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  • In addition we are continuing our

    2019-06-20

    In addition, we are continuing our regular editorial policies of commissioning more specialised Clinical Reviews and Series across Group to provide a more focused and in-depth assessment for key diseases. And beyond providing knowledge and information, we want to encourage academic and practising clinicians to use this knowledge for advocacy and change. In 2014, published the first in the UK and in February, 2015, we launched our first based on this Commission. A as a joint effort between and followed in April. Clinical Campaigns aim to effect change based on data, knowledge, and expert interpretation in partnership with others. Further Clinical Commissions on asthma, hypertension, dementia, tuberculosis, traumatic Picroside II cost injury, psychotherapy, chronic obstructive pulmonary disease, and others are underway across all journals. With these Clinical Commissions and Campaigns, we hope to extend our goal to publish the best science for better lives to being an active partner in using this science for actual change. Commissions and Campaigns will be part of the disease pages to encourage engagement and actions. invites you to be part of this endeavour.
    Claudia Hanson and colleagues (July, 2015) report that maternal mortality was four times higher in women who lived more than 35 km from a hospital in rural Tanzania than in women who lived within 5 km of a hospital. We strongly agree with the findings of their study, but are interested to know whether a similar association was noted between distance and perinatal mortality. Of the 17 427 deliveries at Modilon Hospital, the only referral hospital in the Madang Province of Papua New Guinea, over a 6-year period, three-quarters of pregnancy-related deaths were recorded in women presenting late to hospital as a result of distance and logistical constrains limiting access to hospital. Additionally, poor quality obstetric care in peripheral health facilities caused a clinically significant increase in the risk of late presentation and maternal deaths in our setting in Papua New Guinea. Because of the high maternal mortality in Papua New Guinea, increased efforts have been made by the government and its partners to improve availability and accessibility of quality obstetric care. Consequently, our in-hospital maternal mortality ratio declined from 893 per 100 000 livebirths in 2009 to 363 per 100 000 livebirths in 2014 (p<0·001; ). We would be interested to know whether Hanson and colleagues noted any correlation between maternal and perinatal mortality in relation to distance in their study. Although access to professional health care during childbirth should obviously reduce perinatal mortality in parallel with maternal mortality, we did not find this in our setting (p=0·10; ). This result highlights the fact that efforts aimed at reducing maternal mortality in developing countries should not overlook neonatal survival.
    We thank John Bolnga and colleagues for raising the question of whether we saw an effect of distance to a health facility on perinatal mortality. We are, unfortunately, not able to report on perinatal mortality as we did not record stillbirths. However, our data show some evidence of neonatal mortality rising with distance to a hospital. Neonatal mortality increased from 29·6 (95% CI 25·4–34·6) per 1000 livebirths for those living less than 5 km from a hospital to 39·7 (33·5–47·1) for those living more than 35 km from a hospital (crude odds ratio 1·31 [95% CI 0·98–1·76], p=0·0139 using a test for trend; ). Others have also reported that distance to care is a determinant of neonatal mortality—although not in all settings.
    In calling for a switch of fossil fuel subsidies to funding of universal health coverage, Vinay Gupta and colleagues (June, 2015) miss two health-relevant issues: all fossil fuels are not the same and all subsidies are not the same. Liquefied petroleum gas (LPG) has major, direct health advantages in household cooking in countries of low and middle income, its primary use. Indeed, the Global Burden of Disease study estimate that 4 million premature deaths annually are attributable to solid cookfuels was calculated using LPG as a benchmark. In other words, the burden could be described as due to the absence of full LPG availability. Simply removing LPG subsidies would have substantial negative health effects by reverting hundreds of millions back to biomass or coal. Targeting of most fossil fuel subsidies is, however, notoriously ineffective, with only 7% distributed to the lowest quintile. Thus, it is not appropriate to compare fossil fuel subsidies with targeted support for health coverage. Indeed, if appropriate targeting is achieved with modern information technologies, rather than being described as subsidies, public funds to enhance health coverage and LPG use by the poor could be better characterised as social investments as with expenditures on primary education and primary health care.