Cause-specific mortality and socioeconomic status in Chakaria, Bangladesh

A Framework for Neonatal Prematurity Information System Development Based on a Systematic Review on Current Registries: An Original Research

Background

Registries are regarded as a just valuable fount of data on determining neonates suffering prematurity or low birth weight (LBW), ameliorating provided care, and developing studies.

Objective

This study aimed to probe the studies, including premature infants' registries, adapt the needed minimum data set, and provide an offered framework for premature infants' registries.

Material and Methods

For this descriptive study, electronic databases including PubMed, Scopus, Web of Science, ProQuest, and Embase/Medline were searched. In addition, a review of gray literature was undertaken to identify relevant studies in English on current registries and databases. Screening of titles, abstracts, and full texts was conducted independently based on PRISMA guidelines. The basic registry information, scope, registry type, data source, the purpose of the registry, and important variables were extracted and analyzed.

Results

Fifty-six papers were qualified and contained in the process that presented 51 systems and databases linked in prematurity at the popular and government levels in 34 countries from 1963 to 2017. As a central model of the information management system and knowledge management, a prematurity registry framework was offered based on data, information, and knowledge structure.

Conclusion

To the best of our knowledge, this is a comprehensive study that has systematically reviewed prematurity-related registries. Since there are international standards to develop new registries, the proposed framework in this article can be beneficial too. This framework is essential not only to facilitate the prematurity registry design but also to help the collection of high-value clinical data necessary for the acquisition of better clinical knowledge.

Non-prescribed antibiotic use for children at community levels in low- and middle-income countries: a systematic review and meta-analysis

BACKGROUND

Non-prescribed antibiotic use is an emerging risky practice around the globe. An inappropriate use involving nonprescription access is one cause of the rapid increase in antibiotic resistance. Children commonly encounter many self-limiting illnesses for which they frequently use antibiotics without prescription. However, no specific and conclusive evidence exists to inform actions against this unsafe practice. We thus aimed to estimate the pooled proportion of non-prescribed antibiotic use for children at community levels in low- and middle-income countries.

METHODS

A systematic search of records was conducted from PubMed/Medline, Embase, Scopus, CINAHL, and Google scholar. Eligible English-language publications were original articles which reported on community-based non-prescribed antibiotic use for children and conducted in low- and middle-income countries. Study features and the number of antibiotics used without prescriptions were extracted and pooled for effect sizes employing a random-effects model. The pooled proportion of non-prescribed antibiotic use was estimated as a percentage.

RESULTS

In this analysis, we included a total of 39 articles consisting of 40,450 participants. Of these, 16,315 participants used non-prescribed antibiotics. The pooled percentage for this use of non-prescribed antibiotics was 45% (95% CI: 40-50%). The estimate was considerably higher in studies involving simulated patient methods (56%; 95% CI: 49-62%) than those studies with community surveys (40%; 95% CI: 34-46%) (P = 0.001). It was also varied by the recall period of antibiotics use-56% (95% CI: 50-62%) for instantly observed practice, 36% (95% CI: 22-50%) for within two week recall, 35% (95% CI: 26-45%) for 1-6 months recall, and 46% (95% CI: 37-54%) for more than six months recall (P = 0.001). Primary access points for the non-prescribed antibiotic uses were retail drug outlets.

CONCLUSIONS

We found that nearly half of the antibiotics used for children in community settings were without prescriptions. For these unsafe practices, caregivers accessed antibiotics mainly from drug outlets. Hence, context-specific educational and regulatory interventions at these outlets and the community levels are the first steps to improving antibiotic usage for children in low- and middle-income countries.

TRIAL REGISTRATION NUMBER

CRD42021288971 (PROSPERO).  https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021288971 .

Oral Polio Vaccine Campaigns May Reduce the Risk of Death from Respiratory Infections

Oral polio vaccine (OPV) campaigns, but not other campaigns, have been associated with major reductions in child mortality. Studies have shown that OPV reduces the risk of respiratory infections. We analysed the causes of death at 0–2 years of age in Chakaria, a health and demographic surveillance Systems in Bangladesh, in the period 2012–2019 where 13 national campaigns with combinations of OPV (n = 4), vitamin A supplementation (n = 9), measles vaccine (MV) (n = 2), and albendazole (n = 2) were implemented. OPV-only campaigns reduced overall mortality by 30% (95% confidence interval: −10–56%). Deaths from respiratory infections were reduced by 62% (20–82%, p = 0.01) in the post-neonatal period (1–35 months), whereas there was as slight increase of 19% (−37–127%, p = 0.54) for deaths from other causes. There was no benefit of other types of campaigns. Hence, the hypothesis that OPV may have beneficial non-specific effects, protecting particularly against respiratory infections, was confirmed.

Burden of disease among the world's poorest billion people: An expert-informed secondary analysis of Global Burden of Disease estimates

Background

The health of populations living in extreme poverty has been a long-standing focus of global development efforts, and continues to be a priority during the Sustainable Development Goal era. However, there has not been a systematic attempt to quantify the magnitude and causes of the burden in this specific population for almost two decades. We estimated disease rates by cause for the world’s poorest billion and compared these rates to those in high-income populations.

Methods

We defined the population in extreme poverty using a multidimensional poverty index. We used national-level disease burden estimates from the 2017 Global Burden of Disease Study and adjusted these to account for within-country variation in rates. To adjust for within-country variation, we looked to the relationship between rates of extreme poverty and disease rates across countries. In our main modeling approach, we used these relationships when there was consistency with expert opinion from a survey we conducted of disease experts regarding the associations between household poverty and the incidence and fatality of conditions. Otherwise, no within-country variation was assumed. We compared results across multiple approaches for estimating the burden in the poorest billion, including aggregating national-level burden from the countries with the highest poverty rates. We examined the composition of the estimated disease burden among the poorest billion and made comparisons with estimates for high-income countries.

Results

The composition of disease burden among the poorest billion, as measured by disability-adjusted life years (DALYs), was 65% communicable, maternal, neonatal, and nutritional (CMNN) diseases, 29% non-communicable diseases (NCDs), and 6% injuries. Age-standardized DALY rates from NCDs were 44% higher in the poorest billion (23,583 DALYs per 100,000) compared to high-income regions (16,344 DALYs per 100,000). Age-standardized DALY rates were 2,147% higher for CMNN conditions (32,334 DALYs per 100,000) and 86% higher for injuries (4,182 DALYs per 100,000) in the poorest billion, compared to high-income regions.

Conclusion

The disease burden among the poorest people globally compared to that in high income countries is highly influenced by demographics as well as large disparities in burden from many conditions. The comparisons show that the largest disparities remain in communicable, maternal, neonatal, and nutritional diseases, though NCDs and injuries are an important part of the “unfinished agenda” of poor health among those living in extreme poverty.

Penta is associated with an increased female-male mortality ratio: cohort study from Bangladesh

Diphtheria-tetanus-pertussis (DTP) vaccine may be associated with excess female deaths. There are few studies of possible nonspecific effects of the DTP-containing vaccine Penta (DTP-hepatitis B-Haemophilus influenzae type b). We therefore investigated whether Penta vaccinations were associated with excess female deaths in rural Bangladesh. Between June 29, 2011 and April 20, 2016, we examined the mortality rates of 7644 children followed between 6 weeks and 9 months of age. We analyzed mortality using crude mortality rate ratio (MRR) and age-adjusted MRR (aMRR) from a Cox proportional hazards model. Mortality was analyzed according to sex, number of doses of Penta, and the order in which BCG and Penta were administered. During follow-up, 43 children died. For children who were only BCG vaccinated (BCG-only), the adjusted F/M MRR was 0.47 (0.09-2.48). However, among children who had Penta as their most recent vaccination, the adjusted F/M MRR was 9.91 (1.16-84.44). Hence, the adjusted F/M MRR differed significantly for BCG-only and for Penta as the most recent administered vaccination. Although the mortality rate was low in rural Bangladesh, there was a marked difference between adjusted F/M MRR's for children vaccinated with BCG-only compared with children where Penta was the most recent administered vaccination. Although usually ascribed to differential treatment and access to care, DTP-containing vaccines may be part of the explanation for the excessive female mortality reported in some regions.

Public health management: systemic analysis of social determinants of health in Brazilian municipalities

The health sector is considered extremely important by governments and multilateral international organisms, due to its implication to life, as well as material and human struggling involved. This study adopts a systematical approach in order to question if the mortality outcomes in medium Brazilian cities explain or may be explained by factors considered external to the public health service, expressed by health social determinants. Therefore, this study aims to investigate health conditions in public health management in medium Brazilian cities. The scenario adopted contains 192 cities with a population contingent between 100 000 and 500 000 inhabitants, between the years 2007 and 2011. The database produced, containing 30 indicators representing conceptual models referenced, allowed the elaboration of an operational model of health social determinants from a Bayesian network. As result, we elaborated a model of health system formed by six factors, showing associations that allow a better comprehension about relations among health social determinants and health conditions, producing contextualized information, able to subsidize the formulation of strategies by managers of Sistema Único de Saúde.

A comparison of all-cause and cause-specific mortality by household socioeconomic status across seven INDEPTH network health and demographic surveillance systems in sub-Saharan Africa

Background: Understanding socioeconomic disparities in all-cause and cause-specific mortality can help inform prevention and treatment strategies.

Objectives: To quantify cause-specific mortality rates by socioeconomic status across seven health and demographic surveillance systems (HDSS) in five countries (Ethiopia, Kenya, Malawi, Mozambique, and Nigeria) in the INDEPTH Network in sub-Saharan Africa.

Methods: We linked demographic residence data with household survey data containing living standards and education information we used to create a poverty index. Person-years lived and deaths between 2003 and 2016 (periods varied by HDSS) were stratified in each HDSS by age, sex, year, and number of deprivations on the poverty index (0–8). Causes of death were assigned to each death using the InterVA-4 model based on responses to verbal autopsy questionnaires. We estimated rate ratios between socioeconomic groups (2–4 and 5–8 deprivations on our poverty index compared to 0–2 deprivations) for specific causes of death and calculated life expectancy for the deprivation groups.

Results: Our pooled data contained almost 3.5 million person-years of observation and 25,038 deaths. All-cause mortality rates were higher among people in households with 5–8 deprivations on our poverty index compared to 0–2 deprivations, controlling for age, sex, and year (rate ratios ranged 1.42 to 2.06 across HDSS sites). The poorest group had consistently higher death rates in communicable, maternal, neonatal, and nutritional conditions (rate ratios ranged 1.34–4.05) and for non-communicable diseases in several sites (1.14–1.93). The disparities in mortality between 5–8 deprivation groups and 0–2 deprivation groups led to lower life expectancy in the higher-deprivation groups by six years in all sites and more than 10 years in five sites.

Conclusions: We show large disparities in mortality on the basis of socioeconomic status across seven HDSS in sub-Saharan Africa due to disparities in communicable disease mortality and from non-communicable diseases in some sites. Life expectancy gaps between socioeconomic groups within sites were similar to the gaps between high-income and lower-middle-income countries. Prevention and treatment efforts can benefit from understanding subpopulations facing higher mortality from specific conditions.

Changes in inequality of childhood morbidity in Bangladesh 1993-2014: A decomposition analysis

INTRODUCTION

Child health remains an important public health concern at the global level, with preventable diseases such as diarrheal disease, acute respiratory infection (ARI) and fever posing a large public health burden in low- and middle-income countries including Bangladesh. Improvements in socio-economic conditions have tended to benefit advantaged groups in societies, which has resulted in widespread inequalities in health outcomes. This study examined how socioeconomic inequality is associated with childhood morbidity in Bangladesh, and identified the factors affecting three illnesses: diarrhea, ARI and fever.

MATERIALS AND METHODS

A total of 43,860 sample observations from the Bangladesh Demographic and Health Survey, spanning a 22-year period (1993-2014), were analysed. Concentration curve and concentration index methods were used to evaluate changes in the degree of household wealth-related inequalities and related trends in childhood morbidity. Regression-based decomposition analyses were used to attribute the inequality disparities to individual determinants for the three selected causes of childhood morbidity.

RESULTS

The overall magnitude of inequality in relation to childhood morbidity has been declining slowly over the 22-year period. The magnitude of socio-economic inequality as a cause of childhood morbidity varied during the period. Decomposition analyses attributed the inequalities to poor maternal education attainment, inadequate pre-delivery care, adverse chronic undernutrition status and low immunisation coverage.

CONCLUSIONS

High rates of childhood morbidity were observed, although these have declined over time. Socio-economic inequality is strongly associated with childhood morbidity. Socio-economically disadvantaged communities need to be assisted and interventions should emphasise improvements of, and easier access to, health care services. These will be key to improving the health status of children in Bangladesh and should reduce economic inequality through improved health over time.

Self-reported health problems, health care seeking behaviour and cost coping mechanism of older people: Implication for primary health care delivery in rural Bangladesh

BACKGROUND

Optimum utilization of primary health care system by older people is a challenge for every low and middle income country. Little is known about self reported health problems, health care seeking behaviour and cost coping mechanism of older people in developing countries.

OBJECTIVES

This study aimed to measure self-reported health problems, health care seeking behaviour and expenditure coping mechanism of older people, and to describe its implication for primary health care delivery in rural Bangladesh.

METHODOLOGY

It was a cross sectional study. In total, 362 older people were enrolled who sought health care preceding the last month of the interview. Descriptive and bivariate data analysis along with proportion test (z test) was carried out.

RESULTS

The most frequent self-reported health problems were fever (43.8%) followed by physical pain (15.2%). More than half of the respondents (57.5%) had a second health problem. Only one third (33.8%) visited qualified health providers having minimum western health or medical training from government approved authority. More than half (54%) of the older people spent for health care out of pocket from their own. Only 2% older people sold their assets or took loans to meet their health care. 36% older people thought that they could afford to pay for health care in future.

CONCLUSIONS

The findings of this study will help in developing primary health care policy for older people in rural Bangladesh and similar settings in South Asia.

Comparing tariff and medical assistant assigned causes of death from verbal autopsy interviews in Matlab, Bangladesh: implications for a health and demographic surveillance system

BACKGROUND

Deaths in developing countries often occur outside health facilities, making it extremely difficult to gather reliable cause of death (COD) information. Automated COD assignment using a verbal autopsy instrument (VAI) has been proposed as a reliable and cost-effective alternative to traditional physician-certified verbal autopsy, but its performance is still being evaluated. The purpose of this study was to compare the similarity of diagnosis by Medical Assistants (MA) in the Matlab Health and Demographic Surveillance System (HDSS) with the SmartVA Analyze 1.2 (Tariff 2.0) diagnosis.

METHODS

This study took place between January 2011 and April 2014 in Matlab, Bangladesh. MA with 3 years of medical training assigned COD to Matlab residents by reviewing the information collected using the Population Health Metrics Research Consortium (PHMRC) long-form VAI. Smart VA Analyze 1.2 automatically assigned COD using the same questionnaire. COD agreement and cause-specific mortality fractions (CSMFs) were compared for MA and Tariff.

RESULTS

Of the 4969 verbal autopsy cases reviewed, 4328 were adults, 296 were children, and 345 were neonates. Cohen's kappa was 0.38 (0.36, 0.40) for adults, 0.43 (0.38, 0.49) for children, and 0.27 (0.22, 0.33) for neonates. For adults, the top two COD for MA were stroke (29.6%) and ischemic heart diseases (IHD) (14.2%) and for Tariff these were stroke (32.0%) and IHD (14.0%). For children, the top two COD for MA were drowning (33.5%) and pneumonia (13.2%) and for Tariff these were also drowning (36.8%) and pneumonia (12.4%). For neonates, the top two COD for MA were birth asphyxia (41.2%) and meningitis/sepsis (22.3%) and for Tariff these were birth asphyxia (37.0%) and preterm delivery (30.9%).

CONCLUSION

The CSMFs for Tariff and MA showed very close agreement across all age categories but some differences were observed for neonate preterm delivery and meningitis/sepsis. Given the known advantages of automated methods over physician certified verbal autopsy, the SmartVA software, incorporating the shortened VAI questionnaire and Tariff 2.0, could serve as a cost-effective alternative to Matlab MA to routinely collect and analyze verbal autopsy data in a HDSS to generate essential population level COD data for planning.

Reporting of ethics in peer-reviewed verbal autopsy studies: a systematic review

Introduction

Verbal autopsy (VA) is a method that determines the cause of death by interviewing a relative of the deceased about the events occurring before the death, in regions where medical certification of cause of death is incomplete. This paper aims to review the ethical standards reported in peer-reviewed VA studies.

Methods

A systematic review of Medline and Ovid was conducted by two independent researchers. Data were extracted and analysed for articles based on three key areas: Institutional Review Board (IRB) clearance and consenting process; data collection and management procedures, including: time between death and interview; training and education of interviewer, confidentiality of data and data security; and declarations of funding and conflict of interest.

Results

The review identified 802 articles, of which 288 were included. The review found that 48% all the studies reported having IRB clearance or obtaining consent of participants. The interviewer training and education levels were reported in 62% and 21% of the articles, respectively. Confidentiality of data was reported for 14% of all studies, 18% did not report the type of respondent interviewed and 51% reported time between death and the interview for the VA. Data security was reported in 8% of all studies. Funding was declared in 63% of all studies and conflict of interest in 42%. Reporting of all these variables increased over time.

Conclusions

The results of this systematic review show that although there has been an increase in ethical reporting for VA studies, there still remains a large gap in reporting.

A systematic approach to injury policy assessment: introducing the assessment of child injury prevention policies (A-CHIPP)

Introduction

This study presents a systematic approach—assessment of child injury prevention policies (A-CHIPP)—to assess and track policies on effective child injury interventions at the national level. Results from an initial pilot test of the approach in selected countries are presented.

Method

A literature review was conducted to identify conceptual models for injury policy assessment, and domains and indicators were proposed for assessing national injury policies for children aged 1–9 years. The indicators focused on current evidence-supported interventions targeting the leading external causes of child injury mortality globally, and were organised into a self-administered A-CHIPP questionnaire comprising 22 questions. The questionnaire was modified based on reviews by experts in child injury prevention. For an initial test of the approach, 13 countries from all six WHO regions were selected to examine the accuracy, usefulness and ease of understanding of the A-CHIPP questionnaire.

Results

Data on the A-CHIPP questionnaire were received from nine countries. Drowning and road traffic injuries were reported as the leading causes of child injury deaths in seven of these countries. Most of the countries lacked national policies on interventions that address child injuries; supportive factors such as finance and leadership for injury prevention were also lacking. All countries rated the questionnaire highly on its relevance for assessment of injury prevention policies.

Conclusion

The A-CHIPP questionnaire is useful for national assessment of child injury policies, and such an assessment could draw attention of stakeholders to policy gaps and progress in child injury prevention in all countries.

The association between socioeconomic status and subclinical atherosclerosis in a rural Bangladesh population

BACKGROUND

In Bangladesh, CVD accounts for the majority of non-communicable mortality. The purpose of this study was to determine the role of socioeconomic status (SES) on subclinical atherosclerosis measured as carotid intima-media thickness (IMT) in a rural Bangladesh population.

METHODS

Carotid IMT was measured between 2010 and 2011 in 1022 participants (average age 46, 40% male) randomly selected from the Health Effects of Arsenic Longitudinal Study (HEALS), a population-based prospective cohort study based in rural Bangladesh. SES was measured as occupation type, land ownership, educational attainment, and television ownership.

RESULTS

Half of the participants received formal education (53%) and under half owned land (48%) and a television (44%). Women were primarily homemakers (95%) and men worked as factory workers (24%), laborers (18%), or in business (55%). In univariate analysis, those owning greater than one acre of land (p=0.03), owning a television (p=0.02), or laborers and business owners compared to factory workers had higher levels of carotid IMT (p<0.01). In multivariate analysis after adjustment for confounders, only men employed in the business sector had elevated carotid IMT compared to factory workers. The association was strongest in older men (58.7μm, 95% CI 17.2-100.0, ≥50years old) compared to younger men (13.7μm, 95% CI -7.8-35.2, <50years old).

CONCLUSION

Business sector employment was positively associated with subclinical atherosclerosis after adjustment for confounders. This finding is consistent with evidence from other developing nations suggesting that certain SES factors are independent predictors of CVD.

Gender differences in hypertension awareness, antihypertensive use and blood pressure control in Bangladeshi adults: findings from a national cross-sectional survey

BACKGROUND

Bangladesh is facing an epidemiological transition with a growing burden of non-communicable diseases. Traditionally, hypertension and associated complications in women receive less recognition, and there is a dearth of related publications. The study aims to explore gender differences in high blood pressure awareness and antihypertensive use in Bangladeshi adults at the community level. Another objective is to identify factors associated with uncontrolled hypertension among antihypertensive users.

METHODS

Data from the Bangladesh Demographic and Health Survey (BDHS 2011) was analysed. From a nationally representative sample of 3870 males and 3955 females, aged ≥35 years, blood pressure and related information were collected following WHO guidelines. Logistic regression models were used to estimate adjusted odds ratio (AOR) for factors affecting blood pressure awareness, antihypertensive use and uncontrolled hypertension among males and females taking antihypertensive medications. All analyses were weighted according to the complex survey design.

RESULTS

Women were more likely to have their blood pressure measured (76% vs. males 71%, p < 0.001) and to be 'aware' about their own high BP (55% vs. males 43%, p < 0.001). No gender difference was observed in antihypertensive medication use among those who were aware of their own high BP (females 67%, males 65%, p = 0.39). Non-working females were less likely to use antihypertensive (67% vs. non-working males 77%, p < 0.05). Poor women were worse off compared with poor males in antihypertensive medication use. One-in-three antihypertensive medication users had stage 2 hypertension (SBP ≥160/DBP ≥100 mmHg). Female sex, older age, increased wealth, higher BMI and certain geographical regions were associated with poor blood pressure control among antihypertensive medication users.

CONCLUSIONS

BP check-ups and hypertension awareness were higher among women than men but did not translate into better antihypertensive medication practice. Gender disadvantage and inequity were observed in antihypertensive medication use. Our findings reiterate the importance of sex-disaggregated analysis and reporting. Policy makers should explore the uncontrolled hypertension burden and geographical variations in Bangladesh.

Health literacy in a community with low levels of education: findings from Chakaria, a rural area of Bangladesh

BACKGROUND

Health literacy (HL) helps individuals to make effective use of available health services. In low-income countries such as Bangladesh, the less than optimum use of services could be due to low levels of HL. Bangladesh's health service delivery is pluralistic with a mix of public, private and informally trained healthcare providers. Emphasis on HL has been inadequate. Thus, it is important to assess the levels of HL and service utilization patterns. The findings from this study aim to bridge the knowledge gap.

MATERIALS AND METHODS

The data for this study came from a cross-sectional survey carried out in September 2014, in Chakaria, a rural area in Bangladesh. A total of 1500 respondents were randomly selected from the population of 80,000 living in the Chakaria study area of icddr, b (International Centre for Diarrhoeal Disease Research, Bangladesh). HL was assessed in terms of knowledge of existing health facilities and sources of information on health care, immunization, diabetes and hypertension. Descriptive and cross-tabular analyses were carried out.

RESULTS

Chambers of the rural practitioners of allopathic medicine, commonly known as 'village doctors', were mentioned by 86% of the respondents as a known health service facility in their area, followed by two public sector community clinics (54.6%) and Union Health and Family Welfare Centres (28.6%). Major sources of information on childhood immunization were government health workers. Almost all of the respondents had heard about diabetes and hypertension (97.4% and 95.4%, respectively). The top three sources of information for diabetes were neighbours (85.7%), followed by relatives (27.9%) and MBBS (Bachelor of Medicine and Bachelor of Surgery) doctors (20.4%). For hypertension, the sources were neighbours (78.0%), followed by village doctors (38.2%), MBBS doctors (23.2%) and relatives (15%). The proportions of respondents who knew diabetes and hypertension control measures were 40.9% and 28.0%, respectively. More females knew about the control of diabetes (44.4% to 36.6%) and hypertension (31.1% to 24.2%) than males.

CONCLUSIONS

A low level of HL in terms of modern health service facilities, diabetes and hypertension clearly indicated the need for a systematic HL programme. The relatively high levels of literacy concerning immunization show that it is possible to enhance HL in areas with low levels of education through systematic awareness-raising programmes, which could result in higher service coverage.

Prevalence, pattern and sociodemographic differentials in smokeless tobacco consumption in Bangladesh: evidence from a population-based cross-sectional study in Chakaria

BACKGROUND

The health hazards associated with the use of smokeless tobacco (SLT) are similar to those of smoking. However, unlike smoking, limited initiatives have been taken to control the use of SLT, despite its widespread use in South and Southeast Asian countries including Bangladesh. It is therefore important to examine the prevalence of SLT use and its social determinants for designing appropriate strategies and programmes to control its use.

OBJECTIVE

To investigate the use of SLT in terms of prevalence, pattern and sociodemographic differentials in a rural area of Bangladesh.

DESIGN

Population-based cross-sectional household survey.

SETTING AND PARTICIPANTS

A total of 6178 individuals aged ≥13 years from 1753 households under the Chakaria HDSS area were interviewed during October-November 2011.

METHODS

The current use of SLT, namely sadapatha (dried tobacco leaves) and zarda (industrially processed leaves), was used as the outcome variable. The crude and net associations between the sociodemographic characteristics of respondents and the outcome variables were examined using cross-tabular and multivariable logistic regression analysis, respectively.

RESULTS

23% of the total respondents (men: 27.0%, women: 19.3%) used any form of SLT. Of the respondents, 10.4% used only sadapatha,13.6% used only zarda and 2.2% used both. SLT use was significantly higher among men, older people, illiterate, ever married, day labourers and relatively poorer respondents. The odds of being a sadapatha user were 3.5-fold greater for women than for men and the odds of being a zarda user were 3.6-fold greater for men than for women.

CONCLUSIONS

The prevalence of SLT use was high in the study area and was higher among socioeconomically disadvantaged groups. The limitation of the existing regulatory measures for controlling the use of non-industrial SLT products should be understood and discussion for developing new strategies should be a priority.

Main causes of death in Dande, Angola: results from Verbal Autopsies of deaths occurring during 2009-2012

BACKGROUND

The Dande Health and Demographic Surveillance System (HDSS) located in Bengo Province, Angola, covers nearly 65,500 residents living in approximately 19,800 households. This study aims to describe the main causes of deaths (CoD) occurred within the HDSS, from 2009 to 2012, and to explore associations between demographic or socioeconomic factors and broad mortality groups (Group I-Communicable diseases, maternal, perinatal and nutritional conditions; Group II-Non-communicable diseases; Group III-Injuries; IND-Indeterminate).

METHODS

Verbal Autopsies (VA) were performed after death identification during routine HDSS visits. Associations between broad groups of CoD and sex, age, education, socioeconomic position, place of residence and place of death, were explored using chi-square tests and fitting logistic regression models.

RESULTS

From a total of 1488 deaths registered, 1009 verbal autopsies were performed and 798 of these were assigned a CoD based on the 10(th) revision of the International Classification of Diseases (ICD-10). Mortality was led by CD (61.0 %), followed by IND (18.3 %), NCD (11.6 %) and INJ (9.1 %). Intestinal infectious diseases, malnutrition and acute respiratory infections were the main contributors to under-five mortality (44.2 %). Malaria was the most common CoD among children under 15 years old (38.6 %). Tuberculosis, traffic accidents and malaria led the CoD among adults aged 15-49 (13.5 %, 10.5 % and 8.0 % respectively). Among adults aged 50 or more, diseases of the circulatory system (23.2 %) were the major CoD, followed by tuberculosis (8.2 %) and malaria (7.7 %). CD were more frequent CoD among less educated people (adjusted odds ratio, 95 % confidence interval for none vs. 5 or more years of school: 1.68, 1.04-2.72).

CONCLUSION

Infectious diseases were the leading CoD in this region. Verbal autopsies proved useful to identify the main CoD, being an important tool in settings where vital statistics are scarce and death registration systems have limitations.

Consensus Recommendation for India and Bangladesh for the Use of Pneumococcal Vaccine in Mass Gatherings with Special Reference to Hajj Pilgrims

Respiratory tract infections are prevalent among Hajj pilgrims with pneumonia being a leading cause of hospitalization. Streptococcus pneumoniae is a common pathogen isolated from patients with pneumonia and respiratory tract infections during Hajj. There is a significant burden of pneumococcal disease in India, which can be prevented. Guidelines for preventive measures and adult immunization have been published in India, but the implementation of the guidelines is low. Data from Bangladesh are available about significant mortality due to respiratory infections; however, literature regarding guidelines for adult immunization is limited. There is a need for extensive awareness programs across India and Bangladesh. Hence, there was a general consensus about the necessity for a rapid and urgent implementation of measures to prevent respiratory infections in pilgrims traveling to Hajj. About ten countries have developed recommendations for pneumococcal vaccination in Hajj pilgrims: France, the USA, Kuwait, Qatar, Bahrain, the UAE (Dubai Health Authority), Singapore, Malaysia, Egypt, and Indonesia. At any given point whether it is Hajj or Umrah, more than a million people are present in the holy places of Mecca and Madina. Therefore, the preventive measures taken for Hajj apply for Umrah as well. This document puts forward the consensus recommendations by a group of twenty doctors following a closed-door discussion based on the scientific evidence available for India and Bangladesh regarding the prevention of respiratory tract infections in Hajj pilgrims.

Cause-specific mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

BACKGROUND

Because most deaths in Africa and Asia are not well documented, estimates of mortality are often made using scanty data. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering all deaths over time and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available.

OBJECTIVE

To build a large standardised mortality database from African and Asian sites, detailing the relevant methods, and use it to describe cause-specific mortality patterns.

DESIGN

Individual demographic and verbal autopsy (VA) data from 22 INDEPTH sites were collated into a standardised database. The INDEPTH 2013 population was used for standardisation. The WHO 2012 VA standard and the InterVA-4 model were used for assigning cause of death.

RESULTS

A total of 111,910 deaths occurring over 12,204,043 person-years (accumulated between 1992 and 2012) were registered across the 22 sites, and for 98,429 of these deaths (88.0%) verbal autopsies were successfully completed. There was considerable variation in all-cause mortality between sites, with most of the differences being accounted for by variations in infectious causes as a proportion of all deaths.

CONCLUSIONS

This dataset documents individual deaths across Africa and Asia in a standardised way, and on an unprecedented scale. While INDEPTH sites are not constructed to constitute a representative sample, and VA may not be the ideal method of determining cause of death, nevertheless these findings represent detailed mortality patterns for parts of the world that are severely under-served in terms of measuring mortality. Further papers explore details of mortality patterns among children and specifically for NCDs, external causes, pregnancy-related mortality, malaria, and HIV/AIDS. Comparisons will also be made where possible with other findings on mortality in the same regions. Findings presented here and in accompanying papers support the need for continued work towards much wider implementation of universal civil registration of deaths by cause on a worldwide basis.