Risk factors and trends in injury mortality in Rufiji Demographic Surveillance System, rural Tanzania from 2002 to 2007

Research report in partial fulfillment for the degree of MSc (Med), Population Based Field Epidemiology, University of the WitwatersrandBackground Worldwide, injuries are ranked among the leading causes of death and disability, killing over 5 million people and injuring over 50 million others globally. Approximately 90% of these deaths occur in developing countries. The burden and pattern of injuries in low-income countries are poorly known and not well studied. Few studies have been conducted on injury mortality and therefore this study can add to the scientific literature. Analyzing injury mortality in rural Tanzania can assist African countries to develop intervention programmes and policy reform to reduce the burden caused by injuries. Objectives The objective of this study was to identify the risk factors and trend in injury mortality in the Rufiji Demographic Surveillance Area in rural Tanzania from 2002-2007. Specifically, the study would identify and describe the types and trends in injury mortality, calculate the crude death rates of injury mortality by gender, SES and age groups, describe the risks factors associated with injury mortality, and measure association between the risk factors and injury mortality. Methods Rufiji HDSS data used included people aged 1 year and older from 2002-2007. Verbal Autopsy data was used to determine the causes of death which was based on the tenth revision of the International Classification of Diseases (ICD 10) recommended by WHO. Injury Crude death rates (ICDR) were calculated by dividing number of deaths in each year by person years observed and multiplying by 100,000. Principal Component Analysis (PCA) was used to construct household wealth index using household characteristics and assets ownership. Also trend test analysis was done to assess a linear relationship in the injury mortality rates across the six year period. Poisson regression was used to investigate v association between risk factors and injury mortality and all tests for significant associations were based on p-values at 5% significance level and a 95% confidence interval. Results The overall injury crude mortality rate was 33.4 per 100,000 PYO. Injuries contributed 4% of total mortality burden with statistical significant association between gender, age and occupation. Mortality rate was higher for males [Adjusted IRR=3.04, P=0.001, 95% CI (2.22 - 4.17)]. The elderly (65+) were 2.8 times more likely to die from injuries compared to children [Adjusted IRR=2.83, P=0.048, 95% CI (1.01 - 7.93)]. The unemployed, casual workers, the retired, and farmers all had an increased risk of dying from injuries compared to students (P<0.005). Most injury deaths were due to road traffic accidents (28%), unspecified external injuries (20%), drowning (16%), burns (9%), accidental poisoning (8%), homicidal (8%) and animal attack (5%). Conclusion The contribution of injury to mortality burden in the Rufiji Demographic Surveillance Area was relatively low. However, there is the need to institute measures that would help prevent injuries. Life saving interventions such as road safety education, regular road maintenance, rapid response to accidents, use of life jackets for fishermen and recreational swimmers are very necessary in preventing injuries. Also, proper fishing practices should be imparted to the populace as precautionary measures to reduce the burden of injury mortality

Risk Factors for Injury Mortality in Rural Tanzania: A Secondary Data Analysis.

\ud \ud Injuries rank high among the leading causes of death and disability annually, injuring over 50 million and killing over 5 million people globally. Approximately 90% of these deaths occur in developing countries. To estimate and identify the risk factors for injury mortality in the Rufiji Health and Demographic Surveillance System (RHDSS) in Tanzania. Secondary data from the RHDSS covering the period 2002 and 2007 was examined. Verbal autopsy data was used to determine the causes of death based on the 10th revision of the International Classification of Diseases (ICD-10). Trend and Poisson regression tests were used to investigate the associations between risk factors and injury mortality. The overall crude injury death rate was 33.4/100 000 population. Injuries accounted for 4% of total deaths. Men were three times more likely to die from injuries compared with women (adjusted IRR (incidence risk ratios)=3.04, p=0.001, 95% CI (2.22 to 4.17)). The elderly (defined as 65+) were 2.8 times more likely to die from injuries compared with children under 15 years of age (adjusted IRR=2.83, p=0.048, 95% CI (1.01 to 7.93)). The highest frequency of deaths resulted from road traffic crashes. Injury is becoming an important cause of mortality in the Rufiji district. Injury mortality varied by age and gender in this area. Most injuries are preventable, policy makers need to institute measures to address the issue

Situational analysis of service provision for adolescents with mental and neurological disorders in in two districts of Ghana.

BACKGROUND: Prevalence among adolescents with mental disorders are about 20% worldwide. In 2012, Ghana enacted the Mental Health Act, Act 846 to regulate mental health care, but did not include specific programmatic details of service provision nor any measurable indicators for adolescent mental health. Currently no service programmes focused on adolescents and no aggregated data exists documenting prevalence of mental and neurological disorders among adolescents. In the Brong Ahafo region, mental health providers carry out simultaneous programmes to diagnose, treat, and counsel patients. There is a need to investigate how these service programmes are currently functioning as measured by World Health Organisation guidelines. This study therefore, investigated quality of service provision for adolescents with mental disorders in Kintampo North and South districts of central Ghana. METHODS: Mixed method approach of quantitative and qualitative data collection, organization, and analysis was implored. Quantitative method data collection used case registers to identify mental and neurological disorders among adolescents. Qualitative methods used in-depth interviews of service providers, primary caregivers, and users of healthcare on the services available to treat mental and neurological disorders among adolescents. A combination of quality standards tools was used to assess services. RESULTS: Epilepsy was the most common treated disorder among adolescents receiving services at the four facilities in the two districts. Providers and stakeholders had limited or no training in adolescent mental health. Validated diagnostic tools were not being used to rule out differential diagnosis; medication procurement was a challenge to consistent treatment. Data collection and analysis was not standardized. Providers, stakeholders, patients, and their primary caregivers reported challenges with funding, transportation logistics, and stigma against people with mental and neurological disorders. CONCLUSION: There are few mental health service providers for people living with mental disorders in the two Kintampo districts, with no specific services for adolescents. The Mental Health Act 846 of 2012 is an important milestone in mental health care but there are not specific plans for its implementation. Community sensitization, education in mental health and neurological disorders, and advocacy against stigma are all successful programmes that have the potential to be scaled up

Psychological comorbidities in epilepsy: a cross-sectional survey among Ghanaian epilepsy patients

Objective: To evaluate the prevalence and patterns of psychiatric disorders in epilepsy patients at the Korle-Bu Teaching hospital, Accra, Ghana.Design: The study design was a cross-sectional surveySetting: The study was conducted at the Neurology Clinic of the Department of Medicine and Therapeutics, Korle-nBu Teaching hospital, Accra, Ghana.Participants: A total of one hundred and sixty-six patients diagnosed with epilepsy aged at least 18 years and accessing services at the neurology clinic participated in the study.Main Outcome Measure: Prevalence and patterns of psychiatric disorders among patients diagnosed with epilepsy using the Brief Symptom Inventory.Results: The mean age for onset of epilepsy was 20.1 ± 16.9 years, and generalized epilepsy (73.2%) was the major type of epilepsy identified. The aetiology of the epilepsy condition was unknown in most patients (71.1%). The estimated mean Brief Symptom Inventory scores in all the nine diagnostic psychiatry characteristics (Depression, Anxiety, Somatization, Hostility, Phobic Anxiety, Obsessive Compulsive Disorder, Psychoticism, Interpersonal Sensitivity, and Paranoid Ideation) were higher in the epilepsy patients compared to the normative data scores for non-patients. Global Severity Index scores for females were significantly higher (p=0.002) than the scores for males on all the psychological outcomes except hostility.Conclusion: Psychological disorders were prevalent among epilepsy patients, with females more likely to experience psychological problems than males. The findings call for a holistic approach in managing epilepsy to highlight and manage some exceptional psychological comorbidities

Prevalence and risk factors for Active Convulsive Epilepsy in Kintampo, Ghana

Introduction: epilepsy is common in sub-Saharan Africa, but there is little data in West Africa, to develop public health measures for epilepsy in this region. Methods: we conducted a three-stage cross-sectional survey to determine the prevalence and risk factors for active convulsive epilepsy (ACE), and estimated the treatment gap in Kintampo situated in the middle of Ghana. Results: 249 people with ACE were identified in a study population of 113,796 individuals. After adjusting for attrition and the sensitivity of the screening method, the prevalence of ACE was 10.1/1000 (95% Confidence Interval (95%CI) 9.5-10.7). In children aged \u3c18 years, risk factors for ACE were: family history of seizures (OR=3.31; 95%CI: 1.83-5.96), abnormal delivery (OR=2.99; 95%CI: 1.07-8.34), problems after birth (OR=3.51; 95%CI: 1.02-12.06), and exposure to Onchocerca volvulus (OR=2.32; 95%CI: 1.12-4.78). In adults, a family history of seizures (OR=1.83; 95%CI: 1.05-3.20), never attended school (OR=11.68; 95%CI: 4.80-28.40), cassava consumption (OR=3.92; 95%CI: 1.14-13.54), pork consumption (OR=1.68; 95%CI: 1.09-2.58), history of snoring at least 3 nights per week (OR=3.40: 95%CI: 1.56-7.41), exposure to Toxoplasma gondii (OR=1.99; 95%CI: 1.15-3.45) and Onchocerca volvulus (OR=2.09: 95%CI: 1.29-3.40) were significant risk factors for the development of ACE. The self-reported treatment gap was 86.9% (95%CI: 83.5%-90.3%). Conclusion: ACE is common within the middle belt of Ghana and could be reduced with improved obstetric care and prevention of parasite infestations such as Onchocerca volvulus and Toxoplasma gondii

Exposure to carbon monoxide and particulate matter among cassava grits processors in the middle belt of Ghana: a cross-sectional study.

INTRODUCTION: exposure to smoke from biomass combustion during economic activities is a major health risk. One of such commercial activities that use biomass fuel is gari (cassava grits) processing. Cassava grits is a staple food produced from grated and fermented cassava. Several studies have depicted exposure to carbon monoxide (CO) and particulate matter (PM2.5) at the household level and fewer studies on small-scale industries such as the aforementioned one. METHODS: a cross-sectional study was conducted among 17 cassava grits processors (CGPs) using Lascar CO monitors for 24 hours and micro personal exposure monitoring devices for 72 hours, in the Kintampo South District of Ghana. CGPs were monitored during working hours and off-working hours. Two focus groups were conducted among CGPs and five in-depth interviews among community gatekeepers. RESULTS: CGPs were exposed to high CO and PM2.5 levels during working hours from 6:00 AM - 5:00 PM and off-working hours from 5:00 PM - 5:59 AM. CGPs, community gatekeepers shared different opinions on health effects of biomass fuel use. CONCLUSION: traditional cookstoves are used due to the liquefied petroleum gas (LPG) cost, the quantity and the quality of cassava grits from biomass fuel. This activity exposes CGPs to CO and PM2.5 concentrations above the 14 ppm safe levels recommended by the World Health Organisation

A systematic review and synthesis of the strengths and limitations of measuring malaria mortality through verbal autopsy.

BACKGROUND: Lack of valid and reliable data on malaria deaths continues to be a problem that plagues the global health community. To address this gap, the verbal autopsy (VA) method was developed to ascertain cause of death at the population level. Despite the adoption and wide use of VA, there are many recognized limitations of VA tools and methods, especially for measuring malaria mortality. This study synthesizes the strengths and limitations of existing VA tools and methods for measuring malaria mortality (MM) in low- and middle-income countries through a systematic literature review. METHODS: The authors searched PubMed, Cochrane Library, Popline, WHOLIS, Google Scholar, and INDEPTH Network Health and Demographic Surveillance System sites' websites from 1 January 1990 to 15 January 2016 for articles and reports on MM measurement through VA. INCLUSION CRITERIA: article presented results from a VA study where malaria was a cause of death; article discussed limitations/challenges related to measurement of MM through VA. Two authors independently searched the databases and websites and conducted a synthesis of articles using a standard matrix. RESULTS: The authors identified 828 publications; 88 were included in the final review. Most publications were VA studies; others were systematic reviews discussing VA tools or methods; editorials or commentaries; and studies using VA data to develop MM estimates. The main limitation were low sensitivity and specificity of VA tools for measuring MM. Other limitations included lack of standardized VA tools and methods, lack of a 'true' gold standard to assess accuracy of VA malaria mortality. CONCLUSIONS: Existing VA tools and methods for measuring MM have limitations. Given the need for data to measure progress toward the World Health Organization's Global Technical Strategy for Malaria 2016-2030 goals, the malaria community should define strategies for improving MM estimates, including exploring whether VA tools and methods could be further improved. Longer term strategies should focus on improving countries' vital registration systems for more robust and timely cause of death data

"Making the Mentally Ill Count", lessons from a Health and Demographic Surveillance System for people with mental and neurological disorders in the Kintampo districts of Ghana.

BACKGROUND: Persons with mental and neurological disorders (PMNDs) are among the most marginalised groups in developing countries, as they are socially excluded and overlooked in most developmental efforts. Due to high levels of stigma and other operational difficulties, PMNDs are often marginalised in routine enumeration exercises. Health and Demographic Surveillance System is an important public health research platform especially in countries that lacks reliable data systems, as it registers and monitor basic demographic and health events such as births, deaths and migration in a geographically defined population. This information is essential for policy development and resource distribution and service delivery. We aim to document the reasons for not counting PMNDs in our communities and demonstrate the usefulness of the Kintampo Health and Demographic Surveillance Systems (KHDSS) platform in counting PMNDs over time. We also documented strategies in providing vital information that helps in establishing the rights of PMNDs. METHODS: As a longitudinal study, psychiatric case register was established. Both quantitative and qualitative data collection techniques were used to solicit responses from stakeholders regarding the non-consideration of PMNDs as part of household membership in the study area. PMNDs were identified using the KHDSS and followed every 6 months. The "targeted" (actively searching for PMNDs) and "service provision" (providing medical treatment for PMNDs) approaches were adopted to enhance the identification of PMNDs. RESULTS: Stigma was the main reason cited for the non-counting of PMNDs in the area. Following a "targeted" and "service provision" approach, the number of PMNDs enrolled into the psychiatric case register went up to 68% in 2010; as against the previous levels of 49 and 54% in 2005 and 2008 respectively. The study highlights the intrinsic value of such an approach for social inclusion of PMNDs. CONCLUSIONS: Stigma against PMNDs was report in this study. We provided evidence that the KHDSS platform is useful for identification of PMNDs for service provision. The paper highlights evidence for policy formulation and implementation

Electroencephalographic features of convulsive epilepsy in Africa: A multicentre study of prevalence, pattern and associated factors

Objective: We investigated the prevalence and pattern of electroencephalographic (EEG) features of epilepsy and the associated factors in Africans with active convulsive epilepsy (ACE). Methods: We characterized electroencephalographic features and determined associated factors in a sample of people with ACE in five African sites. Mixed-effects modified Poisson regression model was used to determine factors associated with abnormal EEGs. Results: Recordings were performed on 1426 people of whom 751 (53%) had abnormal EEGs, being an adjusted prevalence of 2.7 (95% confidence interval (95% CI), 2.5–2.9) per 1000. 52% of the abnormal EEG had focal features (75% with temporal lobe involvement). The frequency and pattern of changes differed with site. Abnormal EEGs were associated with adverse perinatal events (risk ratio (RR) = 1.19 (95% CI, 1.07–1.33)), cognitive impairments (RR = 1.50 (95% CI, 1.30–1.73)), use of anti-epileptic drugs (RR = 1.25 (95% CI, 1.05–1.49)), focal seizures (RR = 1.09 (95% CI, 1.00–1.19)) and seizure frequency (RR = 1.18 (95% CI, 1.10–1.26) for daily seizures; RR = 1.22 (95% CI, 1.10–1.35) for weekly seizures and RR = 1.15 (95% CI, 1.03–1.28) for monthly seizures)). Conclusions: EEG abnormalities are common in Africans with epilepsy and are associated with preventable risk factors. Significance: EEG is helpful in identifying focal epilepsy in Africa, where timing of focal aetiologies is problematic and there is a lack of neuroimaging services

Mutuality as a method: advancing a social paradigm for global mental health through mutual learning

Purpose: Calls for “mutuality” in global mental health (GMH) aim to produce knowledge more equitably across epistemic and power differences. With funding, convening, and publishing power still concentrated in institutions in the global North, efforts to decolonize GMH emphasize the need for mutual learning instead of unidirectional knowledge transfers. This article reflects on mutuality as a concept and practice that engenders sustainable relations, conceptual innovation, and queries how epistemic power can be shared. // Methods: We draw on insights from an online mutual learning process over 8 months between 39 community-based and academic collaborators working in 24 countries. They came together to advance the shift towards a social paradigm in GMH. // Results: Our theorization of mutuality emphasizes that the processes and outcomes of knowledge production are inextricable. Mutual learning required an open-ended, iterative, and slower paced process that prioritized trust and remained responsive to all collaborators’ needs and critiques. This resulted in a social paradigm that calls for GMH to (1) move from a deficit to a strength-based view of community mental health, (2) include local and experiential knowledge in scaling processes, (3) direct funding to community organizations, and (4) challenge concepts, such as trauma and resilience, through the lens of lived experience of communities in the global South. // Conclusion: Under the current institutional arrangements in GMH, mutuality can only be imperfectly achieved. We present key ingredients of our partial success at mutual learning and conclude that challenging existing structural constraints is crucial to prevent a tokenistic use of the concept