Millennium Development Goals

The Millennium Development Goals (MDGs) are the eight international development goals that were
established following the Millennium Summitof the United Nations in 2000, following the adoption of
the United Nations Millennium Declaration. All 189 United Nations member states at the time (there are 193
currently), and at least 23 international organizations, committed to help achieve the following Millennium
Development Goals by 2015:
1. To eradicate extreme poverty and hunger
2. To achieve universal primary education
3. To promote gender equality and empower women
4. To reduce child mortality
5. To improve maternal health
6. To combat HIV/AIDS, malaria, and other diseases
7. To ensure environmental sustainability[1]
8. To develop a global partnership for development
Each goal has specific targets, and dates for achieving those targets. To accelerate progress, the G8 finance
ministers agreed in June 2005 to provide enough funds to the World Bank, theInternational Monetary
Fund (IMF) and the African Development Bank (AfDB) to cancel $40 to $55 billion in debt owed by members
of the heavily indebted poor countries (HIPC) to allow them to redirect resources to programs for improving
health and education and for alleviating poverty.
The MDGs originated from the United Nations Millennium Declaration. The Declaration asserted that every
individual has dignity; and hence, the right to freedom, equality, a basic standard of living that includes
freedom from hunger and violence and encourages tolerance and solidarity. The MDGs set concrete targets
and indicators for poverty reduction in order to achieve the rights set forth in the Declaration. [3]

Goals[edit]

A poster at the United Nations Headquarters in New York City, New York, USA, showing the Millennium Development
Goals.

The MDGs were developed out of several commitments set forth in the Millennium Declaration, signed in
September 2000. There are eight goals with 21 targets,[6] and a series of measurable health
indicators and economic indicators for each target.[7][8]

Goal 1: Eradicate extreme poverty and hunger[edit]

Target 1A: Halve, between 1990 and 2015, the proportion of people living on less than $1.25 a day [9]

Poverty gap ratio [incidence x depth of poverty]

Share of poorest quintile in national consumption

Target 1B: Achieve Decent Employment for Women, Men, and Young People

GDP Growth per Employed Person

Employment Rate

Proportion of employed population below $1.25 per day (PPP values)

Proportion of family-based workers in employed population

Target 1C: Halve, between 1990 and 2015, the proportion of people who suffer from hunger

Prevalence of underweight children under five years of age

Proportion of population below minimum level of dietary energy consumption [10]

Goal 2: Achieve universal primary education[edit]

Target 2A: By 2015, all children can complete a full course of primary schooling, girls and boys

Enrollment in primary education

Completion of primary education[11]

Goal 3: Promote gender equality and empower women[edit]

Target 3A: Eliminate gender disparity in primary and secondary education preferably by 2005, and at
all levels by 2015

Ratios of girls to boys in primary, secondary and tertiary education

Share of women in wage employment in the non-agricultural sector

Proportion of seats held by women in national parliament[12]

Goal 4: Reduce child mortality rates[edit]

Target 4A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

Under-five mortality rate

Infant (under 1) mortality rate

Proportion of 1-year-old children immunized against measles[13]

Goal 5: Improve maternal health[edit]

Target 5A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

Maternal mortality ratio

Proportion of births attended by skilled health personnel

Target 5B: Achieve, by 2015, universal access to reproductive health

Contraceptive prevalence rate

Adolescent birth rate

Antenatal care coverage

Unmet need for family planning[14]

Goal 6: Combat HIV/AIDS, malaria, and other diseases[edit]

Target 6A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS

HIV prevalence among population aged 1524 years

Condom use at last high-risk sex

Proportion of population aged 1524 years with comprehensive correct knowledge of

HIV/AIDS

Target 6B: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it

Proportion of population with advanced HIV infection with access to antiretroviral drugs
Target 6C: Have halted by 2015 and begun to reverse the incidence of malaria and other major

diseases

Prevalence and death rates associated with malaria

Proportion of children under 5 sleeping under insecticide-treated bednets

Proportion of children under 5 with fever who are treated with appropriate anti-malarial drugs

Incidence, prevalence and death rates associated with tuberculosis

Proportion of tuberculosis cases detected and cured under DOTS (Directly Observed
Treatment Short Course)[15]

Goal 7: Ensure environmental sustainability[edit]

Target 7A: Integrate the principles of sustainable development into country policies and programs;
reverse loss of environmental resources

Target 7B: Reduce biodiversity loss, achieving, by 2010, a significant reduction in the rate of loss

Proportion of land area covered by forest

CO2 emissions, total, per capita and per $1 GDP (PPP)

Consumption of ozone-depleting substances

Proportion of fish stocks within safe biological limits

Proportion of total water resources used

Proportion of terrestrial and marine areas protected

Proportion of species threatened with extinction

Target 7C: Halve, by 2015, the proportion of the population without sustainable access to safe
drinking water and basic sanitation

Proportion of population with sustainable access to an improved water source, urban and
rural

Proportion of urban population with access to improved sanitation

Target 7D: By 2020, to have achieved a significant improvement in the lives of at least 100 million

slum-dwellers

Proportion of urban population living in slums[16]

Goal 8:Develop a global partnership for development[edit]

Target 8A: Develop further an open, rule-based, predictable, non-discriminatory trading and financial
system

Includes a commitment to good governance, development, and poverty reduction both

nationally and internationally

Target 8B: Address the Special Needs of the Least Developed Countries (LDCs)

Includes: tariff and quota free access for LDC exports; enhanced programme of debt relief for
HIPC and cancellation of official bilateral debt; and more generous ODA (Official Development
Assistance) for countries committed to poverty reduction

Target 8C: Address the special needs of landlocked developing countries and small island developing
States

Through the Programme of Action for the Sustainable Development of Small Island
Developing States and the outcome of the twenty-second special session of the General Assembly

Target 8D: Deal comprehensively with the debt problems of developing countries through national
and international measures in order to make debt sustainable in the long term

Some of the indicators listed below are monitored separately for the least developed
countries (LDCs), Africa, landlocked developing countries and small island developing States.

Official development assistance (ODA):

Net ODA, total and to LDCs, as percentage of OECD/DAC donors GNI

Proportion of total sector-allocable ODA of OECD/DAC donors to basic social

services (basic education, primary health care, nutrition, safe water and sanitation)

Proportion of bilateral ODA of OECD/DAC donors that is untied

ODA received in landlocked countries as proportion of their GNIs

ODA received in small island developing States as proportion of their GNIs

Market access:

Proportion of total developed country imports (by value and excluding arms) from
developing countries and from LDCs, admitted free of duty

Average tariffs imposed by developed countries on agricultural products and textiles

and clothing from developing countries

Agricultural support estimate for OECD countries as percentage of their GDP

Proportion of ODA provided to help build trade capacity

Debt sustainability:

Total number of countries that have reached their HIPC decision points and number
that have reached their HIPC completion points (cumulative)

Debt relief committed under HIPC initiative, US$

Debt service as a percentage of exports of goods and services

Target 8E: In co-operation with pharmaceutical companies, provide access to affordable, essential
drugs in developing countries

Proportion of population with access to affordable essential drugs on a sustainable basis

Target 8F: In co-operation with the private sector, make available the benefits of new technologies,

especially information and communications

Telephone lines and cellular subscribers per 100 population

Personal computers in use per 100 population

Internet users per 100 Population[17]

Non-communicable disease
Non-communicable disease (NCD) is a medical condition or disease that is non-infectious or nontransmissible. NCDs can refer to chronic diseases which last for long periods of time and progress slowly.
Sometimes, NCDs result in rapid deaths such as seen in certain diseases such asautoimmune

diseases, heart diseases, stroke, cancers, diabetes, chronic kidney disease, osteoporosis, Alzheimer's
disease, cataracts, and others. While sometimes (incorrectly) referred to as synonymous with "chronic
diseases", NCDs are distinguished only by their non-infectious cause, not necessarily by their duration. Some
chronic diseases of long duration, such as HIV/AIDS, are caused by infections. Chronic diseases
require chronic care management as do all diseases that are slow to develop and of long duration.
NCDs are the leading cause of death globally. In 2012 they cause 68% of all deaths (38 million) up from 60%
in 2000.[1] About half were under age 70 and half were women. [2] Risk factors such as a person's background,
lifestyle and environment increase the likelihood of certain NCDs. Every year, at least 5 million people die
because of tobacco use and about 2.8 million die from being overweight. High cholesterol accounts for
roughly 2.6 million deaths and 7.5 million die because of high blood pressure.
Risk factors such as a person's background; lifestyle and environment are known to increase the likelihood of
certain non-communicable diseases. They include age, gender, genetics, exposure to air pollution, and
behaviors such as smoking, unhealthy diet and physical inactivity which can lead
to hypertension and obesity, in turn leading to increased risk of many NCDs. Most NCDs are considered
preventable because they are caused by modifiable risk factors.
The WHO's World Health Report 2002 identified five important risk factors for non-communicable disease in
the top ten leading risks to health. These are raised blood pressure, raisedcholesterol, tobacco use, alcohol
consumption, and overweight. The other factors associated with higher risk of NCDs include a person's
economic and social conditions, also known as the "[social determinants of health]."
It has been estimated that if the primary risk factors were eliminated, 80% of the cases of heart disease,
stroke and type 2 diabetes and 40% of cancers could be prevented. Interventions targeting the main risk
factors could have a significant impact on reducing the burden of disease worldwide. Efforts focused on
better diet and increased physical activity have been shown to control the prevalence of NCDs .

Environmental diseases
NCDs include many environmental diseases covering a broad category of avoidable and unavoidable human
health conditions caused by external factors, such as sunlight, nutrition, pollution, and lifestyle choices.
The diseases of affluence are non-infectious diseases with environmental causes. Examples include:

Many types of cardiovascular disease (CVD)

Chronic obstructive pulmonary disease (COPD) caused by smoking tobacco

Diabetes mellitus type 2

Lower back pain caused by too little exercise

Malnutrition caused by too little food, or eating the wrong kinds of food (e.g. scurvy from lack
of Vitamin C)

Skin cancer caused by radiation from the sun

Obesity

NCD Alliance[edit]
The NCD Alliance is a global partnership founded in May 2009 by four international federations
representing cardiovascular disease, diabetes, cancer, and chronic respiratory disease. The NCD Alliance
brings together roughly 900 national member associations to fight non-communicable disease. Long term
aims of the Alliance include:[6]
1. NCD/disease national plans for all
2. A tobacco free world
3. Improved lifestyles
4. Strengthened health systems
5. Global access to affordable and good quality medicines and technologies
6. Human rights for people with NCDs.

Key diseases

Cancer[edit]
Main article: Cancer
For the vast majority of cancers, risk factors are environmental or lifestyle-related, thus cancers are mostly
preventable NCD.[10] Greater than 30% of cancer is preventable via avoiding risk factors including: tobacco,
being overweight or obesity, low fruit and vegetable intake, physical inactivity, alcohol, sexually transmitted

infections, and air pollution.[11] Infectious agents are responsible for some cancers, for instance almost
all cervical cancers are caused by human papillomavirus infection.

Cardiovascular disease[edit]
Main article: Cardiovascular disease
The first studies on cardiovascular health were performed in 1949 by Jerry Morris using occupational health
data and were published in 1958.[12] The causes, prevention, and/or treatment of all forms of cardiovascular
disease remain active fields of biomedical research, with hundreds of scientific studies being published on a
weekly basis. A trend has emerged, particularly in the early 2000s, in which numerous studies have revealed
a link between fast food and an increase in heart disease. These studies include those conducted by the
Ryan Mackey Memorial Research Institute, Harvard University and the Sydney Center for Cardiovascular
Health. Many major fast food chains, particularly McDonald's, have protested the methods used in these
studies and have responded with healthier menu options.
A fairly recent emphasis is on the link between low-grade inflammation that hallmarks atherosclerosis and its
possible interventions. C-reactive protein (CRP) is a common inflammatory marker that has been found to be
present in increased levels in patients at risk for cardiovascular disease. [13] Also osteoprotegerin which
involved with regulation of a key inflammatory transcription factor called NF-B has been found to be a risk
factor of cardiovascular disease and mortality.[14][15]

Diabetes[edit]
Main article: Diabetes
Type 2 Diabetes Mellitus is a chronic condition which is largely preventable and manageable but difficult to
cure. Management concentrates on keeping blood sugar levels as close to normal ("euglycemia") as possible
without presenting undue patient danger. This can usually be with close dietary management, exercise, and
use of appropriate medications (insulin only in the case of type 1 diabetes mellitus. Oral medications may be
used in the case of type 2 diabetes, as well as insulin).
Patient education, understanding, and participation is vital since the complications of diabetes are far less
common and less severe in people who have well-managed blood sugar levels. [16][17] Wider health problems
may accelerate the deleterious effects of diabetes. These include smoking, elevated
cholesterol levels, obesity, high blood pressure, and lack of regularexercise.

Chronic kidney disease[edit]

Main article: Chronic kidney disease
Although chronic kidney disease (CKD) is not currently identified as one of WHO's main targets for global
NCD control, there is compelling evidence that CKD is not only common, harmful and treatable but also a
major contributing factor to the incidence and outcomes of at least three of the diseases targeted by WHO
(diabetes, hypertension and CVD).[18] CKD strongly predisposes to hypertension and CVD; diabetes,
hypertension and CVD are all major causes of CKD; and major risk factors for diabetes, hypertension and
CVD (such as obesity and smoking) also cause or exacerbate CKD. In addition, among people with diabetes,
hypertension, or CVD, the subset who also have CKD are at highest risk of adverse outcomes and high
health care costs. Thus, CKD, diabetes and cardiovascular disease are closely associated conditions that
often coexist; share common risk factors and treatments; and would benefit from a coordinated global
approach to prevention and control.

Ballard Maturational Assessment

The Ballard Maturational Assessment, Ballard Score, or Ballard Scale is a commonly used technique of
gestational age assessment. It assigns a score to various criteria, the sum of all of which is then extrapolated
to the gestational age of the baby. These criteria are divided into Physical and Neurological criteria. This
scoring allows for the estimation of age in the range of 26 weeks-44 weeks. The New Ballard Score is an
extension of the above to include extremely pre-term babies i.e. up to 20 weeks.
The scoring relies on the intra-uterine changes that the fetus undergoes during its maturation. Whereas the
neurological criteria depend mainly upon muscle tone, the physical ones rely on anatomical changes.
The neonate (less than 37 weeks of age) is in a state of physiological hypotonia. This tone increases
throughout the fetal growth period, meaning a more prematurebaby would have lesser muscle tone.
It was developed in 1979.[1]

The Neuromuscular criteria[edit]

These are:
1. Posture
2. Square window
3. Arm recoil
4. Popliteal angle
5. Scarf sign
6. Heel To ear[2]

The Physical criteria[edit]

These are:
1. Skin
2. Ear/eye
3. Lanugo hair
4. Plantar surface
5. Breast bud
6. Genitals

Scoring[edit]
Each of the above criteria are scored from 0 through 5, in the original Ballard Score. The scores were then
ranged from 5 to 50, with the corresponding gestational ages being 26 weeks and 44 weeks. An increase in
the score by 5 increases the age by 2 weeks. The New Ballard Score allows scores of -1 for the criteria,
hence making negative scores possible. The possible scores then range from -10 to 50, the gestational range

extending up to 20 weeks. (A simple formula to come directly to the age from the Ballard Score is
Age=(2*score+120) /5)

Apgar score
Virginia Apgar invented the Apgar score in 1952 as a method to quickly summarize the health
of newborn children.[1][2] Apgar was ananesthesiologist who developed the score in order to ascertain the
effects of obstetric anesthesia on babies.
The Apgar scale is determined by evaluating the newborn baby on five simple criteria on a scale from zero to
two, then summing up the five values thus obtained. The resulting Apgar score ranges from zero to 10. The
five criteria are summarized using words chosen to form
a backronym(Appearance, Pulse, Grimace, Activity, Respiration).

Interpretation of scores[edit]

Mind map showing summary for the Apgar score

The test is generally done at one and five minutes after birth, and may be repeated later if the score is and
remains low. Scores 7 and above are generally normal, 4 to 6 fairly low, and 3 and below are generally
regarded as critically low.
A low score on the one-minute test may show that the neonate requires medical attention [3] but does not
necessarily indicate a long-term problem, particularly if the score improves at the five-minute test. An Apgar
score that remains below 3 at later timessuch as 10, 15, or 30 minutesmay indicate longer-

term neurological damage, including a small but significant increase in the risk of cerebral palsy. However,
the Apgar test's purpose is to determine quickly whether a newborn needs immediate medical care. It
is not designed to predict long term health issues.[1]
A score of 10 is uncommon, due to the prevalence of transient cyanosis, and does not substantially differ
from a score of 9. Transient cyanosis is common, particularly in babies born at high altitude. A study that
compared babies born in Peru near sea level with babies born at very high altitude (4340 m) found a
significant average difference in the first Apgar score, but not the second. Oxygen saturation (see Pulse
oximetry) also was lower at high altitude.[4]

Backronym[edit]
Some ten years after initial publication, a backronym for APGAR was coined in the United States as
a mnemonic learning aid:Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity
(muscle tone), and Respiration. In Spanish, the
words Apariencia, Pulso, Gesticulacin, Actividad, Respiracin are used; in
Portuguese, Aparncia, Pulso, Gesticulao,Atividade, Respirao; and, in
French, Apparence, Pouls, Grimace, Activit, Respiration. In German, the words
are Atmung, Puls, Grundtonus, Aussehen, Reflexe, representing the same tests but in a different order
(respiration, pulse, muscle tone, appearance, reflex). Another eponymous backronym from Virginia Apgar's
name is American Pediatric Gross Assessment Record.
Another mnemonic for the test is How Ready Is This Child?which summarizes the test criteria as Heart
rate, Respiratory effort, Irritability, Tone, and Color.