Deaths In Rural Areas Research Articles

A Cross-sectional Study to Evaluate Causes of Maternal Mortality in Rural Areas of Punjab, India

Introduction: Maternal mortality is an index of reproductive health of the society. In India illiteracy, late referrals, low socio-economic status of the community and direct causes are responsible for high incidence of maternal deaths which contributes to one-fifth of the global burden. Aim: To evaluate the causes of maternal death in rural areas of Punjab. Materials and Methods: The present retrospective cross-sectional study was conducted in 10 districts of Punjab, India chosen from five different zones i.e., east, west, north, south and central zone for a period of one year from 2016 to 2017. Information of all the deaths was taken from the civil surgeon office of the chosen district and then data of maternal deaths occurring within 42 days of delivery was collected by visiting patient’s residence and verbal autopsy was conducted. The data was collected and entered in predesigned proforma and percentages were calculated in Microsoft Excel version 2016. Results: A total of 67 maternal deaths were noted from above five zones, out of total rural population of 94,59,553. Maximum (n=51) maternal deaths were between age range of 20-30 years. Of these 67, majority 29 (43.28%) were illiterate, 66 (98.5%) women belonged to middle and low socio-economic status, 55 (82.1%) deaths occurred in the postnatal period, 33 (49.25%) occurred at more than 37 weeks period of gestation and 51 (76.12%) were due to direct causes. Out of 67 deaths, haemorrhage (n=29) was the most common cause. Anaemia contributed to 16.7% (11) as an indirect cause of maternal death. Conclusion: The maximum maternal deaths were contributed by illiterate women from middle and low socio-economic status. The most common cause was postpartum haemorrhage followed by pre-eclampsia/eclampsia.

Modern Contradictions and Prospects for the Development of Non-Urban (Rural) Territories

The article is devoted to the problems of the current state and prospects for the development of rural areas of the Russian Federation. The issues of the integrated development of rural areas are currently acquiring special relevance. The main factors in the development of non-urban areas are associated with the political, economic and social development strategy of the country. Considering the dynamics of changes in the number of municipalities, we observe a decrease in the number of rural settlements. The main reasons of this situation are considered: a decrease in the rural population, a decrease in the number of births in the countryside, an annual decline in natural population growth, an increase in deaths in rural areas. The existence of many problems of life in villages and villages is confirmed by a sociological survey of rural residents. The existing system for managing the development of rural areas definitely has positive results, but mainly where production has been preserved and operates. Enterprises that perform production activities in the countryside are most often city-forming. They help the municipality to solve economic and social problems. These organizations participate in program projects for the development of the territory with their own share of co-financing. They are primarily interested in creating decent living conditions in the countryside, an influx of population into rural areas, an increase in the number of ablebodied people and jobs. We have identified the main contradictions that hinder the integrated development of non-urban areas, contribute to the outflow of rural residents and the extinction of villages. But it is the “Population” indicator that is one of the determining ones when calculating subsidies in the territory for equalizing the budget, for solving issues of local importance related to the construction and repair of schools, maintenance of roads, maintenance of housing and communal services, provision of drinking water, etc. The article identifies the main directions for the further development of rural areas in order to enhance the socio - economic situation in the countryside.

Changes in causes and age of death in an eastern German county over a period of 14 years. Comparison of rural and urban populations. Focus on COPD and ischemic heart disease

We aimed to determine whether the causes of death, age of death and burden of disease have changed in the last years and whether there are differences between males and females as well as urban and rural populations. We investigated the causes of death, comorbidities and age of death as a cross-sectional study of an entire Thuringian county (approximately 100,000 inhabitants; 5 small cities with a total of 63,050 inhabitants and about 36,950 inhabitants in the countryside) for a 14-year period. All death certificates that were issued between 2002 and 2015 were reviewed for a total of 18,868 cases. The data were checked, and causes of death were coded by ICD-10 code. Because traditionally most corpses are cremated in Germany, in 79.68% of all cases a second inspection of the corpse by a pathologist, forensic pathologist or coroner was carried out for clarification of the cause of death according to the Thuringian laws. During the 14-year period, the age of death increased from 70.61 years to 74.49 years for males and from 78.94 years to 82.44 years for females. While in most of the investigated diseases the age of death also increased in parallel to the average age of death, an antiparallel development was found for COPD: the age of death for males with COPD was reduced by 0.045 years and for females by 0.15 years during the observation period. The burden of disease as measured by disability-adjusted life years (DALY) also steadily increased for COPD in both genders. The highest number of lost years of life was found for lung/bronchial cancer in both genders and for breast cancer. The highest burden of disease was calculated for ischemic heart disease in men and breast cancer in women. In general, the age of death in rural areas was nearly the same as in urban areas. Only for death from ischemic heart disease was there an increase in the age of death for men living in rural areas after the opening of a local cardiac catheterization laboratory in 2008. In all cases men exhibited an earlier age of death than women. While in all other investigated diseases the age of death increased, it dropped for COPD. COPD seems to have become a more frequent cause of death in recent years.

Tetanus Neonatorum in the Bethesda Hospital Y ogyakarta

Thirty cases of tetanus neonatorum admitted to the Bethesda Hospital Yogyakarta, from January through December 1974, were analyzed. Twenty seven cases (90%) were born at home attended by traditional midwives, 2 (6.7%) were delivered at home attended by midwives while 1 (3.3%) was born in the obstetric ward of the hospital. The fatality rate is high. The possible cause of neonatal tetanus in these cases might be the delivery at home by traditional midwives and the application of contaminated materials such as traditional medicines on the umbilical stump. Tetanus neonatorum is an important cause of neonatal death in rural areas. The cost of treatment of tetanus neonatorum is much higher than the cost of antenatal tetanus immunization, which is one of the practical effective and safe methods in preventing tetanus neonatorum.

Unintentional injury mortality among children under age five in urban and rural areas in the Sichuan province of west China, 2009\u20132017

This study analysed trends in the unintentional injuries specific mortality rates among children under age five (UI-specific U5MRs) in urban and rural areas in the Sichuan province of western China. Data were obtained from the National Health Statistics Survey System. The Cochran-Armitage trend test was used to analyse the trends in UI-specific U5MRs and the proportion of unintentional injury deaths to total deaths. The Poisson regression model was used to compare the UI-specific U5MRs between rural and urban areas. The overall UI-specific U5MRs decreased from 3.8 to 1.7 per 1,000 live births from 2009 to 2017, with an average annual decline in the rates of 8.78% and 10.05% in urban and rural areas, respectively. The UI risk of death in rural areas was approximately 1.95 times that in urban areas (95% CI: 1.73–2.18; p < 0.01). A total of 49.9% of all the children in the study did not receive any treatment before death caused by UI. The UI-specific U5MRs significantly declined in Sichuan province from 2009 to 2017, but large disparities in UI-specific U5MRs in urban and rural areas still exist. Reducing the U5MRs due to UI should be a major public health concern in western China.

Primary health care among rural pregnant women in China: achievements and challenges in maternal mortality ratio.

The maternal mortality ratio (MMR) is not only an important indicator of maternal and infant safety, but also a sign of the development of economy, education, and medical care in a country. In the last 60 years, the Chinese government has implemented various strategies and policies to reduce the MMR, especially in the rural areas. This study aimed to discuss the strategies developed by the Chinese government, showing the successful experience of Chinese intervention programs and highlighting the challenges to the government in the context of current economic and social status. This study probed into the Chinese government's efforts and achievements in the MMR reducing by reviewing the relevant health policies, extracting the data from China Health Statistics Yearbook of 2015, analyzing the reduction of maternal death in rural areas and the major causes from 1991 to 2015, comparing the MMR trend in urban and rural areas, and discussing the changes of the situation in China. Although it seems that Chinese government's efforts have brought evangel to the rural pregnant women and significantly reduced rural maternal mortality, the government still needs to develop more equitable and flexible primary health care policies to narrow the imbalance in health resource allocation and pay more attention to the health care for the rural-to-urban migration in China.

Perinatal Deaths in Rural a Health Area, Case of the Health District of Kadiolo, Mali

The perinatal mortality is a public health issue in developing countries. In fact, the perinatal death rate seems the highest in a Malian rural area. The objective of this work was to study the perinatal mortality in a rural area of Mali (Kadiolo). Methodology: It was a cross-sectional descriptive study conducted in Kadiolo over 12 months. The study took place from April 1, 2016 to March 31, 2017. We have included in our study all dead fetuses in gestational age ≥ 28 weeks of amenorrhea (WA) or weight ≥ 500 grams (g) and infants died during the first week of life. Mothers who have experienced a perinatal death were included. Results: During the 12 months of study period, we have recorded a total of 2212 births out of which we have collected 205 perinatal deaths, a perinatal mortality rate of 205/2212 with 93 per 1000. The stillbirth rate was 152/2212 with 69‰ and the early neonatal mortality rate was 53/2212 with 24‰. The sociodemographic characteristic of the patients was: patient who has been evacuated 71.70%, unschooled 77.1%, coming out of the city Kadiolo 76%, young women 65% and patient who did not receive antenatal care 35%. Conclusion: Our study confirms the high rates of perinatal deaths in rural areas. The implementation of a coherent and efficient care strategy should help in reducing the still high rates.

Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan and Nonmetropolitan Areas - United States.

Problem/ConditionDrug overdoses are a leading cause of injury death in the United States, resulting in approximately 52,000 deaths in 2015. Understanding differences in illicit drug use, illicit drug use disorders, and overall drug overdose deaths in metropolitan and nonmetropolitan areas is important for informing public health programs, interventions, and policies.Reporting PeriodIllicit drug use and drug use disorders during 2003–2014, and drug overdose deaths during 1999–2015.Description of DataThe National Survey of Drug Use and Health (NSDUH) collects information through face-to-face household interviews about the use of illicit drugs, alcohol, and tobacco among the U.S. noninstitutionalized civilian population aged ≥12 years. Respondents include residents of households and noninstitutional group quarters (e.g., shelters, rooming houses, dormitories, migratory workers’ camps, and halfway houses) and civilians living on military bases. NSDUH variables include sex, age, race/ethnicity, residence (metropolitan/nonmetropolitan), annual household income, self-reported drug use, and drug use disorders.National Vital Statistics System Mortality (NVSS-M) data for U.S. residents include information from death certificates filed in the 50 states and the District of Columbia. Cases were selected with an underlying cause of death based on the ICD-10 codes for drug overdoses (X40–X44, X60–X64, X85, and Y10–Y14). NVSS-M variables include decedent characteristics (sex, age, and race/ethnicity) and information on intent (unintentional, suicide, homicide, or undetermined), location of death (medical facility, in a home, or other [including nursing homes, hospices, unknown, and other locations]) and county of residence (metropolitan/nonmetropolitan).Metropolitan/nonmetropolitan status is assigned independently in each data system. NSDUH uses a three-category system: Core Based Statistical Area (CBSA) of ≥1 million persons; CBSA of <1 million persons; and not a CBSA, which for simplicity were labeled large metropolitan, small metropolitan, and nonmetropolitan. Deaths from NVSS-M are categorized by the county of residence of the decedent using CDC’s National Center for Health Statistics 2013 Urban-Rural Classification Scheme, collapsed into two categories (metropolitan and nonmetropolitan).ResultsAlthough both metropolitan and nonmetropolitan areas experienced significant increases from 2003–2005 to 2012–2014 in self-reported past-month use of illicit drugs, the prevalence was highest for the large metropolitan areas compared with small metropolitan or nonmetropolitan areas throughout the study period. Notably, past-month use of illicit drugs declined over the study period for the youngest respondents (aged 12–17 years). The prevalence of past-year illicit drug use disorders among persons using illicit drugs in the past year varied by metropolitan/nonmetropolitan status and changed over time. Across both metropolitan and nonmetropolitan areas, the prevalence of past-year illicit drug use disorders declined during 2003–2014.In 2015, approximately six times as many drug overdose deaths occurred in metropolitan areas than occurred in nonmetropolitan areas (metropolitan: 45,059; nonmetropolitan: 7,345). Drug overdose death rates (per 100,000 population) for metropolitan areas were higher than in nonmetropolitan areas in 1999 (6.4 versus 4.0), however, the rates converged in 2004, and by 2015, the nonmetropolitan rate (17.0) was slightly higher than the metropolitan rate (16.2).InterpretationDrug use and subsequent overdoses continue to be a critical and complicated public health challenge across metropolitan/nonmetropolitan areas. The decline in illicit drug use by youth and the lower prevalence of illicit drug use disorders in rural areas during 2012–2014 are encouraging signs. However, the increasing rate of drug overdose deaths in rural areas, which surpassed rates in urban areas, is cause for concern.Public Health ActionsUnderstanding the differences between metropolitan and nonmetropolitan areas in drug use, drug use disorders, and drug overdose deaths can help public health professionals to identify, monitor, and prioritize responses. Consideration of where persons live and where they die from overdose could enhance specific overdose prevention interventions, such as training on naloxone administration or rescue breathing. Educating prescribers on CDC’s guideline for prescribing opioids for chronic pain (Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep 2016;66[No. RR-1]) and facilitating better access to medication-assisted treatment with methadone, buprenorphine, or naltrexone could benefit communities with high opioid use disorder rates.

Strengthening the primary care workforce to deliver community case management for child health in rural Indonesia.

Objectives The aim of the present study was to report on the implementation of community case management (CCM) to reduce infant mortality in a rural district, namely Kutai Timur, Kalimantan Indonesia. Methods An interpretive qualitative methodology was used. In-depth interviews were conducted with 18 primary healthcare workers (PHCWs), and PHCWs were observed during a consultation with mothers to gain insight into the delivery of the new protocol and workforce issues. The field notes and interview transcripts were analysed thematically. Results PHCWs reported that their performance had improved as a result of increased knowledge and confidence. The implementation of CCM had also reportedly enhanced the PHCWs' clinical reasoning. However, the participants noted confusion surrounding their role in prescribing medication. Conclusions CCM is viewed as a useful model of care in terms of enhancing the capacity of rural PHCWs to provide child health care and improve the uptake of life-saving interventions. However, work is needed to strengthen the workforce and to fully integrate CCM into maternal and child health service delivery across Indonesia. What is known about the topic? Indonesia has successfully reduced infant mortality in the past 10 years. However, concerns remain regarding issues related to disparities between districts. The number of infant deaths in rural areas tends to be staggeringly high compared with that in the cities. One of the causes is inadequate access to child health care. What does this paper add? CCM is a model of care that is designed to address childhood illnesses in limited-resource settings. In CCM, PHCWs are trained to deliver life-saving interventions to sick children in rural communities. In the present study, CCM improved the capacity of PHCWs to treat childhood illnesses. What are the implications for practitioners? CCM can be considered to strengthen PHCWs' competence in addressing infant mortality in areas where access to child health care is challenging. Policy regarding task shifting needs to be examined further so that CCM can be integrated into current health service delivery in Indonesia.

An analysis of Malaysia road traffic death distribution by road environment

Various initiatives, strategies and programmes have been taken by the Government of Malaysia to resolve issues pertaining to road traffic deaths. Nevertheless, the implementation of the programmes outlined in Malaysian Road Safety Plan 2006 needs to be enhanced in order to achieve the set targets. In this regard, it is imperative for all parties concerning road safety to determine the factors that significantly contribute to road traffic deaths. According to the Ministry of Works, Malaysia, the blackspot treatment programme (which is centred on the elimination of road hazards by engineering approaches) is successful in reducing the number of injuries due to road traffic accidents up to a certain extent. This study is focussed on analysing road traffic deaths caused by various road environment elements recorded by the police from 2000 to 2011 in order to determine their distribution, proportion and relationship with fatal accidents. The Chi-square test and Marascuilo procedure with 5% level of significance are used in this study. Based on locality, the number of road traffic deaths in rural area (66%) is significantly higher compared with that in urban areas (34%). Based on road category, the number of road traffic deaths is the highest for federal roads, whereas the highest rate of fatalities per kilometre is recorded for expressways. Based on road segment, the number of road traffic deaths is the highest for straight road segments, followed by bends. In addition, the number of road traffic deaths is the highest for Y/T junctions, followed by cross junctions. The lowest number of road traffic deaths is recorded for interchanges and roundabouts. The results show that only 11.25% of the total road traffic deaths are related to road defects. The highest proportion of deaths due to road defects (48.6%) is associated with lack of street lighting provision, whereas road shoulder edge drop-off and potholes contribute 15.4% and 11.2% of road traffic deaths, respectively.

To study hematological profile in malaria patients

Background: Malaria has been a problem in India for centuries and it is responsible for many deaths in rural areas. This study was done to observe hematological profile in malaria patients and to study the incidence of complications in different species of malaria patients and to find any relation with hematological changes.Methods: The study was conducted at MLN Medical College, Allahabad in the Department of Medicine between January 2016 to December 2016. One hundred consecutive patients aged 18 years or more with malaria fever were interviewed and examined.Results: Out of 100 patients 26 patients had Plasmodium vivax malaria and 59 patients had Plasmodium falciparum infection while 15 patients had mixed PV and PF infection. In present study thrombocytopenia was most common hematological abnormality. Thrombocytopenia was present in 87 patients, out of them 18 had very severe thrombocytopenia while 69 had mild to moderate thrombocytopenia. Frank bleeding was present in 14 of total studied population and had both PV and PF infection. Petechial rashes were present in 10 patients. Anemia was present in 80 patients.Conclusions: Thrombocytopenia is very frequent finding in patients suffering from malaria, and even in presence of thrombocytopenia bleeding manifestations are uncommon. So, platelet transfusion should not be performed routinely in all thrombocytopenia patients, rather it should be indicated only if bleeding manifestations are present. Anemia, pancytopenia and leucopenia are other frequent laboratory findings of malaria infection.

Socioeconomic inequalities in neonatal and postneonatal mortality: Evidence from rural Iran, 1998\u20132013

BackgroundOver the past three decades, interventions have been implemented to reduce childhood mortality in Iran. Despite declines in overall mortality rates, inequalities in mortality across socioeconomic groups have remained unchanged. In this study, we assessed inequalities in infant mortality in rural regions of Iran.MethodsWe obtained data from the Iranian vital registration system, which includes data on 5,626,158 live births, 79,457 neonatal deaths, and 36,397 postneonatal deaths in rural areas of Iran over the course of a 16-year period, which was then divided into 4 four-year intervals. In addition to building multivariate regression models to identify factors associated with mortality, we calculated a concentration index for each province to measure inequalities in neonatal and postneonatal mortality, using wealth index as the socioeconomic variable of interest. We further assessed these inequalities as a component of their contributors by using the decomposition method.ResultsAlthough both neonatal (17.62 to 10.92) and postneonatal (8.11 to 5.14) mortality rates exhibited decreasing trends from 1998-2001 to 2010–2013, the inequalities observed in these indices remained nearly unchanged (concentration indices of −0.062 to −0.047 and −0.098 to −0.083, respectively). Furthermore, fraction of births occurred in hospitals and literate women contributed positively to the inequalities observed in both neonatal and postneonatal mortality rates, whereas the proportion of infants classified as low birth weight contributed negatively over all study periods. We also identified decreasing trends in inequalities of the proportion of infants classified as having low birth weight, being born in hospitals, being covered by health insurance, mothers’ age, and literacy of women within the time intervals under study.ConclusionsAlthough infant mortality rates in Iran decreased over the studied time period, we observed notable inequalities in these measures. Several steps are needed to overcome these inequalities, including improving access to professional health services for lower income households, fairly distributing facilities and human resources, and improving insurance coverage to protect families from financial hardships. Moreover, social factors, such as literacy of women, were found to be important in decreasing inequalities in infant mortality. These steps require improving societal awareness of infant mortality and implementing improved and problem-oriented health policies.

Association of Serum Creatinine and Electrolyte Abnormalities in Preterm Low Birth Weight Neonates

Introduction: Being born prematurely is a threat to survival and the subsequent quality of life ICDDR,B Health and Science Bulletin published in March 2006 reported that prematurity and low birth weight contributes to 27.8% of neonatal deaths in rural areas of Bangladesh Premature infant are at increased risk of developing dehydration or over hydration. Therefore, high index of suspicion, prompt recognition and thorough understanding of common electrolyte abnormalities are necessary to improve neonatal outcome. The investigation of renal function in pretenn neonate is complicated because of continuing renal development, rise in creatinine is transient and may not be clinically significcmt. Serum creatinine is most widely used marker of renal function in adults and children but its validity as a marker of GFR/ renal function is doubtful a few studies have been conducted on assessment of renal function and electrolytes in the context of prematurity in Bangladesh. But it seems to be essential for immediate management for planning appropriate fluid and electrolyte therapy and thereby for improved outcome. Information was collected who gave consent and participated in the study willingly. The sample size was 50. Duration of data collection was approximately 6 (Six) months.Patients admitted to the Holy Family Red Crescent Medical College and hospital and after meeting the inclusion and exclusion criteria a simple random sampling technique was applied for selecting the sample patients. Total 50 pretenn LBW neonates fulfilling the inclusion criteria were studied during this study period. Mean creatinine level was .82 mmoKrange was 0.40-1.90 mg/d1. Abnormal electrolytes were documented in 20(40%) pretenn LBW neonates of which hyperkalemia was the predominant electrolyte abnormality found in 8(16.0%) neonates, hyponatremia was found in 7 (14.0%), hypokalemia in 3 (6.0%) and hypernatremia 2 (4.0%). In the present study 20 of preterm LBW babies have electrolyte abnormalities. Hyperkalemia was found in 8(16.0%) babies in this study from above findings it is evident that prematurity causes transient renal impairment, in preterm neonates which is inversely related to gestational age. Renal impairment should be suspected if the serum creatinine rises or fails to show normal post-natal fall. It was observed that electrolyte abnormalities are common in preterm LBW neonates and transient renal failure also occurs in a large number of preterm LBW babies. So, identification of renal failure and associated electrolyte abnormalities and proper management of fluid and electrolytes and close monitoring are important.

National and subnational all-cause and cause-specific child mortality in China, 1996-2015: a systematic analysis with implications for the Sustainable Development Goals.

SummaryBackgroundChina has achieved Millennium Development Goal 4 to reduce under-5 mortality rate by two-thirds between 1990 and 2015. In this study, we estimated the national and subnational levels and causes of child mortality in China annually from 1996 to 2015 to draw implications for achievement of the SDGs for China and other low-income and middle-income countries.MethodsIn this systematic analysis, we adjusted empirical data on levels and causes of child mortality collected in the China Maternal and Child Health Surveillance System to generate representative estimates at the national and subnational levels. In adjusting the data, we considered the sampling design and probability, applied smoothing techniques to produce stable trends, fitted livebirth and age-specific death estimates to natvional estimates produced by the UN for international comparison, and partitioned national estimates of infrequent causes produced by independent sources to the subnational level.FindingsBetween 1996 and 2015, the under-5 mortality rate in China declined from 50·8 per 1000 livebirths to 10·7 per 1000 livebirths, at an average annual rate of reduction of 8·2%. However, 181 600 children still died before their fifth birthday, with 93 400 (51·5%) deaths occurring in neonates. Great inequity exists in child mortality across regions and in urban versus rural areas. The leading causes of under-5 mortality in 2015 were congenital abnormalities (35 700 deaths, 95% uncertainty range [UR] 28 400–45 200), preterm birth complications (30 900 deaths, 24 200–40 800), and injuries (26 600 deaths, 21 000–33 400). Pneumonia contributed to a higher proportion of deaths in the western region of China than in the eastern and central regions, and injury was a main cause of death in rural areas. Variations in cause-of-death composition by age were also examined. The contribution of preterm birth complications to mortality decreased after the neonatal period; congenital abnormalities remained an important cause of mortality throughout infancy, whereas the contribution of injuries to mortality increased after the first year of life.InterpretationChina has achieved a rapid reduction in child mortality in 1996–2015. The decline has been widespread across regions, urban and rural areas, age groups, and cause-of-death categories, but great disparities remain. The western region and rural areas and especially western rural areas should receive most attention in improving child survival through enhanced policy and programmes in the Sustainable Development Goals era. Continued investment is crucial in primary and secondary prevention of deaths due to congenital abnormalities, preterm birth complications, and injuries nationally, and of deaths due to pneumonia in western rural areas. The study also has implications for improving child survival and civil registration and vital statistics in other low-income and middle-income countries.FundingBill & Melinda Gates Foundation.

Pattern of Homicidal Deaths among Autopsied Cases at BIMS, Belagavi-a Two Year Retrospective Study

A retrospective study was conducted at the Department of Forensic Medicine & Toxicology, BIMS, Belagavi to determine the pattern of Homicidal deaths among cases autopsied at BIMS-Hospital mortuary for period of 2 years from Jan 1st 2011 to Dec. 31st 2012. During the above said period of 2 years a total number of 1541 cases were autopsied out of which 55 cases were homicidal in nature (3.56%). Majority of victims fall in the age group of 20–29 yrs, 22 cases (40%). Sex wise distribution showed male preponderance with 32 cases (58.18%). In the present study number of Homicidal deaths in rural areas were more, 36 (65.41%). Among pattern of injuries observed death being caused by sharp weapon inflicts were maximum, 19 cases (34.5%). As per information obtained from Police records property dispute seemed to be main motive, 16 cases, (29%) followed closely by illicit relationship, 12(21.8%).

The epidemiological transition of first-ever stroke among low-income population in China: a population-based study from 1992 to 2014

BackgroundStroke is the leading cause of death in rural areas and the third cause of death in urban areas in China, but the epidemiological transition of stroke during periods of rapid economic development is unknown in China, especially in rural areas. We aimed to investigate the secular trends in incidence, prevalence, and the 30-day case fatality of first-ever stroke in rural China between 1992 and 2014. MethodsWe assessed the secular trends in the epidemiological transition of stroke in Tianjin, China. The study population was from the Tianjin Brain Study, a population-based stroke surveillance study among low-income residents in a township in Tianjin, China, where stroke events and all deaths have been registered annually from 1992 to 2014. We used data from the Tianjin Brain Study to estimate case-fatality rates, the age-standardised incidence and prevalence of first-ever stroke per 100 000 population with the world standardisation population. Trends in age-standardised incidence and prevalence of stroke were assessed from annual percentage of change by sex and subtypes using the regression model: log(rt)=a+bt, where log denotes the natural logarithm and t is the year, and 100b represents the estimated annual percentage of change. FindingsBetween 1992 and 2014, the age-standardised incidence of first-ever stroke per 100 000 population increased annually by 6·3% overall, by 5·5% in men, and by 7·8% in women (p<0·0001); the case fatality decreased annually by 3·9% overall (p=0·024) and by 6·0% in women (p=0·015), but did not change in men (p=0·072). Simultaneously, the age-standardised prevalence of first-ever stroke per 100 000 population increased annually by 10·6% overall, by 9·9% in men, and by 11·5% in women (p<0·0001). With respect to stroke subtypes, the age-standardised incidence of first-ever stroke from intracerebral haemorrhage increased annually by 4·6% overall (p=0·022), by 3·5% in men (p=0·009), and by 4·8% in women (p=0·016), whereas the incidence of ischaemic stroke increased annually by 7·2% overall, by 6·6% in men, and by 8·3% in women (p<0·0001). The corresponding prevalence of intracerebral haemorrhage increased annually by 8·0% overall, 7·0% in men, and 9·9% in women, whereas the prevalence of ischaemic stroke increased annually by 11·4% overall, by 10·9% in men, and by 12·4% in women. InterpretationThe epidemiological transition of stroke was found among a low-income population in China. The incidence and prevalence of stroke from intracerebral haemorrhage and ischaemic stroke increased rapidly in both men and women. These findings suggest that it is crucial to prevent stroke among low-income population in China to reduce the burden of disease worldwide. FundingThe Ministry of Science and Technology of the People's Republic of China and National Key Project of Clinical Neurology, Tianjin Medical University General Hospital.

Why Was Infant Mortality So High in Eastern England in the Mid Nineteenth Century?

This paper re-examines the high rates of infant mortality observed in rural areas of eastern England in the early years of civil registration. Infant mortality rates in some rural registration districts in the East Riding of Yorkshire, Cambridgeshire and Norfolk were higher than those in the mill towns of Lancashire. After describing the areas affected, this paper considers three potential explanations: environmental factors, poor-quality child care associated with the employment of women in agriculture, and the possibility that the high rates were the artefactual consequence of migrant women workers bringing their children to these areas. These explanations are then assessed using a range of evidence. In the absence of reliable cause of death data, recourse is had to three alternative approaches. The first involves the use of the exceptionally detailed tabulations of ages at death within the first year of life provided in the Registrar General's Annual Reports for the 1840s to assess whether the 'excess' infant deaths in rural areas of eastern England happened in the immediate post-natal period or later in the first year of life. Second, data on the seasonality of mortality in the 1840s are examined to see whether the zone of 'excess' infant mortality manifested a distinctive seasonal pattern. Finally, a regression approach is employed involving the addition of covariates to regression models. The conclusion is that no single factor was responsible for the 'excess' infant mortality, but a plausible account can be constructed which blends elements of all three of the potential explanations mentioned above with the specific historical context of these areas of eastern England.

Reversible Myocarditis and Pericarditis after Black Widow Spider Bite or Kounis Syndrome?

Clinical manifestation of black widow spider bite is variable and occasionally leads to death in rural areas. Cases of myocarditis and pericarditis after black widow spider bite are rare and the associated prognostic significance is unknown. Kounis syndrome has been defined as an acute coronary syndrome in the setting of allergic or hypersensitivity and anaphylactic or anaphylactoid insults that manifests as vasospastic angina or acute myocardial infarction or stent thrombosis. Allergic myocarditis is caused by myocardial inflammation triggered by infectious pathogens, toxic, ischemic, or mechanical injuries, such as drug-related inflammation and other immune reactions. A 15-year-old child was admitted to the emergency department with pulmonary edema after spider bite. ST segment depression on ECG, elevated cardiac enzymes and global left ventricular hypokinesia (with ejection fraction of 22%), and local pericardial effusion findings confirmed the diagnosis of myopericarditis. After heart failure and pulmonary edema oriented medical therapy, clinical status improved. Patient showed a progressive improvement and LV functions returned to normal on the sixth day. Myopericarditis complicating spider bite is rare and sometimes fatal. The mechanism is not clearly known. Alpha-latrotoxin of the black widow spider is mostly convicted in these cases. But allergy or hypersensitivity may play a role in myocardial damage.

Pattern of Unnatural Female Deaths in Rural Area of Western Maharashtra

Unnatural deaths may be accidental, suicidal, homicidal or undetermined. The cause of death profile is an important set of public health information and forms the cornerstone of the health information system. This study was carried out to understand the pattern of unnatural deaths among females in rural area of western Maharashtra. Most of the females were married (73.46%). The most common age group affected was 21 - 30 years (34.69%) followed by 31 - 40 years (24.48%). Considering manner of death accidental death was reported in 69.38% cases followed by suicidal deaths. Among accident cases head injury due to road traffic accident was most common cause of death. The most common method for suicide was hanging which is followed by poisoning.

Illicit Fentanyl use in Rural Australia – An Exploratory Study

Introduction and Aims: Australia has seen an increase in the non-medical use of fentanyl transdermal patches (FTP) and associated deaths, with an over-representation of deaths in rural areas. Non-medical use of FTP involves high risk preparation and administration methods. However, no rural Australian drug user-focused research has been published to date. Frontline workers are without up-to-date harm reduction information. This study aimed to explore the perceptions and experiences of individuals using FTP for non-medical purposes. Design and method: Interviews were conducted with adult participants (n=12) who had injected FTP twice or more and resided in regional/rural NSW or Victoria. The thematic data analysis identified key points around participant’s harm reduction practices, perceptions and experiences with using FTP. Results: Fentanyl was easily obtained in rural locations. Study participants described high risk preparation and administration methods. Misinformation shared across peer networks was likely to contribute to overdose. Discussion and Conclusion: Beliefs and practices about obtaining and using fentanyl are transmitted and reproduced across groups of illicit drug users, amplifying and distorting information about methods and harms of fentanyl use. However, fentanyl injectors were experienced illicit drug users who perceived they had good knowledge of ways to use fentanyl safely in spite of knowing people who had died from overdose. It is unlikely this group would seek out harm reduction information. Peer networks are critical sites of harm reduction action that are challenging to infiltrate in the rural context where dispersed populations, distance and risks associated with disclosing illicit drug use are significant barriers to disseminating harm reduction information. Peer-to-peer education is a costeffective method of disseminating correct health information and harm reduction messages in dispersed and isolated populations.