The magnitude of mortality from acute respiratory infections in children under 5 years in developing countries.

This article reviews the available evidence of mortality from acute respiratory infections (ARI) among children aged under 5 years in contemporary developing countries and compares the findings with European populations before 1965. In European populations before 1965, the level of mortality was found to be a determinant of the proportion of deaths due to ARI. There were marked differences according to regional patterns of mortality. Deaths from ARI played a smaller role after 1950, when the use of antibiotics became generalized. In developing countries, the role of ARI mortality seems to be similar to the European experience. The age pattern is very marked. In absolute values, ARI mortality is highest in the neonatal period and decreases with age. In relative values, ARI mortality is highest in the postneonatal period. ARI, mainly pneumonia, accounts for about 18% of underlying causes of death in developing countries. Pneumonia and other ARI are frequent complications of measles and pertussis; ARI is also commonly found after other infections and in association with severe malnutrition. Virtually no data are available in developing countries to provide final estimates of the role of ARI in mortality of children aged under 5 years. However, the WHO figure of 1 out of 3 deaths due to--or associated with--ARI may be close to the real range of the ARI-proportional mortality in children of developing countries. Results are discussed in light of the definitions of ARI used in various studies, the difficulties in ascertaining and coding multiple causes of death and the quality of data from some sources.     

南方低温雨雪冰冻灾害的疾病负担研究

目的评估低温雨雪冰冻灾害可能造成的健康损失,为采取针对性的预防和减轻措施提供依据。方法收集了我国南方某省CZ市SX区1月13日到2月8日灾害期间主要医疗机构的临床记录,筛查其中死亡、骨折、一氧化碳中毒和心脏病急性发作等病例,并以人口普查资料作为计算本次发生率的分母,对灾害期数据与前两年同期数据进行了比较。结果与2006-2007年同期相比,灾害期间被调查地区的超额死亡率为0.98/10 000,其中循环系统和CO中毒的超额死亡率分别为0.49/10 000和0.35/10 000;与2004-2007年同期相比,灾害期间被调查地区主要与灾害有关的传染病超额发病率为-3.75/100 000;与2007年同期相比,灾害期间被调查地区急救转运病例发生率增加了0.98‰,医疗机构门诊就诊率下降了2.1‰,而急诊科门诊就诊率增加了0.08‰;医疗机构病人住院率下降了0.11‰,而CO中毒和骨折病人住院率分别增加了0.41‰和0.16‰。结论低温雨雪冰冻灾害增加了CO中毒、骨折和循环系统等特殊疾病的死亡率或发病率。有必要采取措施,预防和缓解和寒冷有关的疾病,特别是一氧化碳中毒的发生。     

Acute respiratory infections: a review.

Acute respiratory infections (ARI) constitute one of the principal causes of morbidity and mortality in many countries. Data from 88 countries in five continents, with a total population of nearly 1200 million, showed that deaths due to ARI in 1972 amounted to 666 000. Pneumonia, both viral and bacterial, accounted for 75.5% of the total deaths from ARI. Mortality from ARI represents 6.3% of deaths from all causes. Considerable differences in mortality rates exist both between and within continents. Mortality from ARI is highest in infants and old people. The data suggest that in some areas of the world mortality due to ARI is extremely high.     

Trends and geographical disparities in coronary heart disease in France: are results concordant when different definitions of events are used?

OBJECTIVES: To assess whether different definitions of acute coronary events yielded concordant results concerning trends and geographical disparities in coronary heart disease (CHD) mortality and morbidity in France. STUDY DESIGN: Data from three French CHD registries participating in the WHO MONICA Project during the period 1985-1992. SETTING: Three areas of about one million inhabitants each in the North, South and East of France. SUBJECTS: About 2,000 acute coronary events each year. MAIN OUTCOME MEASURES: Mortality, annual rate of fatal and non-fatal events, incidence of first and recurrent events, case-fatality rates. RESULTS: For incidence and mortality, the broader the broader the definition of the acute event, the higher the reported rates. The same tendency was not observed for case-fatality rates. Comparing between-registry rates for mortality, 28-day case-fatality and hospital case fatality yielded relatively concordant results whatever the definition of event. As a whole, the higher mortality rate in Lille and its intermediate rank in Strasbourg were related more to disparities in case-fatality rates, with only small variations in incidence rates, independently of the definition used. Comparing temporal trends in rates within and between regions, a consistent decrease in annual mortality rates and case-fatality rates was observed, whatever the definition. In contrast, the incidence of non-fatal probable myocardial infarction did not change during the period in any register. CONCLUSIONS: Although the absolute estimates of rates were variable with the definition of the event, major findings in relation to trends and geographical disparities were fairly consistent across the definitions: the North-South gradient in mortality observed in France was found to be much more pronounced for case fatality than for incidence. The proportion of milder acute myocardial infarction is currently increasing and this element should be taken into account when analysing CHD rates.     

Outcomes associated with vancomycin-resistant enterococci: a meta-analysis.

BACKGROUND: Because patients with vancomycin-resistant Enterococcus bacteremia (VREB) usually have a higher severity of illness, it has been unclear whether VREB is worse than vancomycin-susceptible Enterococcus bacteremia (VSEB). METHODS: Data on morbidity and case fatality rates and costs were pooled from studies comparing VREB and VSEB, identified by Medline January 1986 to April 2002) and meeting abstracts. Heterogeneity across studies was assessed with contingency table chi-square. Multivariate analyses (MVAs) controlling for other predictors were evaluated. RESULTS: Thirteen studies compared case-fatality rates of VREB and VSEB. VREB case fatality was significantly higher (48.9% vs 19%; RR, 2.57; CI95, 2.27 to 2.91; attributable mortality = 30%). Five studies compared VREB with VSEB when bacteremia was the direct cause of death; VREB case fatality was significantly higher (39.1% vs 21.8%; RR, 1.79; CI95, 1.28 to 2.5; attributable mortality = 17%). Four MVAs found significant increases in case-fatality rates (OR, 2.10 to 4.0), 3 showed trends toward increase (OR, 1.74 to 3.34 with wide confidence intervals), and 3 with low statistical power found no difference. VREB recurred in 16.9% versus 3.7% with VSEB (P < .0001). Three studies reported significant increases in LOS, costs, or both with VREB. CONCLUSION: Most studies have had inadequate sample size, inadequate adjustment for other predictors of adverse outcomes, or both, but available data suggest that VREB is associated with higher recurrence, mortality, and excess costs than VSEB including multiple studies adjusting for severity of illness.     

Mortality among ferrous foundry workers

Mortality analyses were carried out for 278 male hourly workers who were employed for at least 10 years at a gray iron foundry and who died between January 1, 1970 and December 31, 1981. Statistically significant excess proportional mortality due to non-malignant respiratory disease (SPMR = 177), lung cancer (SPMR = 148), and leukemia (SPMR = 284) was found among the 221 white males. Among nonwhite males there was a significant excess in proportional mortality due to circulatory diseases (SPMR = 143). White males in the Finishing classification experienced a significant excess of proportional mortality due to nonmalignant respiratory disease (SPMR = 279) and lung cancer (SPMR = 179). White males in the Core Room classification experienced an excess of proportional mortality due to nonmalignant respiratory disease (SPMR = 321). Case-control studies demonstrated a significant association between nonmalignant respiratory disease and the Finishing classification after controlling for the effects of age, prior occupations in coal mining or foundries, and smoking. A positive but nonsignificant association between lung cancer and Finishing was also found after controlling for age, prior work history, and smoking in case control studies.     

The utilisation of vaccines in humanitarian crises, 2015–2019: A review of practice

BackgroundThe risk factors that emerge with the onset and protraction of humanitarian crises leave populations at a heightened risk of excess morbidity and mortality from vaccine-preventable diseases (VPDs). There is currently little clarity on which vaccines are being used in crises throughout the world, and whether vaccination decisions correspond to local disease threats. This review aimed to collect and analyse such information.MethodsWe reviewed vaccination services from January 2015 to June 2019 across all 25 humanitarian responses that had an activated coordination mechanism during this period. A range of online sources and informants within the humanitarian sector were consulted to compile data on which vaccines were provided in each crisis, and the modality and timing of vaccine provision. The package of vaccination services since the start of each crisis was then compared with local disease burden (baseline + excess due to crisis-emergent risk factors).ResultsThe range of vaccines used in humanitarian crises appears limited. When offered, vaccines were primarily delivered through the pre-existing routine schedule, with few supplementary actions taken in recognition of the need for rapidly enhancing population immunity. Vaccine packages mostly did not address the actual range of VPDs that likely accounted for substantial disease risk.ConclusionsThis review suggests inconsistencies and inequities in vaccine provision to crisis-affected populations. A consistent, standardised and broader approach to vaccine use in crises is needed.     

Racial differences in colorectal cancer mortality. The importance of stage and socioeconomic status

This investigation studies racial and socioeconomic differences in mortality from colorectal cancer, and how they vary by stage and age at diagnosis. Cox proportional hazards models were used to estimate the hazard ratio of dying from colorectal cancer, controlling for tumor characteristics and sociodemographic factors. Black adults had a greater risk of death from colorectal cancer, especially in early stages. The gender gap in mortality is wider among blacks than whites. Differences in tumor characteristics and socioeconomic factors each accounted for approximately one third of the excess risk of death among blacks. Effects of socioeconomic factors and race varied significantly by age. Higher stage-specific mortality rates and more advanced stage at diagnosis both contribute to the higher case-fatality rates from colorectal cancer among black adults, only some of which is due to socioeconomic differences. Socioeconomic and racial factors have their most significant effects in different age groups.     

Small and light arms violence reduction as a public health measure: the case of Libya

The conflict environment in Libya is characterized by continued pervasive insecurity amidst the widespread availability of small arms and light weapons (SALW). After the First Civil War, armed brigades took the law into their own hands and the resulting violence terminated a short-lived post-conflict period that has relapsed into a Second Civil War. The Libyan government has struggled to assert authority over armed groups and these brigades, refusing to disarm have contributed directly the initiation of a second conflict; some are motivated by self-defense, status, criminality, vindication or political aims.Once, a bastion of public health in the Middle East and North Africa (MENA), the country now faces a substantial and unprecedented challenge: to rebuild a devastated health system amidst the burden of armed violence and the proliferation of small and light weapons (SALW) especially firearms of various kinds. The health system in Libya is compromised; healthcare professionals have little time to record or document such cases given the immediate clinical needs of the patient. This corresponding decreased capacity to deal with an increasing demand on services caused by SALW-related morbidity compounds the challenge of data collection and indicates that external support and advocacy are required.A public health strategy towards effective SALW armed violence reduction and injury prevention requires the interdisciplinary advocacy of practitioners across the fields of justice, security, development, health and education. Through surveillance of firearms and injuries in the post-conflict environment we can better evaluate and respond to the burden of armed violence in Libya. In order to reduce armed a reconceptualisation of arms reduction campaigns must occur. Notable emerging evidence recommends the inclusion of community-based interventions and development programs which address local motivations for firearms ownership alongside improved international coordination. This renewed approach holds importance for recovery, development and securing the transition to peace.The high prevalence of firearm ownership, weak institutions, nascent security forces, porous borders, inadequate weapons stockpiles, combined with high military spending, compounds public weaponisation as a health crisis for the entire MENA region.     

Traffic-related mortality in industrialized and less developed countries.

Road traffic-related mortality has traditionally been regarded as a problem primarily of industrialized countries. There is, however, growing evidence of a strong negative relationship between economic development and exposure-adjusted traffic-related death rates. Cross-sectional data on road traffic-related deaths in 1990 were obtained from 83 countries. The relationship between such mortality and a number of independent variables was examined at the individual country level by means of multiple regression techniques. These were also used to elucidate factors associated with variations in age, sex, and case-fatality patterns of road traffic mortality. Countries were grouped according to region and socioeconomic features, and the mortality data were summarized by these groups. The gross national product per capita was positively correlated with traffic-related mortality/100,000 population/year (P = 0.01), but negatively correlated with traffic deaths/1000 registered vehicles (P < 0.0001). Increasing population density was associated with a proportionately greater number of traffic-related deaths in the young and the elderly (P = 0.036). Increasing GNP per capita and increased proportional spending on health care were associated with decreasing case-fatality rates among traffic-accident victims (P = 0.02 and 0.017, respectively). Middle-income countries appear to have, on average, the largest road-traffic mortality burden. After adjusting for motor vehicle numbers, however, the poorest countries show the highest road traffic-related mortality rates. Many industrialized countries would appear to have introduced interventions that reduce the incidence of road traffic injury, and improve the survival of those injured. A major public health challenge is to utilize this experience to avoid the predicted increase in traffic-related mortality in less developed countries.     

Newborn vitamin A dosing reduces the case fatality but not incidence of common childhood morbidities in South India

Vitamin A supplementation reduces mortality in young children in areas of endemic vitamin A deficiency. However, it has no impact on the incidence of common morbidities. This discrepancy has been explained by an impact on case fatality, although with the exception of hospitalized measles cases, there is little direct evidence to support this hypothesis. We assessed the impact of newborn dosing with vitamin A on the incidence and case fatality of common childhood morbidities in early infancy in a community-based, randomized trial in South India. Morbidity for each day in the previous 2 wk was assessed for the first 6 mo of life. A total of 11,619 live-born infants were enrolled and randomized to receive either 48,000 IU (50.4 micromol retinol) of oral vitamin A or placebo following delivery. There was no difference between treatment groups in the incidence of acute or chronic diarrhea, dysentery, or fever but a small increased incidence of acute respiratory illness (ARI). Case fatality for diarrhea and fever were significantly reduced in the vitamin A group compared with placebo (relative case fatality [95% CI] of 0.50 [0.27, 0.90] and 0.60 [0.40, 0.88], respectively). There was a trend in reduction of case fatality for various definitions of ARI, but the evidence for this effect was modest. Survival analysis among those with morbid episodes confirmed the case fatality analysis. This trial demonstrated that the reduction in overall mortality due to newborn vitamin A dosing was driven primarily by a reduction in case fatality among infants.     

An exploration of social determinants of health amongst internally displaced persons in northern Uganda

Social determinants of health describe the conditions in which people are born, grow, live, work and age and their influence on health. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. Armed conflict and forced displacement are important influences on the social determinants of health. There is limited evidence on the social determinants of health of internally displaced persons (IDPs) who have been forced from their homes due to armed conflict but remain within the borders of their country. The aim of this study was to explore the social determinants of overall physical and mental health of IDPs, including the response strategies used by IDPs to support their health needs. Northern Uganda was chosen as a case-study, and 21 face-to-face semi-structured interviews with IDPs were conducted in fifteen IDP camps between November and December 2006.     

The public health implications of resource wars

Competition for resources between or within nations is likely to become an increasingly common cause of armed conflict. Competition for petroleum is especially likely to trigger armed conflict because petroleum is a highly valuable resource whose supply is destined to contract. Wars fought over petroleum and other resources can create public health concerns by causing morbidity and mortality, damaging societal infrastructure, diverting resources, uprooting people, and violating human rights. Public health workers and the organizations with which they are affiliated can help prevent resource wars and minimize their consequences by (1) promoting renewable energy and conservation, (2) documenting the impact of past and potential future resource wars, (3) protecting the human rights of affected noncombatant civilian populations during armed conflict, and (4) developing and advocating for policies that promote peaceful dispute resolution.     

Armed conflict,health spending,and HIV

Among current studies, there is still question as to whether conflict increases, decreases, or has no effect on HIV prevalence. This lack of clarity can be attributed to the scarcity of quantitative analysis in this field. Thus, studies about conflict and HIV have failed to specify the ways conflict affects HIV prevalence, if indeed it does. In this paper, I argue that armed conflict increases HIV prevalence by reducing total per capita health spending. Using HIV prevalence data from 1990 to 2009, I find supporting evidence in the case of civil conflicts for these arguments. In addition, I find that as the severity of civil conflict increases, so do HIV rates. These findings have significant policy implications for individual governments, as well as for the international community.     

Effect of an armed conflict on relative socioeconomic position of rural households: case study from western Côte d'Ivoire

Background  

Current conceptual frameworks on the interrelationship between armed conflict and poverty are based primarily on aggregated macro-level data and/or qualitative evidence and usually focus on adherents of warring factions. In contrast, there is a paucity of quantitative studies about the socioeconomic consequences of armed conflict at the micro-level, i.e., noncommitted local households and civilians.     

Challenges in measuring measles case fatality ratios in settings without vital registration

Measles, a highly infectious vaccine-preventable viral disease, is potentially fatal. Historically, measles case-fatality ratios (CFRs) have been reported to vary from 0.1% in the developed world to as high as 30% in emergency settings. Estimates of the global burden of mortality from measles, critical to prioritizing measles vaccination among other health interventions, are highly sensitive to the CFR estimates used in modeling; however, due to the lack of reliable, up-to-date data, considerable debate exists as to what CFR estimates are appropriate to use. To determine current measles CFRs in high-burden settings without vital registration we have conducted six retrospective measles mortality studies in such settings. This paper examines the methodological challenges of this work and our solutions to these challenges, including the integration of lessons from retrospective all-cause mortality studies into CFR studies, approaches to laboratory confirmation of outbreaks, and means of obtaining a representative sample of case-patients. Our experiences are relevant to those conducting retrospective CFR studies for measles or other diseases, and to those interested in all-cause mortality studies.     

Trends in traffic accidents in Campinas, São Paulo State, Brazil: the increasing involvement of motorcyclists

In order to describe trends in traffic accidents, mortality, vehicle types, fleet sizes, and victims' characteristics in Campinas, S?o Paulo State, Brazil, from 1995 to 2008, this study analyzed vehicle rates, traffic accident rates per inhabitant and per vehicle, case-fatality rates, proportional mortality, mortality rates, and rates ratios. The motorcycle fleet increased 241%. Although the case-fatality rate of motorcycle users from 2000 to 2008 decreased, in 2008 they accounted for 49.3% of fatal accidents on public byways in Campinas. Motorcycles were responsible for the highest run-over rate (66.7 pedestrians/1,000 accidents) and highest pedestrian fatality rate (4 deaths/1,000 accidents). Men showed much higher mortality rates than women. Pedestrian victims were mainly elderly; most vehicle occupants in traffic accidents were in the 15 to 29-year age bracket. From 2006 to 2008, nearly 80% of vehicle users 15 to 39 years of age were motorcyclists. Motorcycle accident prevention should be a priority, using multi-institutional measures.     

Standard management of acute respiratory infections in a children's hospital in Pakistan: impact on antibiotic use and case fatality.

Acute respiratory infections (ARI) are a leading cause of childhood morbidity and mortality in Pakistan. The National ARI Control Programme was launched in 1989 in order to reduce the mortality attributed to pneumonia, and rationalize the use of drugs in the management of patients with ARI. WHO''s standard ARI case management guidelines were adopted to achieve these objectives. The medical staff at the Children''s Hospital, Islamabad, were trained in such management in early 1990; further training sessions were conducted when new staff arrived. Data on outpatients were obtained from special ARI abstract registers, which have been maintained in the outpatient department since January 1990. Details on inpatients who were admitted with ARI were obtained from hospital registers. During the period 1989-92, the use of antibiotics in the outpatient department decreased from 54.6% to 22.9% (P < 0.0001). The case fatality rate (CFR) in children admitted with ARI fell from 9.9% to 4.9% (P < 0.0001), while the overall case fatality rate fell from 8.7% to 6.2%. Our results from a tertiary health care facility show that standard ARI case management reduced both antibiotic use and expenditure on drugs. Although the ARI case management criteria, which are more sensitive than the conventional diagnostic criteria of auscultation and radiography, led to more admissions, we believe that this strategy contributed to a significant reduction in the ARI case fatality rate.     

Stroke: the global burden

Stroke is a major global health problem. It is a major causeof mortality, morbidity and disability in developed and increasinglyin less developed countries. Worldwide, it is the leading causeof healthy years lost in late adulthood, and evidence indicatesthat the burden of stroke, particularly in terms of morbidityand disability, will almost certainly increase in the foreseeablefuture. This review aims to generate a better understanding of the presentand projected future global burden of stroke, with particularemphasis on the non-established market economy countries (NEMEC).The first part summarizes and interprets the currently availableevidence on stroke mortality, incidence, case-fatality and relateddisability rates from both established and non-established marketeconomy countries. The second part reviews the main risk factorsfor stroke. For the modifiable factors, it examines currentprevalence rates in NEMEC with a view towards identifying patternsthat are relevant for predicting future rates of the disease.Reversing the consequences of stroke is difficult, thus primaryprevention is of utmost importance. The potential for preventionis illustrated by the experience of Japan, which in the lasttwo decades has seen substantial declines in stroke mortality- mostly due to reductions in dietary salt intake. The lastsection discusses potential strategies and approaches to effectivestroke prevention and highlights other areas that need to beaddressed if stroke management in the coming decades is to beeffective.