Death Rate Research Articles

AI DRIVEN BLOOD CELL ANALYSIS FOR MALARIA AND BLOOD CANCER SCREENING

Malaria and blood Cancer is one of the deadliest diseases cross the globe. This is caused by the bite of female Anopheles mosquito that transmits the Plasmodium parasites. Some current malaria detection techniques include manual microscopic examination and RDT. These approaches are vulnerable to human mistakes. Early detection of malaria can help in reducing the death rates across the globe.Deep Learning can emerge as a highly beneficial solution in the diagnosis of disease. This model gives a faster and cheaper method for detecting plasmodium parasites. It Was Designed to Identify Malaria Parasites and Cancerous Cell Presence in Blood Using Images of Blood Samples which got Tested with Giemsa-stain. Convolutional neural networks (CNNs) are then trained on these extracted features to accurately classify blood cell images into disease positive or disease-negative categories. The CNN detects malaria parasites in microscopic images by classifying them into parasitized and healthy cells, enabling the detection of malaria parasites. The proposed model consists of three convolutional layers and fully connected layers each. The neural network presented is a cascade of several convolutional layers having multiple filters present in layers, which yields the exceptionally good accuracy as per the available resources. The experiment results demonstrate a significant improvement in malaria parasite and blood cancer recognition. Compared to traditional manual microscopy, the proposed system is more accurate and faster. Finally, this study demonstrates the need to provide robust and efficient solutions by leveraging state-of-the-art technologies to combat malaria and blood cancer. Keywords : Deep Learning, CNN, Image analysis , InceptionresnetV2

New York Heart Association functional class and implantable cardioverter-defibrillator in non-ischaemic heart failure with reduced ejection fraction: Extended follow-up of the DANISH trial.

Current guidelines recommend implantable cardioverter-defibrillator (ICD) therapy in patients with heart failure, a left ventricular ejection fraction of ≤35%, and New York Heart Association (NYHA) class II-III. However, the evidence regarding the benefit of primary prevention ICD is less consistent in patients with NYHA class III. We investigated the long-term effects of primary prevention ICD implantation according to NYHA class in an extended follow-up study of the DANISH trial. The DANISH trial randomized 1116 patients with non-ischaemic heart failure with reduced ejection fraction (HFrEF) to ICD implantation or usual care. Outcomes were analysed according to NYHA class at baseline (NYHA class II and III/IV). The primary outcome was all-cause mortality. Of the 1116 patients randomized in the DANISH trial, 597 (53.5%) were in NYHA class II at baseline, 505 (45.3%) in NYHA class III, and 14 (1.3%) in NYHA class IV. During a median follow-up of 9.5 years, NYHA class III/IV, compared with NYHA class II, were associated with a greater long-term rate of all-cause mortality (hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.20-1.93) and cardiovascular death (HR 1.95 [1.47-2.60]). ICD implantation, compared with usual care, did not reduce the long-term rate of all-cause mortality (all participants: HR 0.89 [95% CI 0.74-1.08]; NYHA class II: HR 0.85 [0.64-1.13]; NYHA class III/IV: HR 0.89 [0.69-1.14]; pinteraction = 0.78) or cardiovascular death (all participants: HR 0.87 [95% CI 0.70-1.09]; NYHA class II: HR 0.78 [0.54-1.12]; NYHA class III/IV: HR 0.89 [0.67-1.19]; pinteraction = 0.58), irrespective of NYHA class. Similarly, NYHA class did not modify the beneficial effects of ICD implantation on sudden cardiovascular death (all participants: HR 0.60 [95% CI 0.40-0.92]; NYHA class II: HR 0.73 [0.40-1.36]; NYHA class III/IV: HR 0.52 [0.29-0.94]; pinteraction = 0.39). In patients with non-ischaemic HFrEF, ICD implantation, compared with usual care, did not reduce the overall mortality rate, but it did reduce sudden cardiovascular death, regardless of baseline NYHA class. ClinicalTrials.gov NCT00542945.

Efficacy and Safety of Bufei Jiedu Granules in Treating Multidrug-Resistant Pulmonary Tuberculosis: A Multi-center, Double-Blinded and Randomized Controlled Trial.

To assess the efficacy and safety of Bufei Jiedu (BFJD) ranules as adjuvant therapy for patients with multidrug-resistant pulmonary tuberculosis (MDR-PTB). A large-scale, multi-center, double-blinded, and randomized controlled trial was conducted in 18 sentinel hospitals in China from December 2012 to December 2016. A total of 312 MDR-PTB patients were randomly assigned to BFJD Granules or placebo groups (1:1) using a stratified randomization method, which both received the long-course chemotherapy regimen for 18 months (6 Am-Lfx-P-Z-Pto, 12 Lfx-P-Z-Pto). Meanwhile, patients in both groups also received BFJD Granules or placebo twice a day for a total of 18 months, respectively. The primary outcome was cure rate. The secondary outcomes included time to sputum-culture conversion, changes in lung cavities and quality of life (QoL) of patients. Adverse reactions were monitored during and after the trial. A total of 216 cases completed the trial, 111 in the BFJD Granules group and 105 in the placebo group. BFJD Granules, as an adjuvant treatment, increased the cure rate by 13.6% at the end of treatment, compared with the placebo (58.4% vs. 44.8%, P=0.02), and accelerated the median time to sputum-culture conversion (5 months vs. 11 months). The cavity closure rate of the BFJD Granules group (50.6%, 43/85) was higher than that of the placebo group (32.1%, 26/81; P=0.02) in patients who completed the treatment. At the end of the intensive treatment, according to the 36-item Short Form, the BFJD Granules significantly improved physical functioning, general health, and vitality of patients relative to the placebo group (all P<0.01). Overall, the death rates in the two groups were not significantly different; 5.1% (8/156) in the BFJD Granules group and 2.6% (4/156) in the placebo group. Supplementing BFJD Granules with the long-course chemotherapy regimen significantly increased the cure rate and cavity closure rates, and rapidly improved QoL of patients with MDR-PTB (Registration No. ChiCTR-TRC-12002850).

Prone positioning in awake patients without ventilatory support does not alter major clinical outcomes in severe COVID-19: results from a retrospective observational cohort study, systematic review and meta-analysis

ABSTRACT Objectives During the Coronavirus disease (COVID-19) pandemic, clinicians recommended awake-prone positioning (APP) to avoid the worst outcomes. The objectives of this study were to investigate if APP reduces intubation, death rates, and hospital length of stay (HLOS) in acute COVID-19. Methods We performed a retrospective cohort with non-mechanically ventilated patients hospitalized in a reference center in Manaus, Brazil, 2020. Participants were stratified into APP and awake-not-prone positioning (ANPP) groups. Also, we conducted a systematic review and performed a meta-analysis to understand if this intervention had different outcomes in resource-limited settings (PROSPERO CRD42023422452). Results A total of 115 participants were allocated into the groups. There was no statistical difference between both groups regarding time to intubation (HR: 0.861; 95CI: 0.474-1.1562; p=0.622) and time to death (HR: 1.666; 95CI: 0.939-2.951; p=0.081). APP was not significantly associated with reduced HLOS. A total of 86 articles were included in the systematic review, of which 76 (88,3%) show similar findings after APP. Also, low/middle, and high-income countries were similar regarding such outcomes. Conclusion APP in COVID-19 does not present clinical improvement that affects mortality, intubation rate and HLOS. The lack of a prone position protocol, obtained through a controlled study, is necessary. After 3 years, APP benefits are still inconclusive.

Trends in the survival of patients with trisomy 13 from 1995 to 2021: A population study in Japan.

It remains unclear whether recent changes in the prognosis and management of patients with trisomy 13 impact patient survival. We investigated changes in survival of patients with trisomy 13 in Japan. Data from the Vital Statistics Database in Japan was retrieved to examine the association of sex, surgical history, and years of birth and death with changes in survival patterns in 1164 patients with trisomy 13 between 1995 and 2021. The rates of deaths due to trisomy 13 increased from 9.8% to 23.1% in those over 1 year of age and from 7.3% to 19.2% in those within 24 h of birth between 1995 and 2021. The median survival time was longer in 2009-2021 than in 1996-2008 (40 vs. 84 days, p < 0.001). The median survival time and the rate of patients with surgical history increased from 91 days and 16.0% in 1996-2008 to 179 days and 28.0% in 2009-2021, respectively. Median survival time among patients with trisomy 13 has increased over the last 26 years, with almost 1 in 3 patients currently surviving for more than 1 year. The increased surgical intervention rate might have contributed to this improvement.

ASSESSMENT OF TREATMENT OUTCOMES AND SOME RISK FACTORS FOR MORTALITY OF COMMUNITY-ACQUIRED PNEUMONIA CAUSED BY STAPHYLOCOCCUS AUREUS IN THE ELDERLY POPULATION

Objectives: Community-acquired pneumonia is a notable contributor to mortality from infectious diseases on a worldwide scale, especially in the older population. Staphylococcus aureus is a prevalent infection known to cause severe pneumonia, often leading to a high incidence of complications and fatality. The study's objective was to assess the treatment outcomes and some factors associated with mortality rates of Staphylococcus aureus pneumonia in older people. Subjects and method: A cross-sectional study was conducted with 93 patients diagnosed with Staphylococcus aureus pneumonia admitted to Can Tho Central General Hospital from April 2021 to May 2023. Results: The research results showed clinical outcomes including 30-day all-cause death rates and pneumonia-related complications were slightly higher in the age group over 60 compared to those aged 60 and under, but the difference was not statistically significant. After performing multivariate analysis, it was found that heart failure (OR = 5.68, 95% CI: 1.01-32.1, p = 0.049) and central nervous system disease (OR = 5.26, 95% CI: 1.32-20.9, p = 0.018) were found to be independent factors that increased the mortality rate in individuals aged over 60. Conclusion: Clinical practitioners should evaluate and manage comorbidities regarding heart failure and central nervous system diseases during treatment of Staphylococcus aureus pneumonia due to its elevated fatality rate, especially in old patients.

How do we understand the value of drug checking as a component of harm reduction services? A qualitative exploration of client and provider perspectives

BackgroundMortality related to opioid overdose in the U.S. has risen sharply in the past decade. In California, opioid overdose death rates more than tripled from 2018 to 2021, and deaths from synthetic opioids such as fentanyl increased more than seven times in those three years alone. Heightened attention to this crisis has attracted funding and programming opportunities for prevention and harm reduction interventions. Drug checking services offer people who use drugs the opportunity to test the chemical content of their own supply, but are not widely used in North America. We report on qualitative data from providers and clients of harm reduction and drug checking services, to explore how these services are used, experienced, and considered.MethodsWe conducted in-depth semi-structured key informant interviews across two samples of drug checking stakeholders: “clients” (individuals who use drugs and receive harm reduction services) and “providers” (subject matter experts and those providing clinical and harm reduction services to people who use drugs). Provider interviews were conducted via Zoom from June-November, 2022. Client interviews were conducted in person in San Francisco over a one-week period in November 2022. Data were analyzed following the tenets of thematic analysis.ResultsWe found that the value of drug checking includes but extends well beyond overdose prevention. Participants discussed ways that drug checking can fill a regulatory vacuum, serve as a tool of informal market regulation at the community level, and empower public health surveillance systems and clinical response. We present our findings within three key themes: (1) the role of drug checking in overdose prevention; (2) benefits to the overall agency, health, and wellbeing of people who use drugs; and (3) impacts of drug checking services at the community and systems levels.ConclusionThis study contributes to growing evidence of the effectiveness of drug checking services in mitigating risks associated with substance use, including overdose, through enabling people who use and sell drugs to test their own supply. It further contributes to discussions around the utility of drug checking and harm reduction, in order to inform legislation and funding allocation.

Global trends in pharmacovigilance-related events: a 30-year analysis from the 2019 global burden of disease study.

Establishing effective pharmacovigilance systems globally is challenging due to the need for comprehensive epidemiological data on pharmacovigilance-related events, particularly in countries at different stages of development. This study aimed to determine magnitude and drivers of change in the global and regional burden of pharmacovigilance-related events from 1990 to 2019, analyzing variations between age groups and sex, providing data support for policymakers to adjust their pharmacovigilance policies. Pharmacovigilance-related events were defined as Adverse Effects of Medical Treatment (AEMT) and Drug Use Disorders (DUD) in the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. Time trend analysis utilized joinpoint regression, age-period-cohort model, and decomposition method. Disease burden was measured in incidence, deaths, and disability-adjusted life years (DALYs). The global burden of pharmacovigilance-related events remained high, driven predominantly by population growth. Children and older adults were identified as particularly susceptible groups. Across various regions and periods of the socio-demographic index (SDI), the risk of death from AEMT showed a decreasing trend. In contrast, the incidence of AEMT and both the incidence and death rates from DUD showed a stable or worsening trend. Significant regional disparities in the burden of these diseases were noted between different SDI levels. The study underscores the critical need for robust pharmacovigilance systems worldwide. The observed trends in the burden of pharmacovigilance-related events offer a clear direction for countries to refine and strengthen their pharmacovigilance policies and practices.

Extracorporeal life support after surgical repair for acute type a aortic dissection: A systematic review and meta-analysis.

The use of extracorporeal life support (ECLS) in patients after surgical repair for acute type A aortic dissection (ATAAD) has not been well documented. We performed a systematic review and meta-analysis to assess the outcomes of ECLS after surgery for ATAAD with data published by October 2023 in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. The protocol was registered in PROSPERO (CRD42023479955). Twelve observational studies met our eligibility criteria, including 280 patients. Mean age was 55.0 years and women represented 25.3% of the overall population. Although the mean preoperative left ventricle ejection fraction was 59.8%, 60.8% of patients developed left ventricle failure and 34.0% developed biventricular failure. Coronary involvement and malperfusion were found in 37.1% and 25.6%, respectively. Concomitant coronary bypass surgery was performed in 38.5% of patients. Regarding ECLS, retrograde flow (femoral) was present in 39.9% and central cannulation was present in 35.4%. In-hospital mortality was 62.8% and pooled estimate of successful weaning was 50.8%. Neurological complications, bleeding and renal failure were found in 25.9%, 38.7%, and 65.5%, respectively. ECLS after surgical repair for ATAAD remains associated with high rates of in-hospital death and complications, but it still represents a chance of survival in critical situations. ECLS remains a salvage attempt and surgeons should not try to avoid ECLS at all costs after repairing an ATAAD case.

A Comparative Study between Time Series and Machine Learning Technique to Predict Dengue Fever in Dhaka City

The dengue virus is the most dangerous one that mosquitoes may spread to people. Despite attempts by the government, dengue outbreaks are becoming increasingly common in Bangladesh. Interventions in public health rely heavily on KAP (knowledge, attitude, and practice) studies. The primary goal of this research is to forecast the occurrence of dengue disease in the city of Dhaka using methods from machine learning and time series analysis and then to compare the models in order to find the one with the lowest MAPE. From January 2016 through July 2021, monthly data were retrieved for this study from WHO and the Directorate General of Health and Services (DGHS). According to the findings of this research, neural networks outperform time series analysis when it comes to making predictions. The best-fitted neural network (NN) model was found in model 04 with 05 hidden layers which produced the minimum error model with the value of error 0.003032557, and the values of RMSE and MAPE are 7.588889e − 06 and 1.15273, respectively, for the prediction of the dengue fever in Dhaka city. In contrast, the original dengue data in the time series analysis is not stationary. Take the difference and run the unit root test by the augmented Dickey–Fuller (ADF) test to make it stationary. The dengue data series is stationary at the first-order difference, as evidenced by the ACF and PACF, which show no noticeable spike in the first-order difference. The ARIMA (6, 1, 1) model with the lowest AIC = −251.8, RMSE = 0.0310797, and MAPE = 15.2892 is the best choice model for predicting the dengue death rate. Therefore, from these two models, the NN model gives better prediction performance with the lowest value of MAPE. So, the neural network gives better prediction performance than time series analysis. The NN model forecasted 12-month death rates of dengue fever that suggest the death rate in dengue fever falling month by month. This study is more innovative than any other research because this research approach is different from any other research approach. The model selection criteria are based on the most effective performance metrics MAPE, indicating the lowest error and better prediction performance. Therefore, from this research, the author suggests machine learning gives better prediction performance than time series analysis for any other prediction performance.

The Scabbard of Excalibur: An Allegory on the Role of an Efficient and Effective Healthcare System under Universal Health Coverage during the Pandemic Response

During the COVID-19 pandemic, while some countries succeeded in reducing their rate of death after SARS-CoV-2 infection via vaccination by the end of 2021, some of them also faced hospital capacity strain, leading to social anxiety about delays in the diagnosis and treatment of patients with other diseases. This essay presents an allegory to explain the situation during the COVID-19 pandemic. Through an allegory and Le Morte d’Arthur (Arthur’s Death), this essay indicates that “the scabbard of Excalibur” that we are looking for is an efficient and effective healthcare system that can diagnose patients who might become severely ill due to COVID-19 and to treat them without hospital capacity strain. In Le Morte d’Arthur, the scabbard of Excalibur was lost, and we have not been able to find any alternatives to end the COVID-19 pandemic. We can choose a future in which “the scabbard of Excalibur” exists, providing a different ending for the next pandemic.

Persistent high mortality rates for Diabetes Mellitus and Hypertension after excluding deaths associated with COVID-19 in Brazil, 2020-2022.

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) posed a significant public health challenge globally, with Brazil being no exception. Excess mortality during this period reached alarming levels. Cardiovascular diseases (CVD), Systemic Hypertension (HTN), and Diabetes Mellitus (DM) were associated with increased mortality. However, the specific impact of DM and HTN on mortality during the pandemic remains poorly understood. This study analyzed mortality data from Brazil's mortality system, covering the period from 2015 to 2022. Data included all causes of death as listed on death certificates, categorized by International Classification of Diseases 10th edition (ICD-10) codes. Population data were obtained from the Brazilian Census. Mortality ratios (MRs) were calculated by comparing death rates in 2020, 2021, and 2022 to the average rates from 2015 to 2019. Adjusted MRs were calculated using Poisson models. Between 2015 and 2022, Brazil recorded a total of 11,423,288 deaths. Death rates remained relatively stable until 2019 but experienced a sharp increase in 2020 and 2021. In 2022, although a decrease was observed, it did not return to pre-pandemic levels. This trend persisted even when analyzing records mentioning DM, HTN, or CVD. Excluding death certificates mentioning COVID-19 codes, the trends still showed increases from 2020 through 2022, though less pronounced. This study highlights the persistent high mortality rates for DM and HTN in Brazil during the years 2020-2022, even after excluding deaths associated with COVID-19. These findings emphasize the need for continued attention to managing and preventing DM and HTN as part of public health strategies, both during and beyond the COVID-19 pandemic. There are complex interactions between these conditions and the pandemic's impact on mortality rates.

Extracellular vesicles in disorders of hemostasis following traumatic brain injury

Traumatic brain injury (TBI) is a global health priority. In addition to being the leading cause of trauma related death, TBI can result in long-term disability and loss of health. Disorders of haemostasis are common despite the absence of some of the traditional risk factors for coagulopathy following trauma. Similar to trauma induced coagulopathy, this manifests with a biphasic response consisting of an early hypocoagulable phase and delayed hypercoagulable state. This coagulopathy is clinically significant and associated with increased rates of haemorrhagic expansion, disability and death. The pathophysiology of TBI-induced coagulopathy is complex but there is biologic plausibility and emerging evidence to suggest that extracellular vesicles (EVs) have a role to play. TBI and damage to the blood brain barrier result in release of brain-derived EVs that contain tissue factor and phosphatidylserine on their surface. This provides a platform on which coagulation can occur. Preclinical animal models have shown that an early rapid release of EVs results in overwhelming activation of coagulation resulting in a consumptive coagulopathy. This phenomenon can be attenuated with administration of substances to promote EV clearance and block their effects. Small clinical studies have demonstrated elevated levels of procoagulant EVs in patients with TBI correlating with clinical outcome. EVs represent a promising opportunity for use as minimally invasive biomarkers and potential therapeutic targets for TBI patients. However, additional research is necessary to bridge the gap between their potential and practical application in clinical settings.

Patients with scheduled heart valve interventions are at very high risk for acute heart failure during prolonged waiting time

Abstract Funding Acknowledgements None. Background Postponement of non-emergency cardiac interventions is associated with increased rates of emergency hospitalizations. Affected patients show signs of acute heart failure during the waiting time. Since this worse outcome has been proven to persist even long post-procedure, patients at risk must be identified in advance. Purpose This study sought to identify predictors associated with acute heart failure during prolonged waiting time in cardiac patients scheduled for non-emergency interventions. Methods A retrospective, observational cohort study was conducted that included consecutive patients whose non-emergency cardiac intervention was postponed during the first Covid-19 related lockdown between March 19th and April 30th, 2020. The endpoint was heart failure at admission to the procedure performed, indicated by a NT-proBNP level &amp;gt; 900 pg/ml. Cox regression analysis was performed to identify characteristics of patients who met the endpoint. Results After postponing their non-emergency cardiac intervention for an average of 23 days, 89 of 178 postponed patients (59 %) at a mean age slightly above 70 years had a NT-proBNP level &amp;gt; 900 pg/ml. Cox regression analysis showed the criterion "planned heart valve procedure" to independently predict achievement of the endpoint (p &amp;lt; 0.001, OR 12.040, 95 % CI 3.423 – 42.353). Subgroup analysis (n = 49) showed that especially patients with atrioventricular valve regurgitation are at risk with an endpoint rate of 94.74 % compared to 69.00 % in patients undergoing aortic valve replacement (p = 0.008). Moreover, the intervention of the affected patients was performed more frequently as emergency hospitalization (p = 0.005) and lasted longer (p &amp;lt; 0.001). This was accompanied by worse cardiac status at the time of admission including worse NYHA class, higher biomarker levels and lower cardiac function (each p &amp;lt; 0.001). Additionally, worse outcome as demonstrated by higher rates of emergency hospitalization and death persisted even 12, 24 and 36 months after the procedure (each p &amp;lt; 0.001). Conclusion Patients scheduled for heart valve interventions and particularly due to atrioventricular valve regurgitation are at high risk of heart failure in case of prolonged waiting time. Therefore, this population does not appear to be suitable for postponement but, in contrast, seems to require acute cardiovascular care.

Factors associated with pregnancy termination in six sub-Saharan African countries

Pregnancy termination continues to be a leading cause of maternal morbidity and mortality among young women in Africa. The sub-Saharan Africa region has the highest rate of abortion-related deaths in the world, at 185 maternal deaths per 100,000 abortions. The aim of this study is to investigate the factors associated with pregnancy termination among women aged 15 to 29 years in six sub-Saharan African countries. We used secondary data from the most recent Demographic and Health Survey of six sub-Saharan African countries: Kenya, Tanzania, Ethiopia, Burundi, Nigeria, and Rwanda. A total weighted sample of 74,652 women aged 15–29 were analyzed. A multivariable logistic regression model was used to identify the factors associated with pregnancy termination at a p-value &lt; 0.05. Results were presented using adjusted odds ratios (AOR) with 95% confidence interval. The study showed that 6.3% of women aged 15–29 reported pregnancy termination with a higher prevalence rate in Tanzania (8.8%) and lowest in Ethiopia (4%). Highest odds of pregnancy termination occurred among women aged 20–24 as compared to women aged 15–19 in Rwanda (AOR: 4.04, 95%CI 2.05, 7.97) followed by Nigeria (AOR: 2.62, 95% CI 1.99, 3.43), Kenya (AOR: 2.33, 95%CI 1.48, 3.66), Burundi (AOR: 1.99 95%CI 1.48, 2.85), Tanzania (AOR: 1.71 95%CI 1.29, 2.27), and Ethiopia (AOR: 1.69, 95% CI 1.19, 2.42). Women with no education had 4 times higher odds of pregnancy termination compared to women with higher education in Tanzania (AOR: 4.03 95%CI 1.00, 16.13) while women with no education and primary level education were 1.58 times (AOR: 1.58 95% CI 1.17, 2.13) and 1.78 times (AOR: 1.78 95% CI 1.34, 2.37) as likely to terminate pregnancy in Ethiopia. In Tanzania, the likelihood of a pregnancy termination was associated with a relationship to the household head; head (AOR: 3.66, 95% CI (2.32, 5.78), wife (AOR: 3.68, 95% CI 2.60, 5.12), and in-law (AOR:2.62, 1.71, 4.03). This study revealed that a significant number of women had pregnancy termination. Being in the age group of 20–24 &amp; 25–29, having a lower level of education, being a domestic employee and professional, being single/never-in-union, being in the poorest and richer wealth quantile category, and being head, wife, daughter, and in-law to the household head were the significantly associated with pregnancy termination. Taking these socio-economic factors into consideration by stakeholders and specific sexual education targeted to women aged 15 to 29 would help tackle the problem.

Resilience in the time of crisis: A review of the maternal, perinatal and reproductive health effects of COVID-19 in South Africa

Background. The COVID‐19 pandemic had a profound effect on the health sector globally and in South Africa (SA). Objective. To review the effects of COVID‐19 on maternal, perinatal and reproductive health outcomes and service utilisation in SA. Methods. Three routine national data collection systems were sourced: the District Health Information System, the Saving Mothers reports of the National Committee on Confidential Enquiry into Maternal Deaths and the Saving Babies reports from the National Perinatal Morbidity and Mortality Committee using data from the Perinatal Problem Identification Program. Results. There were 35% and 8% increases in maternal and stillbirth mortality rates, respectively, in 2020 and 2021, which correlated with the COVID‐19 waves. However, in 2022, rates returned to pre‐COVID levels. Antenatal visits and facility births showed little change, but there was a shift to more rural provinces. The use of oral and injectable contraceptives and termination of pregnancy services decreased markedly in 2020 and 2021, with a sustained shift to long‐acting reversible contraceptives. The increase in maternal deaths was predominantly due to COVID‐19 respiratory complications, but also an increase in obstetric haemorrhage. Stillbirths increased significantly (10%) for birthweights between 2 000 g and 2 499 g, categorised mostly as unexplained stillbirths or preterm labour, but no increase in neonatal deaths was observed. Administrative avoidable factors increased by 24% in the 2020 ‐ 2022 triennium, but there was no increase in patient/community level or healthcare provider‐related avoidable factors during the pandemic years. Conclusion. COVID‐19 caused a marked increase in maternal death and stillbirth rates in 2020 and 2021 due to both direct effects of the virus and indirect effects on functioning of the health system. The continued, although modified, health‐seeking behaviour of women and the rapid return to pre‐COVID‐19 mortality rates demonstrates enormous resilience in women and the health system.

Were the 2022 Summer Heatwaves a Strong Cause of Europe’s Excess Deaths?

During the 2022 summer, Europe experienced heatwaves with record temperatures, and a study has argued that they caused about 62,000 deaths between 30 May and 4 September. The total number of excess deaths during the same period was about 137,000, indicating that the heatwaves were a substantial contributor. Not ruling out that explanation entirely, this paper argues that it was unlikely a strong cause. First, if the heatwaves were a strong cause of numerous deaths, one would assume that the older and deprived were relatively likely to die. However, during the 2022 summer heatwaves in England, which were claimed to have caused about 2900 deaths, the oldest age cohort did not have a higher excess death rate than the middle age cohort, and the excess death rate actually decreased with deprivation status. Moreover, Iceland had among Europe’s highest excess death rates during the summer, which cannot be attributed to heatwaves. During June, July, and August 2022, comparable southern hemisphere countries furthermore had high excess death rates, which cannot be attributed to heatwaves either, as it was during their winter. Also, Europe’s excess death rate was higher during the 2022–2023 winter than during the 2022 summer, and intuitively not attributed to heatwaves, but neither to cold weather, as that winter was abnormally mild. Finally, the paper discusses the puzzling issue that about 56% more women than men, relative to the population, presumably died from the heatwaves.

Quality assessment of oral antimalarial and antiretroviral medicines used by public health systems in Sahel countries

Malaria and Human Immunodeficiency Virus infections are among the top 10 causes of death in low income countries. Furthermore, many medicines used in these treatment areas are substandard, which contributes to the high death rate. Using a monitoring system to identify substandard and falsified medicines, the study aims to evaluate the quality of antimalarial and antiretroviral medicines in Sahel countries, assessing site conditions, compliance of medicines with pharmacopoeia tests, formulation equivalence with a reference medicine, and the influence of climate on quality attributes. Ultra Performance Liquid Chromatography methods for eight active pharmaceutical ingredients were validated following the International Conference for Harmonization guideline for its detection and quantification. Quality control consists of visual inspections to detect any misinformation or imperfections and pharmacopeial testing to determine the quality of pharmaceutical products. Medicines which complied with uniformity dosage units and dissolution tests were stored under accelerated conditions for 6 months. Artemether/Lumefantrine and Lopinavir/Ritonavir formulations failed uniformity dosage units and disintegration tests respectively, detecting a total of 28.6% substandard medicines. After 6 months stored under accelerated conditions (40 °C // 75% relative humidity) simulating climatic conditions in Sahel countries, some medicines failed pharmacopeia tests. It demonstrated the influence of these two factors in their quality attributes. This study emphasizes the need of certified quality control laboratories as well as the need for regulatory systems to maintain standards in pharmaceutical manufacturing and distribution in these countries, especially when medicines are transported to rural areas where these climatic conditions are harsher.

Patent ductus arteriosus management in very-low-birth-weight prematurity: a place for early surgery?

To evaluate neonatal outcomes based on treatment strategies and time points for haemodynamically significant patent ductus arteriosus (hsPDA) in very-low-birth-weight (VLBW) preterm infants, with a particular focus on surgical closure. This retrospective study included VLBW infants born between 2014 and 2021, received active treatment for hsPDA. Neonatal outcomes were compared between: (1) primary surgical closure vs primary ibuprofen, (2) early (<14th post-natal day) vs late primary surgical closure (≥14th post-natal day), and (3) primary vs secondary surgical closure after ibuprofen failure. Further analysis using 1:1 propensity score matching was performed. Logistic regression was conducted to analyze the risk factors for post-ligation cardiac syndrome (PLCS) and/or acute kidney injury (AKI). A total of 145 hsPDA infants underwent active treatment for closure. In-hospital death rate and severe bronchopulmonary dysplasia (BPD) were similar between the primary surgical closure group and primary ibuprofen group in 1:1 matched analysis. Severe BPD was significantly higher in late surgical closure group than in early primary surgical closure group with 1:1 propensity score matching (72.7% vs 40.9%, p=0.033). The secondary surgical closure group showed the mildest clinical condition, however, the probability of PLCS/AKI was highest (38.6%), compared to early (15.2%) or late primary surgical group (28.1%, p<0.001) especially in extremely premature infants (gestational age <28weeks). Surgical PDA closure is not inferior to pharmacological treatment. Timely decision and efforts should be made considering the harmful effect of prolonged PDA shunt exposure to minimize the risk of severe BPD and PLCS/AKI after surgical closure.

Estimation of cause-specific mortality in Rakai, Uganda, using verbal autopsy 1999-2019

ABSTRACT Background There are scant data on the causes of adult deaths in sub-Saharan Africa. We estimated the level and trends in adult mortality, overall and by different causes, in rural Rakai, Uganda, by age, sex, and HIV status. Objectives To estimate and analyse adult cause-specific mortality trends in Rakai, Uganda. Methodology Mortality information by cause, age, sex, and HIV status was recorded in the Rakai Community Cohort study using verbal autopsy interviews, HIV serosurveys, and residency data. We estimated the average number of years lived in adulthood. Using demographic decomposition methods, we estimated the contribution of each cause of death to adult mortality based on the average number of years lived in adulthood. Results Between 1999 and 2019, 63082 adults (15–60 years) were censused, with 1670 deaths registered. Of these, 1656 (99.2%) had completed cause of death data from verbal autopsy. The crude adult death rate was 5.60 (95% confidence interval (CI): 5.33–5.87) per 1000 person-years of observation (pyo). The crude death rate decreased from 11.41 (95% CI: 10.61–12.28) to 3.27 (95% CI: 2.89–3.68) per 1000 pyo between 1999–2004 and 2015–2019. The average number of years lived in adulthood increased in people living with HIV and decreased in HIV-negative individuals between 2000 and 2019. Communicable diseases, primarily HIV and Malaria, had the biggest decreases, which improved the average number of years lived by approximately extra 12 years of life in females and 6 years in males. There were increases in deaths due to non-communicable diseases and external causes, which reduced the average number of years lived in adulthood by 2.0 years and 1.5 years in females and males, respectively. Conclusion There has been a significant decline in overall mortality from 1999 to 2019, with the greatest decline seen in people living with HIV since the availability of antiretroviral therapy in 2004. By 2020, the predominant causes of death among females were non-communicable diseases, with external causes of death dominating in males.