Part I - Overview
Madagascar
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*Madagascar at present can be still found on the list of the 50 poorest countries in the world
*Children make up more than half of Madagascar’s population of 17 million – half of whom live on less than $1 a
day. Natural disasters, such as cyclones and floods, are a frequent risk
*Madagascar has one of the highest infant mortality rates (75/1000 as compared to 7/1000 in the U.S.),
*Madagascar has a low average life expectancy (57 years compared to 78 years in the US).
* Half of all children under five are suffer from some form of malnourishment.
* In rural areas only about 3 out of 10 people have access to safe water and sanitation.
Since we live in New York City metropolitan area which has roughly the same population as Madagascar, we made
a comparison of health care statistics between the two areas. This comparison highlights the major differences
of vital statistics and health care needs.( Data Source: CDC.gov, nyc.gov, WHO, UNICEF, UN.org)
1000
Madagascar – Antisnarana -Millenium clinic project
part I. Madagascar - overview
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Identified Major public health challenges
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New York City
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Madagascar
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1
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prevalence of smoking
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1
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limited access to health care / low personnel
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2
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poor lifestyle ( inactivity/obesity)
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2
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limited access to clean water
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3
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related cardiovascular diseases & cancers
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3
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infections: malaria & lower Resp. infections
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4
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sexually transmitted diseases & HIV
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4
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limited peri-natal care
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5
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environmental health -pollution
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5
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limited immunizations
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6
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mental health and disability
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6
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water borne diseases- diarrhea
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7
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access to health care / uninsured
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7
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cardiovascular disease
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8
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communicable disease control: TB/HIV
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8
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communicable dis. control: tuberculosis/HIV
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9
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chronic disease control
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9
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limited nutrition
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10
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health care costs
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10
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health care costs
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Comparison of causes of child ( under 5y) mortality United States versus Madagascar
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UNITED STATES
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MADAGASCAR
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1
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Neonatal causes
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57%
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1
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Neonatal causes
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26%
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2
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Pneumonia
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1%
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2
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Pneumonia
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21%
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3
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Malaria
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0%
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3
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Malaria
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20%
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4
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Diarrhea
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0%
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4
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Diarrheal diseases
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17%
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5
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Measles
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0%
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5
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Measles
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5%
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6
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Injuries
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11%
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6
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Injuries
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2%
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7
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HIV
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~ 0.001%
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7
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HIV
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1%
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8
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other
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31%
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other
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8%
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9
|
|
|
|
|
|
10
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total
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100%
|
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total
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100%
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Children under age 5
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|
|
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United States
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Madagascar
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child mortality (under age 5)
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3/1000
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123/1000
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Comparison of the leading causes of infant mortality : United States vs Madagascar
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UNITED STATES
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MADAGASCAR
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1
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Congenital anomalies
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21%
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1
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severe infections
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27%
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2
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Sudden infant death syndrome
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14%
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2
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Birth asphyxia
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24%
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3
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Low birth weight/premature death
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12.9%
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3
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preterm birth
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23%
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4
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Respiratory distress syndrome
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5.9%
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4
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neonatal tetanus
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9%
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5
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Maternal diseases affecting
newborn
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4%
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5
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Congenital anomalies
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6
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6
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Newborn affected by disease of
placenta/cord
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3%
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6
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diarrhea
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3%
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7
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Accidents
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2.9%
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7
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other
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7%
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8
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perinatal infections
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2.7%
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8
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|
|
9
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Pneumonia and flu
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1.5%
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9
|
|
|
10
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Birth Asphyxia
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34%
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10
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|
|
10
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total
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100%
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|
total
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100%
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Children- INFANTS
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United States
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Madagascar
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Infant mortality
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6-7/1000
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74/1000
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|
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Children
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Comparison of the leading causes of death : United States vs Madagascar
source: CDC and WHO vital statistics 2004-2005
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UNITED STATES
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US (percent)
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NYC
(percent)
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MADAGASCAR
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|
1
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Diseases of the heart
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28%
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39.4
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lower respiratory infections
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27%
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2
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Cancer
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22.7
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23.7
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Malaria
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14%
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3
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Influenza and pneumonia
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2.7
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5.2
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diarrhea
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9%
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4
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Cerebro-vascular dis.-strok
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6.4
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3.1
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perinatal conditions
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7%
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5
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diabetes mellitus
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3.0
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3.0
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measles
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5%
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6
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chronic lower respiratory disease
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5.2%
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2.9
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cerebrovascular disease/stroke
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5%
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7
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HIV related deaths
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0.7
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2.5%
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diseases of the heart
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5%
|
8
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Accidents
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4.5%
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1.8%
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tuberculosis
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4%
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9
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All other causes
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20.8
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18.4%
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HIV
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3%
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10
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|
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road traffic accidents
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3%
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10
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total
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100%
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100%
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total
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100%
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Populations- basic statistics : New York City Metropolitan Area vs
Madagascar
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New York City metrop. Area
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Madagascar
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population
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17 million
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18 million
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population characteristics
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mostly urban
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mostly rural / 27% urban
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very diverse
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very homogeneous
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life expectancy
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78 years
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55 years
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infant mortality
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6-7/1000 infants
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74/1000 infants
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child mortality (under age 5)
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23/1000 children
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123/1000 children
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maternal mortality per 100,000 live
births
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23/100,000 live
birth
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508/100, 000 people
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tuberculosis cases per 100,000
people
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0.1/100,000
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407/100,000 people
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HIV prevalence
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1.3-1.7%
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1.7%
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Undernourished people
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no data
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36.6%
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Access to drinking water
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no data-100%
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35-70% depending on the
area
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Health care delivery, financing and human power- basic data
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New York City metrop. Area
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New york City
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Madagascar
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Average gross income per capita
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$40,000 annually
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$290 annually
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Per Capita Health care expenditure
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$6,600
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~$30
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number of doctors
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~40,000
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~5,200
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number of doctors per 1000
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7-15/1000
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0.14/1000
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