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Whitaker J, Edem I, Amoah AS, Dube A, D'Ambruoso L, Rickard RF, Leather AJM, Davies J. Understanding the health system utilisation and reasons for avoidable mortality after fatal injury within a Three-Delays framework in Karonga, Northern Malawi: a retrospective analysis of verbal autopsy data. BMJ Open 2024; 14:e081652. [PMID: 38684258 PMCID: PMC11086451 DOI: 10.1136/bmjopen-2023-081652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/10/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES To use verbal autopsy (VA) data to understand health system utilisation and the potential avoidability associated with fatal injury. Then to categorise any evident barriers driving avoidable delays to care within a Three-Delays framework that considers delays to seeking (Delay 1), reaching (Delay 2) or receiving (Delay 3) quality injury care. DESIGN Retrospective analysis of existing VA data routinely collected by a demographic surveillance site. SETTING Karonga Health and Demographic Surveillance Site (HDSS) population, Northern Malawi. PARTICIPANTS Fatally injured members of the HDSS. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the proportion of fatal injury deaths that were potentially avoidable. Secondary outcomes were the delay stage and corresponding barriers associated with avoidable deaths and the health system utilisation for fatal injuries within the health system. RESULTS Of the 252 deaths due to external causes, 185 injury-related deaths were analysed. Deaths were predominantly among young males (median age 30, IQR 11-48), 71.9% (133/185). 35.1% (65/185) were assessed as potentially avoidable. Delay 1 was implicated in 30.8% (20/65) of potentially avoidable deaths, Delay 2 in 61.5% (40/65) and Delay 3 in 75.4% (49/65). Within Delay 1, 'healthcare literacy' was most commonly implicated barrier in 75% (15/20). Within Delay 2, 'communication' and 'prehospital care' were the most commonly implicated in 92.5% (37/40). Within Delay 3, 'physical resources' were most commonly implicated, 85.7% (42/49). CONCLUSIONS VA is feasible for studying pathways to care and health system responsiveness in avoidable deaths following injury and ascertaining the delays that contribute to deaths. A large proportion of injury deaths were avoidable, and we have identified several barriers as potential targets for intervention. Refining and integrating VA with other health system assessment methods is likely necessary to holistically understand an injury care health system.
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Affiliation(s)
- John Whitaker
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - Idara Edem
- Insight Institute of Neurosurgery & Neuroscience, Flint, Michigan, USA
- Michigan State University, East Lansing, Michigan, USA
| | - Abena S Amoah
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Malawi Epidemiological and Intervention Research Unit, Chilumba, Malawi
| | - Albert Dube
- Malawi Epidemiological and Intervention Research Unit, Chilumba, Malawi
| | - Lucia D'Ambruoso
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Surgery, Stellenbosch University, Stellenbosch, South Africa
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Public Health, National Health Service (NHS) Grampian, Grampian, Scotland
| | - Rory F Rickard
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - Andy J M Leather
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Surgery, Stellenbosch University, Stellenbosch, South Africa
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Akinkuotu AC, Purcell LN, Varela C, Hayes A, Charles A. Childhood Drownings: An Opportunity for Injury Prevention in a Resource-Limited Setting. J Trop Pediatr 2022; 68:6655718. [PMID: 35925067 DOI: 10.1093/tropej/fmac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Drowning is a public health problem that is under-reported in Africa. We sought to evaluate the epidemiology and risk factors for drownings in Malawi. METHODS We performed a retrospective review of all pediatric (≤15 years old) patients who presented following a drowning incident to Kamuzu Central Hospital in Lilongwe, Malawi, from 2009-19. Demographics and outcomes were compared between survivors and non-survivors. Logistic multivariate regression analysis was used to identify factors associated with increased odds of mortality. RESULTS There were 156 pediatric drowning victims during the study period. The median age at presentation was 3 (IQR: 2-7 years). Survivors were younger [median age: 2 years (IQR: 2-5) vs. 5 years (IQR: 2-10), p = 0.004], with a higher proportion of drownings occurring at home (85.6% vs. 58.3%, p = 0.001) compared to non-survivors. Patients who had a drowning event at a public space had increased odds of mortality (OR 8.17, 95% CI 2.34-28.6). Patients who were transferred (OR 0.03, 95% CI 0.003-0.25) and had other injuries (OR 0.20, 95% CI 0.06-0.70) had decreased odds of mortality following drowning. CONCLUSION Over half of pediatric drowning victims at a tertiary-care facility in Malawi survived. Drowning survivors were significantly younger, more likely to have drowned at home, and transported by private vehicles and minibus than non-survivors. There is a need for scalable, cost-effective drowning prevention strategies that focus on water safety education and training community members and police officers in basic life support and resuscitation.
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Affiliation(s)
- Adesola C Akinkuotu
- Department of Surgery, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura N Purcell
- Department of Surgery, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carlos Varela
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Andrea Hayes
- Department of Surgery, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony Charles
- Department of Surgery, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Fenta EH, Sisay BG, Gebreyesus SH, Endris BS. Trends and causes of adult mortality from 2007 to 2017 using verbal autopsy method, Addis Ababa, Ethiopia. BMJ Open 2021; 11:e047095. [PMID: 34785542 PMCID: PMC8596056 DOI: 10.1136/bmjopen-2020-047095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 10/28/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES We aim to analyse the trends and causes of mortality among adults in Addis Ababa. SETTING This analysis was conducted using verbal autopsy data from the Addis Ababa Mortality Surveillance in Addis Ababa, Ethiopia. PARTICIPANTS All deceased adults aged 15 years and above between 2007-2012 and 2015-2017 were included in the analysis. OUTCOME MEASURES We collected verbal autopsy and conducted physician review to ascertain cause of death. RESULT A total of 7911 data were included in this analysis. Non-communicable disease (NCD) accounted for 62.8% of adult mortality. Mortality from communicable diseases, maternal conditions and nutritional deficiencies followed this by accounting for 30.3% of total mortality. Injury accounted for 6.8% of total mortality. We have observed a significant decline in mortality attributed to group one cause of death (43.25% in 2007 to 12.34% in 2017, p<0.001). However, we observed a significant increase in mortality attributed to group II cause of death (from 49.95% in 2007 to 81.17% in 2017, p<0.001). The top five leading cause of death in 2017 were cerebrovascular disease (12.8%), diabetes mellitus (8.1%), chronic liver disease (6.3%), hypertension (5.7%), ischaemic heart disease (5.7%) and other specified neoplasm (5.2%). CONCLUSION We documented an epidemiological shift in cause of mortality from communicable diseases to NCD over 10 years. There is a great progress in reducing mortality due to communicable diseases over the past years. However, the burden of NCDs call for actions for improving access to quality health service, improved case detection and community education to increase awareness. Integrating NCD intervention in to a well-established and successful programme targeting communicable diseases in the country might be beneficial for improving provision of comprehensive healthcare.
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Affiliation(s)
- Esete Habtemariam Fenta
- Department of Nutrition and Dietetics, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Binyam Girma Sisay
- Department of Nutrition and Dietetics, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Seifu H Gebreyesus
- Department of Nutrition and Dietetics, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bilal Shikur Endris
- Department of Nutrition and Dietetics, Addis Ababa University, Addis Ababa, Ethiopia
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Mulima G, Purcell LN, Maine R, Bjornstad EC, Charles A. Epidemiology of prehospital trauma deaths in Malawi: A retrospective cohort study. Afr J Emerg Med 2021; 11:258-262. [PMID: 33859929 PMCID: PMC8027520 DOI: 10.1016/j.afjem.2021.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/25/2021] [Accepted: 03/13/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Trauma is among the leading causes of death and disability in both adults and children worldwide. In Malawi, trauma patients are commonly brought in dead (BID). We aimed to describe the prevalence, sociodemographic, and injury-related characteristics of patients BID to Kamuzu Central Hospital (KCH), a referral hospital in Lilongwe, Malawi. Methods We retrospectively reviewed records of all patients BID in the trauma surveillance registry at KCH from February 2008 to September 2019. We excluded patients BID that did not present to the emergency centre, and were instead taken to the mortuary directly. We used descriptive statistics to evaluate the epidemiology of patients BID. Results We reviewed 106,198 trauma records and 1889 (1.8%) were BID patients. Most patients BID were male, in both adult (n = 1337/1528, 88.4%) and children (n = 231/360, 64.9%) cohorts. The mean age was 34.7 (SD 11.9) years in adults and 7.8 (SD 5.4) years in children. Among the adult BID patients, 33.2% were unemployed, 25.6% were construction workers, and 10.1% were small business owners or managers. The common injury mechanisms in adults were road traffic-related injuries (RTIs) (47.1%) and assaults (23.6%). In children, injuries resulted from RTIs (39.7%), with 74.4% of those were pedestrians hit by cars, drowning (22.9%), and burns (12.4%). In both groups, most injuries occurred on roads (60.2%) or at home (22.1%). Reported alcohol use at the time of trauma was present in 6.3%. The police (57.9%) and privately-owned vehicles (26.6%) transported most BID patients to KCH. Conclusion Efforts to reduce prehospital trauma mortality must focus on improving prehospital care, including training the police and community in basic life support and improving resources towards prehospital trauma care. Further efforts to reduce prehospital mortality must aim to decrease injuries on the roads and at home.
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Banda GT, Banda N, Chadza A, Mthunzi C. Suicide epidemic in Malawi: what can we do? Pan Afr Med J 2021; 38:69. [PMID: 33889235 PMCID: PMC8028359 DOI: 10.11604/pamj.2021.38.69.27843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 11/29/2022] Open
Abstract
Suicide continues to be a global health concern, affecting all continents. Although some studies have associated it with mental disorders such as severe depression, research also shows that a significant number of cases occur due to emerging life stresses. It is one of the leading causes of death among young people and is steady on the rise in Malawi. Malawi’s suicide cases disproportionately affect young males from rural areas. These cases are also higher than those of neighbouring countries. During the lockdown period to mitigate the impact of the COVID-19 pandemic between April and September 2020, Malawi saw a rise in suicide cases, most of which were due to the resulting financial hardship. There is need to tackle the suicide epidemic holistically, on all tiers of intervention. People need to be equipped with socially acceptable coping mechanisms which are easily adaptable to a low resource setting. There is a need for initiative to be taken in training individuals who can manage mental ill health without overwhelming the health system. The entire health system and health policies should acknowledge the importance of mental ill-health and its consequences. Malawi needs to prioritise mental health issues, realising that indeed, there is no health, without mental health.
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Affiliation(s)
- Gift Treighcy Banda
- Global Health, Department of Communications, Free Spirits Mental Health Awareness Group, Blantyre, Malawi
| | - Natasha Banda
- Queen Elizabeth Central Hospital, Department of Logistics, Free Spirits Mental Health Awareness Group, Blantyre, Malawi
| | - Anthony Chadza
- The Catholic University of Malawi, Counselling, Free Spirits Mental Health Awareness Group, Blantyre, Malawi
| | - Chisomo Mthunzi
- Global Health, Department of Communications, Free Spirits Mental Health Awareness Group, Blantyre, Malawi
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Trends in mortality from external causes in the Republic of Seychelles between 1989 and 2018. Sci Rep 2020; 10:22186. [PMID: 33335193 PMCID: PMC7746745 DOI: 10.1038/s41598-020-79228-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/02/2020] [Indexed: 11/23/2022] Open
Abstract
Data on injury-related mortality are scarce in the African region. Mortality from external causes in the Seychelles was assessed, where all deaths are medically certified and the population is regularly enumerated. The four fields for underlying causes of death recorded were reviewed in the national vital statistics register. The age-standardised mortality rates were estimated (per 100,000 person-years) from external causes in 1989–1998, 1999–2008, and 2009–2018. Mortality rates per 100,000 person-years from external causes were 4–5 times higher among males than females, and decreased among males over the three 10-year periods (127.5, 101.4, 97.1) but not among females (26.9, 23.1, 26.9). The contribution of external causes to total mortality did not change markedly over time (males 11.6%, females 4.3% in 1989–2018). Apart from external deaths from undetermined causes (males 14.6, females 2.4) and “other unintentional injuries” (males 14.1, females 8.0), the leading external causes of death in 2009–2018 were drowning (25.9), road traffic injuries (18.0) and suicide (10.4) among males; and road traffic injuries (4.6), drowning (3.4) and poisoning (2.6) among females. Mortality from broad categories of external causes did not change consistently over time but rates of road traffic injuries increased among males. External causes contributed approximately 1 in 10 deaths among males and 1 in 20 among females, with no marked change in cause-specific rates over time, except for road traffic injuries. These findings emphasise the need for programs and policies in various sectors to address this large, but mostly avoidable health burden.
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Anteneh A, Endris BS. Injury related adult deaths in Addis Ababa, Ethiopia: analysis of data from verbal autopsy. BMC Public Health 2020; 20:926. [PMID: 32539824 PMCID: PMC7294602 DOI: 10.1186/s12889-020-08944-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 05/18/2020] [Indexed: 11/18/2022] Open
Abstract
Background Injury related deaths are causing huge impact on families and communities throughout the world. Reports show that developing countries are highly affected by injury deaths. Ethiopia is among the countries that are highly affected by injury deaths especially road traffic accident. Previous studies in Ethiopia concerning injury deaths were mostly based on hospital records. However, in the context of Ethiopia, where majority of the deaths are happening outside health facilities, hospital-based studies cannot give the exact proportion of injury deaths. This study aimed to assess the proportion and types of injury deaths in Addis Ababa and the distribution with different socio-demographic characteristics using data from verbal autopsy. Methods We used verbal autopsy data of Addis Ababa Mortality Surveillance Program. The basic source of data for Addis Ababa Mortality Surveillance is burial surveillance from all cemeteries of Addis Ababa. We analyzed causes of injury mortality by different characteristics and tried to show the trends. Results Over the 8 years period of time injury has contributed about 7 % of the total deaths. Majority of injury related deaths were among males. Traffic accidents were the major injury related deaths for both sexes; intentional self-harm was highly observed among males compared with females. The findings of this study showed that the proportion of injury related deaths decreased with increasing age. Conclusions This study witnessed that deaths resulting from injuries are substantial health challenges in Addis Ababa. Road traffic accident is the most common cause of injury related deaths in the study area. The findings also indicated that males and the productive age groups are highly affected by injury deaths.
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Affiliation(s)
- Aderaw Anteneh
- Population Services International-Ethiopia, Addis Ababa, Ethiopia.
| | - Bilal Shikur Endris
- PI of AAMSP, School of Public Health, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
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Chasimpha SJ, Mclean EM, Dube A, McCormack V, dos-Santos-Silva I, Glynn JR. Assessing the validity of and factors that influence accurate self-reporting of HIV status after testing: a population-based study. AIDS 2020; 34:931-941. [PMID: 32073446 PMCID: PMC7553190 DOI: 10.1097/qad.0000000000002513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/29/2020] [Accepted: 02/10/2020] [Indexed: 12/03/2022]
Abstract
OBJECTIVES To assess the validity of self-reported HIV status, and investigate factors that influence accurate reporting of HIV-positive status, in a population tested and informed of their HIV test result. DESIGN Prospective cohort study. METHODS We compared self-reported HIV status with biomarker-confirmed HIV test status among participants of Karonga Health and Demographic Surveillance Site in rural northern Malawi. We linked information on HIV test results to subsequent self-reported HIV status, and calculated sensitivity, specificity, positive predictive value and negative predictive value for self-reported HIV status (considered as a diagnostic test). We used Poisson regression with robust variance estimators to examine predictors of accurate self-reporting of HIV-positive status. RESULTS Among 17 445 adults who tested for HIV, were recorded as having received their HIV test results, and had a subsequent self-reported HIV status between 2007 and 2018: positive predictive value of self-reported HIV status was 98.0% (95% confidence interval: 97.3-98.7); negative predictive value was 98.3 (98.1-98.5); sensitivity was 86.1% (84.5-87.7); and specificity was 99.8% (99.7-99.9). Among true HIV-positive people, those who were younger, interviewed in community settings, and had tested for HIV longer ago were more likely to misreport their HIV-positive status. CONCLUSION In this setting, self-report provides good estimates of test-detected HIV prevalence, suggesting that it can be used when HIV test results are not available. Despite frequent HIV testing, younger people and those interviewed in community settings were less likely to accurately report their HIV-positive status. More research on barriers to self-reporting of HIV status is needed in these subgroups.
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Affiliation(s)
- Steady J.D. Chasimpha
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Estelle M. Mclean
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Albert Dube
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | - Valerie McCormack
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Isabel dos-Santos-Silva
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Judith R. Glynn
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Whitworth HS, Pando J, Hansen C, Howard N, Moshi A, Rocky O, Mahanga H, Jabbar M, Ayieko P, Kapiga S, Grosskurth H, Watson-Jones D. Drowning among fishing communities on the Tanzanian shore of lake Victoria: a mixed-methods study to examine incidence, risk factors and socioeconomic impact. BMJ Open 2019; 9:e032428. [PMID: 31843838 PMCID: PMC6924839 DOI: 10.1136/bmjopen-2019-032428] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To estimate the incidence of unintentional fatal drowning and describe associated risk factors among Lake Victoria fishing communities, and to assess perceived social, financial and other impacts among families and colleagues of persons who drowned. DESIGN A retrospective, observational mixed-methods study, conducted between September 2017 and February 2018. SETTING Eight Tanzanian fishing communities on Lake Victoria. PARTICIPANTS Persons who drowned in the preceding 24 months were identified using an extensive community networking approach. Adult family members, colleagues or community members familiar with the habits and behaviours of people who drowned and/or circumstances of drowning incidents participated in surveys (n=44) and in-depth interviews (n=22). MAIN OUTCOME MEASURES Pooled drowning incidence, with sensitivity analyses allowing for uncertainties in population estimates. Risk factors were identified through the evaluation of behavioural characteristics of persons who drowned and circumstances of drowning incidents. Perceived socioeconomic impacts were assessed through semi-structured interviews with their family members and colleagues. RESULTS The estimated drowning incidence was 217/100 000 person-years (95% CI 118 to 425/100 000). Of 86 victims identified, 70 (81%) were fishermen (79% aged 18-40 years; all men) and 9 were children (all ≤10 years). All deaths occurred in the lake. Most adults (65/77; 84%) were fishing from a boat when they drowned; 57/77 (74%) died in the evening (from ~5 pm) or at night. Six children (67%) drowned while swimming/playing at the lakeshore unsupervised. Few victims (2/86; 2%) were wearing a life jacket at the time of death. Reported socioeconomic impacts of these deaths ranged from income loss to family break-up. CONCLUSIONS Drowning is a significant risk in Tanzanian lakeside fishing communities, with estimated mortality exceeding national incidence rates of fatal malaria, tuberculosis or HIV, but preventative strategies appear uncommon. Socioeconomic impact at the family level may be substantial. Intervention strategies are required to reduce the drowning burden among this neglected at-risk population.
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Affiliation(s)
- Hilary S Whitworth
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Joyce Pando
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Christian Hansen
- Uganda Virus Research Institute, Entebbe, Uganda
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Natasha Howard
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Amen Moshi
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Otto Rocky
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | | | - Mtoro Jabbar
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Philip Ayieko
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Heiner Grosskurth
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Deborah Watson-Jones
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Epidemiology, Risk Factors and Measures for Preventing Drowning in Africa: A Systematic Review. ACTA ACUST UNITED AC 2019; 55:medicina55100637. [PMID: 31557943 PMCID: PMC6843779 DOI: 10.3390/medicina55100637] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/01/2019] [Accepted: 09/18/2019] [Indexed: 12/20/2022]
Abstract
Background and Objectives: Drowning is a leading cause of unintentional injury related mortality worldwide, and accounts for roughly 320,000 deaths yearly. Over 90% of these deaths occur in low- and middle-income countries with inadequate prevention measures. The highest rates of drowning are observed in Africa. The aim of this review is to describe the epidemiology of drowning and identify the risk factors and strategies for prevention of drowning in Africa. Materials and Methods: A review of multiple databases (MEDLINE, CINAHL, PsycINFO, Scopus and Emcare) was conducted from inception of the databases to the 1st of April 2019 to identify studies investigating drowning in Africa. The preferred reporting items for systematic review and meta-analysis (PRISMA) was utilised. Results: Forty-two articles from 15 countries were included. Twelve articles explored drowning, while in 30 articles, drowning was reported as part of a wider study. The data sources were coronial, central registry, hospital record, sea rescue and self-generated data. Measures used to describe drowning were proportions and rates. There was a huge variation in the proportion and incidence rate of drowning reported by the studies included in the review. The potential risk factors for drowning included young age, male gender, ethnicity, alcohol, access to bodies of water, age and carrying capacity of the boat, weather and summer season. No study evaluated prevention strategies, however, strategies proposed were education, increased supervision and community awareness. Conclusions: There is a need to address the high rate of drowning in Africa. Good epidemiological studies across all African countries are needed to describe the patterns of drowning and understand risk factors. Further research is needed to investigate the risk factors and to evaluate prevention strategies.
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Aliyu MH, Abdullahi AT, Iliyasu Z, Salihu AS, Adamu H, Sabo U, Garcia JP, Abdullahi SU, Mande A, Xian H, Yakasai HM, Schootman M, Ingles DJ, Patel AA, Yakasai A, Curry-Johnson S, Wudil UJ, DeBaun MR, Trevathan E. Bridging the childhood epilepsy treatment gap in northern Nigeria (BRIDGE): Rationale and design of pre-clinical trial studies. Contemp Clin Trials Commun 2019; 15:100362. [PMID: 31049462 PMCID: PMC6484289 DOI: 10.1016/j.conctc.2019.100362] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/07/2019] [Accepted: 04/10/2019] [Indexed: 01/26/2023] Open
Abstract
Epilepsy is the most common serious childhood neurological disorder. In the low- and middle-income countries (LMICs) of Africa, children with epilepsy suffer increased morbidity and mortality compared to their counterparts in high-income countries, and the majority do not receive treatment - the childhood epilepsy treatment gap. Reports of the childhood epilepsy treatment gap in Africa are likely underestimates; most surveys do not include several common childhood seizure types, including most types of non-convulsive epilepsy. Efforts to scale up childhood epilepsy care services in the LMICs of Africa must contend with a shortage of physicians and diagnostic technology [e.g., electroencephalograms (EEGs)]. One pragmatic solution is to integrate epilepsy care into primary care by task-shifting to community health extension workers. The aims of this project (BRIDGE) are to: 1) train, develop, and pilot task-shifted epilepsy care teams; 2) develop and pilot innovative childhood epilepsy screening and diagnostic paradigms adapted to the local Hausa language/culture in Kano, northern Nigeria; and, 3) quantify and map the childhood epilepsy treatment gap, using geographic information systems (GIS), to target limited resources to areas of greatest need. Task-shifted teams will diagnose and manage childhood epilepsy using an innovative epilepsy screening tools and diagnostic and management paradigms in environments with limited EEG access. If validated and demonstrated efficacious in clinical trials, this project can be taken to scale across broader areas of west Africa's LMICs that share language and culture. BRIDGE has the potential to enhance access to basic childhood epilepsy care and establish the foundation for childhood epilepsy clinical trials in west Africa.
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Affiliation(s)
- Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Health Policy, Vanderbilt University, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aminu T Abdullahi
- Department of Psychiatry, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Zubairu Iliyasu
- Department of Community Medicine, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Auwal S Salihu
- Department of Psychiatry, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Halima Adamu
- Department of Pediatrics, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Umar Sabo
- Department of Pediatrics, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Juanita Prieto Garcia
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shehu U Abdullahi
- Department of Pediatrics, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Aliyu Mande
- Department of Community Medicine, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Hong Xian
- Department of Epidemiology & Biostatistics, College for Public Health and Social Justice, Saint Louis University St. Louis, MO, USA
| | - Hafizu M Yakasai
- Centre for Nigerian Languages and Folklore, Bayero University, Kano, Nigeria
| | - Mario Schootman
- Department of Epidemiology & Biostatistics, College for Public Health and Social Justice, Saint Louis University St. Louis, MO, USA
| | - Donna J Ingles
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Archana A Patel
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Abubakar Yakasai
- Department of Psychiatry, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Stacy Curry-Johnson
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Eskind Biomedical Library, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Usman J Wudil
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael R DeBaun
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edwin Trevathan
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA
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12
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Mulwafu W, Chokotho L, Mkandawire N, Pandit H, Deckelbaum DL, Lavy C, Jacobsen KH. Trauma care in Malawi: A call to action. Malawi Med J 2018; 29:198-202. [PMID: 28955433 PMCID: PMC5610296 DOI: 10.4314/mmj.v29i2.23] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Injuries are a global public health concern because most are preventable yet they continue to be a major cause of death and disability, especially among children, adolescents, and young adults. This enormous loss of human potential has numerous negative social and economic consequences. Malawi has no formal system of prehospital trauma care, and there is limited access to hospital-based trauma care, orthopaedic surgery, and rehabilitation. While some hospitals and research teams have established local trauma registries and quantified the burden of injuries in parts of Malawi, there is no national injury surveillance database compiling the data needed in order to develop and implement evidence-based prevention initiatives and guidelines to improve the quality of clinical care. Studies in other low- and middle-income countries (LMICs) have demonstrated cost-effective methods for enhancing prehospital, in-hospital, and post-discharge care of trauma patients. We encourage health sectors leaders from across Malawi to take action to improve trauma care and reduce the burden from injury in this country.
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Affiliation(s)
- Wakisa Mulwafu
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Nyengo Mkandawire
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Dan L Deckelbaum
- Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Chris Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; University of Oxford, Oxford, United Kindgom
| | - Kathryn H Jacobsen
- Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
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13
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Tyler MD, Richards DB, Reske-Nielsen C, Saghafi O, Morse EA, Carey R, Jacquet GA. The epidemiology of drowning in low- and middle-income countries: a systematic review. BMC Public Health 2017; 17:413. [PMID: 28482868 PMCID: PMC5423024 DOI: 10.1186/s12889-017-4239-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 04/06/2017] [Indexed: 12/03/2022] Open
Abstract
Background According to the World Health Organization, drowning is the 3rd leading cause of unintentional injury-related deaths worldwide, accounting for 370,000 annual deaths and 7% of all injury-related deaths. Low- and middle-income countries are the most affected, accounting for 91% of unintentional drowning deaths. Methods The authors performed a systematic review of literature indexed in EMBASE, PubMed, Web of Science, Cochrane Library, and Traumatology journals formerly indexed in PubMed in January 2014 and again in September 2016. Abstracts were limited to human studies in English, conducted in low- and middle-income countries, and containing quantitative data on drowning epidemiology. Results A total of 62 articles met inclusion criteria. The majority of articles originate from Asia (56%) and Africa (26%). Risk factors for drowning included young age (<17–20 years old), male gender (75% vs. 25% female), rural environment (84% vs. 16% urban), occurring in the daytime (95% vs. 5% night time), lack of adult supervision (76% vs. 18% supervised), and limited swimming ability (86% vs. 10% with swimming ability). There was almost equal risk of drowning in a small body of water versus a large body of water (42% ponds, ditches, streams, wells; 46% lakes, rivers, sea, ocean). Conclusion Drowning is a significant cause of injury-related deaths, especially in LMICs. Young males who are unsupervised in rural areas and have limited formal swimming instruction are at greatest risk of drowning in small bodies of water around their homes. Preventative strategies include covering wells and cisterns, fencing off ditches and small ponds, establishing community daycares, providing formal swimming lessons, and increasing awareness of the risks of drowning. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4239-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | - Robert Carey
- Boston University School of Medicine, Boston, USA
| | - Gabrielle A Jacquet
- Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
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14
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Chokotho L, Mulwafu W, Singini I, Njalale Y, Jacobsen KH. Improving hospital-based trauma care for road traffic injuries in Malawi. World J Emerg Med 2017; 8:85-90. [PMID: 28458750 DOI: 10.5847/wjem.j.1920-8642.2017.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The mortality rate from road traffic injuries has increased in sub-Saharan Africa as the number of motor vehicles increase. This study examined the capacity of hospitals along Malawi's main north-south highway to provide emergency trauma care. METHODS Structured interviews and checklists were used to evaluate the infrastructure, personnel, supplies, and equipment at all four of Malawi's central hospitals, ten district hospitals, and one mission hospital in 2014. Most of these facilities are along the main north-south highway that spans the country. RESULTS Between July 2013 and March 2014, more than 9 200 road traffic injuries (RTIs) and 100 RTI deaths were recorded by the participating hospitals. All of the hospitals reported staff shortages, especially during nights and weekends. Few clinicians had completed formal training in emergency trauma management, and healthcare workers reported gaps in knowledge and skills, especially at district hospitals. Most central hospitals had access to the critical supplies and medications necessary for trauma care, but district hospitals lacked some of the supplies and equipment needed for diagnosis, treatment, and personal protection. CONCLUSION The mortality and disability burden from road traffic injuries in Malawi (and other low-income countries in sub-Saharan Africa) can be reduced by ensuring that every central and district hospital has a dedicated trauma unit with qualified staff who have completed primary trauma care courses and have access to the equipment necessary to save lives.
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Affiliation(s)
| | - Wakisa Mulwafu
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | | | - Kathryn H Jacobsen
- Department of Global & Community Health, George Mason University, Fairfax, Virginia, USA
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15
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Abstract
Introduction Road traffic collisions are a common cause of injuries and injury-related deaths in sub-Saharan Africa (SSA). Basic prehospital care can be the difference between life and death for injured drivers, passengers, and pedestrians. Problem This study examined the challenges associated with current first response practices in Malawi. METHODS In April 2014, focus groups were conducted in two areas of Malawi: Karonga (in the Northern Region) and Blantyre (in the Southern Region; both are along the M1 highway), and a qualitative synthesis approach was used to identify themes. All governmental and nongovernmental first response organizations identified by key informants were contacted, and a checklist was used to identify the services they offer. RESULTS Access to professional prehospital care in Malawi is almost nonexistent, aside from a few city fire departments and private ambulance services. Rapid transportation to a hospital is usually the primary goal of roadside care because of limited first aid knowledge and a lack of access to basic safety equipment. The key informants recommended: expanding community-based first aid training; emphasizing umunthu (shared humanity) to inspire bystander involvement in roadside care; empowering local leaders to coordinate on-site responses; improving emergency communication systems; equipping traffic police with road safety gear; and expanding access to ambulance services. CONCLUSION Prehospital care in Malawi would be improved by the creation of a formal network of community leaders, police, commercial drivers, and other lay volunteers who are trained in basic first aid and are equipped to respond to crash sites to provide roadside care to trauma patients and prepare them for safe transport to hospitals. Chokotho L , Mulwafu W , Singini I , Njalale Y , Maliwichi-Senganimalunje L , Jacobsen KH . First responders and prehospital care for road traffic injuries in Malawi. Prehosp Disaster Med. 2017;32(1):14-19.
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Salcedo-Arellano MJ, Lozano R, Tassone F, Hagerman RJ, Saldarriaga W. Alcohol use dependence in fragile X syndrome. Intractable Rare Dis Res 2016; 5:207-13. [PMID: 27672544 PMCID: PMC4995423 DOI: 10.5582/irdr.2016.01046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 11/05/2022] Open
Abstract
Alcohol use disorders (AUDs) have been reported in a limited number of individuals with cognitive impairment but rarely in those with fragile X syndrome (FXS). However, in Colombia, culturally, alcohol consumption is very common. Here, we report eight cases of patients with FXS who have frequent alcohol consumption in Ricaurte, Colombia. Some of these patients have also used tobacco and illegal substances, including cocaine, which use has not been previously reported in those with FXS. Alcohol and substance use dependence is associated with exacerbation of their behavioral problems, such as increased impulsivity and aggression, as well as of medical problems such as an increased frequency of seizures.
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Affiliation(s)
- María J Salcedo-Arellano
- School of Medicine, Universidad del Valle, Cali, Colombia
- Research Group in Congenital & Perinatal Malformations, Dysmorphology and Clinical Genetics (MACOS), Universidad del Valle, Cali, Colombia
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Reymundo Lozano
- Seaver Autism Center. Departments of Genomic Sciences, Psychiatry and Pediatrics. Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Flora Tassone
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis Medical Center, Sacramento, CA, USA
- Department of Biochemistry and Molecular Medicine, University of California, Davis, USA
| | - Randi J Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis Medical Center, Sacramento, CA, USA
- Department of Pediatrics, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Wilmar Saldarriaga
- School of Medicine, Universidad del Valle, Cali, Colombia
- Research Group in Congenital & Perinatal Malformations, Dysmorphology and Clinical Genetics (MACOS), Universidad del Valle, Cali, Colombia
- Departments of Morphology and Obstetrics & Gynecology, Universidad del Valle, Hospital Universitario Del Valle, Cali, Colombia
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