Publications by authors named "Sojib Bin Zaman"

24 Publications

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Feasibility of community health workers using a clinical decision support system to screen and monitor non-communicable diseases in resource-poor settings: study protocol.

Mhealth 2021 20;7:15. Epub 2021 Jan 20.

Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.

Background: It is imperative that coordinated and systematic action is undertaken, at all levels, to minimize the consequences of the growing global burden of non-communicable diseases (NCDs). An integrated multi-disciplinary primary care-based preventive program has the potential to reduce lifestyle-related risk factors contributing to NCDs. Accredited Social Health Activists (ASHAs), who are community health workers (CHWs), may be employed to screen populations for NCDs in rural India. To enable ASHAs to be supported when they are on their own in the community, we have developed a clinical decision support system (CDSS) "Arogya Sahyog" (a Hindi term meaning 'health assistant') to guide them through the process. Herein, we describe the protocol for testing this CDSS and the associated community-based management program for people with NCDs.

Methods: This mixed-method study involving both qualitative and quantitative approaches will be conducted in two phases to test: (I) feasibility of the CDSS itself, and (II) feasibility of utilizing the app to develop capacity within the ASHA workforce. First, we will use a semi-structured questionnaire to determine details about the acceptance of using the app, satisfaction with the CDSS, perceived barriers, ideas for improvement, and willingness to use the CDSS. We will also test the usability of this CDSS for the identification of people with hypertension, with or without co-morbidities, by ASHAs and their supervisors. The CDSS will be installed on a tablet and is designed to help ASHAs to screen, provide lifestyle advice, and refer critical patients to primary care physicians. Second, to develop capacity within the ASHA workforce, ASHAs will be taught about NCDs, so they can motivate people to adhere to healthy activities and self-manage their NCDs. We will also test whether this training program improves ASHAs' knowledge about NCDs. We will further evaluate ASHAs' capacity to provide health promotional interventions to patients with, or at risk of, NCDs using the tablet device.

Discussion: The study will enable us to test a CDSS and an educational training program. Specifically, we will test whether the program is user-friendly, easy-to-comprehend, easy-to-deliver, workflow-oriented, and comprehensive. We will determine whether mobilizing this ASHA workforce with the support of a CDSS could result in better management of hypertension and co-morbidities than usual care.
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http://dx.doi.org/10.21037/mhealth-19-258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882273PMC
January 2021

Smartphone overuse: A hidden crisis in COVID-19.

Health Policy Technol 2021 Jan 23. Epub 2021 Jan 23.

School of Health and Society, University of Wollongong, NSW, Australia.

•COVID-19 related lockdown policies and stay at home strategy may lead to the overuse or excessive usage of smartphones.•Excessive use of smartphones can potentially lead to gaming disorders and internet use disorders and eventually be considered to cause psychosocial crisis.•Without proper initiative, problematic smartphone usage can turn into an emerging public health challenge to annihilate lives by perpetuating the socio-psychological problems.•It will be a crucial step to monitor smartphone overuse and take necessary action to minimise the problem through protective policies and family support during and after this COVID 19 pandemic.
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http://dx.doi.org/10.1016/j.hlpt.2021.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825859PMC
January 2021

COVID-19 Vaccine: Critical Questions with Complicated Answers.

Biomol Ther (Seoul) 2021 Jan;29(1):1-10

Department of Integrative Biotechnology, and Biomedical Institute for Convergence at SKKU (BICS), Sungkyunkwan University, Suwon 16419, Republic of Korea.

COVID-19 has caused extensive human casualties with significant economic impacts around the globe, and has imposed new challenges on health systems worldwide. Over the past decade, SARS, Ebola, and Zika also led to significant concerns among the scientific community. Interestingly, the SARS and Zika epidemics ended before vaccine development; however, the scholarly community and the pharmaceutical companies responded very quickly at that time. Similarly, when the genetic sequence of SARSCoV-2 was revealed, global vaccine companies and scientists have stepped forward to develop a vaccine, triggering a race toward vaccine development that the whole world is relying on. Similarly, an effective and safe vaccine could play a pivotal role in eradicating COVID-19. However, few important questions regarding SARS-CoV-2 vaccine development are explored in this review.
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http://dx.doi.org/10.4062/biomolther.2020.178DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7771841PMC
January 2021

Assessment of the validity of the measurement of newborn and maternal health-care coverage in hospitals (EN-BIRTH): an observational study.

Lancet Glob Health 2021 03 14;9(3):e267-e279. Epub 2020 Dec 14.

Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK.

Background: Progress in reducing maternal and neonatal deaths and stillbirths is impeded by data gaps, especially regarding coverage and quality of care in hospitals. We aimed to assess the validity of indicators of maternal and newborn health-care coverage around the time of birth in survey data and routine facility register data.

Methods: Every Newborn-BIRTH Indicators Research Tracking in Hospitals was an observational study in five hospitals in Bangladesh, Nepal, and Tanzania. We included women and their newborn babies who consented on admission to hospital. Exclusion critiera at admission were no fetal heartbeat heard or imminent birth. For coverage of uterotonics to prevent post-partum haemorrhage, early initiation of breastfeeding (within 1 h), neonatal bag-mask ventilation, kangaroo mother care (KMC), and antibiotics for clinically defined neonatal infection (sepsis, pneumonia, or meningitis), we collected time-stamped, direct observation or case note verification data as gold standard. We compared data reported via hospital exit surveys and via hospital registers to the gold standard, pooled using random effects meta-analysis. We calculated population-level validity ratios (measured coverage to observed coverage) plus individual-level validity metrics.

Findings: We observed 23 471 births and 840 mother-baby KMC pairs, and verified the case notes of 1015 admitted newborn babies regarding antibiotic treatment. Exit-survey-reported coverage for KMC was 99·9% (95% CI 98·3-100) compared with observed coverage of 100% (99·9-100), but exit surveys underestimated coverage for uterotonics (84·7% [79·1-89·5]) vs 99·4% [98·7-99·8] observed), bag-mask ventilation (0·8% [0·4-1·4]) vs 4·4% [1·9-8·1]), and antibiotics for neonatal infection (74·7% [55·3-90·1] vs 96·4% [94·0-98·6] observed). Early breastfeeding coverage was overestimated in exit surveys (53·2% [39·4-66·8) vs 10·9% [3·8-21·0] observed). "Don't know" responses concerning clinical interventions were more common in the exit survey after caesarean birth. Register data underestimated coverage of uterotonics (77·9% [37·8-99·5] vs 99·2% [98·6-99·7] observed), bag-mask ventilation (4·3% [2·1-7·3] vs 5·1% [2·0-9·6] observed), KMC (92·9% [84·2-98·5] vs 100% [99·9-100] observed), and overestimated early breastfeeding (85·9% (58·1-99·6) vs 12·5% [4·6-23·6] observed). Inter-hospital heterogeneity was higher for register-recorded coverage than for exit survey report. Even with the same register design, accuracy varied between hospitals.

Interpretation: Coverage indicators for newborn and maternal health care in exit surveys had low accuracy for specific clinical interventions, except for self-report of KMC, which had high sensitivity after admission to a KMC ward or corner and could be considered for further assessment. Hospital register design and completion are less standardised than surveys, resulting in variable data quality, with good validity for the best performing sites. Because approximately 80% of births worldwide take place in facilities, standardising register design and information systems has the potential to sustainably improve the quality of data on care at birth.

Funding: Children's Investment Fund Foundation and Swedish Research Council.
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http://dx.doi.org/10.1016/S2214-109X(20)30504-0DOI Listing
March 2021

Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study.

Authors:
Spencer L James Chris D Castle Zachary V Dingels Jack T Fox Erin B Hamilton Zichen Liu Nicholas L S Roberts Dillon O Sylte Gregory J Bertolacci Matthew Cunningham Nathaniel J Henry Kate E LeGrand Ahmed Abdelalim Ibrahim Abdollahpour Rizwan Suliankatchi Abdulkader Aidin Abedi Kedir Hussein Abegaz Akine Eshete Abosetugn Abdelrahman I Abushouk Oladimeji M Adebayo Jose C Adsuar Shailesh M Advani Marcela Agudelo-Botero Tauseef Ahmad Muktar Beshir Ahmed Rushdia Ahmed Miloud Taki Eddine Aichour Fares Alahdab Fahad Mashhour Alanezi Niguse Meles Alema Biresaw Wassihun Alemu Suliman A Alghnam Beriwan Abdulqadir Ali Saqib Ali Cyrus Alinia Vahid Alipour Syed Mohamed Aljunid Amir Almasi-Hashiani Nihad A Almasri Khalid Altirkawi Yasser Sami Abdeldayem Amer Catalina Liliana Andrei Alireza Ansari-Moghaddam Carl Abelardo T Antonio Davood Anvari Seth Christopher Yaw Appiah Jalal Arabloo Morteza Arab-Zozani Zohreh Arefi Olatunde Aremu Filippo Ariani Amit Arora Malke Asaad Beatriz Paulina Ayala Quintanilla Getinet Ayano Martin Amogre Ayanore Ghasem Azarian Alaa Badawi Ashish D Badiye Atif Amin Baig Mohan Bairwa Ahad Bakhtiari Arun Balachandran Maciej Banach Srikanta K Banerjee Palash Chandra Banik Amrit Banstola Suzanne Lyn Barker-Collo Till Winfried Bärnighausen Akbar Barzegar Mohsen Bayati Shahrzad Bazargan-Hejazi Neeraj Bedi Masoud Behzadifar Habte Belete Derrick A Bennett Isabela M Bensenor Kidanemaryam Berhe Akshaya Srikanth Bhagavathula Pankaj Bhardwaj Anusha Ganapati Bhat Krittika Bhattacharyya Zulfiqar A Bhutta Sadia Bibi Ali Bijani Archith Boloor Guilherme Borges Rohan Borschmann Antonio Maria Borzì Soufiane Boufous Dejana Braithwaite Nikolay Ivanovich Briko Traolach Brugha Shyam S Budhathoki Josip Car Rosario Cárdenas Félix Carvalho João Mauricio Castaldelli-Maia Carlos A Castañeda-Orjuela Giulio Castelpietra Ferrán Catalá-López Ester Cerin Joht S Chandan Jens Robert Chapman Vijay Kumar Chattu Soosanna Kumary Chattu Irini Chatziralli Neha Chaudhary Daniel Youngwhan Cho Jee-Young J Choi Mohiuddin Ahsanul Kabir Chowdhury Devasahayam J Christopher Dinh-Toi Chu Flavia M Cicuttini João M Coelho Vera M Costa Saad M A Dahlawi Ahmad Daryani Claudio Alberto Dávila-Cervantes Diego De Leo Feleke Mekonnen Demeke Gebre Teklemariam Demoz Desalegn Getnet Demsie Kebede Deribe Rupak Desai Mostafa Dianati Nasab Diana Dias da Silva Zahra Sadat Dibaji Forooshani Hoa Thi Do Kerrie E Doyle Tim Robert Driscoll Eleonora Dubljanin Bereket Duko Adema Arielle Wilder Eagan Demelash Abewa Elemineh Shaimaa I El-Jaafary Ziad El-Khatib Christian Lycke Ellingsen Maysaa El Sayed Zaki Sharareh Eskandarieh Oghenowede Eyawo Pawan Sirwan Faris Andre Faro Farshad Farzadfar Seyed-Mohammad Fereshtehnejad Eduarda Fernandes Pietro Ferrara Florian Fischer Morenike Oluwatoyin Folayan Artem Alekseevich Fomenkov Masoud Foroutan Joel Msafiri Francis Richard Charles Franklin Takeshi Fukumoto Biniyam Sahiledengle Geberemariyam Hadush Gebremariam Ketema Bizuwork Gebremedhin Leake G Gebremeskel Gebreamlak Gebremedhn Gebremeskel Berhe Gebremichael Getnet Azeze Gedefaw Birhanu Geta Agegnehu Bante Getenet Mansour Ghafourifard Farhad Ghamari Reza Ghanei Gheshlagh Asadollah Gholamian Syed Amir Gilani Tiffany K Gill Amir Hossein Goudarzian Alessandra C Goulart Ayman Grada Michal Grivna Rafael Alves Guimarães Yuming Guo Gaurav Gupta Juanita A Haagsma Brian James Hall Randah R Hamadeh Samer Hamidi Demelash Woldeyohannes Handiso Josep Maria Haro Amir Hasanzadeh Shoaib Hassan Soheil Hassanipour Hadi Hassankhani Hamid Yimam Hassen Rasmus Havmoeller Delia Hendrie Fatemeh Heydarpour Martha Híjar Hung Chak Ho Chi Linh Hoang Michael K Hole Ramesh Holla Naznin Hossain Mehdi Hosseinzadeh Sorin Hostiuc Guoqing Hu Segun Emmanuel Ibitoye Olayinka Stephen Ilesanmi Leeberk Raja Inbaraj Seyed Sina Naghibi Irvani M Mofizul Islam Sheikh Mohammed Shariful Islam Rebecca Q Ivers Mohammad Ali Jahani Mihajlo Jakovljevic Farzad Jalilian Sudha Jayaraman Achala Upendra Jayatilleke Ravi Prakash Jha Yetunde O John-Akinola Jost B Jonas Kelly M Jones Nitin Joseph Farahnaz Joukar Jacek Jerzy Jozwiak Suresh Banayya Jungari Mikk Jürisson Ali Kabir Amaha Kahsay Leila R Kalankesh Rohollah Kalhor Teshome Abegaz Kamil Tanuj Kanchan Neeti Kapoor Manoochehr Karami Amir Kasaeian Hagazi Gebremedhin Kassaye Taras Kavetskyy Gbenga A Kayode Peter Njenga Keiyoro Abraham Getachew Kelbore Yousef Saleh Khader Morteza Abdullatif Khafaie Nauman Khalid Ibrahim A Khalil Rovshan Khalilov Maseer Khan Ejaz Ahmad Khan Junaid Khan Tripti Khanna Salman Khazaei Habibolah Khazaie Roba Khundkar Daniel N Kiirithio Young-Eun Kim Yun Jin Kim Daniel Kim Sezer Kisa Adnan Kisa Hamidreza Komaki Shivakumar K M Kondlahalli Ali Koolivand Vladimir Andreevich Korshunov Ai Koyanagi Moritz U G Kraemer Kewal Krishan Barthelemy Kuate Defo Burcu Kucuk Bicer Nuworza Kugbey Nithin Kumar Manasi Kumar Vivek Kumar Narinder Kumar Girikumar Kumaresh Faris Hasan Lami Van C Lansingh Savita Lasrado Arman Latifi Paolo Lauriola Carlo La Vecchia Janet L Leasher Shaun Wen Huey Lee Shanshan Li Xuefeng Liu Alan D Lopez Paulo A Lotufo Ronan A Lyons Daiane Borges Machado Mohammed Madadin Muhammed Magdy Abd El Razek Narayan Bahadur Mahotra Marek Majdan Azeem Majeed Venkatesh Maled Deborah Carvalho Malta Navid Manafi Amir Manafi Ana-Laura Manda Narayana Manjunatha Fariborz Mansour-Ghanaei Mohammad Ali Mansournia Joemer C Maravilla Amanda J Mason-Jones Seyedeh Zahra Masoumi Benjamin Ballard Massenburg Pallab K Maulik Man Mohan Mehndiratta Zeleke Aschalew Melketsedik Peter T N Memiah Walter Mendoza Ritesh G Menezes Melkamu Merid Mengesha Tuomo J Meretoja Atte Meretoja Hayimro Edemealem Merie Tomislav Mestrovic Bartosz Miazgowski Tomasz Miazgowski Ted R Miller G K Mini Andreea Mirica Erkin M Mirrakhimov Mehdi Mirzaei-Alavijeh Prasanna Mithra Babak Moazen Masoud Moghadaszadeh Efat Mohamadi Yousef Mohammad Aso Mohammad Darwesh Abdollah Mohammadian-Hafshejani Reza Mohammadpourhodki Shafiu Mohammed Jemal Abdu Mohammed Farnam Mohebi Mohammad A Mohseni Bandpei Mariam Molokhia Lorenzo Monasta Yoshan Moodley Masoud Moradi Ghobad Moradi Maziar Moradi-Lakeh Rahmatollah Moradzadeh Lidia Morawska Ilais Moreno Velásquez Shane Douglas Morrison Tilahun Belete Mossie Atalay Goshu Muluneh Kamarul Imran Musa Ghulam Mustafa Mehdi Naderi Ahamarshan Jayaraman Nagarajan Gurudatta Naik Mukhammad David Naimzada Farid Najafi Vinay Nangia Bruno Ramos Nascimento Morteza Naserbakht Vinod Nayak Javad Nazari Duduzile Edith Ndwandwe Ionut Negoi Josephine W Ngunjiri Trang Huyen Nguyen Cuong Tat Nguyen Diep Ngoc Nguyen Huong Lan Thi Nguyen Rajan Nikbakhsh Dina Nur Anggraini Ningrum Chukwudi A Nnaji Richard Ofori-Asenso Felix Akpojene Ogbo Onome Bright Oghenetega In-Hwan Oh Andrew T Olagunju Tinuke O Olagunju Ahmed Omar Bali Obinna E Onwujekwe Heather M Orpana Erika Ota Nikita Otstavnov Stanislav S Otstavnov Mahesh P A Jagadish Rao Padubidri Smita Pakhale Keyvan Pakshir Songhomitra Panda-Jonas Eun-Kee Park Sangram Kishor Patel Ashish Pathak Sanghamitra Pati Kebreab Paulos Amy E Peden Veincent Christian Filipino Pepito Jeevan Pereira Michael R Phillips Roman V Polibin Suzanne Polinder Farshad Pourmalek Akram Pourshams Hossein Poustchi Swayam Prakash Dimas Ria Angga Pribadi Parul Puri Zahiruddin Quazi Syed Navid Rabiee Mohammad Rabiee Amir Radfar Anwar Rafay Ata Rafiee Alireza Rafiei Fakher Rahim Siavash Rahimi Muhammad Aziz Rahman Ali Rajabpour-Sanati Fatemeh Rajati Ivo Rakovac Sowmya J Rao Vahid Rashedi Prateek Rastogi Priya Rathi Salman Rawaf Lal Rawal Reza Rawassizadeh Vishnu Renjith Serge Resnikoff Aziz Rezapour Ana Isabel Ribeiro Jennifer Rickard Carlos Miguel Rios González Leonardo Roever Luca Ronfani Gholamreza Roshandel Basema Saddik Hamid Safarpour Mahdi Safdarian S Mohammad Sajadi Payman Salamati Marwa R Rashad Salem Hosni Salem Inbal Salz Abdallah M Samy Juan Sanabria Lidia Sanchez Riera Milena M Santric Milicevic Abdur Razzaque Sarker Arash Sarveazad Brijesh Sathian Monika Sawhney Mehdi Sayyah David C Schwebel Soraya Seedat Subramanian Senthilkumaran Seyedmojtaba Seyedmousavi Feng Sha Faramarz Shaahmadi Saeed Shahabi Masood Ali Shaikh Mehran Shams-Beyranvand Aziz Sheikh Mika Shigematsu Jae Il Shin Rahman Shiri Soraya Siabani Inga Dora Sigfusdottir Jasvinder A Singh Pankaj Kumar Singh Dhirendra Narain Sinha Amin Soheili Joan B Soriano Muluken Bekele Sorrie Ireneous N Soyiri Mark A Stokes Mu'awiyyah Babale Sufiyan Bryan L Sykes Rafael Tabarés-Seisdedos Karen M Tabb Biruk Wogayehu Taddele Yonatal Mesfin Tefera Arash Tehrani-Banihashemi Gebretsadkan Hintsa Tekulu Ayenew Kassie Tesema Tesema Berhe Etsay Tesfay Rekha Thapar Mariya Vladimirovna Titova Kenean Getaneh Tlaye Hamid Reza Tohidinik Roman Topor-Madry Khanh Bao Tran Bach Xuan Tran Jaya Prasad Tripathy Alexander C Tsai Aristidis Tsatsakis Lorainne Tudor Car Irfan Ullah Saif Ullah Bhaskaran Unnikrishnan Era Upadhyay Olalekan A Uthman Pascual R Valdez Tommi Juhani Vasankari Yousef Veisani Narayanaswamy Venketasubramanian Francesco S Violante Vasily Vlassov Yasir Waheed Yuan-Pang Wang Taweewat Wiangkham Haileab Fekadu Wolde Dawit Habte Woldeyes Temesgen Gebeyehu Wondmeneh Adam Belay Wondmieneh Ai-Min Wu Grant M A Wyper Rajaram Yadav Ali Yadollahpour Yuichiro Yano Sanni Yaya Vahid Yazdi-Feyzabadi Pengpeng Ye Paul Yip Engida Yisma Naohiro Yonemoto Seok-Jun Yoon Yoosik Youm Mustafa Z Younis Zabihollah Yousefi Chuanhua Yu Yong Yu Telma Zahirian Moghadam Zoubida Zaidi Sojib Bin Zaman Mohammad Zamani Hamed Zandian Fatemeh Zarei Zhi-Jiang Zhang Yunquan Zhang Arash Ziapour Sanjay Zodpey Rakhi Dandona Samath Dhamminda Dharmaratne Simon I Hay Ali H Mokdad David M Pigott Robert C Reiner Theo Vos

Inj Prev 2020 Oct 24;26(Supp 1):i125-i153. Epub 2020 Aug 24.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.

Background: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.

Methods: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.

Results: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes.

Conclusions: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.
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http://dx.doi.org/10.1136/injuryprev-2019-043531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571362PMC
October 2020

Labour and delivery ward register data availability, quality, and utility - Every Newborn - birth indicators research tracking in hospitals (EN-BIRTH) study baseline analysis in three countries.

BMC Health Serv Res 2020 Aug 12;20(1):737. Epub 2020 Aug 12.

Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK.

Background: Countries with the highest burden of maternal and newborn deaths and stillbirths often have little information on these deaths. Since over 81% of births worldwide now occur in facilities, using routine facility data could reduce this data gap. We assessed the availability, quality, and utility of routine labour and delivery ward register data in five hospitals in Bangladesh, Nepal, and Tanzania. This paper forms the baseline register assessment for the Every Newborn-Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study.

Methods: We extracted 21 data elements from routine hospital labour ward registers, useful to calculate selected maternal and newborn health (MNH) indicators. The study sites were five public hospitals during a one-year period (2016-17). We measured 1) availability: completeness of data elements by register design, 2) data quality: implausibility, internal consistency, and heaping of birthweight and explored 3) utility by calculating selected MNH indicators using the available data.

Results: Data were extracted for 20,075 births. Register design was different between the five hospitals with 10-17 of the 21 selected MNH data elements available. More data were available for health outcomes than interventions. Nearly all available data elements were > 95% complete in four of the five hospitals and implausible values were rare. Data elements captured in specific columns were 85.2% highly complete compared to 25.0% captured in non-specific columns. Birthweight data were less complete for stillbirths than live births at two hospitals, and significant heaping was found in all sites, especially at 2500g and 3000g. All five hospitals recorded count data required to calculate impact indicators including; stillbirth rate, low birthweight rate, Caesarean section rate, and mortality rates.

Conclusions: Data needed to calculate MNH indicators are mostly available and highly complete in EN-BIRTH study hospital routine labour ward registers in Bangladesh, Nepal and Tanzania. Register designs need to include interventions for coverage measurement. There is potential to improve data quality if Health Management Information Systems utilization with feedback loops can be strengthened. Routine health facility data could contribute to reduce the coverage and impact data gap around the time of birth.
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http://dx.doi.org/10.1186/s12913-020-5028-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422224PMC
August 2020

Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017.

Authors:
Spencer L James Chris D Castle Zachary V Dingels Jack T Fox Erin B Hamilton Zichen Liu Nicholas L S Roberts Dillon O Sylte Nathaniel J Henry Kate E LeGrand Ahmed Abdelalim Amir Abdoli Ibrahim Abdollahpour Rizwan Suliankatchi Abdulkader Aidin Abedi Akine Eshete Abosetugn Abdelrahman I Abushouk Oladimeji M Adebayo Marcela Agudelo-Botero Tauseef Ahmad Rushdia Ahmed Muktar Beshir Ahmed Miloud Taki Eddine Aichour Fares Alahdab Genet Melak Alamene Fahad Mashhour Alanezi Animut Alebel Niguse Meles Alema Suliman A Alghnam Samar Al-Hajj Beriwan Abdulqadir Ali Saqib Ali Mahtab Alikhani Cyrus Alinia Vahid Alipour Syed Mohamed Aljunid Amir Almasi-Hashiani Nihad A Almasri Khalid Altirkawi Yasser Sami Abdeldayem Amer Saeed Amini Arianna Maever Loreche Amit Catalina Liliana Andrei Alireza Ansari-Moghaddam Carl Abelardo T Antonio Seth Christopher Yaw Appiah Jalal Arabloo Morteza Arab-Zozani Zohreh Arefi Olatunde Aremu Filippo Ariani Amit Arora Malke Asaad Babak Asghari Nefsu Awoke Beatriz Paulina Ayala Quintanilla Getinet Ayano Martin Amogre Ayanore Samad Azari Ghasem Azarian Alaa Badawi Ashish D Badiye Eleni Bagli Atif Amin Baig Mohan Bairwa Ahad Bakhtiari Arun Balachandran Maciej Banach Srikanta K Banerjee Palash Chandra Banik Amrit Banstola Suzanne Lyn Barker-Collo Till Winfried Bärnighausen Lope H Barrero Akbar Barzegar Mohsen Bayati Bayisa Abdissa Baye Neeraj Bedi Masoud Behzadifar Tariku Tesfaye Bekuma Habte Belete Corina Benjet Derrick A Bennett Isabela M Bensenor Kidanemaryam Berhe Pankaj Bhardwaj Anusha Ganapati Bhat Krittika Bhattacharyya Sadia Bibi Ali Bijani Muhammad Shahdaat Bin Sayeed Guilherme Borges Antonio Maria Borzì Soufiane Boufous Alexandra Brazinova Nikolay Ivanovich Briko Shyam S Budhathoki Josip Car Rosario Cárdenas Félix Carvalho João Mauricio Castaldelli-Maia Carlos A Castañeda-Orjuela Giulio Castelpietra Ferrán Catalá-López Ester Cerin Joht S Chandan Wagaye Fentahun Chanie Soosanna Kumary Chattu Vijay Kumar Chattu Irini Chatziralli Neha Chaudhary Daniel Youngwhan Cho Mohiuddin Ahsanul Kabir Chowdhury Dinh-Toi Chu Samantha M Colquhoun Maria-Magdalena Constantin Vera M Costa Giovanni Damiani Ahmad Daryani Claudio Alberto Dávila-Cervantes Feleke Mekonnen Demeke Asmamaw Bizuneh Demis Gebre Teklemariam Demoz Desalegn Getnet Demsie Afshin Derakhshani Kebede Deribe Rupak Desai Mostafa Dianati Nasab Diana Dias da Silva Zahra Sadat Dibaji Forooshani Kerrie E Doyle Tim Robert Driscoll Eleonora Dubljanin Bereket Duko Adema Arielle Wilder Eagan Aziz Eftekhari Elham Ehsani-Chimeh Maysaa El Sayed Zaki Demelash Abewa Elemineh Shaimaa I El-Jaafary Ziad El-Khatib Christian Lycke Ellingsen Mohammad Hassan Emamian Daniel Adane Endalew Sharareh Eskandarieh Pawan Sirwan Faris Andre Faro Farshad Farzadfar Yousef Fatahi Wubalem Fekadu Tomas Y Ferede Seyed-Mohammad Fereshtehnejad Eduarda Fernandes Pietro Ferrara Garumma Tolu Feyissa Irina Filip Florian Fischer Morenike Oluwatoyin Folayan Masoud Foroutan Joel Msafiri Francis Richard Charles Franklin Takeshi Fukumoto Biniyam Sahiledengle Geberemariyam Abadi Kahsu Gebre Ketema Bizuwork Gebremedhin Gebreamlak Gebremedhn Gebremeskel Berhe Gebremichael Getnet Azeze Gedefaw Birhanu Geta Mansour Ghafourifard Farhad Ghamari Ahmad Ghashghaee Asadollah Gholamian Tiffany K Gill Alessandra C Goulart Ayman Grada Michal Grivna Mohammed Ibrahim Mohialdeen Gubari Rafael Alves Guimarães Yuming Guo Gaurav Gupta Juanita A Haagsma Nima Hafezi-Nejad Hassan Haghparast Bidgoli Brian James Hall Randah R Hamadeh Samer Hamidi Josep Maria Haro Md Mehedi Hasan Amir Hasanzadeh Soheil Hassanipour Hadi Hassankhani Hamid Yimam Hassen Rasmus Havmoeller Khezar Hayat Delia Hendrie Fatemeh Heydarpour Martha Híjar Hung Chak Ho Chi Linh Hoang Michael K Hole Ramesh Holla Naznin Hossain Mehdi Hosseinzadeh Sorin Hostiuc Guoqing Hu Segun Emmanuel Ibitoye Olayinka Stephen Ilesanmi Irena Ilic Milena D Ilic Leeberk Raja Inbaraj Endang Indriasih Seyed Sina Naghibi Irvani Sheikh Mohammed Shariful Islam M Mofizul Islam Rebecca Q Ivers Kathryn H Jacobsen Mohammad Ali Jahani Nader Jahanmehr Mihajlo Jakovljevic Farzad Jalilian Sudha Jayaraman Achala Upendra Jayatilleke Ravi Prakash Jha Yetunde O John-Akinola Jost B Jonas Nitin Joseph Farahnaz Joukar Jacek Jerzy Jozwiak Suresh Banayya Jungari Mikk Jürisson Ali Kabir Rajendra Kadel Amaha Kahsay Leila R Kalankesh Rohollah Kalhor Teshome Abegaz Kamil Tanuj Kanchan Neeti Kapoor Manoochehr Karami Amir Kasaeian Hagazi Gebremedhin Kassaye Taras Kavetskyy Hafte Kahsay Kebede Peter Njenga Keiyoro Abraham Getachew Kelbore Bayew Kelkay Yousef Saleh Khader Morteza Abdullatif Khafaie Nauman Khalid Ibrahim A Khalil Rovshan Khalilov Mohammad Khammarnia Ejaz Ahmad Khan Maseer Khan Tripti Khanna Habibolah Khazaie Fatemeh Khosravi Shadmani Roba Khundkar Daniel N Kiirithio Young-Eun Kim Daniel Kim Yun Jin Kim Adnan Kisa Sezer Kisa Hamidreza Komaki Shivakumar K M Kondlahalli Vladimir Andreevich Korshunov Ai Koyanagi Moritz U G Kraemer Kewal Krishan Burcu Kucuk Bicer Nuworza Kugbey Vivek Kumar Nithin Kumar G Anil Kumar Manasi Kumar Girikumar Kumaresh Om P Kurmi Oluwatosin Kuti Carlo La Vecchia Faris Hasan Lami Prabhat Lamichhane Justin J Lang Van C Lansingh Dennis Odai Laryea Savita Lasrado Arman Latifi Paolo Lauriola Janet L Leasher Shaun Wen Huey Lee Tsegaye Lolaso Lenjebo Miriam Levi Shanshan Li Shai Linn Xuefeng Liu Alan D Lopez Paulo A Lotufo Raimundas Lunevicius Ronan A Lyons Mohammed Madadin Muhammed Magdy Abd El Razek Narayan Bahadur Mahotra Marek Majdan Azeem Majeed Jeadran N Malagon-Rojas Venkatesh Maled Reza Malekzadeh Deborah Carvalho Malta Navid Manafi Amir Manafi Ana-Laura Manda Narayana Manjunatha Fariborz Mansour-Ghanaei Borhan Mansouri Mohammad Ali Mansournia Joemer C Maravilla Lyn M March Amanda J Mason-Jones Seyedeh Zahra Masoumi Benjamin Ballard Massenburg Pallab K Maulik Gebrekiros Gebremichael Meles Addisu Melese Zeleke Aschalew Melketsedik Peter T N Memiah Walter Mendoza Ritesh G Menezes Meresa Berwo Mengesha Melkamu Merid Mengesha Tuomo J Meretoja Atte Meretoja Hayimro Edemealem Merie Tomislav Mestrovic Bartosz Miazgowski Tomasz Miazgowski Ted R Miller G K Mini Andreea Mirica Erkin M Mirrakhimov Mehdi Mirzaei-Alavijeh Prasanna Mithra Babak Moazen Masoud Moghadaszadeh Efat Mohamadi Yousef Mohammad Karzan Abdulmuhsin Mohammad Aso Mohammad Darwesh Naser Mohammad Gholi Mezerji Abdollah Mohammadian-Hafshejani Milad Mohammadoo-Khorasani Reza Mohammadpourhodki Shafiu Mohammed Jemal Abdu Mohammed Farnam Mohebi Mariam Molokhia Lorenzo Monasta Yoshan Moodley Mahmood Moosazadeh Masoud Moradi Ghobad Moradi Maziar Moradi-Lakeh Farhad Moradpour Lidia Morawska Ilais Moreno Velásquez Naho Morisaki Shane Douglas Morrison Tilahun Belete Mossie Atalay Goshu Muluneh Srinivas Murthy Kamarul Imran Musa Ghulam Mustafa Ashraf F Nabhan Ahamarshan Jayaraman Nagarajan Gurudatta Naik Mukhammad David Naimzada Farid Najafi Vinay Nangia Bruno Ramos Nascimento Morteza Naserbakht Vinod Nayak Duduzile Edith Ndwandwe Ionut Negoi Josephine W Ngunjiri Cuong Tat Nguyen Huong Lan Thi Nguyen Rajan Nikbakhsh Dina Nur Anggraini Ningrum Chukwudi A Nnaji Peter S Nyasulu Felix Akpojene Ogbo Onome Bright Oghenetega In-Hwan Oh Emmanuel Wandera Okunga Andrew T Olagunju Tinuke O Olagunju Ahmed Omar Bali Obinna E Onwujekwe Kwaku Oppong Asante Heather M Orpana Erika Ota Nikita Otstavnov Stanislav S Otstavnov Mahesh P A Jagadish Rao Padubidri Smita Pakhale Keyvan Pakshir Songhomitra Panda-Jonas Eun-Kee Park Sangram Kishor Patel Ashish Pathak Sanghamitra Pati George C Patton Kebreab Paulos Amy E Peden Veincent Christian Filipino Pepito Jeevan Pereira Hai Quang Pham Michael R Phillips Marina Pinheiro Roman V Polibin Suzanne Polinder Hossein Poustchi Swayam Prakash Dimas Ria Angga Pribadi Parul Puri Zahiruddin Quazi Syed Mohammad Rabiee Navid Rabiee Amir Radfar Anwar Rafay Ata Rafiee Alireza Rafiei Fakher Rahim Siavash Rahimi Vafa Rahimi-Movaghar Muhammad Aziz Rahman Ali Rajabpour-Sanati Fatemeh Rajati Ivo Rakovac Kavitha Ranganathan Sowmya J Rao Vahid Rashedi Prateek Rastogi Priya Rathi Salman Rawaf Lal Rawal Reza Rawassizadeh Vishnu Renjith Andre M N Renzaho Serge Resnikoff Aziz Rezapour Ana Isabel Ribeiro Jennifer Rickard Carlos Miguel Rios González Luca Ronfani Gholamreza Roshandel Anas M Saad Yogesh Damodar Sabde Siamak Sabour Basema Saddik Saeed Safari Roya Safari-Faramani Hamid Safarpour Mahdi Safdarian S Mohammad Sajadi Payman Salamati Farkhonde Salehi Saleh Salehi Zahabi Marwa R Rashad Salem Hosni Salem Omar Salman Inbal Salz Abdallah M Samy Juan Sanabria Lidia Sanchez Riera Milena M Santric Milicevic Abdur Razzaque Sarker Arash Sarveazad Brijesh Sathian Monika Sawhney Susan M Sawyer Sonia Saxena Mehdi Sayyah David C Schwebel Soraya Seedat Subramanian Senthilkumaran Sadaf G Sepanlou Seyedmojtaba Seyedmousavi Feng Sha Faramarz Shaahmadi Saeed Shahabi Masood Ali Shaikh Mehran Shams-Beyranvand Morteza Shamsizadeh Mahdi Sharif-Alhoseini Hamid Sharifi Aziz Sheikh Mika Shigematsu Jae Il Shin Rahman Shiri Soraya Siabani Inga Dora Sigfusdottir Pankaj Kumar Singh Jasvinder A Singh Dhirendra Narain Sinha Catalin-Gabriel Smarandache Emma U R Smith Amin Soheili Bija Soleymani Ali Reza Soltanian Joan B Soriano Muluken Bekele Sorrie Ireneous N Soyiri Dan J Stein Mark A Stokes Mu'awiyyah Babale Sufiyan Hafiz Ansar Rasul Suleria Bryan L Sykes Rafael Tabarés-Seisdedos Karen M Tabb Biruk Wogayehu Taddele Degena Bahrey Tadesse Animut Tagele Tamiru Ingan Ukur Tarigan Yonatal Mesfin Tefera Arash Tehrani-Banihashemi Merhawi Gebremedhin Tekle Gebretsadkan Hintsa Tekulu Ayenew Kassie Tesema Berhe Etsay Tesfay Rekha Thapar Asres Bedaso Tilahune Kenean Getaneh Tlaye Hamid Reza Tohidinik Roman Topor-Madry Bach Xuan Tran Khanh Bao Tran Jaya Prasad Tripathy Alexander C Tsai Lorainne Tudor Car Saif Ullah Irfan Ullah Maida Umar Bhaskaran Unnikrishnan Era Upadhyay Olalekan A Uthman Pascual R Valdez Tommi Juhani Vasankari Narayanaswamy Venketasubramanian Francesco S Violante Vasily Vlassov Yasir Waheed Girmay Teklay Weldesamuel Andrea Werdecker Taweewat Wiangkham Haileab Fekadu Wolde Dawit Habte Woldeyes Dawit Zewdu Wondafrash Temesgen Gebeyehu Wondmeneh Adam Belay Wondmieneh Ai-Min Wu Rajaram Yadav Ali Yadollahpour Yuichiro Yano Sanni Yaya Vahid Yazdi-Feyzabadi Paul Yip Engida Yisma Naohiro Yonemoto Seok-Jun Yoon Yoosik Youm Mustafa Z Younis Zabihollah Yousefi Yong Yu Chuanhua Yu Hasan Yusefzadeh Telma Zahirian Moghadam Zoubida Zaidi Sojib Bin Zaman Mohammad Zamani Maryam Zamanian Hamed Zandian Ahmad Zarei Fatemeh Zare Zhi-Jiang Zhang Yunquan Zhang Sanjay Zodpey Lalit Dandona Rakhi Dandona Louisa Degenhardt Samath Dhamminda Dharmaratne Simon I Hay Ali H Mokdad Robert C Reiner Benn Sartorius Theo Vos

Inj Prev 2020 Oct 24;26(Supp 1):i96-i114. Epub 2020 Apr 24.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.

Background: Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.

Methods: We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).

Findings: In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505).

Interpretation: Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.
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http://dx.doi.org/10.1136/injuryprev-2019-043494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571366PMC
October 2020

Clustering of hypertension, diabetes and overweight/obesity according to socioeconomic status among Bangladeshi adults.

J Biosoc Sci 2021 Mar 9;53(2):157-166. Epub 2020 Mar 9.

Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.

The prevalences of hypertension, diabetes and overweight/obesity are increasing in most developing countries, including Bangladesh. Although earlier studies have investigated the factors associated with these three conditions, little is known about whether socioeconomic status is associated with their co-existence. This cross-sectional study analysed data from the 2011 Bangladesh Demographic and Health Survey. An individual was considered hypertensive, diabetic and overweight/obese if their systolic/diastolic blood pressure, fasting plasma glucose concentration, and body mass index were ≥130/80 mmHg, ≥7 mmol/l and ≥23 kg/m2, respectively. Furthermore, individuals who reported taking anti-hypertensive and anti-diabetic drugs were also considered as hypertensive and diabetic, respectively. Two socioeconomic variables were investigated: education level and household wealth quintile. Descriptive analyses and multilevel logistic regression were conducted. Among the 7932 respondents (50.5% female) aged ≥35 years, the prevalences of hypertension, diabetes, overweight/obesity, any one condition and the co-existence of the three conditions were 48.0%, 11.0%, 25.3%, 60.9% and 3.6%, respectively. In adjusted analysis, individuals with secondary (adjusted odds ratio [AOR]: 1.8, 95% confidence interval [CI]: 1.2-2.8) and college or above (AOR: 3.6; 95% CI: 2.2-5.7) education levels had higher odds of the co-existence of all three conditions compared with those with no formal education. Similarly, compared with the poorest wealth quintile, the richer (AOR: 4.6; 95% CI: 2.2-9.4) and richest (AOR: 11.8; 95% CI: 5.8-24.1) wealth quintiles had higher odds of co-existence of these three conditions. Education and wealth quintile also showed significant relationships with each of the three conditions separately. In conclusion, in Bangladesh, hypertension, diabetes and overweight/obesity are associated with indicators of higher socioeconomic status. These findings highlight the importance of developing healthy lifestyle interventions (e.g. physical exercise and dietary modification) targeting individuals of higher socioeconomic status to minimize the burden of these non-communicable diseases.
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http://dx.doi.org/10.1017/S0021932020000085DOI Listing
March 2021

The burden of unintentional drowning: global, regional and national estimates of mortality from the Global Burden of Disease 2017 Study.

Authors:
Richard Charles Franklin Amy E Peden Erin B Hamilton Catherine Bisignano Chris D Castle Zachary V Dingels Simon I Hay Zichen Liu Ali H Mokdad Nicholas L S Roberts Dillon O Sylte Theo Vos Gdiom Gebreheat Abady Akine Eshete Abosetugn Rushdia Ahmed Fares Alahdab Catalina Liliana Andrei Carl Abelardo T Antonio Jalal Arabloo Aseb Arba Kinfe Arba Ashish D Badiye Shankar M Bakkannavar Maciej Banach Palash Chandra Banik Amrit Banstola Suzanne Lyn Barker-Collo Akbar Barzegar Mohsen Bayati Pankaj Bhardwaj Soumyadeep Bhaumik Zulfiqar A Bhutta Ali Bijani Archith Boloor Félix Carvalho Mohiuddin Ahsanul Kabir Chowdhury Dinh-Toi Chu Samantha M Colquhoun Henok Dagne Baye Dagnew Lalit Dandona Rakhi Dandona Ahmad Daryani Samath Dhamminda Dharmaratne Zahra Sadat Dibaji Forooshani Hoa Thi Do Tim Robert Driscoll Arielle Wilder Eagan Ziad El-Khatib Eduarda Fernandes Irina Filip Florian Fischer Berhe Gebremichael Gaurav Gupta Juanita A Haagsma Shoaib Hassan Delia Hendrie Chi Linh Hoang Michael K Hole Ramesh Holla Sorin Hostiuc Mowafa Househ Olayinka Stephen Ilesanmi Leeberk Raja Inbaraj Seyed Sina Naghibi Irvani M Mofizul Islam Rebecca Q Ivers Achala Upendra Jayatilleke Farahnaz Joukar Rohollah Kalhor Tanuj Kanchan Neeti Kapoor Amir Kasaeian Maseer Khan Ejaz Ahmad Khan Jagdish Khubchandani Kewal Krishan G Anil Kumar Paolo Lauriola Alan D Lopez Mohammed Madadin Marek Majdan Venkatesh Maled Navid Manafi Ali Manafi Martin McKee Hagazi Gebre Meles Ritesh G Menezes Tuomo J Meretoja Ted R Miller Prasanna Mithra Abdollah Mohammadian-Hafshejani Reza Mohammadpourhodki Farnam Mohebi Mariam Molokhia Ghulam Mustafa Ionut Negoi Cuong Tat Nguyen Huong Lan Thi Nguyen Andrew T Olagunju Tinuke O Olagunju Jagadish Rao Padubidri Keyvan Pakshir Ashish Pathak Suzanne Polinder Dimas Ria Angga Pribadi Navid Rabiee Amir Radfar Saleem Muhammad Rana Jennifer Rickard Saeed Safari Payman Salamati Abdallah M Samy Abdur Razzaque Sarker David C Schwebel Subramanian Senthilkumaran Faramarz Shaahmadi Masood Ali Shaikh Jae Il Shin Pankaj Kumar Singh Amin Soheili Mark A Stokes Hafiz Ansar Rasul Suleria Ingan Ukur Tarigan Mohamad-Hani Temsah Berhe Etsay Tesfay Pascual R Valdez Yousef Veisani Pengpeng Ye Naohiro Yonemoto Chuanhua Yu Hasan Yusefzadeh Sojib Bin Zaman Zhi-Jiang Zhang Spencer L James

Inj Prev 2020 Oct 20;26(Supp 1):i83-i95. Epub 2020 Feb 20.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA

Background: Drowning is a leading cause of injury-related mortality globally. Unintentional drowning (International Classification of Diseases (ICD) 10 codes W65-74 and ICD9 E910) is one of the 30 mutually exclusive and collectively exhaustive causes of injury-related mortality in the Global Burden of Disease (GBD) study. This study's objective is to describe unintentional drowning using GBD estimates from 1990 to 2017.

Methods: Unintentional drowning from GBD 2017 was estimated for cause-specific mortality and years of life lost (YLLs), age, sex, country, region, Socio-demographic Index (SDI) quintile, and trends from 1990 to 2017. GBD 2017 used standard GBD methods for estimating mortality from drowning.

Results: Globally, unintentional drowning mortality decreased by 44.5% between 1990 and 2017, from 531 956 (uncertainty interval (UI): 484 107 to 572 854) to 295 210 (284 493 to 306 187) deaths. Global age-standardised mortality rates decreased 57.4%, from 9.3 (8.5 to 10.0) in 1990 to 4.0 (3.8 to 4.1) per 100 000 per annum in 2017. Unintentional drowning-associated mortality was generally higher in children, males and in low-SDI to middle-SDI countries. China, India, Pakistan and Bangladesh accounted for 51.2% of all drowning deaths in 2017. Oceania was the region with the highest rate of age-standardised YLLs in 2017, with 45 434 (40 850 to 50 539) YLLs per 100 000 across both sexes.

Conclusions: There has been a decline in global drowning rates. This study shows that the decline was not consistent across countries. The results reinforce the need for continued and improved policy, prevention and research efforts, with a focus on low- and middle-income countries.
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http://dx.doi.org/10.1136/injuryprev-2019-043484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571364PMC
October 2020

Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017.

Authors:
Juanita A Haagsma Spencer L James Chris D Castle Zachary V Dingels Jack T Fox Erin B Hamilton Zichen Liu Lydia R Lucchesi Nicholas L S Roberts Dillon O Sylte Oladimeji M Adebayo Alireza Ahmadi Muktar Beshir Ahmed Miloud Taki Eddine Aichour Fares Alahdab Suliman A Alghnam Syed Mohamed Aljunid Rajaa M Al-Raddadi Ubai Alsharif Khalid Altirkawi Mina Anjomshoa Carl Abelardo T Antonio Seth Christopher Yaw Appiah Olatunde Aremu Amit Arora Hamid Asayesh Reza Assadi Ashish Awasthi Beatriz Paulina Ayala Quintanilla Shivanthi Balalla Amrit Banstola Suzanne Lyn Barker-Collo Till Winfried Bärnighausen Shahrzad Bazargan-Hejazi Neeraj Bedi Masoud Behzadifar Meysam Behzadifar Corina Benjet Derrick A Bennett Isabela M Bensenor Soumyadeep Bhaumik Zulfiqar A Bhutta Ali Bijani Guilherme Borges Rohan Borschmann Dipan Bose Soufiane Boufous Alexandra Brazinova Julio Cesar Campuzano Rincon Rosario Cárdenas Juan J Carrero Félix Carvalho Carlos A Castañeda-Orjuela Ferrán Catalá-López Jee-Young J Choi Devasahayam J Christopher Christopher Stephen Crowe Koustuv Dalal Ahmad Daryani Dragos Virgil Davitoiu Louisa Degenhardt Diego De Leo Jan-Walter De Neve Kebede Deribe Getenet Ayalew Dessie Gabrielle Aline deVeber Samath Dhamminda Dharmaratne Linh Phuong Doan Kate A Dolan Tim Robert Driscoll Manisha Dubey Ziad El-Khatib Christian Lycke Ellingsen Maysaa El Sayed Zaki Aman Yesuf Endries Sharareh Eskandarieh Andre Faro Seyed-Mohammad Fereshtehnejad Eduarda Fernandes Irina Filip Florian Fischer Richard Charles Franklin Takeshi Fukumoto Kebede Embaye Gezae Tiffany K Gill Alessandra C Goulart Ayman Grada Yuming Guo Rahul Gupta Hassan Haghparast Bidgoli Arvin Haj-Mirzaian Arya Haj-Mirzaian Randah R Hamadeh Samer Hamidi Josep Maria Haro Hadi Hassankhani Hamid Yimam Hassen Rasmus Havmoeller Delia Hendrie Andualem Henok Martha Híjar Michael K Hole Enayatollah Homaie Rad Naznin Hossain Sorin Hostiuc Guoqing Hu Ehimario U Igumbor Olayinka Stephen Ilesanmi Seyed Sina Naghibi Irvani Sheikh Mohammed Shariful Islam Rebecca Q Ivers Kathryn H Jacobsen Nader Jahanmehr Mihajlo Jakovljevic Achala Upendra Jayatilleke Ravi Prakash Jha Jost B Jonas Zahra Jorjoran Shushtari Jacek Jerzy Jozwiak Mikk Jürisson Ali Kabir Rizwan Kalani Amir Kasaeian Abraham Getachew Kelbore Andre Pascal Kengne Yousef Saleh Khader Morteza Abdullatif Khafaie Nauman Khalid Ejaz Ahmad Khan Abdullah T Khoja Aliasghar A Kiadaliri Young-Eun Kim Daniel Kim Adnan Kisa Ai Koyanagi Barthelemy Kuate Defo Burcu Kucuk Bicer Manasi Kumar Ratilal Lalloo Hilton Lam Faris Hasan Lami Van C Lansingh Janet L Leasher Shanshan Li Shai Linn Raimundas Lunevicius Flavia R Machado Hassan Magdy Abd El Razek Muhammed Magdy Abd El Razek Narayan Bahadur Mahotra Marek Majdan Azeem Majeed Reza Malekzadeh Manzoor Ahmad Malik Deborah Carvalho Malta Ana-Laura Manda Mohammad Ali Mansournia Benjamin Ballard Massenburg Pallab K Maulik Hailemariam Abiy Alemu Meheretu Man Mohan Mehndiratta Addisu Melese Walter Mendoza Melkamu Merid Mengesha Tuomo J Meretoja Atte Meretoja Tomislav Mestrovic Tomasz Miazgowski Ted R Miller G K Mini Erkin M Mirrakhimov Babak Moazen Naser Mohammad Gholi Mezerji Roghayeh Mohammadibakhsh Shafiu Mohammed Mariam Molokhia Lorenzo Monasta Stefania Mondello Pablo A Montero-Zamora Yoshan Moodley Mahmood Moosazadeh Ghobad Moradi Maziar Moradi-Lakeh Lidia Morawska Ilais Moreno Velásquez Shane Douglas Morrison Marilita M Moschos Seyyed Meysam Mousavi Srinivas Murthy Kamarul Imran Musa Gurudatta Naik Farid Najafi Vinay Nangia Bruno Ramos Nascimento Duduzile Edith Ndwandwe Ionut Negoi Trang Huyen Nguyen Son Hoang Nguyen Long Hoang Nguyen Huong Lan Thi Nguyen Dina Nur Anggraini Ningrum Yirga Legesse Nirayo Richard Ofori-Asenso Felix Akpojene Ogbo In-Hwan Oh Olanrewaju Oladimeji Andrew T Olagunju Tinuke O Olagunju Pedro R Olivares Heather M Orpana Stanislav S Otstavnov Mahesh P A Smita Pakhale Eun-Kee Park George C Patton Konrad Pesudovs Michael R Phillips Suzanne Polinder Swayam Prakash Amir Radfar Anwar Rafay Alireza Rafiei Siavash Rahimi Vafa Rahimi-Movaghar Muhammad Aziz Rahman Rajesh Kumar Rai Kiana Ramezanzadeh Salman Rawaf David Laith Rawaf Andre M N Renzaho Serge Resnikoff Shahab Rezaeian Leonardo Roever Luca Ronfani Gholamreza Roshandel Yogesh Damodar Sabde Basema Saddik Payman Salamati Yahya Salimi Inbal Salz Abdallah M Samy Juan Sanabria Lidia Sanchez Riera Milena M Santric Milicevic Maheswar Satpathy Monika Sawhney Susan M Sawyer Sonia Saxena Mete Saylan Ione J C Schneider David C Schwebel Soraya Seedat Sadaf G Sepanlou Masood Ali Shaikh Mehran Shams-Beyranvand Morteza Shamsizadeh Mahdi Sharif-Alhoseini Aziz Sheikh Jiabin Shen Mika Shigematsu Rahman Shiri Ivy Shiue João Pedro Silva Jasvinder A Singh Dhirendra Narain Sinha Adauto Martins Soares Filho Joan B Soriano Sergey Soshnikov Ireneous N Soyiri Vladimir I Starodubov Dan J Stein Mark A Stokes Mu'awiyyah Babale Sufiyan Jacob E Sunshine Bryan L Sykes Rafael Tabarés-Seisdedos Karen M Tabb Arash Tehrani-Banihashemi Gizachew Assefa Tessema Jarnail Singh Thakur Khanh Bao Tran Bach Xuan Tran Lorainne Tudor Car Olalekan A Uthman Benjamin S Chudi Uzochukwu Pascual R Valdez Elena Varavikova Ana Maria Nogales Vasconcelos Narayanaswamy Venketasubramanian Francesco S Violante Vasily Vlassov Yasir Waheed Yuan-Pang Wang Tissa Wijeratne Andrea Sylvia Winkler Priyanka Yadav Yuichiro Yano Muluken Azage Yenesew Paul Yip Engida Yisma Naohiro Yonemoto Mustafa Z Younis Chuanhua Yu Shamsa Zafar Zoubida Zaidi Sojib Bin Zaman Mohammad Zamani Yong Zhao Sanjay Zodpey Simon I Hay Alan D Lopez Ali H Mokdad Theo Vos

Inj Prev 2020 Oct 8;26(Supp 1):i12-i26. Epub 2020 Jan 8.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.

Background: The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates.

Methods: Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate.

Results: For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced.

Conclusions: The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.
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http://dx.doi.org/10.1136/injuryprev-2019-043296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571356PMC
October 2020

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017.

Authors:
Roy Burstein Nathaniel J Henry Michael L Collison Laurie B Marczak Amber Sligar Stefanie Watson Neal Marquez Mahdieh Abbasalizad-Farhangi Masoumeh Abbasi Foad Abd-Allah Amir Abdoli Mohammad Abdollahi Ibrahim Abdollahpour Rizwan Suliankatchi Abdulkader Michael R M Abrigo Dilaram Acharya Oladimeji M Adebayo Victor Adekanmbi Davoud Adham Mahdi Afshari Mohammad Aghaali Keivan Ahmadi Mehdi Ahmadi Ehsan Ahmadpour Rushdia Ahmed Chalachew Genet Akal Joshua O Akinyemi Fares Alahdab Noore Alam Genet Melak Alamene Kefyalew Addis Alene Mehran Alijanzadeh Cyrus Alinia Vahid Alipour Syed Mohamed Aljunid Mohammed J Almalki Hesham M Al-Mekhlafi Khalid Altirkawi Nelson Alvis-Guzman Adeladza Kofi Amegah Saeed Amini Arianna Maever Loreche Amit Zohreh Anbari Sofia Androudi Mina Anjomshoa Fereshteh Ansari Carl Abelardo T Antonio Jalal Arabloo Zohreh Arefi Olatunde Aremu Bahram Armoon Amit Arora Al Artaman Anvar Asadi Mehran Asadi-Aliabadi Amir Ashraf-Ganjouei Reza Assadi Bahar Ataeinia Sachin R Atre Beatriz Paulina Ayala Quintanilla Martin Amogre Ayanore Samad Azari Ebrahim Babaee Arefeh Babazadeh Alaa Badawi Soghra Bagheri Mojtaba Bagherzadeh Nafiseh Baheiraei Abbas Balouchi Aleksandra Barac Quique Bassat Bernhard T Baune Mohsen Bayati Neeraj Bedi Ettore Beghi Masoud Behzadifar Meysam Behzadifar Yared Belete Belay Brent Bell Michelle L Bell Dessalegn Ajema Berbada Robert S Bernstein Natalia V Bhattacharjee Suraj Bhattarai Zulfiqar A Bhutta Ali Bijani Somayeh Bohlouli Nicholas J K Breitborde Gabrielle Britton Annie J Browne Sharath Burugina Nagaraja Reinhard Busse Zahid A Butt Josip Car Rosario Cárdenas Carlos A Castañeda-Orjuela Ester Cerin Wagaye Fentahun Chanie Pranab Chatterjee Dinh-Toi Chu Cyrus Cooper Vera M Costa Koustuv Dalal Lalit Dandona Rakhi Dandona Farah Daoud Ahmad Daryani Rajat Das Gupta Ian Davis Nicole Davis Weaver Dragos Virgil Davitoiu Jan-Walter De Neve Feleke Mekonnen Demeke Gebre Teklemariam Demoz Kebede Deribe Rupak Desai Aniruddha Deshpande Hanna Demelash Desyibelew Sagnik Dey Samath Dhamminda Dharmaratne Meghnath Dhimal Daniel Diaz Leila Doshmangir Andre R Duraes Laura Dwyer-Lindgren Lucas Earl Roya Ebrahimi Soheil Ebrahimpour Andem Effiong Aziz Eftekhari Elham Ehsani-Chimeh Iman El Sayed Maysaa El Sayed Zaki Maha El Tantawi Ziad El-Khatib Mohammad Hassan Emamian Shymaa Enany Sharareh Eskandarieh Oghenowede Eyawo Maha Ezalarab Mahbobeh Faramarzi Mohammad Fareed Roghiyeh Faridnia Andre Faro Ali Akbar Fazaeli Mehdi Fazlzadeh Netsanet Fentahun Seyed-Mohammad Fereshtehnejad João C Fernandes Irina Filip Florian Fischer Nataliya A Foigt Masoud Foroutan Joel Msafiri Francis Takeshi Fukumoto Nancy Fullman Silvano Gallus Destallem Gebremedhin Gebre Tsegaye Tewelde Gebrehiwot Gebreamlak Gebremedhn Gebremeskel Bradford D Gessner Birhanu Geta Peter W Gething Reza Ghadimi Keyghobad Ghadiri Mahsa Ghajarzadeh Ahmad Ghashghaee Paramjit Singh Gill Tiffany K Gill Nick Golding Nelson G M Gomes Philimon N Gona Sameer Vali Gopalani Giuseppe Gorini Bárbara Niegia Garcia Goulart Nicholas Graetz Felix Greaves Manfred S Green Yuming Guo Arvin Haj-Mirzaian Arya Haj-Mirzaian Brian James Hall Samer Hamidi Hamidreza Haririan Josep Maria Haro Milad Hasankhani Edris Hasanpoor Amir Hasanzadeh Hadi Hassankhani Hamid Yimam Hassen Mohamed I Hegazy Delia Hendrie Fatemeh Heydarpour Thomas R Hird Chi Linh Hoang Gillian Hollerich Enayatollah Homaie Rad Mojtaba Hoseini-Ghahfarokhi Naznin Hossain Mostafa Hosseini Mehdi Hosseinzadeh Mihaela Hostiuc Sorin Hostiuc Mowafa Househ Mohamed Hsairi Olayinka Stephen Ilesanmi Mohammad Hasan Imani-Nasab Usman Iqbal Seyed Sina Naghibi Irvani Nazrul Islam Sheikh Mohammed Shariful Islam Mikk Jürisson Nader Jafari Balalami Amir Jalali Javad Javidnia Achala Upendra Jayatilleke Ensiyeh Jenabi John S Ji Yash B Jobanputra Kimberly Johnson Jost B Jonas Zahra Jorjoran Shushtari Jacek Jerzy Jozwiak Ali Kabir Amaha Kahsay Hamed Kalani Rohollah Kalhor Manoochehr Karami Surendra Karki Amir Kasaeian Nicholas J Kassebaum Peter Njenga Keiyoro Grant Rodgers Kemp Roghayeh Khabiri Yousef Saleh Khader Morteza Abdullatif Khafaie Ejaz Ahmad Khan Junaid Khan Muhammad Shahzeb Khan Young-Ho Khang Khaled Khatab Amir Khater Mona M Khater Alireza Khatony Mohammad Khazaei Salman Khazaei Maryam Khazaei-Pool Jagdish Khubchandani Neda Kianipour Yun Jin Kim Ruth W Kimokoti Damaris K Kinyoki Adnan Kisa Sezer Kisa Tufa Kolola Soewarta Kosen Parvaiz A Koul Ai Koyanagi Moritz U G Kraemer Kewal Krishan Kris J Krohn Nuworza Kugbey G Anil Kumar Manasi Kumar Pushpendra Kumar Desmond Kuupiel Ben Lacey Sheetal D Lad Faris Hasan Lami Anders O Larsson Paul H Lee Mostafa Leili Aubrey J Levine Shanshan Li Lee-Ling Lim Stefan Listl Joshua Longbottom Jaifred Christian F Lopez Stefan Lorkowski Sameh Magdeldin Hassan Magdy Abd El Razek Muhammed Magdy Abd El Razek Azeem Majeed Afshin Maleki Reza Malekzadeh Deborah Carvalho Malta Abdullah A Mamun Navid Manafi Ana-Laura Manda Morteza Mansourian Francisco Rogerlândio Martins-Melo Anthony Masaka Benjamin Ballard Massenburg Pallab K Maulik Benjamin K Mayala Mohsen Mazidi Martin McKee Ravi Mehrotra Kala M Mehta Gebrekiros Gebremichael Meles Walter Mendoza Ritesh G Menezes Atte Meretoja Tuomo J Meretoja Tomislav Mestrovic Ted R Miller Molly K Miller-Petrie Edward J Mills George J Milne G K Mini Seyed Mostafa Mir Hamed Mirjalali Erkin M Mirrakhimov Efat Mohamadi Dara K Mohammad Aso Mohammad Darwesh Naser Mohammad Gholi Mezerji Ammas Siraj Mohammed Shafiu Mohammed Ali H Mokdad Mariam Molokhia Lorenzo Monasta Yoshan Moodley Mahmood Moosazadeh Ghobad Moradi Masoud Moradi Yousef Moradi Maziar Moradi-Lakeh Mehdi Moradinazar Paula Moraga Lidia Morawska Abbas Mosapour Seyyed Meysam Mousavi Ulrich Otto Mueller Atalay Goshu Muluneh Ghulam Mustafa Behnam Nabavizadeh Mehdi Naderi Ahamarshan Jayaraman Nagarajan Azin Nahvijou Farid Najafi Vinay Nangia Duduzile Edith Ndwandwe Nahid Neamati Ionut Negoi Ruxandra Irina Negoi Josephine W Ngunjiri Huong Lan Thi Nguyen Long Hoang Nguyen Son Hoang Nguyen Katie R Nielsen Dina Nur Anggraini Ningrum Yirga Legesse Nirayo Molly R Nixon Chukwudi A Nnaji Marzieh Nojomi Mehdi Noroozi Shirin Nosratnejad Jean Jacques Noubiap Soraya Nouraei Motlagh Richard Ofori-Asenso Felix Akpojene Ogbo Kelechi E Oladimeji Andrew T Olagunju Meysam Olfatifar Solomon Olum Bolajoko Olubukunola Olusanya Mojisola Morenike Oluwasanu Obinna E Onwujekwe Eyal Oren Doris D V Ortega-Altamirano Alberto Ortiz Osayomwanbo Osarenotor Frank B Osei Aaron E Osgood-Zimmerman Stanislav S Otstavnov Mayowa Ojo Owolabi Mahesh P A Abdol Sattar Pagheh Smita Pakhale Songhomitra Panda-Jonas Animika Pandey Eun-Kee Park Hadi Parsian Tahereh Pashaei Sangram Kishor Patel Veincent Christian Filipino Pepito Alexandre Pereira Samantha Perkins Brandon V Pickering Thomas Pilgrim Majid Pirestani Bakhtiar Piroozi Meghdad Pirsaheb Oleguer Plana-Ripoll Hadi Pourjafar Parul Puri Mostafa Qorbani Hedley Quintana Mohammad Rabiee Navid Rabiee Amir Radfar Alireza Rafiei Fakher Rahim Zohreh Rahimi Vafa Rahimi-Movaghar Shadi Rahimzadeh Fatemeh Rajati Sree Bhushan Raju Azra Ramezankhani Chhabi Lal Ranabhat Davide Rasella Vahid Rashedi Lal Rawal Robert C Reiner Andre M N Renzaho Satar Rezaei Aziz Rezapour Seyed Mohammad Riahi Ana Isabel Ribeiro Leonardo Roever Elias Merdassa Roro Max Roser Gholamreza Roshandel Daem Roshani Ali Rostami Enrico Rubagotti Salvatore Rubino Siamak Sabour Nafis Sadat Ehsan Sadeghi Reza Saeedi Yahya Safari Roya Safari-Faramani Mahdi Safdarian Amirhossein Sahebkar Mohammad Reza Salahshoor Nasir Salam Payman Salamati Farkhonde Salehi Saleh Salehi Zahabi Yahya Salimi Hamideh Salimzadeh Joshua A Salomon Evanson Zondani Sambala Abdallah M Samy Milena M Santric Milicevic Bruno Piassi Sao Jose Sivan Yegnanarayana Iyer Saraswathy Rodrigo Sarmiento-Suárez Benn Sartorius Brijesh Sathian Sonia Saxena Alyssa N Sbarra Lauren E Schaeffer David C Schwebel Sadaf G Sepanlou Seyedmojtaba Seyedmousavi Faramarz Shaahmadi Masood Ali Shaikh Mehran Shams-Beyranvand Amir Shamshirian Morteza Shamsizadeh Kiomars Sharafi Mehdi Sharif Mahdi Sharif-Alhoseini Hamid Sharifi Jayendra Sharma Rajesh Sharma Aziz Sheikh Chloe Shields Mika Shigematsu Rahman Shiri Ivy Shiue Kerem Shuval Tariq J Siddiqi João Pedro Silva Jasvinder A Singh Dhirendra Narain Sinha Malede Mequanent Sisay Solomon Sisay Karen Sliwa David L Smith Ranjani Somayaji Moslem Soofi Joan B Soriano Chandrashekhar T Sreeramareddy Agus Sudaryanto Mu'awiyyah Babale Sufiyan Bryan L Sykes P N Sylaja Rafael Tabarés-Seisdedos Karen M Tabb Takahiro Tabuchi Nuno Taveira Mohamad-Hani Temsah Abdullah Sulieman Terkawi Zemenu Tadesse Tessema Kavumpurathu Raman Thankappan Sathish Thirunavukkarasu Quyen G To Marcos Roberto Tovani-Palone Bach Xuan Tran Khanh Bao Tran Irfan Ullah Muhammad Shariq Usman Olalekan A Uthman Amir Vahedian-Azimi Pascual R Valdez Job F M van Boven Tommi Juhani Vasankari Yasser Vasseghian Yousef Veisani Narayanaswamy Venketasubramanian Francesco S Violante Sergey Konstantinovitch Vladimirov Vasily Vlassov Theo Vos Giang Thu Vu Isidora S Vujcic Yasir Waheed Jon Wakefield Haidong Wang Yafeng Wang Yuan-Pang Wang Joseph L Ward Robert G Weintraub Kidu Gidey Weldegwergs Girmay Teklay Weldesamuel Ronny Westerman Charles Shey Wiysonge Dawit Zewdu Wondafrash Lauren Woyczynski Ai-Min Wu Gelin Xu Abbas Yadegar Tomohide Yamada Vahid Yazdi-Feyzabadi Christopher Sabo Yilgwan Paul Yip Naohiro Yonemoto Javad Yoosefi Lebni Mustafa Z Younis Mahmoud Yousefifard Hebat-Allah Salah A Yousof Chuanhua Yu Hasan Yusefzadeh Erfan Zabeh Telma Zahirian Moghadam Sojib Bin Zaman Mohammad Zamani Hamed Zandian Alireza Zangeneh Taddese Alemu Zerfu Yunquan Zhang Arash Ziapour Sanjay Zodpey Christopher J L Murray Simon I Hay

Nature 2019 10 16;574(7778):353-358. Epub 2019 Oct 16.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.
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http://dx.doi.org/10.1038/s41586-019-1545-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800389PMC
October 2019

Factors associated with hypertension among adults in Nepal as per the Joint National Committee 7 and 2017 American College of Cardiology/American Heart Association hypertension guidelines: a cross-sectional analysis of the demographic and health survey 2016.

BMJ Open 2019 08 10;9(8):e030206. Epub 2019 Aug 10.

Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, USA.

Objectives: This study investigated the determinants of hypertension in Nepal according to both the Joint National Committee 7 (JNC7) and the American College of Cardiology/American Heart Association (2017 ACC/AHA) guidelines.

Design: Cross-sectional study.

Setting: This study used data collected from the 2016 Nepal Demographic and Health Survey data.

Participants: 13 393 weighted adults aged ≥18 years enrolled by a stratified cluster sampling strategy were included in our analysis.

Primary And Secondary Outcome Measures: The primary outcome was hypertension, which was defined according to JNC7 (systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg) and 2017 ACC/AHA guidelines (SBP ≥130 mm Hg and/or DBP ≥80 mm Hg). Antihypertensive medication users were also classified as hypertensive. After descriptive analysis, multilevel logistic regression was applied to obtain ORs.

Results: About 21% (n=2827) and 44% (n=5918) of the individuals aged ≥18 years were classified as hypertensive according to the JNC7 and 2017 ACC/AHA guidelines, respectively. Following factors were found to be significantly associated with hypertension according to the 2017 ACC/AHA guideline: ≥70 years (adjusted OR (AOR) 5.2; 95% CI 4.3 to 6.2), 50-69 years (AOR 3.9; 95% CI 3.4 to 4.4) and 30-49 years (AOR 2.7; 95% CI 2.4 to 3.0) age groups, male gender (AOR 1.7; 95% CI 1.6 to 1.9), being overweight/obese (AOR 3.0; 95% CI 2.7 to 3.3), residence in provinces 4 (AOR 1.5; 95% CI 1.2 to 2.0) and 5 (AOR 1.5; 95% CI 1.2 to 1.9). No significant association was identified with household wealth status and ecological regions of residence using the 2017 ACC/AHA guideline.

Conclusions: Per both guidelines, multiple factors were associated with hypertension. Public health programme aiming to prevent and control hypertension in Nepal should prioritise these factors and focus on individuals with a higher likelihood of hypertension irrespective of educational level, household wealth status and ecological regions of residence.
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http://dx.doi.org/10.1136/bmjopen-2019-030206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6701821PMC
August 2019

Case Report: Unprovoked venous thromboembolism in a young adult male.

F1000Res 2019 14;8:182. Epub 2019 Feb 14.

Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

A 24-year-old male was presented to us with sudden onset of chest pain and dyspnea for the past one hour. There was no history of calf pain, trauma, surgery, prolonged immobilization, long-haul air travel, bleeding diathesis or any other co-morbidity. The patient denied any addiction history. The heart rate was 114 beats/min, and blood pressure was 106/90 mmHg. Electrocardiogram showed tachycardia with S Q T pattern. The left arterio-venous Doppler study was suggestive of a thrombus in popliteal vein and sapheno-popliteal junction. The CT-Pulmonary Angiogram scan was suggestive of a massive pulmonary thromboembolism. The patient was thrombolysed with Intravenous Alteplase immediately and was put on tab Rivaroxaban for maintenance. He was later discharged after being stable. Unprovoked venous thromboembolism (VTE) is very rare and has the potential to lead to pulmonary embolism which could be disastrous, especially in young adults. We present such a case where unprovoked VTE was diagnosed and treated. This case suggests that high clinical suspicion is the key for the diagnosis of acute pulmonary embolism, especially in the absence of history suggestive of deep vein thrombosis.
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http://dx.doi.org/10.12688/f1000research.18202.2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6446494PMC
June 2020

"-BIRTH" protocol: observational study validating indicators for coverage and quality of maternal and newborn health care in Bangladesh, Nepal and Tanzania.

J Glob Health 2019 Jun;9(1):010902

Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK.

Background: To achieve Sustainable Development Goals and Universal Health Coverage, programmatic data are essential. The Every Newborn Action Plan, agreed by all United Nations member states and >80 development partners, includes an ambitious Measurement Improvement Roadmap. Quality of care at birth is prioritised by both Every Newborn and Ending Preventable Maternal Mortality strategies, hence metrics need to advance from health service contact alone, to content of care. As facility births increase, monitoring using routine facility data in DHIS2 has potential, yet validation research has mainly focussed on maternal recall surveys. The - Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study aims to validate selected newborn and maternal indicators for routine tracking of coverage and quality of facility-based care for use at district, national and global levels.

Methods: EN-BIRTH is an observational study including >20 000 facility births in three countries (Tanzania, Bangladesh and Nepal) to validate selected indicators. Direct clinical observation will be compared with facility register data and a pre-discharge maternal recall survey for indicators including: uterotonic administration, immediate newborn care, neonatal resuscitation and Kangaroo mother care. Indicators including neonatal infection management and antenatal corticosteroid administration, which cannot be easily observed, will be validated using inpatient records. Trained clinical observers in Labour/Delivery ward, Operation theatre, and Kangaroo mother care ward/areas will collect data using a tablet-based customised data capturing application. Sensitivity will be calculated for numerators of all indicators and specificity for those numerators with adequate information. Other objectives include comparison of denominator options (ie, true target population or surrogates) and quality of care analyses, especially regarding intervention timing. Barriers and enablers to routine recording and data usage will be assessed by data flow assessments, quantitative and qualitative analyses.

Conclusions: To our knowledge, this is the first large, multi-country study validating facility-based routine data compared to direct observation for maternal and newborn care, designed to provide evidence to inform selection of a core list of indicators recommended for inclusion in national DHIS2. Availability and use of such data are fundamental to drive progress towards ending the annual 5.5 million preventable stillbirths, maternal and newborn deaths.
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http://dx.doi.org/10.7189/jogh.09.01902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406050PMC
June 2019

Not Salt But Sugar As Aetiological In Osteoporosis: A Review.

Mo Med 2018 May-Jun;115(3):247-252

James H. O'Keefe, MD, MSMA member since 2003, is at Saint Luke's Mid America Heart Institute, Kansas City, Mo.

Salt has notoriously been blamed for causing an increase in the urinary excretion of calcium, and thus is a considered a risk factor for osteoporosis. However, the increase in the urinary excretion of calcium with higher sodium intakes can be offset by the increased intestinal absorption of dietary calcium. Thus, the overall calcium balance does not appear to be reduced with a higher sodium intake. However, the other ubiquitous white crystal, sugar, may lead to osteoporosis by increasing inflammation, hyperinsulinemia, increased renal acid load, reduced calcium intake, and increased urinary calcium excretion. Sugar, not salt, is the more likely white crystal to be a risk factor for osteoporosis when overconsumed.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140170PMC
August 2019

Associations between Body Mass Index and Chronic Kidney Disease in Type 2 Diabetes Mellitus Patients: Findings from the Northeast of Thailand.

Diabetes Metab J 2018 Aug;42(4):330-337

School of Public Health, University of Queensland, Brisbane, Australia.

Background: Chronic kidney disease (CKD) has emerged as a public health burden globally. Obesity and long-term hyperglycaemia can initiate the renal vascular complications in patients with type 2 diabetes mellitus (T2DM). This study aimed to investigate the association of body mass index (BMI) with the CKD in patients with T2DM.

Methods: This study has used retrospective medical records, biochemical reports, and anthropometric measurements of 3,580 T2DM patients which were collected between January to December 2015 from a district hospital in Thailand. CKD was defined according to the measurement of estimated glomerular filtration rate (<60 mL/min/1.73 m²). Multiple logistic regression analysis was used to explore the association between BMI and CKD in patients with T2DM.

Results: The mean age of the participants was 60.86±9.67 years, 53.68% had poor glycaemic control, and 45.21% were overweight. About one-in-four (23.26%) T2DM patients had CKD. The mean BMI of non-CKD group was slightly higher (25.30 kg/m² vs. 24.30 kg/m²) when compared with CKD patients. Multivariable analysis showed that older age, female sex, hypertension, and microalbuminuria were associated with the presence of CKD. No association was observed between CKD and poorly controlled glycosylated hemoglobin or hypercholesterolemia. Adjusted analysis further showed overweight and obesity were negatively associated with CKD (adjusted odds ratio [AOR], 0.73; 95% confidence interval [CI], 0.58 to 0.93) and (AOR, 0.53; 95% CI, 0.35 to 0.81), respectively.

Conclusion: The negative association of BMI with CKD could reflect the reverse causality. Lower BMI might not lead a diabetic patient to develop CKD, but there are possibilities that CKD leads the patient to experience reduced BMI.
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http://dx.doi.org/10.4093/dmj.2017.0052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6107363PMC
August 2018

Husband's involvement with mother's awareness and knowledge of newborn danger signs in facility-based childbirth settings: a cross-sectional study from rural Bangladesh.

BMC Res Notes 2018 May 9;11(1):286. Epub 2018 May 9.

Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

Objective: The aim of this study was to examine the association between husband involvement and maternal awareness and knowledge of newborn danger signs. This cross-sectional study was conducted in three rural hospitals of Bangladesh among the recently delivered women (RDW).

Results: RDW were interviewed to determine their knowledge and understanding of seven key neonatal danger signs. About 51.4% of the respondents were able to identify at least one danger sign. 'Fever' was the most correctly identified (43.7%), and hypothermia was the least (26.1%) identified danger sign. The factors associated with RDW possessing knowledge of at least one neonatal danger sign were: secondary education (COR: 1.3, 95% CI 1.1-1.6), increased ANC visits (COR: 1.2, 95% CI 1.1-1.3), previous history of facility delivery (COR: 1.3, 95% CI 1.1-1.4), and husband involvement in the mother's facility delivery (COR: 1.3, 95% CI 1.1-1.5). RDW were more likely to recall at least one newborn danger sign (AOR: 1.2, 95% CI 1.1-1.4) when the husband was actively involved in his wife's antenatal, delivery and postnatal care. In conclusion, this study found that husband involvement was significantly associated with the maternal knowledge related to identification of neonatal danger signs.
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http://dx.doi.org/10.1186/s13104-018-3386-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944176PMC
May 2018

Evaluation of antibiotic susceptibility in wound infections: A pilot study from Bangladesh.

F1000Res 2017 7;6:2103. Epub 2017 Dec 7.

Institute of Tropical Medicine and International Health, Berlin, Germany.

: Infections due to antibiotic resistant bacteria have increased alarmingly in both developed and developing countries. Unrestrained and rapidly spreading bacterial growth has turned the management of wound infections into a serious challenge. This study aimed to determine the prevalence of different bacterial pathogens and their antibiotic susceptibility in various types of wound infections. :  A cross-sectional study was conducted to collect 105 wound swabs. All isolated bacteria were identified based on colony characteristics, gram stain and standard biochemical tests, and antibiotic susceptibility testing (AST) with the disc diffusion method. Descriptive statistics were used to present the study findings, and all analyses were performed using Stata Version 13. :  The rate of isolation of bacteria was 92.3%. was found to be the most frequent isolate (55.7%), followed by (23.7%), spp. (8.2%), and (7.2%). Gram-positive bacteria were mostly (60%) found sensitive to vancomycin, azithromycin, gentamicin, imipenem, cefixime, and ceftriaxone in this study. Among the Gram-negative bacteria, (>60%) showed sensitivity to cefixime, azithromycin, cefuroxime, ceftriaxone, cefotaxime, gentamycin, and ceftazidime. : The diversity of isolated bacteria and their susceptibility patterns signify a need to implement a proper infection control strategy, which can be achieved by carrying out antibiotic sensitivity tests of the isolates.
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http://dx.doi.org/10.12688/f1000research.12887.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5820593PMC
December 2017

Plasma triglycerides as a risk factor for chronic kidney disease in type 2 diabetes mellitus: Evidence from northeastern Thailand.

Diabetes Res Clin Pract 2018 Apr 12;138:238-245. Epub 2018 Feb 12.

Sydney Medical School, University of Sydney, Australia; Cardiovascular Division, The George Institute for Global Health, Australia; Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia.

Aims: To investigate the observational association between plasma triglyceride and CKD in patients with T2DM.

Methods: A hospital-based retrospective registry was used to obtain data of 3,748 T2DM patients from May 2016 to October 2016. Anthropometric measurements and biochemical reports of T2DM patients with CKD were obtained by data extraction of medical records. CKD was defined according to the estimated glomerular filtration rate (eGFR< 60 mL/min/1.73 m). Multiple logistic regression was used to determine the association between plasma triglyceride and CKD.

Results: The mean age of the participants was 61.4 ± 11.0 years, and a majority of them was female (64%) with poor glycemic control (83%), increased plasma triglyceride (51%) and 27% of T2DM patients had CKD. There was a significant trend towards deteriorating renal function (lower eGFR) with categorically raised triglyceride levels. After controlling for age, sex and other confounders, 'borderline high' (adjusted odds ratio (OR): 1.24, 95% confidence interval (CI): 1.01-1.54), 'high' (adjusted OR: 1.52, 95% CI: 1.24-1.85) and 'very high' (adjusted OR: 3.40, 95% CI: 1.94-5.94) triglyceride level groups had higher likelihood to have CKD compared to normal triglyceride level.

Conclusion: CKD was associated with a higher level of plasma triglyceride among patients with T2DM. These results support the rationale to screen and manage increased triglyceride in routine clinical practices among persons with diabetes to prevent CKD.
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http://dx.doi.org/10.1016/j.diabres.2018.02.011DOI Listing
April 2018

CRISPR-Cas9: a promising genetic engineering approach in cancer research.

Ther Adv Med Oncol 2018 5;10:1758834018755089. Epub 2018 Feb 5.

Department of Genetic Engineering, Sungkyunkwan University, 2066 Seobu-ro, Suwon 16419, Korea.

Bacteria and archaea possess adaptive immunity against foreign genetic materials through clustered regularly interspaced short palindromic repeat (CRISPR) systems. The discovery of this intriguing bacterial system heralded a revolutionary change in the field of medical science. The CRISPR and CRISPR-associated protein 9 (Cas9) based molecular mechanism has been applied to genome editing. This CRISPR-Cas9 technique is now able to mediate precise genetic corrections or disruptions in and environments. The accuracy and versatility of CRISPR-Cas have been capitalized upon in biological and medical research and bring new hope to cancer research. Cancer involves complex alterations and multiple mutations, translocations and chromosomal losses and gains. The ability to identify and correct such mutations is an important goal in cancer treatment. In the context of this complex cancer genomic landscape, there is a need for a simple and flexible genetic tool that can easily identify functional cancer driver genes within a comparatively short time. The CRISPR-Cas system shows promising potential for modeling, repairing and correcting genetic events in different types of cancer. This article reviews the concept of CRISPR-Cas, its application and related advantages in oncology.
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http://dx.doi.org/10.1177/1758834018755089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802696PMC
February 2018

A Review on Antibiotic Resistance: Alarm Bells are Ringing.

Cureus 2017 Jun 28;9(6):e1403. Epub 2017 Jun 28.

Department of Pharmacology, Dhaka Medical College, Dhaka, Bangladesh.

Antibiotics are the 'wonder drugs' to combat microbes. For decades, multiple varieties of antibiotics have not only been used for therapeutic purposes but practiced prophylactically across other industries such as agriculture and animal husbandry. Uncertainty has arisen, as microbes have become resistant to common antibiotics while the host remains unaware that antibiotic resistance has emerged. The aim of this review is to explore the origin, development, and the current state of antibiotic resistance, regulation, and challenges by examining available literature. We found that antibiotic resistance is increasing at an alarming rate. A growing list of infections i.e., pneumonia, tuberculosis, and gonorrhea are becoming harder and at times impossible to treat while antibiotics are becoming less effective. Antibiotic-resistant infections correlate with the level of antibiotic consumption. Non-judicial use of antibiotics is mostly responsible for making the microbes resistant. The antibiotic treatment repertoire for existing or emerging hard-to-treat multidrug-resistant bacterial infections is limited, resulting in high morbidity and mortality report. This review article reiterates the optimal use of antimicrobial medicines in human and animal health to reduce antibiotic resistance. Evidence from the literature suggests that the knowledge regarding antibiotic resistance in the population is still scarce. Therefore, the need of educating patients and the public is essential to fight against the antimicrobial resistance battle.
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http://dx.doi.org/10.7759/cureus.1403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573035PMC
June 2017

Detection of Chronic Kidney Disease by Using Different Equations of Glomerular Filtration Rate in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Analysis.

Authors:
Sojib Bin Zaman

Cureus 2017 Jun 14;9(6):e1352. Epub 2017 Jun 14.

Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh.

Introduction Chronic kidney disease (CKD) is a global threat due to its high mortality. It is essential to know the actual magnitude of diabetic CKD to design a specific management program. However, there is limited knowledge regarding the most suitable equation to measure CKD in patients with Type 2 diabetes mellitus (T2DM). This paper aimed to analyze estimated glomerular filtration rate (eGFR) based on different equations to detect the CKD among T2DM.  Methods A hospital-based cross-sectional study was carried out, and a clinical registry was used to collect 4,042 T2DM patients from a large district hospital in Northeast Thailand. CKD patients were diagnosed when eGFR was less than 60 ml/min/1.73m. Using Stata statistical software (StataCorp LP, College Station, TX), three standard equations, such as 'modification of diet in renal disease (MDRD-4)', 'chronic kidney disease epidemiology collaboration (CKD-EPI)', and 'Cockcroft-Gault (C-G)' equations, were used to produce eGFR values to report and compare stages of CKD. Results The mean age of the patients was 61.4 (± 10.7) years and male to female ratio was 1:1.9. According to the MDRD-4, CKD-EPI, and C-G equation, the prevalence of diabetic CKD was 21.4%, 21.9%, and 31.4%, respectively, and the frequency of CKD Stage 3 to 5 was found to be different among T2DM. About 3,789 (93.9%) measurements appeared to be classified as different stages of CKD (Stages 1 to 5) between MDRD-4 and CKD-EPI equations (kappa: 0.905; 95% confidence interval (CI): 0.83 - 0.97, p < 0.001). However, this study found that the above-mentioned agreement was 70.9% between CKD-EPI and C-G equation (kappa: 0.56, 95% CI: 0.44 - 0.67, p < 0.001). Conclusions CKD-EPI equations can overcome the constraint of MDRD-4 and C-G equations to report CKD and can be used in patients with T2DM.
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http://dx.doi.org/10.7759/cureus.1352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5510968PMC
June 2017

Application of Fluorescence In Situ Hybridization (FISH) Technique for the Detection of Genetic Aberration in Medical Science.

Cureus 2017 Jun 9;9(6):e1325. Epub 2017 Jun 9.

Medicine, Yamagata University Faculty of Medicine, Japan.

Fluorescence in situ hybridization (FISH) is a macromolecule recognition technique, which is considered as a new advent in the field of cytology. Initially, it was developed as a physical mapping tool to delineate genes within chromosomes. The accuracy and versatility of FISH were subsequently capitalized upon in biological and medical research. This visually appealing technique provides an intermediate degree of resolution between DNA analysis and chromosomal investigations. FISH consists of a hybridizing DNA probe, which can be labeled directly or indirectly. In the case of direct labeling, fluorescent nucleotides are used, while indirect labeling is incorporated with reporter molecules that are subsequently detected by fluorescent antibodies or other affinity molecules. FISH is applied to detect genetic abnormalities that include different characteristic gene fusions or the presence of an abnormal number of chromosomes in a cell or loss of a chromosomal region or a whole chromosome. It is also applied in different research applications, such as gene mapping or the identification of novel oncogenes. This article reviews the concept of FISH, its application, and its advantages in medical science.
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http://dx.doi.org/10.7759/cureus.1325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5501716PMC
June 2017

Managing Neonatal and Early Childhood Syndromic Sepsis in Sub-District Hospitals in Resource Poor Settings: Improvement in Quality of Care through Introduction of a Package of Interventions in Rural Bangladesh.

PLoS One 2017 23;12(1):e0170267. Epub 2017 Jan 23.

The Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada.

Introduction: Sepsis is dysregulated systemic inflammatory response which can lead to tissue damage, organ failure, and death. With an estimated 30 million cases per year, it is a global public health concern. Severe infections leading to sepsis account for more than half of all under five deaths and around one quarter of all neonatal deaths annually. Most of these deaths occur in low and middle income countries and could be averted by rapid assessment and appropriate treatment. Evidence suggests that service provision and quality of care pertaining to sepsis management in resource poor settings can be improved significantly with minimum resource allocation and investments. Cognizant of the stark realities, a project titled 'Interrupting Pathways to Sepsis Initiative' (IPSI) introduced a package of interventions for improving quality of care pertaining to sepsis management at 2 sub-district level public hospitals in rural Bangladesh. We present here the quality improvement process and achievements regarding some fundamental steps of sepsis management which include rapid identification and admission, followed by assessment for hypoxemia, hypoglycaemia and hypothermia, immediate resuscitation when required and early administration of parenteral broad spectrum antibiotics.

Materials And Method: Key components of the intervention package include identification of structural and functional gaps through a baseline environmental scan, capacity development on protocolized management through training and supportive supervision by onsite 'Program Coaches', facilitating triage and rapid transfer of patients through 'Welcoming Persons' and enabling rapid treatment through 'Task Shifting' from on-call physicians to on-duty paramedics in the emergency department and on-call physicians to on-duty nurses in the inpatient department.

Results: From August, 2013 to March, 2015, 1,262 under-5 children were identified as syndromic sepsis in the emergency departments; of which 82% were admitted. More neonates (30%) were referred to higher level facilities than post-neonates (6%) (p<0.05). Immediately after admission, around 99% were assessed for hypoxemia, hypoglycaemia and hypothermia. Around 21% were hypoxemic (neonate-37%, post-neonate-18%, p<0.05), among which 94% received immediate oxygenation. Vascular access was established in 78% cases and 85% received recommended broad spectrum antibiotics parenterally within 1 hour of admission. There was significant improvement in the rate of establishing vascular access and choice of recommended first line parenteral antibiotic over time. After arrival in the emergency department, the median time taken for identification of syndromic sepsis and completion of admission procedure was 6 minutes. The median time taken for completion of assessment for complications was 15 minutes and administration of first dose of broad spectrum antibiotics was 35 minutes. There were only 3 inpatient deaths during the reporting period.

Discussion And Conclusion: Needs based health systems strengthening, supportive-supervision and task shifting can improve the quality and timeliness of in-patient management of syndromic sepsis in resource limited settings.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0170267PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5256881PMC
August 2017