WHO ICD Research Articles

A two-year retrospective study of maternal mortality in tertiary care hospitals in South India

Background: The death of a woman during pregnancy or within 42 completed days after delivery of the baby, irrespective of the duration or site of pregnancy, from any cause related to or aggravated by pregnancy, but not from accidental or incidental causes is labelled as maternal mortality. The study was conducted with the objectives to assess the existing MMR and the causes of maternal mortality over 2 years in a tertiary care hospital. Methods: Retrospective study done from March 2021 to February 2023 at RIMS Raichur. The medical records of all maternal death over 2 years were reviewed and analysed. The data of all the maternal deaths during the study period at the department of Obstetrics & Gynecology, RIMS Raichur were recorded using a predesigned and semistructured questionnaire. Results: A total of 75 deaths were assessed over 2 years and MMR was calculated to be 726.5/1 lakh live births. Most of the maternal deaths occurred in the age group of 21-30 years (73.3%), most maternal deaths were observed in primipara (30.7%), 32% of deaths occurred within 24 hours of admission. Hypertensive disorders in pregnancy (32%) were the leading direct cause followed by non-obstetric complications (17%), and haemorrhage (16%). Conclusion: To reduce maternal mortality, the crucial work starts at the grassroots level. Most deaths could have been prevented with the help of early referral, quick efficient transport facilities and the availability of blood and its products. Keywords: maternal mortality ratio; post-partum haemorrhage; pregnancy; WHO ICD

The key role of examining the placenta in establishing a probable cause for stillbirth

IntroductionAutopsy is regarded as the “gold standard” to determine probable causes of stillbirths. However, autopsy is expensive and not readily available in low- and middle-income countries. Therefore, we assessed how the clinical cause of death is modified by adding placental histology and autopsy findings. MethodData from the Safe Passage Study was used where 7060 pregnant women were followed prospectively. Following a stillbirth, each case was discussed and classified at weekly perinatal mortality meetings. This classification was later adapted to the WHO ICD PM system. Clinical information was presented first, and a possible cause of death decided upon and noted. The placental histology was then presented and, again, a possible cause of death, using the placental and clinical information, was decided upon and noted, followed by autopsy information. Diagnoses were then compared to determine how often the additional information changed the initial clinical findings. ResultsClinical information, placental histology, and autopsy results were available in 47 stillbirths. There were major amendments from the clinical only diagnoses when placental histology was added. Forty cases were classified as due to M1: complications of placenta, cord, and membranes, when placental histology was added compared to 7 cases with clinical classification only, and M5: No maternal condition identified decreased from 30 cases to 3 cases. Autopsy findings confirmed the clinical and placental histology findings. DiscussionClinical information together with examination of the placenta revealed sufficient information to diagnose the most probable cause of death in 40 of 47 cases of stillbirth (85%).

Pattern Of Childhood Severe Vision Impairment And Blindness In Blind Schools Of Hilly State Of Himachal Pradesh

The aim of this study was to determine the pattern of childhood severe vision impairment (SVI)and blindness in blind schools of Himachal Pradesh. This study was carried out in 3 blind schools for children (<16 years). The vision was categorized (WHO ICD 11 classification, 2018) and the cause of vision loss was determined. A total of 96 children were examined. The main cause of SVI and blindness was congenital ocular defects (microphthalmos, anophthalmos, and coloboma in 33.33% of children). The second major cause was retinal dystrophies (20.83%) followed by optic atrophy (11.45%). The preventable and treatable causes were present in 15.63% of children attributed to vitamin A deficiency, trauma, retinopathy of prematurity, and cataract. Congenital ocular defects constituted a major cause of SVI and blindness followed by retinal dystrophies and optic atrophy. The avoidable and preventable causes of SVI and blindness were present in 1/6th of children entailing the strengthening of comprehensive eye care services, blindness preventable, and rehabilitation programs.

What do the numbers say? - Introduction of the WHO ICD-PM classification and fetuses-at risk approach in perinatal audit, South India

Objective: In India, despite a reduction in perinatal mortality rate from 2014 to 2019, still birth rate is still the same at the national average of 4/1000 live births. As yet there is no nation-wide audit in India except for facility based audits. Hence the need for a simplified yet effective audit process exists. The aim of this study was to perform a qualitative perinatal audit and devise methods for future audits. Methods: We conducted a one year audit for all perinatal deaths using WHO ICD PM and 3-delay classification. Gestational age (GA) specific mortality was calculated for significant underlying factors using fetuses-at risk approach. Results: We recorded a perinatal mortality rate of 6.1/1000 births among booked cases and 21.32/1000 births among referred cases. Fetal growth restriction was the most common antenatal condition, accounting to 33.3% of antepartum deaths. Prematurity accounted to 52% of neonatal deaths. Phase 2 delay with delayed referrals in severe pre-eclampsia and Phase 1 delay with late visit (> 24 h) to hospital after experiencing absent fetal movements were the most common identifiable delays. Hypertension stood out to be the single most common risk-factor. GA specific mortalities, calculated using fetuses-at risk approach, show a peak mortality rate at 30 weeks, 37 weeks and 38 weeks in pregnancies with early-onset preeclampsia, severe fetal growth restriction and medically treated gestational diabetes respectively. Conclusion: The audit identified significant contributing factors to the mortality. ICD-PM and 3-delay classification was simpler and easier to apply with wide areas of opportunities for secondary analysis.

PSU27 ANALYSIS OF THE UTILIZATION OF ONE-DAY SURGERY AMONG CASES RELATED TO THE DISEASES OF THE MUSCULOSKELETAL SYSTEM OR CONNECTIVE TISSUE

In Hungary, most of the theoretically performable one-day surgery interventions are linked to musculoskeletal diseases. Because of the constantly increasing life expectancy at birth, the incidence of degenerative diseases related to the musculoskeletal system are increasing. The aim of the study was to analyze the change of the role of one-day surgery in musculoskeletal diseases. The database of the research was ensured by the National Health Insurance Fund Administration of Hungary, and it contained both inpatient, and one-day surgery cases related to the diseases of musculoskeletal system and connective tissue (M00–M99) according to the WHO ICD-10 between 2010-2018. The database also consisted data related to the codes of DRG, the types of health care institutes, as well as information about related medical fields. During the analyzed period the total case number related to musculoskeletal diseases were 1,239,355. The market share of inpatient treatment was significant (88.2%), while the market share of one-day surgery was marginal (11.8%). Between 2010-2018, the number of inpatient case numbers increased only 103.5% in comparison with the one-day surgery case numbers, which increased significantly (294.5%). During the analyzed period the quantity of theoretically performable one-day surgery interventions related to musculoskeletal diseases were increased (2010: 52 interventions, 2018: 130 interventions) according to the 9th appendix of the 9/1993. (IV.2.) Decree adopted by the Minister of Public Welfare. The most common diagnosis was the damage of meniscus because of previous injury (35,013 cases) (WHO ICD – M2320) with the market share of 23,9% from the total one-day surgery case numbers. One-day surgery interventions related to the musculoskeletal diseases have been increasing, but most of the cases were treated in inpatient form. Based on recent experiences related the constantly increasing utilization of one-day surgery in Hungary, its market share could increase in the following years related to musculoskeletal diseases.

Perinatal risk factors for type 1 diabetes revisited: a population-based register study

Aims/hypothesisSingle-centre studies and meta-analyses have found diverging results as to which early life factors affect the risk of type 1 diabetes during childhood. We wanted to use a large, nationwide, prospective database to further clarify and analyse the associations between perinatal factors and the subsequent risk for childhood-onset type 1 diabetes using a case–control design.MethodsThe Swedish Childhood Diabetes Register was linked to the Swedish Medical Birth Register and National Patient Register, and 14,949 cases with type 1 diabetes onset at ages 0–14 years were compared with 55,712 matched controls born from the start of the Medical Birth Register in 1973 to 2013. After excluding confounders (i.e. children multiple births, those whose mother had maternal diabetes and those with a non-Nordic mother), we used conditional logistic regression analyses to determine risk factors for childhood-onset type 1 diabetes. We used WHO ICD codes for child and maternal diagnoses.ResultsIn multivariate analysis, there were small but statistically significant associations between higher birthweight z score (OR 1.08, 95% CI 1.06, 1.10), delivery by Caesarean section (OR 1.08, 95% CI 1.02, 1.15), premature rupture of membranes (OR 1.08, 95% CI 1.01, 1.16) and maternal urinary tract infection during pregnancy (OR 1.39, 95% CI 1.04, 1.86) and the subsequent risk of childhood-onset type 1 diabetes. Birth before 32 weeks of gestation was associated with a lower risk of childhood-onset type 1 diabetes compared with full-term infants (OR 0.54, 95% CI 0.38, 0.76), whereas birth between 32 and 36 weeks’ gestation was associated with a higher risk (OR 1.24, 95% CI 1.14, 1.35). In subgroup analyses (birth years 1992–2013), maternal obesity was independently associated with subsequent type 1 diabetes in the children (OR 1.27, 95% CI 1.15, 1.41) and rendered the association with Caesarean section non-significant. In contrast to previous studies, we found no association of childhood-onset type 1 diabetes with maternal–child blood-group incompatibility, maternal pre-eclampsia, perinatal infections or treatment of the newborn with phototherapy for neonatal jaundice. The proportion of children with neonatal jaundice was significantly higher in the 1973–1982 birth cohort compared with later cohorts.Conclusions/interpretationPerinatal factors make small but statistically significant contributions to the overall risk of childhood-onset type 1 diabetes. Some of these risk factors, such as maternal obesity, may be amendable with improved antenatal care. Better perinatal practices may have affected some previously noted risk factors over time.

Concordance between the diagnostic guidelines for alcohol and cannabis use disorders in the draft ICD-11 and other classification systems: analysis of data from the WHO's World Mental Health Surveys.

The World Health Organization's (WHO's) proposed International Classification of Diseases, 11th edition (ICD-11) includes several major revisions to substance use disorder (SUD) diagnoses. It is essential to ensure the consistency of within-subject diagnostic findings throughout countries, languages and cultures. To date, agreement analyses between different SUD diagnostic systems have largely been based in high-income countries and clinical samples rather than general population samples. We aimed to evaluate the prevalence of, and concordance between diagnoses using the ICD-11, The WHO's ICD 10th edition (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th editions (DSM-IV, DSM-5); the prevalence of disaggregated ICD-10 and ICD-11 symptoms; and variation in clinical features across diagnostic groups. Cross-sectional household surveys. Representative surveys of the general population in 10 countries (Argentina, Australia, Brazil, Colombia, Iraq, Northern Ireland, Poland, Portugal, Romania and Spain) of the World Mental Health Survey Initiative. Questions about SUDs were asked of 12 182 regular alcohol users and 1788 cannabis users. Each survey used the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview version 3.0 (WMH-CIDI). Among regular alcohol users, prevalence (95% confidence interval) of life-time ICD-11 alcohol harmful use and dependence were 21.6% (20.5-22.6%) and 7.0% (6.4-7.7%), respectively. Among cannabis users, 9.3% (7.4-11.1%) met criteria for ICD-11 harmful use and 3.2% (2.3-4.0%) for dependence. For both substances, all comparisons of ICD-11 with ICD-10 and DSM-IV showed excellent concordance (all κ≥0.9). Concordance between ICD-11 and DSM-5 ranged from good (for SUD and comparisons of dependence and severe SUD) to poor (for comparisons of harmful use and mild SUD). Very low endorsement rates were observed for new ICD-11 feature for harmful use ('harm to others'). Minimal variation in clinical features was observed across diagnostic systems. The World Health Organization's proposed International Classification of Diseases, 11th edition (ICD-11) classifications for substance use disorder diagnoses are highly consistent with the ICD 10th edition and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Concordance between ICD-11 and the DSM 5th edition (DSM-5) varies, due largely to low levels of agreement for the ICD harmful use and DSM-5 mild use disorder. Diagnostic validity of self-reported 'harm to others' is questionable.

The geospatial relationship of pterygium and senile cataract with ambient solar ultraviolet in tropical Ecuador.

Tropical Ecuador presents a unique climate in which we study the relationship between the ambient levels of solar ultraviolet radiation and eye disease in the absence of a latitudinal gradient. The national distribution of surface ultraviolet, taking into account MODIS and OMI satellite observation of aerosol, ozone, surface albedo, local elevation and cloud fractions measured during 2011, was compared with the national pterygium (WHO ICD H11) and senile cataract (WHO ICD H25) incidence projected from the 2010 National Institute of Statistics and Census (Ecuador). Public Health Ministry projections for age categories 0 to 39, 40 to 59 and 60+ years were compared to surface ultraviolet irradiance data in 1040 parishes. Correlations drawn between modelled surface ultraviolet and eye disease incidence show a significant increase in both pterygium and senile cataract in the highest ambient exposure regions of the Pacific coast and western lowlands with incidence rates of 34.39 and 16.17 per 100 000 residents respectively. The lowest rates of incidence for pterygium (6.89 per 100 000) and senile cataract (2.90 per 100 000) were determined in high altitude sites and are attributed here to increased daily cloud fraction for parishes located in the Andean mountain range. The South American Andes experience the highest solar UV exposures on Earth and report frequent high incidence of keratinocyte cancer. Our results show the high Andes to be the location of the lowest eye disease incidence suggesting that both pterygium and senile cataract are the result of cumulative exposure to solar ultraviolet. These findings have clear implications for the agricultural workers and fishermen of the lowland districts of Ecuador, contrary to conventional understanding that greater risks are faced in locations of high altitude.

Social Functioning in Schizophrenia: the Role of Emotion Recognition Abilities

Introduction One of the current concerns in the research on schizophrenia is the relationship between social functioning and emotion recognition abilities, more specifically of the role that this can have, as a potential pathway for building subsequent psychosocial intervention methods. Objectives To establish the precise role that the ability to recognize emotions has on social functioning in subjects with a diagnosis of Schizophrenia. Aim To help develop psychotherapeutic intervention programs that will increase social functioning. Method This paper analyzed a sample of subjects (N=31) with a diagnosis of Schizophrenia (according to the WHO ICD 10), who were selected based on inclusion/exclusion criteria. The following parameters were assessed: socio-demographic (gender, age of onset, level of education, family and professional status), social functioning (SFS scale) and the ability to identify emotions in the eyes (‘Reading the Mind in the Eyes’ test). Results The ability of recognizing the emotion ‘anger’ is directly correlated with the ability to communicate and keep interpersonal relations (Spearman R = 0.310, p Conclusion We noted that ‘anger’ is the only emotion that was correlated with social functioning. Anger must be understood beyond its negative connotation, also as a positive element, in the sense of positioning the individual in the society and of taking action in regard to personal needs.

A study on pattern of diseases of skin and subcutaneous tissue

Background: Skin the largest organ in the human body plays a vital role in one's health care. This anatomical barrier regulates the body temperature and interface with the environment for protecting the body against pathogens. The type of skin problems varies in different geographical areas, climate, economic and other factors including personal characteristics such as age and sex. Objectives: The main objective of this study is to find out the age and sex wise distribution of diseases of skin and subcutaneous tissue during the study period of 5 years. Materials and Methods: It is a hospital based retrospective study of 5 years. Hospital Medical records department follows the guidelines of WHO ICD 10 for the classification of diseases. The data were collected from the medical records and analyzed by using Microsoft excel. 'Z' test was applied for finding out the comparison of proportions. Result: Out of 4276 patients admitted in the hospital during the study period, 2518 (58.88%) were males and 1758 (41.12%) were females. 0-15 years have highest skin problems (31.7%) compared to other age groups. The age groups 15-30 years ( P = 0.001), 45-60 years ( P = 0.003) shows significant difference between males and females in skin diseases. Infective type is more common, it is 63.21% and non-infective type is 36.79%. Conclusion: The present study shows the preponderance of males and 0-15 year's age group. Infectious types are more common type compared to non-infective type. Infective types are higher in poor hygiene and insanitary conditions. Public awareness regarding personal and healthy living is necessary to reduce the burden of skin disease and for improved quality of life.

An Analysis of Pregnancy-Related Mortality in the KEMRI/CDC Health and Demographic Surveillance System in Western Kenya

BackgroundPregnancy-related (PR) deaths are often a result of direct obstetric complications occurring at childbirth.Methods and FindingsTo estimate the burden of and characterize risk factors for PR mortality, we evaluated deaths that occurred between 2003 and 2008 among women of childbearing age (15 to 49 years) using Health and Demographic Surveillance System data in rural western Kenya. WHO ICD definition of PR mortality was used: “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death”. In addition, symptoms and events at the time of death were examined using the WHO verbal autopsy methodology. Deaths were categorized as either (i) directly PR: main cause of death was ascribed as obstetric, or (ii) indirectly PR: main cause of death was non-obstetric. Of 3,223 deaths in women 15 to 49 years, 249 (7.7%) were PR. One-third (34%) of these were due to direct obstetric causes, predominantly postpartum hemorrhage, abortion complications and puerperal sepsis. Two-thirds were indirect; three-quarters were attributable to human immunodeficiency virus (HIV/AIDS), malaria and tuberculosis. Significantly more women who died in lower socio-economic groups sought care from traditional birth attendants (p = 0.034), while less impoverished women were more likely to seek hospital care (p = 0.001). The PR mortality ratio over the six years was 740 (95% CI 651–838) per 100,000 live births, with no evidence of reduction over time (χ2 linear trend = 1.07; p = 0.3).ConclusionsThese data supplement current scanty information on the relationship between infectious diseases and poor maternal outcomes in Africa. They indicate low uptake of maternal health interventions in women dying during pregnancy and postpartum, suggesting improved access to and increased uptake of skilled obstetric care, as well as preventive measures against HIV/AIDS, malaria and tuberculosis among all women of childbearing age may help to reduce pregnancy-related mortality.

Impact of assisted reproduction treatments on Spanish newborns: report of 14,119 pregnancies

To investigate neonatal malformation, prematurity, and stillbirth in singleton and multiple pregnancies derived from different Assisted Reproductive Techniques (ART). In this prospective cohort study data were collected, from private and public Spanish IVF units, during the years 2008 and 2009. During this period, 8,682 pregnancies were analysed from the initial 14,119 pregnancies reported. Pregnancies included in the study derived from IUI (n = 1,065), IVF (n = 838), ICSI (n = 5,080), FET (n = 1,404) and PGD (n = 295). This first analysis focuses primarily on neonatal malformation, prematurity, and stillbirth both in singleton and multiple pregnancies derived from different ART. Malformations were classified according to the WHO ICD 10 code. Malformations were found in 0.83% of our newborns. No differences in malformations were observed between singletons or multiples independently of the ART used. There was a significant difference in prematurity rate among singletons depending on treatment but this association was not observed in multiple pregnancies. Stillbirth was significantly lower in singleton (0.72%) than in multiple pregnancies (1.82%). The percentage of malformations observed in ART newborns was similar to the rate observed in the normally-conceived Spanish population. Multiplicity seems to be the most important factor associated with an increased incidence of newborn complications such as prematurity or stillbirth.

Profile of abortion in Chile, with extremely restrictive law

Chile, together with El Salvador, Malta and Nicaragua has the most restrictive abortion laws. In these countries there is very little information on pregnancies that end in abortions. An analysis is made of official information regarding hospital discharges for abortion in Chile between 2001 and 2010, classified according to age and according to the WHO ICD 10. The Chilean Ministry of Health’s Statistics Office (DEIS) collected the data. In 334,485 hospital discharges for abortion, Ectopic Abortion (O00), the Hydatidiform Mole (O01) and Other Abnormal Products of Conception (O02) corresponded to 37.2% of hospital discharges. Spontaneous Abortion (O03) reached 15% and Non Specified Abortion (O06) reached 35.5% and most probably included complications of induced abortions. 77% of hospital discharges corresponded to women between 20 and 34 years of age. Adolescents correspond to 11% of hospital discharges. In the annual average of 33,500 hospital discharges, Other Abnormal Products of Conception (O02), Other Abortions (O05), and Non Specified Abortions (O05) contribute to 72.7% of hospital discharges. This is explained by incomplete diagnoses, by means of the omission of induced abortion as this would mean jail for the woman and legal red-tape for the health personnel involved. Maternal mortality has not fallen. Abortion Mortality and Fatality rates do not change. There is a discrepancy between the law and hospital discharge diagnoses for abortion. The antiabortion law remains unheeded and obeys an ideological bias that brings damage and abuse to Chilean women. The aim of this study is to gain better information from a country that does not allow abortion under any circumstance, and its usefulness to countries in similar situations, together with its negative consequences on woman’s health and rights.

Tratamento etiológico em psiquiatria: o modelo da neurossífilis

Este trabalho tem como objetivo estudar a evolução histórica, durante 60 anos, das admissões por diagnóstico de neurossífilis em um hospital psiquiátrico e descrever o impacto da moderna antibioticoterapia. Foi baseado nos dados e planilhas do hospital psiquiátrico em estudo, de 1931 à 1991. O banco de dados do hospital contém informações do tipo: nome, sexo, idade, estado civil, nacionalidade, procedência, profissão, classe social, número de admissões por neurossífilis e outros diagnósticos, data de admissão, data de alta e diagnóstico pelo CID 9/WHO. A análise estatística envolveu todas as admissões até o último registro de paciente com diagnóstico de neurossífilis e comparado com resultados por outros tipos de admissões. Observou-se que antes da introdução da penicilina, nos serviços de saúde de Pelotas, em 1948, 19% das admissões eram por neurossífilis. Depois, os registros hospitalares descrevem uma tendência decrescente até a última admissão em 1968. O impacto da antibioticoterapia na história natural da neurossífilis foi o maior até hoje e nunca antes visto com outros recursos terapêuticos (biológicos, psicofarmacológicos e psicoterápicos), para outras doenças psiquiátricas.