nos inhibitor Tobacco use is poised to kill as many
Tobacco use is poised to kill as many as 1 billion people in the 21st century, primarily from non-communicable diseases. Less often noted is the effect of tobacco use and second-hand smoke exposure on maternal and child health. Cigarette smoking during pregnancy poses serious risk to the mother and her developing child, and second-hand smoke exposure is now recognised as an important cause of adult and child morbidity and mortality. Pregnancy is an ideal opportunity to intervene with mothers and nos inhibitor to prevent and control tobacco use, and should be a priority for both tobacco control and maternal and child health experts.
Understanding the scope of maternal tobacco use and mothers\' and children\'s second-hand smoke exposure to intervene and address these problems requires up-to-date, nationally representative, comparable data. However, surveillance deficits are common, even in high-income countries in which women\'s tobacco use has been a problem for decades. Deficits in data are far more pronounced in low-income and middle-income countries (LMICs), especially those in which tobacco control efforts are not yet robust.
In , Rishi Caleyachetty and colleagues provide the most comprehensive assessment of tobacco use in pregnant women in LMICs so far. The authors used data from the nationally representative household Demographic and Health Surveys (DHS) that provide data for many topics, including tobacco use in pregnancy. In 54 countries where the DHS was conducted between 2001 and 2012, the overall prevalence of any form of tobacco use in pregnant women was 2·6% (1·3% smoking; 0·9% smokeless tobacco). Tobacco use during pregnancy was reported in all WHO regions, and some countries had much higher maternal smoking rates, such as Nepal (5·9%), Jordan (9·6%), and Turkey (15·0%). In 21 countries, maternal smokeless tobacco use was higher than was tobacco smoking, emphasizing the importance of assessing all forms of tobacco use.
The sex ratio of mortality in children younger than 5 years (under-5s) has always been regarded as an important indicator for child health and survival, especially in the context of sex preference and discrimination in many cultures such as those in south Asia. However, the effective use of this indicator to improve child health and survival has been constrained by the absence of a clear understanding of what the ideal ratio should be. In , Leontine Alkema and colleagues report findings from their systematic assessment of country-specific sex ratios for mortality in infants (aged <1 year), children (aged 1–4 years), and under-5s. Using Bayesian hierarchical time series models, the investigators examine changes from 1990 to 2012. They also attempt to identify outlying countries with excessive female mortality rates. The investigators thus address an important topic and their study is likely to generate much interest, not only among researchers interested in the methodological aspects of the analysis, but more so among public health practitioners who are now increasingly concerned about reducing disparities as we make progress by saving the lives of increasing number of children.
Avahan, the India AIDS Initiative funded by the Bill & Melinda Gates Foundation, is one of the largest HIV prevention programmes targeted to populations at high risk of infection. The initiative operated across 22 districts and committed US$258 million from 2004 to 2009, reaching 154 425 individuals. Through work with non-governmental organisations (NGOs), and a focus on peer-led interventions, trichocysts offered a package of services that included risk-reduction education, access to condoms, screening and treatment for sexually transmitted infection, and referral to clinical services as appropriate. Avahan was a full-scale, real-world test of the generally accepted principle that focused prevention in high-risk groups, particularly in the context of a concentrated epidemic, can substantially and efficiently reduce the incidence of HIV infection. Although these findings are not novel, showing them in the context of a programme of this scale is important and should increase the confidence of global health decision makers that investments in thoughtfully designed, scaled-up prevention programmes can yield large effects on health.