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Oct 12 2011

Asbestos-linked cancer warning for emerging economies

Cancer deaths caused by asbestos exposure are starting to fall in high-income countries thanks to widescale prohibition of its use. But many low- and middle-income countries that continue to use the mineral in building and transport industries face a surge of deaths in the coming decades, warns a study published this month in the Bulletin of the World Health Organization.


The study, for the first time, counts total deaths reported to WHO from malignant mesothelioma, a rare but fatal cancer that is almost always traced to exposure to asbestos. It usually takes longer than 30 years to develop but, once diagnosed, average survival time is less than one year.


Between 1994 and 2008, most (88%) of the 92 000 deaths from malignant mesothelioma occurred in older men in high-income settings, including Australia, Japan, the United States of America (USA) and many European countries. Most of these countries have since banned the use of asbestos. For example, the United States Environmental Protection Agency (EPA) banned all new uses of asbestos in 1989. The European Union introduced a ban in 1999 that came into effect in 2005.


“We found that mesothelioma deaths are starting to decrease in the USA but are still increasing in Europe and Japan, reflecting the time lag following historical use of asbestos,” says researcher Ken Takahashi, from the University of Occupational and Environmental Health, Kitakyushu City, Japan. “The real concern is that many developing countries continue to use this deadly material but don’t report data to WHO on the deaths it causes.”


WHO relies on countries to report death statistics. It currently receives data on mesothelioma from mostly high-income countries, representing just one-third of the world’s population. No data is available from China, India, Kazakhstan, the Russian Federation and Thailand, the world’s top five consumers of the 2.5 million metric tonnes of asbestos still produced each year.


The World Health Organization has called on countries to stop using all types of asbestos and improve reporting. “We know the risks,” says Dr Ivan Ivanov, scientist at WHO. “All forms of asbestos are carcinogenic and may cause mesothelioma and cancer of the lung, larynx and ovary, as well as other diseases. Even if these countries stop using asbestos today, they are going to see an increase in asbestos-related deaths for many decades to come.”


Malignant mesothelioma affects the protective lining that covers many of the body’s internal organs, most commonly the outer lining of the lungs and the chest wall, but also the lining of the abdominal cavity, and sacs around the heart and testes.


Read the paper here




The Bulletin of the World Health Organization is one of the world’s leading public health journals. It is the flagship periodical of WHO, with a special focus on developing countries. Articles are peer-reviewed and are independent of WHO guidelines. Abstracts are now available in the six official languages of the United Nations.


This month’s issue has a special focus on the social determinants of health to coincide with a conference on this theme in Rio de Janeiro, Brazil, from 19-21 October. Items include:


  • Glasgow tackles stark inequities in health
  • Health is key to economic growth in Brazil, says Minister of Health
  • All in the family: a study of tuberculosis in children in Greenland
  • A decade towards better health in Chile
  • Estimating global numbers for Japanese encephalitis
  • Call for more research on hospital infections in Africa


The October issue table of contents can be found at: http://www.who.int/bulletin/volumes/89/10/en/index.html


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Oct 12 2011

WHO Warns of Consequences of Underfunding TB

11 OCTOBER 2011 |  WASHINGTON DC – The World Health Organization (WHO)  reports for the first time that the number of people falling ill with tuberculosis (TB) each year is declining.  New data, published today in the WHO 2011 Global Tuberculosis Control Report, also show that the number of people dying from the disease fell to its lowest level in a decade. Yet, current progress is at risk from under-funding, especially efforts to combat drug-resistant TB.


The new report finds:

  • The number of people who fell ill with TB dropped to 8.8 million in 2010, after peaking at 9 million in 2005; 
  • TB deaths fell to 1.4 million in 2010, after reaching 1.8 million in 2003;
  • The TB death rate dropped 40% between 1990 and 2010, and all regions, except Africa, are on track to achieve a 50% decline in mortality by 2015;
  • In 2009, 87% of patients treated were cured, with 46 million people successfully treated and 7 million lives saved since 1995. However, a third of estimated TB cases worldwide are not notified and therefore it is unknown whether they have been diagnosed and properly treated.


“Fewer people are dying of tuberculosis, and fewer are falling ill. This is cause for celebration.” said United Nations Secretary-General Ban-ki Moon. “But it is no cause for complacency. Too many millions still develop TB each year, and too many die. I urge serious and sustained support for the Stop TB Partnership in the years to come.”


Much of the progress reported today is the result of expanded efforts in large countries.


“In many countries, strong leadership and domestic financing, with robust donor support, has started to make a real difference in the fight against TB,” said WHO’s Director-General, Dr Margaret Chan. “The challenge now is to build on that commitment, to increase the global effort – and to pay particular attention to the growing threat of multidrug-resistant TB.”


Among these countries are Kenya and the United Republic of Tanzania. In these African countries, the burden of TB is estimated to have been declining for much of the last decade after a peak linked to the HIV epidemic. Brazil has reported a significant and sustained decline in its TB burden since 1990. In China the progress has been dramatic. Between 1990 and 2010, China’s TB death rate fell by almost 80%, with deaths falling from 216,000 in 1990, to 55,000 in 2010.  In the same period, TB prevalence halved, from 215 to 108 per 100,000 population.


Worldwide, the share of domestic funding allocated to TB rose to 86% for 2012. But most low income countries still rely heavily on external funding. Overall, countries have reported a funding shortfall of US$1 billion for TB implementation in 2012.



Treating multidrug-resistant TB (MDR-TB)* remains one of the most under-funded areas. While the number of MDR-TB patients treated increased to 46,000 in 2010 – this is just 16% of the estimated number of MDR-TB patients that needed treatment. Of the US$1 billion gap reported by countries for 2012, US$200 million is for the MDR-TB response.


“A new rapid test for MDR-TB is revolutionizing TB diagnosis with 26 countries using the test only six months after its endorsement by WHO last December, with at least ten more countries expected to have it by the end of 2011,” said Dr Mario Raviglione, Director of WHO’s Stop TB Department, “But the promise of testing more people must be matched with the commitment to treat all detected. It would be a scandal to leave diagnosed patients without treatment”.



People living with HIV, who are also infected with the bacteria causing TB, are up to 34 times more likely to develop TB disease. In 2010, 1.1 million people living with HIV developed TB – 82% of them (900,000 people) in Africa. Worldwide, 12% of TB patients have HIV co infection.


Progress has been made in addressing the TB/HIV co-epidemic, with coverage of testing for HIV rising to 59% of TB patients in Africa.  But further commitment is needed if the region is to meet key 2015 TB targets. In 2010, almost half of TB patients testing positive for HIV in Africa were taking antiretrovirals, and about three-quarters began co-trimoxazole preventive therapy, which helps reduce mortality. Both treatments are among the essential elements of TB/HIV care.



 The report features promising developments in TB diagnostics, drugs and vaccines. Among these, there are strong prospects for shortened drug regimens. Results from three Phase III drug trials are expected between 2012 and 2013, while results from two Phase II trials of new MDR-TB drugs are expected in 2012.


The data on TB and its prevention, care and control, included in the 2011 Global Tuberculosis Control Report, were submitted to WHO by 198 countries. Profiles for these countries are also included in the report.


*MDR-TB is caused by bacteria that are resistant to the most effective anti-TB drugs (isoniazid and rifampicin). This form of TB does not respond to the standard six month treatment with first-line anti-TB drugs and can take two years or more to treat with drugs that are less potent, more toxic and much more expensive.


Additional link:

The WHO 2011 Global Tuberculosis Control Report can be found at: www.who.int/tb


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Sep 27 2011

WHO to Launch a Global Database for Air Quality and Health

WHAT: On Monday 26 September 2011, the World Health Organization (WHO) will launch the first WHO Air Quality global database in Geneva, Switzerland. It covers almost 1100 cities in 91 countries, revealing sometimes startling air pollution levels and trends. The database shows where air pollution and the related health burden is.


For further information please contact:


Ms Nada Osseiran, Communications Officer, Department of Public Health and Environment, WHO, Geneva, Tel. +41 22 791 4475, Mobile +41 79 445 1624, Email: osseirann@who.int


Gregory Härtl, Communications Advisor, Health Security and Environment Cluster, WHO, Geneva, Tel: +4122 791 4458: Mobile: + 41 79 203 67 15, Email: hartlg@who.int


All WHO information can be found at: www.who.int


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Sep 22 2011

UN General Assembly Announces Historic Commitment to Fight Noncommunicable Diseases

19 SEPTEMBER 2011 | GENEVA / NEW YORK – The World Health Organization (WHO) welcomes the adoption today by the UN General Assembly of the political declaration on the prevention and control of noncommunicable diseases such as diabetes, heart disease and stroke, chronic respiratory disease and cancer which together kill some 36 million people each year. For the first time, global leaders have reached consensus in the General Assembly on concrete actions to tackle these diseases.


Governments agreed on the need for global targets to monitor these diseases and their risk factors like tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol. The UN General Assembly has asked WHO to develop a framework for monitoring global progress and to prepare, before the end of 2012, recommendations for a set of global targets to monitor trends and assess the progress in countries to reduce the toll of suffering, disability and premature death due to these diseases.


Global leaders committed to greater efforts to prevent and treat noncommunicable diseases and improve health care including better access to vital medicines. Success will depend on  the engagement of non-health sectors such as finance, agriculture, transportation, urban development, and trade. Governments will integrate policies to reduce noncommunicable diseases into health planning processes and national development agendas.


The declaration is a clear signal that global leaders acknowledge the devastating impact of noncommunicable diseases worldwide and that they are committed to reducing it.  The next step is to act on those commitments.


Related links:

United Nations high-level meeting on noncommunicable disease prevention and control http://www.who.int/nmh/events/un_ncd_summit2011/en/index.html


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Sep 15 2011

WHO Maps Noncommunicable Disease Trends in All Countries

14 SEPTEMBER 2011 | GENEVA – A new World Health Organization (WHO) report features information about the noncommunicable diseases (NCDs) situation in 193 countries, as global leaders prepare to meet at the United Nations high-level meeting on noncommunicable diseases in New York, 19-20 September 2011.


“This report indicates where each government needs to focus to prevent and treat the four major killers: cancer, heart disease and stroke, lung disease and diabetes,” says Dr Ala Alwan, Assistant Director-General for Noncommunicable Diseases and Mental Health at WHO.


The report includes details of what proportion of each country’s deaths are due to noncommunicable diseases. Using graphs in a page-per country presentation format, the report provides information on prevalence, trends in metabolic risk factors (cholesterol, blood pressure, body mass index and blood sugar) alongside data on the country’s capacity to tackle the diseases.


Noncommunicable diseases are the top cause of death worldwide, killing more than 36 million people in 2008. Cardiovascular diseases were responsible for 48% of these deaths, cancers 21%, chronic respiratory diseases 12%, and diabetes 3%.


“Premature” deaths

In 2008, more than 9 million of all deaths attributed to NCDs occurred before the age of 60; 90% of these “premature” deaths occurred in low and middle income countries. One of the findings shows that men and women in low-income countries are around three times more likely to die of NCDs before the age of sixty than in high-income countries.


According to these estimates, the proportion of men dying under the age of 60 from NCDs can be as high as 67%. Among women under 60, the highest proportion was 58%.


The lowest rates of mortality from noncommunicable diseases for men under 60 were 8% and for women under 60 it was 6%.


Risk factors

The profiles report on the proportion of people who smoke and are physically inactive. They also indicate trends for four factors that increase people’s risk of developing these diseases, blood pressure, cholesterol, body mass index and blood sugar over the past 30 years.


In the United States of America, for example, 87% of all deaths are due to noncommunicable diseases. 16% of the population smokes and 43% are physically inactive. On average, blood pressure has decreased since 1980; body mass index has increased; and glucose levels have risen.


Overall, the trends indicate that in many high income countries, action to reduce blood pressure and cholesterol is having an impact, but there is a need to do more on body mass index and managing diabetes.


Countries’ capacity to prevent and treat noncommunicable diseases

The profiles show what countries are doing to tackle noncommunicable diseases in terms of institutional capacity, specified funding, and actions to address the four main diseases and their associated risk factors.


The report also highlights what all countries need to do to reduce people’s exposure to risk factors and improve services to prevent and treat noncommunicable diseases.


UN high-level meeting on noncommunicable diseases

The UN meeting will highlight the importance of setting targets for progress. This report provides all countries with a baseline for monitoring epidemiological trends and assessing the progress they are making to address noncommunicable diseases. The WHO plans to issue an updated report in 2013.


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Sep 01 2011

Newborn Deaths Decrease but Account for Higher Share of Global Child Deaths

The World Health Organization and Save the Children release most comprehensive newborn death estimates to date and call for more action to reduce newborn mortality


30 AUGUST 2011 | GENEVA/WASHINGTON – Fewer newborns are dying worldwide, but progress is too slow and Africa particularly is being left further behind. These are the findings of a new study published in the medical journal PLoS Medicine today. The study covering 20 years and all 193 WHO Member States was led by researchers from the World Health Organization( WHO), Save the Children and the London School of Hygiene and Tropical Medicine. The estimates are based on more data than ever and extensive consultations with countries. The study shows detailed trends over time and forecasts potential future progress.


Newborn deaths decreased from 4.6 million in 1990 to 3.3 million in 2009, but fell slightly faster since 2000. More investment into health care for women and children in the last decade when the United Nations Millennium Development Goals (MDGs) were set, contributed to more rapid progress for the survival of mothers (2.3% per year) and children under the age of five (2.1% per year) than for newborns (1.7% per year).


According to the new figures, newborn deaths, that is deaths in the first four weeks of life (neonatal period), today account for 41% of all child deaths before the age of five. That share grew from 37% in 1990, and is likely to increase further. The first week of life is the riskiest week for newborns, and yet many countries are only just beginning postnatal care programmes to reach mothers and babies at this critical time.


Three causes account for three quarters of  neonatal deaths in the world: preterm delivery (29%), asphyxia (23%) and severe infections, such as sepsis and pneumonia (25%).  Existing interventions can prevent two-thirds or more of these deaths if they reach those in need.


“Newborn survival is being left behind despite well-documented, cost-effective solutions to prevent these deaths,” says Dr. Flavia Bustreo,  WHO Assistant Director-General for Family, Women’s and Children’s Health. “With four years to achieve the Millennium Development Goals, more attention and action for newborns is critical.”


Almost 99% of newborn deaths occur in the developing world. The new study found that in part because of their large populations, more than half of these deaths now happen in just five large countries – India, Nigeria, Pakistan, China and Democratic Republic of the Congo. India alone has more than 900,000 newborn deaths per year, nearly 28% of the global total. Nigeria, the world’s seventh most populous country, now ranks second in newborn deaths up from fifth in 1990. This is due to an increase in the total number of births while the risk of newborn death has decreased only slightly. In contrast, because the number of births went down and the risk of newborn death was cut in half (23 to 11 per 1000), China moved from second place to fourth place.


With a reduction of 1% per year, Africa has seen the slowest progress of any region in the world.


Among the 15 countries with more than 39 neonatal deaths per 1000 live births, 12 were from the WHO African Region (Angola, Burundi, Chad, Central African Republic, Democratic Republic of the Congo, Equatorial Guinea, Guinea, Guinea-Bissau, Mali, Mauritania, Mozambique, and Sierra Leone) plus Afghanistan, Pakistan and Somalia. At the current rate of progress it would take the African continent more than 150 years to reach U.S. or U.K. newborn survival levels.


Of the ten countries with a newborn mortality reduction of more than two-thirds in these two decades, eight were high income countries (Cyprus, Czech Republic, Estonia, Greece, Luxembourg, Oman,  San Marino, and Singapore), and two were middle income countries (Maldives and Serbia).


“This study shows in stark terms that where babies are born dramatically influences their chances of survival, and that especially in Africa far too many mothers experience the heartbreak of losing their baby,” said co-author Dr. Joy Lawn of Save the Children’s Saving Newborn Lives program. “Millions of babies should not be dying when there are proven, cost-effective  interventions to prevent the leading causes of newborn death.”


To read the paper in PLoS Medicine please go to:



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Aug 31 2011

Psychology Headlines Around the World from Socialpsychology.org

  1. Illinois college becomes first to ask undergrads if they’re gay
  2. Census: More same-sex couples in more places
  3. Last of the pink-triangle wearers survived deadly Nazi homophobia
  4. Anti-aging Techniques Not Yet Viewed As Acceptable According To U Of T Research
  5. The Cost of Mental Health in Europe
  6. Being Right Is Not Enough For Four-Year-Olds
  7. East-West Differences In Romantic Love
  8. Mass Media Messages And Fat-Stigma   

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May 16 2011

Many Countries Hit by Health Threats from Both Infectious and Chronic Diseases – New Data Site Makes WHO Data and Analyses Widely Available

13 MAY 2011 | GENEVA – An increasing number of countries are facing a double burden of disease as the prevalence of risk factors for chronic diseases such as diabetes, heart diseases and cancers increase and many countries still struggle to reduce maternal and child deaths caused by infectious diseases, for the Millennium Development Goals, according to the World Health Statistics 2011 released by the World Health Organization (WHO) today.


Noncommunicable diseases such heart diseases, stroke, diabetes and cancer, now make up two-thirds of all deaths globally, due to the population aging and the spread of risk factors associated with globalization and urbanization. The control of risk factors such as tobacco use, sedentary lifestyle, unhealthy diet and excessive use of alcohol becomes more critical. The latest WHO figures showed that about 4 out of 10 men and 1 in 11 women are using tobacco and about 1 in 8 adults is obese.


In addition many developing countries continue to battle health issues such as pneumonia, diarrhoea and malaria that are most likely to kill children under the age of five. In 2009, 40% of all child deaths were among newborns (aged 28 days or less). Much more needs to be done to achieve the MDGs by the target date of 2015, but progress has accelerated:


Child mortality declined at 2.7% per year since 2000, twice as fast as during the 1990s (1.3%). Mortality among children under five years fell from 12.4 million in 1990 to 8.1 million in 2009.
Maternal mortality declined at 3.3% per year since 2000, almost twice as fast in the decade after 2000 than during the 1990s (2%). The number of women dying as a result of complications during pregnancy and childbirth has decreased from 546,000 in 1990 to 358,000 in 2008.


“This evidence really shows that no country in the world can address health from either an infectious disease perspective or a noncommunicable disease one.  Everyone must develop a health system that addresses the full range of the health threats in both areas.” says Ties Boerma, Director of WHO’s Department of Health Statistics and Informatics.


The report also shows that more money is being spent on health and people can expect to live longer (life expectancy in 2009 was 68 years, up from 64 years in 1990); but the gap in health spending between low- and high-income countries remains very large:


In low-income countries, per capita, health expenditure is an estimated USD 32 (or about 5.4% of gross domestic product) and in high-income countries it is US$ 4590 (or about 11% of gross domestic product).
High-income countries have, per capita, on average 10 times more doctors, 12 times more nurses and midwives and 30 times more dentists than low-income countries.
Virtually all deliveries of babies in high-income countries are attended by skilled health personnel; but this is the case for only 40% of deliveries in low-income countries.


World Health Statistics 2011 is an annual report based on more than 100 health indicators reported by WHO’s 193 Member States and other reliable sources. These data provide a snapshot of the global health situation and trends.  However, timely, accurate health information is hard to obtain in some parts of the world, because the country health information systems are weak.


“While the World Health Statistics 2011 provide clear evidence of the improvements occurring in information gathering, there are still large gaps in global health data,” says Colin Mathers, Coordinator of Mortality and Burden of Disease at WHO.  “WHO is committed to working with its Member States, other UN agencies and partners to continue to improve the information available to monitor the health of the world’s people and the effectiveness of health systems and interventions.”


The release of the report coincides with the launch of WHO’s new Global Health Observatory, a new website that serves as a one-stop shop for data and analyses on health priorities around the world. The Observatory provides easy access to the world’s largest and most comprehensive collection of health data, bringing together WHO’s data from all major health and disease programmes. It includes easy access to over 50 databases and 800 indicators with analyses of the global health situation and trends, covering priority health topics such as child, maternal and reproductive health, infectious diseases, noncommunicable diseases and risk factors, environmental health, mortality and burden of diseases, road safety, health systems and equity.  An online version of the World Health Statistics dataset is also available through the Observatory.


The World Health Statistics 2011 can be found at : http://www.who.int/gho/publications/en/  


For further information, please contact:


Dr Ties Boerma; Director, Health Statistics and Informatics, WHO Geneva

Telephone: +41.22.791.1481, Mobile: +, Email: boermat@who.int


All WHO information can be found at www.who.int


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Apr 18 2011

Landmark Agreement Improves Global Preparedness for Influenza Pandemics

News Release WHO/6


17 APRIL 2011 | GENEVA – After a week of negotiations continued through Friday night and into Saturday morning, an open-ended working-group meeting of Member States successfully agreed upon a Framework that ensures that in a pandemic, influenza virus samples will be shared with partners who need the information to take steps to protect public health. 


The working-group meeting was convened under the authority of the World Health Assembly and coordinated by the World Health Organization (WHO).


The new Framework includes certain binding legal regimes for WHO, national influenza laboratories around the world and industry partners in both developed and developing countries that will strengthen how the world responds more effectively with the next flu pandemic. By making sure that the roles and obligations among key players are better established than in the past — including through the use of contracts — the Framework will help increase and expedite access to essential vaccines, antivirals and diagnostic kits, especially for lower-income countries.


In addition, the Framework will also put the world in a better position for seasonal influenza and potential pandemic threats such as the H5N1 virus, because some key activities will begin before the next pandemic, such as greater support for strengthening laboratories and surveillance, and partnership contributions from the industry.


During an influenza outbreak, knowing the exact makeup of the virus is critical for monitoring the spread of the disease, for knowing the potential of the virus to cause a pandemic and for creating the life-saving vaccines as well as other technological benefits. However, developing countries often have limited access to these vaccines for several reasons: they often do not have their own manufacturing capacity, global supplies can be limited when there is a surge in demand as is seen during pandemics, and vaccines can often be priced out of the reach of some countries. 


The new Framework will help ensure more equitable access to affordable vaccines and at the same time, also guarantee the flow of virus samples into the WHO system so that the critical information and analyses needed to assess public health risks and develop vaccines are available.


“This has been a long journey to come to this agreement, but the end result is a very significant victory for public health,” says Dr Margaret Chan, Director-General of the World Health Organization. “It has reinforced my belief that global health in the 21st century hinges on bringing governments and key stakeholders like civil society and industry together to find solutions.”


The legal regimes will address clear roles and responsibilities of WHO, national labs and vaccine and pharmaceutical manufacturers.


“The framework provides a much more coherent and unified global approach for ensuring that influenza viruses are available to the WHO system for monitoring and development of critical benefits such as vaccines, antiviral drugs and scientific information while, at the same time, ensuring more equitable access to these benefits by developing countries,” says Dr Keiji Fukuda, Assistant Director-General of Health Security and Environment at WHO.


The working group was co-chaired by Ambassador Juan José Gomez-Camacho (Mexico) and Ambassador Bente Angell-Hansen (Norway) and included the participation of WHO Member States, industry representatives, civil society and other organizations involved in influenza pandemic preparedness.


“It was a historic negotiation that proved that when governments show statesmanship, stature, responsibility and fine diplomacy, they can successfully meet the most pressing global challenges,” says Gomez-Camacho. “It also helped us realize that public and private partnerships that bring together governments, corporations and civil society are extraordinarily powerful tools that, in the future, I believe will be the only possible way for the world to face these incredibly complex challenges.”


“This agreement promotes global health security and solidarity in pandemic times.  It reflects also a unique partnership with industry, and contains concrete measures of cooperation with both industry and civil society,” says Angell-Hansen. “I am grateful to the very many who contributed to this positive outcome.  It demonstrates what we can achieve through health diplomacy in WHO.”


The agreed upon framework will be presented to the World Health Assembly in May this year for its consideration and approval.


The negotiations by 193 WHO Member States began in November 2007 amid concerns that the avian influenza (H5N1) virus in South-East Asia could become a human pandemic.


Additional link: 
Please note that  when available the documents will be posted on www.who.int/gb and http://apps.who.int/gb/pip


Media contacts:
Christy Feig; Director of communications, WHO: Tel:+ 41 22 791 3075; Mob: + 41 79 251 70 55; email: feigc@who.int


Gregory Härtl; Team Leader, WHO. Communications for Global Alert and Response (GAR)
Tel: +41 22 791 4458 ;Mob: +41 79 203 6715; Email. hartlg@who.int


Fadéla Chaib, WHO Communications officer: Tel: + 41 22 791 3228; Mob: + 41 79 475 55 56; Email: chaibf@who.int


All WHO information can be found at www.who.int


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Apr 14 2011

2.6 Million Babies Stillborn in 2009. New Global and Country Estimates Published in Lancet Series

14 APRIL 2011 | GENEVA – Some 2.6 million stillbirths occurred worldwide in 2009, according to the first comprehensive set of estimates published today in a special series of The Lancet medical journal.


Every day more than 7 200 babies are stillborn ─ a death just when parents expect to welcome a new life ─ and 98% of them occur in low- and middle-income countries.  High-income countries are not immune, with one in 320 babies stillborn ─ a rate that has changed little in the past decade.


The new estimates show that the number of stillbirths worldwide has declined by only 1.1% per year, from 3 million in 1995 to 2.6 million in 2009.  This is even slower than reductions for both maternal and child mortality in the same period.


The five main causes of stillbirth are childbirth complications, maternal infections in pregnancy, maternal disorders (especially hypertension and diabetes), fetal growth restriction and congenital abnormalities.


When and where do stillbirths occur?


Almost half of all stillbirths, 1.2 million, happen when the woman is in labour.  These deaths are directly related to the lack of skilled care at this critical time for mothers and babies.


Two-thirds happen in rural areas, where skilled birth attendants ─ in particular midwives and physicians ─ are not always available for essential care during childbirth and for obstetric emergencies, including caesarean sections.


The stillbirth rate varies sharply by country, from the lowest rates of 2 per 1 000 births in Finland and Singapore and 2.2 per 1 000 births in Denmark and Norway, to highs of 47 in Pakistan and 42 in Nigeria, 36 in Bangladesh, and 34 in Djibouti and Senegal.  Rates also vary widely within countries.  In India, for example, rates range from 20 to 66 per 1 000 births in different states.


It is estimated that 66% ─ some 1.8 million stillbirths ─ occur in just 10 countries: India, Pakistan, Nigeria, China, Bangladesh, Democratic Republic of the Congo, Ethiopia, Indonesia, Afghanistan and the United Republic of Tanzania.


Comparing stillbirth rates in 1995 to 2009, the least progress has been seen in Sub-Saharan Africa and Oceania.  However, some large countries have made progress, such as China, Bangladesh, and India, with a combined estimate of 400 000 fewer stillbirths in 2009 than in 1995.  Mexico has halved its rate of stillbirths in that time.


“Many stillbirths are invisible because they go unrecorded, and are not seen as a major public health problem.  Yet, it is a heartbreaking loss for women and families.  We need to acknowledge these losses and do everything we can to prevent them.  Stillbirths need to be part of the maternal, newborn and child health agenda,” says Dr Flavia Bustreo, WHO’s Assistant Director-General for Family and Community Health.


Well-known interventions for women and babies would save stillbirths too


The Series shows that the way to address the problem of stillbirth is to strengthen existing maternal, newborn, and child health programmes by focusing on key interventions, which also have benefits for mothers and newborns.


According to an analysis to which WHO contributed in The Lancet Stillbirth Series, as many as 1.1 million stillbirths could be averted with universal coverage of the following interventions:


Comprehensive emergency obstetric care                                                       696 000
Syphilis detection and treatment                                                                     136 000
Detection and management of fetal growth restriction                                   107 000
Detection and management of hypertension during pregnancy                        57 000
Identification and induction for mothers with >41 weeks gestation                  52 000
Malaria prevention, including bednets and drugs                                              35 000
Folic acid fortification before conception                                                             27 000
Detection and management of diabetes in pregnancy                                       24 000


Strengthening family planning services would also save lives by reducing the numbers of unintended pregnancies, especially among high-risk women, and thereby reduce stillbirths.


“If every woman had access to a skilled birth attendant ─ a midwife, and if necessary a physician ─ for both essential care and for procedures such as emergency caesarean sections, we would see a dramatic decrease in the number of stillbirths,” says Dr Carole Presern, Director of The Partnership for Maternal, Newborn & Child Health (PMNCH), and a trained midwife.


Stillbirths overlooked


Despite the large numbers, stillbirths have been relatively overlooked. They are not included in the Millennium Development Goals for improving maternal health and reducing child mortality.


The estimates were generated using a statistical model that took records of births and deaths (known as ‘vital registration’ data) from 79 countries, surveys from 39 countries, and studies from 42 countries.  Weak vital registration systems, especially in the regions where most stillbirths occur, limit the availability of data and hamper the calculation of precise estimates.  Vital registration systems must be improved so that all stillbirths are counted.


The new estimates aim to improve knowledge about the extent of the problem, and draw public and professional attention to stillbirths as a significant global public health issue.


Some 69 authors from more than 50 organizations in 18 countries wrote the six scientific papers, two research articles, and eight linked commentaries included in The Lancet Stillbirth Series, which was initiated by the World Health Organization ( WHO) and the Norwegian Institute of Public Health.


UN commitment


In September 2010, UN Secretary-General Ban Ki-moon announced the Global Strategy for Women’s and Children’s Health, aimed at saving 16 million women and children over the next five years.  In the framework of the Strategy, numerous countries have committed to improving access to family planning, antenatal care and skilled birth attendants, which should lead to reductions in stillbirths.


In September this year, a special session on noncommunicable diseases (NCDs) will be held at the UN General Assembly.  NCDs such as diabetes and hypertension (high blood pressure) are risk factors for stillbirth.


For further information


Olivia Lawe-Davies, Department of Maternal, Newborn, Child and Adolescent Health, WHO
Email: lawedavieso@who.int; Office: + 41 22 791 1209; Mobile: +41 79 475 5545


Tammy Farrell, Partnership for Maternal, Newborn & Child Health (PMNCH)
Email: farrellt@who.int; Office: + 41 22 791 4711


All WHO information can be found at www.who.int


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