Us Agency For International Development

Addis Ababa, Ethiopia

Us Agency For International Development

Addis Ababa, Ethiopia
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Chopra M.,UNICEF | Mason E.,World Health Organization | Borrazzo J.,Us Agency For International Development | Campbell H.,University of Edinburgh | And 2 more authors.
The Lancet | Year: 2013

Global under-5 mortality has fallen rapidly from 12 million deaths in 1990, to 6·9 million in 2011; however, this number still falls short of the target of a two-thirds reduction or a maximum of 4 million deaths by 2015. Acceleration of reductions in deaths due to pneumonia and diarrhoea, which together account for about 2 million child deaths every year, is essential if the target is to be met. Scaling up of existing interventions against the two diseases to 80% and immunisation to 90% would eliminate more than two-thirds of deaths from these two diseases at a cost of US$6·715 billion by 2025. Modelling in this report shows that if all countries could attain the rates of decline of the regional leaders, then cause-specific death rates of fewer than three deaths per 1000 livebirths from pneumonia and less than one death per 1000 livebirths from diarrhoea could be achieved by 2025. These rates are those at which preventable deaths have been avoided. Increasing of awareness of the size of the problem; strengthening of leadership, intersectoral collaboration, and resource mobilisation; and increasing of efficiency through the selection of the optimum mix of a growing set of cost-effective interventions depending on local contexts are the priority actions needed to achieve the goal of ending preventable deaths from pneumonia and diarrhoea by 2025. © 2013 Elsevier Ltd.


Morse S.S.,Columbia University | Morse S.S.,University of California at Davis | Mazet J.A.K.,University of California at Davis | Woolhouse M.,University of Edinburgh | And 7 more authors.
The Lancet | Year: 2012

Most pandemics-eg, HIV/AIDS, severe acute respiratory syndrome, pandemic influenza-originate in animals, are caused by viruses, and are driven to emerge by ecological, behavioural, or socioeconomic changes. Despite their substantial effects on global public health and growing understanding of the process by which they emerge, no pandemic has been predicted before infecting human beings. We review what is known about the pathogens that emerge, the hosts that they originate in, and the factors that drive their emergence. We discuss challenges to their control and new efforts to predict pandemics, target surveillance to the most crucial interfaces, and identify prevention strategies. New mathematical modelling, diagnostic, communications, and informatics technologies can identify and report hitherto unknown microbes in other species, and thus new risk assessment approaches are needed to identify microbes most likely to cause human disease. We lay out a series of research and surveillance opportunities and goals that could help to overcome these challenges and move the global pandemic strategy from response to pre-emption.


Johnson H.L.,Johns Hopkins University | Deloria-Knoll M.,Johns Hopkins University | Levine O.S.,Johns Hopkins University | Stoszek S.K.,Westat | And 5 more authors.
PLoS Medicine | Year: 2010

Background: Approximately 800,000 children die each year due to pneumococcal disease and > 90% of these deaths occur in developing countries where few children have access to life-saving serotype-based vaccines. Understanding the serotype epidemiology of invasive pneumococcal disease (IPD) among children is necessary for vaccine development and introduction policies. The aim of this study was to systematically estimate the global and regional distributions of serotypes causing IPD in children < 5 years of age. Methods and Findings: We systematically reviewed studies with IPD serotype data among children < 5 years of age from the published literature and unpublished data provided by researchers. Studies conducted prior to pneumococcal conjugate vaccine (PCV) introduction, from 1980 to 2007, with ≥ 12 months of surveillance, and reporting ≥ 20 serotyped isolates were included. Serotype-specific proportions were pooled in a random effects meta-analysis and combined with PD incidence and mortality estimates to infer global and regional serotype-specific PD burden. Of 1,292, studies reviewed, 169 were included comprising 60,090 isolates from 70 countries. Globally and regionally, six to 11 serotypes accounted for ≥70% of IPD. Seven serotypes (1, 5, 6A, 6B, 14, 19F, 23F) were the most common globally; and based on year 2000 incidence and mortality estimates these seven serotypes accounted for ≥300,000 deaths in Africa and 200,000 deaths in Asia. Serotypes included in both the 10- and 13-valent PCVs accounted for 10 million cases and 600,000 deaths worldwide. Conclusions: A limited number of serotypes cause most IPD worldwide. The serotypes included in existing PCV formulations account for 49%-88% of deaths in Africa and Asia where PD morbidity and mortality are the highest, but few children have access to these life-saving vaccines. © 2010 Johnson et al.


McCubbin D.,Us Agency For International Development | Sovacool B.K.,Vermont Law School
Energy Policy | Year: 2013

How tangible are the costs of natural gas compared to the benefits of one of the fastest growing sources of electricity - wind energy - in the United States? To answer this question, this article calculates the benefits of wind energy derived from two locations: the 580. MW wind farm at Altamont Pass, CA, and the 22. MW wind farm in Sawtooth, ID. Both wind farms have environmental and economic benefits that should be considered when evaluating the comparative costs of natural gas and wind energy. Though there are uncertainties within the data collected, for the period 2012-2031, the turbines at Altamont Pass will likely avoid anywhere from $560 million to $4.38 billion in human health and climate related externalities, and the turbines at Sawtooth will likely avoid $18 million to $104 million of human health and climate-related externalities. Translating these negative externalities into a cost per kWh of electricity, we estimate that Altamont will avoid costs of 1.8-11.8 cents/kWh and Sawtooth will avoid costs of 1.5-8.2 cents/kWh. © 2012 Elsevier Ltd.


Sanghvi T.G.,Academy for Educational Development | Wainwright E.,Us Agency For International Development
Food and Nutrition Bulletin | Year: 2010

Background. According to a World Health Organization (WHO) review of nationally representative surveys from 1993 to 2005, 42% of pregnant women have anemia worldwide. Almost 90% of anemic women reside in Africa or Asia. Most countries have policies and programs for prenatal iron-folic acid supplementation, but coverage remains low and little emphasis is placed on this intervention within efforts to strengthen antenatal care services. The evidence of the public health impact of iron-folic acid supplementation and documentation of the potential for scaling up have not been reviewed recently. Objective. The purpose of this review is to examine the evidence regarding the impact on maternal mortality of iron-folic acid supplementation and the evidence for the effectiveness of this intervention in supplementation trials and large-scale programs. Methods. The impact on mortality is reviewed from observational studies that were analyzed for the Global Burden of Disease Analysis in 2004. Reviews of ironfolic acid supplementation trials were analyzed by other researchers and are summarized. Data on anemia reduction from two large-scale national programs are presented, and factors responsible for high coverage with iron-folic acid supplementation are discussed. Results. Iron-deficiency anemia underlies 115,000 maternal deaths per year. In Asia, anemia is the second highest cause of maternal mortality. Even mild and moderate anemia increase the risk of death in pregnant women. Iron-folic acid supplementation of pregnant women increases hemoglobin by 1.17 g/dL in developed countries and 1.13 g/dL in developing countries. The prevalence of maternal anemia can be reduced by one-third to one-half over a decade if action is taken to launch focused, large-scale programs that are based on lessons learned from countries with successful programs, such as Thailand and Nicaragua. Conclusions. Iron-folic acid supplementation is an under-resourced, affordable intervention with substantial potential for contributing to Millennium Development Goal 5 (maternal mortality reduction) in countries where iron intakes among pregnant women are low and anemia prevalence is high. This can be achieved in the near term, as policies are already in place in most countries and iron-folic acid supplements are already in lists of essential drugs. What is needed is to systematically adopt lessons about how to strengthen demand and supply systems from successful programs. © 2010, The United Nations University.


Heiby J.,Us Agency For International Development
International Journal for Quality in Health Care | Year: 2014

There is a growing international consensus that African health systems need to improve, but no agreement on how to accomplish this. From the perspective of modern quality improvement (QI), a central issue for low performance in these health systems is the relative neglect of health-care processes. Both health system leaders and international donors have focused their efforts elsewhere, producing noteworthy health gains. But these gains are at risk if health systems do not develop the capacity to study and improve care processes. Substantial experience with QI in Africa shows impressive potential for broad-based process improvement. But this experience also highlights the need for modifying these growing programs to incorporate a more rigorous learning component to address challenges that have emerged recently. The addition of a region-wide knowledge management program could increase the efficiency of each country's QI program by learning from the experiences of other programs. With a coordinated donor initiative, it is reasonable to project that within 5 years, evidence-based improvement will become a norm in health services, and African health systems will approach the model of a learning organization.


Greenstein J.,Us Agency For International Development
Transportation Research Record | Year: 2011

The goal of donors in poor countries and in countries after conflicts and natural disasters has been to restore safe road accessibility, create employment, and build the local capacity of road infrastructure management. The paper presents the engineering considerations and the socioeconomic outcomes of low-cost road and bridge improvement and maintenance projects that have been planned and implemented at various locations around the world. The 2008 Haitian rainy season caused a complete collapse of the transport system, including the Ennery Bridge, as well as major crop destruction. The U.S. Agency for International Development supported the Haitian government to accelerate the restoration of safe accessibility over the Ennery River by building a 60-m two-lane ford in 2 months in 2009. In southern Sudan, demining work along priority roads had to be completed before the implementation of basic engineering activities needed to develop effective road improvement work. Low-volume road projects in Latin America demonstrated that hundreds of community-based microenterprises can produce effective road maintenance services on more than 15,000 km of unpaved roads at an average cost of $700/km/year. In the Central African Republic, the low cost of reconstruction of roads and timber-deck bridges was essential to the provision of affordable accessibility.


Butler A.R.,Imperial College London | Smith J.A.,Imperial College London | Polis C.B.,Us Agency For International Development | Gregson S.,Imperial College London | And 2 more authors.
AIDS | Year: 2013

Background: Some, but not all, observational studies have suggested an increase in the risk of HIV acquisition for women using injectable hormonal contraception (IHC). Design: We used country-level data to explore the effects of reducing IHC use on the number of HIV infections, the number of live births and the resulting net consequences on AIDS deaths and maternal mortality for each country. Results: High IHC use coincides with high HIV incidence primarily in southern and eastern Africa. If IHC increases the risk of HIV acquisition, this could generate 27000-130000 infections per year globally, 87-88% of which occur in this region. Reducing IHC use could result in fewer HIV infections but also a substantial increase in live births and maternal mortality in countries with high IHC use, high birth rates and high maternal mortality: mainly southern and eastern Africa, South-East Asia, and Central and South America. For most countries, the net impact of reducing IHC use on maternal and AIDS-related deaths is dependent on the magnitude of the assumed IHC-HIV interaction. Conclusions: If IHC use increases HIV acquisition risk, reducing IHC could reduce new HIV infections; however, this must be balanced against other important consequences, including unintended pregnancy, which impacts maternal and infant mortality. Unless the true effect size approaches a relative risk of 2.19, it is unlikely that reductions in IHC could result in public health benefit, with the possible exception of those countries in southern Africa with the largest HIV epidemics. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Balster R.L.,Virginia Commonwealth University | Levy S.,Us Agency For International Development | Stammer E.,Knowledge Management Services
Journal of Health Communication | Year: 2014

Recognizing the need for evidence to inform public health officials and health care workers in the U.S. government and low-and middle-income country governments on efficient, effective behavior change policies, strategies, and programs for child health and development, the U.S. government convened the Evidence Summit on Enhancing Child Survival and Development in Lower-and Middle-Income Countries by Achieving Population-Level Behavior Change. This article summarizes the background and methods for the acquisition and evaluation of the evidence used to the achieve the goals of the summit that is reviewed in other articles in this special issue of the Journal of Health Communication. The process began by identifying focal questions intended to inform the U.S. and low-and middle-income governments about behavior change interventions that accelerate reductions in under-5 mortality and optimize healthy and protective child development to 5 years of age. Experts were selected representing the research and program communities, academia, relevant nongovernmental organizations, and government agencies and assembled into evidence review teams. This was followed by the systematic gathering of relevant peer-reviewed literature that would inform the focal questions. Members of the evidence review teams were invited to add relevant articles not identified in the initial literature review to complete the bibliographies. Details of the search processes and methods used for screening and quality reviews are described. The evidence review teams were asked to comply with a specific evaluation framework for recommendations on practice and policy on the basis of both expert opinion and the quality of the data reviewed.


Fieno J.,Us Agency For International Development | Leclerc-Madlala S.,Us Agency For International Development
African Journal of AIDS Research | Year: 2014

As the search for more effective HIV prevention strategies continues, increased attention is being paid to the potential role of cash transfers in prevention programming in sub-Saharan Africa. To date, studies testing the impact of both conditional and unconditional cash transfers on HIV-related behaviours and outcomes in sub-Saharan Africa have been relatively small-scale and their potential feasibility, costs and benefits at scale, among other things, remain largely unexplored. This article examines elements of a successful cash transfer program from Latin America and discusses challenges inherent in scaling-up such programs. The authors attempt a cost simulation of a cash transfer program for HIV prevention in South Africa comparing its cost and relative effectiveness-in number of HIV infections averted-against other prevention interventions. If a cash transfer program were to be taken to scale, the intervention would not have a substantial effect on decreasing the force of the epidemic in middle-and low-income countries. The integration of cash transfer programs into other sectors and linking them to a broader objective such as girls educational attainment may be one way of addressing doubts raised by the authors regarding their value for HIV prevention. © 2014 NISC (Pty) Ltd.

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