Suchergebnisse

BACKGROUND: The reduction of maternal mortality in developing countries such as the Democratic Republic of Congo (DRC) still raises many questions. Indeed, this large country in the heart of Africa ranks 4th among the eight countries that alone account for more than 50% of maternal deaths in the world, behind India, Nigeria and Pakistan. However, there is no up-to-date data on maternal mortality in eastern DRC. This study measures the mortality rate rate in health facilities in eastern DRC and identifies the associated risk factors. METHODS: This analytical epidemiological study was based on retrospective data materna deaths recorded in 59 health facilities, in three health zones in the southern part of Maniema province in east DRC. The study was conducted from July 1, 2015 to June 30, 2020. Descriptive, bi and multivariate analyses were used. RESULTS: The maternal mortality rate was estimated at 620 deaths per 100,000 live births, of which 46% of maternal deaths were related to a parturients' delayed decision in seeking healthcare in time (first delay). Maternal deaths were significantly associated with extreme ages (≤ 19 years and ≥ 40 years: p = < 0.001), patient parity (in primigravidas and in large multiparas: p = 0.001), complications such as hemorrhagic, (p = < 0.001), uterine ruptures:(p = < 0.001), infections, (p = < 0.001), and dystocia (p = < 0.001). CONCLUSION: Despite the efforts made by the DRC and its partners in the fight against maternal mortality, women continue to lose their lives when they decide to give birth. The results imply that it is imperative to strengthen both women and health professionals' knowledge about pregnancy and maternal health and their power to reduce instances of first delay by supporting women in formulating their birth plans.

Résumé Objectifs: Le risque de décéder aux âges élevés est associé avec l'état matrimonial, mais également avec la situation de ménage de la personne considérée (avec qui une personne vit). Cette étude analyse comment l'association entre situation de ménage et risque de décéder varie en fonction de l'âge et du sexe. Données et méthodes: Nous utilisons des données extraites du Registre national belge concernant la situation de ménage de plus de 3 millions de personnes âgées de 60 ans et plus, ob-servées du 1er janvier 1991 au 31 décembre 2010. Tout d'abord nous calculons et comparons les probabilités annuelles de décéder pour les personnes selon les différentes situations de ménage. Ensuite nous construisons des tables de mortalité mul-ti-états en utilisant les probabilités annuelles de transition entre différentes situations de ménage et ce, afin de reconstituer les trajectoires de situation de ménage. Résultats: Nos résultats confirment l'effet protectif associé au fait de vivre en couple marié, mais ils montrent également que vivre seul aux âges plus élevés devient favo-rable à la survie. Un croisement apparaît entre les risques de décéder de ceux vivant seuls et ceux vivant avec d'autres personnes, mais pas avec leur conjoint. Toutefois de fortes différences ressortent selon le sexe. Enfin vivre en ménage collectif est largement défavorable pour la survie par comparaison à tous les types de ménages privés et ce, pour les deux sexes. Discussion: La façon dont le risque de décéder varie selon la situation de ménage est différente selon le sexe et diminue avec l'âge de fa-çon relative. Parmi d'autres explications, le rôle sélectif de l'état de santé est majeur, tout comme le soutien du conjoint qui est, dans la plupart des cas, le premier donneur de soin. Selon cette perspective, la différence d'espérance de vie en santé entre hommes et femmes et la différence d'âges entre conjoints pourraient contribuer à expliquer les différences du risque de décéder selon la situation de ménage entre les hommes et les femmes. Nos résultats sont importants dans le cadre des politiques sociales relatives aux personnes âgées et plus particulièrement pour l'évaluation des besoins futurs de nos populations vieillissantes. Abstract Objectives: Mortality risk in old age is associated with both marital status and living arrangements (with whom a person is living). This study analyses how the association between living arrangements and mortality risk varies by age and gender. Data and methods: We use a dataset extracted from the Belgian national register for the population aged 60 years and over, from 1 January 1991 to 31 December 2010, that includes more than three million persons and describes their living arrangements. First we compute and compare single-year probabilities of death for each living arrangement. Then, in order to recompose the living arrangement trajectories, we construct multistate life tables using annual probabilities of the transitions between successive living arrangements. Results: Our results confirm the protective effect of living with a spouse, and also show that at older ages living alone becomes advantageous. A crossover occurs in the mortality risks of those living alone and those living with others (not with a spouse), but large differences appear between the genders. Institutional living arrangements are largely detrimental for survival compared with private living arrangements for both genders. Discussion: The variation of mortality risk by living arrangements is gender-specific and decreases by age in relative terms. Among possible explanations, the selective role of health is paramount, as well as the presence of a spouse, who is the primary caregiver in most cases. According to this perspective, the gender gap in healthy life expectancy and the age difference between spouses contribute to explaining the gender differences. Our findings are highly relevant to social policies and the social discourse pertaining to the future needs of the elderly within the context of population ageing.

EUROCARE-5 data were used to provide an estimate of the potential number of lives saved by a series of assumptions about improving management for selected cancers in the European Union. Age-standardized mortality analyses allowed comparisons among different years and countries with different age distributions. Strategies to monitor and improve outcomes for cancer patients will have to be deliverable in the context of an ever-increasing number of older cancer patients.

This research discusses the pregnant mothers which makes a visit ANC during pregnancy with the incidence of neonatal death.Neonatal death is a health issue that still a major concern in the world.Neonatal death can be caused by various factors, both in terms of maternal factors, infant factors and health services factors. Frequency of visits ANC is part of health services which is deterrent occurrence of neonatal death if pregnant mothers are advised to follow all the antenatal care, ie a visit ANC ≥ 4 times during the three trimesters of pregnancy.This research uses cross-sectional design using multiple logistic regression analysis.This research indicate that the cause of neonatal death is the frequency of visits ANC, parity, pregnancy complications, birth weight infants, early neonatal examination.There is interaction between the frequency of visits ANC with birth weight infants that mother who did not make a visit ANC or 4000 gram who are at high risk for the occurrence of neonatal death,so expect to do further research on neonatal mortality to infant weight> 4000 gram.And related to the frequency of visits ANC, expected from the government to make policies more firmly on the obligations of pregnant women for pregnancy check at least 4 times in the third trimester during pregnancy.

BACKGROUND: India has made substantial progress in improving child survival over the past few decades, but a comprehensive understanding of child mortality trends at disaggregated geographical levels is not available. We present a detailed analysis of subnational trends of child mortality to inform efforts aimed at meeting the India National Health Policy (NHP) and Sustainable Development Goal (SDG) targets for child mortality. METHODS: We assessed the under-5 mortality rate (U5MR) and neonatal mortality rate (NMR) from 2000 to 2017 in 5 × 5 km grids across India, and for the districts and states of India, using all accessible data from various sources including surveys with subnational geographical information. The 31 states and groups of union territories were categorised into three groups using their Socio-demographic Index (SDI) level, calculated as part of the Global Burden of Diseases, Injuries, and Risk Factors Study on the basis of per-capita income, mean education, and total fertility rate in women younger than 25 years. Inequality between districts within the states was assessed using the coefficient of variation. We projected U5MR and NMR for the states and districts up to 2025 and 2030 on the basis of the trends from 2000 to 2017 and compared these projections with the NHP 2025 and SDG 2030 targets for U5MR (23 deaths and 25 deaths per 1000 livebirths, respectively) and NMR (16 deaths and 12 deaths per 1000 livebirths, respectively). We assessed the causes of child death and the contribution of risk factors to child deaths at the state level. FINDINGS: U5MR in India decreased from 83·1 (95% uncertainty interval [UI] 76·7-90·1) in 2000 to 42·4 (36·5-50·0) per 1000 livebirths in 2017, and NMR from 38·0 (34·2-41·6) to 23·5 (20·1-27·8) per 1000 livebirths. U5MR varied 5·7 times between the states of India and 10·5 times between the 723 districts of India in 2017, whereas NMR varied 4·5 times and 8·0 times, respectively. In the low SDI states, 275 (88%) districts had a U5MR of 40 or more per 1000 livebirths and 291 (93%) districts had an NMR of 20 or more per 1000 livebirths in 2017. The annual rate of change from 2010 to 2017 varied among the districts from a 9·02% (95% UI 6·30-11·63) reduction to no significant change for U5MR and from an 8·05% (95% UI 5·34-10·74) reduction to no significant change for NMR. Inequality between districts within the states increased from 2000 to 2017 in 23 of the 31 states for U5MR and in 24 states for NMR, with the largest increases in Odisha and Assam among the low SDI states. If the trends observed up to 2017 were to continue, India would meet the SDG 2030 U5MR target but not the SDG 2030 NMR target or either of the NHP 2025 targets. To reach the SDG 2030 targets individually, 246 (34%) districts for U5MR and 430 (59%) districts for NMR would need a higher rate of improvement than they had up to 2017. For all major causes of under-5 death in India, the death rate decreased between 2000 and 2017, with the highest decline for infectious diseases, intermediate decline for neonatal disorders, and the smallest decline for congenital birth defects, although the magnitude of decline varied widely between the states. Child and maternal malnutrition was the predominant risk factor, to which 68·2% (65·8-70·7) of under-5 deaths and 83·0% (80·6-85·0) of neonatal deaths in India could be attributed in 2017; 10·8% (9·1-12·4) of under-5 deaths could be attributed to unsafe water and sanitation and 8·8% (7·0-10·3) to air pollution. INTERPRETATION: India has made gains in child survival, but there are substantial variations between the states in the magnitude and rate of decline in mortality, and even higher variations between the districts of India. Inequality between districts within states has increased for the majority of the states. The district-level trends presented here can provide crucial guidance for targeted efforts needed in India to reduce child mortality to meet the Indian and global child survival targets. District-level mortality trends along with state-level trends in causes of under-5 and neonatal death and the risk factors in this Article provide a comprehensive reference for further planning of child mortality reduction in India. FUNDING: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Using cross-sectional, individual-level survey data from Maharashtra, Tamil Nadu and Uttar Pradesh collected under the Indian National Family Health Survey programme of 1992–93, statistical modelling was used to analyse the impact of a range of variables on the survival status of children during their first 2 years of life. Attention was focused on the potential impact of the mother's autonomy. The strongest predictors of mortality were demographic and biological factors, breast-feeding behaviour, and use and knowledge of health services. Variables that can be interpreted as being related to maternal autonomy, such as the presence of a mother-in-law in the household, did not have a significant direct effect on child survival at the individual level, and their indirect effects were very limited.

A number of recent analyses have computed present and future costs associated with a risk by estimating what would happen if the risk were absent. Two sources of bias are associated with this approach: (1) differences in confounding factors between present risk avoiders and risk takers, and (2) the difficulty of selecting an unbiased sample of risk avoiders. A staff memo from the Office of Technology Assessment used this approach to estimate mortality due to smoking. Numbers of deaths and age at death distributions of U.S. smokers and nonsmokers for all causes, all cancers, lung cancers, heart disease, and cerebrovascular lesions are used to assess the accuracy of these estimates. Large errors in the OTA estimates are found. Conditions are discussed that might help reduce errors from this approach.

Background: Predicted cancer mortality figures and rates are useful for public health planning. Materials and methods: We retrieved cancer death certification data for 10 major cancer sites and total cancers from the World Health Organization (WHO) database and population data from WHO and United Nations Population Division databases. We obtained figures for Russia, Israel, Hong Kong, Japan, the Philippines, Korea, and Australia in 1970–2015. We predicted numbers of deaths by age group and age-standardized rates (world population) for 2018 by applying a linear regression to mortality data of each age group over the most recent trend segment identified by a joinpoint regression model. Results: Russia had the highest predicted total cancer mortality rates, 158.5/100 000 men and 84.1/100 000 women. Men in the Philippines showed the lowest rates for 2018 (84.6/100 000) and Korean males the most favourable predicted fall (21% between 2012 and 2018). Women in Korea had the lowest total cancer predicted rate (52.5/100 000). Between 1993 and 2018, i.e. by applying the 1993 rates to populations in subsequent years, a substantial number of cancer deaths was avoided in Russia (1 000 000 deaths, 821 000 in men and 179 000 in women), Israel (40 000 deaths, 21 000 in men and 19 000 in women), Hong Kong (63 000 deaths, 40 000 in men and 23 000 in women), Japan (651 000 deaths, 473 000 in men and 178 000 in women), Korea (327 000 deaths, 250 000 in men and 77 000 in women), and Australia (181 000 deaths, 125 000 in men and 56 000 in women). No appreciable reduction in cancer deaths was found in the Philippines. Conclusion: Overall, we predicted falls in cancer mortality. However, these are less marked and later compared with the European Union and United States. Substantial numbers of deaths were avoided in all countries considered except the Philippines. Lung cancer mortality remains exceedingly high in Russian men, despite recent falls.

The synopsis of this cumulative dissertation reports the theoretical background, methodology and main results of five studies addressing the role of intergroup versus interpersonal similarities for mediated social encounters under conditions of mortality salience (MS). Drawing upon terror management theory (TMT, Greenberg, Pyszczynski, & Solomon, 1986) individuals were expected to prefer similar over dissimilar others under conditions of MS. In theory, similarity can take place on the intergroup level (i.e. by belonging to the same in-group) as well as on the interpersonal level (e.g., by holding the same attitudes). So far, the relative relevance of intergroup versus interpersonal similarity has not been studied systematically. Particularly in mediated social encounters, intergroup and interpersonal similarity can be independent from each other and might have different effects. The results of five studies in different contexts confirmed intergroup and interpersonal similarities to have different effects in mediated encounters under conditions of MS. In an online dating context, a similarity-attraction effect emerged only among in-group but not out-group members (Study 1), and intergroup but not interpersonal dissimilarity threatened the individuals' defense against MS (Study 2). In a gaming context, individuals preferred an interpersonally similar in-group (versus out-group) avatar (Study 4) but showed no in-group bias when the avatar was interpersonally dissimilar (Study 3). Further, the valence of the in-group played a role under conditions of interpersonal dissimilarity (Study 3), but not under conditions of interpersonal similarity (Study 4). Finally, Study 5 found an increased interest in media content by in-group but not out-group members under conditions of MS even when the content (extremist propaganda) was negatively valenced and did not match the recipients' political attitude. The results are discussed regarding their implications.

Christopher Au-Yeung1, Steve Kanters1, Erin Ding1, Philippe Glaziou2, Aranka Anema1,3, Curtis L Cooper4, Julio SG Montaner1,3, Robert S Hogg1,5, Edward J Mills1,61BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; 2Stop TB Department, World Health Organization, Geneva, Switzerland; 3Faculty of Medicine, University of British Columbia, Vancouver, Canada; 4The Ottawa Hospital Division of Infectious Diseases; 5Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada; 6Faculty of Health Sciences, University of Ottawa, Ottawa, CanadaObjective: Tuberculosis (TB) is a leading cause of death in human immunodeficiency virus (HIV)-positive individuals. We sought to compare mortality rates in TB/HIV co-infected individuals globally and by country/territory.Design: We conducted a cross-national systematic assessment.Methods: TB mortality rates in HIV-positive and HIV-negative individuals were obtained from the World Health Organization (WHO) Stop TB department for 212 recognized countries/territories in the years 2006–2008. Multivariate linear regression determined the impact of health care resource and economic variables on our outcome variable, and TB mortality rates.Results: In 2008, an estimated 13 TB/HIV deaths occurred per 100,000 population globally with the African region having the highest death rate ([AFRH] ≥4% adult HIV-infection rate) at 86 per 100,000 individuals. The next highest rates were for the Eastern European Region (EEUR) and the Latin American Region (LAMR) at 4 and 3 respectively per 100,000 population. African countries' HIV-positive TB mortality rates were 29.9 times higher than non-African countries (95% confidence interval [CI]: 16.8–53.4). Every US$100 of government per capita health expenditure was associated with a 33% (95% CI: 24%–42%) decrease in TB/HIV mortality rates. The multivariate model also accounted for calendar year and did not include highly active antiretroviral therapy (HAART) coverage.Conclusions: Our results indicate that while the AFRH has the highest TB/HIV death rates, countries in EEUR and LAMR also have elevated mortality rates. Increasing health expenditure directed towards universal HAART access may reduce mortality from both diseases.Keywords: tuberculosis, HIV, antiretroviral therapy, mortality

Infant mortality : a social problem? / Eilidh Garrett ... [et al.] -- George Newman--a life in public health / Chris Galley -- Newman's Infant mortality as an agenda for research / Robert Woods -- Place and status as determinants of infant mortality in England c.1550-1837 / Richard Smith and Jim Oeppen -- A double penalty? : infant mortality in the Lincolnshire Fens, 1870-1900 / Sam Sneddon -- Infant mortality in Northamptonshire : a vaccination register study / Tricia James -- Urban-rural differences in infant mortality : a view from the death registers of Skye and Kilmarnock, Scotland / Eilidh Garrett --

Objective: To perform a spatial analysis of suicide mortality and its correlation with socioeconomic indicators in Brazilian municipalities. Methods: This is an ecological study with Brazilian municipalities as a unit of analysis. Data on deaths from suicide and contextual variables were analyzed. The spatial distribution, intensity and significance of the clusters were analyzed with the global Moran index, MoranMap and local indicators of spatial association (LISA), seeking to identify patterns through geostatistical analysis. Results: A total of 50,664 deaths from suicide were registered in Brazil between 2010 and 2014. The average suicide mortality rate in Brazil was 5.23/100,000 population. The Brazilian municipalities presenting the highest rates were Taipas do Tocantins, state of Tocantins (79.68 deaths per 100,000 population), Itaporã, state of Mato Grosso do Sul (75.15 deaths per 100,000 population), Mampituba, state of Rio Grande do Sul (52.98 deaths per 100,000 population), Paranhos, state of Mato Grosso do Sul (52.41 deaths per 100,000 population), and Monjolos, state of Minas Gerais (52.08 deaths per 100,000 population). Although weak spatial autocorrelation was observed for suicide mortality (I = 0.2608), there was a formation of clusters in the South. In the bivariate spatial and classical analysis, no correlation was observed between suicide mortality and contextual variables. Conclusion: Suicide mortality in Brazil presents a weak spatial correlation and low or no spatial relationship with socioeconomic factors.