• 2018-07
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  • br As one of the


    As one of the few countries that have achieved Millennium Development Goals 4 and 5, China has had a remarkable decline in under-5 mortality rate in past three decades. Drivers of such rapid improvement in China have been widely discussed. In , Chunhua He and colleagues report a decline in under-5 mortality rate in China at the national and regional level, and the level and trend of cause-specific mortality for under-5 age groups. Results presented in this study are important for China in the Sustainable Development Goal era and are of global relevance in guiding effective interventions and evidence-based decision making in other developing countries. As shown in He and colleagues\' study, major reductions have been observed for mortality due to neonatal tetanus, diarrhoea, and pneumonia from 1996 to 2015. By contrast, the decline in mortality due to concomitant congenital malformations and complications of preterm birth was lower. There are two possible reasons for the reductions: natural reduction or disappearance of the causative agent, and deliberate interventions or improvement in socioeconomic conditions of the fiin under investigation. Many researchers have argued that improvements in hospital delivery rate, nutrition, sanitary conditions, and medical services in general are the main contributing factors for the decline of mortality rates caused by neonatal tetanus, diarrhoea, and pneumonia in China. The relatively slower progress made in mortality due to congenital malformations and prematurity complications might be associated with worsening environmental conditions. Identification of the major risk factors for death, reduction of the pathogenic effect, and implementation of early screening and intervention for these diseases are crucial to further improve survival and reduce health disparity in children younger than 5 years in China.
    In the , Martin Wegman and colleagues present their study of opioid use in opioid-dependent individuals released from compulsory drug detention centres (CDDCs) compared with those from voluntary methadone treatment centres (VTCs) in Malaysia. This study was the first prospective observational study to compare drug-use outcomes between the two facility types. The investigators showed that opioid-dependent individuals in CDDCs were significantly more likely to relapse to opioid use after release than opioid-dependent individuals receiving methadone in VTCs (in unadjusted analyses, CDDC participants had significantly more rapid relapse to opioid use post-release compared with VTC participants [median time to relapse 31 days IQR 26–32 352 days 256–inestimable , log rank test p<0·0001). As such, the findings of this study make another contribution to the growing literature base on the ineffectiveness of CDDCs in treating drug dependence. The study also builds on an expanding evidence base of scientific research into the effectiveness of pharmacological drug dependence treatment approaches. These findings are an important addition to the many reports on CDDCs undertaken mainly by non-governmental organisations committed to promoting human rights of marginalised and vulnerable individuals, but which at times have not contained the scientific rigour needed to warrant government attention, especially from governments that do not welcome criticism of the CDDCs\' approach to curtailing drug use and drug dependence.
    Tackling of child malnutrition is key to achieving the third Sustainable Development Goal of good health and wellbeing for all. During the past 15 years, improvements have been achieved in overall mortality from acute childhood illnesses such as malaria, diarrhoea, and pneumonia. However, children with impaired growth are still at elevated risk of death from these common infections and are limited in their neurodevelopmental potential. Stunting (ie, low height-for-age) is the commonest form of malnutrition, and the most difficult to prevent or treat.