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  • This time last year to coincide with March

    2019-05-15

    This time last year, to coincide with (March 9), launched a to highlight the rising burden of kidney disease and to encourage research partnerships to address gaps in knowledge and care, including the affordability of such care. Nephrology research and collaboration has come a relatively long way since 2002 when the first guidelines on the evaluation and classification of chronic kidney disease were published by the US National Kidney Foundation. The burden of kidney diseases in high-income and some middle-income countries is becoming much better understood. In their analysis of data from the nationally representative Million Death Study in India, published in the January issue, estimated that renal failure (either from end-stage chronic kidney disease [ESKD] or acute kidney injury) was the cause of almost 3% of deaths in 2010–13, up from just over 2% a decade earlier. Yet knowledge is not keeping up with care. Dare and colleagues point out that the health system is poorly equipped to face the rising burden of ESKD, with only just over a third of patients being on any form of renal replacement therapy (RRT).
    As a result of several studies, a coherent view of reproductive, newborn, maternal, and child health inequalities has begun to emerge. Overall, and in most countries, inequalities have been decreasing. However, inequalities have been growing in a small but substantial proportion of countries, and in many of these countries, a decline in health status and health-service coverage among poor populations is part of the cause. In , Cesar Victora and colleagues present the findings of the latest study of these trends. The focus of the Article is inequalities in service coverage—as measured by a composite reproductive, maternal, newborn, and child health service indicator—in developing countries as a whole and in economically defined country sets. The main finding of this selective serotonin reuptake inhibitor research is that coverage inequalities have been decreasing in the past 20 years because of faster progress within poor populations and rural populations. Victora and colleagues do not discuss variations in individual-country experiences, and neither do they assess differentials in health status. But these factors have been investigated in other studies, such as that by Wagstaff and colleagues, who showed that, between 1990 and 2011, overall health-service coverage increased and coverage inequalities fell on average and in most countries (findings similar to those of Victora and colleagues). But the outcomes of Wagstaff and colleagues\' more detailed investigations are much less reassuring: in 28% of countries, coverage inequalities have risen, and in 24%, coverage among the poorest 40% of the population has decreased. Trends for health status were also less encouraging than those for service coverage—health-status inequalities have increased in 42% of countries, and health status among the poorest 40% of the population declined in about a quarter of the countries. A similar picture emerges from several other studies that have been done in the past few years. The only study of child mortality, for which trends are especially difficult to assess because of the large sample sizes required, was done by Eran Bendavid, who reported faster declines in child mortality among poor populations than among wealthier populations overall and in 61 of the 85 countries he studied between 2002 and 2012. The remaining studies focused on health-service coverage. Two covered several types of reproductive, maternal, newborn, and child health interventions: Sarah Alkenbrack and colleagues reported overall inequality declines for the four intervention types that they examined, and Victora and colleagues noted a similar trend for the several interventions that they studied. Others have focused on specific types of reproductive, maternal, newborn, and child health intervention. For example, John Ross showed that the poor–rich disparity in terms of contraceptive prevalence fell overall and in three-quarters of 46 countries followed. Similarly, two multicountry investigations of changes in immunisation inequalities showed overall reductions but wide intercountry variations.