Comment
For every woman, every child, everywhere: a universal agenda for the health of women, children, and adolescents
www.thelancet.com Vol 385 May 16, 2015
health service delivery is made both more possible and more probable in crisis settings and in the context of disasters and conflicts. Key steps for such strengthening include a single systematic RMNCA health planning, monitoring, and accountability framework that fully integrates humanitarian interventions within broader country development plans. This framework would encompass population data, multihazard health sector risk assessment, including gender and conflict sensitivity analyses, and the input of local communities, notably women and young people. Risk assessment and mitigation, disaster planning, and contingency funding must become an integral part of RMNCA health services design, investment, maintenance, and review. Investment in the capacities of health and related systems to absorb shocks from humanitarian crises, conflicts, and disasters is important so that health systems are better able to respond during times of crisis and recover capacity more quickly. Most critically, there must be greater accountability to women and young people themselves, who are among the first to be affected by, and respond to, humanitarian crises, conflicts, and disasters. In recognition of their innate resilience and value as partners across the development and humanitarian contiguum, the Abu Dhabi Declaration calls on governments and the international community to design and deliver
Osman Orsal/Reuters/Corbis
Preventable mortality and morbidity among women, adolescents, and children are severe in humanitarian settings. Data from the Organisation for Economic Co-operation and Development on 50 fragile states show that 60% of preventable maternal deaths, 53% of deaths in children younger than 5 years, and 45% of neonatal deaths take place in fragile settings of conflict, displacement, and natural disasters.1–3 Worldwide, women and children are up to 14 times more likely than men to die in a disaster.4 In a humanitarian crisis, the health and wellbeing of every woman, child, newborn baby, and adolescent is at grave risk.5 Yet, more often than not, national development planning processes do not take account of humanitarian crises, whether in terms of preparedness, response, or recovery. Humanitarian crises, conflicts, and disasters are likely to be a long-term feature of the global landscape, and present major impediments to countries’ development. Therefore, it is essential that the international community commit to a truly universal agenda for every woman and every child in every setting. Although the UN Secretary-General’s 2010 global strategy Every Woman Every Child was a major breakthrough that galvanised efforts to accelerate achievement of the Millennium Development Goals (MDGs), it did not address the part played by humanitarian and crisis settings in driving health outcomes across the life course. However, an international expert meeting, held in February, 2015, in Abu Dhabi, United Arab Emirates, under the leadership of the United Arab Emirates Supreme Council on Motherhood and Childhood, has addressed this issue in the Abu Dhabi Declaration,6 which will inform the next Every Woman Every Child global strategy for the post-2015 Sustainable Development Goals. This declaration calls for a more strategic focus on reproductive, maternal, newborn, child, and adolescent (RMNCA) health and wellbeing across three areas: first, within a development and humanitarian contiguum;7 second, over the life course; and, third, in accordance with the exigencies of specific settings.6 The Abu Dhabi Declaration calls for purposeful national and subnational strengthening of the resilience of health systems and RMNCA services so that quality
1919
Comment
demand-driven interventions, establish more active partnerships with women and young people, and root accountability for the results of RMNCA health efforts in affected communities. More lives can be saved more readily if humanitarian, development, and RMNCA health communities come together and support each other to work in more complementary ways. Cooperation between and across different areas of expertise, actors, and systems currently working in parallel is vital to bridge gaps and maximise opportunities for sustained impact in the interests of those most at risk in fragile and humanitarian settings. This approach could deliver a new reality for every woman and every child everywhere in every setting. It is imperative that the Sustainable Development Goals and the next Every Woman Every Child global strategy include clear measures to better support countries and the international community to uphold fundamental human rights across the life course in every setting. This would be an important step towards maximising the opportunities for sustained impact on the health and wellbeing of women, newborn babies, children, and young people whose human rights oblige this of us, and whose potential contribution to their communities’ and countries’ resilience, response, and recovery from emergencies and crises will surely reward such effort. The next Every Woman Every Child strategy will help accelerate efforts to implement the Abu Dhabi Declaration.
*Sarah Zeid, Flavia Bustreo, Maha Taysir Barakat, Peter Maurer, Kate Gilmore Partnership on Maternal, Newborn and Child Health, Geneva 1211, Switzerland (SZ); World Health Organization, Geneva, Switzerland (FB), Health Authority Abu Dhabi, Abu Dhabi, United Arab Emirates (MTB); International Committee of the Red Cross, Geneva, Switzerland (PM); and United Nations Population Fund, New York, USA (KG) [email protected] We declare no competing interests. © 2015. World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. 1
2
3
4
5
6
7
Organisation for Economic Co-operation and Development. States of fragility 2015: meeting post-2015 ambitions. Paris: Organisation for Economic Co-operation and Development, 2015. WHO, UNICEF, UNFPA, World Bank, United Nations Population Division. Trends in maternal mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, World Bank and United Nations Population Division. Geneva: World Health Organization, 2014. UNICEF, WHO, World Bank, UN, UN Inter-agency Group for Child Mortality Estimation. Levels and trends in child mortality report 2014: estimates developed by the UN Inter-agency Group for Child Mortality Estimation. New York: United Nations Children’s Fund, 2014. Plan International. Because I am a girl: the state of the world’s girls 2013. In double jeopardy: adolescent girls and disasters. Surrey, UK: Plan International, 2013. Oestergaard MZ, Inoue M, Yoshida S, et al, on behalf of the United Nations Inter-agency Group for Child Mortality Estimation and the Child Health Epidemiology Reference Group. Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities. PLoS Med 2011, 8: e1001080. The Abu Dhabi Declaration. February, 2015. http://www. everywomaneverychild.org/images/The_Abu_Dhabi_Declaration_ Feb_2015_7.pdf (accessed April 27, 2015). Lewis J. Continuum or contiguum? Development for survival and vulnerability reduction. Fifth European Sociological Association Conference 2001; Helsinki, Finland; Aug 28–Sept 1, 2001. 250 (abstr). http://www. dcscrn.org/cms/uploads/esa2001/lewies%20-%20continuum%20or%20 contiguum.pdf (accessed April 27, 2015).
A new ASPECT for complicated urinary tract infections Published Online April 28, 2015 http://dx.doi.org/10.1016/ S0140-6736(14)62482-X See Articles page 1949
1920
Complicated urinary-tract infections are a major cause of bacteraemia and are associated with high mortality rates of 20–40% among critically ill patients worldwide.1,2 Antibacterials with broad-spectrum activity, especially against uropathogenic Gramnegative bacteria, are often used as empirical treatment for complicated urinary-tract infections.3 The increasing prevalence of multidrug-resistant Enterobacteriaceae spp and Pseudomonas aeruginosa among urinary isolates, however, has led to major challenges in the selection of effective antibiotic treatments. For example, the fluoroquinolones comprise a class of antibacterials that have excellent bioavailability and broad-spectrum
antimicrobial activity against most uropathogenic Gram-negative bacteria, including Enterobacteriaceae spp and P aeruginosa. More than 35% of urinary isolates of Escherichia coli collected from patients admitted to hospital in countries across the world, however, are resistant to fluoroquinolones.4 Furthermore, resistance to fluoroquinolones is especially high (more than 50%) among E coli that produce extended-spectrum β-lactamases (ESBL).4 Thus, there is an urgent need for the development of new antibacterials to treat complicated urinary-tract infections. Ceftolozane-tazobactam is a novel combination drug that includes a cephalosporin-β-lactamase inhibitor www.thelancet.com Vol 385 May 16, 2015
For every woman, every child, everywhere: a universal agenda for the health of women, children, and adolescents
www.thelancet.com Vol 385 May 16, 2015
health service delivery is made both more possible and more probable in crisis settings and in the context of disasters and conflicts. Key steps for such strengthening include a single systematic RMNCA health planning, monitoring, and accountability framework that fully integrates humanitarian interventions within broader country development plans. This framework would encompass population data, multihazard health sector risk assessment, including gender and conflict sensitivity analyses, and the input of local communities, notably women and young people. Risk assessment and mitigation, disaster planning, and contingency funding must become an integral part of RMNCA health services design, investment, maintenance, and review. Investment in the capacities of health and related systems to absorb shocks from humanitarian crises, conflicts, and disasters is important so that health systems are better able to respond during times of crisis and recover capacity more quickly. Most critically, there must be greater accountability to women and young people themselves, who are among the first to be affected by, and respond to, humanitarian crises, conflicts, and disasters. In recognition of their innate resilience and value as partners across the development and humanitarian contiguum, the Abu Dhabi Declaration calls on governments and the international community to design and deliver
Osman Orsal/Reuters/Corbis
Preventable mortality and morbidity among women, adolescents, and children are severe in humanitarian settings. Data from the Organisation for Economic Co-operation and Development on 50 fragile states show that 60% of preventable maternal deaths, 53% of deaths in children younger than 5 years, and 45% of neonatal deaths take place in fragile settings of conflict, displacement, and natural disasters.1–3 Worldwide, women and children are up to 14 times more likely than men to die in a disaster.4 In a humanitarian crisis, the health and wellbeing of every woman, child, newborn baby, and adolescent is at grave risk.5 Yet, more often than not, national development planning processes do not take account of humanitarian crises, whether in terms of preparedness, response, or recovery. Humanitarian crises, conflicts, and disasters are likely to be a long-term feature of the global landscape, and present major impediments to countries’ development. Therefore, it is essential that the international community commit to a truly universal agenda for every woman and every child in every setting. Although the UN Secretary-General’s 2010 global strategy Every Woman Every Child was a major breakthrough that galvanised efforts to accelerate achievement of the Millennium Development Goals (MDGs), it did not address the part played by humanitarian and crisis settings in driving health outcomes across the life course. However, an international expert meeting, held in February, 2015, in Abu Dhabi, United Arab Emirates, under the leadership of the United Arab Emirates Supreme Council on Motherhood and Childhood, has addressed this issue in the Abu Dhabi Declaration,6 which will inform the next Every Woman Every Child global strategy for the post-2015 Sustainable Development Goals. This declaration calls for a more strategic focus on reproductive, maternal, newborn, child, and adolescent (RMNCA) health and wellbeing across three areas: first, within a development and humanitarian contiguum;7 second, over the life course; and, third, in accordance with the exigencies of specific settings.6 The Abu Dhabi Declaration calls for purposeful national and subnational strengthening of the resilience of health systems and RMNCA services so that quality
1919
Comment
demand-driven interventions, establish more active partnerships with women and young people, and root accountability for the results of RMNCA health efforts in affected communities. More lives can be saved more readily if humanitarian, development, and RMNCA health communities come together and support each other to work in more complementary ways. Cooperation between and across different areas of expertise, actors, and systems currently working in parallel is vital to bridge gaps and maximise opportunities for sustained impact in the interests of those most at risk in fragile and humanitarian settings. This approach could deliver a new reality for every woman and every child everywhere in every setting. It is imperative that the Sustainable Development Goals and the next Every Woman Every Child global strategy include clear measures to better support countries and the international community to uphold fundamental human rights across the life course in every setting. This would be an important step towards maximising the opportunities for sustained impact on the health and wellbeing of women, newborn babies, children, and young people whose human rights oblige this of us, and whose potential contribution to their communities’ and countries’ resilience, response, and recovery from emergencies and crises will surely reward such effort. The next Every Woman Every Child strategy will help accelerate efforts to implement the Abu Dhabi Declaration.
*Sarah Zeid, Flavia Bustreo, Maha Taysir Barakat, Peter Maurer, Kate Gilmore Partnership on Maternal, Newborn and Child Health, Geneva 1211, Switzerland (SZ); World Health Organization, Geneva, Switzerland (FB), Health Authority Abu Dhabi, Abu Dhabi, United Arab Emirates (MTB); International Committee of the Red Cross, Geneva, Switzerland (PM); and United Nations Population Fund, New York, USA (KG) [email protected] We declare no competing interests. © 2015. World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. 1
2
3
4
5
6
7
Organisation for Economic Co-operation and Development. States of fragility 2015: meeting post-2015 ambitions. Paris: Organisation for Economic Co-operation and Development, 2015. WHO, UNICEF, UNFPA, World Bank, United Nations Population Division. Trends in maternal mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, World Bank and United Nations Population Division. Geneva: World Health Organization, 2014. UNICEF, WHO, World Bank, UN, UN Inter-agency Group for Child Mortality Estimation. Levels and trends in child mortality report 2014: estimates developed by the UN Inter-agency Group for Child Mortality Estimation. New York: United Nations Children’s Fund, 2014. Plan International. Because I am a girl: the state of the world’s girls 2013. In double jeopardy: adolescent girls and disasters. Surrey, UK: Plan International, 2013. Oestergaard MZ, Inoue M, Yoshida S, et al, on behalf of the United Nations Inter-agency Group for Child Mortality Estimation and the Child Health Epidemiology Reference Group. Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities. PLoS Med 2011, 8: e1001080. The Abu Dhabi Declaration. February, 2015. http://www. everywomaneverychild.org/images/The_Abu_Dhabi_Declaration_ Feb_2015_7.pdf (accessed April 27, 2015). Lewis J. Continuum or contiguum? Development for survival and vulnerability reduction. Fifth European Sociological Association Conference 2001; Helsinki, Finland; Aug 28–Sept 1, 2001. 250 (abstr). http://www. dcscrn.org/cms/uploads/esa2001/lewies%20-%20continuum%20or%20 contiguum.pdf (accessed April 27, 2015).
A new ASPECT for complicated urinary tract infections Published Online April 28, 2015 http://dx.doi.org/10.1016/ S0140-6736(14)62482-X See Articles page 1949
1920
Complicated urinary-tract infections are a major cause of bacteraemia and are associated with high mortality rates of 20–40% among critically ill patients worldwide.1,2 Antibacterials with broad-spectrum activity, especially against uropathogenic Gramnegative bacteria, are often used as empirical treatment for complicated urinary-tract infections.3 The increasing prevalence of multidrug-resistant Enterobacteriaceae spp and Pseudomonas aeruginosa among urinary isolates, however, has led to major challenges in the selection of effective antibiotic treatments. For example, the fluoroquinolones comprise a class of antibacterials that have excellent bioavailability and broad-spectrum
antimicrobial activity against most uropathogenic Gram-negative bacteria, including Enterobacteriaceae spp and P aeruginosa. More than 35% of urinary isolates of Escherichia coli collected from patients admitted to hospital in countries across the world, however, are resistant to fluoroquinolones.4 Furthermore, resistance to fluoroquinolones is especially high (more than 50%) among E coli that produce extended-spectrum β-lactamases (ESBL).4 Thus, there is an urgent need for the development of new antibacterials to treat complicated urinary-tract infections. Ceftolozane-tazobactam is a novel combination drug that includes a cephalosporin-β-lactamase inhibitor www.thelancet.com Vol 385 May 16, 2015
