals have an elevated mortality risk. Mortality risk is highest for children born to mothers under age 19.

The 1993 NDS also collected information necessary for the calculation of adult and maternal mortality using the sisterhood method. For both males and females, at all ages, male mortality is higher than that of females. Matemal mortality ratio for the 1980-1986 is estimated at 213 per 100,000 births, and for the 1987-1993 period 209 per 100,000 births. However, due to the small number of sibling deaths reported in the survey, age-specific rates should be used with caution.

Information on health and family planning services available to the residents of the 1993 NDS barangay was collected from a group of respondents in each location. Distance and time to reach a family planning service provider has insignificant association with whether a woman uses contraception or the choice of contraception being used. On the other hand, being close to a hospital increases the likelihood that antenatal care and births are to respondents who receive ANC and are delivered by a medical personnel or delivered in a health facility.

Geographic coverage

National. The main objective of the 1993 NDS sample is to allow analysis to be carried out for urban and rural areas separately, for 14 of the 15 regions in the country. Due to the recent formation of the 15th region, Autonomous Region in Muslim Mindanao (ARMM), the sample did not allow for a separate estimate for this region.

Analysis unit

• Household
• Women age 15-49

Universe

The population covered by the 1993 Phillipines NDS is defined as the universe of all females age 15-49 years, who are members of the sample household or visitors present at the time of interview and had slept in the sample households the night prior to the time of interview, regardless of marital status.

Kind of data

Sample survey data

Sampling procedure

The main objective of the 1993 National Demographic Survey (NDS) sample is to provide estimates with an acceptable precision for sociodemographics characteristics, like fertility, family planning, health and mortality variables and to allow analysis to be carried out for urban and rural areas separately, for 14 of the 15 regions in the country. Due to the recent formation of the 15th region, Autonomous Region in Muslim Mindanao (ARMM), the sample did not allow for a separate estimate for this region.

The sample is nationally representative with a total size of about 15,000 women aged 15 to 49. The Integrated Survey of Households (ISH) was used as a frame. The ISH was developed in 1980, and was comprised of samples of primary sampling units (PSUs) systematically selected and with a probability proportional to size in each of the 14 regions. The PSUs were reselected in 1991, using the 1990 Population Census data on

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Chronic Obstructive Pulmonary Disease Drugs Market Size 2025-2029

The chronic obstructive pulmonary disease drugs market size is forecast to increase by USD 7.84 billion at a CAGR of 6.4% between 2024 and 2029.

The Chronic Obstructive Pulmonary Disease (COPD) Drugs Market is characterized by several key drivers, trends, and challenges. The rising prevalence of COPD, a progressive and debilitating condition, represents a significant growth opportunity for market participants. As per the latest research, COPD is projected to become the third leading cause of death worldwide by 2030. This increasing burden of disease is primarily attributed to the global population aging and the rising prevalence of smoking and air pollution. Another trend shaping the market is the expanding research in curative approaches for COPD. The focus on developing innovative therapeutic options, including gene therapy and stem cell therapy, is expected to revolutionize the treatment landscape.
However, the market faces challenges, including the low diagnosis rates for COPD. Despite being a leading cause of morbidity and mortality, COPD remains underdiagnosed and undertreated, particularly in developing countries. This presents a significant opportunity for market players to invest in awareness campaigns and diagnostic tools to improve early detection and intervention. Additionally, the complex nature of COPD and its comorbidities necessitate a personalized treatment approach, adding to the market's complexity. Companies seeking to capitalize on market opportunities and navigate challenges effectively must stay abreast of the latest research and trends while addressing the unmet needs of patients and healthcare providers. Patent expiry and the availability of generic drugs and biosimilars offer cost-effective treatment options.

What will be the Size of the Chronic Obstructive Pulmonary Disease Drugs Market during the forecast period?

Explore in-depth regional segment analysis with market size data - historical 2019-2023 and forecasts 2025-2029 - in the full report.
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The market for chronic obstructive pulmonary disease (COPD) drugs continues to evolve, driven by the ongoing development of innovative treatment approaches and the increasing recognition of the need for comprehensive care. Patient education and smoking cessation programs are essential components of long-term treatment strategies, with studies showing that up to 70% of COPD exacerbations are attributable to smoking. Pulmonary rehabilitation, preventive measures such as vaccination programs, and medication adherence programs are also crucial in managing disease progression and improving exercise tolerance. Cough severity and lung function decline are significant concerns for COPD patients, with lung function decline estimated to progress at an annual rate of 30-100 ml/year. Microbial identification plays a pivotal role in antibiotic selection, ensuring appropriate treatment and mitigating antibiotic resistance.

Airway remodeling, drug interactions, and early detection strategies are key areas of focus for disease severity classification and effective symptom management. Lifestyle modifications, including risk factor identification and sputum production reduction, are essential in mitigating disease progression and hospitalization rates. Shortness of breath, chest tightness, and respiratory infections are common symptoms of COPD, and effective symptom management is crucial in reducing mortality risk. According to industry estimates, the global COPD market is expected to grow at a steady pace, with a projected CAGR of 4.5% over the next decade. Despite this growth, challenges such as disease monitoring, drug side effects, and disease severity classification persist, requiring ongoing research and innovation. Antimicrobial coatings and surfaces, biofilm disruptors, and personalized medicine are innovative solutions addressing the challenge of antibiotic resistance.

How is this Chronic Obstructive Pulmonary Disease Drugs Industry segmented?

The chronic obstructive pulmonary disease drugs industry research report provides comprehensive data (region-wise segment analysis), with forecasts and estimates in 'USD million' for the period 2025-2029, as well as historical data from 2019-2023 for the following segments.

Product

  Combination therapy
  Monotherapy


Distribution Channel

  Hospital pharmacies
  Retail pharmacies
  Online pharmacies


Route Of Administration

  Inhalation
  Oral
  Injectable


Disease Type

  Chronic bronchitis
  Emphysema


Geography

  North America

    US
    Canada


  Europe

    France
    Germany
    Spain
    The Netherlands
    UK


  APAC

    China
    Japan


  South America

    Brazil


  Rest of World (ROW)

By Product Insights

The Combination therapy segment is estimated to witness significant growth during the f

In 2023, with just *** death per one thousand people, Qatar and the United Arab Emirates were the countries with the lowest death rates worldwide. This statistic shows a ranking of the 20 countries with the lowest death rates worldwide, as of 2023. Health in high-income countries Countries with the highest life expectancies are also often high-income countries with well-developed economic, social and health care systems, providing adequate resources and access to treatment for health concerns. Health care expenditure as a share of GDP varies per country; for example, spending in the United States is higher than in other OECD countries due to higher costs and prices for care services and products. In developed countries, the main burden of disease is often due to non-communicable diseases occurring in old age, such as cardiovascular diseases and cancer. High burden in low-income countries The countries with the lowest life expectancy worldwide are all in Africa- including Nigeria, Chad, and Lesotho- with life expectancies reaching up to 20 years shorter than the average global life expectancy. Leading causes of death in low-income countries include respiratory infections and diarrheal diseases, as these countries are often hit with the double burden of infectious diseases plus non-communicable diseases, such as those related to cardiovascular pathologies. Additionally, these countries often lack the resources and infrastructure to sustain effective healthcare systems and fail to provide appropriate access and treatment for their populations.

BackgroundIn developing countries, pneumonia is one of the leading causes of death in children under five years of age and hence timely and accurate diagnosis is critical. In North America, pneumonia is also a common source of childhood morbidity and occasionally mortality. Clinicians traditionally have used the chest radiograph as the gold standard in the diagnosis of pneumonia, but they are becoming increasingly aware that it is not ideal. Numerous studies have shown that chest radiography findings lack precision in defining the etiology of childhood pneumonia. There is no single test that reliably distinguishes bacterial from non-bacterial causes. These factors have resulted in clinicians historically using a combination of physical signs and chest radiographs as a ‘gold standard’, though this combination of tests has been shown to be imperfect for diagnosis and assigning treatment. The objectives of this systematic review are to: 1) identify and categorize studies that have used single or multiple tests as a gold standard for assessing accuracy of other tests, and 2) given the ‘gold standard’ used, determine the accuracy of these other tests for diagnosing childhood bacterial pneumonia.Methods and FindingsSearch strategies were developed using a combination of subject headings and keywords adapted for 18 electronic bibliographic databases from inception to May 2008. Published studies were included if they: 1) included children one month to 18 years of age, 2) provided sufficient data regarding diagnostic accuracy to construct a 2×2 table, and 3) assessed the accuracy of one or more index tests as compared with other test(s) used as a ‘gold standard’. The literature search revealed 5,989 references of which 256 were screened for inclusion, resulting in 25 studies that satisfied all inclusion criteria. The studies examined a range of bacterium types and assessed the accuracy of several combinations of diagnostic tests. Eleven different gold standards were studied in the 25 included studies. Criterion validity was calculated for fourteen different index tests using eleven different gold standards. The most common gold standard utilized was blood culture tests used in six studies. Fourteen different tests were measured as index tests. PCT was the most common measured in five studies each with a different gold standard.ConclusionsWe have found that studies assessing the diagnostic accuracy of clinical, radiological, and laboratory tests for bacterial childhood pneumonia have used a heterogeneous group of gold standards, and found, at least in part because of this, that index tests have widely different accuracies. These findings highlight the need for identifying a widely accepted gold standard for diagnosis of bacterial pneumonia in children.

The Sudan Demographic and Health Survey (SDHS) was conducted in two phases between November 15, 1989 and May 21, 1990 by the Department of Statistics of the Ministry of Economic and National Planning. The survey collected information on fertility levels, marriage patterns, reproductive intentions, knowledge and use of contraception, maternal and child health, maternal mortality, and female circumcision. The survey findings provide the National Population Committee and the Ministry of Health with valuable information for use in evaluating population policy and planning public health programmes. A total of 5860 ever-married women age 15-49 were interviewed in six regions in northern Sudan; three regions in southern Sudan could not be included in the survey because of civil unrest in that part of the country. The SDHS provides data on fertility and mortality comparable to the 1978-79 Sudan Fertility Survey (SFS) and complements the information collected in the 1983 census. The primary objective of the SDHS was to provide data on fertility, nuptiality, family planning, fertility preferences, childhood mortality, indicators of maternal health care, and utilization of child health services. Additional information was coUected on educational level, literacy, source of household water, and other housing conditions. The SDHS is intended to serve as a source of demographic data for comparison with the 1983 census and the Sudan Fertility Survey (SFS) 1978-79, and to provide population and health data for policymakers and researchers. The objectives of the survey are to: assess the overall demographic situation in Sudan, assist in the evaluation of population and health programmes, assist the Department of Statistics in strengthening and improving its technical skills for conducting demographic and health surveys, enable the National Population Committee (NPC) to develop a population policy for the country, and measure changes in fertility and contraceptive prevalence, and study the factors which affect these changes, and examine the basic indicators of maternal and child health in Sudan. MAIN RESULTS Fertility levels and trends Fertility has declined sharply in Sudan, from an average of six children per women in the Sudan Fertility Survey (TFR 6.0) to five children in the Sudan DHS survey flTR 5.0). Women living in urban areas have lower fertility (TFR 4.1) than those in rural areas (5.6), and fertility is lower in the Khartoum and Northern regions than in other regions. The difference in fertility by education is particularly striking; at current rates, women who have attained secondary school education will have an average of 3.3 children compared with 5.9 children for women with no education, a difference of almost three children. Although fertility in Sudan is low compared with most sub-Saharan countries, the desire for children is strong. One in three currently married women wants to have another child within two years and the same proportion want another child in two or more years; only one in four married women wants to stop childbearing. The proportion of women who want no more children increases with family size and age. The average ideal family size, 5.9 children, exceeds the total fertility rate (5.0) by approximately one child. Older women are more likely to want large families than younger women, and women just beginning their families say they want to have about five children. Marriage Almost all Sudanese women marry during their lifetime. At the time of the survey, 55 percent of women 15-49 were currently married and 5 percent were widowed or divorced. Nearly one in five currently married women lives in a polygynous union (i.e., is married to a man who has more than one wife). The prevalence of polygyny is about the same in the SDHS as it was in the Sudan Fertility Survey. Marriage occurs at a fairly young age, although there is a trend toward later marriage among younger women (especially those with junior secondary or higher level of schooling). The proportion of women 15-49 who have never married is 12 percentage points higher in the SDHS than in the Sudan Fertiliy Survey. There has been a substantial increase in the average age at first marriage in Sudan. Among SDHS. Since age at first marriage is closely associated with fertility, it is likely that fertility will decrease in the future. With marriages occurring later, women am having their first birth at a later age. While one in three women age 45-49 had her first birth before age 18, only one in six women age 20-24 began childbearing prior to age 18. The women most likely to postpone marriage and childbearing are those who live in urban areas ur in the Khartoum and Northern regions, and women with pest-primary education. Breastfeeding and postpartum abstinence Breastfeeding and postpartum abstinence provide substantial protection from pregnancy after the birth uf a child. In addition to the health benefits to the child, breastfeeding prolongs the length of postpartum amenorrhea. In Sudan, almost all women breastfeed their children; 93 percent of children are still being breastfed 10-11 months after birth, and 41 percent continue breastfeeding for 20-21 months. Postpartum abstinence is traditional in Sudan and in the first two months following the birth of a child 90 percent of women were abstaining; this decreases to 32 percent after two months, and to 5 percent at~er one year. The survey results indicate that the combined effects of breastfeeding and postpartum abstinence protect women from pregnancy for an average of 15 months after the birth of a child. Knowledge and use of contraception Most currently married women (71 percent) know at least one method of family planning, and 59 percent know a source for a method. The pill (70 percent) is the most widely known method, followed by injection, female sterilisation, and the IUD. Only 39 percent of women knew a traditional method of family planning. Despite widespread knowledge of family planning, only about one-fourth of ever-married women have ever used a contraceptive method, and among currently married women, only 9 percent were using a method at the time of the survey (6 percent modem methods and 3 percent traditional methods). The level of contraceptive use while still low, has increased from less than 5 percent reported in the Sudan Fertility Survey. Use of family planning varies by age, residence, and level of education. Current use is less than 4 percent among women 15-19, increases to 10 percent for women 30-44, then decreases to 6 percent for women 45-49. Seventeen percent of urban women practice family planning compared with only 4 percent of rural women; and women with senior secondary education are more likely to practice family planning (26 percent) than women with no education (3 percent). There is widespread approval of family planning in Sudan. Almost two-thirds of currently married women who know a family planning method approve of the use of contraception. Husbands generally share their wives's views on family planning. Three-fourths of married women who were not using a contraceptive method at the time of the survey said they did not intend to use a method in the future. Communication between husbands and wives is important for successful family planning. Less than half of currently married women who know a contraceptive method said they had talked about family planning with their husbands in the year before the survey; one in four women discussed it once or twice; and one in five discussed it more than twice. Younger women and older women were less likely to discuss family planning than those age 20 to 39. Mortality among children The neonatal mortality rate in Sudan remained virtually unchanged in the decade between the SDHS and the SFS (44 deaths per 1000 births), but under-five mortality decreased by 14 percent (from 143 deaths per 1000 births to 123 per thousand). Under-five mortality is 19 percent lower in urban areas (117 per 1000 births) than in rural areas (144 per 10(30 births). The level of mother's education and the length of the preceding birth interval play important roles in child survival. Children of mothers with no education experience nearly twice the level of under-five mortality as children whose mother had attained senior secondary or nigher education. Mortality among children under five is 2.7 times higher among children born after an interval of less than 24 months than among children born after interval of 48 months or more. Maternal mortality The maternal mortality rate (maternal deaths per 1000 women years of exposure) has remained nearly constant over the twenty years preceding the survey, while the maternal mortality ratio (number of maternal deaths per 100,000 births), has increased (despite declining fertility). Using the direct method of estimation, the maternal mortality ratio is 352 maternal deaths per 100,000 births for the period 1976-82, and 552 per 100,000 births for the period 1983-89. The indirect estimate for the maternal mortality ratio is 537. The latter estimate is an average of women's experience over an extended period before the survey centred on 1977. Maternal health care The health care mothers receive during pregnancy and delivery is important to the survival and well-being of both children and mothers. The SDHS results indicate that most women in Sudan made at least one antenatal visit to a doctor or trained health worker/midwife. Eighty-seven percent of births benefitted from professional antenatal care in urban areas compared with 62 percent in rural areas. Although the proportion of pregnant mothers seen by trained health workers/midwives are similar in urban and rural areas, doctors provided antenatal care for 42 percent and 19 percent of births in urban and rural areas, respectively. Neonatal tetanus, a major cause of infant deaths in developing countries, can be prevented if mothers receive tetanus toxoid vaccinations.

Background: Under-five mortality remains concentrated in resource-poor countries. Post-discharge mortality is becoming increasingly recognized as a significant contributor to overall child mortality. With a substantial recent expansion of research and novel data synthesis methods, this study aims to update the current evidence base by providing a more nuanced understanding of the burden and associated risk factors of pediatric post-discharge mortality after acute illness. Methods: Eligible studies published between January 1, 2017 and January 31, 2023, were retrieved using MEDLINE, Embase, and CINAHL databases. Studies published before 2017 were identified in a previous review and added to the total pool of studies. Only studies from countries with low or low-middle Socio-Demographic Index with a post-discharge observation period greater than seven days were included. Risk of bias was assessed using a modified version of the Joanna Briggs Institute critical appraisal tool for prevalence studies. Studies were grouped by patient population, and 6-month post-discharge mortality rates were quantified by random-effects meta-analysis. Secondary outcomes included post-discharge mortality relative to in-hospital mortality, pooled risk factor estimates, and pooled post-discharge Kaplan–Meier survival curves. PROSPERO study registration: #CRD42022350975. Findings: Of 1963 articles screened, 42 eligible articles were identified and combined with 22 articles identified in the previous review, resulting in 64 total articles. These articles represented 46 unique patient cohorts and included a total of 105,560 children. For children admitted with a general acute illness, the pooled risk of mortality six months post-discharge was 4.4% (95% CI: 3.5%–5.4%, I2 = 94.2%, n = 11 studies, 34,457 children), and the pooled in-hospital mortality rate was 5.9% (95% CI: 4.2%–7.7%, I2 = 98.7%, n = 12 studies, 63,307 children). Among disease subgroups, severe malnutrition (12.2%, 95% CI: 6.2%–19.7%, I2 = 98.2%, n = 10 studies, 7760 children) and severe anemia (6.4%, 95% CI: 4.2%–9.1%, I2 = 93.3%, n = 9 studies, 7806 children) demonstrated the highest 6-month post-discharge mortality estimates. Diarrhea demonstrated the shortest median time to death (3.3 weeks) and anemia the longest (8.9 weeks). Most significant risk factors for post-discharge mortality included unplanned discharges, severe malnutrition, and HIV seropositivity. Interpretation: Pediatric post-discharge mortality rates remain high in resource-poor settings, especially among children admitted with malnutrition or anemia. Global health strategies must prioritize this health issue by dedicating resources to research and policy innovation. Data Processing Methods: Data were extracted using a standard data extraction form developed by the review authors. Kaplan–Meier survival curves, where provided, were extracted using a plot digitizer. The data extraction file, “PDMSR2023_DataExtraction_Dataset_SD” was generated as described above and analyzed as is. Co-ordinates were extracted from the survival curves in their original, published form, using a plot digitizer (https://automeris.io/WebPlotDigitizer/). The co-ordinates for each survival curve were then cleaned up to: 1. Re-scale the time points to weeks 2. Curves which reported % mortality were converted to % survival (1 – mortality) 3. First co-ordinate was set to (0, 1), i.e., survival is 100% at time-point 0 4. Include the numbers at risk (if reported), primary reference, and subgroup information Using these cleaned co-ordinates, individual-level patient data were extracted (see Guyot et al, 2012, https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/1471-2288-12-9) and the survival curves re-constructed to obtain the survival and number at risk at specified time-points (0-52 weeks). Where possible, disease and age subgroups were combined to create all admissions curves by combining the individual-level patient data from multiple curves in the same study. Additional data from the survival curves were extracted to produce the “PDMSR2023_AdditionalDataSurvivalCurves6M_Dataset_SD” and “PDMSR2023_AdditionalDataSurvivalCurves12M_Dataset_SD” files by extracting the survival rate at 6 and 12 months. Previously unpublished hazards ratios were extracted from the dataset used in the Wiens et al (2015) study on post-discharge mortality (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4663423/) to produce the “PDMSR2023_HazardsRatiosFromWiens2015_Dataset_SD” file. These original data are published on Dataverse at: https://doi.org/10.5683/SP2/VBPLRM Analyses were in R version 4.3.0 (R Foundation for Statistical Computing, Vienna, Austria), and RStudio version 2023.6.1 (RStudio, Boston, MA). Additional Files: Survival curves in their original, published form, as well as survival curve coordinates files can be made available by request. NOTE for restricted files: If you are not yet a CoLab member, please complete our...

In Kenya, cervical cancer is the 2nd commonly diagnosed type of cancer and the top cause of cancer-related deaths among women. Globally, over 50% of cervical cancer diagnoses are made late, with this proportion rising to 80% in developing countries. Poor Health systems can cause delays in diagnosis, thus, this study focused on determining the health facility-level factors that contribute to delayed diagnosis among cervical cancer patients at the Kenyatta National Hospital (KNH). An analytical cross-sectional mixed method study was adopted to collect data on hospital and referral experiences from 139 cervical cancer patients systematically sampled at KNH, using a semi-structured questionnaire. Associations between the stage at diagnosis and hospital and referral experiences were tested using a logistic regression model at 95% Confidence Interval. 86 (61.9%) were diagnosed at advanced stages III and IV. The potential predictors for delayed diagnosis were; More number of hospital referral times (p-value=0.000), Facing referral challenges (p-value=0.041), Longer time taken for diagnosis appointment (p-value=0.059), and Longer time taken for diagnostic results (p-value=0.007) in the bivariate analysis. More number of hospital referral times (p-value=0.001) and longer time taken for diagnostic results (p-value=0.025), were significantly associated with delayed diagnosis of cervical cancer in the multivariate logistic regression test model. Referral challenges included misdiagnosis, cost of diagnosis, and prolonged diagnosis appointments. The study concluded that the cause of delays in diagnosis for most patients is due to poor health and referral systems and inadequate medical personnel and diagnosis equipment. This study recommends improving referral systems and encouraging partnerships to decentralize diagnostic centers and equipment and train more expertise on cervical cancer. Methods Systematic sampling was used to select 139 cervical cancer patients diagnosed and receiving treatment at KNH, aged above 18, and diagnosed within the last one year since time of data collection. The study excluded patients whose medical records did not have clear staging information, those diagnosed with other cancer types, those with recurrent cervical cancer, those in palliative care, those with psychotic health issues, and those who were unwilling to participate in the study. The participants were interviewed using a semi-structured questionnaire, with questions regarding their hospital and referral experiences such as type of medical facility they visited first, number of hospitals visits they made before diagnosis, if they were referred to KNH, number of referral times, referral challenges they faced, and period taken to get diagnosis appointments and results. The key outcome of delayed diagnosis was stage at diagnosis, categorized as either; early (stages IA to IIB) or delayed (IIIA and IVC) diagnosis using the FIGO staging system. The stage at diagnosis was retrieved as stage of malignancy recorded by the doctor in the patients’ files using abstraction forms. Qualitative data was collected from 8 Key Informants including Medical and Radio Oncologists, Nurses, and Social Workers in audio recorded sessions, to provide in depth information. Statistical analysis was done via Stata 14.2. and the association between delayed diagnosis and health facility-level factors was determined by logistic regression test, at 95% Confidence Interval and Odds Ratios and P-Values were reported. Audio recordings for qualitative data were transcribed in verbatim, transcripts verified, then deductive thematic analysis conducted using NVIVO 14.