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    • The study by Quentin Vincent and colleagues in makes good

    2019-05-13

    The study by Quentin Vincent and colleagues in makes good use of data collected with the WHO Buruli ulcer forms. Vincent and colleagues exploited and analysed data for 1357 laboratory-confirmed cases of Buruli ulcer during 10 years at the treatment centre in Pobè, Benin, to provide qualitative and quantitative information about clinical features, diagnosis, treatment, and follow-up. Unlike other published studies that have included clinically diagnosed cases only, this analysis was done on laboratory-confirmed cases of Buruli ulcer, which lends significance to the study. In this study, oedema was most frequent in children, and in the most severe form, led to sequelae in 30% of cases. Plaques and nodules were also more frequent in children and all these clinical presentations decreased significantly with age. Another interesting finding is that osteomyelitis caused by presented without any skin lesion in 20% of cases. Clinicians should therefore pay more attention to the diagnosis of osteomyelitis in young people in endemic areas. They also need to be aware of the special challenges in the diagnosis and management of Buruli ulcer according to lesion type. Some characteristics of the disease reported in other studies were also confirmed by Vincent and colleagues: patients with Buruli ulcer were young, with a median age of 12 years, lesions were mainly localised in the limbs, and 90% of lesions were unifocal. The disseminated non-ulcerative form of infection as oedema is well known and has been reported in severe forms in children.
    Although Millennium Development Goals 4, 5, and 6 have helped mobilise global action to improve health, many sub-Saharan African countries will not come close to achieving the maternal and child mortality targets. Millennium Development Goals 4 and 5a, which call for a two-thirds dna staining in under-5 mortality (U5MR) and a three-quarters reduction in maternal mortality (MMR) on the basis of reductions reported in a few countries outside of sub-Saharan Africa, have been used as benchmarks against which to measure every country. By these measures, 75% of African countries are considered off-track for both goals, despite often impressive gains. Grouping of all sub-Saharan African countries short of these targets as off-track does not differentiate between countries that are making impressive progress and those that are lagging behind reasonable expectations, rendering such targets of minimal use for planning and evaluation. Because successful countries take into account existing resources and context when planning cross-sectoral investments to reduce maternal and child mortality, the targets they aim for should also account for local contexts. While retaining the ambition of the global goals, country-specific targets might be more operational. With 2015 approaching and new goals for 2030 in discussion, a risk of again setting impracticable goals exists for countries where progress is most needed. Global targets for MMR of 70 per 100 000 livebirths, neonatal mortality (NMR) of 12 per 1000 livebirths, and U5MR of 25 per 1000 livebirths by 2030 are being discussed. As a test of the practicality of these proposed targets, we determined how many countries could reach them under a regional best performance scenario.
    When the UN Secretary-General submitted his September, 2013, report to a meeting of the UN General Assembly on the post-2015 development agenda, sexual and reproductive health issues were recognised as key elements of sustainable development. The report called for women and girls to have access to “the full range of health services, including in the area of sexual and reproductive health and reproductive rights”. This call is notable for several reasons; not only for the willingness of the Secretary-General to consider sexual and reproductive health as an important element for sustainable societies and the future global health agenda but also, unfortunately, for what it omits. Specifically, within the Secretary-General\'s proposed health goal, with its aim “to realise women\'s reproductive health and rights”, no mention of human sexuality and concomitant rights in relation to sexual health is present, and, importantly, the report only calls for services to be available for half the population.