Sudden unexplained infant deaths among American Indians and whites in North and South Dakota

Differences in risk factors for sudden unexplained infant death (SUID) were studied among American Indian and White infants in North and South Dakota. From 1977 to 1984, the incidence of SUID was 3.9 times higher among Indians compared with Whites. Indian SUID cases appeared to die at a slightly younger age than Whites, and the association of male gender and young maternal age with SUID was weak or absent among Indians. Low maternal education and late or no prenatal care were strongly related to SUID in both races. The Indian-White risk ratio was unaltered by adjustment for birthweight and maternal age but declined to 2.5 (95% confidence intervals = 1.9, 3.4) when adjusted for maternal education and trimester prenatal care began.     

Sudden unexplained infant deaths among American Indians and Whites in North and South Dakota

Summary. Differences in risk factors for sudden unexplained infant death (SUID) were studied among American Indian and White infants in North and South Dakota. From 1977 to 1984, the incidence of SUID was 3.9 times higher among Indians compared with Whites. Indian SUID cases appeared to die at a slightly younger age than Whites, and the association of male gender and young maternal age with SUID was weak or absent among Indians. Low maternal education and late or no prenatal care were strongly related to SUID in both races. The Indian-White risk ratio was unaltered by adjustment for birthweight and maternal age but declined to 2.5 (95% confidence intervals = 1.9, 3.4) when adjusted for maternal education and trimester prenatal care began.     

Sudden death in sleep of Laotian-Hmong refugees in Thailand: a case-control study

A syndrome of sudden and unexpected death during sleep occurs among adult Southeast Asian refugees in the United States. Surveillance for sudden deaths was conducted among Laotian-Hmong refugees in the Ban Vinai refugee camp in northeastern Thailand to determine if a similar cause of death occurs there. Sixteen sudden and unexpected deaths associated with sleep were found that were similar to the sudden deaths noted among Southeast Asian refugees in the United States. A case-control study in Ban Vinai revealed associations between sudden death in sleep and membership in the Green-Hmong subgroup, a family history of sudden death, and previous non-fatal sleep disturbances. Sudden and unexpected death during sleep of young adults is a regional phenomenon within Asia and occurs in populations that are culturally and genetically distinct. Migrants from affected populations in Asia carry with them the susceptibility to sudden death in sleep.     

A cluster of unexplained deaths in a nursing home in Florida.

In the two-week period November 13-27, 1984, 12 patients died in a 54-bed nursing home in Florida; based on previous mortality patterns, 2.5 deaths would have been expected for the whole month. There was no similar increase in deaths in November 1984 and no comparable monthly death rate for any of 69 nursing homes in the same county from 1976-84. Comparison of the 12 deaths in November with 28 deaths that occurred during the previous 10 months and with 31 surviving patients who were continuously present in the nursing home between November 12-28, 1984 revealed that the patients who died in November were more likely to have had onset of the terminal event during the night shift, had a recent visitor, and had an admitting diagnosis of organic brain syndrome. The abrupt increase in the death rate for November 1984 was not associated with a measurable change in population characteristics, an outbreak of infectious disease, or changes in procedures or the environment. Reviews of employee schedules revealed a consistent and strong association between the duty times of two nurses and the onsets of the terminal episode and the times of patient deaths. Continuing epidemiologic surveillance of adverse outcomes in nursing homes is recommended.     

Prenatal or early postnatal events predict infectious deaths in young adulthood in rural Africa

BACKGROUND: Research over the past decade has suggested that prenatal and early postnatal nutrition influence the risk of developing chronic degenerative diseases up to 60 years later. We now present evidence that risk of death from infectious diseases in young adulthood is similarly programmed by early life events. METHODS: In three rural Gambian villages, affected by a marked annual seasonality in diet and disease, we have kept detailed demographic, anthropometric and health records since 1949. Fate was known with certainty for 3,162 individuals (2,059 alive/1,103 dead, most dying in childhood). For this case-control analysis of antecedent predictors of premature mortality, all adult deaths (n = 61) were paired with two randomly selected controls matched for sex and year of birth. RESULTS: Mean age at death was 25 (SD: 8) years. Adult death was associated with a profound bias in month of birth with 49 cases born in the nutritionally-debilitating hungry season (Jul-Dec) versus 12 in the harvest season (Jan-Jun). Relative to harvest season the hazard ratio for early death in hungry-season births rose from 3.7 (for deaths >14.5 years, P = 0.000013) to 10.3 (for deaths >25 years, P = 0.00002). Anthropometric and haematological status at 18 months of age was identical in cases and controls, indicating an earlier origin to the defect. Most deaths for which cause was known had a definite or possible infectious aetiology; none were from degenerative diseases of affluence. CONCLUSIONS: Early life exposures, correlated with season of birth, strongly influence susceptibility to fatal infections in young adulthood. The evidence suggests that nutritionally-mediated intrauterine growth retardation may permanently impair the development of immune function.     

Fatherhood,marriage and HIV risk among young men in rural Uganda

Compared to a large body of work on how gender may affect young women’s vulnerability to HIV, we know little about how masculine ideals and practices relating to marriage and fertility desires shape young men’s HIV risk. Using life-history interview data with 30 HIV-positive and HIV-negative young men aged 15–24 years, this analysis offers an in-depth perspective on young men’s transition through adolescence, the desire for fatherhood and experience of sexual partnerships in rural Uganda. Young men consistently reported the desire for fatherhood as a cornerstone of masculinity and transition to adulthood. Ideally young men wanted children within socially sanctioned unions. Yet, most young men were unable to realise their marital intentions. Gendered expectations to be economic providers combined with structural constraints, such as limited access to educational and income-generating opportunities, led some young men to engage in a variety of HIV-risk behaviours. Multiple partnerships and limited condom use were at times an attempt by some young men to attain some part of their aspirations related to fatherhood and marriage. Our findings suggest that young men possess relationship and parenthood aspirations that – in an environment of economic scarcity – may influence HIV-related risk.     

Pandemic (H1N1) 2009-associated deaths detected by unexplained death and medical examiner surveillance

During the pandemic (H1N1) 2009 outbreak, Minnesota, New Mexico, and Oregon used several surveillance methods to detect associated deaths. Surveillance using unexplained death and medical examiner data allowed for detection of 34 (18%) pandemic (H1N1) 2009-associated deaths that were not detected by hospital-based surveillance.     

Sudden infant deaths and clear weather in a subtropical environment

Particulate pollution levels were found to decrease, on average, over the 10-day period preceding SIDS incidence in a study of 369 cases over 15 years in Brisbane, Australia. This unexpected association could not be explained by correlations between daily pollution levels and daily precipitation, wind velocity, air temperature or cloud. Of the meterological variables studied, which might have given rise to the particulate-SIDS associations, only visibility showed associations with SIDS incidence. Average visibility increased prior to SIDS in both summer and winter cases. It is hypothesised that these findings may be due to either direct effects of light, or due to increased outdoor exposure of infants and/or to changes in parental behaviour during clear weather.     

Factors associated with HIV sero-positivity in young, rural South African men

OBJECTIVE: To describe factors associated with HIV infection in men aged 15-26 years. SETTING: Rural Eastern Cape Province, South Africa. SAMPLE: A total of 1277 sexually experienced Xhosa male volunteers from 70 villages participating in a cluster randomized controlled trial of an HIV behavioural intervention. Xhosas circumcise during manhood initiation rituals. DESIGN: Cross-sectional, analysis of the study's baseline interviews. MAIN MEASURE: HIV sero-status, sexual practices measured with an interviewer-administered questionnaire. RESULTS: About 2% of the men were HIV positive. A logistic regression model showed HIV positivity to be associated with age (OR 1.55; 95%CI 1.22-1.95), having made a woman pregnant (OR 2.93; 95% CI 1.28-6.68), having been circumcised (OR 0.40; 95% CI 0.16-0.98), and having had sex with a man (OR 3.61; 95% CI 1.0-13.0). CONCLUSIONS: Our findings provide further evidence to suggest that circumcision is protective. There was much heterosexual risk taking among men but only pregnancy (with its association with sexual frequency) predicted HIV sero-positivity. Although relatively rare, same-sex sexual experiences were a risk factor. Male-male sexual contact is rarely assessed in HIV research in Africa and almost never addressed in general HIV prevention programming. Our findings suggest that it should be given more attention.     

Sudden infant deaths and seasonality in Tasmania, 1970-1976

Analyses of monthly minimum temperatures and daily minimum temperatures show that significantly more Sudden Infant Deaths and 'pneumonitis' deaths occur in colder conditions in southern Tasmania. Low minimum monthly and low minimum daily temperatures 'explain' part of the observed winter seasonal peak of deaths. However, a sharp change of temperature over 24 hours, either upwards or downwards, is associated with fewer deaths than occurred when little or no change of temperature had been experienced. Utilising the additional data of the Tasmania-wide series it is shown that the winter seasonal effect is especially evident in infants over 3 months of age compared with those aged only 0-3 months, in whom seasonal variation did not occur.     

Community-based surveillance of maternal deaths in rural Ghana

Objective

To examine the feasibility and effectiveness of community-based maternal mortality surveillance in rural Ghana, where most information on maternal deaths usually comes from retrospective surveys and hospital records.

Methods

In 2013, community-based surveillance volunteers used a modified reproductive age mortality survey (RAMOS 4+2) to interview family members of women of reproductive age (13–49 years) who died in Bosomtwe district in the previous five years. The survey comprised four yes–no questions and two supplementary questions. Verbal autopsies were done if there was a positive answer to at least one yes–no question. A mortality review committee established the cause of death.

Findings

Survey results were available for 357 women of reproductive age who died in the district. A positive response to at least one yes–no question was recorded for respondents reporting on the deaths of 132 women. These women had either a maternal death or died within one year of termination of pregnancy. Review of 108 available verbal autopsies found that 64 women had a maternal or late maternal death and 36 died of causes unrelated to childbearing. The most common causes of death were haemorrhage (15) and abortion (14). The resulting maternal mortality ratio was 357 per 100 000 live births, compared with 128 per 100 000 live births derived from hospital records.

Conclusion

The community-based mortality survey was effective for ascertaining maternal deaths and identified many deaths not included in hospital records. National surveys could provide the information needed to end preventable maternal mortality by 2030.     

Sudden unexplained death during sleep occurred commonly in the general population in the Philippines: a sub study of the National Nutrition and Health Survey

OBJECTIVE: Sudden unexplained death during sleep (SUDS) is found frequently among Asians. The nationwide incidence of SUDS in the Philippines was measured using a questionnaire, validated in a previous study versus autopsy. STUDY DESIGN AND SETTING: The questionnaire was administered as part of the 2003 National Nutrition and Health Survey. A total of 4,747 households were sampled in a stratified randomized manner. Household members were interviewed regarding the occurrence of presumptive SUDS within the last 5 years. Presumptive SUDS was death in a young (<40 years) healthy individual with no reasonable alternative explanation for death. RESULTS: After adjustment for age and sampling weight, the 5-year incidence of sudden death during sleep was 380 (95% CI 210-640) per 100,000, whereas that of SUDS was 110 (95% CI 29-540) per 100,000 in the 20-39 year age group. The computed annualized incidence of sudden death during sleep in the 20-39 year age group was 76 per 100,000, that of SUDS 22 was per 100,000. Computed annualized incidence of SUDS based on the questionnaire accuracy was 43 per 100,000. CONCLUSION: SUDS occurs commonly among young Filipinos affecting 43 per 100,000 per year of which most are young males.