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Background Young infants with a possible serious bacterial infection (SBI) are a very common presentation to emergency centres (ECs). It is often difficult to distinguish clinically between self-limiting viral infections and an SBI. Available evaluation algorithms to assist clinicians are mostly from high-income countries. Data to inform clinical practice in low- and middle-income countries are lacking. Objectives To determine the period prevalence of SBI and invasive bacterial infection (IBI) and describe current practice in the assessment and management of young infants aged 21–90 days presenting with a possible SBI to a Paediatric Emergency centre (PEC) in Cape Town, South Africa. Methods A retrospective cross-sectional review of infants 21–90 days old presenting to the Tygerberg Hospital PED between 1 January 2016 and 31 May 2016. Results A total of 248 infants 21–90 days were included in the study. Sixty-two patients (25%, 95% CI 20–30) had an SBI and 13 (5.2%, 95% CI 3–8) had an IBI. One hundred and sixty-five infants had a possible SBI based on WHO IMCI criteria. The sensitivity of the WHO IMCI criteria in detecting SBI was 82.3% (95% CI 70.5–90.8) and the specificity 38.7% (95% CI 31.7–46.1). More than half (51.2%) of the infants received antibiotics within the 48 h prior to presentation, of which 33.5% included intramuscular injection of Ceftriaxone. Only 20 (8.0%) patients in this age group were discharged home after initial evaluation. A significant relationship was noted between fever and the risk of SBI (p-value 0.010) and IBI (p-value 0.009). There also appeared to be a significant relationship between nutritional status and IBI (p-value 0.013). Conclusion Period prevalence of SBI and IBI was higher compared to that published in the literature. Validated evaluation algorithms to stratify risk of SBI are needed to assist clinicians in diagnosing and managing infants appropriately in low- and middle-income settings.

Teenage pregnancy is associated with numerous health risks, both to mothers and infants, and may contribute to entrenched social inequalities. In countries with high rates of teenage pregnancy there is disagreement on effective action to reduce rates. England's Teenage Pregnancy Strategy, which cost £280 million over its ten year implementation period, has been highlighted as an effective way of reducing pregnancies after rates fell by more than 50% from 1998 to 2014 and widely advocated as a replicable model for other countries. However, it is not clear whether the fall is attributable to the strategy or to background trends and other events. We aimed to evaluate the impact of the Teenage Pregnancy Strategy on pregnancy and birth rates using comparators. We compared under-18 pregnancy rates in England with Scotland and Wales using interrupted time series methods. We compared under-18 birth rates and under-20 pregnancy rates in England with European and English-speaking high-income countries using synthetic control methods. In the controlled interrupted time series analyses, trends in rates of teenage pregnancy in England closely followed those in Scotland (0.08 fewer pregnancies per 1000 women per year in England; −0.74 to 0.59) and Wales (0.14 more pregnancies per 1000 women per year in England; −0.48 to 0.76). In synthetic control analyses, under-18 birth rates were very similar in England and the synthetic control. Under-20 pregnancy rates were marginally higher in England than control. Although teenage pregnancies and births in England fell following implementation of the Teenage Pregnancy Strategy, comparisons with other countries suggest the strategy had little, if any, effect on pregnancy rates. This raises doubts about whether the strategy should be used as a model for future public health interventions in countries aiming to reduce teenage pregnancy., Highlights • England's Teenage Pregnancy Strategy has been promoted as a successful intervention. • Previous studies show a 51% drop in teenage pregnancies across the strategy period. • This study compares England with unexposed countries to test strategy effectiveness. • We found similar patterns in controls in all comparative analyses. • Our study suggests there was little or no effect of the strategy on teenage pregnancy rates.

This chapter is a summary of the Institute for Health Metrics and Evaluation article describing its human capital index for 195 countries from 1990 to 2016. Its index, called expected human capital, included four equally weighted components: Expected years lived, functional health status, educational attainment, and learning. Expected years lived for each birth cohort was defined as years lived from age 20 to 64; functional health status depended upon seven health conditions; educational attainment was defined as the quantity of education and learning as the quality of education. Rankings for expected human capital and each of its four components were presented for all 195 countries, for high income countries and regional aggregates.

The global agenda is undoubtedly determined by the success of achieving the Sustainable Development Goals (SDGs). Both public and private institutions show great efforts towards the full integration of the SDGs in their own agendas. Ultimately, national governments are responsible for the effective budget allocation for sustainable development. The lack of open, discussed and widely accepted general guidelines related to how to link national public spending (based on the classification of the functions of government) to the achievement of the SDGs is reported in the literature. Thus, the aim of this paper is to propose an initial mapping between them, as well as to assess, through data envelopment analysis (DEA), the national public spending efficiency where government expenditure is consumed (inputs) to attain a certain progress in indicators specific to all 17 SDGs (outputs). On the one hand, results were analyzed for each SDG by income groups, unraveling inefficient spending strategies, thus identifying potential weaknesses that should be overcome before some countries can achieve the same level of progress on SDGs as the best performing nations. On the other hand, it was demonstrated that low income and high income countries deliver higher average public spending efficiency. Countries of these two groups are more often deemed efficient, being displayed alongside the efficient frontiers of the DEA. This finding highlights that low middle-income and upper middle-income countries exhibit the major room for improvement in public spending. One of the authors (J. Cristóbal) acknowledges financial support from the Spanish Ministry of Science, Innovation and Universities through the "Beatriz Galindo" grant (BEAGAL18/00035)

In this chapter, we describe specific details on the three regions of the world from where we come, to highlight the differences in approaches to HPV vaccination, delivery, challenges, and outcomes in high income countries where vaccination programs were first initiated. In addition, we describe a global viewpoint within the context of space allowed. This chapter deals with a rapidly changing area, particularly since the call to action by the Director General of WHO, Dr. Tedros, for elimination of cervical cancer as a public health matter This is a massive goal to accomplish, but achievable given political will and that we have the tools to do so.

Over the last thirty to forty years, many low and middle-income countries have invested heavily in their educational systems. They have made tremendous strides with respect to literacy rates as well as the quantity of education with significant improvements in enrolments across primary, secondary and tertiary levels. This chapter focuses on the capacity of labor markets in poor countries to absorb the increased supply of educated labor and whether this has resulted in increased mismatch relative to middle and high income countries. In particular, we examine the incidence of mismatch, its determinants and also consequences with respect to wages, job satisfaction and economic growth. Throughout we pay attention to the specific characteristics of developing country labor markets.

Artículo escrito por un elevado número de autores, solo se referencia el nombre del grupo de colaboración, si le hubiere, y los autores pertenecientes a la UAM, Antihypertensive medicines are effective in reducing adverse cardiovascular events. Our aim was to compare hypertension awareness, treatment, and control, and how they have changed over time, in highincome countries. Methods We used data from people aged 40–79 years who participated in 123 national health examination surveys from 1976 to 2017 in 12 high-income countries: Australia, Canada, Finland, Germany, Ireland, Italy, Japan, New Zealand, South Korea, Spain, the UK, and the USA. We calculated the proportion of participants with hypertension, which was defined as systolic blood pressure of 140 mm Hg or more, or diastolic blood pressure of 90 mm Hg or more, or being on pharmacological treatment for hypertension, who were aware of their condition, who were treated, and whose hypertension was controlled (ie, lower than 140/90 mm Hg). Findings Data from 526 336 participants were used in these analyses. In their most recent surveys, Canada, South Korea, Australia, and the UK had the lowest prevalence of hypertension, and Finland the highest. In the 1980s and early 1990s, treatment rates were at most 40% and control rates were less than 25% in most countries and age and sex groups. Over the time period assessed, hypertension awareness and treatment increased and control rate improved in all 12 countries, with South Korea and Germany experiencing the largest improvements. Most of the observed increase occurred in the 1990s and early-mid 2000s, having plateaued since in most countries. In their most recent surveys, Canada, Germany, South Korea, and the USA had the highest rates of awareness, treatment, and control, whereas Finland, Ireland, Japan, and Spain had the lowest. Even in the best performing countries, treatment coverage was at most 80% and control rates were less than 70%. Interpretation Hypertension awareness, treatment, and control have improved substantially in high-income countries since the 1980s and 1990s. However, control rates have plateaued in the past decade, at levels lower than those in highquality hypertension programmes. There is substantial variation across countries in the rates of hypertension awareness, treatment, and control, Wellcome Trust and WHO

Invoking health benefits to promote climate-friendly household behavior has three unique advantages: (i) health co-benefits accrue directly to the acting individual, they are "private goods" rather than public ones; (ii) the evidence base for, and magnitude of health co-benefits is well-established; and (iii) the idea of a healthy life-style is well-engrained in public discourse, much more so than that of a climate-friendly life-style. In previous research, assessing the influence of information on health effects on people’s motivation to adopt mitigation actions, health co-benefits for the individual were typically confounded with collective health co-benefits, for example from pollution reduction. The present research aims to overcome this limitation by providing information on individual health co-benefits that are unconditional on the actions of others (direct health co-benefits). We report effects of this kind of health information on stated willingness to adopt mitigation actions as well as on simulation-based carbon emission reductions in a pre-registered experimental setting among 308 households in 4 mid-size case-study cities in 4 European high-income countries: France, Germany, Norway and Sweden. For each mitigation action from the sectors food, housing, and mobility, half of the sample received the amount of CO2equivalents (CO2-eq) saved and the financial costs or savings the respective action generated. The other half additionally received information on direct health co-benefits, where applicable. For households receiving information on direct health co-benefits, we find a higher mean willingness to adopt food and housing actions, and a greater proportion very willing to adopt one or more mitigation actions (OR 1.86, 95% CI 1.1, 3.12); and a greater simulated reduction in overall carbon footprint: difference in percent reduction -2.70%, (95% CI -5.34, -0.04) overall and -4.45%, (95% CI -8.26, -0.64) for food. Our study is the first to show that providing information on strictly unconditional, individual health co-benefits can motivate households in high-income countries to adopt mitigation actions.

Household food waste has a significant detrimental impact on the environment. However, despite national campaigns, people in high income countries throw away a sizeable proportion of the food they purchase. The present study investigated whether self-affirmation could promote openness to information detailing the negative consequences of household food waste, with a particular focus on fruit and vegetable waste. Participants (N = 362) completed either a standard self-affirmation manipulation, an integrated self-affirmation manipulation or a control task before reading the information and completing a series of measures assessing cognitive antecedents of behaviour. Household fruit and vegetable waste was self-reported one-week later. Compared to their non-affirmed counterparts, participants in the standard self-affirmation condition wasted less fruit and vegetables at follow-up. The findings suggest that self-affirmation has the potential to promote engagement with pro-environmental behaviour. Research should continue to explore how to integrate self-affirmation successfully within pro-environmental campaigns.

Modern food retail outlets (convenience stores, supermarkets and hypermarkets) have long dominated food sales in high income countries. Since 1990 there has been a rapid expansion of these formats in low and middle income countries beginning in Latin America and then in East and Southeast Asia. This expansion has generally begun with targeting high income urban consumers before diversifying their target markets to include more diverse consumers and expanding geographically. The concentration of modern retail in selling packaged, processed foods has been successful but there has been some limits on their ability to penetrate local fresh produce sales, particularly in Southeast Asia.

In countries with a low incidence of multidrug-resistant tuberculosis (MDR-TB), universal testing with GeneXpert might not be always cost-effective. This study provides hospital managers in low MDR-TB incidence countries with criteria on when decentralised universal GeneXpert testing would make sense. The alternatives taken into consideration include: universal microbiological culture and drug susceptibility testing (DST) only (comparator); as above but with concurrent centralized GeneXpert in a referral laboratory vs a decentralized GeneXpert system in every hospital to test smear-positive cases only; as above but testing all samples with GeneXpert regardless of smear status. The parameters were from the national TB statistics for England and from a systematic review. Decentralised GeneXpert to test any suspected TB case was the most cost-effective option when 6% or more TB patients belonged to the high-risk group, defined as previous TB diagnosis and or being born in countries with a high MDR-TB incidence. Hospital managers in England and other low MDR-TB incidence countries could use these findings to decide when to invest in GeneXpert or other molecular diagnostics with similar performance criteria for TB diagnostics.

Escherichia coli are leading causes of diarrhea in children from less developed areas of the world and in travelers from industrialized countries visiting these regions. They are increasingly recognized as pathogens in high income countries, where the mode of transmission is frequently via food and waterborne vehicles. Based on their pathogenic phenotypes and the diseases that they cause, diarrheagenic E. coli have been classified into 6 groups: enteropathogenic (EPEC), enterotoxigenic (ETEC), enteroinvasive (EIEC), enteroaggregative (EAEC), diffusely adherent (DAEC), and Shiga toxin producing (STEC) (this last group is also termed enterohemorrhagic (EHEC)). The pathogenic mechanisms by which these groups cause diarrhea are often shared, such as the type 3 secretion system found in EPEC and EHEC, and group-specific, such as the production of Shiga toxins. Although their public health importance is large, the diagnosis of diarrheagenic E. coli in patients and populations is still largely limited to research laboratories. Hence, our knowledge of the spectrum of diseases and syndromes that they cause is quite limited. Also, because we cannot readily identify infected patients, there are many difficulties defining modes of acquisition, prevention and treatment strategies, and estimating the burden of infectious sequelae. These infections pose many challenges, and progress will not occur until we improve our diagnostic capabilities for these agents.