Global Burden Of Mortality Research Articles

Maintaining Momentum for Rotavirus Immunization in Africa during the COVID-19 Era: Report of the 13th African Rotavirus Symposium.

The 13th African Rotavirus Symposium was held as a virtual event hosted by the University of Nairobi, Kenya and The Kenya Paediatric Association on 3rd and 4th November 2021. This biennial event organized under the auspices of the African Rotavirus Network shapes the agenda for rotavirus research and prevention on the continent, attracting key international and regional opinion leaders, researchers, and public health scientists. The African Rotavirus Network is a regional network of institutions initially established in 1999, and now encompassing much of the diarrheal disease and rotavirus related research in Africa, in collaboration with the World Health Organization African Regional Office (WHO-AFRO), Ministries of Health, and other partners. Surges in SARS-CoV2 variants and concomitant travel restrictions limited the meeting to a webinar platform with invited scientific presentations and scientific presentations from selected abstracts. The scientific program covered updates on burden of diarrheal diseases including rotavirus, the genomic characterization of rotavirus strains pre- and post-rotavirus vaccine introduction, and data from clinical evaluation of new rotavirus vaccines in Africa. Finally, 42 of the 54 African countries have fully introduced rotavirus vaccination at the time of the meeting, including the two recently WHO pre-qualified vaccines from India. Nonetheless, the full benefit of rotavirus vaccination is yet to be realized in Africa where approximately 80% of the global burden of rotavirus mortality exists.

Associations of exposure to multiple metals with blood pressure and hypertension: A cross-sectional study in Chinese preschool children

Exposure to metals might be a risk factor for hypertension, which contributes largely to the global burden of disease and mortality. However, relevant epidemiological studies of associations between metals exposure with hypertension among preschoolers are limited. This study aimed to explore the associations of urine metals with blood pressure and hypertension among Chinese preschoolers. A total of 1220 eligible participants who had urine metals measurement, blood pressure measurements, and relevant covariates were included in this cross-sectional study. Urine concentrations of metals were measured by inductively coupled plasma mass spectrometer. The single and multiple metals regression models were used to investigate the associations of urine metal with blood pressure and the risk of hypertension after adjusting for potential confounders. We observed urine concentrations of chromium, iron, and barium were negatively associated with levels of systolic blood pressure, diastolic blood pressure and the risk of hypertension in the single metal model (all P-FDR adjustment <0.05). Significant associations of urine chromium concentrations with systolic blood pressure, diastolic blood pressure and the risk of hypertension were found in the multi-metal model (β or OR (95% confidence interval) was −3.07 (−5.12, −1.02), −2.25 (−4.29, −0.22), and 0.51 (0.26, 0.97) for 3rd quartile, compared with 1st quartile, respectively). The same association was found for barium concentrations in the multi-metal model, while none of the associations among iron quartiles was significant. In addition, urine chromium, iron and barium may have joint effects on systolic blood pressure, diastolic blood pressure and hypertension. Children's age and body mass index could modify the associations of chromium, iron, and barium concentrations with blood pressure. Our findings suggested that exposure to chromium, iron, and barium was inversely associated with blood pressure and hypertension among preschool children. These findings need further validation in prospective studies.

An 11-Year Analysis of Bacterial Foodborne Disease Outbreaks in Zhejiang Province, China.

Background: Foodborne diseases are a growing public health problem and contribute significantly to the global burden of disease and mortality. Bacteria are the most common foodborne pathogens. We aimed to explore characteristics of bacterial foodborne disease outbreaks (FBDOs) in Zhejiang Province and to provide data support for foodborne disease prevention and control. Methods: Descriptive statistical methods were used to analyze the data reported by centers for disease control (CDCs) at all levels in Zhejiang Province through Foodborne Disease Outbreaks Surveillance System (FDOSS) during 2010–2020. Results: CDCs in Zhejiang Province reported 517 bacterial FBDOs in 11 years, resulting in 7031 cases, 911 hospitalizations, and 3 deaths. Vibrio parahaemolyticus had the highest number of outbreaks, accounting for 58.41% of the total bacterial outbreaks, followed by Salmonella (18.38%). In all settings, restaurants (37.14%), staff canteens (11.99%), and households (11.80%) were responsible for the large number of outbreaks. Aquatic products (42.08%), meat and meat products (23.56%), cereals (10.81%), and flour products (9.27%) were the most common single foods reported. Further analysis showed that the settings and food vehicles of outbreaks caused by different pathogens were different. Conclusions: Bacterial outbreaks are the most common type of FBDOs in Zhejiang Province. By analyzing the epidemiological characteristics of common pathogenic bacteria, we can identify the etiology, food, and setting that the government needs to focus on, and issue relevant targeted policies to reduce the number of FBDOs.

Worldwide Distribution, Risk Factors, and Temporal Trends of Testicular Cancer Incidence and Mortality: A Global Analysis

BackgroundTesticular cancer is a common malignancy among young males in western countries. ObjectiveTo examine the global disease burden and trends of testicular cancer incidence and mortality by age and country, and their associations with human development index (HDI), gross domestic product (GDP), lifestyle habits, and metabolic risk factors. Design, setting, and participantsWe retrieved the Global Cancer Observatory database for the testicular cancer incidence and mortality in 2020; the World Bank for GDP per capita; the United Nations for HDI; the WHO Global Health Observatory for prevalence of smoking and alcohol drinking; and the Cancer Incidence in Five Continents, WHO mortality database, Surveillance, Epidemiology, and End Results programme and Nordic Cancer Registries (NORDCAN) for trend analysis. Outcome measurements and statistical analysisWe presented the testicular cancer incidence and mortality using age-standardised rates. We examined their associations with HDI, GDP, smoking, alcohol drinking, physical inactivity, overweight, obesity, and medical conditions including diabetes, hypertension, and hypercholesterolaemia by linear regression. We estimated the 10-yr trend of incidence and mortality by joinpoint regression with average annual percentage change with 95% confidence intervals in different age groups. Results and limitationsThere was a wide variation in the testicular cancer burden with the highest mortality found in low-income countries, and the regions of Central America and South America, while the highest incidence was observed in high-income countries, especially in Western and Northern Europe. We found a positive association for HDI, GDP, alcohol drinking, inactivity, overweight, obesity, and hypercholesterolaemia with testicular cancer incidence, while a negative correlation was observed between GDP and mortality of testicular cancer. Globally, there was an overall increasing incidence trend of testicular cancer for the past decade, particularly in younger males; the mortality trends of testicular cancer were relatively stable. However, we did not analyse the trend of different stages and subtypes of testicular cancer due to data unavailability. ConclusionsThere was a global variation in the testicular cancer burden associated with HDI, GDP, alcohol drinking, inactivity, overweight, obesity, and hypercholesterolaemia. Testicular cancer had an increasing incidence but decreasing mortality. The increasing testicular cancer incidence in the younger population is of concern and calls for early detection and preventive interventions. Patient summaryGlobally, testicular cancer incidence had been increasing particularly in the younger population, although its deaths rates had been decreasing. Socioeconomic indices, alcohol drinking, inactivity, overweight, obesity, and high plasma lipid levels are associated with testicular cancer incidence and mortality.

Community based sensitization to address maternal and child health problems in tribal population of India

Background: India fights with substantial maternal and child health (MCH) concerns, accounting about one quarter of the global burden of maternal and childhood mortality. The current study was tried to assess the impact of community partnerships between medical students, community stakeholders (TBAs and local tribal girls) and general community members on their awareness levels about MCH care and services.Methods: a community-based pilot interventional study was conducted at one of the rural blocks of Maharashtra state of India. Of 120, sixty (50%) first year undergraduate MBBS medical students (intervention group) posted at two months rural healthcare training programme’ participated in preparing MCH related health education material (HEM) in local language. Similarly local tribal girls, TBAs and general community people were trained about MCH and their knowledge levels were assessed.Results: Pre and post training assessment scores of participants (students, TBAs, tribal girls and general people) indicated significant (p&lt;0.05) differences in their knowledge about MCH. The used approach of community collaborations in this study upgraded the knowledge of stakeholders (TBAs, tribal girls) and common tribal people about basic aspects of MCH and associated welfare schemes. The study also reported positive attitudes of all participants about an intervention.Conclusions: Productive and synergistic community partnerships can be created among health care providers, community health workers and other stakeholders to ensure commitment and engagement towards positive health.

Global and national burden and trends of mortality and disability-adjusted life years for silicosis, from 1990 to 2019: results from the Global Burden of Disease study 2019

BackgroundSilicosis, as an important type of pneumoconiosis, leads to progressive and irreversible conditions from the beginning of inflammation and fibrosis. However, the data on the global burden of silicosis and long-term trends were limited.MethodsDerived from the Global Burden of Disease study 2019 (online publicly available: Global Health Data Exchange), data on both crude and age-standardized rates (ASR) per 100,00 people of mortality and disability-adjusted life years (DALYs) due to silicosis was collected and analyzed. The burden and trends of mortality and DALYs due to silicosis was assessed by 204 countries and territories, by 5-year interval of age group and by sex from 1990 to 2019. And all the regions were divided into 5 categories according to Sociodemographic Index (SDI). Temporal trends in mortality and DALY were evaluated only to ASR by the Joinpoint regression model.ResultsMore than 12.9 thousand [95% Uncertainty Intervals (UI): 10.9, 16.2] death cases occurred due to silicosis worldwide, and 655.7 thousand (95% UI: 519.3, 828.0) DALYs were attributed to silicosis in 2019. From 1990 to 2019, global number of mortality and DALYs in countries with high SDI quintile decreased by 0.35% (95% UI: − 0.45, − 0.17) and 0.32% (95% UI: − 0.45, − 0.01), respectively. There was a greater burden in low- and middle-income countries were estimated in 2019 according to ASRs. The global number of mortality and DALYs among males accounted for over 95% of all in 2019. Both age-sex-specific mortality and DALY rate were increasing with aging and reached their peak at 85–89 age group. During the past 30 years, ASR of mortality and DALYs showed a decreasing trend with average annual percentage change at -3.0% [95% Confidence Intervals (CI): − 3.2, − 2.9] and − 2.0 (95% CI: − 1.7, − 2.2), respectively.ConclusionsSilicosis remains an important health issue and causes a potentially serious burden worldwide. Attention should be paid to making preventable, affordable and effective measures in lower SDI regions.

Addressing the global burden of paediatric critical COVID-19 and mortality

Addressing the global burden of paediatric critical COVID-19 and mortality

Global, regional, and national burden of mortality associated with short-term temperature variability from 2000–19: a three-stage modelling study

SummaryBackgroundIncreased mortality risk is associated with short-term temperature variability. However, to our knowledge, there has been no comprehensive assessment of the temperature variability-related mortality burden worldwide. In this study, using data from the MCC Collaborative Research Network, we first explored the association between temperature variability and mortality across 43 countries or regions. Then, to provide a more comprehensive picture of the global burden of mortality associated with temperature variability, global gridded temperature data with a resolution of 0·5° × 0·5° were used to assess the temperature variability-related mortality burden at the global, regional, and national levels. Furthermore, temporal trends in temperature variability-related mortality burden were also explored from 2000–19.MethodsIn this modelling study, we applied a three-stage meta-analytical approach to assess the global temperature variability-related mortality burden at a spatial resolution of 0·5° × 0·5° from 2000–19. Temperature variability was calculated as the SD of the average of the same and previous days’ minimum and maximum temperatures. We first obtained location-specific temperature variability related-mortality associations based on a daily time series of 750 locations from the Multi-country Multi-city Collaborative Research Network. We subsequently constructed a multivariable meta-regression model with five predictors to estimate grid-specific temperature variability related-mortality associations across the globe. Finally, percentage excess in mortality and excess mortality rate were calculated to quantify the temperature variability-related mortality burden and to further explore its temporal trend over two decades.FindingsAn increasing trend in temperature variability was identified at the global level from 2000 to 2019. Globally, 1 753 392 deaths (95% CI 1 159 901–2 357 718) were associated with temperature variability per year, accounting for 3·4% (2·2–4·6) of all deaths. Most of Asia, Australia, and New Zealand were observed to have a higher percentage excess in mortality than the global mean. Globally, the percentage excess in mortality increased by about 4·6% (3·7–5·3) per decade. The largest increase occurred in Australia and New Zealand (7·3%, 95% CI 4·3–10·4), followed by Europe (4·4%, 2·2–5·6) and Africa (3·3, 1·9–4·6).InterpretationGlobally, a substantial mortality burden was associated with temperature variability, showing geographical heterogeneity and a slightly increasing temporal trend. Our findings could assist in raising public awareness and improving the understanding of the health impacts of temperature variability.FundingAustralian Research Council, Australian National Health & Medical Research Council.

A Comparative Study on Bacterial Co-Infections and Prevalence of Multidrug Resistant Organisms among Patients in COVID and Non-COVID Intensive Care Units.

SummaryIntroductionSecondary bacterial infections have been reported in majority of patients hospitalized with coronavirus disease 2019 (COVID-19). A study of the antimicrobial susceptibility profiles of these bacterial strains revealed that they were multidrug resistant, demonstrating their resistance to at least three classes of antimicrobial agents including beta-lactams, fluoroquinolones and aminoglycosides. Bacterial co-infection remains as an important cause for high mortality in patients hospitalized with COVID-19.MethodsIn our study, we conducted a retrospective comparative analysis of bacterial co-infections and the antimicrobial resistance profile of bacterial isolates obtained from inpatients admitted in COVID-19 and non-COVID-19 intensive care units. The goal was to obtain the etiology and antimicrobial resistance of these infections for more accurate use of antimicrobials in clinical settings. This study involved a total of 648 samples collected from 356 COVID-19 positive patients and 292 COVID-19 negative patients admitted in the intensive care unit over a period of six months from May to October 2020.ResultsAmong the co-infections found, maximum antimicrobial resistance was found in Acinetobacter species followed by Klebsiella species in both the ICU’s. Incidence of bacterial co-infection was found to be higher in COVID-19 intensive care patients and most of these isolates were multidrug resistant strains.ConclusionTherefore, it is important that co-infections should not be underestimated and instead be made part of an integrated plan to limit the global burden of morbidity and mortality during the SARS-CoV-2 pandemic and beyond.

Individual and Community-Level Determinants of Institutional Delivery Services among Women in Bangladesh: A Cross-Sectional Study.

Background Improving maternal mortality attracts considerable interest with the critical invention through institutional delivery services (IDS) in reducing maternal death during delivery and ensuring safe childbirth. The influence of both individual and community-level factors is essential to using IDS. Problem Statement. Maternal death may occur at any time, but delivery without designated healthcare is by far the most dangerous time for both woman and her baby. Therefore, to combat the global burden of maternal mortality, it is necessary to ensure IDS worldwide. Objectives This study explores the current knowledge of individual and community-level covariates and examines their extent of influence on the utilization of IDS in Bangladesh. Methods Utilizing Bangladesh Demographic and Health Survey (BDHS) data, this study has used two-level random intercept binary logistic regression, together with the average annual rate of increase (AARI) in the utilization of IDS and related variables. Results This study found appreciable changes in seeking IDS, increases from 3.4% in 2007 to 51.9% in 2017, and half of the total deliveries (51%) took place in healthcare. About 26% of the total variation in the utilization of IDS is owing to differences across communities. Further, covariates including communities with higher educated women, higher utilization of ANC and access to media and at individual level, religion, maternal and parental education, wealth index, and mother-level factors (i.e., age at birth, BMI, occupation, ANC visit, birth order, own health care decision, pregnancy intention, and exposure to media) showed significant association with the utilization of IDS. Conclusion This study observed the association between individual and community-level factors and IDS uptake. Thus, any future strategies must address individual level and community-level challenges and undertake a multisectoral approach to enhance the uptake of IDS.

Perceived Vaccine Efficacy, Willingness to Pay for COVID-19 Vaccine and Associated Determinants among Foreign Migrants in China

Objectives: The COVID-19 public health crisis has increased the global burden of diseases and mortality. Hence, global vaccination becomes non-negotiable to support immunity to reduce morbidity and mortality burdens. The COVID-19 vaccine campaign hinges on health promotion and equitable distribution, especially among minority groups. Therefore, the current study investigated the determinants of perceived vaccine efficacy and willingness to pay among foreign migrants in China. Methods: The study appraised data from an online-based survey carried out among foreign migrants in mainland China through the WeChat platform. Data analysis was carried out through bivariate and multivariate logistic regression. Results: A total of 498 foreign migrants were recruited, with male 47.65%, female 45.2%, and other gender minority groups (7.15%). The study found that females, gender minorities, students, preference for alternative medicine, culture neutrality, belief against vaccination, and prefer free vaccination were less likely to pay for COVID-19 vaccination. Meanwhile, those whose families/relatives are opposed to vaccination and have good subjective health than others in their age group were less likely to believe in vaccine efficacy. Those who have received at least a dose of COVID-19 vaccine (AoR: 3.32, 95% CI: 1.94-5.58, p<0.001), believe vaccines are accessible (AoR: 2.40, 95% CI: 1.52-3.98, p<0.001) and have high perceived susceptibility to COVID-19 (AoR: 1.97, 95% CI: 1.18-3.28, p<0.01) were more likely to believe in vaccine efficacy. Conclusion: The research extends evidence on vaccination behavior among foreign migrant groups. Vaccination support among migrants should target indicators like culture, gender identity, psychological health, subjective health, and perceived severity to eradicate vaccine hesitancy and misinformation that can translate to increased vaccine participation among minority groups.

A five-year review of perinatal and maternal outcomes and their predisposing socio-demographic factors in a tertiary hospital in South-South Nigeria

Background: With a ‘Very High’ maternal mortality ratio (MMR) of 814 per 100,000 live births, Nigeria contributes the largest proportion of 19% to the global burden of maternal mortality. The causes of maternal and perinatal mortality in Nigeria are linked to the three levels of delay in accessing maternal healthcare. The objective of the study was to identify the sociodemographic contributors to adverse maternal and perinatal outcomes and mortalities in the facility and make appropriate recommendations that would improve maternal and perinatal outcomes/mortalities.Methods: This research was a retrospective study. It was conducted between January, 2016 and December, 2020. Relevant data was retrieved, entered into a pre-designed proforma, and analysed using Statistical Product and Service Solutions for windows® version 25, SPSS Inc.; Chicago, USA.Results: Age of the women (X2=12.94; p-0.005), marital status (X2=66.86; p-0.001), level of education (X2=8.77; p-0.033) and occupation of participants (X2=26.30; p-0.001) were sociodemographic characteristics that are significantly associated with the outcome of pregnancies in this centre. perinatal mortality was also associated with age of the women (X2=15.52; p-0.001), their marital status (X2=105.48; p-0.001), level of education (X2=223.15; p-0.005) and occupation (X2=229.6; p-0.001).Conclusions: Our study revealed that socio-demographic factors of the patients to a large extent contributes to maternal and perinatal morbidity and mortality, and not just the three delays.

Asthma management in low and middle income countries: case for change.

Asthma is the most common noncommunicable disease in children, and among the most common in adults. The great majority of people with asthma live in low and middle income countries (LMICs), which have disproportionately high asthma-related morbidity and mortality. Essential inhaled medications, particularly those containing inhaled corticosteroids (ICS), are often unavailable or unaffordable, and this explains much of the global burden of preventable asthma morbidity and mortality. Guidelines developed for LMICs are generally based on the outdated assumption that patients with asthma symptoms <1–3 times per week do not need (or benefit from) ICS. Even when ICS are prescribed, many patients manage their asthma with oral or inhaled short-acting β2-agonists (SABA) alone, owing to issues of availability and affordability. A single ICS–formoterol inhaler-based approach to asthma management for all severities of asthma, from mild to severe, starting at diagnosis, might overcome SABA overuse/over-reliance and reduce the burden of symptoms and severe exacerbations. However, ICS–formoterol inhalers are currently very poorly available or unaffordable in LMICs. There is a pressing need for pragmatic clinical trial evidence of the feasibility and cost-effectiveness of this and other strategies to improve asthma care in these countries. The global health inequality in asthma care that deprives so many children, adolescents and adults of healthy lives and puts them at increased risk of death, despite the availability of highly effective therapeutic approaches, is unacceptable. A World Health Assembly Resolution on universal access to affordable and effective asthma care is needed to focus attention and investment on addressing this need.

Burden of Covid-19 restrictions: National, regional and global estimates.

SummaryBackgroundA growing literature has documented the high global morbidity, mortality and mental health burden associated with the current Covid-19 pandemic. In this paper, we aimed to quantify the total utility and quality of life loss resulting from Covid-19-related government restrictions imposed at the national, regional and global levels.MethodsWe conducted quality of life online surveys in France, India, Italy, UK and the United States of America between June 21st and September 13th 2021, and used regression models to estimate the average quality of life loss due to light and severe restrictions in these countries. We then combined estimated disutility weights from the pooled sample with the latest data on Covid-19 restrictions exposure in each country to estimate the total disutility generated by restrictions at the national, regional and global level. We also embedded a discrete choice experiment (DCE) into the online survey to estimate average willingness to pay to avoid specific restrictions.FindingsA total of 947 surveys were completed. Thirty-five percent of respondents were female, and 69.5% were between 18 and 39 years old. The weighted average utility weight was 0.71 (95% CIs 0.69–0.74) for light restrictions, and 0.65 (0.63–0.68) for severe restrictions. At the global scale, this implies a total loss of 3259 million QALYs (95% 3021, 3496) as of September 6th, 2021, with the highest burden in lower and upper middle-income countries. Utility losses appear to be particularly large for closures of schools and daycares as well as restaurants and bars, and seem relatively small for wearing masks and travel restrictions.InterpretationThe results presented here suggest that the QALY losses due to restrictions are substantial. Future mitigation strategies should try to balance potential reductions in disease transmission achievable through specific measures against their respective impact on quality of life. Additional research is needed to determine differences in restriction-specific disutilities across countries, and to determine optimal policy responses to similar future disease threats.FundingNo funding was received for this project.

Whole-genome analysis to determine the rate and patterns of intra-subtype reassortment among influenza type-A viruses in Africa.

Influenza type-A viruses (IAVs) present a global burden of human respiratory infections and mortality. Genome reassortment is an important mechanism through which epidemiologically novel influenza viruses emerge and a core step in the safe reassortment-incompetent live-attenuated influenza vaccine development. Currently, there are no data on the rate, spatial and temporal distribution, and role of reassortment in the evolution and diversification of IAVs circulating in Africa. We aimed to detect intra-subtype reassortment among Africa pandemic H1N1pdm09 (2009–10), seasonal H1N1pdm09 (2011–20), and seasonal H3N2 viruses and characterize the genomic architecture and temporal and spatial distribution patterns of the resulting reassortants. Our study was nested within the Uganda National Influenza Surveillance Programme. Next-generation sequencing was used to generate whole genomes (WGs) from 234 H1N1pdm09 (n = 116) and H3N2 (n = 118) viruses sampled between 2010 and 2018 from seven districts in Uganda. We combined our newly generated WGs with 658 H1N1pdm09 and 1131 H3N2 WGs sampled between 1994 and 2020 across Africa and identified reassortants using an automated Graph Incompatibility Based Reassortment Finder software. Viral reassortment rates were estimated using a coalescent reassortant constant population model. Phylogenetic analysis was used to assess the effect of reassortment on viral genetic evolution. We observed a high frequency of intra-subtype reassortment events, 12 · 4 per cent (94/758) and 20 · 9 per cent (256/1,224), and reassortants, 13 · 3 per cent (101/758) and 38 · 6 per cent (472/1,224), among Africa H1N1pdm09 and H3N2 viruses, respectively. H1N1pdm09 reassorted at higher rates (0.1237–0.4255) than H3N2 viruses (0 · 00912–0.0355 events/lineage/year), a case unique to Uganda. Viral reassortants were sampled in 2009 through 2020, except in 2012. 78 · 2 per cent (79/101) of H1N1pdm09 reassortants acquired new non-structural, while 57 · 8 per cent (273/472) of the H3N2 reassortants had new hemagglutinin (H3) genes. Africa H3N2 viruses underwent more reassortment events involving larger reassortant sets than H1N1pdm09 viruses. Viruses with a specific reassortment architecture circulated for up to five consecutive years in specific countries and regions. The Eastern (Uganda and Kenya) and Western Africa harboured 84 · 2 per cent (85/101) and 55 · 9 per cent (264/472) of the continent’s H1N1pdm09 and H3N2 reassortants, respectively. The frequent reassortment involving multi-genes observed among Africa IAVs showed the intracontinental viral evolution and diversification possibly sustained by viral importation from outside Africa and/or local viral genomic mixing and transmission. Novel reassortant viruses emerged every year, and some persisted in different countries and regions, thereby presenting a risk of influenza outbreaks in Africa. Our findings highlight Africa as part of the global influenza ecology and the advantage of implementing routine whole-over partial genome sequencing and analyses to monitor circulating and detect emerging viruses. Furthermore, this study provides evidence and heightens our knowledge on IAV evolution, which is integral in directing vaccine strain selection and the update of master donor viruses used in recombinant vaccine development.

Health practitioners\u2019 perceptions of structural barriers to the identification of intimate partner abuse: a qualitative meta-synthesis

BackgroundHealth care practitioners (HCPs) play a critical role in identifying and responding to intimate partner abuse (IPA). Despite this, studies consistently demonstrate a range of barriers that prevent HCPs from effectively identifying and responding to IPA. These barriers can occur at the individual level or at a broader systems or organisational level. In this article, we report the findings of a meta-synthesis of qualitative studies focused on HCPs’ perceptions of the structural or organisational barriers to IPA identification.MethodsSeven databases were searched to identify English-language studies published between 2012 and 2020 that used qualitative methods to explore the perspectives of HCPs in relation to structural or organisational barriers to identifying IPA. Two reviewers independently screened the articles. Findings from the included studies were analysed using Thomas and Hardin’s method of using a thematic synthesis and critiqued using the Critical Appraisal Skills Program tool for qualitative studies and the methodological component of the GRADE-CERQual.ResultsForty-three studies conducted in 22 countries informed the review. Eleven HCP settings were represented. Three themes were developed that described the structural barriers experienced by HCPs: The environment works against us (limited time with patients, lack of privacy); Trying to tackle the problem on my own (lack of management support and a health system that fails to provide adequate training, policies and response protocols and resources), Societal beliefs enable us to blame the victim (normalisation of IPA, only presents in certain types of women, women will lie or are not reliable).ConclusionThis meta-synthesis highlights the need for structural change to address these barriers. These include changing health systems to enable more time and to improve privacy, training, policies, and referral protocols. On a broader level IPA in health systems is currently not seen as a priority in terms of global burden of disease, mortality and morbidity and community attitudes need to address blaming the victim.

Antenatal Care Research in East Africa During the Millennium Development Goals Initiative: A Scoping Review

The global burden of maternal mortality remains high and inequitably distributed between countries. Antenatal care (ANC) was identified as critical component in achieving the Millennium Development Goal of improving maternal health. This scoping review aimed to summarize trends and critically explore research about ANC attendance for East African women conducted during the Millennium Development Goals initiative, with a specific focus on barriers to ANC access. Using a scoping review methodology, aggregator databases were searched for relevant articles. Articles were screened by independent reviewers using a priori inclusion criteria. Eligible articles were retained for data charting and analysis. Following screening, 211 articles were analyzed. The number of relevant articles increased over time; utilized primarily quantitative methods; and involved authors with affiliations from various African countries. Many interrelated physical, social, and cultural factors influenced women's seeking, reaching, and receiving of quality ANC. The extent of studies identified suggest that ANC is a priority research area, yet key gaps in the literature exist. Limited qualitative research, and few articles examining ANC experiences of women from vulnerable groups (e.g. adolescents, women with a disability, and Indigenous women) were identified. These context-specific findings are important considering the Sustainable Development Goals aim to nearly triple the maternal mortality reductions by 2030. In order to achieve this goal, interventions should focus on improving the quality of ANC care and patient-provider interactions. Furthermore, additional qualitative research examining vulnerable populations of women and exploring the inclusion of men in ANC would help inform interventions intended to improve ANC attendance in East Africa.

Barriers and Enablers to Pulmonary Rehabilitation in Low- and Middle-Income Countries: A Qualitative Study of Healthcare Professionals.

IntroductionLow- and middle-income countries bear a disproportionately high burden of global morbidity and mortality caused by chronic respiratory diseases. Pulmonary rehabilitation is recommended as a core intervention in the management of people with chronic respiratory diseases. However, the intervention remains poorly accessed/utilised globally, especially in low- and middle-income countries.AimThis qualitative study explored barriers and enablers to pulmonary rehabilitation in low- and middle-income countries from the perspective of healthcare professionals with pulmonary rehabilitation experience in these settings.MethodsOnline-based semi-structured in-depth interviews with healthcare professionals were undertaken to data saturation, exploring lived barriers and enablers to pulmonary rehabilitation in their low- or middle-income country. Anonymised interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis.ResultsA total of seven healthcare professionals from seven low- and middle-income countries representing Africa, Asia, and South America were interviewed. They included five physiotherapists (four females), one family physician (male), and one pulmonologist (female). Themes for barriers to pulmonary rehabilitation included limited resources, low awareness, coronavirus disease 2019, and patient access-related costs. Themes for enablers included local adaptation, motivated patients, coronavirus disease 2019 (which spanned both enablers and barriers), better awareness/recognition, provision of PR training, and resource support.ConclusionBarriers to pulmonary rehabilitation in low- and middle-income countries include limited resources, low awareness, coronavirus disease 2019, and patient access-related costs. Enablers include local adaptation, motivated patients, coronavirus disease 2019 (which spanned both enablers and barriers), better awareness/recognition, provision of PR training, and resource support. Successful implementation of these enablers will require engagement with multiple stakeholders. The findings of this study are a necessary step towards developing strategies that can overcome the existing pulmonary rehabilitation evidence-practice gap in low- and middle-income countries and alleviating the burden of chronic respiratory diseases in these countries.

Valuing Health Loss in Karachi City from Water Contamination and Household Defensive Behavior

Clean water is essential for healthy living and the use of contaminated water is a major source of global and regional burden of disease and mortality in less developed countries. This study identifies the extent of water contamination through standardized laboratory tests from the metropolitan city of Karachi, which is the largest city of Pakistan. Moreover, a household survey data is used to estimate a health production function focusing on waterborne diseases. The study finds the average probability of waterborne diseases and estimates the cost of illness from the sample data. Probability of illness and defensive behavior are proxied by the prevalence of diarrhea and household expenditures on water treatment, respectively. The results show that the likelihood of getting diarrhea is higher among households who make less expenditures on water treatment. Water contamination positively affects and filtration negatively affects the prevalence of diarrhea in the city. Further, the study finds that the total direct monthly health cost of untreated water consumption for the entire population of Karachi is PKR 80.7 million.

Vaginal probiotics as an adjunct to antibiotic prophylaxis in the management of preterm premature rupture of the membranes

Preterm birth is a leading cause of perinatal morbidity and mortality and Preterm premature rupture of the membranes (PPROM) is a major risk factor contributing to approximately one third of preterm deliveries. Vaginal infections are often associated with PPROM and are characterised by loss of lactobacillin normal vaginal flora and overgrowth of other pathogenic microorganisms. Probiotics appear to have an emerging role in prolonging pregnancy after PPROM. This trial compared the efficacy of a vaginal probiotic in combination with standard antibiotic prophylaxis versus only antibiotic in prolongation of latency period and on perinatal outcome in cases of PPROM between 24 and 34 weeks. Although no significant difference was observed in the mean latency period (p = 0.937) and mean gestational age at birth (p = 0.863) between the two groups, the overall neonatal outcome was better in the study group. There is need of further large-scale clinical trials to demonstrate effectiveness of probiotics. IMPACT STATEMENT What is already known on this subject? PPROM is an important cause of preterm birth. Prematurity leads significant global burden of neonatal morbidity and mortality. Antibiotics in PPROM have a proven benefit to prolong latency period from start of PPROM to birth. Probiotics have a role in improving vaginal flora and reducing infections and have been tried in PPROM. What do the results of this study add? The usefulness of probiotics in prolonging latency period and improving neonatal outcome has been reported in limited trials. In our study it has shown an improvement in neonatal outcome overall but not statistically significant compared to few studies which have reported significant beneficial effects. This might be due to existence of variation in the type of the vaginal microflora in different study population. What are the implications of these findings for clinical practice and/or further research? Preliminary results suggest that use of probiotic may benefit women with PPROM. This also implies need of multicentric larger scales trials with different types of probiotics so as to clarify whether any intervention in vaginal microflora can lead to any benefits in reducing the prematurity and its consequence, both on the neonate and heath care infrastructure.