Routine Mortality Data Research Articles

A retrospective analysis of malaria deaths in the pre- and intra- COVID 19 pandemic era, Ghana, 2016-2021.

Global efforts over the years have resulted in a 27% reduction in malaria incidence and an estimated 51% reduction in malaria mortality since 2000. Meanwhile, COVID-19 pandemic disrupted provision and utilization of malaria services, leading to a surge in malaria incidence and mortality. Globally, 627000 malaria deaths were recorded in 2020, representing about 69000 more deaths compared to 2019. Also, 14 million more cases of malaria were recorded in 2020 compared to 2019. This study sought to determine whether excess malaria deaths were recorded in Ghana during the COVID-19 pandemic era. This was a descriptive study on routine malaria mortality data in Ghana for the period 2016 to 2021. Data was retrieved from the District Health Information Management System using a data extraction guide. Excess mortality was defined as occurrence of malaria deaths more than expected value for the period 2020 and 2021. The expected number of mortalities for 2020 and 2021 were determined using 2016 to 2019 average. Excess mortality (P-score) was estimated using the formula: [(reported mortalities-expected mortalities)/expected mortalities X 100%]. Data were summarized and processed in Microsoft excel version 16.0. Malaria mortality in Ghana and its regions was described using tables and line graphs. An average of 535 malaria deaths per year were recorded nationwide from 2016 to 2020. About 50% (1603/3207) of deaths occurred in children aged less than five years. The p-scores for the country were -53% and -58% for 2020 and 2021 respectively. No region recorded excess all-age malaria mortality in 2020, rather significant reduction. Stratified by age, Greater Accra region reported 90% higher than expected deaths among persons aged five years and above in 2020 (p-score = 90%, 95% CI: 21-159). All regions reported reduction in under-five mortality in 2020. No significant excess malaria mortalities were reported among the regions in 2021. Although negative p-scores suggested a decline in malaria mortalities nationwide, some regions recorded excess deaths during the COVID-19 pandemic era. There is a need to integrate COVID-19 control activities with malaria control and prevention efforts to mitigate the impact of COVID-19 on malaria case management and mortality.

The influence of context on the implementation of integrated palliative care in an academic teaching hospital in South Africa.

Palliative care (PC) has been integrated to a limited extent in the South African healthcare system. Contextual factors may be a pivotal influence in this integration. This study aims to explore contextual factors that are possibly influencing the integration or lack thereof in an academic teaching hospital (ATH). A mixed-method study was conducted in a large ATH in South Africa. The mixed methods were conducted in parallel and then merged. Findings were integrated to describe the contextual factors influencing PC integration, to develop a timeline of implementation and assess the probable influence of context on the integration process. The mixed-methods phases included a narrative review of published literature related to health systems, integration of health interventions and PC in teaching hospital settings; followed by interviews, documentary and routine data analyses. Semi-structured interviews with purposively sampled participants provided the qualitative data. Primary national, provincial and organizational documents expanded the contextual phenomena and corroborated findings. Routine hospital admission and mortality data was statistically analysed to expand further and corroborate findings. All qualitative data was thematically analysed using deductive coding, drawing from the aspects of the contextual dimensions of integration. Enabling contextual factors for local PC integration were global and local advocacy, demonstrated need, PC being a human right, as well as the personal experiences of hospital staff. Impeding factors were numerous misconceptions, PC not valued as a healthcare priority, as well as limitations in functional elements necessary for PC integration: national and regional political support, leadership at all levels and sustainable financing. The normative and functional contextual aspects interplay at macro, meso and micro levels positively and negatively. How stakeholders understand and value PC directly and indirectly impacts on PC integration. Strategic interventions such as mandatory education are required to ensure PC integration. The health system is dynamic, and understanding the context in which the health system functions is core to the integration of PC. This may assist in developing integration strategies to address PC integration and the transferability of these strategies.

Institutionalising maternal and newborn quality-of-care standards in Bangladesh, Ghana and Tanzania: a quasi-experimental study

IntroductionFacility interventions to improve quality of care around childbirth are known but need to be packaged, tested and institutionalised within health systems to impact on maternal and newborn outcomes.MethodsWe conducted...

Comparison of all-cause mortality in England with Europe and the USA: January 2020 to February 2021

BackgroundAssessing mortality during the COVID-19 pandemic is vital for informing public health strategies and policy decision making. All-cause excess mortality provides an objective measure of the impact of the pandemic including both the direct and indirect effects. Our study considers the burden of mortality in the UK, Europe and the USA. We examine variation between countries, by age and sex. We explore the extent to which this variation is associated with COVID-19 case rates and other population characteristics.MethodsThe study is a secondary analysis of routine administrative population and mortality data. Weekly death occurrences and population estimates were obtained from Eurostat and national statistical agencies. Contextual information on COVID-19 case rates, population-level risk factors and healthcare were obtained from various open-source databases. Weekly age-standardised mortality rates (ASMRs) were calculated and presented relative to a baseline average from the preceding 5-year period. Relative cumulative (rc) ASMRs were then calculated to provide a comparable assessment of excess mortality at a point in time.ResultsPreliminary results show that, by end of the analysis period, England had an overall rcASMR of 10.09%. Higher excess mortality was identified for some countries (eg USA 14.58%) and lower - even below average mortality - for others (eg Norway -6.8%). Under 65 rcASMR showed substantial variation between countries. Cumulative COVID-19 case rates showed a moderate effect size (R2 = 0.51) when used to explain the proportion of variation observed between rcASMRs. Other population factors showed a smaller effect.ConclusionsThe burden of mortality experienced between countries and populations over the COVID-19 pandemic period has shown significant variation. Factors which may have contributed to the position of some countries should be further explored in order to inform ongoing management of Covid-19 and future pandemic events.Key messages Significant variation in all-cause excess mortality has been identified across the COVID-19 pandemic period between nations and particularly in younger age groups.COVID-19 case rates are associated with relative cumulative all-cause excess mortality among the nations assessed.

Estimating completeness of national and subnational death reporting in Brazil: application of record linkage methods

BackgroundIn Brazil, both the Civil Registry (CR) and Ministry of Health (MoH) Mortality Information System (SIM) are sources of routine mortality data, but neither is 100% complete. Deaths from these two sources can be linked to facilitate estimation of completeness of mortality reporting and measurement of adjusted mortality indicators using generalized linear modeling (GLM).MethodsThe 2015 and 2016 CR and SIM data were linked using deterministic methods. GLM with covariates of the deceased’s sex, age, state of residence, cause of death and place of death, and municipality-level education decile and population density decile, was used to estimate total deaths and completeness nationally, subnationally and by population sub-group, and to identify the characteristics of unreported deaths. The empirical completeness method and Global Burden of Disease (GBD) 2017 estimates were comparators at the national and state level.ResultsCompleteness was 98% for SIM and 95% for CR. The vast majority of deaths in Brazil were captured by either system and 94% were reported by both sources. For each source, completeness was lowest in the north. SIM completeness was consistently high across all sub-groups while CR completeness was lowest for deaths at younger ages, outside facilities, and in the lowest deciles of municipality education and population density. There was no clear municipality-level relationship in SIM and CR completeness, suggesting minimal dependence between sources. The empirical completeness method model 1 and GBD completeness estimates were each, on average, less than three percentage points different from GLM estimates at the state level. Life expectancy was lowest in the northeast and 7.5 years higher in females than males.ConclusionsGLM using socio-economic and demographic covariates is a valuable tool to accurately estimate completeness from linked data sources. Close scrutiny of the quality of variables used to link deaths, targeted identification of unreported deaths in poorer, northern states, and closer coordination of the two systems will help Brazil achieve 100% death reporting completeness. The results also confirm the validity of the empirical completeness method.

Spatial analysis of completeness of death registration in Egypt

PurposeCivil registration and vital statistics (CRVS) systems should be the primary source of routine mortality data. However, there is lack of information about the completeness of death registration at the sub-national level of Egypt. The current study was conducted to estimate the completeness of death registration at the national and sub-national levels of Egypt, to investigate the spatial patterns of the completeness, and to examine the factors that influence it.MethodsData from the Central Agency for Public Mobilization and Statistics (CAPMAS, 2018) and Egypt Demographic and Health Survey (EDHS 2008, 2014) were used to estimate the completeness of death registration using an empirical method (random-effects models); hot spot analysis was conducted using Moran’s I and Getis-Ord Gi*; and the geographically weighted regression (GWR) model has been also carried out.ResultsThe study estimates show that Egypt has 96% completeness of death registration, and all governorates have completeness of more than 90% except for Beni-Suef, Menia, Aswan, Suhag, Luxor, ELWadi ELGidid, and South Sinai. According to sex, the death registration of females is slightly better than that of males (96.8% compared to 95.4%). Concerning residence, urban area has almost complete death registration compared to rural area (99.5% and 85.4%, respectively). Hot spot analysis shows that all hot spots are centered on the north of Egypt, while all cold spots are focused on the south. However, according to the geographically weighted regression (GWR) model, poverty, illiteracy, and health office density are considered major factors for the completeness of death registration.ConclusionAlthough the completeness in Egypt is almost 100%, this analysis suggests that it may not be, and that it could be somewhat lower in some rural areas. However, there is uncertainty in the sub-national estimates because deaths are only reported by place of occurrence and not place of usual residence. Thus, efforts should focus on improving the quality of data of the vital registration system in some rural areas and in lower Egyptian governorates.

Generation Scotland - Using Electronic Health Records for Research

Background Generation Scotland is a family-based genetic epidemiology study of ~24,000 volunteers from ~7000 families recruited across Scotland with the capacity for follow-up through record linkage and re-contact. Broad consent was obtained for linkage to “medical records” for 98% of the cohort. This created a resource for investigation of the genetics of common conditions, available to researchers worldwide.
 Methods Participants completed a demographic, health and lifestyle questionnaire, provided samples, and underwent detailed clinical assessment. The samples and data collected form a resource with broad consent for research on the genetics of conditions of current and projected public health importance. This has become a longitudinal dataset by linkage to routine NHS hospital, maternity, lab tests, prescribing, dentistry, and mortality data.
 Results Researchers can use the linked datasets to find prevalent and incident disease cases, and healthy controls, in a stratified population. They can also do targeted recruitment of participants to new studies, including recall by genotype. We have established and validated EHR linkage, overcoming technical and governance issues in the process. Using consented data avoids some limitations of safe havens for analysis.
 Genome-wide association studies (GWAS) have been done on a wide range of quantitative traits and biomarker measurements. Generation Scotland is a contributor to major international consortia and has collaborated with Dementia Platforms UK and Health Data Research UK to make the resources more widely known. There have been over 300 research collaborations, and GS data has contributed to 200 publications, with more in the pipeline.
 Conclusions Generation Scotland has thoroughly tested the linkage process and is extending it to include primary care data and scanned images, with plans to collect more samples and data. The resources are available to academic and commercial researchers through a managed access process (www.generationscotland.org).

Determinants of the decline in mortality from acute stroke in England: linked national database study of 795 869 adults

ObjectivesTo study trends in stroke mortality rates, event rates, and case fatality, and to explain the extent to which the reduction in stroke mortality rates was influenced by changes in...

Can routine inpatient mortality data improve HIV mortality estimates? Inpatient mortality at an urban hospital in South Africa.

South Africa (SA) has one of the world's largest HIV treatment programmes, to which a dramatic increase in life expectancy has been attributed. However, there continue to be concerns regarding the reporting of HIV-related mortality in SA, which varies by source. As accurate HIV mortality estimates are key to measuring the success of the national programme as well as identifying areas for improvement, we propose a complementary approach to monitoring changes in HIV-related mortality using routine inpatient records to examine trends in causes of death and HIV status over time. To investigate the feasibility of this approach by calculating mortality due to natural causes in the medical ward of a hospital during 2010 by HIV status. We conducted a cross-sectional study of inpatient mortality at a regional hospital in Johannesburg, SA, analysing all deaths due to natural causes among adult medical ward inpatients. Cause of death was recorded from the mortuary register. HIV status was ascertained directly from the mortuary register or from laboratory tests specific for HIV diagnosis or monitoring. Of 1 167 inpatients who died, the majority were HIV-positive (58%). HIV positivity among males (55%) was slightly lower than that among females (61%), and HIV-positive patients were younger (median 40 years) than those who were HIV-negative (56 years) and of unknown HIV status (68 years). 'Infections and parasites' was the most common cause of natural death (29%). On average, HIV-positive patients were admitted for slightly longer (mean 10.5 days) than HIV-negative patients (9.6 days) and those of unknown HIV status (8.9days), yet HIV-positive inpatient deaths accounted for the majority (62%) of the total bed days. Even with widespread access to antiretroviral therapy, the majority of inpatient natural deaths at a large public sector hospital in 2010 were of HIV-positive patients and were probably related to HIV. In view of the importance of accurate data on causes of death, both for the HIV programme and to track other diseases, large-scale expansion of this approach over a longer period should be considered.

Generation Scotland - Using Electronic Health Records for Research

Generation Scotland: Scottish Family Health Study (GS:SFHS) is a family-based genetic epidemiology study of ~24,000 volunteers from ~7000 families recruited across Scotland between 2006 and 2011 with the capacity for follow-up through record linkage and re-contact. Broad consent was obtained for linkage to “medical records” for 98% of the cohort.
 Participants completed a questionnaire, provided samples, and underwent clinical assessment. The samples and data collected form a resource with consent for research on the genetics of health, becoming a longitudinal dataset by linkage to routine NHS hospital, maternity, lab test, prescribing, dentistry and mortality data.
 Researchers can use the linked datasets to test research hypotheses on a stratified population and target recruitment to new studies. We have established and validated EHR linkage, overcoming technical and governance issues in the process. We plan to collaborate with UK Biobank, creating a combined cohort of over 50,000 people in Scotland, and using the SHARE register to obtain new research samples from routine NHS tests.
 We will extend linkage to include primary care data and scanned images in the next year. The resources are available to academic and commercial researchers through a managed access process.

Palliative care service in Cyprus, a population-based needs assessment based on routine mortality data

Background: Cyprus is currently forming its public healthcare system aiming to accompany people from cradle to grave. This population-based palliative care service needs assessment was performed under increasing demographic, economic, and societal pressures.Objectives: The primary aim was to assess the palliative care service needs in Cyprus using routine mortality data and this was achieved by: (a) analysis of mortality death registration statistics making inferences to palliative care needs; (b) reviewing existing palliative care service provision in Cyprus.Methods: Data derived from death registrations from January 2011 to December 2013 were analysed using specific International Classification of Diseases and Related Health Problems –10th Revision codes. The method developed by Rosenwax and Murtagh with further refinement of the disease categorisations was used to give a population-based estimate of palliative care needs at a minimum and at a maximum value, combined with symptom prevalence.Results: Out of the 5500 people on average dying in Cyprus annually, a minimum 2634 and a maximum 3927 could benefit from a palliative care service. Palliative care provision in Cyprus today focuses almost exclusively on cancer, depending largely on philanthropic funding with some services being reduced despite evidence of increasing need.Conclusion: Palliative care should be integrated into the public healthcare system with appropriate resource allocation. Recommendations are made to facilitate this.

Stillbirths at the West Gonja hospital in northern Ghana

In most parts of Ghana, stillbirths (SBs) do not count in routine mortality data collection and there-fore are not seen as a major public health problem. The aim of this study was to determine still-birth rate, trend, causes and factors associated with stillbirth at the West Gonja Hospital in northern Ghana and offer recommendations. This study reviewed antenatal cards of mothers and records in the labour and maternity wards for cases of SBs from January 2009 to December 2013 for foetal and maternal characteristics. Data were entered and analyzed using SPSS software (version 18, Chicago). There were 3,641 births and 121 SBs during the study period with an average SBs rate of 33.2 per 1000 births. There was a gradual rise in the annual incidence of SBs from 2.9% in 2009 to 3.9% in 2012. Majority (55.4%) of the SBs were fresh. A total of 58 (47. 9%) of the SBs had no identifiable cause. The mean gestational age of SBs was 34.8 weeks (SD=4.2), and the mean weight was 2.4 Kg (SD=0.8). Majority (73.9%) of the mothers were housewives. We found strong positive associations between SBs and maternal occupation (p<0.00), but negatives associations with maturity of pregnancy (p= 0.01), mode of delivery (p<0.00), type of pregnancy (p=0.04) and the causes of stillbirths (p<0.00). This study found a high SBs rate of 33.2 per 1000 births, with a gradual rise in the incidence over the study period. Many of the SBs had no identifiable cause. Most of the mothers who had stillbirths were house wives and many of the cases had no identifiable causes. There is the need for improve SBs data collection and the need for further investigations on the causes of stillbirth in Ghana.Journal of Medical and Biomedical Sciences (2016) 5(1), 1-7Keywords: Mortality data, causes, incidence rate, parity, gestational week

The Need for Palliative Care in Ireland: A Population-Based Estimate of Palliative Care Using Routine Mortality Data, Inclusive of Nonmalignant Conditions

ContextOver the history of palliative care provision in Ireland, services have predominantly provided care to those with cancer. Previous estimates of palliative care need focused primarily on specialist palliative care and included only a limited number of nonmalignant diseases. ObjectivesThe primary aim of this study was to estimate the potential population with generalist and/or specialist palliative care needs in Ireland using routine mortality data inclusive of nonmalignant conditions. The secondary aim was to consider the quality of Irish data available for this population-based estimate. MethodsIrish routine mortality data (2007–2011) were analyzed for malignant and nonmalignant conditions recognized as potentially requiring palliative care input, using specific International Statistical Classification of Diseases and Related Health Problems-10th Revision codes. The method developed by Murtagh et al. was used to give a population-based palliative care needs estimate, encompassing generalist and specialist palliative care need. ResultsDuring the period 2007–2011, there were 141,807 deaths. Eighty percent were from conditions recognized as having associated palliative care needs, with 41,253 (30%) deaths from cancer and 71,226 (50%) deaths from noncancer conditions. The majority of deaths, 81% (91,914), were among those ≥65 years. There was a 13.9% (901) increase in deaths of those ≥85 years. Deaths from dementia increased by 51.3%, with an increase in deaths from neurodegenerative disease (42.8%) and cancer (9.5%). ConclusionFuture palliative care policy decisions in Ireland must consider the rapidly aging Irish population with the accompanying increase in deaths from cancer, dementia, and neurodegenerative disease and associated palliative care need. New models of palliative care may be required to address this.

Apgar score and the risk of cause-specific infant mortality: a population-based cohort study

The Apgar score has been used worldwide as an index of early neonatal condition for more than 60 years. With advances in health-care service provision, neonatal resuscitation, and infant care, its present relevance is unclear. The aim of the study was to establish the strength of the relation between Apgar score at 5 min and the risk of neonatal and infant mortality, subdivided by specific causes. We linked routine discharge and mortality data for all births in Scotland, UK between 1992 and 2010. We restricted our analyses to singleton livebirths, in women aged over 10 years, with a gestational age at delivery between 22 and 44 weeks, and excluded deaths due to congenital anomalies or isoimmunisation. We calculated the relative risks (RRs) of neonatal and infant death of neonates with low (0-3) and intermediate (4-6) Apgar scores at 5 min referent to neonates with normal Apgar score (7-10) using binomial log-linear modelling with adjustment for confounders. Analyses were stratified by gestational age at birth because it was a significant effect modifier. Missing covariate data were imputed. Complete data were available for 1,029,207 eligible livebirths. Across all gestational strata, low Apgar score at 5 min was associated with an increased risk of neonatal and infant death. However, the strength of the association (adjusted RR, 95% CI referent to Apgar 7-10) was strongest at term (p<0·0001). A low Apgar (0-3) was associated with an adjusted RR of 359·4 (95% CI 277·3-465·9) for early neonatal death, 30·5 (18·0-51·6) for late neonatal death, and 50·2 (42·8-59·0) for infant death. We noted similar associations of a lower magnitude for intermediate Apgar (4-6). The strongest associations were for deaths attributed to anoxia and low Apgar (0-3) for term infants (RR 961·7, 95% CI 681·3-1357·5) and preterm infants (141·7, 90·1-222·8). No association between Apgar score at 5 min and the risk of sudden infant death syndrome was noted at any gestational age (RR 0·6, 95% CI 0·1-4·6 at term; 1·2, 0·3-4·8 at preterm). Low Apgar score at 5 min was strongly associated with the risk of neonatal and infant death. Our findings support its continued usefulness in contemporary practice. None.

WHAT IS THE LONG-TERM EMOTIONAL AND BEHAVIORAL IMPACT OF GENETIC RISK ASSESSMENT FOR ALZHEIMER'S DISEASE? FINDINGS FROM THE REVEAL STUDY

information linked to routine hospital and mortality data, and to be contacted again by the researchers. A second wave of data collection is ongoing (20142017) with additional questions onmemory, carers and diet. The cohort is also being replenished and coverage widened to include the entire Yorkshire and Humber region (pop 5.25mn). The new recruitment target for the cohort is 50,000. In the first wave of recruitment 28,000 adults (1,700 aged 75 or over) returned completed Health Questionnaires. The response rate was 17%. As expected, respondents were more likely to be female, over 55 years, and living in areas of low deprivation. However, the population is broadly representative of the reference population. To date 12 health studies have identified and recruited over 1100 participants to their studies (including randomised controlled trials, qualitative interviews, matched case control studies) and local authorities are using the data to inform their Joint Strategic Needs Assessments. With over 3000 participants likely to receive a diagnosis of dementia in the next five years, the Yorkshire Health Study provides an opportunity to test a range of individual and public health level interventions to treat, manage and/or prevent dementia and to understand more about the health related behaviours that affect the onset and trajectory of dementia.

Inaccuracies in oral cavity–pharynx cancer coded as the underlying cause of death on U.S. death certificates, and trends in mortality rates (1999–2010)

To enhance surveillance of mortality from oral cavity-pharynx cancer (OCPC) by considering inaccuracies in the cancer site coded as the underlying cause of death on death certificates vs. cancer site in a population-based cancer registry (as the gold standard). A database was used for 9 population-based cancer registries of the Surveillance, Epidemiology and End Results (SEER) Program, including deaths in 1999-2010 for patients diagnosed in 1973-2010. Numbers of deaths and death rates for OCPC in the SEER population were modified for apparent inaccuracies in the cancer site coded as the underlying cause of death. For age groups <65 years, deaths from OCPC were underestimated by 22-35% by using unmodified (vs. modified) numbers, but temporal declines in death rates were still evident in the SEER population and were similar to declines using routine mortality data for the entire U.S. population. Deaths were underestimated by about 70-80% using underlying cause for tonsillar cancers, strongly associated with human papillomavirus (HPV) infection, but a lack of decline in death rates was still evident. Routine mortality statistics based on underlying cause of death underestimate OCPC deaths but demonstrate trends in OCPC death rates that require continued surveillance in view of increasing incidence rates for HPV-related OCPC.

Identifying important comorbidity among cancer populations using administrative data: Prevalence and impact on survival

Our study sought to optimize the identification and investigate the impact of comorbidity in cancer patients using routinely collected hospitalization data. We undertook an iterative process of classification of important clinical conditions involving evaluation of relevant literature and consultation with clinicians. Patients diagnosed with colon, rectal, breast, ovarian, uterine, stomach, liver, renal or bladder cancers (n = 14,096) between 2006 and 2008 were identified from the New Zealand Cancer Registry. Conditions were identified using data on diagnoses from hospital admissions for 5 years prior to cancer diagnosis. Patients were followed up until end of 2009 using routine mortality data. Prevalence estimates for each condition by site were calculated. All-cause mortality impact of common conditions was investigated using Cox regression models adjusted for age and stage at diagnosis. Patients with liver and stomach cancers tended to have higher comorbidity and those with breast cancer, lower comorbidity than other cancer patients. Of the 50 conditions, the most common were hypertension (prevalence 8.0-20.9%), cardiac conditions (2.1-13.5%) and diabetes with (2.3-13.3%) and without (2.9-12.9%) complications. Comorbidity was associated with higher all-cause mortality but the impact varied by condition and across cancer site, with impact less for cancers with poor prognoses. Conditions most consistently associated with adverse outcomes across all cancer sites were renal disease, coagulopathies and congestive heart failure. Comorbidity is highly prevalent in cancer populations, but prevalence and impact of conditions differ markedly by cancer type.

Scale-up of home-based management of malaria based on rapid diagnostic tests and artemisinin-based combination therapy in a resource-poor country: results in Senegal

BackgroundEffective case management of malaria requires prompt diagnosis and treatment within 24 hours. Home-based management of malaria (HMM) improves access to treatment for populations with limited access to health facilities. In Senegal, an HMM pilot study in 2008 demonstrated the feasibility of integrated use of RDTs and ACT in remote villages by volunteer Home Care Providers (HCP). Scale-up of the strategy began in 2009, reaching 408 villages in 2009 and 861 villages in 2010. This paper reports the results of the scale-up in the targeted communities and the impact of the strategy on malaria in the formal health sector.MethodsData reported by the HCPs were used to assess their performance in 2009 and 2010, while routine malaria morbidity and mortality data were used to assess the impact of the HMM programme. Two high transmission regions where HMM was not implemented until 2010 were used as a comparison.Results and discussionFrom July 2009 through May 2010, 12582 suspected cases were managed by HCPs, 93% (11672) of whom were tested with an RDT. Among those tested, 37% (4270) had a positive RDT, 97% (4126) of whom were reported treated and cured. Home care providers referred 6871 patients to health posts for management: 6486 with a negative RDT, 119 infants < 2 months, 105 pregnant women, and 161 severe cases. There were no deaths among these patients. In 2009 compared to 2008, incidence of suspected and confirmed malaria cases, all hospitalizations and malaria-related hospitalizations decreased in both intervention and comparison regions. Incidence of in-hospital deaths due to malaria decreased by 62.5% (95% CI 43.8-81.2) in the intervention regions, while the decrease in comparison regions was smaller and not statistically significant.ConclusionHome-based management of malaria including diagnosis with RDT and treatment based on test results is a promising strategy to improve the access of remote populations to prompt and effective management of uncomplicated malaria and to decrease mortality due to malaria. When scaled-up to serve remote village communities in the regions of Senegal with the highest malaria prevalence, home care providers demonstrated excellent adherence to guidelines, potentially contributing to a decrease in hospital deaths attributed to malaria.

Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: linked national database study

Objective To report trends in event and case fatality rates for acute myocardial infarction and examine the relative contributions of changes in these rates to changes in total mortality from...

Incidence and 30-day case fatality for acute myocardial infarction in England in 2010: national-linked database study

Background: There are limited national population-based epidemiological data on acute myocardial infarction (AMI) in England, making the current burden of disease, and clinical prognosis, difficult to quantify. The aim of this study was to provide national estimates of incidence and 30-day case fatality rate (CFR) for first and recurrent AMI in England. Methods: Population-based study using person-linked routine hospital and mortality data on 79 896 individuals of any age, who were admitted to hospital for AMI or who died suddenly from AMI in 2010. Results: Of 82 252 AMI events in 2010, 83% were first. Age-standardized incidence of first AMI per 100 000 population was 130 (95% CI 129–131) in men and 55.9 (95% CI 55.3–56.6) in women. Age-standardized 30-day overall CFRs including sudden AMI deaths for men and women, respectively, were 32.4% (95% CI 32.0–32.9) and 30.3% (95% CI 29.8–30.9) for first AMI and 29.7% (95% CI 28.7–30.7) and 26.7% (95% CI 25.5–27.9) for recurrent AMI. Age-standardized hospitalized 30-day CFR was 12.0% (95% CI 11.6–12.3) for men and 12.3% (95% CI 11.9–12.7) for women. Conclusions: While the majority of AMIs are not fatal, of those that are, two-thirds occur as sudden AMI deaths. About one in six of all AMIs are recurrent events. These findings reinforce the importance of primary and secondary prevention in reducing AMI morbidity and mortality.