前期25「イギリス文化論」 日英高齢化社会資料リンク集 xapaga

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2014

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2014

WHO Library Cataloguing-in-Publication Data

World health statistics 2014.

1.Health status indicators. 2.World health. 3.Health services – statistics. 4.Mortality. 5.Morbidity. 6.Life expectancy. 7.Demography.

9.Statistics. I.World Health Organization.

ISBN 978 92 4 156471 7 (NLM classification: WA 900.1)

ISBN 978 92 4 069267 1 (PDF)

© World Health Organization 2014

All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be

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whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its

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Original cover by WHO Graphics

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Table of Contents

Abbreviations 7

Introduction 8

Part I. Health-related Millennium Development Goals 11

Summary of status and trends 13

Regional and country charts 20

1. AARD (%) in under-five mortality rate, 1990–2012 22

2. Measles immunization coverage among 1-year-olds (%) 23

3. AARD (%) in maternal mortality ratio, 1990–2013 24

4. Births attended by skilled health personnel (%) 25

5. Antenatal care coverage (%): at least one visit and at least four visits 26

6. Unmet need for family planning (%) 27

7. AARD (%) in HIV prevalence, 2001–2012 28

8. Antiretroviral therapy coverage among people eligible for treatment (%) 29

9. Children aged < 5 years sleeping under insecticide-treated nets (%) 30

10. Children aged < 5 years with fever who received treatment with any antimalarial (%) 31

11. AARD (%) in tuberculosis mortality rate, 1990–2012 32

12. AARD (%) in proportion of population without access to improved drinking-water sources 33

13. AARD (%) in proportion of population without access to improved sanitation 34

Part II. Highlighted topics 35

Putting an ending to preventable maternal mortality – the next steps 37

Rising childhood obesity – time to act 40

Life expectancy in the world in 2012 42

Years of life lost due to premature mortality – trends and causes 45

Civil registration and vital statistics –

the key to national and global advancement 50

Part III. Global health indicators 55

General notes 57

1. Life expectancy and mortality 59

Life expectancy at birth (years)

Life expectancy at age 60 (years)

Healthy life expectancy at birth (years)

Neonatal mortality rate (per 1000 live births)

Infant mortality rate (probability of dying by age 1 per 1000 live births)

Under-five mortality rate (probability of dying by age 5 per 1000 live births)

Adult mortality rate (probability of dying between 15 and 60 years of age per 1000 population)

2. Cause-specific mortality and morbidity 71

Mortality

Age-standardized mortality rates by cause (per 100 000 population)

Years of life lost (per 100 000 population)

Number of deaths among children aged < 5 years (000s)

Distribution of causes of death among children aged < 5 years (%)

Maternal mortality ratio (per 100 000 live births)

Cause-specific mortality rate (per 100 000 population)

Morbidity

Incidence rate (per 100 000 population)

Prevalence (per 100 000 population)

3. Selected infectious diseases 93

Cholera

Diphtheria

Human African trypanosomiasis

Japanese encephalitis

Leishmaniasis

Leprosy

Malaria

Measles

Meningitis

Mumps

Pertussis

Poliomyelitis

Congenital rubella syndrome

Rubella

Neonatal tetanus

Total tetanus

Tuberculosis

Yellow fever

4. Health service coverage 104

Unmet need for family planning (%)

Contraceptive prevalence (%)

Antenatal care coverage (%)

Births attended by skilled health personnel (%)

Births by caesarean section (%)

Postnatal care visit within two days of childbirth (%)

Neonates protected at birth against neonatal tetanus (%)

Immunization coverage among 1-year-olds (%)

Children aged 6–59 months who received vitamin A supplementation (%)

Children aged < 5 years with ARI symptoms taken to a health facility (%)

Children aged < 5 years with suspected pneumonia receiving antibiotics (%)

Children aged < 5 years with diarrhoea receiving ORT (ORS and/or RHF) (%)

Children aged < 5 years sleeping under insecticide-treated nets (%)

Children aged < 5 years with fever who received treatment with any antimalarial (%)

Pregnant women with HIV receiving antiretrovirals to prevent MTCT (%)

Antiretroviral therapy coverage among people eligible for treatment (%)

Case-detection rate for all forms of tuberculosis (%)

Treatment-success rate for smear-positive tuberculosis (%)

5. Risk factors 116

Population using improved drinking-water sources (%)

Population using improved sanitation (%)

Population using solid fuels (%)

Preterm birth rate (per 100 live births)

Infants exclusively breastfed for the first 6 months of life (%)

Children aged < 5 years who are wasted (%)

Children aged < 5 years who are stunted (%)

Children aged < 5 years who are underweight (%)

Children aged < 5 years who are overweight (%)

Prevalence of raised fasting blood glucose among adults aged ≥ 25 years (%)

Prevalence of raised blood pressure among adults aged ≥ 25 years (%)

Adults aged ≥ 20 years who are obese (%)

Alcohol consumption among adults aged ≥ 15 years (litres of pure alcohol per person per year)

Prevalence of smoking any tobacco product among adults aged ≥ 15 years (%)

Prevalence of current tobacco use among adolescents aged 13–15 years (%)

Prevalence of condom use by adults aged 15–49 years during higher-risk sex (%)

Population aged 15–24 years with comprehensive correct knowledge of HIV/AIDS (%)

6. Health systems 128

Health workforce

Density of physicians per 10 000 population

Density of nursing and midwifery personnel per 10 000 population

Density of dentistry personnel per 10 000 population

Density of pharmaceutical personnel per 10 000 population

Density of psychiatrists per 10 000 population

Infrastructure and technologies

Hospitals (per 10 000 population)

Hospital beds (per 10 000 population)

Psychiatric beds (per 10 000 population)

Computed tomography units (per million population)

Radiotherapy units (per million population)

Mammography units (per million females aged 50–69 years)

Essential medicines

Median availability of selected generic medicines in public and private sectors (%)

Median consumer price ratio of selected generic medicines in public and private sectors

7. Health expenditure 141

Health expenditure ratios

Total expenditure on health as a percentage of gross domestic product

General government expenditure on health as a percentage of total expenditure on health

Private expenditure on health as a percentage of total expenditure on health

General government expenditure on health as a percentage of total government expenditure

External resources for health as a percentage of total expenditure on health

Social security expenditure on health as a percentage of general government expenditure on health

Out-of-pocket expenditure as a percentage of private expenditure on health

Private prepaid plans as a percentage of private expenditure on health

Per capita health expenditures

Per capita total expenditure on health at average exchange rate (US$)

Per capita total expenditure on health (PPP int. $)

Per capita government expenditure on health at average exchange rate (US$)

Per capita government expenditure on health (PPP int. $)

8. Health inequities 153

Contraceptive prevalence: modern methods (%)

Antenatal care coverage: at least four visits (%)

Births attended by skilled health personnel (%)

DTP3 immunization coverage among 1-year-olds (%)

Children aged < 5 years who are stunted (%)

Under-five mortality rate (probability of dying by age 5 per 1000 live births)

9. Demographic and socioeconomic statistics 165

Total population (000s)

Median age of population (years)

Population aged < 15 years (%)

Population aged > 60 years (%)

Annual population growth rate (%)

Population living in urban areas (%)

Civil registration coverage (%) of births and causes of death

Crude birth rate (per 1000 population)

Crude death rate (per 1000 population)

Total fertility rate (per woman)

Adolescent fertility rate (per 1000 girls aged 15–19 years)

Literacy rate among adults aged ≥ 15 years (%)

Net primary school enrolment rate (%)

Gross national income per capita (PPP int. $)

Population living on < $1 (PPP int. $) a day (%)

Cellular phone subscribers (per 100 population)

Annex 1. Regional and income groupings 176

WHO regional groupings 176

Income groupings 177

Abbreviations

AARD average annual rate of decline

AFR WHO African Region

AIDS acquired immunodeficiency syndrome

AMR WHO Region of the Americas

ARI acute respiratory infection

ART antiretroviral therapy

CRS Creditor Reporting System

CRVS civil registration and vital statistics

DAC Development Assistance Committee,

OECD

DHS Demographic and Health Survey

DTP3 3 doses of diphtheria-tetanus-

pertussis vaccine

EML essential medicines list

EMR WHO Eastern Mediterranean Region

EUR WHO European Region

GDP gross domestic product

GHO Global Health Observatory

HAI Health Action International

HALE healthy life expectancy

HepB3 3 doses of hepatitis B vaccine

Hib3 3 doses of Haemophilus influenzae

type B vaccine

HIV human immunodeficiency virus

ICD International Classification of Diseases

ICPD+5 International Conference on Population

and Development, five-year follow-up

IGME Inter-agency Group for Child Mortality

Estimation

ITU United Nations International

Telecommunication Union

MCV measles-containing vaccine

MDG Millennium Development Goal

MDR-TB multi-drug resistant tuberculosis

MICS Multiple Indicator Cluster Survey

MSH Management Sciences for Health

MTCT mother-to-child transmission

NCD noncommunicable disease

NGO nongovernmental organization

NHA national health account

NTD neglected tropical disease

OECD Organisation for Economic

Cooperation and Development

ORS oral rehydration salts

ORT oral rehydration therapy

PPP Purchasing Power Parity

RHF recommended home fluids

SAVVY Sample Registration with Verbal

Autopsy

SD standard deviation

SEAR WHO South-East Asia Region

UNAIDS Joint United Nations Programme on

HIV/AIDS

UNDESA United Nations Department of

Economic and Social Affairs

UNESCAP United Nations Economic and Social

Commission for Asia and the Pacific

UNESCO United Nations Educational, Scientific

and Cultural Organization

UNICEF United Nations Children’s Fund

WPR WHO Western Pacific Region

YLL years of life lost

Introduction

The World Health Statistics series is WHO’s annual

compilation of health-related data for its 194 Mem-

ber States, and includes a summary of the progress

made towards achieving the health-related Millennium

Development Goals (MDGs) and associated targets.

This year, it also includes highlight summaries on the

ongoing commitment to end preventable maternal

deaths; on the need to act now to combat rising levels

of childhood obesity; on recent trends in both life

expectancy and premature deaths; and on the crucial

role of civil registration and vital statistics systems in

national and global advancement.

The series is produced by the WHO Department of

Health Statistics and Information Systems of the

Health Systems and Innovation Cluster. As in previ-

ous years, World Health Statistics 2014 has been

compiled using publications and databases produced

and maintained by WHO technical programmes and

regional offices. A number of demographic and so-

cioeconomic statistics have also been derived from

databases maintained by a range of other organiza-

tions. These include the United Nations International

Telecommunication Union (ITU), the United Nations

Department of Economic and Social Affairs (UNDESA),

the United Nations Educational, Scientific and Cultural

Organization (UNESCO), the United Nations Children’s

Fund (UNICEF) and the World Bank.

Indicators have been included on the basis of their

relevance to global public health; the availability and

quality of the data; and the reliability and comparabil-

ity of the resulting estimates. Taken together, these

indicators provide a comprehensive summary of the

current status of national health and health systems

in the following nine areas:

■ life expectancy and mortality

■ cause-specific mortality and morbidity

■ selected infectious diseases

■ health service coverage

■ risk factors

■ health systems

■ health expenditure

■ health inequities

■ demographic and socioeconomic statistics.

The estimates given in this report are derived from

multiple sources, depending on each indicator and

on the availability and quality of data. In many coun-

tries, statistical and health information systems are

weak and the underlying empirical data may not be

available or may be of poor quality. Every effort has

been made to ensure the best use of country-reported

data – adjusted where necessary to deal with missing

values, to correct for known biases, and to maximize

the comparability of the statistics across countries and

over time. In addition, statistical modelling and other

techniques have been used to fill data gaps.

Because of the weakness of the underlying empirical

data in many countries, a number of the indicators pre-

sented here are associated with significant uncertainty.

It is WHO policy to ensure statistical transparency, and

to make available to users the methods of estimation

and the margins of uncertainty for relevant indicators.

However, to ensure readability while covering such a

comprehensive range of health topics, printed versions

of the World Health Statistics series do not include

the margins of uncertainty which are instead made

available through online WHO databases such as the

Global Health Observatory. ¹

While every effort has been made to maximize the

comparability of the statistics across countries and over

time, users are advised that country data may differ

in terms of the definitions, data-collection methods,

1. The Global Health Observatory (GHO) is WHO’s portal

providing access to data and analyses for monitoring the global

health situation. See: http://www.who.int/gho/en/, accessed

22 March 2014.

population coverage and estimation methods used.

More-detailed information on indicator metadata is

available in the WHO Indicator and Measurement

Registry. ¹

WHO presents World Health Statistics 2014 as an

integral part of its ongoing efforts to provide enhanced

access to comparable high-quality statistics on core

measures of population health and national health

systems. Unless otherwise stated, all estimates have

been cleared following consultation with Member

States and are published here as official WHO figures.

However, these best estimates have been derived us-

ing standard categories and methods to enhance their

cross-national comparability. As a result, they should

not be regarded as the nationally endorsed statistics

of Member States which may have been derived using

alternative methodologies.

1. See: http://www.who.int/gho/indicator_registry/en/, accessed

22 March 2014.

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2014

Part I

Health-related Millennium

Development Goals

Nevertheless, nearly 18 000 children worldwide died

every day in 2012, and the global speed of decline in

mortality rate remains insufficient to reach the target

of a two-thirds reduction in the 1990 levels of mortal-

ity by the year 2015. Table 1 shows the number of

countries that have achieved this target; those that

are on track to meet the target by 2015 if the current

rate of progress is maintained; those that are at least

halfway to achieving a two-thirds reduction in the 1990

level of mortality but are unlikely to achieve it by 2015

at the current rate of progress; and those that are less

than halfway to meeting the target. Less than one-third

of all countries have achieved or are on track to meet

the MDG target by 2015.

Inequities in child mortality between high-income

and low-income countries remain large. In 2012, the

under-five mortality rate in low-income countries was

82 deaths per 1000 live births – more than 13 times

the average rate in high-income countries (Fig. 1).

Reducing these inequities across countries and saving

the lives of more children by ending preventable child

deaths are key priorities.

With one year to go until the 2015 target date for

achieving the MDGs, substantial progress can be re-

ported on many health-related goals. The global target

of halving the proportion of people without access to

improved sources of drinking water was met in 2010,

with remarkable progress also having been made in

reducing child mortality, improving nutrition, and com-

bating HIV, tuberculosis and malaria.

Between 1990 and 2012, mortality in children under

5 years of age declined by 47%, from an estimated

rate of 90 deaths per 1000 live births to 48 deaths

per 1000 live births. This translates into 17 000 fewer

children dying every day in 2012 than in 1990. The risk

of a child dying before their fifth birthday is still highest

in the WHO African Region (95 per 1000 live births)

– eight times higher than that in the WHO European

Region (12 per 1000 live births). There are, however,

signs of progress in the region as the pace of decline

in the under-five mortality rate has accelerated over

time; increasing from 0.6% per year between 1990

and 1995 to 4.2% per year between 2005 and 2012.

The global rate of decline during the same two periods

was 1.2% per year and 3.8% per year, respectively.

Table 1. Number of countries according to MDG Target 4.A achievement status, by WHO region, 2012

WHO region

MDG Target 4.A – achievement status

Total

Achieved On track

Halfway

or more

Less than

halfway

African Region (AFR) ^{3 6 21 16 46}

Region of the Americas (AMR) ^{5 3 22 5 35}

South-East Asia Region (SEAR) ^{4 3 4 0 11}

European Region (EUR) ^{17 8 28 0 53}

Eastern Mediterranean Region (EMR) ^{6 2 11 3 22}

Western Pacific Region (WPR) ^{2 1 18 6 27}

Global ^{37 23 104 30 194}

(19%) (12%) (54%) (15%) (100%)

Calculated using unrounded under-five mortality rates, 1990 and 2012.

Summary of status and trends

The first 28 days of life – the neonatal period – represent

the most vulnerable time for a child’s survival. In 2012,

around 44% of under-five deaths occurred during this

period, up from 37% in 1990 (Fig. 1). As overall under-

five mortality rates decline the proportion of such deaths

occurring during the neonatal period is increasing. This

highlights the crucial need for health interventions that

specifically address the major causes of neonatal deaths,

particularly as these typically differ from the interventions

needed to address other under-five deaths.

Current evidence indicates that undernutrition ¹ is the un-

derlying cause of death in an estimated 45% of all deaths

among children under 5 years of age. ² The number of

underweight children globally declined from 160 million

in 1990 to 99 million in 2012, representing a decline in

the proportion of underweight children from 25% to 15%.

This rate of progress is close to that required to meet the

1. Including fetal growth restriction, stunting, wasting, and

deficiencies of vitamin A and zinc, along with suboptimal

breastfeeding.

2. Black RE, Victora CG, Walker SP, Bhutta ZA Christian P,

de Onis M et al. Maternal and child undernutrition and

overweight in low-income and middle-income countries.

Lancet. 3 August 2013;382(9890):427–51. doi:10.1016/

S0140-6736(13)60937-X (http://www.thelancet.com/journals/

lancet/article/PIIS0140-6736%2813%2960937-X/abstract,

accessed 12 March 2014).

relevant MDG target, but varies between regions (Fig. 2).

Beyond the MDGs, a new global target was recently set

for a 40% reduction in the number of stunted children

by 2025 against the 2010 baseline, along with five other

targets on maternal, infant and young-child nutrition. ³

Between 1990 and 2012, the number of children affected

by stunting declined from 257 million to 162 million, rep-

resenting a global decrease of 37%.

In 2012, global measles immunization coverage

reached 84% among children aged 12–23 months.

More countries are now achieving high levels of vac-

cination coverage, with 66% of WHO Member States

reaching at least 90% coverage in 2012, up from only

43% in 2000. Between 2000 and 2012, the estimated

number of total measles deaths worldwide decreased

by 78% from 562 000 to 122 000.

MDG 5 – Improve maternal health – sets out the targets

of reducing the maternal mortality ratio from its 1990

level by three quarters and achieving universal access

to reproductive-health services by the year 2015. The

3. Comprehensive implementation plan on maternal, infant

and young child nutrition. Sixty-fifth World Health Assembly,

WHA resolution 65.6 and Annex 2. Geneva: World Health

Organization; 2012. (WHA65/2012/REC/1; http://apps.who.

int/gb/ebwha/pdf_files/WHA65-REC1/A65_REC1-en.pdf,

accessed 7 April 2014).

Figure 1. Neonatal and under-five mortality rates – globally and by country income group, 1990 and 2012

Each bar indicates the total under-five mortality rate as the sum of the neonatal mortality rate (0–27 days; lighter-shaded bars) plus the

combined mortality rate for infants aged 1–11 months and children aged 1-4 years (darker-shaded bars).

180

160

140

120

100

80

60

40

20

0

Pr obability of dying per 1000 live births

Upper-middle-income

countries

Lower-middle-income

countries

Low-income

countries

Global High-income

countries

1–59 months

0–27 days

(neonatal)

1990 2012

number of women dying due to complications dur-

ing pregnancy and childbirth decreased by nearly

50% from an estimated 523 000 in 1990 to 289 000

in 2013. While such progress is notable, the average

annual rate of decline (AARD) is far below that needed

to achieve the MDG target (5.5%), and the number

of deaths remains unacceptably high. In 2013, nearly

800 women died every day from maternal causes.

Almost all of these deaths (99%) occur in developing

countries, and most can be avoided as the necessary

medical interventions exist and are well known. The

key obstacle is the lack of access to quality care by

pregnant women before, during and after childbirth.

In many countries, programmes have been imple-

mented to eliminate or reduce the barriers that prevent

access to effective reproductive-health interventions.

Despite increasing overall levels of contraceptive use,

there still remain significant gaps between the de-

sire of women to delay or avoid having children and

their actual use of contraception. Globally in 2011,

around one in every eight women aged 15–49 years

who were married or in a union had an unmet need

for family planning. In the WHO African Region, the

figure was around one in four. Although the propor-

tion of women receiving antenatal care at least once

during pregnancy was 81% globally for the period

2006–2013, the figure dropped to around 56% for

the recommended minimum of four visits or more.

Around seven in every 10 births globally are attended

by skilled health personnel. However, coverage varies

sharply across country-income level from almost all

births (99%) in high-income countries to less than half

of births (46%) in low-income countries.

Despite progress in reducing the birth rate among

adolescents, more than 15 million of the estimated

135 million live births worldwide are to girls aged 15–19

years. Pregnant adolescents are more likely than adults

to have unsafe abortions, and early childbearing in-

creases risks for both mothers and their newborns.

Complications from pregnancy and childbirth are a

major cause of death among girls aged 15–19 in low-

and middle-income countries.

Globally, an estimated 2.3 million people were newly

infected with HIV in 2012 – representing a 33% de-

cline compared with the 3.4 million new infections

estimated for 2001. People living in sub-Saharan

Africa accounted for 70% of all new infections. As

access to antiretroviral therapy (ART) improves, the

population living with HIV increases as fewer people

die from AIDS-related causes. In 2012, an estimated

35.3 million people were living with HIV – with 9.7

million people in low- and middle-income countries

receiving ART. It has been estimated that during the

Figure 2. Prevalence of underweight children under 5 years of age – globally and by WHO region, 1990–2012

50

45

40

35

30

25

20

15

10

5

0

Childr en aged < 5 years underweight (%)

2005

2000

1995

1990 2010 2012

AFR

AMR

SEAR

EUR

EMR

WPR

Global

period 1995–2012, ART cumulatively averted 5.5

million deaths in such countries (Fig. 3). Globally, an

estimated 1.6 million people died of HIV/AIDS in 2012;

down from the peak of 2.3 million in 2005.

In 2012, an estimated 8.6 million people developed

tuberculosis and 1.3 million died from the disease

(including 320 000 ¹ deaths among HIV-positive

people). ² The rate of new tuberculosis cases worldwide

has been falling for about a decade, thus achieving

MDG target 6.C to reverse the spread of the disease

by 2015. In addition, two WHO regions – the WHO

Region of the Americas and the WHO Western Pacific

Region – have also achieved related 2015 targets ³ to

reduce tuberculosis incidence, prevalence and mortal-

ity rates (Fig. 4). Globally, the tuberculosis mortality

rate has fallen by 45% since 1990 and the target of a

1. Global report: UNAIDS report on the global AIDS epidemic

2013. Geneva: Joint United Nations Programme on HIV/AIDS

(UNAIDS); 2013.

2. Table 2 in Part III presents data on mortality due to tuberculosis

among HIV-negative people. Tuberculosis-related deaths

among HIV-positive people are included in the mortality data

for HIV/AIDS.

3. Stop TB Partnership targets linked to the MDG target 6.C of

halting and beginning to reverse the incidence of major diseases

such as tuberculosis by 2015, include reducing tuberculosis

prevalence and deaths by 50% by 2015 compared with the

1990 baseline.

50% reduction by 2015 is within reach. Nevertheless,

despite this decline in mortality rate, the number of

tuberculosis deaths remains unacceptably high given

that most are preventable.

Between 1995 and 2012, 56 million people were suc-

cessfully treated for tuberculosis and 22 million lives

were saved. However, multi-drug resistant tuberculo-

sis (MDR-TB), which emerged primarily as a result of

inadequate treatment, continues to pose problems.

In 2012, an estimated 450 000 people worldwide

developed MDR-TB, but only 94 000 were newly

detected. Treatment options for MDR-TB are often

limited and expensive, and recommended medicines

are not always available or may cause numerous

adverse side-effects.

Infection with HIV is the strongest risk factor for de-

veloping active tuberculosis disease. Many countries

have made considerable progress in addressing the

tuberculosis and HIV co-epidemic. However, less than

half of notified tuberculosis patients had a documented

HIV test result in 2012, with only 57% of those who

tested positive being on ART or started on ART.

In 2012, almost half of the world’s population – 3.4

billion people – was estimated to be at risk of malaria.

Of these, 1.2 billion people were considered to be at

high risk, with more than one case of malaria occur-

Figure 3. Impact of ART use on the estimated number of deaths due to HIV/AIDS (millions) that would otherwise

have occurred in low- and middle-income countries, 1995–2012 ¹

3.0

2.5

2.0

1.5

1.0

0.5

0

Number of deaths (millions)

2005

2000

1995 2010 2012

With ART

Without ART

Figure 4. Reductions in tuberculosis incidence,

prevalence and mortality, by WHO region, 1990–2012

ring per 1000 population. The WHO African Region

bears the highest burden of malaria, with 80% of

the estimated 207 million cases and 90% of the es-

timated 627 000 malaria deaths worldwide occurring

in this region in 2012. More than three quarters (77%)

of all malaria deaths occur in children under 5 years

of age (Fig. 5).

During the period 2000–2012, malaria incidence rates

among populations at risk ¹ are estimated to have fallen

by 25% globally and by 31% in the WHO African Re-

gion. Over the same period, estimated malaria mortality

rates ¹ decreased by 42% globally, by 49% in the WHO

African Region and by 48% in children under 5 years

of age globally. An estimated 3.3 million lives were

saved as a result of scaling-up malaria interventions

during the same period. If the annual rate of decrease

is maintained, malaria mortality rates are projected to

decrease by 52% globally, and by 62% in the WHO

African Region and by 60% in children under 5 years

of age, by 2015. Of 103 countries that had ongoing

malaria transmission in 2000, 62 have produced re-

liable trend data indicating that 59 are meeting the

MDG target of reversing its incidence. In the other 41

countries – accounting for 80% of estimated cases of

malaria – it is not possible to reliably assess national

malaria trends using the data reported to WHO.

Neglected tropical diseases (NTDs) ² are endemic in 149

countries, often cause multiple infections in a single indi-

vidual, and can lead to severe pain, permanent disability

and death. Many of these diseases can be prevented,

eliminated or even eradicated with improved access to

existing safe and cost-effective tools. The reported num-

ber of cases of human African trypanosomiasis dropped

to less than 10 000 in 2009 – the lowest level in 50 years.

In 2013, the number of cases of dracunculiasis worldwide

1. The percentage changes shown in this paragraph are based

upon malaria incidence rates defined as cases per 1000

population at risk, and mortality rates as deaths per 100 000

population at risk. Elsewhere in this report, malaria incidence

and mortality rates are calculated per 100 000 population.

2. The diseases concerned are: Buruli ulcer; Chagas disease;

cysticercosis; dengue; dracunculiasis; echinococcosis;

endemic treponematoses; foodborne trematode infections;

human African trypanosomiasis; leishmaniasis; leprosy;

lymphatic filariasis, onchocerciasis; rabies; schistosomiasis;

soil-transmitted helminthiases; and trachoma.

WHO African Region, < 5 years

WHO African Region, 5 years and older

Rest of the world, 5 years and older

Rest of the world, < 5 years

462 000

100 000

20 000

45 000

Figure 5. Estimated number of deaths due to malaria,

2012

80%

70%

60%

50%

40%

30%

20%

10%

0%

Global AFR AMR SEAR EUR EMR WPR

Global AFR AMR SEAR EUR EMR WPR

Global AFR AMR SEAR EUR EMR WPR

Decline in incidence per 100 000 population

Decline in mortality per 100 000 population

Decline in prevalence per 100 000 population

60%

50%

40%

30%

20%

10%

0%

–10%

70%

60%

50%

40%

30%

20%

10%

0%

fell below 150 for the first time. Leprosy has now been

eliminated as a public health problem in 119 out of the

122 countries where it was previously endemic, and 728

million people worldwide were treated for at least one

NTD through preventive chemotherapy in 2011. However,

NTDs still affect more than one billion people worldwide,

weaken impoverished populations, and frustrate the

achievement of the health-related MDGs and other

desirable global public health outcomes. In the case of

dengue – the world’s fastest growing viral infection – more

than 2.5 billion people are estimated to be at risk.

The MDG target 7.C in relation to drinking-water, as

measured by the proxy indicator of access to improved

drinking-water sources, was met in 2010. Neverthe-

less, despite 2.3 billion people gaining access over the

last 22 years as part of attaining the target, 748 million

people remain un-served. This number increases to

the order of billions if water quality and service sus-

tainability are taken into account. Additionally, despite

impressive progress, wide disparities exist between

different regions, between urban and rural areas and

between different socioeconomic groups – particularly

between the rich and the poor. With regard to basic

sanitation, more than 1949 million people have gained

access to an improved sanitation facility since 1990.

However, in 2012, 2523 million people (more than one

third of the global population) still lacked such access.

The current rate of progress is not sufficient to meet

the sanitation target globally, which is projected to be

missed by the order of 620 million people. The WHO

Western Pacific Region is the only WHO region where

access to basic sanitation has increased for more than

one third of the population since 1990 (Fig. 6). In this

region, the proportion of population using improved

sanitation increased from 36% in 1990 to 70% in 2012

representing an increase of 34 percentage points.

Increasing access to affordable essential medicines ¹ is

vitally important in achieving the health-related MDGs.

However, several factors undermine the availability of

such medicines in a number of countries, including poor

medicine supply and distribution systems, insufficient

health facilities and staff, low investment in health and

1. Essential medicines are medicines that help meet the priority

health-care needs of a population. They are selected with

regard to disease prevalence, and evidence of their efficacy,

safety and comparative cost–effectiveness.

the high cost of medicines. Surveys undertaken from

2007 to 2012 indicated that selected generic medicines

were only available in 56% of public outlets in low- and

middle-income countries. Prices to patients of the low-

est-priced generics in the private sector averaged five

times the international reference prices, ranging upwards

to around 14 times higher in some countries. As a result,

the treatment of diseases with even the lowest-priced

generics becomes impossible for many low-income

households. The problem is aggravated when several

household members become ill at the same time.

In conclusion, encouraging accomplishments across

a broad range of international health-related goals

and targets have clearly demonstrated that focused

global actions can make a difference. At the same time,

much remains to be done, and efforts continue to be

needed to accelerate progress in achieving the MDGs

and related objectives. Furthermore, efforts to improve

health, and to achieve health equity, will continue well

beyond 2015. This undertaking goes hand-in-hand

with efforts to ensure universal health coverage – an

aspiration backed by a United Nations General Assem-

bly resolution adopted in December 2012 which urges

governments to move towards providing all people with

access to affordable good-quality health-care services.

Figure 6. Proportion of population with access to

improved sanitation in 2012 and corresponding

percentage change 1990–2012 – globally and by

WHO region

Global AFR AMR SEAR EUR EMR WPR

100

80

60

40

20

0

Use of improved sanitation (%)

64

33

88

45

93

68 ⁷⁰

100

80

60

40

20

0

Percentage point change 1990–2012

17

6 ⁸

20

2

15

34

Regional and country charts

Following the global and WHO regional summary shown in Figure 7, charts 1–13 provide country-

by-country summaries of national trends in MDG indicators for which data are available.

Depending on the availability of data for each indicator, there are two types of chart:

Chart type I

For six indicators – under-five mortality rate; maternal mortality ratio; HIV prevalence; tuberculosis

mortality rate; proportion of population without access to improved drinking-water sources; and

proportion of population without access to improved sanitation – the charts show the average annual

rate of decline (AARD) since 1990 up to the latest available year (or for the year range indicated),

and the overall AARD required for the country to achieve the relevant MDG by 2015. The country

figures show data for the latest available year.

Chart type II

For seven indicators – measles immunization coverage among 1-year-olds; births attended by

skilled health personnel; antenatal care coverage; unmet need for family planning; antiretroviral

therapy coverage among people eligible for treatment; children aged < 5 years sleeping under

insecticide-treated nets; and children aged < 5 years with fever who received treatment with any

antimalarial – the charts show only data for the latest available year, along with an indication of a

WHO or partner agency target.

... indicates data not available or not applicable.

Further details can be found in the country tables shown in Part III as indicated below each chart.