Why mothers die: Analysis of verbal autopsy data from Kersa Health and Demographic Surveillance System, Eastern Ethiopia

Background

Despite registering tremendous improvement as part of the Millennium Development Goals, Ethiopia has still one of the highest numbers of maternal mortality. Although maternal mortality is one of the commonest indicators for comparison or measuring progress, its measurement remained a challenge. In a situation where, vital registration is not in place and only few women gave birth in facilities, alternative data sources from population-based surveys are essential to describe maternal deaths. In this paper, we reported estimates of maternal mortality and causes in a predominantly rural setting in eastern Ethiopia.

Methods

Data were used from the ongoing prospective open cohort of Kersa Health and Demographic Surveillance System (HDSS), located in eastern Ethiopia. At enrolment, detailed sociodemographic and household conditions were recorded for every member, followed by household visit every six months to identify any vital events: births, deaths, and migration. Whenever a death was reported, additional information about the deceased - age, sex, pregnancy status, and perceived cause of deaths - were collected through interview of the closest family member(s). Then, the probable cause of death was assigned using an automated verbal autopsy system (InterVA). In this paper, we included all deaths among women during pregnancy, childbirth or within 42 days of termination of pregnancy. To describe the trends, we calculated annual maternal mortality ratio (MMR) along with their 95% Confidence Interval (CI).

Results

From 2008 to 2019, a total of 32 680 live births and 720 deaths among reproductive age women were registered. Of the 720 deaths, 158 (21.9%) were during pregnancy or within 42 days of termination of pregnancy, corresponding with an MMR of 484 per 100 000 live births. The three leading causes of deaths were pregnancy related sepsis, obstetric haemorrhage and anaemia of pregnancy. There was non-significant reduction in the MMR from 744 in 2008 to 665 in 2019, with three lowest ratios recorded in 2013 (172 per 100 000 live births), 2009 (280 per 100 000 live births) and 2016 (285 per 100 000 live births).

Conclusions

There was no significant decrement of MMR during the study period. Most deaths occurred at home from pregnancy related sepsis and haemorrhage implicating the unfinished agenda of ensuring skilled delivery and appropriate postnatal management.

Trend and Determinants of Mortality Among Women of Reproductive Age: A Twelve-Year Open Cohort Study in Eastern Ethiopia

Background: With only less than a decade left till 2030, it is essential to research the burden and trends of women of reproductive age (WRA) mortality in order to design appropriate interventions toward achieving goal three of the sustainable development goals (SDGs), good health and well-being. For several low-income countries, such data are often lacking or sometimes extrapolated from non-representative facility-based studies. In this paper, we presented trends, causes, and determinants of mortality among reproductive-age women under follow-up for 12 years through the Health and Demographic Surveillance System (HDSS) located in eastern Ethiopia.

Methods: We used 12 years of (2008 to 2019) open cohort data of women aged 15–49 living in Kersa HDSS in Eastern Ethiopia. In the HDSS, data on socio-demographic and basic household conditions are recorded for every household member at enrollment, and data on vital events such as births, deaths, and migration were collected and updated biannually as the event happened. Mortality was determined by automated verbal autopsy (InterVA) algorism. We assessed trends in women's reproductive age mortality and the associated determinants using crude and adjusted Cox regression models.

Results: In the 12-years cohort, we followed 74,790 women of reproductive age for 339,909.26 person-years-at-risk of observation (PYO), of whom 919 died. Overall, the standardized mortality rate was 270 per 100,000 PYO. There was a notable increase in mortality in the first 3 years (2009 to 2011) which then declined significantly (p = 0.0001) until 2019. Most of the deaths were caused by HIV/AIDS (27.88%) and pulmonary tuberculosis (10.62%). In the adjusted Cox regression analysis, the hazard of death was higher among rural residents (AHR, 2.03: 95% CI: 1.60–2.58), unemployed women (AHR, 1.50: 95% CI: 1.19–1.89), and women with no formal education (AHR, 1.24: 95% CI: 1.01–1.52).

Conclusion: The study showed a high number of women of reproductive age are still dying mainly due to causes for which preventable strategies are known and have been successfully implemented. The study identified that the main causes of death were related to HIV/AIDS and tuberculosis, and there was a higher hazard of mortality among rural residents, unemployed women, and those with no formal education, who need effective implementation in achieving the SDG three.

Magnitude of death and associated factors among road traffic injury victims admitted to emergency outpatient departments of public and private hospitals at Adama Town, East Shewa Zone, Ethiopia

Objectives:

Road traffic injuries, disabilities, and deaths have been a major public health problem worldwide and in Ethiopia. Globally, around 1.35 million people die every year on the roads and 20–50 million sustain nonfatal injuries as a result of road traffic crashes. This study aimed to assess the magnitude of deaths and associated factors among road traffic injury victims admitted to emergency outpatient departments of public and private hospitals at Adama town, East Shewa Zone, Ethiopia.

Methods:

Institution-based cross-sectional study was conducted among 381 road traffic injury victims admitted to hospitals in Adama town, East Shewa, Ethiopia, from 14 December 2019 to 29 February 2020. Data were collected using interviewer-administered structured questionnaires. Data were entered into EpiData version 4.6.0.2 and analyzed using SPSS version 21. Bivariable and multivariable logistic regressions were fitted to identify variables significantly associated with road traffic injury–related deaths and the results were presented with adjusted odds ratios and 95% confidence interval. Statistical significance was declared at p-value < 0.05.

Results:

The magnitude of deaths among road traffic injury victims were 12.9%. Age (25–44 years) (adjusted odds ratio = 4.24, 95% confidence interval = 1.70–10.61), rural resident (adjusted odds ratio = 2.26, 95% confidence interval = 1.11–4.55), pedestrian (adjusted odds ratio = 3.72, 95% confidence interval = 1.67–7.99), night-time injury (adjusted odds ratio = 5.29, 95% confidence interval = 2.52–11.10), injuries on weekends (adjusted odds ratio = 2.32, 95% confidence interval = 1.12–4.80), not getting first aid at injury site (adjusted odds ratio = 2.64, 95% confidence interval = 1.02–6.84), and known comorbidity conditions (adjusted odds ratio = 3.01, 95% confidence interval = 1.23–7.38) were significantly associated with road traffic injuries–related deaths.

Conclusion:

A significant proportion of road traffic injuries resulted in death. Age, place of residence, pedestrians, night-time injury, and not getting first aid were associated with road traffic injuries–related deaths. Preventive strategies that focus on young adults, rural residents, pedestrians, and people with comorbidities would minimize road traffic injuries–related deaths. Moreover, strict supervision on weekend and night-time drives, and providing accessible lifesaving first aid services would have significant importance.

The Burden of Primary Liver Cancer and Underlying Etiologies From 1990 to 2015 at the Global, Regional, and National Level: Results From the Global Burden of Disease Study 2015

Importance

Objective

Design, Settings, and Participants

Main Outcomes and Measures

Results

Conclusions and Relevance

Question

Findings

Meaning

The global burden of tuberculosis: results from the Global Burden of Disease Study 2015

BACKGROUND

An understanding of the trends in tuberculosis incidence, prevalence, and mortality is crucial to tracking of the success of tuberculosis control programmes and identification of remaining challenges. We assessed trends in the fatal and non-fatal burden of tuberculosis over the past 25 years for 195 countries and territories.

METHODS

We analysed 10 691 site-years of vital registration data, 768 site-years of verbal autopsy data, and 361 site-years of mortality surveillance data using the Cause of Death Ensemble model to estimate tuberculosis mortality rates. We analysed all available age-specific and sex-specific data sources, including annual case notifications, prevalence surveys, and estimated cause-specific mortality, to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how observed tuberculosis incidence, prevalence, and mortality differed from expected trends as predicted by the Socio-demographic Index (SDI), a composite indicator based on income per capita, average years of schooling, and total fertility rate. We also estimated tuberculosis mortality and disability-adjusted life-years attributable to the independent effects of risk factors including smoking, alcohol use, and diabetes.

FINDINGS

Globally, in 2015, the number of tuberculosis incident cases (including new and relapse cases) was 10·2 million (95% uncertainty interval 9·2 million to 11·5 million), the number of prevalent cases was 10·1 million (9·2 million to 11·1 million), and the number of deaths was 1·3 million (1·1 million to 1·6 million). Among individuals who were HIV negative, the number of incident cases was 8·8 million (8·0 million to 9·9 million), the number of prevalent cases was 8·9 million (8·1 million to 9·7 million), and the number of deaths was 1·1 million (0·9 million to 1·4 million). Annualised rates of change from 2005 to 2015 showed a faster decline in mortality (-4·1% [-5·0 to -3·4]) than in incidence (-1·6% [-1·9 to -1·2]) and prevalence (-0·7% [-1·0 to -0·5]) among HIV-negative individuals. The SDI was inversely associated with HIV-negative mortality rates but did not show a clear gradient for incidence and prevalence. Most of Asia, eastern Europe, and sub-Saharan Africa had higher rates of HIV-negative tuberculosis burden than expected given their SDI. Alcohol use accounted for 11·4% (9·3-13·0) of global tuberculosis deaths among HIV-negative individuals in 2015, diabetes accounted for 10·6% (6·8-14·8), and smoking accounted for 7·8% (3·8-12·0).

INTERPRETATION

Despite a concerted global effort to reduce the burden of tuberculosis, it still causes a large disease burden globally. Strengthening of health systems for early detection of tuberculosis and improvement of the quality of tuberculosis care, including prompt and accurate diagnosis, early initiation of treatment, and regular follow-up, are priorities. Countries with higher than expected tuberculosis rates for their level of sociodemographic development should investigate the reasons for lagging behind and take remedial action. Efforts to prevent smoking, alcohol use, and diabetes could also substantially reduce the burden of tuberculosis.

FUNDING

Bill & Melinda Gates Foundation.

Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015

Background

The burden of cardiovascular diseases (CVDs) remains unclear in many regions of the world.

Objectives

The GBD (Global Burden of Disease) 2015 study integrated data on disease incidence, prevalence, and mortality to produce consistent, up-to-date estimates for cardiovascular burden.

Methods

CVD mortality was estimated from vital registration and verbal autopsy data. CVD prevalence was estimated using modeling software and data from health surveys, prospective cohorts, health system administrative data, and registries. Years lived with disability (YLD) were estimated by multiplying prevalence by disability weights. Years of life lost (YLL) were estimated by multiplying age-specific CVD deaths by a reference life expectancy. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility.

Results

In 2015, there were an estimated 422.7 million cases of CVD (95% uncertainty interval: 415.53 to 427.87 million cases) and 17.92 million CVD deaths (95% uncertainty interval: 17.59 to 18.28 million CVD deaths). Declines in the age-standardized CVD death rate occurred between 1990 and 2015 in all high-income and some middle-income countries. Ischemic heart disease was the leading cause of CVD health lost globally, as well as in each world region, followed by stroke. As SDI increased beyond 0.25, the highest CVD mortality shifted from women to men. CVD mortality decreased sharply for both sexes in countries with an SDI >0.75.

Conclusions

CVDs remain a major cause of health loss for all regions of the world. Sociodemographic change over the past 25 years has been associated with dramatic declines in CVD in regions with very high SDI, but only a gradual decrease or no change in most regions. Future updates of the GBD study can be used to guide policymakers who are focused on reducing the overall burden of noncommunicable disease and achieving specific global health targets for CVD.

The effect of minimalist, maximalist and energy return footwear of equal mass on running economy and substrate utilisation

The aim of the current study was to explore the effects of minimalist, maximalist and energy return footwear of equal mass on economy and substrate utilisation during steady state running. Ten male runners completed 6 min steady state runs in minimalist, maximalist and energy return footwear. The mass of the footwear was controlled by adding lead tape to the lighter shoes. Running economy, shoe comfort, rating of perceived exertion and % contribution of carbohydrate to total calorie expenditure were assessed. Participants also subjectively indicated which shoe condition they preferred for running. Differences in shoe comfort and physiological parameters were examined using paired samples t-tests, whilst shoe preferences were tested using a chi-square test. The results showed firstly that running economy was significantly improved in the energy return (35.9 ml∙kg/min) compared to minimalist footwear (37.8 ml∙kg/min). In addition % carbohydrate was significantly greater in the minimalist (76.4%) in comparison to energy return footwear (72.9%). As running economy was improved and carbohydrate utilisation reduced in the energy return in comparison to minimalist footwear, the current investigation shows that these footwear are more economical when shoe mass is controlled.

Effects of minimalist and maximalist footwear on Achilles tendon load in recreational runners

The current investigation aimed to comparatively examine the effects of minimalist, maximalist and conventional footwear on Achilles tendon forces (ATF) during running. Twelve male runners (age 23.11±5.01 years, height 1.78±0.10 cm and body mass 77.13±7.89 kg) ran at 4.0 m/s in the three footwear conditions. ATF’s were calculated using Opensim software allowing the magnitudal and temporal aspects of the ATF to be quantified. Differences between footwear were examined using one-way repeated measures ANOVA. The results showed the peak ATF was significantly larger in minimalist footwear (5.97±1.38 body weight (BW)) compared to maximalist (5.07±1.42 BW). In addition it was revealed that ATF per mile was significantly larger in minimalist (492.31±157.72 BW) in comparison to both maximalist (377.31±148.06 BW) and conventional (402.71±125.51 BW) footwear. Given the relationship between high ATF and Achilles tendon degradation, the current investigation indicated that minimalist footwear may increase runners risk for Achilles tendon injury.

Neurological implications of aniseikonic tilts and stereoscopic completions through homogeneous visual space

In 1965, it was first reported that BROKEN visual contours complete themselves in textured stereovision across empty or homogeneous space and that they do so strongly following directly the optics of crossed versus uncrossed disparities. The importance was then also noted of this completion effect for any neurophysiological model of stereovision. We now extend these measurements with several additional targets and to an analogous aniseikonic target, and confirm that the completion range has a maximum of about 5 degrees. There is much dependence upon target eccentricity and disparity sign, and some on size. That aniseikonic tilts may also be generated over this same range confirms the fact that global neurointegrative processes are of critical importance in all facets of stereovision, and in texture vision in general.

Special housing needs of the elderly patient

The physician is increasingly asked to play a role in relocating elderly patients to special housing. The goal is to find the housing that is best suited to the patient's needs. Important factors to be considered are building design, sponsorship, financing and nonshelter services. Proper housing, with appropriate support services, enables the elderly to remain independent longer and contributes to their physical and mental health.

Complementary spatial locations, width, and disparity

An alternative analysis is offered for human depth perception in addition to the depth cue of disparity. The new analysis considers locations both proximal and distal to the fixation point and offers an explanation as to why a stimulus presented at one disparity sign may be mistakenly considered to possess the opposite sign. Three descriptions of applications, the Pulfrich phenomenon, an interpretation of the Hornbostel effect (the three-dimensional Necker cube), and the determination of the limits of stereoscopic vision, are discussed. In addition the new analysis discloses a particular advantage of binocular over monocular vision which had not been appreciated formerly. The new analysis offers a powerful analytical tool of simple mathematical form. The means of conversion from the new analysis to and from disparity is included. In addition the similarity between the new approach and the classical lens equation is examined.

Transfer of age-associated restrained tumor growth in mice by old-to-young bone marrow transplantation

B16 melanoma and Lewis lung carcinoma grow more slowly in aged mice. Immunesenescent changes may account for this age-related difference. To test for the effect of immune deficiency on the growth of these tumors, we treated young mice with an immunosuppressive dose of radiation and then observed tumor growth. We also radiated young mice to a higher (lethal) dose and then rescued them with either young or old bone marrow transfusion. Tumors grew more slowly in radiated mice than controls and in those reconstituted with old bone marrow. These findings support the concept of immunesenescent-related reduced tumor growth.

Psychosocial approach for long-term care

Long-term institutional care in the United States is in the midst of crisis. One of the major reasons for the problems it is encountering is that care and financing mechanisms are structured in terms of the medical needs defined for acute care facilities rather than in terms of the psychosocial needs of long-term care facilities. If the dependency of elderly patients is to be reduced instead of fostered, public policy must become responsive to the true dimensions of long-term care.

Arousal and activity level of rats with lesions in the dorsal hippocampus

The effect on gross locomotor activity of irrelevant stimuli, prior exposure to these stimuli and two dosages of amphetamine were assessed on rats with lesions in the dorsal hippocampus. These animals were significantly more active post-operatively than sham-lesioned subjects. Prior exposure to the irrelevant stimuli increased post-operative differentiation between stimuli, whereas the introduction of amphetamine had the reverse effect. Changes in locomotor activity occurred at lower dosages of amphetamine than in previous studies, suggesting that the irrelevant stimuli have an arousal effect which acts additively with amphetamine and hippocampal impairment.