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    • Ethiopia is faced with challenging circumstances It is

    2019-05-18

    Ethiopia is faced with challenging circumstances. It is a low-income country, with a gross domestic product estimated by the International Monetary Fund at US$570 per person in 2014, and 66% of the order T0901317 living on less than US$2 per day in 2011—rates that are even lower than the averages for sub-Saharan Africa. The population\'s health status is also poor overall, with a healthy life expectancy at birth of 55 years and an under-5 mortality rate of 55 per 1000 livebirths. The high rates of poverty and mortality in Ethiopia allows such an extended cost-effectiveness analysis to contribute to the ongoing debate about intervention prioritisation in the country.
    Three of the eight Millennium Development Goals (MDGs) concerned health. There is only one health goal in 17 proposed Sustainable Development Goals (SDGs). Critiques of the MDGs included missed opportunities to realise positive interactions between goals. Here we report on an interdisciplinary analytical review of the SDG process, in which experts in different SDG areas identified potential interactions through a series of interdisciplinary workshops. This process generated a framework that reveals potential conflicts and synergies between goals, and how their interactions might be governed. In our framework, the 17 SDGs are represented in three concentric layers, reflecting their main intended outcomes (). The single health goal is in the inner layer of people-centred goals that aim to deliver individual and collective wellbeing through improved health and education, ensuring equitable distribution within and between individuals and countries. The wellbeing goals are supported by second-level goals that relate to the production, distribution, and delivery of goods and services including food, energy, clean water, and waste and sanitation services in cities and human settlements. We call these infrastructure goals, as they address essential functions of modern societies necessary to deliver the wellbeing goals and provide a platform for delivering the wellbeing goals. The figure\'s outer layer contains three natural environment goals which relate to the governance of natural resources and public goods in land, ocean, and air, including biodiversity and climate change. The biophysical systems that underpin sustainable development are all here. Although these systems are not dependent on human activities, human activities strongly influence them.
    In low-income and middle-income countries (LMICs), systematic research regarding the prevalence and personal consequences of patients who are unable to pay their medical bills has been scarce. However, news headlines frequently tell a simple story of detention—eg, “Kenyan mothers too poor to pay for treatment locked up in hospital”. Similar reports are found in Burundi, Ghana, India, Liberia, Nigeria, the Philippines, and Zimbabwe.
    With more than 20 000 cases reported, the outbreak of Ebola virus disease (EVD) in west Africa is by far the largest in recorded history. Despite the scale of the current outbreak, EVD is often perceived as a “small-scale killer”. By comparison, malaria caused an estimated 854 000 deaths worldwide in 2013. However, although limited at the global level, the impact of EVD on mortality could be substantial in countries with intense transmission. We thus aimed to compare EVD with other causes of death in Liberia, Sierra Leone, and Guinea in 2014. We did an uncertainty analysis of EVD mortality (see ), based on two parameters: the extent of under-reporting of EVD cases and the case fatality rate (CFR)—ie, the proportion of EVD cases who die. Similar to other analyses of EVD spread, we hypothesised that there were up to 2·5 times more EVD cases than reported. This factor derives from a mathematical model, which compared the reported number of EVD cases to the number of beds in use in Ebola treatment units in August, 2014. We assumed that the CFR varied between 60% and 85%. The lower rate corresponds to CFRs seen among hospitalised EVD patients with known disease outcomes. Lower CFRs have been documented, but only in Ebola treatment units that implement non-standard treatment protocols. The upper order T0901317 rate corresponds to CFRs seen in non-hospitalised EVD patients.