This Week in PLOS Medicine: Global Burden of Depression, Syphilis Treatment in Pregnancy, Response to Measles Outbreaks, & Maternal Rights
This week PLOS Medicine publishes the following new articles:
In their research article, Ferrari and colleagues report the most recent and comprehensive estimates on how much death and disability is attributable to depression, both world-wide and in individual countries and regions. The rates among all causes of disability are highest in Afghanistan and lowest in Japan, and depression ranks first in Central America and Central and Southeast Asia. Disability from depression affects mostly people in their working years, and women more than men. When compared to other diseases and injuries, major depressive disorder (MDD) ranked as the second leading cause of global disability (or YLDs) and the eleventh leading cause of global burden (or DALYs) in 2010. However, MDD also contributes to mortality for a number of other conditions, namely suicide and ischemic heart disease.
Yukari Manabe and colleagues evaluate the cost-effectiveness and budget impact of antenatal syphilis screening for 43 countries in sub-Saharan Africa and estimate the impact of universal screening on averted stillbirths, neonatal deaths, congenital syphilis, and disability-adjusted life years (DALYs). In sub-Saharan Africa, where it is estimated that up to 17% of pregnant women are infected and risk passing the bacterium to their fetus, current screening only achieves 40% coverage. They found that at current syphilis prevalence rates, the intervention could prevent up to 25,000 newborn deaths of and 64,000 stillbirths in sub-Saharan Africa every year. Importantly, although estimated costs varied between countries, on average the cost of each DALY averted was only $11, much less than interventions to prevent mother-to-child transmission of HIV. The authors suggest that an integrated approach to the prevention of mother-to-child transmission of HIV and syphilis combined, as has been introduced in Asia and South America, might further improve cost-efficiency.
In a featured Policy Forum, Andrea Minetti and colleagues compare measles outbreak responses from the Democratic Republic of the Congo (DRC) and Malawi, and argue that outbreak response strategies should be tailored to local measles epidemiology. The authors argue that in DRC, where measles transmission is high, outbreaks occur frequently, and typically young children are the most affected, immunization of youngest children should be prioritized. In comparison, settings with a measles elimination goal that do not have frequent outbreaks, such as Malawi, should target all age groups infected with measles to reduce the number of infected persons and to decrease transmission.
In a featured Essay, Alicia Yamin argues that applying human rights frameworks and approaches to maternal health offers strategies and tools to address the root causes of maternal morbidity and mortality within and beyond health systems, in addition to addressing other violations of women’s sexual and reproductive health and rights.