Inequalities in diarrhoea, pneumonia and measles deaths: estimates for 21 sub-Saharan African countries.

Objective: To develop new methods to analyse the distributions of diarrhoea, pneumonia and measles deaths in children younger than 5 years across wealth quintiles.

Methods: We used Demographic and Health Surveys conducted since 2013 from 21 sub-Saharan African countries. We implemented multidimensional optimization techniques to estimate the joint impact of risk factors (that is, stunting, wasting, underweight, vitamin A deficiency and unsafe sanitation), immunization coverage and treatment utilization, on the distribution of deaths from diarrhoea, pneumonia and measles across wealth quintiles in each country.

Beyond their nutritional value, school meal programs support agricultural and food transition toward sustainability by creating multi-sectoral values in France.

The COVID pandemic has highlighted the essential role of school meal programs, not only for education but also for children's nutrition. In France, school meals are shaped by ambitious policies to ensure their safety and nutritional quality, while promoting sustainable eating practices and awareness of environmental and agricultural challenges. In this article, we used the case study of France to discuss the multi-sectoral value of these programs.

Universal Free School Meal Policies and Participation in the US National School Meal Programs.

Importance: School meals can support children's health and educational outcomes; however, in the US, only students from households with incomes at or below 185% of the federal poverty level qualify for free or reduced-price meals. Although the Community Eligibility Provision (CEP) enables schools in higher poverty areas to offer free meals to all students, many schools do not participate; the temporary implementation of federal Universal Free School Meal (UFSM) policies during the COVID-19 pandemic and subsequent state-level policies highlight the need for assessing their impact on participation rates in school meal programs.

Objective: To examine the impact of federal- and state-level UFSM and related policies on National School Lunch Program (NSLP) and School Breakfast Program (SBP) participation rates during and after the COVID-19 pandemic.

Assessing the geographic and socioeconomic determinants of vaccine coverage in Ethiopia: A spatial and multistage analysis at the district level.

Background: Despite substantial progress over the past decades, many Ethiopian children still lack the full WHO-recommended immunization schedule. Notably, diphtheria-pertussis-tetanus-Hib-HepB and measles vaccines present large coverage disparities in Ethiopia. This study integrated routine, survey and census data from health, geographic and socioeconomic sources at the district level.

The association of travel distance and other patient characteristics with breast cancer stage at diagnosis and treatment completion at a rural Rwandan cancer facility.

Background: Butaro Cancer Center of Excellence (BCCOE) was founded to serve Rwanda's rural low-income population, providing subsidized cancer diagnosis and treatment with transport stipends for the lowest-income patients. We examined whether travel distance to BCCOE was associated with advanced-stage diagnoses and treatment completion.

Methods: We conducted a retrospective cohort study using medical record data from BCCOE patients with pathologically-confirmed breast cancer from 2012-2016.

Value-Based Pricing for Drugs With Uncertain Clinical Benefits.

Policymakers can use cost-effectiveness analysis to set value-based prices (VBP) for new pharmaceuticals. However, the uncertainty of investigational drug benefits complicates this pricing strategy. Such complexity stems from decision-makers' risk aversion and the potential change in the estimated value with emerging evidence.

Inequalities in tuberculosis control in Ethiopia: A district-level distributional modelling analysis.

Background: Implementation studies indicate that the addition of tuberculosis diagnosis and treatment services into the community health extension workers' tasks-that is 'task-shifting'-improved case detection and treatment outcomes in Ethiopia. Given resource and operational constraints, only a limited number of areas can be targeted by an expanded task-shifting program. Therefore, we mapped the distributional disparities in tuberculosis services across regions and districts and modelled the equity pathways towards optimising national scale-up of this task-shifting intervention in Ethiopia.

Global health 2050: the path to halving premature death by mid-century.

Global health 2050 (GH2050), a new report from the Lancet Commission on Investing in Health, finds that dramatic improvements in human welfare are achievable by mid-century with focused health investments. By 2050, countries that choose to do so can halve their probability of premature death (PPD)—the probability of dying before age 70—from their pre-pandemic level in 2019. We call this goal “50 by 50”: a 50% reduction in PPD by 2050.

The economic value of reducing mortality due to noncommunicable diseases and injuries.

With population aging, national health systems face difficult trade-offs in allocating resources. The World Bank launched the Healthy Longevity Initiative to generate evidence for investing in policies that can improve healthy longevity and human capital. As part of this initiative, we quantified the economic value of reducing avoidable mortality from major noncommunicable diseases and injuries.

Estimating immunization coverage at the district level: A case study of measles and diphtheria-pertussis-tetanus-Hib-HepB vaccines in Ethiopia.

Ethiopia has made significant progress in the last two decades in improving the availability and coverage of essential maternal and child health services including childhood immunizations. As Ethiopia keeps momentum towards achieving national immunization goals, methods must be developed to analyze routinely collected health facility data and generate localized coverage estimates. This study leverages the District Health Information Software (DHIS2) platform to estimate immunization coverage for the first dose of measles vaccine (MCV1) and the third dose of diphtheria-pertussis-tetanus-Hib-HepB vaccine (Penta3) across Ethiopian districts ("woredas").

Modeling the relative influence of socio-demographic variables on post-acute COVID-19 quality of life.

Importance: Post-acute sequelae of SARS-CoV-2, referred to as "long COVID", are a globally pervasive threat. While their many clinical determinants are commonly considered, their plausible social correlates are often overlooked.

Objective: To compare social and clinical predictors of differences in quality of life (QoL) with long COVID.

Association between achieving adequate antenatal care and health-seeking behaviors: A study of Demographic and Health Surveys in 47 low- and middle-income countries.

Background: Antenatal care (ANC) is essential for ensuring the well-being of pregnant women and their fetuses. This study models the association between achieving adequate ANC and various health and health-seeking indicators across wealth quintiles in low- and middle-income countries (LMICs).

Methods And Findings: We analyzed data from 638,265 women across 47 LMICs using available Demographic and Health Surveys from 2010 to 2022.

Extended cost-effectiveness analysis of interventions to improve uptake of diabetes services in South Africa.

The rising prevalence of diabetes in South Africa (SA), coupled with significant levels of unmet need for diagnosis and treatment, results in high rates of diabetes-associated complications. Income status is a determinant of utilization of diagnosis and treatment services, with transport costs and loss of wages being key barriers to care. A conditional cash transfer (CCT) programme, targeted to compensate for such costs, may improve service utilization.

Evolution in key indicators of maternal and child health across the wealth gradient in 41 sub-Saharan African countries, 1986-2019.

Background: Aggregate trends can be useful for summarizing large amounts of information, but this can obscure important distributional aspects. Some population subgroups can be worse off even as averages climb, for example. Distributional information can identify health inequalities, which is essential to understanding their drivers and possible remedies.

Investing in school systems: conceptualising returns on investment across the health, education and social protection sectors.

Public policies often aim to improve welfare, economic injustice and reduce inequality, particularly in the social protection, labour, health and education sectors. While these policies frequently operate in silos, the education sphere can operate as a cross-sectoral link. Schools represent a unique locus, with globally hundreds of millions of children attending class every day.

Economic Growth and Childhood Malnutrition in Low- and Middle-Income Countries.

Importance: Economic growth may reduce childhood malnutrition through improvements of several contributing factors, but the empirical evidence is mixed. Identifying the most important factors that contribute to child malnutrition and their associations with economic growth can inform decision-making about targeted investments to improve children's health.

Objective: To assess the associations between economic growth and malnutrition, contributing factors and malnutrition, and economic growth and contributing factors of malnutrition in low- and middle-income countries (LMICs).

Financial hardship associated with catastrophic out-of-pocket spending tied to primary care services in low- and lower-middle-income countries: findings from a modeling study.

Background: Financial risk protection (FRP) is a key component of universal health coverage (UHC): all individuals must be able to obtain the health services they need without experiencing financial hardship. In many low-income and lower-middle-income countries, however, the health system fails to provide sufficient protection against high out-of-pocket (OOP) spending on health services. In 2018, OOP health spending comprised approximately 40% of current health expenditures in low-income and lower-middle-income countries.

When should global health actors prioritise more uncertain interventions?

Global health actors use economic evaluations, including cost-effectiveness analyses, to estimate the effect of different interventions they might fund. However, producing reliable cost-effectiveness estimates is difficult, meaning organisations must often choose between funding interventions for which reliable predictions of efficacy exist and those for which they do not. In practice, many organisations appear to be risk-averse, favouring more certain interventions simply because they are more certain.

Examining the computation of the underlying components of DALYs.

Disability-adjusted life years (DALYs) capture the mortality and morbidity arising from a disease: they incorporate the years of life lost (YLLs) and the years of life lived with disability (YLD) due to a disease. The relative importance of YLLs and YLDs differs across diseases. The magnitudes of YLLs and YLDs depend on parameters such as the age of onset of disease, duration of disease, the case fatality ratio and disability weight.

Out-of-pocket expenditures and financial risks associated with treatment of vaccine-preventable diseases in Ethiopia: A cross-sectional costing analysis.

Background: Vaccine-preventable diseases (VPDs) remain major causes of morbidity and mortality in low- and middle-income countries (LMICs). Universal access to vaccination, besides improved health outcomes, would substantially reduce VPD-related out-of-pocket (OOP) expenditures and associated financial risks. This paper aims to estimate the extent of OOP expenditures and the magnitude of the associated catastrophic health expenditures (CHEs) for selected VPDs in Ethiopia.

Joint distribution of child mortality and wealth across 30 sub-Saharan African countries over 2000-2019.

Background: While reductions in child mortality have been observed across sub-Saharan African countries in the last 30 years, narrowing the gaps in under-five mortality across socioeconomic groups also requires an understanding of the multiple associations between health and welfare and socioeconomic drivers. We examined the probability density distributions in under-five mortality within countries and joint pathways of under-five mortality and wealth over time.

Methods: We used 69 Demographic and Health Surveys and 19 Malaria Indicator Surveys from 30 sub-Saharan African countries, with each country having at least two surveys conducted since 2000.