Retrospective Mortality Survey Research Articles

Unacceptably High Mortality Related to Measles Epidemics in Niger, Nigeria, and Chad

BackgroundDespite the comprehensive World Health Organization (WHO)/United Nations Children's Fund (UNICEF) measles mortality–reduction strategy and the Measles Initiative, a partnership of international organizations supporting measles mortality reduction in Africa, certain high-burden countries continue to face recurrent epidemics. To our knowledge, few recent studies have documented measles mortality in sub-Saharan Africa. The objective of our study was to investigate measles mortality in three recent epidemics in Niamey (Niger), N'Djamena (Chad), and Adamawa State (Nigeria).Methods and FindingsWe conducted three exhaustive household retrospective mortality surveys in one neighbourhood of each of the three affected areas: Boukoki, Niamey, Niger (April 2004, n = 26,795); Moursal, N'Djamena, Chad (June 2005, n = 21,812); and Dong District, Adamawa State, Nigeria (April 2005, n = 16,249), where n is the total surveyed population in each of the respective areas. Study populations included all persons resident for at least 2 wk prior to the study, a duration encompassing the measles incubation period. Heads of households provided information on measles cases, clinical outcomes up to 30 d after rash onset, and health-seeking behaviour during the epidemic. Measles cases and deaths were ascertained using standard WHO surveillance-case definitions. Our main outcome measures were measles attack rates (ARs) and case fatality ratios (CFRs) by age group, and descriptions of measles complications and health-seeking behaviour. Measles ARs were the highest in children under 5 y old (under 5 y): 17.1% in Boukoki, 17.2% in Moursal, and 24.3% in Dong District. CFRs in under 5-y-olds were 4.6%, 4.0%, and 10.8% in Boukoki, Moursal, and Dong District, respectively. In all sites, more than half of measles cases in children aged under 5 y experienced acute respiratory infection and/or diarrhoea in the 30 d following rash onset. Of measles cases, it was reported that 85.7% (979/1,142) of patients visited a health-care facility within 30 d after rash onset in Boukoki, 73.5% (519/706) in Moursal, and 52.8% (603/1,142) in Dong District.ConclusionsChildren in these countries still face unacceptably high mortality from a completely preventable disease. While the successes of measles mortality–reduction strategies and progress observed in measles control in other countries of the region are laudable and evident, they should not overshadow the need for intensive efforts in countries that have just begun implementation of the WHO/UNICEF comprehensive strategy.

High mortality in an internally displaced population in Ituri, Democratic Republic of Congo, 2005: Results of a rapid assessment under difficult conditions

The ongoing conflict in Ituri, Democratic Republic of Congo (DRC), has led to more than 50,000 deaths, more than 500,000 displaced civilians and continuing, unacceptably high, mortality since 1999. In February 2005, after a resurgence of violence and further displacements, Médecins Sans Frontières (MSF) launched an emergency response in three internally displaced persons (IDP) camps in Ituri. We performed a rapid health assessment in April 2005 in one of the IDP camps to evaluate mortality (due to violence or disease) and camp living conditions. The retrospective mortality survey, covering a recall period from 18 December 2004 to 27 March 2005, indicated a crude mortality rate of 4.1 deaths/10,000/day (95% CI: 2.8–5.4) and an under-five mortality rate of 6.9 deaths/10,000/day (95% CI: 4.4–9.4). Living conditions in the camp were extremely poor (average 286 persons per latrine). Despite efforts of the international community and humanitarian organizations, the security situation continues to deteriorate. Regular assessments should be undertaken to monitor the situation.

<b>Letter to the editor</b>: Public health issues in a therapeutic feeding center-problems encountered and lessons learned

The town of Gode, in somali region of Ethiopia was considered the epicenter of the drought and attracted sustained media attention and resources since April 2000. Between January and June 2000, the population was reported to swell from 15,000 to 40,000 with consequent stress on food, water, and sanitation and health facilities. Different assessments at the initial stage estimated a global malnutrition rate of over 50% with 10% severe malnutrition. Although accurate mortality was difficult to determine with changing population denominators and differing methodologies, based on a retrospective mortality survey childhood mortality rates were persistently high between December 1999 on July 2000 (3.4/10000/day and 9.8/1000/day respectively). Outbreaks like measles and bloody diarrhea were important contributory factors to the high mortality. A cluster survey conducted in August showed over half (51%) of the deaths were caused primarily by diarrheal diseases (35%) and measles (16%). By drawing on our experience, this letter attempts to identify mechanisms and processes that have both facilitated and constrained success in the treatment of severely malnourished during the recent emergency in Gode, Somali region. (Ethiopian Journal of Health Development, 2001, 15(1): 51)

Epidemiological study of myasthenia gravis in the province of Reggio Emilia, Italy.

We carried out a retrospective incidence, prevalence and mortality survey of myasthenia gravis in the province of Reggio Emilia in Northern Italy. Based on 49 patients, the mean incidence per year for the period 1980 through 1994 was 7.8 per 1,000,000. On 31 December 1994 the prevalence rate was 117.5 per 1,000,000 for all patients, either active or recovered (50 cases in a population of 427,493) and 103.4 per 1,000,000 for the active disease. In the 15-year period 1980-1994 the average mortality rate was 1.0 per 1,000,000 per year. The average age at onset was 44.6 +/- 21.0, and the average age at the time of prevalence determination was 51.1 +/- 19.6 for the active disease. At the time of diagnosis, 21 patients (36.8%) were classed in group I according to Osserman's criteria, 31 in group II (54.4%), (19 in group II-A and 12 in group II-B), and the other 5 (8.8%) in group III. Of all the prevalence cases, 6 (12%) were in remission without therapy and 6 with therapy, while most of the others 16 (32%) were classed in group I, 15 (30%) in group II, and 1 (2%) in group III. Thymectomy was performed in 20 patients (35.1%), 12 (21%) had thymoma (malignant in 4 cases), 6 had thymic hyperplasia while in two patients thymic histology was normal. The relation the grade of Osserman's scale at the time of incidence and the presence of thymoma were significant. Higher grades of Osserman's scale were associated were malignant thymoma. Furthermore the relationship between thymectomy and the grade of Osserman's scale at the date of prevalence was significant for the presence of lower grades of Osserman's scale in the patients submitted to thymectomy.

Epidemiological survey of amyotrophic lateral sclerosis in the province of Reggio Emilia, Italy: influence of environmental exposure to lead.

We carried out a retrospective incidence, prevalence and mortality survey of amyotrophic lateral sclerosis (ALS) in the province of Reggio Emilia, northern Italy. Based on 79 patients, the mean incidence per year for the period 1980 through 1992 was 1.5 cases per 100,000. On December 31st, 1992, the prevalence rate was 5.4 per 100,000. In the 10-year period of 1983-1992 the average mortality rate was 1.3 per 100,000 per year. The average age at onset was 61.3 +/- 10.2, the average survival period thereafter was 26.3 months +/- 17.7; 27.3 +/- 17.6 for classic ALS, 19.5 +/- 8.4 for progressive bulbar palsy and 36.3 +/- 41.4 for pseudopolyneuritic ALS. The incidence rate, recorded in public health district No.12, an area with documented lead pollution since the 1970s, was standardized to the sex and age of the population of the province. Its incidence and prevalence rate were comparable to the rates found in the remaining area of the province.

Acute Malnutrition and High Childhood Mortality Related to Diarrhea

To determine the extent, major causes, and contributory factors of high rates of morbidity and mortality among children at mountain camps along the Turkey-Iraq border during the 1991 Kurdish refugee crisis. A cross-sectional rapid nutrition survey among children and a retrospective mortality survey covering a 2-month period from the onset of the crisis. Households of Kurdish refugees at resettlement camp 1 near Zakho in northern Iraq. Prevalence of wasting (low weight-for-height) and mean weight-for-height status, prevalence of diarrhea, and crude and age-specific mortality rates. Weight-for-height measurements indicated that children under 2 years of age had suffered significant (P < .001) recent malnutrition. The elevated prevalence of wasting and the reduced mean weight-for-height status in this group indicated generalized weight loss. This weight loss was likely the result of the high rates of diarrhea, which still affected 50% of the younger children at the time of survey. The crude mortality rate for all ages was 8.9 per 1000 per month (expected rate, 0.6 per 1000); two thirds of the deaths occurred among children aged 5 years or younger, and half among infants younger than 1 year. An estimated 12% of all infants died during the first 2 months of the crisis. Most deaths were due to diarrhea, dehydration, and resulting malnutrition. The high rates of malnutrition and mortality related to diarrhea in infants and younger children of Kurdish refugees took place rapidly despite prompt relief efforts and a previously healthy population. This experience underscores the need for early and aggressive public health management of sanitation, water sources, and diarrhea control programs to augment the traditional focus on food and medical relief during the emergency phase of a refugee crisis.

Sudden Death in Epilepsy: An Avoidable Outcome?

In a retrospective survey of mortality among the first 1000 unselected patients referred to the Epilepsy Research Unit at the Western Infirmary in Glasgow between 1985 and 1990, a total of 18 deaths were identified. Three patients had committed suicide and one each had died of status epilepticus in hospital, a subdural haematoma and a myocardial infarction. The remaining 12 deaths (67%) were sudden (median age 32 years; range 22-68 years). Poor seizure control and poor compliance with antiepileptic drug therapy were recorded in only three (25%) of these patients. There was a change in antiepileptic drug regimen in five (28%) in the month before death. Only two (17%) underwent postmortem examination. In nine of the 12 patients dying suddenly, the primary cause of death was not listed as epilepsy but as asphyxia (3), aspiration (2) and one each of ischaemic heart disease, myocardial infarction, asystole and drowning (in the bath). 'Status epilepticus' was assumed to have been responsible for the other three deaths, two of which were unwitnessed. Sudden death in people with epilepsy is an entity of great concern. Appropriate death certification and mandatory postmortem examination are essential to provide a truer picture of this neglected phenomenon.

The sources of error in Brass's method for estimating child survival: the case of Bangladesh

Abstract Brass's method for estimating child mortality is based on an ingeniously simplified model. However, it frequently leads to values of q(x) that are not consistent with each other. This is most obvious for estimates of q(1). This paper examines the extent to which such inconsistencies are caused by simplifications in the model. Three assumptions are relaxed by adjusting for differences in infant mortality by birth order, taking account of annual fluctuations in mortality, and using a different age pattern of fertility for each cohort. These adjustments are applied to data from the 1974 Bangladesh Retrospective Survey of Fertility and Mortality and the 1975 Bangladesh Fertility Survey in which additional data from the Cholera Research Laboratory are used. The resulting estimates are more consistent both internally and with estimates from other surveys and by other procedures.