PBIT Despite impressive progress towards elimination social

Despite impressive progress towards elimination, social unrest, gaps in the coverage of populations at risk, competing health interests, and possible donor fatigue present challenges to successful elimination of human African trypanosomiasis caused by and subsequent maintenance of this status. The timely findings of Sutherland and colleagues show the value of adopting new control methods for diagnosis, treatment, and surveillance that are expected to accelerate elimination cost-effectively, in a range of settings. Translation of these findings into field implementation will require continued awareness and commitment among governments and key players in global public health, until 2030 and beyond.
Chronic kidney disease is now recognised as a major medical problem worldwide. The Global Burden of Disease (GBD) study 2015 ranked chronic kidney disease 17th among the causes of deaths globally (age-standardised annual PBIT of 19·2 deaths per 100 000 population). In many countries, chronic kidney disease is now among the top five causes of death. In India, GBD 2015 ranks chronic kidney disease as the eighth leading cause of death. In the , Dare and colleagues present data on the number of deaths due to renal failure in India. These figures come from the Million Deaths Study (MDS), which ascribed cause to all deaths in a nationally representative sample of 1·1 million households using an enhanced verbal autopsy tool between 2001 and 2013. Deaths due to renal failure constituted 2·9% of all deaths in 2010–13 among 15–69 year-olds, an increase of 50% from 2001–03. Diabetes was the largest contributor to renal failure deaths. Substantial regional differences were noted in renal failure death rates. The reported proportion of renal failure deaths is close to the GBD 2015 estimate of 3·04%, up from 1·94% in 2000. These data provide strong evidence of the rising contribution of kidney failure to premature deaths in India, which has one sixth of the world\'s population, accounts for about 19% of all global deaths, but has dismal cause of death reporting systems. The GBD 2013 report specifically highlighted this situation by observing that “Important gaps exist in empirical data for cause of death estimates for some countries; for example, no national data for India is available for the past decade.” Because of the large population and ongoing demographic transitions, data from India are important to understand health-care dynamics for the world at large. Absence of such information creates a void in global estimates.
Insecticide-treated bed nets (ITNs) are thought to be the key driver of the large reductions in malaria transmission observed over the past 10–15 years. ITNs work particularly well where the local vectors usually bite indoors late at night, on average halving cases of malaria disease. However, the effect of ITN is less consistently shown in Latin America where some local mosquito vectors often bite outdoors (exophagic behaviour) or earlier in the evening before people go to bed. In , Laura Steinhardt and colleagues report the first evaluation of ITN in Haiti, where the goal is to eliminate malaria by 2020. The ideal way to assess the effect of ITN on malaria transmission, as noted by the authors, is a cluster-randomised controlled trial. However, now that ITNs are a routine intervention against malaria, it is hard to have a control group without nets. In Haiti, such a study would also require an extremely large sample size in view of the low malaria incidence. In the face of these challenges, Steinhardt and colleagues used a case-control study design to measure association between ITN use and positivity for infection in patients with fever at health facilities following a mass distribution of ITNs. They found no significant effect of ITN despite using different indicators of ITN use and a sophisticated set of analyses designed to minimise confounding and bias. The authors conclude that “alternative malaria control strategies should be prioritised” in Haiti.