1.  Title: Expanding access to injectable contraception. Author: Family Health International [FHI] Source: [Unpublished] [2009]. 12 p. Abstract: A number of technological developments can make injections safer for administration, whether by health personnel, trained community workers or the women themselves: sub-cutaneous injections, which have less complications than intra-muscular injections; non-reusable disposable syringes Distribution by community health workers needs special attention to: the possibility that a woman is already pregnant (or seeking an abortion by using an injectable); the screening of women with pre-existing conditions or on medications; the need for counselling for side-effects (in particular: vaginal bleeding irregularities, amenorrhea, weight gain, delay in return to fertility); the safety of injections to the woman and to the health worker; the possible confusion between different injectables --provided by public and private sectors. To complement pre-service and in-service training, a number of job aids are available to support community workers providing injectables: medical eligibility criteria wheel to screen for eligibility; pregnancy checklist; simplified material for the management of side-effects (bleeding, amenorrhea, weight changes, etc). (Excerpt) Language: English Keywords: GLOBAL | TABLES AND CHARTS | INJECTABLES | DEPO-PROVERA | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE PREVALENCE | CONTRACEPTIVE AVAILABILITY | PROGRAM ACCESSIBILITY | COMMUNITY-BASED DISTRIBUTION | CONTRACEPTIVE SAFETY | MATERNAL MORTALITY | CAUSES OF DEATH | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Usage | Program Evaluation | Programs | Organization and Administration | Nonclinical Distribution | Distributional Activities | Program Activities | Safety | Public Health | Health | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 331838 |
| 2. Title: Diarrheal disease: solutions to defeat a global killer. Author: Program for Appropriate Technology in Health [PATH] Source: Washington, D.C., PATH, 2009. 38 p. Abstract: Today, the leading causes of death among children under the age of five, particularly in the developing world, are pneumonia and diarrhea. These illnesses are both preventable and treatable. The global health community possesses the interventions and knowledge to save millions of children's lives worldwide. We can do this by reprioritizing diarrheal disease on the global health agenda; educating, increasing awareness, and mobilizing health care providers, policymakers, and the larger global community around the burden of diarrheal disease and the lifesaving interventions that exist today; and by implementing these solutions with a coordinated approach. Proven, lifesaving, prevention and treatment methods [include]: safe water, improved sanitation and good hygiene; vaccines; exclusive breastfeeding and optimal complementary feeding; oral rehydration therapy (ORT) / oral rehydration solution (ORS); zinc treatment and other micronutrients. (Excerpts) Language: English Keywords: DEVELOPING COUNTRIES | SUMMARY REPORT | LOW INCOME POPULATION | CHILDREN | DIARRHEA | MALNUTRITION | CHILD MORTALITY | ZINC | WATER QUALITY | CAUSES OF DEATH | SANITATION | TREATMENT | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Nutrition Disorders | Mortality | Population Dynamics | Metals | Vitamins and Minerals | Physiology | Biology | Water | Natural Resources | Environment | Public Health | Health | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 331382 |
3.  Peer Reviewed Title: Maternal mortality in Syria: causes, contributing factors and preventability. Author: Bashour H; Abdulsalam A; Jabr A; Cheikha S; Tabbaa M; Lahham M; Dihman R; Khadra M; Campbell OM Source: Tropical Medicine and International Health. 2009 Sep;14(9):1122-7. Abstract: OBJECTIVES: To describe the biomedical and other causes of maternal death in Syria and to assess their preventability. METHODS: A reproductive age mortality study (RAMOS) design was used to identify pregnancy related deaths. All deaths among women aged 15-49 reported to the national civil register for 2003 were investigated through home interviews. Verbal autopsies were used to ascertain the cause of death among pregnancy related maternal deaths, and causes and preventability of deaths were assessed by a panel of doctors. RESULTS: A total of 129 maternal deaths were identified and reviewed. Direct medical causes accounted for 88%, and haemorrhage was the main cause of death (65%). Sixty nine deaths (54%) occurred during labour or delivery. Poor clinical skills and lack of clinical competency were behind 54% of maternal deaths. Ninety one percent of maternal deaths were preventable. CONCLUSIONS: The causes of maternal death in Syria and their contributing factors reflect serious defects in the quality of maternal care that need to be urgently rectified. Language: English Keywords: SYRIA | RESEARCH REPORT | RECORDS | MATERNAL MORTALITY | CAUSES OF DEATH | PREGNANCY OUTCOMES | MATERNAL HEALTH SERVICES | QUALITY OF HEALTH CARE | Developing Countries | Middle East | Information Processing | Information | Mortality | Population Dynamics | Demographic Factors | Population | Pregnancy | Reproduction | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration Document Number: 342964 |
| 4. Title: The President's Emergency Plan for AIDS Relief in Africa: an evaluation of outcomes. Author: Bendavid E; Bhattacharya J Source: Annals of Internal Medicine. 2009 May 19;150(10):688-95. Abstract: BACKGROUND: Since 2003, the President's Emergency Plan for AIDS Relief (PEPFAR) has been the most ambitious initiative to address the global HIV epidemic. However, the effect of PEPFAR on HIV-related outcomes is unknown. OBJECTIVE: To assess the effect of PEPFAR on HIV-related deaths, the number of people living with HIV, and HIV prevalence in sub-Saharan Africa. DESIGN: Comparison of trends before and after the initiation of PEPFAR's activities. SETTING: 12 African focus countries and 29 control countries with a generalized HIV epidemic from 1997 to 2007 (451 country-year observations). INTERVENTION: A 5-year, $15 billion program for HIV treatment, prevention, and care that started in late 2003. MEASUREMENTS: HIV-related deaths, the number of people living with HIV, and HIV prevalence. RESULTS: Between 2004 and 2007, the difference in the annual change in the number of HIV-related deaths was 10.5% lower in the focus countries than in the control countries (P = 0.001). The difference in trends between the groups before 2003 was not significant. The annual growth in the number of people living with HIV was 3.7% slower in the focus countries than in the control countries from 1997 to 2002 (P = 0.05), but during PEPFAR's activities, the difference was no longer significant. The difference in the change in HIV prevalence did not significantly differ throughout the study period. These estimates were stable after sensitivity analysis. LIMITATION: The selection of the focus countries was not random, which limits the generalizability of the results. CONCLUSION: After 4 years of PEPFAR activity, HIV-related deaths decreased in sub-Saharan African focus countries compared with control countries, but trends in adult prevalence did not differ. Assessment of epidemiologic effectiveness should be part of PEPFAR's evaluation programs. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality. Language: English Keywords: AFRICA | RESEARCH REPORT | COMPARATIVE STUDIES | PREVALENCE | PERSONS LIVING WITH HIV/AIDS | CAUSES OF DEATH | HIV INFECTIONS | AIDS | PROGRAM EFFECTIVENESS | PROGRAM EVALUATION | Developing Countries | Studies | Research Methodology | Measurement | Viral Diseases | Diseases | Mortality | Population Dynamics | Demographic Factors | Population | Programs | Organization and Administration Document Number: 341612 |
| 5. Peer Reviewed Title: Effect of human immunodeficiency virus treatment on maternal mortality at a tertiary center in South Africa: a 5-year audit. Author: Black V; Brooke S; Chersich MF Source: Obstetrics and Gynecology. 2009 Aug;114(2 Pt 1):292-9. Abstract: OBJECTIVE:: To review facility-based maternal deaths at a tertiary-level center in Johannesburg, South Africa, during a 5-year period (2003 to 2007) and to investigate the proportion of deaths attributable to human immunodeficiency virus (HIV), the etiology of deaths, and the effects of antiretroviral treatment introduced in late 2004. METHODS:: Patient case files, birth registers, death certificates, and mortality summaries were reviewed. Cause of death was assigned through clinical case discussion. Annual maternal mortality ratios were calculated and disaggregated by HIV status. RESULTS:: During the 5-year period, 106 maternal deaths occurred out of 36,708 births (facility-based maternal mortality ratios 289/100,000 live births, 95% confidence interval [CI] 237-349/100,000). In 72% of cases, HIV status was known (76/106), with the majority being HIV-infected (78%, 59/76). Among HIV-infected women, only two had initiated antiretroviral treatment, and 70% of deaths were HIV-related (41/59), mainly from tuberculosis (21) and pneumonia (12). Direct obstetric causes of death such as hypertension and pregnancy-related sepsis predominated in women who were HIV-negative or of unknown status (48.9%, 23/47). Maternal mortality ratios in HIV-infected women were 776/100,000 (95% CI 591-1,000/100,000), 6.2-fold higher (95% CI 3.6-11.4) than in HIV-negative women (124/100,000, 95% CI 72-199/100,000). Changes in mortality over time were not detected. Although HIV testing increased 1.4-fold each year (95% CI 1.3-1.4) and estimated coverage of antiretroviral treatment for pregnant women reached 59.2% in 2007, levels remain suboptimal. CONCLUSION:: In Johannesburg, HIV remains the major cause of maternal mortality despite integration of antiretroviral treatment into prenatal services. Maternal health services should target barriers to uptake of HIV treatment and care. LEVEL OF EVIDENCE:: III. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | PREGNANT WOMEN | HYPERTENSION | MATERNAL-CHILD HEALTH SERVICES | HIV INFECTIONS | AIDS | MATERNAL MORTALITY | CAUSES OF DEATH | HIV/FP INTEGRATION | TREATMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Population Characteristics | Demographic Factors | Population | Vascular Diseases | Diseases | Primary Health Care | Health Services | Delivery of Health Care | Health | Viral Diseases | Mortality | Population Dynamics | Medical Procedures | Medicine Document Number: 342270 |
| 6. Peer Reviewed Title: Emergence of a peak in early infant mortality due to HIV/AIDS in South Africa. Author: Bourne DE; Thompson M; Brody LL; Cotton M; Draper B; Laubscher R; Abdullah MF; Myers JE Source: AIDS. 2009 Jan 2;23(1):101-6. Abstract: OBJECTIVES: South Africa has among the highest levels of HIV prevalence in the world. Our objectives are to describe the distribution of South African infant and child mortality by age at fine resolution, to identify any trends over recent time and to examine these trends for HIV-associated and non HIV-associated causes of mortality. METHODS: A retrospective review of vital registration data was conducted. All registered postneonatal deaths under 1 year of age in South Africa for the period 1997-2002 were analysed by age in months using a generalized linear model with a log link and Poisson family. RESULTS: Postneonatal mortality increased each year over the period 1997-2002. A peak in HIV-related deaths was observed, centred at 2-3 months of age, rising monotonically over time. CONCLUSION: We interpret the peak in mortality at 2-3 months as an indicator for paediatric AIDS in a South African population with high HIV prevalence and where other causes of death are not sufficiently high to mask HIV effects. Intrauterine and intrapartum infection may contribute to this peak. It is potentially a useful surveillance tool, not requiring an exact cause of death. The findings also illustrate the need for early treatment of mother and child in settings with very high HIV prevalence. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | RETROSPECTIVE STUDIES | LINEAR REGRESSION | INFANT | PERSONS LIVING WITH HIV/AIDS | INFANT MORTALITY | AIDS | CAUSES OF DEATH | CHILD MORTALITY | VITAL STATISTICS | MOTHER-TO-CHILD TRANSMISSION | DEATH RATE | AGE SPECIFIC DEATH RATE | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Statistical Regression | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Mortality | Population Dynamics | Population Statistics | Transmission | Infections Document Number: 330334 |
| 7. Title: Causes of death in HIV-infected persons who have tuberculosis, Thailand. Author: Cain KP; Anekthananon T; Burapat C; Akksilp S; Mankhatitham W; Srinak C; Nateniyom S; Sattayawuthipong W; Tasaneeyapan T; Varma JK Source: Emerging Infectious Diseases. 2009 Feb;15(2):258-64. Abstract: Up to 50% of persons with HIV and a diagnosis of tuberculosis (TB) in Thailand die during TB treatment. In a prospective observational study, a team of physicians ascribed the cause of death after reviewing verbal autopsies (interviews of family members about events preceding death), laboratory data, and medical records. Of 849 HIV-infected TB patients enrolled, 142 (17%) died. The cause of death was TB for 38 (27%), including 6 with multidrug-resistant TB and 20 with disseminated TB; an HIV-associated condition other than TB for 50 (35%); and a condition unrelated to TB or HIV for 22 (15%). Twenty-three patients (16%) were judged not to have had TB at all. Death from all causes except those unrelated to TB or HIV was less common in persons receiving antiretroviral therapy (ART). In addition to increasing the use of ART, death rates may be reduced through expanded use of modern TB diagnostic techniques. Language: English Keywords: THAILAND | RESEARCH REPORT | PROSPECTIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | CAUSES OF DEATH | AUTOPSY | ANTIRETROVIRAL THERAPY | DRUGS | PNEUMONIA | EXAMINATIONS AND DIAGNOSES | Developing Countries | Asia, Southeastern | Asia | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Infections | Mortality | Population Dynamics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | Treatment | Pulmonary Effects | Physiology | Biology Document Number: 341840 |
| 8. Peer Reviewed Title: Saving the lives of South Africa's mothers, babies, and children: can the health system deliver? Author: Chopra M; Daviaud E; Pattinson R; Fonn S; Lawn JE Source: Lancet. 2009 Sep 5;374(9692):835-46. Abstract: South Africa is one of only 12 countries in which mortality rates for children have increased since the baseline for the Millennium Development Goals (MDGs) in 1990. Continuing poverty and the HIV/AIDS epidemic are important factors. Additionally, suboptimum implementation of high-impact interventions limits programme effectiveness; between a quarter and half of maternal, neonatal, and child deaths in national audits have an avoidable health-system factor contributing to the death. Using the LiST model, we estimate that 11,500 infants' lives could be saved by effective implementation of basic neonatal care at 95% coverage. Similar coverage of dual-therapy prevention of mother-to-child transmission with appropriate feeding choices could save 37,200 children's lives in South Africa per year in 2015 compared with 2008. These interventions would also avert many maternal deaths and stillbirths. The total cost of such a target package is US$1.5 billion per year, 24% of the public-sector health expenditure; the incremental cost is $220 million per year. Such progress would put South Africa squarely on track to meet MDG 4 and probably also MDG 5. The costs are affordable and the key gap is leadership and effective implementation at every level of the health system, including national and local accountability for service provision. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | ESTIMATION TECHNIQUES | ECONOMIC MODEL | EXCESS MORTALITY | CAUSES OF DEATH | HIV INFECTIONS | INTERVENTIONS | IMPLEMENTATION | HEALTH POLICY | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | PRIMARY HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | PERFORMANCE IMPROVEMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Theoretical Models | Mortality | Population Dynamics | Demographic Factors | Population | Viral Diseases | Diseases | Programs | Organization and Administration | Policy | Political Factors | Sociocultural Factors | Disease Transmission Control | Prevention and Control | Health Services | Delivery of Health Care | Health | Management Document Number: 342802 |
| 9. Peer Reviewed Title: Causes of maternal mortality decline in Matlab, Bangladesh. Author: Chowdhury ME; Ahmed A; Kalim N; Koblinsky M Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):108-23. Abstract: Bangladesh is distinct among developing countries in achieving a low maternal mortality ratio (MMR) of 322 per 100,000 livebirths despite the very low use of skilled care at delivery (13% nationally). This variation has also been observed in Matlab, a rural area in Bangladesh, where longitudinal data on maternal mortality are available since the mid-1970s. The current study investigated the possible causes of the maternal mortality decline in Matlab. The study analyzed 769 maternal deaths and 215,779 pregnancy records from the Health and Demographic Surveillance System (HDSS) and other sources of safe motherhood data in the ICDDR,B and government service areas in Matlab during 1976-2005. The major interventions that took place in both the areas since the early 1980s were the family-planning programme plus safe menstrual regulation services and safe motherhood interventions (midwives for normal delivery in the ICDDR,B service area from the late 1980s and equal access to comprehensive emergency obstetric care [EmOC] in public facilities for women from both the areas). National programmes for social development and empowerment of women through education and microcredit programmes were implemented in both the areas. The quantitative findings were supplemented by a qualitative study by interviewing local community care providers for their change in practices for maternal healthcare over time. After the introduction of the safe motherhood programme, reduction in maternal mortality was higher in the ICDDR,B service area (68.6%) than in the government service area (50.4%) during 1986-1989 and 2001-2005. Reduction in the number of maternal deaths due to the fertility decline was higher in the government service area (30%) than in the ICDDR,B service area (23%) during 1979-2005. In each area, there has been substantial reduction in abortion-related mortality--86.7% and 78.3%--in the ICDDR,B and government service areas respectively. Education of women was a strong predictor of the maternal mortality decline in both the areas. Possible explanations for the maternal mortality decline in Matlab are: better access to comprehensive EmOC services, reduction in the total fertility rate, and improved education of women. To achieve the Millenium Development Goal 5 targets, policies that bring further improved comprehensive EmOC, strengthened family-planning services, and expanded education of females are essential. Language: English Keywords: BANGLADESH | RURAL AREAS | RESEARCH REPORT | MATERNAL MORTALITY | MORTALITY DECLINE | CAUSES OF DEATH | RISK FACTORS | SAFE MOTHERHOOD | OBSTETRICS | EMERGENCY SERVICES | PROGRAM ACCESSIBILITY | FERTILITY DECLINE | EDUCATIONAL STATUS | Developing Countries | Asia, Southern | Asia | Geographic Factors | Population | Mortality | Population Dynamics | Demographic Factors | Health | Maternal Health | Medicine | Health Services | Delivery of Health Care | Program Evaluation | Programs | Organization and Administration | Fertility Changes | Fertility | Socioeconomic Status | Socioeconomic Factors | Economic Factors Document Number: 341939 |
| 10. Peer Reviewed Title: Estimating the burden of malaria in pregnancy: a case study from rural Madhya Pradesh, India. Author: Diamond-Smith N; Singh N; Gupta RK; Dash A; Thimasarn K; Campbell OM; Chandramohan D Source: Malaria Journal. 2009;8:24. Abstract: BACKGROUND: Malaria in pregnancy (MiP) is inadequately researched in India, and the burden is probably much higher than current estimates suggest. This paper models the burden of MiP and associated foetal losses and maternal deaths, in rural Madhya Pradesh, India. METHODS: Number of pregnancies per year was estimated from the number of births and an estimate of pregnancies that end in foetal loss. The prevalence of MiP, risk of foetal loss attributable to MiP and case fatality rate of MiP were obtained from the literature. The estimated total number of pregnancies was multiplied by the appropriate parameter to estimate the number of MiP cases, and foetal loss and maternal deaths attributable to MiP per year. A Monte Carlo simulation sensitivity analysis was done to assess plausibility of various estimates obtained from the literature. The burden of MiP in tribal women was explored by incorporating the variable prevalence of malaria in tribal and non-tribal populations and in forested and non-forested regions within Madhya Pradesh. RESULTS: Estimates of MiP cases in rural Madhya Pradesh based on the model parameter values found in the literature ranged from 183,000-1.5 million per year, with 73,000-629,000 lost foetuses and 1,500-12,600 maternal deaths attributable to MiP. The Monte Carlo simulation gave a more plausible estimate of 220,000 MiP cases per year (inter-quartile range (IQR): 136,000-305,000), 95,800 lost foetuses (IQR: 56,800-147,600) and 1,000 maternal deaths (IQR: 650-1,600). Tribal women living in forested areas bore 30% of the burden of MiP in Madhya Pradesh, while constituting 18% of the population. CONCLUSION: Although the estimates are uncertain, they suggest MiP is a significant public health problem in rural Madhya Pradesh, affecting many thousands of women and that reducing the MiP burden should be a priority. Language: English Keywords: INDIA | LITERATURE REVIEW | CASE STUDIES | PREVALENCE | RURAL AREAS | PREGNANT WOMEN | MALARIA | MATERNAL MORTALITY | CAUSES OF DEATH | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Measurement | Geographic Factors | Population | Population Characteristics | Demographic Factors | Parasitic Diseases | Diseases | Mortality | Population Dynamics Document Number: 330550 |
| 11. Peer Reviewed Title: The burden of HIV-associated cryptococcal disease [editorial] Author: Harrison TS Source: AIDS. 2009 Feb 20;23(4):531-2. Abstract: In this issue, Park et al. from the Centers for Disease Control, University of Alabama, and Johannesburg, South Africa, have made the first attempt to estimate the global burden of HIV-associated cryptococcal infection. As clearly stated by the authors, the estimates are exactly that -estimates, which rely on the quality of the data on which they are based. Nevertheless, the results are striking, especially for sub-Saharan Africa, where the estimated number of deaths associated with cryptococcal disease, at half a million per year, is comparable with the number attributed to tuberculosis, a much more frequent infection, but one for which we have much more effective and widely available therapy. So are these results credible? The data are sparse, with just three incidence studies driving the estimates for sub- Saharan Africa (ruling out the possibility of evaluating or taking account of possible intraregional differences in incidence); and the reported incidences are variable, resulting in wide ranges for the estimates of cases and associated deaths. However, biases are as possible on the downside as on the upside. As the authors acknowledge, the relatively low incidence estimate from a South African study with which some of the same authors were involved was likely affected by incomplete case ascertainment. (excerpt) Language: English Keywords: GLOBAL | CRITIQUE | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | ESTIMATION TECHNIQUES | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | COMPLICATIONS | PREVALENCE | CAUSES OF DEATH | DEATH RATE | ANTIRETROVIRAL THERAPY | CENTRAL NERVOUS SYSTEM EFFECTS | Studies | Research Methodology | Viral Diseases | Diseases | Measurement | Mortality | Population Dynamics | Demographic Factors | Population | HIV | Central Nervous System | Physiology | Biology Document Number: 341160 |
| 12. Title: Maternal mortality due to cardiac disease in Sri Lanka. Author: Haththotuwa HR; Attygalle D; Jayatilleka AC; Karunaratna V; Thorne SA Source: International Journal of Gynaecology and Obstetrics. 2009 Mar;104(3):194-8. Abstract: OBJECTIVE: To investigate Sri Lankan maternal deaths due to heart disease and to consider low-cost interventions to reduce these deaths. METHODS: A qualitative study based on retrospective audit of all maternal deaths and late maternal deaths in Sri Lanka caused by cardiac disease in 2004. RESULTS: A total of 145 maternal deaths were recorded in 2004, for a maternal mortality rate of 38 per 100,000. There were 42 indirect deaths, 25 of which were due to cardiac disease; 23 deaths had a specific cardiac cause listed. Standard care was identified in prepregnancy counseling, contraception, and prenatal community and specialist care. CONCLUSION: Cardiac disease is a major cause of maternal mortality in Sri Lanka, second only to postpartum hemorrhage. Rheumatic mitral valve disease is responsible for more than a third of maternal deaths from cardiac disease. Substandard care was identified in all cases; strategies to improve care could allow a reduction in maternal cardiac deaths. Language: English Keywords: SRI LANKA | RESEARCH REPORT | RETROSPECTIVE STUDIES | PREGNANT WOMEN | MATERNAL MORTALITY | HEART DISEASES | QUALITY OF HEALTH CARE | EXAMINATIONS AND DIAGNOSES | CAUSES OF DEATH | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Diseases | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341384 |
| 13. Peer Reviewed Title: Mortality profiles in a country facing epidemiological transition: An analysis of registered data. Author: Huicho L; Trelles M; Gonzales F; Mendoza W; Miranda J Source: BMC Public Health. 2009 Feb 2;9(47):39 p. Abstract: Sub-national analyses of causes of death and time-trends help to define public health policy priorities. They are particularly important in countries undergoing epidemiological transition like Peru. There are no studies exploring Peruvian national and regional characteristics of such epidemiological transition. We aimed to describe Peru's national and regional mortality profiles between 1996 and 2000. Registered mortality data for the study period were corrected for underregistration following standardized methods. Main causes of death by age group and by geographical region were determined. Departmental mortality profiles were constructed to evaluate mortality transition, using 1996 data as baseline. Annual cumulative slopes for the period 1996-2000 were estimated for each department and region. For the study period non-communicable diseases explained more than half of all causes of death, communicable diseases more than one third, and injuries 10.8% of all deaths. Lima accounted for 32% of total population and 20% of total deaths. The Andean region, with 38% of Peru´s population, accounted for half of all country deaths. Departmental mortality predominance shifted from communicable diseases in 1996 towards non-communicable diseases and injuries in 2000. Maternal and perinatal conditions, and nutritional deficiencies and nutritional anaemia declined markedly in all departments and regions. Infectious diseases decreased in all regions except Lima. In all regions acute respiratory infections are a leading cause of death, but their proportion ranged from 9.3% in Lima and Callao to 15.3% in the Andean region. Tuberculosis and injuries ranked high in Lima and the Andean region. Peruvian mortality shows a double burden of communicable and noncommunicable, with increasing importance of non-communicable diseases and injuries. This challenges national and sub-national health system performance and policy making. Language: English Keywords: PERU | RESEARCH REPORT | DEMOGRAPHIC TRANSITION | CAUSES OF DEATH | DEATH RATE | MORTALITY | AGE FACTORS | DISEASES | DEFICIENCY DISEASES | TUBERCULOSIS | ACCIDENTS AND INJURIES | South America, Western | South America | Latin America | Americas | Developing Countries | Population Dynamics | Demographic Factors | Population | Population Characteristics | Nutrition Disorders | Infections | Health Document Number: 329534 |
| 14. Peer Reviewed Title: Pregnancy-related deaths in rural Rajasthan, India: exploring causes, context, and care-seeking through verbal autopsy. Author: Iyengar K; Iyengar SD; Suhalka V; Dashora K Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):293-302. Abstract: In 2002-2003, all deaths (n=156) of women aged 15-49 years in a block of southern Rajasthan were investigated to determine the cause of death and care-seeking behaviour. Family members of 156 (98%) of 160 deceased women were interviewed following the comprehensive listing of all deaths among women of reproductive age. Of the 156 deaths, 31 (20%) were pregnancy-related; 77% of these women died during the postpartum period, and 74% of the deaths occurred in the home. Direct and indirect obstetric causes were responsible for 58% and 29% of the deaths respectively; 12% were injury-related deaths. Medical care was sought for 65% of the women, and 29% were hospitalized. Family perception of not being able to afford treatment at distant hospitals was a major barrier to seeking care, and 60% of those who sought care had to borrow money for treatment. Lack of skilled attendance and immediate postpartum care were major factors contributing to deaths. Improved access to emergency obstetric care facilities in rural areas and steps to eliminate costs at public hospitals would be crucial to prevent pregnancy-related deaths. Language: English Keywords: INDIA | RURAL AREAS | RESEARCH REPORT | CASE HISTORIES | LOW LITERATES | MATERNAL MORTALITY | PREGNANCY COMPLICATIONS | AUTOPSY | CAUSES OF DEATH | RURAL HEALTH SERVICES | MATERNAL HEALTH SERVICES | UTILIZATION OF HEALTH CARE | OBSTACLES | Asia, Southern | Asia | Developing Countries | Geographic Factors | Population | Data Collection | Research Methodology | Educational Status | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Maternal-Child Health Services | Primary Health Care | Organization and Administration Document Number: 341928 |
| 15. Peer Reviewed Title: Verbal autopsy of maternal deaths in two districts of Pakistan--filling information gaps. Author: Jafarey SN; Rizvi T; Koblinsky M; Kureshy N Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):170-83. Abstract: In Pakistan, the vital registration system is weak, and population-based data on the maternal mortality ratio are limited. This study was carried out to collect information on maternal deaths from different existing sources during the current year-2007 (prospective) and the past two years--2005 and 2006-(retrospective), identify gaps in information, and critically analyze maternal deaths at the community and health-facility levels in two districts in Pakistan. The verbal autopsy questionnaire was administered to households where a maternal death had occurred. No single source had complete data on maternal deaths. Risk factors identified among 128 deceased women were low socioeconomic status, illiteracy, low-earning jobs, parity, and bad obstetric history. These were similar to the findings of earlier studies. Half of the women did seek antenatal care, 34% having made more than four visits. Of the 104 women who died during or after delivery, 38% had delivered in a private facility and 18% in a government facility. The quality of services in both private and public sectors was inadequate. Sixty-nine percent of deaths occurred in the postpartum period, and 51% took place within 24 hours of delivery. The study identified gaps in reporting of maternal deaths and also provided profile of the dead women and the causes of death. Language: English Keywords: PAKISTAN | RESEARCH REPORT | MATERNAL MORTALITY | CAUSES OF DEATH | RISK FACTORS | AUTOPSY | DEATH RECORDS | SOCIOECONOMIC STATUS | PREGNANCY COMPLICATIONS | PREGNANCY OUTCOMES | UTILIZATION OF HEALTH CARE | Developing Countries | Asia, Southern | Asia | Mortality | Population Dynamics | Demographic Factors | Population | Health | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Vital Statistics | Population Statistics | Research Methodology | Socioeconomic Factors | Economic Factors | Diseases | Pregnancy | Reproduction Document Number: 341936 |
| 16. Peer Reviewed Title: Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan. Author: Jehan I; Harris H; Salat S; Zeb A; Mobeen N; Pasha O; McClure EM; Moore J; Wright LL; Goldenberg RL Source: Bulletin of the World Health Organization. 2009 Feb;87(2):130-8. Abstract: OBJECTIVE: To evaluate the prevalence, sex distribution and causes of neonatal mortality, as well as its risk factors, in an urban Pakistani population with access to obstetric and neonatal care. METHODS: Study area women were enrolled at 20-26 weeks' gestation in a prospective population-based cohort study that was conducted from 2003 to 2005. Physical examinations, antenatal laboratory tests and anthropometric measures were performed, and gestational age was determined by ultrasound to confirm eligibility. Demographic and health data were also collected on pretested study forms by trained female research staff. The women and neonates were seen again within 48 hours postpartum and at day 28 after the birth. All neonatal deaths were reviewed using the Pattinson et al. system to assign obstetric and final causes of death; the circumstances of the death were determined by asking the mother or family and by reviewing hospital records. Frequencies and rates were calculated, and 95% confidence intervals were determined for mortality rates. Relative risks were calculated to evaluate the associations between potential risk factors and neonatal death. Logistic regression models were used to compute adjusted odds ratios. FINDINGS: Birth outcomes were ascertained for 1280 (94%) of the 1369 women enrolled. The 28-day neonatal mortality rate was 47.3 per 1000 live births. Preterm birth, Caesarean section and intrapartum complications were associated with neonatal death. Some 45% of the deaths occurred within 48 hours and 73% within the first week. The primary obstetric causes of death were preterm labour (34%) and intrapartum asphyxia (21%). Final causes were classified as immaturity-related (26%), birth asphyxia or hypoxia (26%) and infection (23%). Neither delivery in a health facility nor by health professionals was associated with fewer neonatal deaths. The Caesarean section rate was 19%. Almost all (88%) neonates who died received treatment and 75% died in the hospital. CONCLUSION: In an urban population with good access to professional care, we found a high neonatal mortality rate, often due to preventable conditions. These results suggest that, to decrease neonatal mortality, improved health service quality is crucial. Language: English Keywords: PAKISTAN | RESEARCH REPORT | PROSPECTIVE STUDIES | URBAN POPULATION | NEONATAL MORTALITY | RISK FACTORS | PREVALENCE | PREMATURE LABOR | CESAREAN SECTION | CAUSES OF DEATH | MATERNAL-CHILD HEALTH SERVICES | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Infant Mortality | Mortality | Population Dynamics | Health | Measurement | Pregnancy Outcomes | Pregnancy | Reproduction | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Primary Health Care Document Number: 341787 |
| 17. Peer Reviewed Title: Evaluating completeness of maternal mortality reporting in a rural health and social affairs unit in Vellore, India, 2004. Author: Kim SY; Rochat R; Rajaratnam A; Digirolamo A Source: Journal of Biosocial Science. 2009 Mar;41(2):195-205. Abstract: Health systems in developing countries infrequently implement and evaluate maternal death surveillance. This study identified under-reported and misclassified maternal deaths among women of reproductive age between 1999 and 2004 in a rural service unit in Vellore, India. In-depth interviews, semi-structured interviews and structured questionnaires were used to identify maternal deaths known to health care providers and community leaders who regularly come in contact with pregnant women. Eighteen under-reported and misclassified cases--or 50% of maternal deaths--were reported. These included 29% of abortion-related and 7% of domestic violence-related deaths. Based on this study's fieldwork, the existing death surveillance system detected 100% of the maternal deaths reported by hospital staff; however, it missed most maternal deaths reported by community workers. The latter are more likely than deaths reported by hospital workers to result from abortion and family violence. The existing surveillance system should be augmented with a community-based death surveillance system. This comprehensive approach identified twice as many maternal deaths than previously recorded and could be applied in other settings. Appropriate public health interventions should be initiated to prevent maternal deaths in this community. Language: English Keywords: INDIA | RESEARCH REPORT | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CLASSIFICATION | KAP SURVEYS | LONGITUDINAL STUDIES | RURAL POPULATION | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | DEATH RATE | MATERNAL MORTALITY | RURAL HEALTH SERVICES | CAUSES OF DEATH | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Surveys | Sampling Studies | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Mortality | Population Dynamics | Health Services | Delivery of Health Care | Health Document Number: 331112 |
| 18. Title: Facility-based maternal death review in three districts in the central region of Malawi: an analysis of causes and characteristics of maternal deaths. Author: Kongnyuy EJ; Mlava G; van den Broek N Source: Women's Health Issues. 2009 Jan-Feb;19(1):14-20. Abstract: PURPOSE: We sought to determine the causes and characteristics maternal deaths that occur in health facilities in Malawi. METHODS: Forty-three maternal deaths were reviewed in 9 hospitals in 3 districts in Central Malawi over a 1-year period. Causes and avoidable factors of maternal deaths were identified during the review, and recommendations made and implemented. MAIN FINDINGS: There were 28 (65.1%) direct obstetric deaths and 15 (34.9%) indirect obstetric deaths. The major causes of maternal deaths were postpartum hemorrhage (25.6%), postpartum sepsis (16.3%), HIV/AIDS (16.3%), ruptured uterus (7.0%), complications of abortion (7.0%), anemia (7.0%), antepartum hemorrhage (4.7), and eclampsia (4.7). Two thirds of the women were referred either from another health facility (51.2%) or by a traditional birth attendant (TBA; 11.6%), and up to 79.1% were critically ill on admission. Four groups of factors that contributed to maternal deaths were identified: 1) health worker factors, 2) administrative factors, 3) patient/family factors, and 4) TBA factors. The major health worker factors were inadequate resuscitation (69.8%), lack of obstetric life-saving skills (60.5%), inadequate monitoring (55.8%), initial assessment incomplete (46.5%), and delay in starting treatment (46.5%). The most common administrative factor was lack of blood for transfusion (20.9%). The major problems encountered include shortage of staff and other resources, difficulty in maintaining anonymity, poor quality of data, and difficulty in implementing recommendations. CONCLUSION: Adequate training on obstetric life-saving skills, addressing HIV/AIDS, and raising community awareness could be important factors for reducing maternal mortality in Malawi and countries with similar socioeconomic profiles. Language: English Keywords: MALAWI | RESEARCH REPORT | MOTHERS | INFANT | HEALTH PERSONNEL | MATERNAL MORTALITY | CAUSES OF DEATH | BLEEDING | POSTPARTUM | PERFORMANCE IMPROVEMENT | EVALUATION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Delivery of Health Care | Health | Mortality | Population Dynamics | Signs and Symptoms | Diseases | Puerperium | Reproduction | Management | Organization and Administration Document Number: 331041 |
| 19. Peer Reviewed Title: Mortality and loss to follow-up among HAART initiators in rural South Africa. Author: MacPherson P; Moshabela M; Martinson N; Pronyk P Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 Jun;103(6):588-93. Abstract: A retrospective cohort study of mortality rates and potential predictors of death was conducted in public-sector patients initiating highly active antiretroviral therapy (HAART) between October 2005 and September 2007 in a rural, under-resourced region of South Africa. The aims were to determine the relative contribution of death to cohort exit and the causes and predictors of mortality among HAART initiators. A community outreach programme traced non-attenders. Patients categorised as dying at home underwent a verbal autopsy (by interviewing family members) and case-file review, and those dying in hospital a case-file review, to determine the probable cause of death. At 24 months 1131 (83.6%) patients were retained on treatment in the programme, 124 (9.2%) had died, 63 (4.7%) had transferred out, and 35 (2.6%) were lost to follow-up. The most common causes of death were tuberculosis (44.3%) and diarrhoeal diseases (24.5%). Death was the major reason for cohort exit. As experience is gained with rural HAART programmes mortality rates may decrease. These results draw attention to the need for early HIV diagnosis, increased access to HAART services with earlier treatment initiation, and routine screening and aggressive management of opportunistic infections, particularly tuberculosis. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | FOLLOW-UP STUDIES | RURAL POPULATION | CLIENTS | MORTALITY | DEATH RATE | HIV | TUBERCULOSIS | SIGNS AND SYMPTOMS | ANTIRETROVIRAL THERAPY | CAUSES OF DEATH | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Population Dynamics | HIV Infections | Viral Diseases | Diseases | Infections Document Number: 342753 |
| 20. Title: Perinatal audit using the 3-delays model in western Tanzania. Author: Mbaruku G; van Roosmalen J; Kimondo I; Bilango F; Bergstrom S Source: International Journal of Gynaecology and Obstetrics. 2009 May 11; Abstract: OBJECTIVE: To audit intrapartum fetal and early neonatal deaths of infants weighing >/=2000 g in a regional hospital in western Tanzania. METHODS: The 3-delays methodology was applied to a cohort of perinatal deaths from July 2002 to July 2004. RESULTS: The overall perinatal mortality rate in the hospital was 38 per 1000 live births, and in just over half of these cases the birth weight was >/=2000 g. The leading clinicopathologic causes of death were birth asphyxia (19.0%), prolonged or obstructed labor (18.5%), antepartum hemorrhage (11.5%), and uterine rupture (9.0%). First delays occurred in 19.0% of the cases, second delays occurred in 21.5%, and third delays occurred in 72.5%. CONCLUSION: For women who delivered in this hospital, most of the substandard care occurred after admission to the health facility. The improvement of institutional health care may have a significant impact on the decision to attend health institutions and, thereby, reduce first delays. Language: English Keywords: TANZANIA | RESEARCH REPORT | COHORT ANALYSIS | PERINATAL MORTALITY | BIRTH WEIGHT | HOSPITALS | QUALITY OF HEALTH CARE | CAUSES OF DEATH | TRANSPORTATION | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Body Weight | Physiology | Biology | Health Facilities | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Economic Factors Document Number: 341453 |
| 21. Peer Reviewed Title: Descriptive epidemiology of mortality and morbidity of health-indicator diseases in hospitalized children from western Jamaica. Author: McCarthy JE; Evans-Gilbert T Source: American Journal of Tropical Medicine and Hygiene. 2009 Apr;80(4):596-600. Abstract: The objectives of our study were to describe the epidemiology of child-health indicator diseases in western Jamaica, examine differences in indicator diseases between sex and age, and generate hypotheses about causes of disease burden. International Classification of Disease, 10th Revision, coded discharge diagnoses were collected from consecutive admissions for 2003-2005 from a public tertiary care hospital. Mortality data were not coded. Perinatal disease was the most common cause of mortality, with hyaline membrane disease the primary cause. Younger children, particularly males, are disproportionately affected by all indicator diseases (P < 0.001) and more likely to die from acute respiratory tract infections and infectious diseases (P < 0.05). Sickle cell disease was the fourth most common diagnosis. Children in western Jamaica are most affected by diseases of prematurity. These children experience disease burden similar to that of children in other developing countries, but fewer neonatal sepsis and insect-borne infections, and more hematologic illness. Language: English Keywords: JAMAICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | EVALUATION INDEXES | CLASSIFICATION | CHILDREN | INFANT | PREVALENCE | HEALTH STATUS INDEXES | CHILD HEALTH | CHILD MORTALITY | CAUSES OF DEATH | SEX FACTORS | RESPIRATORY INFECTIONS | Caribbean | Americas | Developing Countries | Research Methodology | Quantitative Evaluation | Evaluation | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Measurement | Health | Mortality | Population Dynamics | Infections | Diseases Document Number: 331278 |
| 22. Title: Perinatal death pattern in the four districts of Thailand: findings from the Prospective Cohort Study of Thai Children (PCTC). Author: Mo-suwan L; Isaranurug S; Chanvitan P; Techasena W; Sutra S; Supakunpinyo C; Choprapawon C Source: Journal of the Medical Association of Thailand. 2009 May;92(5):660-6. Abstract: OBJECTIVE: To determine the magnitude and investigate causes of perinatal deaths of a cohort of the Prospective Cohort Study of Thai Children. MATERIAL AND METHOD: A semi-structured verbal autopsy questionnaire and review of medical records were used to ascertain the causes of deaths during the perinatal period in four districts of Thailand. RESULTS: The total numbers of 3,522 babies (with 28 pairs of twins) were born from 3,494 pregnant women. The perinatal mortality rate was 10.69 per 1,000 total births, the stillbirth rate was 6.75 per 1,000 births, and the early neonatal mortality rate was 3.97 per 1,000 live-births. About 37.8% of the perinatal deaths were agreed to by two pediatricians and a neonatologist as preventable. About 90% of the preventable stillbirths occurred in the antepartum period. CONCLUSION: Findings from the present study indicates that to further reduce the perinatal death rate, attention should be focused on reducing the stillbirths by a quality antenatal care. Language: English Keywords: THAILAND | RESEARCH REPORT | PROSPECTIVE STUDIES | COHORT ANALYSIS | PREGNANT WOMEN | PERINATAL MORTALITY | DEATH RATE | CAUSES OF DEATH | FETAL DEATH | INFANT MORTALITY | PREMATURE BIRTH | LOW BIRTH WEIGHT | Developing Countries | Asia, Southeastern | Asia | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Pregnancy Outcomes | Pregnancy | Reproduction | Birth Weight | Body Weight | Physiology | Biology Document Number: 341770 |
| 23. Peer Reviewed Title: Clinico-pathological discrepancies in the diagnosis of causes of maternal death in sub-Saharan Africa: retrospective analysis. Author: Ordi J; Ismail MR; Carrilho C; Romagosa C; Osman N; Machungo F; Bombi JA; Balasch J; Alonso PL; Menendez C Source: PLoS Medicine. 2009 Feb 24;6(2):e1000036. Abstract: BACKGROUND: Maternal mortality is a major public-health problem in developing countries. Extreme differences in maternal mortality rates between developed and developing countries indicate that most of these deaths are preventable. Most information on the causes of maternal death in these areas is based on clinical records and verbal autopsies. Clinical diagnostic errors may play a significant role in this problem and might also have major implications for the evaluation of current estimations of causes of maternal death. METHODS AND FINDINGS: A retrospective analysis of clinico-pathologic correlation was carried out, using necropsy as the gold standard for diagnosis. All maternal autopsies (n = 139) during the period from October 2002 to December 2004 at the Maputo Central Hospital, Mozambique were included and major diagnostic discrepancies were analyzed (i.e., those involving the cause of death). Major diagnostic errors were detected in 56 (40.3%) maternal deaths. A high rate of false negative diagnoses was observed for infectious diseases, which showed sensitivities under 50%: HIV/AIDS-related conditions (33.3%), pyogenic bronchopneumonia (35.3%), pyogenic meningitis (40.0%), and puerperal septicemia (50.0%). Eclampsia, was the main source of false positive diagnoses, showing a low predictive positive value (42.9%). CONCLUSIONS: Clinico-pathological discrepancies may have a significant impact on maternal mortality in sub-Saharan Africa and question the validity of reports based on clinical data or verbal autopsies. Increasing clinical awareness of the impact of obstetric and nonobstetric infections with their inclusion in the differential diagnosis, together with a thorough evaluation of cases clinically thought to be eclampsia, could have a significant impact on the reduction of maternal mortality. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | RETROSPECTIVE STUDIES | MATERNAL MORTALITY | CAUSES OF DEATH | EXAMINATIONS AND DIAGNOSES | VALIDITY | DELIVERY OF HEALTH CARE | PREVENTION AND CONTROL | PROGRAM EVALUATION | Africa | Developing Countries | Studies | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Health | Measurement | Diseases | Programs | Organization and Administration Document Number: 341026 |
| 24. Peer Reviewed Title: Global patterns of mortality in young people: a systematic analysis of population health data. Author: Patton GC; Coffey C; Sawyer SM; Viner RM; Haller DM; Bose K; Vos T; Ferguson J; Mathers CD Source: Lancet. 2009 Sep 12;374(9693):881-92. Abstract: BACKGROUND: Pronounced changes in patterns of health take place in adolescence and young adulthood, but the effects on mortality patterns worldwide have not been reported. We analysed worldwide rates and patterns of mortality between early adolescence and young adulthood. METHODS: We obtained data from the 2004 Global Burden of Disease Study, and used all-cause mortality estimates developed for the 2006 World Health Report, with adjustments for revisions in death from HIV/AIDS and from war and natural disasters. Data for cause of death were derived from national vital registration when available; for other countries we used sample registration data, verbal autopsy, and disease surveillance data to model causes of death. Worldwide rates and patterns of mortality were investigated by WHO region, income status, and cause in age-groups of 10-14 years, 15-19 years, and 20-24 years. FINDINGS: 2.6 million deaths occurred in people aged 10-24 years in 2004. 2.56 million (97%) of these deaths were in low-income and middle-income countries, and almost two thirds (1.67 million) were in sub-Saharan Africa and southeast Asia. Pronounced rises in mortality rates were recorded from early adolescence (10-14 years) to young adulthood (20-24 years), but reasons varied by region and sex. Maternal conditions were a leading cause of female deaths at 15%. HIV/AIDS and tuberculosis contributed to 11% of deaths. Traffic accidents were the largest cause and accounted for 14% of male and 5% of female deaths. Other prominent causes included violence (12% of male deaths) and suicide (6% of all deaths). INTERPRETATION: Present global priorities for adolescent health policy, which focus on HIV/AIDS and maternal mortality, are an important but insufficient response to prevent mortality in an age-group in which more than two in five deaths are due to intentional and unintentional injuries. FUNDING: WHO and National Health and Medical Research Council. Language: English Keywords: GLOBAL | RESEARCH REPORT | DATA ANALYSIS | YOUTH | MORTALITY | CAUSES OF DEATH | VITAL STATISTICS | GEOGRAPHIC FACTORS | MATERNAL MORTALITY | ADOLESCENT HEALTH | ACCIDENTS AND INJURIES | SUICIDE | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Population Dynamics | Population Statistics | Health Document Number: 342865 |
| 25. Peer Reviewed Title: Maternal mortality-reduction programme in Andhra Pradesh. Author: Prakasamma M Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):220-34. Abstract: Andhra Pradesh, a large state in southern India, has a high maternal mortality ratio of 195 per 100,000 livebirths despite the improvements in social, demographic and health indicators over the last two decades. This contrary situation has been analyzed using findings of different studies on maternal mortality, and four factors have been presented for consistently-high maternal mortality in the state. First, the disproportionately-high focus on family planning towards population stabilization reduced the emphasis on maternal health in the peripheral hospitals, resulting in low use of these facilities for childbirths. Second, the growth of services in Primary Health Centres was not given adequate emphasis, resulting in the weakening of the peripheral health system. Third, there was little emphasis on developing a cadre of midwives who would have primarily focused on maternal health. Lastly, the low status of women in the state has hampered timely referral and access to services. Language: English Keywords: INDIA | RESEARCH REPORT | CASE STUDIES | MIDWIVES AND MIDWIFERY | MATERNAL MORTALITY | CAUSES OF DEATH | MATERNAL HEALTH SERVICES | PROGRAM ACCESSIBILITY | HEALTH FACILITIES | SAFE MOTHERHOOD | PREGNANCY COMPLICATIONS | UTILIZATION OF HEALTH CARE | AWARENESS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Mortality | Population Dynamics | Demographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Program Evaluation | Programs | Organization and Administration | Maternal Health | Diseases | Knowledge | Sociocultural Factors Document Number: 341933 |
| 26. Peer Reviewed Title: Health services utilization during terminal illness in Addis Ababa, Ethiopia. Author: Reniers G; Tesfai R Source: Health Policy and Planning. 2009 Jul;24(4):312-9. Abstract: OBJECTIVES We describe modern and alternative health services use in terminal illness of adults, and assess whether utilization patterns of TB/AIDS patients are distinct from those of patients suffering from other illnesses. METHODS Data are from post-mortem interviews with close relatives or caretakers of the deceased. We provide descriptive statistics of health care utilization in adults and discuss their covariates in multivariate analyses. RESULTS Over 85% of terminally sick patients visited a modern medical facility, but less than 40% spent more than 24 hours in a medical facility and only 25% died in one. Traditional healer (11%) and holy water (46%) visits offer a common treatment and healing alternative, but these visits do not co-vary in any consistent manner with the utilization of modern medical services. In terms of the cause of death, we find a higher contact rate with both modern and alternative medical service providers among TB/AIDS patients compared with those suffering from other medical conditions. The duration of illness seems to account for a good share of that variability. Other covariates of health services utilization are socio-economic status, education and age. CONCLUSIONS The contact rate of adults with modern medical facilities in terminal illness is almost universal, but their usage intensity is rather low. Alternative curative options are less commonly used, and do not exclude modern health services use. This suggests that both types of services are considered complements rather than alternatives for each other. Because the contact rate with health service providers is greatest for TB/AIDS patients, it is unlikely that HIV/AIDS-related stigma is an impediment to seeking care. We cannot exclude, however, that it delays health-seeking behaviour. Language: English Keywords: ETHIOPIA | RESEARCH REPORT | INTERVIEWS | ADULTS | UTILIZATION OF HEALTH CARE | HEALTH SERVICES | MORTALITY | TRADITIONAL HEALTH PRACTICES | CAUSES OF DEATH | TUBERCULOSIS | AIDS | SOCIOECONOMIC STATUS | EDUCATIONAL STATUS | AGE FACTORS | TIME FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Data Collection | Research Methodology | Population Characteristics | Demographic Factors | Population | Delivery of Health Care | Health | Population Dynamics | Culture | Sociocultural Factors | Infections | Diseases | HIV Infections | Viral Diseases | Socioeconomic Factors | Economic Factors Document Number: 342990 |
| 27. Peer Reviewed Title: Steep declines in population-level AIDS mortality following the introduction of antiretroviral therapy in Addis Ababa, Ethiopia. Author: Reniers G; Araya T; Davey G; Nagelkerke N; Berhane Y; Coutinho R; Sanders EJ Source: AIDS. 2009 Feb 20;23(4):511-8. Abstract: OBJECTIVES: Assessments of population-level effects of antiretroviral therapy (ART) programmes in Africa are rare. We use data from burial sites to estimate trends in adult AIDS mortality and the mitigating effects of ART in Addis Ababa. ART has been available since 2003, and for free since 2005. METHODS: To substitute for deficient vital registration, we use surveillance of burials at all cemeteries. We present trends in all-cause mortality, and estimate AIDS mortality (ages 20-64 years) from lay reports of causes of death. These lay reports are first used as a diagnostic test for the true cause of death. As reference standard, we use the cause of death established via verbal autopsy interviews conducted in 2004. The positive predictive value and sensitivity are subsequently used as anchors to estimate the number of AIDS deaths for the period 2001-2007. Estimates are compared with Spectrum projections. RESULTS: Between 2001 and 2005, the number of AIDS deaths declined by 21.9 and 9.3% for men and women, respectively. Between 2005 and 2007, the number of AIDS deaths declined by 38.2 for men and 42.9% for women. Compared with the expected number in the absence of ART, the reduction in AIDS deaths in 2007 is estimated to be between 56.8 and 63.3%, depending on the coverage of the burial surveillance. CONCLUSION: Five years into the ART programme, adult AIDS mortality has been reduced by more than half. Following the free provision of ART in 2005, the decline accelerated and became more sex balanced. Substantial AIDS mortality, however, persists. Language: English Keywords: ETHIOPIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | INDIRECT ESTIMATION TECHNIQUES | PERSONS LIVING WITH HIV/AIDS | URBAN POPULATION | AIDS | DEATH RATE | ANTIRETROVIRAL THERAPY | CAUSES OF DEATH | AUTOPSY | SEX FACTORS | MORTALITY DECLINE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Estimation Techniques | HIV Infections | Viral Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | HIV | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341166 |
| 28. Peer Reviewed Title: Access to health care and mortality of children under 5 years of age in the Gambia: a case-control study. Author: Rutherford ME; Dockerty JD; Jasseh M; Howie SR; Herbison P; Jeffries DJ; Leach M; Stevens W; Mulholland K; Adegbola RA; Hill PC Source: Bulletin of the World Health Organization. 2009 Mar;87(3):216-24. Abstract: OBJECTIVE: To assess whether traditional measures of access to health care (distance and travel time to a facility) and non-traditional measures (social and financial support indicators) are associated with mortality among children under 5 years of age in the Gambia. METHODS: We conducted a case-control study in a population under demographic surveillance. Cases (n = 140) were children under 5 years of age who died between 31 December 2003 and 30 April 2006. Each case was matched in age and sex to five controls (n = 700). Information was gathered by interviewing primary caregivers. The data were analysed using conditional logistic regression. FINDINGS: Of traditional measures of access, only rural versus urban/periurban residence was important: children from rural areas were more likely to die (OR: 4.9; 95% confidence interval, CI: 1.2-20.2). For non-traditional measures, children were more likely to die if their primary caregivers lacked help with meal preparation (OR: 2.3; 95% CI: 1.2-4.1), had no one to relax with (OR: 1.8; 95% CI: 1.1-2.9), had no one who could offer good advice (OR: 23.1; 95% CI: 4.3-123.4), had little say over how earned money was spent (OR: 12.7; 95% CI: 1.3-127.6), were unable to cut spending for health care (OR: 2.5; 95% CI: 1.5-4.2) or had to carry out odd jobs to pay for the care (OR: 3.4; 95% CI: 2.1-5.5). A protective effect was observed when the caregiver had other children to care for (OR: 0.2; 95% CI: 0.1-0.5). CONCLUSION: Improving access to health-care for children in the Gambia and similar settings is not simply a matter of reducing travel time and distance to a health facility, but requires improvements in caregivers' support networks and their access to the financial resources they need. Language: English Keywords: GAMBIA | RESEARCH REPORT | CONTROL GROUPS | STATISTICAL REGRESSION | CHILDREN | HEALTH SERVICES | PROGRAM ACCESSIBILITY | CHILD MORTALITY | CAUSES OF DEATH | DISTANCE | TRANSPORTATION | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Mortality | Population Dynamics | Geographic Factors | Economic Factors Document Number: 342351 |
| 29. Title: Maternal mortality in patients admitted to an intensive care unit in Jamaica. Author: Scarlett M; Isaacs MA; Fredrick-Johnston S; Kulkarni S; McCaw-Binns A Source: International Journal of Gynaecology and Obstetrics. 2009 May;105(2):169-70. Abstract: A retrospective review was conducted of severe acute maternal morbidity (SAMM) admissions to the intensive care unit (ICU) at the University Hospital of the West Indies (UHWI), Jamaica, between January 2001 and December 2006. UHWI has 550 beds and is one of three tertiary care referral centers on the island; it has two 8-bed ICUs. A total of 57 women with SAMM were admitted to the ICU over the study period, representing 2.8% of ICU admissions and 0.4% of total maternal admissions to the hospital. The mean age of the women was 30 years (range, 26-36 years) and the mean duration of stay in the ICU was 6 days (range, 1-35 days). The most common diagnoses were hypertensive disorders of pregnancy, sickle cell disease, and hemorrhagic disorders (Table 1). The cause of the admission in 32 (56.1%) patients was a direct obstetric cause, while for 25 (43.8%) patients the cause was non-obstetric. Only 2 patients with viable pregnancies had inadequate prenatal care. Twenty-five women were admitted after cesarean delivery, 11 after vaginal delivery, 6 following laparotomy, and 6 after induced abortion. Language: English Keywords: JAMAICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | PREGNANCY COMPLICATIONS | MATERNAL MORTALITY | MORBIDITY | HOSPITALS | CAUSES OF DEATH | OBSTETRICS | Caribbean | Americas | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Diseases | Mortality | Population Dynamics | Demographic Factors | Population | Health Facilities | Delivery of Health Care | Health | Medicine | Health Services Document Number: 341380 |
| 30. Title: Socio-demographic characteristics and the three delays of maternal mortality. Author: Shah N; Hossain N; Shoaib R; Hussain A; Gillani R; Khan NH Source: Journal of the College of Physicians and Surgeons - -Pakistan. 2009 Feb;19(2):95-8. Abstract: OBJECTIVE: To describe the socio-demographic characteristics and the three delays of maternal mortality in a tertiary teaching hospital. STUDY DESIGN: Retrospective, observational study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynaecology, Unit III, Civil Hospital, Karachi, from April 2005 to May 2008. METHODOLOGY: One hundred and four consecutive maternal deaths were reviewed. Data regarding age, parity, sociodemographic characteristics, booking status, referral source, cause of death and the three delays was collected on structured proformas, analyzed by the statistical software, SPSS version 13, and presented in the form of frequencies and percentages. RESULTS: The projected maternal mortality ratio was 1650/100,000 live births. The mean age was 28+/-6.2 years and median parity was two. Seventy-one women (68%) were uneducated, 65 (62.5%) belonged to lower socioeconomic class and 60 (58%) had received no antenatal care. Ninety-eight women (94%) had one or more delays, with 70 (71%) having the first delay, 73 (74%) having the second delay and 47 (48%) the third delay. The most frequent reasons for first, second and third delays were lack of awareness in 88.5% women, long distance in 39.7% women and difficulty in getting blood in 49% women respectively. CONCLUSION: The very high maternal mortality ratio suggests lack of access of women to quality healthcare facilities. A majority of these women suffered first and second delays in their management, which could be due to their poor sociodemographic factors. Language: English Keywords: PAKISTAN | RESEARCH REPORT | RETROSPECTIVE STUDIES | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | MATERNAL MORTALITY | DEMOGRAPHIC FACTORS | RISK FACTORS | HOSPITALS | MATERNAL AGE | PARITY | REFERRAL AND CONSULTATION | CAUSES OF DEATH | EDUCATIONAL STATUS | SOCIAL CLASS | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Population | Mortality | Population Dynamics | Health | Health Facilities | Delivery of Health Care | Parental Age | Age Factors | Fertility Measurements | Fertility | Program Activities | Programs | Organization and Administration | Socioeconomic Status | Socioeconomic Factors Document Number: 341161 |
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