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Sub-Saharan Africa

More than 700 million people live in SSA, the region with the world’s highest population growth, infant mortality, and adult mortality rates. SSA is the only region with a lower life expectancy today than in 1980, due largely to the HIV/AIDS pandemic. The region is the world’s most poverty stricken: since 1990, the percentage of people who live on less than $1 a day has increased to nearly 50%.

Some improvements have been achieved: poverty rates have decreased in Ghana, Uganda, and Cameroon; in many countries, primary education enrollment is up, pressuring governments to expand secondary educational systems.

Publications

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Disease Control Priorities in Developing Countries (2nd Edition)
  1. 1. Investing in Health
    1. The 20th Century Takeoff in Human Health
    2. The Economic Benefits of Better Health
    3. Why Has Mortality Declined at Such Different Rates in Different Countries?
    4. Child Health
    5. HIV/AIDS
    6. Health System Development and Finance
    7. Conclusions
  2. 2. Intervention Cost–Effectiveness: Overview of Main Messages
    1. Assessing the Evidence on the Cost-Effectiveness of Interventions
    2. Annex 2.C: Summary of other Interventions
  3. 3. Strengthening Health Systems
    1. Health System Constraints on the Delivery of Public and Personal Health Services
    2. Assessment of Approaches to Strengthen Health System Capacity
    3. Targeting Resources
    4. Solutions in Low-Capacity Environments
    5. Acknowledgments
  4. 4. Priorities for Global Research and Development of Interventions
    1. Needs, Context, Opportunities, and Major Challenges
    2. Priority Setting
    3. Key Recommendations
  5. 7. Economic Approaches to Valuing Global Health Research
    1. The Value of Health Research
  6. 8. Improving the Health of Populations: Lessons of Experience
    1. Research Methods
    2. Cases
    3. General Findings
    4. Intervention Type, Programmatic Characteristics, and Policies
  7. 9. Millennium Development Goals for Health: What Will It Take to Accelerate Progress?
    1. The Millennium Development Goals for Health: Progress and Prospects
    2. Scaling Up: Defining Interventions and Removing Constraints
    3. What Do Countries Need To Do?
    4. Costing and Financing Additional Spending for the MDGs
  8. 10. Gender Differentials in Health
    1. Antecedents
    2. Cost-Effectiveness of Interventions
  9. 11. Fiscal Policies for Health Promotion and Disease Prevention
    1. Subsidies for Health and Health-Related Products
    2. Taxes and Tax Expenditures: Design and Outcomes
  10. 12. Financing Health Systems in the 21st Century
    1. Health Financing Systems
    2. Health Financing Issues in LICs
  11. 13. Recent Trends and Innovations in Development Assistance for Health
    1. Trends and Gaps in Development Assistance for Health
    2. Making Development Assistance for Health More Effective: Lessons Learned
    3. Recent Innovations to Improve the Effectiveness of Development Assistance for Health
  12. 14. Ethical Issues in Resource Allocation, Research, and New Product Development
    1. Ethics in Research and New Product Development
  13. 15. Cost–Effectiveness Analysis for Priority Setting
    1. Estimating Effectiveness in Health
    2. Determining Costs for Interventions
    3. Cost-Effectiveness and Population Impact
  14. 16. Tuberculosis
    1. Epidemiological Burden and Trends
    2. Interventions against Tuberculosis
    3. Alternative and Complementary Approaches to the Diagnosis and Treatment of Active Disease
    4. Cost-Effectiveness of Interventions against Tuberculosis
    5. Cost-Effectiveness of Managing Tuberculosis Outbreaks
    6. Summary of Cost-Effectiveness Analyses
    7. Conclusions
  15. 17. Sexually Transmitted Infections
    1. Introduction
    2. Bacterial and Viral STIs and Their Sequelae
    3. Burden of STIs and Benefits of Control
    4. Effectiveness of the Principal Interventions
    5. Intervention Costs and Cost-Effectiveness
    6. Scaling Up Control Strategies
  16. 18. HIV/AIDS Prevention and Treatment
    1. Obstacles to HIV Control
    2. Action under Uncertainty
    3. Prevention in Theory and Practice: Using Epidemic Profiles and Contextual Factors to Inform Prevention Guidelines
    4. Care and Treatment
  17. 19. Diarrheal Diseases
    1. Public Health Significance of Diarrheal Illnesses
    2. Preventive Strategies
    3. Case Management
  18. 20. Vaccine–Preventable Diseases
    1. Causes and Epidemiology of Diseases Prevented by Vaccines Used in National Immunization Programs
    2. Estimates of the Current Burden of Vaccine-Preventable Diseases and of the Burden Averted by Vaccination
    3. Costs and Cost-Effectiveness of Existing Vaccination Programs
    4. Cost-Effectiveness of Increasing Immunization Coverage for the Traditional EPI
    5. Costs and Cost-Effectiveness of Adding New Antigens to the Current Immunization Schedule
    6. Conclusions
  19. 21. Conquering Malaria
    1. Causes, Epidemiology, Manifestations, and Diagnosis
    2. Burden of Disease
    3. Interventions and Their Effectiveness
    4. Economics of Malaria Control Interventions
    5. Research Priorities
    6. Conclusion
  20. 22. Tropical Diseases Targeted for Elimination: Chagas Disease, Lymphatic Filariasis, Onchocerciasis, and Leprosy
    1. Disease Characteristics and Transmission
    2. Disease Burden
    3. Interventions and Their Effectiveness
    4. Costs and Cost-Effectiveness of Interventions
    5. Conclusion
  21. 23. Tropical Diseases Lacking Adequate Control Measures: Dengue, Leishmaniasis, and African Trypanosomiasis
    1. Disease Characteristics and Transmission
    2. Disease Burden
    3. Management and Control Strategies
    4. Costs and Cost-Effectiveness of Interventions
    5. Problems and Challenges for Disease Control
  22. 24. Helminth Infections: Soil–Transmitted Helminth Infections and Schistosomiasis
    1. Causes and Characteristics of Helminth Infections
    2. Burden of the Disease
    3. Cost-Effectiveness Analysis of Interventions
    4. Averted, Avertable, and Nonavertable Burden
    5. Economic Benefits of Intervention
    6. Implementation of Control Strategies: Lessons of Experience
    7. Research and Development
  23. 25. Acute Respiratory Infections in Children
    1. Causes of ARIs and the Burden of Disease
    2. Interventions
    3. Cost-Effectiveness of Interventions
    4. Implementation of ARI Control Strategies: Lessons of Experience
  24. 26. Maternal and Perinatal Conditions
    1. Epidemiology of Maternal and Perinatal Conditions
    2. Interventions
    3. Cost-Effectiveness of Selected Intervention Packages
    4. Lessons for Implementation
    5. Conclusions
    6. Annex 26.A: CEA Model Assumptions
  25. 27. Newborn Survival
    1. Neonatal Deaths
    2. Interventions
    3. Marginal Impact and Cost of Scaling Up Universal Neonatal Packages
    4. Implementation
    5. Conclusions
  26. 28. Stunting, Wasting, and Micronutrient Deficiency Disorders
    1. Nature, Causes, and Burden of Undernutrition
    2. Interventions
    3. Intervention Costs and Cost-Effectiveness
    4. Economic Benefits of Intervention
  27. 29. Health Service Interventions for Cancer Control in Developing Countries
    1. Burden of Cancer in Developing Countries
    2. Cost-Effectiveness of Cancer Control Interventions
  28. 31. Mental Disorders
    1. Cost-Effectiveness Methods and Results
    2. Policy and Service Implications
    3. Conclusion: Public Support for a Cost-Effective Intervention Package
  29. 32. Neurological Disorders
    1. Epilepsy
    2. Stroke
    3. Cost-Effectiveness of Interventions in Developing Countries
  30. 33. Cardiovascular Disease
    1. Epidemiology of CVD
    2. Burden of Disease
    3. Cost-Effectiveness of Interventions
    4. Conclusions: Pitfalls and Promises
  31. 34. Inherited Disorders of Hemoglobin
    1. Introduction
    2. Burden of Disease
    3. Costs and Effectiveness of Diagnosis and Management
    4. Options for Control and Management of Inherited Hemoglobin Disorders
  32. 35. Respiratory Diseases of Adults
    1. Acute Diseases: Pneumonia and Influenza
    2. Chronic Respiratory Diseases: Nature, Causes, and Burden
    3. Occupational Lung Disease and Other Respiratory Diseases
    4. General Approach to Lowering Risk of Adult Respiratory Disease
  33. 36. Diseases of the Kidney and the Urinary System
    1. Causes of Diseases of the Kidney and Urinary System
    2. Implementation of Control Strategies: Lessons of Experience
    3. Research and Development Agenda
    4. Conclusions: Promises and Pitfalls
  34. 37. Skin Diseases
    1. Prevalence of Skin Diseases
    2. Patterns of Skin Diseases at the Community Level
    3. Skin Diseases
    4. Current Status of Community Control Measures in Dermatology
  35. 38. Oral and Craniofacial Diseases and Disorders
    1. Dental Caries
    2. Aspects of Treatment of Cavities and of Caries Disease
    3. Oral Manifestations of HIV/AIDS
    4. Noma (Cancrum Oris)
    5. Fluorosis of Teeth
  36. 39. Unintentional Injuries
    1. Burden and Causes of Unintentional Injuries
    2. Interventions
    3. Costs, Cost-Effectiveness, and Economic Benefits of Intervention
  37. 40. Interpersonal Violence
    1. The Nature, Burden, and Causes of Interpersonal Violence
    2. Economic Impact of Violence
    3. Interventions
    4. Cost-Effectiveness of Interventions
    5. Implementation of Prevention Strategies
    6. Conclusions: Promises and Pitfalls
  38. 41. Water Supply, Sanitation, and Hygiene Promotion
    1. Water Supply
    2. Excreta Disposal
    3. Hygiene Promotion
    4. Effect on Burden of Disease
  39. 42. Indoor Air Pollution
    1. Nature, Causes, and Burden of Condition
    2. Intervention Costs and Effectiveness
    3. Implementation of Control Strategies: Lessons from Experience
    4. Conclusions
  40. 44. Prevention of Chronic Disease by Means of Diet and Lifestyle Changes
    1. Interventions
    2. Cost-Effectiveness of Interventions
  41. 45. The Growing Burden of Risk from High Blood Pressure, Cholesterol, and Bodyweight
    1. Burden of the Disease, Condition, or Risk Factor
    2. Cost-Effectiveness of Interventions
    3. Economic Benefits of Intervention
  42. 46. Tobacco Addiction
    1. Health Consequences of Smoking
    2. Effectiveness and Cost-Effectiveness of Tobacco-Control Interventions
    3. Constraints to Effective Tobacco-Control Policies
  43. 47. Alcohol
    1. Epidemiology of Alcohol Use and Alcohol-Related Disease Conditions
    2. Interventions for Reducing High-Risk Drinking
    3. Cost-Effectiveness of Interventions
    4. Implementation of Control Strategies: Lessons of Experience
  44. 48. Illicit Opiate Abuse
    1. Nature, Causes, and Health Consequences of Illicit Opioid Use
    2. Interventions for Illicit Opioid Dependence
    3. Annex 48.A: Prevalence of Use, Adverse Health Effects of and Interventions for Cannabis, Cocaine, Amphetamines, and MDMA Use and Dependence
  45. 49. Learning and Developmental Disabilities
    1. Interventions in Low- and Middle-Income Countries
  46. 50. Loss of Vision and Hearing
    1. Nature, Causes, and Epidemiology of Vision Loss
  47. 51. Cost–Effectiveness of Interventions for Musculoskeletal Conditions
    1. Burden of Musculoskeletal Disease
    2. Research and Development
  48. 52. Pain Control for People with Cancer and AIDS
    1. Interventions for Pain Relief
    2. Costs and Cost-Effectiveness
    3. Implementation of Strategies to Improve Pain Control
  49. 53. Public Health Surveillance: A Tool for Targeting and Monitoring Intervention
    1. Selected Surveillance Strategies
    2. The Role of Surveillance in Major Outbreaks
    3. Surveillance for Specific Conditions
  50. 54. Information to Improve Decision Making for Health
    1. Systems and Supply of Health Information
    2. Benefits, Costs, and Cost-Effectiveness of Improved Information
    3. Implementation of Change: Lessons of Experience
  51. 55. Drug Resistance
    1. Risk Factors
    2. Interventions
    3. Implementation of Strategies: Two Lessons from Experience
  52. 56. Community Health and Nutrition Programs
    1. What Is Known about Efficacy and Effectiveness
    2. Community- and Facility-Based Programs
    3. Community-Based Programs—What Are They?
    4. Programmatic Factors
    5. Contextual Factors
    6. Results
    7. Future Applications
  53. 57. Contraception
    1. Nature, Causes, and Burden of the Conditions That Can Be Addressed
    2. Interventions
    3. Intervention Cost and Cost-Effectiveness
    4. Economic Benefits of Intervention
  54. 58. School–Based Health and Nutrition Programs
    1. Infectious Disease and School-Age Children
    2. Interventions
    3. Economic Benefits of Intervention
    4. Implementation of Programs and Lessons from Experience
    5. Research and Development Agenda
  55. 59. Adolescent Health Programs
    1. Nature and Causes of the Burden of Disease in Young People
    2. Interventions
    3. Costs and Cost-Effectiveness of Interventions
    4. Economic Analysis
    5. Program Implementation and Lessons of Experience
  56. 60. Occupational Health
    1. Nature and Causes of Occupational Health Conditions in the Developing World
    2. Interventions
    3. Economic Aspects of Intervention
    4. Implementation
  57. 62. Control and Eradication
    1. Disease-Specific Case Studies
  58. 63. Integrated Management of the Sick Child
    1. Nature, Causes, and Burden of Child Mortality
    2. Policy Shift to Integrated Management
    3. Interventions
    4. Intervention Cost and Cost-Effectiveness
    5. Implementation of Programs: Lessons of Experience
    6. Conclusions: Promises and Pitfalls
  59. 64. General Primary Care
    1. The Scope of General Primary Care Practice
    2. The Effectiveness of General Primary Care
    3. Scaling Up
    4. A Research and Development Agenda for General Primary Care
    5. Acknowledgments
  60. 65. The District Hospital
    1. Economics of District Hospitals: A Summary of Reported Experience
    2. Effecting Change with Cross-Cutting Interventions
    3. The Future: Research and Information Needs
  61. 66. Referral Hospitals
    1. Functions and Benefits
    2. Determinants of an Appropriate Balance of Referral-Level Care
    3. Current Balance of Care in Practice
    4. Getting Better Value for Money from the Hospital System
  62. 67. Surgery
    1. Nature, Causes, and Burden of Surgical Conditions
    2. Costs and Cost-Effectiveness of Interventions
  63. 68. Emergency Medical Services
    1. Interventions for Emergency Care: Systems, Structures, and Organization
    2. Conclusions: Promises and Pitfalls
    3. Definitions
  64. 69. Complementary and Alternative Medicine
    1. Economics of Complementary and Alternative Medicine and Traditional Medicine
    2. Expanding the Beneficial Use of Complementary and Alternative Medicine and Traditional Medicine
  65. 70. Improving the Quality of Care in Developing Countries
    1. Policy Interventions to Improve Quality
    2. Economic Benefits and Costs of Quality Care
  66. 71. Health Workers: Building and Motivating the Workforce
    1. Health Care Staff
    2. Health Worker Incentives
  67. 72. Ensuring Supplies of Appropriate Drugs and Vaccines
    1. Selection of Drugs
    2. Issues for the Future
  68. 73. Strategic Management of Clinical Services
    1. Managing Clinical Services in Different Settings
    2. The Specifics: What Works?
Global Burden of Disease and Risk Factors
  1. 1. Measuring the Global Burden of Disease and Risk Factors, 1990—2001
    1. Improving the Comparative Quantification of Diseases, Injuries, and Risk Factors: The 2001 GBD Study
    2. Major Findings of the 2001 GBD Study
  2. 2. Demographic and Epidemiological Characteristics of Major Regions, 1990—2001
    1. Regional Demographic Characteristics
    2. Changes in Mortality, 1990–2001
    3. Trends in Causes of Child Death, 1990–2001
    4. Discussion
  3. 3. The Burden of Disease and Mortality by Condition: Data, Methods, and Results for 2001
    1. Quantifying the Global Burden of Disease
    2. Estimating Deaths by Cause: Methods and Data
    3. Global and Regional Mortality in 2001
    4. Estimating Incidence, Prevalence, and YLD: Methods and Data
    5. Burden of Disability and Poor Health in 2001
    6. Global Burden of Disease in 2001
    7. Discussion and Conclusions
  4. 5. Sensitivity and Uncertainty Analyses for Burden of Disease and Risk Factor Estimates
    1. Uncertainty Estimates for All-Cause Mortality and Life Expectancies
    2. Uncertainty Estimates for Regional Mortality by Cause
    3. Discussion
  5. 6. Incorporating Deaths Near the Time of Birth into Estimates of the Global Burden of Disease
Priorities in Health
  1. 1. Accomplishments, Challenges, and Priorities
    1. Historical Achievements in World Health
    2. Equity
  2. 2. Success in Addressing Priorities
    1. Successes That Strengthened Weak Health Systems
    2. Cost-Effective Interventions Beyond Health Systems
  3. 3. Cost–Effectiveness Analysis
    1. What Is Cost-Effectiveness Analysis?
    2. How Can Policy Makers Use Cost-Effectiveness Analysis?
  4. 4. Cost–Effective Strategies for the Excess Burden of Disease in Developing Countries
    1. Infectious and Communicable Diseases
    2. Maternal and Neonatal Health
  5. 5. Cost–Effective Strategies for Noncommunicable Diseases, Risk Factors, and Behaviors
    1. Cardiovascular Disease, Diabetes, High Blood Pressure, Cholesterol, and Bodyweight
    2. Cancer
    3. Congenital and Developmental Disorders
    4. Unintentional Injuries
    5. Tobacco Use
    6. Alcohol Abuse
    7. Mental Health
  6. 6. Providing Interventions
    1. Levels of Care
    2. Cross-Level Services and Inputs
    3. Integration of Services Across the Life Cycle
  7. 7. Pillars of the Health System
    1. Information, Surveillance, and Research
    2. Management of Health Services
    3. Human Resources
    4. Financing

Chapter Presentations

Chapter 01. Investing in Health
  1. Changes in Life Expectancy, 1960-2002, By World Bank Region
  2. Rate of Change in Life Expectancy, 1960-2002, By World Bank Region
  3. Under-Five Deaths from AIDS, Malaria, and Other Causes, Sub-Saharan Africa
Chapter 02. Intervention Cost-Effectiveness: Overview of Main Messages
  1. Cost-effectiveness of Interventions for Malaria in Sub-Saharan Africa
  2. Neglected Low-Cost Opportunities in Sub-Saharan Africa: Cardiovascular Disease
  3. Neglected Low-Cost Opportunities in Sub-Saharan Africa: HIV/AIDS and Maternal and Neonatal Care
  4. Neglected Low-Cost Opportunities in Sub-Saharan Africa: Traffic Accidents, Surgical Services, and Emergency Care
  5. Neglected Low-Cost Opportunities in Sub-Saharan Africa: Childhood Immunization, Malaria, and Childhood Illnesses
Chapter 04. Priorities for Global Research and Development of Interventions
  1. Leading Causes of Disease Burden, by Select World Bank Region, 2001
  2. Disease Burden Distribution, by Select World Bank Region, 2001
Chapter 20. Vaccine-Preventable Diseases
  1. Cost per Deaths and Disability Adjusted Life Years Averted by Vaccination, 2001
  2. Deaths Averted by Vaccination for Hib and Hepatitis B, 2001
  3. Deaths Averted by Vaccination for Measles and Yellow Fever, 2001
  4. Annual Cost per Fully Immunized Child for the Traditional Childhood Vaccines, By Region, 2001
  5. Deaths Averted by Vaccination for Diphtheria and Whooping Cough, 2001
  6. Deaths Averted by Vaccination for Tetanus and Polio, 2001
Chapter 10. Gender Differentials in Health
  1. Gender Ratio of Conditions that Affect Women Disproportionately, 2001
  2. Percentage of DALYs Resulting from Selected Conditions Specific to Women, 2001
  3. Burden of Disease, By Gender and Region, 2001
  4. Gender Ratio of Conditions that Affect Women Disproportionately, 2001
Chapter 28. Stunting, Wasting, and Micronutrient Deficiency Disorders
  1. Vitamin A Deficiency Among Children Under Age Five, By Region
  2. Zinc Deficiency Among Children Under Age Five, By Region
  3. Iron Deficiency Anemia Among Children Under Age Five, By Region
  4. Percent of Underweight Children Under Age Five, By Region
  5. Childhood Deaths and DALYs Attributable to Being Underweight, By Region
  6. Iodine Deficiency Among Children Under Age Five, By Region
Chapter 26. Maternal and Perinatal Conditions
  1. Estimates of Maternal Mortality, By Region, 2000
  2. Cost-effectiveness of Interventions for Maternal and Perinatal Conditions
  3. DALYs for Maternal and Early Neonatal* Conditions, Selected Regions, 2001
  4. Deaths in the First Week of Life, Selected Regions, 2001
Chapter 31. Mental Disorders
  1. DALYs Averted by a Mental Health Care Package, By Region
  2. Disease Burden of Selected Major Psychiatric Disorders, By Region, 2001
  3. Costs of a Mental Health Care Package, By Region
  4. Cost-effectiveness of a Mental Health Care Package, By Region
Chapter 21. Conquering Malaria
  1. Estimated Deaths from Malaria in Children Under Age Five in Africa, 2000
Chapter 33. Cardiovascular Disease
  1. Cost-effectiveness of Medical Therapy for Coronary Heart Disease, By Region
  2. Cardiovascular Events and Deaths Preventable By Medical Therapy
  3. Cost-effectiveness of Medical Therapy for Heart Attacks, By Region
Chapter 27. Newborn Survival
  1. Universal Scale-up of Newborn Care
  2. Cost of Adding Newborn Care Packages to Maternal and Child Health Services
Chapter 59. Adolescent Health Programs
  1. Young People Ages 20-24 Who Were Married Before Age 20, By Gender
  2. Young Sexually Active Women Using Contraception, By Age Group
  3. Young Sexually Active Women Using Contraception, By Age Group
Chapter 47. Alcohol
  1. Prevalence of High-Risk Drinking, By Gender, Age, and Region, 2000
  2. DALYs Lost Due to High-Risk Drinking, By Disease Category and Region, 2001
  3. Estimated Impact of Interventions to Reduce High-Risk Drinking in Europe and Central Asia, Latin America and the Caribbean, and Sub-Saharan Africa
  4. Estimated Cost-effectiveness of Interventions to Reduce High-Risk Drinking in Europe and Central Asia, Latin America and the Caribbean, and Sub-Saharan Africa
Chapter 68. Emergency Medical Services
  1. Estimated Cost-effectiveness of Combined Use of Trained Lay First Responders and Paramedics
  2. Estimated Cost-effectiveness of Staffed Community Ambulances in Urban Areas
  3. Estimated Cost-effectiveness of Staffed Community Ambulances in Rural Areas
Chapter 44. Prevention of Chronic Disease by Means of Diet and Lifestyle Changes
  1. Incremental Cost-effectiveness of Reducing Salt Content by Legislation and Public Education
  2. Incremental Cost-effectiveness of Reducing Saturated Fat Content
  3. Incremental Cost-effectiveness of Reducing Trans Fat
Chapter 30. Diabetes: The Pandemic and Potential Solutions
  1. Estimated Direct Medical Costs of Diabetes, By Region, 2003
  2. Estimated Diabetes Deaths and DALYs Lost Among People Ages 20 to 79, By Region, 2001
  3. Estimated Number of People Ages 20 to 79 with Diabetes, By Region, 2003 and 2025
Chapter 39. Unintentional Injuries