1
|
Rieckmann A, Nielsen S, Dworzynski P, Amini H, Mogensen SW, Silva IB, Chang AY, Arah OA, Samek W, Rod NH, Ekstrøm CT, Benn CS, Aaby P, Fisker AB. Discovering Subgroups of Children With High Mortality in Urban Guinea-Bissau: Exploratory and Validation Cohort Study. JMIR Public Health Surveill 2024; 10:e48060. [PMID: 38592761 DOI: 10.2196/48060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 12/22/2023] [Accepted: 01/23/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND The decline in global child mortality is an important public health achievement, yet child mortality remains disproportionally high in many low-income countries like Guinea-Bissau. The persisting high mortality rates necessitate targeted research to identify vulnerable subgroups of children and formulate effective interventions. OBJECTIVE This study aimed to discover subgroups of children at an elevated risk of mortality in the urban setting of Bissau, Guinea-Bissau, West Africa. By identifying these groups, we intend to provide a foundation for developing targeted health interventions and inform public health policy. METHODS We used data from the health and demographic surveillance site, Bandim Health Project, covering 2003 to 2019. We identified baseline variables recorded before children reached the age of 6 weeks. The focus was on determining factors consistently linked with increased mortality up to the age of 3 years. Our multifaceted methodological approach incorporated spatial analysis for visualizing geographical variations in mortality risk, causally adjusted regression analysis to single out specific risk factors, and machine learning techniques for identifying clusters of multifactorial risk factors. To ensure robustness and validity, we divided the data set temporally, assessing the persistence of identified subgroups over different periods. The reassessment of mortality risk used the targeted maximum likelihood estimation (TMLE) method to achieve more robust causal modeling. RESULTS We analyzed data from 21,005 children. The mortality risk (6 weeks to 3 years of age) was 5.2% (95% CI 4.8%-5.6%) for children born between 2003 and 2011, and 2.9% (95% CI 2.5%-3.3%) for children born between 2012 and 2016. Our findings revealed 3 distinct high-risk subgroups with notably higher mortality rates, children residing in a specific urban area (adjusted mortality risk difference of 3.4%, 95% CI 0.3%-6.5%), children born to mothers with no prenatal consultations (adjusted mortality risk difference of 5.8%, 95% CI 2.6%-8.9%), and children from polygamous families born during the dry season (adjusted mortality risk difference of 1.7%, 95% CI 0.4%-2.9%). These subgroups, though small, showed a consistent pattern of higher mortality risk over time. Common social and economic factors were linked to a larger share of the total child deaths. CONCLUSIONS The study's results underscore the need for targeted interventions to address the specific risks faced by these identified high-risk subgroups. These interventions should be designed to work to complement broader public health strategies, creating a comprehensive approach to reducing child mortality. We suggest future research that focuses on developing, testing, and comparing targeted intervention strategies unraveling the proposed hypotheses found in this study. The ultimate aim is to optimize health outcomes for all children in high-mortality settings, leveraging a strategic mix of targeted and general health interventions to address the varied needs of different child subgroups.
Collapse
Affiliation(s)
- Andreas Rieckmann
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sebastian Nielsen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, Research unit Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Piotr Dworzynski
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Heresh Amini
- Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Institute for Climate Change, Environmental Health, and Exposomics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Isaquel Bartolomeu Silva
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, Research unit Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Angela Y Chang
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
- The Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Statistics and Data Science, College of Letters and Science, University of California, Los Angeles, Los Angeles, CA, United States
- Research Unit for Epidemiology, Department of Public Health, University of Aarhus, Aarhus, Denmark
| | - Wojciech Samek
- Department of Artificial Intelligence, Fraunhofer Heinrich Hertz Institute, Berlin, Germany
- Department of Electrical Engineering and Computer Science, Technical University of Berlin, Berlin, Germany
- Berlin Institute for the Foundations of Learning and Data, Berlin, Germany
| | - Naja Hulvej Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Claus Thorn Ekstrøm
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christine Stabell Benn
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, Research unit Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, Odense University Hospital and University of Southern Denmark, Odense, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
| | - Peter Aaby
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, Research unit Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Ane Bærent Fisker
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, Research unit Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| |
Collapse
|
2
|
Gupta PM, Madewell ZJ, Gannon BM, Grahn M, Akelo V, Onyango D, Mahtab S, Madhi SA, Giri J, Blau DM, Ramakrishnan U, Stein AD, Whitney CG, Young MF, Tanumihardjo SA, Suchdev PS. Hepatic Vitamin A Concentrations and Association with Infectious Causes of Child Death. J Pediatr 2024; 265:113816. [PMID: 37931699 PMCID: PMC10869935 DOI: 10.1016/j.jpeds.2023.113816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To assess postmortem vitamin A (VA) concentrations in children under 5 years of age and evaluate the association between VA deficiency (VAD) and infectious causes of death (CoD). STUDY DESIGN In this cross-sectional study from the Child Health and Mortality Prevention Surveillance (CHAMPS) Network, liver biopsies collected within 72 hours of death were analyzed from 405 stillbirths and children under 5 years in Kenya and South Africa. Total liver VA (TLVA) concentrations were quantified using ultra-performance liquid chromatography, and cutoffs of ≤0.1 μmol/g, >0.1 to <0.7 μmol/g, ≥0.7 to <1.0 μmol/g, and ≥1.0 μmol/g were used to define VAD, adequate VA status, high VA, and hypervitaminosis A, respectively. CoD were determined by expert panel review. RESULTS Among 366 liver samples with viable extraction, pooled prevalences of VAD, adequacy, high VA, and hypervitaminosis were 34.2%, 51.1%, 6.0%, and 8.7%, respectively. VAD was more common among neonates compared with stillbirths, infants, or children, and among those with low birthweight (LBW), underweight, or stunting (P < .05). When adjusting for site, age, and sex, there was no significant association of VAD with increased infectious CoD (OR 1.9, 95% confidence interval [CI] 0.9, 3.8, P = .073). In stratified analyses, VA deficient boys, but not girls, had an increased risk of infectious CoD (OR 3.4, 95% CI 1.3, 10.3, P = .013). CONCLUSIONS Definitive postmortem assessment of VA status identified both VAD and VA excess among children under 5 years of age in Kenya and South Africa. VAD in boys was associated with increased risk of infectious mortality. Our findings may inform a transition from universal VA supplementation (VAS) to targeted strategies in certain countries.
Collapse
Affiliation(s)
- Priya M Gupta
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Zachary J Madewell
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA
| | - Bryan M Gannon
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | - Michael Grahn
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | - Victor Akelo
- US Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | | | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Judith Giri
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Dianna M Blau
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Cynthia G Whitney
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Melissa F Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Parminder S Suchdev
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA; Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA; Department of Pediatrics, Emory University, Atlanta, GA.
| |
Collapse
|
3
|
Degefa K, Tadesse A, Ackley C, Madrid L, Assefa N, Breines M, Sivalogan K, Maixenchs M, Blevins J. Using traditional healers to treat child malnutrition: a qualitative study of health-seeking behaviour in eastern Ethiopia. BMC Public Health 2022; 22:873. [PMID: 35501748 PMCID: PMC9059398 DOI: 10.1186/s12889-022-13323-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/18/2022] [Indexed: 11/22/2022] Open
Abstract
Background Malnutrition among children under five years of age is a major public health issue in many low and middle-income constrained countries. According to WHO, 5.3 million under-five children die every year and about 45% of these deaths are linked to malnutrition. While it is clear that poverty and lack of food are important factors in children’s malnutrition, less is known about the ways in which local conceptions of malnutrition affect parents’ treatment choices. In Ethiopia, child malnutrition is a severe public health problem and a common cause of child death, and this paper explores the local views of malnutrition and how these shape people’s health-seeking behaviour. Methods The study was conducted in eastern Ethiopia from December 2017 to January 2019, conducting interviews and focus group discussions to explore different views and treatment options malnutrition. The study used grounded theory because it allows new and unexpected themes to arise from the data. Researchers’ assumptions on local terminologies of child malnutrition are also controlled as a principle of ground theory. Results Child malnutrition was not only perceived to be related to lack of food but was understood in a wider local conceptualization of health and illness. Parents often relied on healers because they are long-standing members of the community, possess indigenous knowledge, and cost less than other options. Because health professionals and the community perceive and speak of health very differently, people often do not seek support from health services. The misalignments between how health professionals and healers diagnose and treat malnourished children have implications on the possibilities to implement change to reduce malnutrition. Conclusions Through an exploration of people’s own terminology and understandings of what a malnourished child is, as well as the underlying reasons for their illness, this paper explores how people understand malnutrition symptoms and why many tend to rely on healers rather than seeking care from health centres.
Collapse
Affiliation(s)
- Ketema Degefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Adugna Tadesse
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | - Lola Madrid
- London School of Hygiene & Tropical Medicine, London, UK
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Markus Breines
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Maria Maixenchs
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - John Blevins
- Emory Global Health Institute, Emory University, Atlanta, GA, USA
| |
Collapse
|
4
|
Girma Gudata Z, Dheresa M, Mengesha G, Roba KT, Yusuf J, Daraje G, Aliyi I, Abebe F, Asefa N. Cohort Profile: The Haramaya health and demographic surveillance system (Haramaya HDSS). Int J Epidemiol 2021; 51:e46-e54. [PMID: 34738113 DOI: 10.1093/ije/dyab232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 10/12/2021] [Indexed: 01/05/2023] Open
Affiliation(s)
| | - Merga Dheresa
- College of Health and Medical Sciences, Haramaya University, Ethiopia
| | - Gezahegn Mengesha
- College of Health and Medical Sciences, Haramaya University, Ethiopia
| | - Kedir Teji Roba
- College of Health and Medical Sciences, Haramaya University, Ethiopia
| | - Jemal Yusuf
- Haramaya University, College of Health and Medical Science, Harar, Ethiopia
| | - Gamachis Daraje
- College of Health and Medical Sciences, Haramaya University, Ethiopia
| | - Ibsa Aliyi
- College of Health and Medical Sciences, Haramaya University, Ethiopia
| | - Feyisa Abebe
- College of Health and Medical Sciences, Haramaya University, Ethiopia
| | - Nega Asefa
- College of Health and Medical Sciences, Haramaya University, Ethiopia
| |
Collapse
|
5
|
Paganelli CR, Goco NJ, McClure EM, Banke KK, Blau DM, Breiman RF, Menéndez C, Rakislova N, Bassat Q. The evolution of minimally invasive tissue sampling in postmortem examination: a narrative review. Glob Health Action 2021; 13:1792682. [PMID: 32713325 PMCID: PMC7480574 DOI: 10.1080/16549716.2020.1792682] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Because of low acceptance rates and limited capacity, complete diagnostic autopsies (CDAs) are seldom conducted in low- and middle-income countries (LMICs). There have been growing investments in less-invasive postmortem examination methodologies, including needle-based autopsy, known as minimally invasive autopsy or minimally invasive tissue sampling (MITS). MITS has been shown to be a feasible and informative alternative to CDA for cause of death investigation and mortality surveillance purposes. OBJECTIVE The aim of this narrative review is to describe historical use and evolution of needle-based postmortem procedures as a tool to ascertain the cause of death, especially in LMICs. METHODS Key word searches were conducted in PubMed and EBSCO in 2018 and 2019. Abstracts were reviewed against inclusion and exclusion criteria. Full publications were reviewed for those abstracts meeting inclusion criteria and a start set was established. A snowball search methodology was used and references for all publications meeting inclusion criteria were manually reviewed until saturation was reached. RESULTS A total of 1,177 publications were initially screened. Following an iterative review of references, 79 publications were included in this review. Twenty-nine studies, published between 1955 and 2019, included MITS as part of postmortem examination. Of the publications included, 76% (60/79) have publication dates after 2010. More than 60% of all publications included addressed MITS in LMICs, and a total of nine publications compared MITS with CDA. CONCLUSIONS Although there is evidence of less-invasive postmortem sampling starting in the 1800s, more structured needle-based postmortem examination publications started to appear in the mid-twentieth century. Early studies were mostly conducted in high-income countries but starting in 2010 the number of publications began to increase, and a growing number of studies were conducted in LMICs. Initial studies in LMICs were disease-specific but since 2015 have evolved to include more expansive postmortem examination.
Collapse
Affiliation(s)
| | | | | | - Kathryn K Banke
- Centers for Disease Control and Prevention , Atlanta, GA, USA
| | - Dianna M Blau
- Centers for Disease Control and Prevention , Atlanta, GA, USA
| | - Robert F Breiman
- Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, GA, USA
| | - Clara Menéndez
- ISGlobal Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona , Barcelona, Spain
| | - Natalia Rakislova
- ISGlobal Department of Pathology Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona , Barcelona, Spain
| | - Quique Bassat
- ISGlobal Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona , Barcelona, Spain
| |
Collapse
|
6
|
Menon GR, Singh L, Sharma P, Yadav P, Sharma S, Kalaskar S, Singh H, Adinarayanan S, Joshua V, Kulothungan V, Yadav J, Watson LK, Fadel SA, Suraweera W, Rao MVV, Dhaliwal RS, Begum R, Sati P, Jamison DT, Jha P. National Burden Estimates of healthy life lost in India, 2017: an analysis using direct mortality data and indirect disability data. LANCET GLOBAL HEALTH 2020; 7:e1675-e1684. [PMID: 31708148 DOI: 10.1016/s2214-109x(19)30451-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 09/13/2019] [Accepted: 10/07/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Many countries, including India, seek locally constructed disease burden estimates comprising mortality and loss of health to aid priority setting for the prevention and treatment of diseases. We created the National Burden Estimates (NBE) to provide transparent and understandable disease burdens at the national and subnational levels, and to identify gaps in knowledge. METHODS To calculate the NBE for India, we combined 2017 UN death totals with national and subnational mortality rates for 2010-17 and causes of death from 211 166 verbal autopsy interviews in the Indian Million Death Study for 2010-14. We calculated years of life lost (YLLs) and years lived with disability (YLDs) for 2017 using published YLD-YLL ratios from WHO Global Health Estimates. We grouped causes of death into 45 groups, including ill-defined deaths, and summed YLLs and YLDs to calculate disability-adjusted life-years (DALYs) for these causes in eight age groups covering rural and urban areas and 21 major states of India. FINDINGS In 2017, there were about 9·7 million deaths and 486 million DALYs in India. About three quarters of deaths and DALYs occurred in rural areas. More than a third of national DALYs arose from communicable, maternal, perinatal, and nutritional disorders. DALY rates in rural areas were at least twice those of urban areas for perinatal and nutritional conditions, chronic respiratory diseases, diarrhoea, and fever of unknown origin. DALY rates for ischaemic heart disease were greater in urban areas. Injuries caused 11·4% of DALYs nationally. The top 15 conditions that accounted for the most DALYs were mostly those causing mortality (ischaemic heart disease, perinatal conditions, chronic respiratory diseases, diarrhoea, respiratory infections, cancer, stroke, road traffic accidents, tuberculosis, and liver and alcohol-related conditions), with disability mostly due to a few conditions (nutritional deficiencies, neuropsychiatric conditions, vision and other sensory loss, musculoskeletal disorders, and genitourinary diseases). Every condition that was common in one part of India was uncommon elsewhere, suggesting state-specific priorities for disease control. INTERPRETATION The NBE method quantifies disease burden using transparent, intuitive, and reproducible methods. It provides a simple, locally operable tool to aid policy makers in priority setting in India and other low-income and middle-income countries. The NBE underlines the need for many more countries to collect nationally representative cause of death data, paired with focused surveys of disability. FUNDING Ministry of Health and Family Welfare, Government of India.
Collapse
Affiliation(s)
- Geetha R Menon
- Indian Council of Medical Research, Ansari Nagar, New Delhi, India.
| | - Lucky Singh
- Indian Council of Medical Research, Ansari Nagar, New Delhi, India
| | - Palak Sharma
- Indian Council of Medical Research, Ansari Nagar, New Delhi, India
| | - Priyanka Yadav
- Indian Council of Medical Research, Ansari Nagar, New Delhi, India
| | - Shweta Sharma
- Indian Council of Medical Research, Ansari Nagar, New Delhi, India
| | | | - Harpreet Singh
- Indian Council of Medical Research, Ansari Nagar, New Delhi, India
| | | | - Vasna Joshua
- Indian Council of Medical Research, Ansari Nagar, New Delhi, India
| | | | - Jeetendra Yadav
- Indian Council of Medical Research, Ansari Nagar, New Delhi, India
| | - Leah K Watson
- Centre for Global Health Research, St Michael's Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Shaza A Fadel
- Centre for Global Health Research, St Michael's Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wilson Suraweera
- Centre for Global Health Research, St Michael's Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - R S Dhaliwal
- Indian Council of Medical Research, Ansari Nagar, New Delhi, India
| | - Rehana Begum
- Centre for Global Health Research, St Michael's Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Prabha Sati
- Centre for Global Health Research, St Michael's Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Dean T Jamison
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Prabhat Jha
- Centre for Global Health Research, St Michael's Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|