Correspondence
11 million births 17 million births
At least four antenatal care visits
48% 50%
9 million births
Skilled birth attendance
40% 18 million births
Contraceptive prevalence among MWRA
53%
10 million women
13% 34 million women
0
5
10 15 20 25 30 People receiving a health service (millions)
35
40
26% 0
20 40 60 80 Population receiving a health service (%)
1990 2012 100
Figure: Population receiving selected health services in sub-Saharan Africa in 1990 and 2012 Sub-Saharan Africa includes all of Africa except northern Africa; Sudan is included in sub-Saharan Africa. Data are from references 2 and 3 and author calculations based on reference 1. MWRA=married or in-union women of reproductive age.
unless programmes and resources are significantly expanded. While the development goals and targets that the world will adopt following 2015 are still unspecified, it is timely to take into account the powerful force that population numbers will play in achieving these goals and targets. The views expressed are those of the authors and do not necessarily reflect the views of the UN. We declare no competing interests.
Vladimíra Kantorová, *Ann Biddlecom, Holly Newby [email protected] United Nations Population Division, Department of Economic and Social Affairs, New York, NY 10017, USA (VK, AB); and Division of Policy and Strategy, United Nations Children’s Fund (UNICEF), New York, NY 10017, USA (HN) Published Online June 23, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)61001-1
1
2
3
United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2012 Revision. http://esa.un.org/unpd/wpp/index.htm (accessed July 3, 2014). United Nations. The Millennium Development Goals Report 2014. http://mdgs.un.org/unsd/ mdg/Default.aspx (accessed July 7, 2014). United Nations, Department of Economic and Social Affairs, Population Division. Model-based Estimates and Projections of Family Planning Indicators 2014. New York: United Nations. http://www.un.org/en/development/desa/ population/theme/family-planning/cp_model. shtml (accessed July 7, 2014).
news highlights how lives could be saved if the UK adopted a similar approach. Despite evidence for the effectiveness2 and cost-effectiveness3 of the lay administration of naloxone, supported by strong recommendations from both Advisory Council on the Misuse of Drugs4 and the UN,5 it is not widely or equitably available to opiate users in England. This year Tower Hamlets became one of the first London boroughs to implement universal access to take-home naloxone to people at risk of accidental opiate overdose. This builds on the experience of the national programmes in Scotland6 and Wales. 7 However, coverage across England remains sparse. Local authorities, clinical commissioning groups, and drugs services need to come together to organise take-home naloxone programmes to reduce the 1000 annual opiate-related deaths in England and Wales.8 We declare no competing interests.
*Tim Crocker-Buque, Chris Lovitt [email protected] Tower Hamlets Local Authority, London, UK 1
Time for universal provision of take-home naloxone It is encouraging to read about the further use of naloxone in the USA to reduce the number of deaths related to opiate overdose,1 and this 308
2
3
4
Alcorn T. America embraces treatment for opioid drug overdose. Lancet 2014; 383: 1957–58. Clark AK, Wilder CM, Winstanley EL. A systematic review of community opioid overdose prevention and naloxone distribution programs. J Addict Med 2014; 8: 153–63. Coffin PO, Sullivan SD. Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal. Ann Intern Med 2013; 158: 1–9. Advisory Council on the Misuse of Drugs. Consideration of naloxone. 2012. https:// www.gov.uk/government/publications/ naloxone-a-review (accessed July 14, 2014).
5
6
7
8
UN Office on Drugs and Crime and WHO. Opioid overdose: preventing and reducing opioid overdose mortality. 2013. http://www. unodc.org/docs/treatment/overdose.pdf (accessed July 14, 2014). McAuley A, Best D, Taylor A, Hunter C, Robertson R. From evidence to policy: the Scottish national naloxone programme. Drugs Educ Prev Policy 2012; 19: 309–19. Bennett T, Holloway K. The impact of take-home naloxone distribution and training on opiate overdose knowledge and response: an evaluation of the THN Project in Wales. Drugs Educ Prev Policy 2012; 19: 320–28. Office for National Statistics. Deaths related to drug poisoning in England and Wales, 2012. http://www.ons.gov.uk/ons/ dcp171778_320841.pdf (accessed July 14, 2014).
Department of Error Bhutta Z, Das J, Bahl R, et al, for The Lancet Every Newborn Study Group. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet 2014; 384: 347–70—In this Series paper, the author “Jeeva M Sankar” should have read “M Jeeva Sankar”. Also, the second sentence of the summary should have read “To meet Every Newborn targets of ten or fewer neonatal deaths and ten or fewer stillbirths per 1000 births in every country by 2035…”. Additionally, the fifth sentence of the Introduction should read “Achievement of the proposed Every Newborn targets of ten or fewer neonatal deaths…”. These corrections have been made to the online version as of June 23, 2014, and to the printed paper. Devos P, Haeffner-Cavaillon N, Ledoux S, Balandier C, Ménard J. Assessing the French Alzheimer plan. Lancet 2014; 383: 1805—In this Correspondence (May 24), the declaration of interests should have read: “JM was involved in the design of the plan. JM has received personal fees from Actelion and Sanofi outside the submitted work. The other authors declare no competing interests”. This correction has been made to the online version as of July 25, 2014.
www.thelancet.com Vol 384 July 26, 2014
11 million births 17 million births
At least four antenatal care visits
48% 50%
9 million births
Skilled birth attendance
40% 18 million births
Contraceptive prevalence among MWRA
53%
10 million women
13% 34 million women
0
5
10 15 20 25 30 People receiving a health service (millions)
35
40
26% 0
20 40 60 80 Population receiving a health service (%)
1990 2012 100
Figure: Population receiving selected health services in sub-Saharan Africa in 1990 and 2012 Sub-Saharan Africa includes all of Africa except northern Africa; Sudan is included in sub-Saharan Africa. Data are from references 2 and 3 and author calculations based on reference 1. MWRA=married or in-union women of reproductive age.
unless programmes and resources are significantly expanded. While the development goals and targets that the world will adopt following 2015 are still unspecified, it is timely to take into account the powerful force that population numbers will play in achieving these goals and targets. The views expressed are those of the authors and do not necessarily reflect the views of the UN. We declare no competing interests.
Vladimíra Kantorová, *Ann Biddlecom, Holly Newby [email protected] United Nations Population Division, Department of Economic and Social Affairs, New York, NY 10017, USA (VK, AB); and Division of Policy and Strategy, United Nations Children’s Fund (UNICEF), New York, NY 10017, USA (HN) Published Online June 23, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)61001-1
1
2
3
United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2012 Revision. http://esa.un.org/unpd/wpp/index.htm (accessed July 3, 2014). United Nations. The Millennium Development Goals Report 2014. http://mdgs.un.org/unsd/ mdg/Default.aspx (accessed July 7, 2014). United Nations, Department of Economic and Social Affairs, Population Division. Model-based Estimates and Projections of Family Planning Indicators 2014. New York: United Nations. http://www.un.org/en/development/desa/ population/theme/family-planning/cp_model. shtml (accessed July 7, 2014).
news highlights how lives could be saved if the UK adopted a similar approach. Despite evidence for the effectiveness2 and cost-effectiveness3 of the lay administration of naloxone, supported by strong recommendations from both Advisory Council on the Misuse of Drugs4 and the UN,5 it is not widely or equitably available to opiate users in England. This year Tower Hamlets became one of the first London boroughs to implement universal access to take-home naloxone to people at risk of accidental opiate overdose. This builds on the experience of the national programmes in Scotland6 and Wales. 7 However, coverage across England remains sparse. Local authorities, clinical commissioning groups, and drugs services need to come together to organise take-home naloxone programmes to reduce the 1000 annual opiate-related deaths in England and Wales.8 We declare no competing interests.
*Tim Crocker-Buque, Chris Lovitt [email protected] Tower Hamlets Local Authority, London, UK 1
Time for universal provision of take-home naloxone It is encouraging to read about the further use of naloxone in the USA to reduce the number of deaths related to opiate overdose,1 and this 308
2
3
4
Alcorn T. America embraces treatment for opioid drug overdose. Lancet 2014; 383: 1957–58. Clark AK, Wilder CM, Winstanley EL. A systematic review of community opioid overdose prevention and naloxone distribution programs. J Addict Med 2014; 8: 153–63. Coffin PO, Sullivan SD. Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal. Ann Intern Med 2013; 158: 1–9. Advisory Council on the Misuse of Drugs. Consideration of naloxone. 2012. https:// www.gov.uk/government/publications/ naloxone-a-review (accessed July 14, 2014).
5
6
7
8
UN Office on Drugs and Crime and WHO. Opioid overdose: preventing and reducing opioid overdose mortality. 2013. http://www. unodc.org/docs/treatment/overdose.pdf (accessed July 14, 2014). McAuley A, Best D, Taylor A, Hunter C, Robertson R. From evidence to policy: the Scottish national naloxone programme. Drugs Educ Prev Policy 2012; 19: 309–19. Bennett T, Holloway K. The impact of take-home naloxone distribution and training on opiate overdose knowledge and response: an evaluation of the THN Project in Wales. Drugs Educ Prev Policy 2012; 19: 320–28. Office for National Statistics. Deaths related to drug poisoning in England and Wales, 2012. http://www.ons.gov.uk/ons/ dcp171778_320841.pdf (accessed July 14, 2014).
Department of Error Bhutta Z, Das J, Bahl R, et al, for The Lancet Every Newborn Study Group. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet 2014; 384: 347–70—In this Series paper, the author “Jeeva M Sankar” should have read “M Jeeva Sankar”. Also, the second sentence of the summary should have read “To meet Every Newborn targets of ten or fewer neonatal deaths and ten or fewer stillbirths per 1000 births in every country by 2035…”. Additionally, the fifth sentence of the Introduction should read “Achievement of the proposed Every Newborn targets of ten or fewer neonatal deaths…”. These corrections have been made to the online version as of June 23, 2014, and to the printed paper. Devos P, Haeffner-Cavaillon N, Ledoux S, Balandier C, Ménard J. Assessing the French Alzheimer plan. Lancet 2014; 383: 1805—In this Correspondence (May 24), the declaration of interests should have read: “JM was involved in the design of the plan. JM has received personal fees from Actelion and Sanofi outside the submitted work. The other authors declare no competing interests”. This correction has been made to the online version as of July 25, 2014.
www.thelancet.com Vol 384 July 26, 2014
