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Abstract Background Infertility is a significant disability, yet there are no reliable estimates of its global prevalence. Studies on infertility prevalence define the condition inconsistently, rendering the comparison of studies or quantitative summaries of the literature difficult. This study analyzed key components of infertility to develop a definition that can be consistently applied to globally available household survey data. Methods We proposed a standard definition of infertility and used it to generate prevalence estimates using 53 Demographic and Health Surveys (DHS). The analysis was restricted to the subset of DHS that contained detailed fertility information collected through the reproductive health calendar. We performed sensitivity analyses for key components of the definition and used these to inform our recommendations for each element of the definition. Results Exposure type (couple status, contraceptive use, and intent), exposure time, and outcomes were key elements of the definition that we proposed. Our definition produced estimates that ranged from 0.6% to 3.4% for primary infertility and 8.7% to 32.6% for secondary infertility. Our sensitivity analyses showed that using an exposure measure of five years is less likely to misclassify fertile unions as infertile. Additionally, using a current, rather than continuous, measure of contraceptive use over five years resulted in a median relative error in secondary infertility of 20.7% (interquartile range of relative error [IQR]: 12.6%-26.9%), while not incorporating intent produced a corresponding error in secondary infertility of 58.2% (IQR: 44.3%-67.9%). Conclusions In order to estimate the global burden of infertility, prevalence estimates using a consistent definition need to be generated. Our analysis provided a recommended definition that could be applied to widely available global household data. We also summarized potential biases that should be considered when making estimates of infertility prevalence using household survey data.

Reduction of indoor air pollution (IAP) exposure from solid fuel use is a potentially important intervention for childhood pneumonia prevention. This review updates a prior meta-analysis and investigates whether risk varies by etiological agent and pneumonia severity among children aged less than 5 years who are exposed to unprocessed solid fuels. Searches were marie of electronic databases (including Africa, China and Latin America) without language restriction. Search terms covered all sources of IAP and wide-ranging descriptions of acute lower respiratory infections, including viral and bacterial agents. From 5317 studies in the main electronic databases (plus 307 African and Latin American, and 588 Chinese studies, in separate databases), 25 were included in the review and 24 were suitable for meta-analysis. Due to substantial statistical heterogeneity, random effects models were used. The overall pooled odds ratio was 1.78 (95% confidence interval, CI: 1.45-2.18), almost unchanged at 1.79 (95% CI: 1.26-2.21) after exclusion of studies with low exposure prevalence (< 15%) and che high outlier. There was evidence of publication bias, and the implications for the results are explored. Sensitivity subanalyses assessed the impact of control selection, adjustment for confounding, exposure and outcome assessment, and age, but no strong effects were identified. Evidence on respiratory syncytial virus was conflicting, while risk for severe or fatal pneumonia was similar to or higher than that for all pneumonia. Despite heterogeneity, this analysis demonstrated sufficient consistency to conclude that risk of pneumonia in young children is increased by exposure to unprocessed solid fuels by a factor of 1.8. Greater efforts are now required to implement effective interventions. Reduire l&apos;exposition a la pollution de l&apos;air interieur due a l&apos;emploi de combustible solide peut etre une intervention importante pour prevenir la pneumonie chez l&apos;enfant. Cette etude met a jour une meta-analyse anterieure et etudie la variation du risque de pneumonie en fonction de l&apos;agent etiologique et de la gravite de la maladie chez les moins de 5 ans exposes a des combustibles solides non traites. Des recherches ont ete effectuees dans des bases de donnees electroniques (notamment en Afrique, en Chine et en Amerique latine), sans limitations d&apos;ordre linguistique. Les termes recherches couvraient toutes les sources de pollution de l&apos;air interieur et des descriptions larges des infections aigues des voies respiratoires inferieures, notamment par des virus et des agents bacteriens. Parmi les 5317 etudes entrees dans les bases de donnees principales (plus 307 etudes africaines et latino-americaines et 588 etudes chinoises dans des bases de donnees separees), 25 ont ete prises en compte dans l&apos;etude et 24 se pretaient a la meta-analyse. En raison de la forte heterogeneite statistique de ces etudes, des modeles a effets aleatoires ont ete utilises. L&apos;odds ratio groupe global etait de 1,78 (intervalle de confiance a 95 %, IC = 1,45-2, 18) et restait presque inchange a 1,79 (intervalle de confiance a 95 %, IC = 1 26-2,21) apres exclusion des etudes avec une faible prevalence de l&apos;exposition (< 15 %) et d&apos;une etude donnant des valeurs anormalement elevees. Il existait des preuves d&apos;un biais de publication et les implications de ce biais sur les resultats sont examinees. Des sous-analyse de sensibilite ont evalue l&apos;impact de la selection des temoins, de l&apos;ajustement pour les facteurs de confusion, des evaluations de l&apos;exposition et des resultats sanitaires, ainsi que de l&apos;age, mais aucun effet important n&apos;a ete mis en evidence. Les donnees concernant le virus respiratoire syncytial etaient contradictoires, tandis que le risque de pneumonie grave ou mortelle etait similaire ou plus eleve, pour toutes les pneumonies. En depit de l&apos;heterogeneite statistique, il a ete prouve que la coherence de cette analyse etait suffisante pour conclure a la majoration d&apos;un facteur 1,8 du risque de pneumonie chez les jeunes enfants par l&apos;exposition a des combustibles solides non traites. Il faut a present consacrer des efforts plus importants a la mise en oeuvre d&apos;interventions efficaces. La reduccion de la exposicion a contaminacien del aire en interiores (CAL) causada por el use de combustibles selidos es una intervencien importante para la prevencien de la neumonia en la ninez. En la presente revision se actualiza un metanalisis anterior y se investiga si el riesgo depende del agente etiolegico y de la gravedad de la neumonia entre les menores de cinco anos expuestos a combustibles solidos no procesados. Se hicieron busquedas en bases de datos electronicas (incluidas Africa, China y America Latina) sin restriccion de idioma. Les terminos de las busquedas abarcaron todas las fuentes de CAL y descripciones amplias de las infecciones agudas de las vias respiratorias inferiores, incluidas causas virales y bacterianas. De les 5317 estudios considerados en las principales bases de datos electronicas (mas 307 estudios africanos y latinoamericanos y 588 estudios chinos, en distintas bases de datos), se seleccionaron 25 para la revisien, y el metanalisis se realizo finalmente con 24 de ellos. Debido a la amplia heterogeneidad estadistica, se emplearon modelos de efectos aleatorios. La razen de posibilidades global fue de 1,78 (intervalo de confianza (IC) del 95%: 1,45-2,18), casi identica a la cifra de 1,79 (IC95%: 1,26-2,21) obtenida al excluir les estudios con baja prevalencia de la exposicion (< 15%) y un valor atipico alto. Habia indicios de un sesgo de publicacien, y se han analizado las implicaciones de ello para les resultados. En les subanalisis de sensibilidad se determine el impacto de la seleccien de les controles, el ajuste respecto de las variables de confusion, la evaluacion de la exposicion y les resultados, y la edad, pero no se observe ningun efecto sustancial. Los datos probatorios sobre el virus sincitial respiratorio fueron contradictorios, mientras que el riesgo para la neumonia grave o mortal fue similar o superior al correspondiente a todos les casos de neumonia. Pese a la heterogeneidad, el analisis realizado tiene la coherencia suficiente para que pueda concluirse que el riesgo de neumonia en les ninos pequenos se ve multiplicado por 1,8 cuando hay exposicion a combustibles solidos no procesados. Hay que hacer un mayor esfuerzo para implementar intervenciones eficaces. [TEXT NOT REPRODUCIBLE IN ASCII.], Introduction With annual deaths from pneumonia in children under 5 years old exceeding 2 million and scant evidence of a decline in this number in the last 5-10 years, prevention [...]

Abstract Public health research and practice is faced with three problems: 1) a focus on disease instead of health, 2) consideration of risk factor/disease relationships one at a time, and 3) attention to individuals with limited regard for the communities in which they live. We propose a framework for health-focused research and practice. This framework encompasses individual and community pathways to health while incorporating the dynamics of context and overall population vulnerability and resilience. Individual pathways to health may differ, but commonalities will exist. By understanding these commonalities, communities can work to support health-promoting pathways in addition to removing barriers. The perspective afforded by viewing health as a dynamic process instead of as a collection of risk factors and diseases expands the number of approaches to improving health globally. Using this approach, multidisciplinary research teams working with active community participants have the potential to reshape health and intervention sciences.

Background: Global, regional, and national estimates of prevalence of and tends in infertility are needed to target prevention and treatment efforts. By applying a consistent algorithm to demographic and reproductive surveys available from developed and developing countries, we estimate infertility prevalence and trends, 1990 to 2010, by country and region. Methods and Findings: We accessed and analyzed household survey data from 277 demographic and reproductive health surveys using a consistent algorithm to calculate infertility. We used a demographic infertility measure with live birth as the outcome and a 5-y exposure period based on union status, contraceptive use, and desire for a child. We corrected for biases arising from the use of incomplete information on past union status and contraceptive use. We used a Bayesian hierarchical model to estimate prevalence of and trends in infertility in 190 countries and territories. In 2010, among women 20-44 y of age who were exposed to the risk of pregnancy, 1.9% (95% uncertainty interval 1.7%, 2.2%) were unable to attain a live birth (primary infertility). Out of women who had had at least one live birth and were exposed to the risk of pregnancy, 10.5% (9.5%, 11.7%) were unable to have another child (secondary infertility). Infertility prevalence was highest in South Asia, Sub-Saharan Africa, North Africa/Middle East, and Central/Eastern Europe and Central Asia. Levels of infertility in 2010 were similar to those in 1990 in most world regions, apart from declines in primary and secondary infertility in Sub-Saharan Africa and primary infertility in South Asia (posterior probability [pp] [greater than or equal to]0.99). Although there were no statistically significant changes in the prevalence of infertility in most regions amongst women who were exposed to the risk of pregnancy, reduced child-seeking behavior resulted in a reduction of primary infertility among all women from 1.6% to 1.5% (pp = 0.90) and a reduction of secondary infertility among all women from 3.9% to 3.0% (pp>0.99) from 1990 to 2010. Due to population growth, however, the absolute number of couples affected by infertility increased from 42.0 million (39.6 million, 44.8 million) in 1990 to 48.5 million (45.0 million, 52.6 million) in 2010. Limitations of the study include gaps in survey data for some countries and the use of proxies to determine exposure to pregnancy. Conclusions: We analyzed demographic and reproductive household survey data to reveal global patterns and trends in infertility. Independent from population growth and worldwide declines in the preferred number of children, we found little evidence of changes in infertility over two decades, apart from in the regions of Sub-Saharan Africa and South Asia. Further research is needed to identify the etiological causes of these patterns and trends. Please see later in the article for the Editors' Summary., Introduction The global health community has had great success in improving maternal and child health in the past decade, partly through a focus on reproductive health [1,2]. Infertility is a [...]

WHO's upcoming report Global health risks will identify the global and regional mortality and disease burden associated with 24 health risks. These risk factors range from environmental risks such as [...]