• The proportion of under-nourished children under five years of age declined from 27% in 1990 to 20% in 2005.
• Some 27% fewer children died before their fifth birthday in 2007 than in 1990.
• Maternal mortality has barely changed since 1990.
• One third of 9.7 million people in developing countries who need treatment for HIV/AIDS were receiving it in 2007.
• MDG target for reducing the incidence of tuberculosis was met globally in 2004.
• 27 countries reported a reduction of up to 50% in the number of malaria cases between 1990 and 2006.
• The number of people with access to safe drinking-water rose from 4.1 billion in 1990 to 5.7 billion in 2006. About 1.1 billion people in developing regions gained access to improved sanitation in the same period.
• Globally, the proportion of children under five years of age suffering from under-nutrition, according to WHO Child Growth Standards, declined from 27% in 1990 to 20% in 2005. But, the progress is uneven, and an estimated 112 million children are underweight.
• Globally, the number of children who die before their fifth birthday has been reduced by 27% from 12.5 million estimated in 1990 to 9 million in 2007. This reduction is due to a combination of interventions, including the use of insecticide-treated mosquito nets for malaria, oral rehydration therapy for diarrhoea, increased access to vaccines for a number of infectious diseases and improved water and sanitation. But pneumonia and diarrhoea continue to kill 3.8 million children aged under five each year, although both conditions are preventable and treatable.
• The global maternal mortality ratio of 400 maternal deaths per 100 000 live births in 2005 has barely changed since 1990. Every year an estimated 536 000 women die in pregnancy or childbirth. Most of these deaths occur in sub-Saharan Africa where the maternal mortality ratio is 900 per 100 000 births and where there has been no measurable improvement since 1990. A woman in Africa may face a 1-in-26 lifetime risk of death during pregnancy and childbirth, compared with only 1 in 7300 in the developed regions. 1 There are, however, signs of progress in some countries in Asia and Latin America and the Caribbean.
• The percentage of adults living with HIV worldwide has remained stable since 2000 but there were an estimated 2.7 million new infections during 2007. Moreover, deaths are increasing in parts of Africa, particularly eastern and southern Africa. The use of antiretroviral therapy has increased; in 2007, about 1 million more people living with HIV received the treatment. That means one third of the estimated 9.7 million people in developing countries who need the treatment were receiving it.
• The MDG target for reducing the incidence of tuberculosis was met globally in 2004. Since then, incidence has continued to fall slowly. Thanks to early detection of new cases and effective treatment using the WHO-recommended DOTS treatment strategy, treatment success rates have been consistently improving, with rates rising from 79% in 1990 to 85% in 2006. Multi-drug resistant tuberculosis is a challenge in countries, such as those of the former Soviet Union, while the lethal combination of HIV and tuberculosis is an issue particularly for sub-Saharan African countries.
• Efforts to control malaria are beginning to pay off with significant increases in the proportion of children sleeping under insecticide-treated mosquito nets. Although it is still too early to register the global impact, 27 countries – including five in Africa – have reported a reduction of up to 50% in malaria cases between 1990 and 2006. In 2006, the number of cases was estimated to be 250 million globally.
• Progress has been made in treating neglected tropical diseases that affect some 1.2 billion people. For example, only 9585 cases of dracunculiasis (guinea-worm disease) were reported in the five countries where the disease is endemic, compared with an estimated 3.5 million reported in 20 such countries in 1985.
• The number of people with access to safe drinking water rose from an estimated 4.1 billion in 1990 to 5.7 billion in 2006. But 900 million people still had to rely on water from what are known as unimproved sources, for example surface water or an unprotected dug well.
• Since 1990, an estimated 1.1 billion people in developing regions have gained access to improved sanitation. In 1990, just under 3 billion people had access to sanitation. Their number rose to more than 4 billion by 2006. Yet, in 2006 some 2.5 billion did not have access to improved sanitation and 1.2 billion had to practise open defecation.
• Although nearly all developing countries publish an essential medicines list, the availability of medicines at public health facilities is often poor. Surveys in about 30 developing countries show that availability of selected medicines at health facilities was only 35% in the public sector and 63% in the private sector. Lack of medicines in the public sector often means patients have no choice but to purchase them privately or do without treatment.
• More than three-quarters of pregnant women in India received at least some antenatal care (ANC), but only half of women had at least three ANC visits with a health provider during their pregnancy.
• The disparity between urban and rural women was especially pronounced, with 74% of urban women having ANC at least three times, compared with 43% of rural women. Births assisted by a health professional increased to 49% from 42%, with 75% of urban women but only 39% of rural women in NFHS-3 received assistance from a health professional.
• Institutional births increased from 34% to 41%, but most women still deliver their children at home. Only about one-third of women received postnatal care within two days of delivery.
Trends in health care infrastructure