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Introduction From 1990–2010, worldwide child mortality declined by 43%, and maternal mortality declined by 40%. This paper compares two sources of progress: improvements in societal coverage of health determinants versus improvements in the impact of health determinants as a result of technical change. Methods This paper decomposes the progress made by 146 low- and middle-income countries (LMICs) in lowering childhood and maternal mortality into one component due to better health determinants like literacy, income, and health coverage and a second component due to changes in the impact of these health determinants. Health determinants were selected from eight distinct health-impacting sectors. Health determinants were selected from eight distinct health-impacting sectors. Regression models are used to estimate impact size in 1990 and again in 2010. Changes in the levels of health determinants were measured using secondary data. Findings The model shows that respectively 100% and 89% of the reductions in maternal and child mortality since 1990 were due to improvements in nationwide coverage of health determinants. The relative share of overall improvement attributable to any single determinant varies by country and by model specification. However, in aggregate, approximately 50% of the mortality reductions were due to improvements in the health sector, and the other 50% of the mortality reductions were due to gains outside the health sector. Conclusions Overall, countries improved maternal and child health (MCH) from 1990 to 2010 mainly through improvements in the societal coverage of a broad array of health system, social, economic and environmental determinants of child health. These findings vindicate efforts by the global community to obtain such improvements, and align with the post-2015 development agenda that builds on the lessons from the MDGs and highlights the importance of promoting health and sustainable development in a more integrated manner across sectors.

The security and socioeconomic development of China’s border areas are of great significance to the nation and the wider world. Using census, statistical, digital elevation model (DEM) and network data, this paper employs visual analysis to capture population distribution patterns in China’s 131 border counties from 1982 to 2010. Multiple stepwise regression is carried out to identify the influencing factors of population dynamics in border regions. The main findings include: China’s most heavily populated border areas are primarily in the northeast, northwest, and the Guangxi-Yunnan region, while rapid growth of population is found in western Inner Mongolia, southwest Xinjiang, northwest Tibet, and southern Yunnan. Given the increasingly market-oriented migration mechanism, the national reclamation policy has been no longer effective in population attraction in the new century. Education has significantly lowered and will continuously lower the fertility rate in remote border areas. The factors influencing population growth show a remarkable regional heterogeneity along China’s long border.

The 2016 Iranian Census reveals that 14 of the country’s 31 provinces have sub-replacement fertility. The province of Tehran, where a woman on average gives birth to 1.5 children during her reproductive period, has the lowest fertility in Iran. However, the ‘two-child’ norm prevails in the country and even a woman of young reproductive age still values having at least two children on average. In other words, there exists a gap between a woman’s actual and desired fertility. This paper examines the demographic and socio-economic factors influencing the gap between actual and desired fertility in Tehran city based on a sample survey of 400 married women aged 15–49 years, conducted in 2015. The findings of the study reveal that the women of Tehran would be able to meet their fertility desires of two or more children if they were able to achieve their intended number of children they stated in the survey. However, should these women face any socio-economic constraint, they would be very likely to restrain their fertility desires and have fewer additional children than they initially intended, and thus continue with the sub-replacement fertility as being observed in Iran today.

IntroductionWithin country inequality in infant mortality poses a big challenge for countries moving towards the internationally agreed upon targets on child mortality by 2030. There is a lack of high-quality evidence on infant mortality measured through different dimensions of social inequality in Angola. Thus, this paper was carried out to address the knowledge gap by conducting in-depth examination of infant mortality rate (IMR) inequality among population subgroups to provide more nuanced evidence to help end IMR disparity in the country.MethodsThe World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) was used to analyze IMR inequality. HEAT is a software application that facilitates examination of disparities in reproductive, maternal, neonatal and child health indicators using the WHO Health Equity Monitor (HEM) database. Inequality of IMR was analyzed through disaggregation by five equity stratifiers: education, wealth, gender, subnational region and residence. These were analyzed through three inequality measures: Population Attributable Risk, Ratio and Slope Index of Inequality. A 95% confidence Interval (CI) was built around point estimates to determine statistical significance.ResultsA notable disadvantage was found for children born to poor (Population Attributable Risk (PAR): -27.0; -28.4, -26.0) and uneducated (PAR: -17.0; -17.9, -16.0), women who live in rural areas (PAR: -7.3;-7.8, -6.7) and those residing in certain regions of the country (PAR: -43.0; 45.3, -4). Male infants had a higher risk of death than female infants (PAR: -6.8;-7.5, -6.2). The subnational regional variation of IMR had been the most evident when compared with the disparities in the other equity stratifers.ConclusionsPolicymakers and planners need to address the disproportionately higher clustering of IMR among infants born to disadvantaged subpopulations through interventions that benefit such subgroups.

Background: Monitoring Caesarean Section (CS) rates is essential to ensure optimal use of the procedure. Information on CS rates in the South African private sector is limited and information from this study will assist in planning for the proposed NHI in South Africa. Objectives: The objectives of this paper are to assess mode of delivery patterns and to determine CS rates amongst South African private health insurance scheme members; and to assess the extent to which CS rates are influenced by age and health status of the mother. Methods: The 2015 claims for members of 10 health insurance schemes were analysed to assess delivery type patterns. Mode of delivery patterns were assessed by 6 delivery types: emergency, elective and "other" for caesarean deliveries; and non-assisted, assisted and "other" for vaginal deliveries; as well as by age and health condition of the mother. Results: Of a total of 6,542 births analysed, 4,815 were CS giving a CS rate of 73.6% (95% CI 72.5%;74.7%). Emergency CS were the most common mode of delivery (37·0%), followed by elective CS (28·4%). CS rates increased with increasing maternal age and were higher for women with a medical condition. Conclusions: CS rates for the South African private sector are considerably higher than the safe rates recommended by the WHO. The high CS rates is a cause for concern for the health system under the proposed NHI. To support initiatives encouraging evidence based practice, further research is required to understand the drivers for the high CS rates. Funding Statement: The authors state: "No funding was received for this study." Declaration of Interests: The authors state: "There were no conflicts of interest in the conduct of this study." Ethics Approval Statement: Ethics approval for the use of the database to carry out this study was granted by the Ethics Committee of the South African Medical Research Council project registration number EC001-1/2019.

The labor participation of Brazilian women has increased during the last few decades. According to the World Bank, the percentage of Brazilian women participating in the labor market rose from 20% in the early 1970s to 65% (for women between 16 and 64 years of age) in 2009. The fertility profile has also changed, the fertility rate has decreased from 6.2 in 1960 to 1.9 in 2009, below the replacement rate, according to the World Bank. This paper will present Brazilian fertility trends during the previous (20(th)) and present (21(st)) centuries and, emphasize the importance of individual profiles for fertility decisions. This work uses Brazilian data from PNAD (Pesquisa Nacional de Amostra por Domicilios) to understand the cause of this relationship and to predict the consequences of these choices on women's economic development.

The worldwide spread of a novel influenza A (H1N1) virus in 2009 showed that influenza remains a significant health threat, even for individuals in the prime of life. This paper focuses on the unusually high young adult mortality observed during the Spanish flu pandemic of 1918. Using historical records from Canada and the U.S., we report a peak of mortality at the exact age of 28 during the pandemic and argue that this increased mortality resulted from an early life exposure to influenza during the previous Russian flu pandemic of 1889-90. We posit that in specific instances, development of immunological memory to an influenza virus strain in early life may lead to a dysregulated immune response to antigenically novel strains encountered in later life, thereby increasing the risk of death. Exposure during critical periods of development could also create holes in the T cell repertoire and impair fetal maturation in general, thereby increasing mortality from infectious diseases later in life. Knowledge of the age-pattern of susceptibility to mortality from influenza could improve crisis management during future influenza pandemics.

The objectives of this paper are to predict life years lost associated with obesity-related diseases (ORDs) for U.S. non-smoking adults, and to examine the relationship between those ORDs and mortality. Data from the National Health Interview Survey, 1997-2000, were used. We employed mixed proportional hazard models to estimate the association between those ORDs and mortality and used simulations to project life years lost associated with the ORDs. We found that obesity-attributable comorbidities are associated with large decreases in life years and increases in mortality rates. The life years lost associated with ORDs is more marked for younger adults than older adults, for blacks than whites, for males than females, and for the more obese than the less obese. Using U.S. non-smoking adults aged 40 to 49 years as an example to illustrate percentage of the life years lost associated with ORDs, we found that the mean life years lost associated with ORDs for U.S. non-smoking black males aged 40 to 49 years with a body mass index above 40 kg/m(2) was 5.43 years, which translates to a 7.5% reduction in total life years. White males of the same age range and same degree of obesity lost 5.23 life years on average - a 6.8% reduction in total life years, followed by black females (5.04 years, a 6.5% reduction in life years), and white females (4.7 years, a 5.8% reduction in life years). Overall, ORDs increased chances of dying and lessened life years by 0.2 to 11.7 years depending on gender, race, BMI classification, and age.