https://publications.hse.ru/mirror/pubs/share/folder/myodg9xfxt/direct/143360779.pdf

Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(13)61809-7.pdf

The end of AIDS: HIV infection as a chronic disease

Background Tuberculosis (TB) is a major contributor to the global burden of disease and has received considerable attention in recent years, particularly in low- and middle-income countries where it is closely associated with HIV/AIDS. Poor adherence to treatment is common despite various interventions aimed at improving treatment completion. Lack of a comprehensive and holistic understanding of barriers to and facilitators of, treatment adherence is currently a major obstacle to finding effective solutions. The aim of this systematic review of qualitative studies was to understand the factors considered important by patients, caregivers and health care providers in contributing to TB medication adherence.

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Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research

AFRICA'S DEVELOPMENT CRISIS is unique. Not only is Africa the poorest region in the world, but it was also the only major developing region with negative growth in income per capita during 1980-2000 (table 1). Some African countries grew during the 1990s, but for the most part this growth recovered ground lost during the 1980s. Moreover, Africa's health conditions are by far the worst on the planet. The AIDS pandemic is wreaking havoc, as is the resurgence of malaria due to rising drug resistance and the lack of effective public health systems. Africa's population continues to soar, adding ecological stresses to the economic strains. Policy-based development lending to Africa over the past twenty years, known as structural adjustment lending, did not solve the problem. A heavy debt burden is evidenced by the 155 Paris Club restructurings of African countries' debt between 1980 and 2001, much more than for any other region. In general, Africa remains mired in poverty and debt. This paper focuses on the tropical sub-Saharan African countries with populations of at least 2 million people in 2001. We leave out North Africa (Algeria, Egypt, Libya, Morocco, and Tunisia,), southernmost Africa (Botswana, Lesotho, Namibia, South Africa, and Swaziland), and a number of very small economies (Cape Verde, Comoros, Djibouti, Equatorial Guinea, Gabon, The Gambia, Guinea-Bissau, Mauritius, Sao Tome and Principe, and Seychelles). Both nontropical ends of Africa are much richer than tropical Africa. They grow temperate crops, escape the worst of malaria, enjoy (in the south) vast deposits per capita of gold and diamonds, and (in the north) benefit from proximity to EU markets. The smallest economies present idiosyncrasies that would distract more than inform the analysis. The thirty-three sub-Saharan African countries on which we focus (and which are listed in table 2) had a combined population of 617 million in 2001, with a population-weighted average annual income of $271 per person, or a mere 74 cents a day. Every country on the list is a low-income country according to World Bank country classifications, and twenty-six are among the forty-nine Least Developed Countries in the world by the United Nations classification. Of the four countries with income per capita of $500 or more, three (Angola, Cameroon, and Congo) are oil exporters, and only Cote d'Ivoire, which is currently in a vertiginous political and economic collapse, is a non-oil exporter. Every country on the list has a life expectancy at birth below sixty years, and in all but Ghana, Madagascar, and Sudan life expectancy at birth is below fifty-five years. Child mortality rates (deaths before the age of five per 1,000 live births) are above 100 in every country. The standard diagnosis is that Africa is suffering from a governance crisis. With highly visible examples of profoundly poor governance, for example in Zimbabwe, and widespread war and violence, as in Angola, the Democratic Republic of the Congo, Liberia, Sierra Leone, and Sudan, the impression of a continent-wide governance crisis is understandable. Yet it is wrong. Many parts of Africa are well governed even though stuck in poverty. Governance is a problem, but Africa's development challenges run much deeper. Using our thirty-three-country sample, table 2 reports some common governance indicators that make this point. The first column presents a ranking of African governance compiled by Steven Radelet, (1) who regresses a set of widely used World Bank governance indicators due to Daniel Kaufmann, Aart Kraay, and Massimo Mastruzzi on GDP per capita, (2) and ranks countries according to the residuals from that regression, thereby standardizing the measurement of governance by level of income. This procedure recognizes that poorer countries have systematically poorer governance measures than richer countries, since good governance itself requires real resources. Well-governed African countries are defined as those with residuals at least 1 standard error above, and poorly governed countries as those with residuals at least 1 standard error below, the regression line. …

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Ending Africa's Poverty Trap

There is a global commitment to reduce premature cardiovascular diseases (CVDs) 25% by 2025. CVD mortality rates have declined dramatically over the past 2 decades, yet the number of life years lost to premature CVD deaths is increasing in low- and middle-income regions. Ischemic heart disease and stroke remain the leading causes of premature death in the world; however, there is wide regional variation in these patterns. Some regions, led by Central Asia, face particularly high rates of premature death from ischemic heart disease. Sub-Saharan Africa and Asia suffer disproportionately from death from stroke. The purpose of the present report is to (1) describe global trends and regional variation in premature mortality attributable to CVD, (2) review past and current approaches to the measurement of these trends, and (3) describe the limitations of existing models of epidemiological transitions for explaining the observed distribution and trends of CVD mortality. We describe extensive variation both between and within regions even while CVD remains a dominant cause of death. Policies and health interventions will need to be tailored and scaled for a broad range of local conditions to achieve global goals for the improvement of cardiovascular health.

Global and regional patterns in cardiovascular mortality from 1990 to 2013.

http://hsrii.org/wp-content/uploads/2014/07/AP681-GHLC-Lancet.pdf

Good Health at Low Cost 25 years on: lessons for the future of health systems strengthening

The International Center for Research on Women (ICRW), in partnership with organizations in Ethiopia, Tanzania, and Zambia, led a study of HIV and AIDS-related stigma and discrimination in these three countries. This project, conducted from April 2001 to September 2003, unraveled the complexities around stigma by investigating the causes, manifestations and consequences of HIV and AIDS-related stigma and discrimination in sub-Saharan Africa. It then uses this analysis to suggest program interventions. Structured text analysis of 730 qualitative transcripts (650 interviews and 80 focus group discussions) and quantitative analysis of 400 survey respondents from rural and urban areas in these countries revealed the following main insights about the causes, context, experience and consequences of stigma: The main causes of stigma relate to incomplete knowledge, fears of death and disease, sexual norms and a lack of recognition of stigma. Insufficient and inaccurate knowledge combines with fears of death and disease to perpetuate beliefs in casual transmission and, thereby, avoidance of those with HIV. The knowledge that HIV can be transmitted sexually combines with an association of HIV with socially “improper” sex, such that people with HIV are stigmatized for their perceived immoral behavior. Finally, people often do not recognize that their words or actions are stigmatizing. Socio-economic status, age and gender all influence the experience of stigma. The poor are blamed less for their infection than the rich, yet they face greater stigma because they have fewer resources to hide an HIV-positive status. Youth are blamed in all three countries for spreading HIV through what is perceived as their highly risky sexual behavior. While both men and women are stigmatized for breaking sexual norms, gender-based power results in women being blamed more easily. At the same time, the consequences of HIV infection, disclosure, stigma and the burden of care are higher for women than for men. People living with HIV and AIDS face physical and social isolation from family, friends, and community; gossip, name-calling and voyeurism; and a loss of rights, decision-making power and access to resources and livelihoods. People with HIV internalize these experiences and consequently feel guilty, ashamed and inferior. They may, as a result, isolate themselves and lose hope. Those associated with people with HIV and AIDS, especially family members, friends and caregivers, face many of these same experiences in the form of secondary stigma. People living with HIV and AIDS and their families develop various strategies to cope with stigma. Decisions around disclosure depend on whether or not disclosing would help to cope (through care) or make the situation worse (through added stigma). Some cope by participating in networks of people with HIV and actively working in the field of HIV or by confronting stigma in their communities. Others look for alternative explanations for HIV besides sexual transmission and seek comfort, often turning to religion to do so. Stigma impedes various programmatic efforts. Testing, disclosure, prevention and care and support for people with HIV are advocated, but are impeded by stigma. Testing and disclosure are recognized as difficult because of stigma, and prevention is hampered because preventive methods such as condom use or discussing safe sex are considered indications of HIV infection or immoral behaviors and are thus stigmatized. Available care and support are accompanied by judgmental attitudes and isolating behavior, which can result in people with HIV delaying care until absolutely necessary. There are also many positive aspects of the way people deal with HIV and stigma. People express good intentions to not stigmatize those with HIV. Many recognize that their limited knowledge has a role in perpetuating stigma and are keen to learn more. Families, religious organizations and communities provide care, empathy and support for people with HIV and AIDS. Finally, people with HIV themselves overcome the stigma they face to challenge stigmatizing social norms. Our study points to five critical elements that programs aiming to tackle stigma need to address: Create greater recognition of stigma and discrimination. Foster in-depth, applied knowledge about all aspects of HIV and AIDS through a participatory and interactive process. Provide safe spaces to discuss the values and beliefs about sex, morality and death that underlie stigma. Find common language to talk about stigma. Ensure a central, contextually-appropriate and ethically-responsible role for people with HIV and AIDS While all individuals and groups have a role in reducing stigma, policymakers and programmers can start with certain key groups that our study suggests are a priority: Families caring for people living with HIV and AIDS: programs can help families both to cope with the burden of care and also to recognize and modify their own stigmatizing behavior. NGOs and other community-based organizations: NGOs can train their own staff to recognize and deal with stigma, incorporate ways to reduce stigma in all activities, and critically examine their communication methods and materials. Religious and faith-based organizations: these can be supportive of people living with HIV and AIDS in their role as religious leaders and can incorporate ways to reduce stigma in their community service activities

http://www.infocenter.nercha.org.sz/sites/default/files/DisentanglingHIVStigma.pdf

Aklilu Kidanu

Papers

Good Health at Low Cost 25 years on: lessons for the future of health systems strengthening

Disentangling HIV and AIDS Stigma in Ethiopia, Tanzania and Zambia