HIV/AIDS-related mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

This paper is part of the Special Issue : INDEPTH Network Cause-Specific MortalityAs the HIV/AIDS pandemic has evolved over recent decades, Africa has been the most affected region, even though a large proportion of HIV/AIDS deaths have not been documented at the individual level. Systematic application of verbal autopsy (VA) methods in defined populations provides an opportunity to assess the mortality burden of the pandemic from individual data.To present standardised comparisons of HIV/AIDS-related mortality at sites across Africa and Asia, including closely related causes of death such as pulmonary tuberculosis (PTB) and pneumonia.Deaths related to HIV/AIDS were extracted from individual demographic and VA data from 22 INDEPTH sites across Africa and Asia. VA data were standardised to WHO 2012 standard causes of death assigned using the InterVA-4 model. Between-site comparisons of mortality rates were standardised using the INDEPTH 2013 standard population.The dataset covered a total of 10,773 deaths attributed to HIV/AIDS, observed over 12,204,043 person-years. HIV/AIDS-related mortality fractions and mortality rates varied widely across Africa and Asia, with highest burdens in eastern and southern Africa, and lowest burdens in Asia. There was evidence of rapidly declining rates at the sites with the heaviest burdens. HIV/AIDS mortality was also strongly related to PTB mortality. On a country basis, there were strong similarities between HIV/AIDS mortality rates at INDEPTH sites and those derived from modelled estimates.Measuring HIV/AIDS-related mortality continues to be a challenging issue, all the more so as anti-retroviral treatment programmes alleviate mortality risks. The congruence between these results and other estimates adds plausibility to both approaches. These data, covering some of the highest mortality observed during the pandemic, will be an important baseline for understanding the future decline of HIV/AIDS.P. Kim Streatfield ... Yohannes A. Melaku ... et.al

Mortality from external causes in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

This paper is part of the Special Issue: INDEPTH Network Cause-Specific MortalityMortality from external causes, of all kinds, is an important component of overall mortality on a global basis. However, these deaths, like others in Africa and Asia, are often not counted or documented on an individual basis. Overviews of the state of external cause mortality in Africa and Asia are therefore based on uncertain information. The INDEPTH Network maintains longitudinal surveillance, including cause of death, at population sites across Africa and Asia, which offers important opportunities to document external cause mortality at the population level across a range of settings.To describe patterns of mortality from external causes at INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories.All deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates.A total of 5,884 deaths due to external causes were documented over 11,828,253 person-years. Approximately one-quarter of those deaths were to children younger than 15 years. Causes of death were dominated by childhood drowning in Bangladesh, and by transport-related deaths and intentional injuries elsewhere. Detailed mortality rates are presented by cause of death, age group, and sex.The patterns of external cause mortality found here generally corresponded with expectations and other sources of information, but they fill some important gaps in population-based mortality data. They provide an important source of information to inform potentially preventive intervention designs.P. Kim Streatfield ... Yohannes A. Melaku ... et. al

Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites

Background: Mortality from non-communicable diseases (NCDs) is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization's Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective: To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories, with separate consideration of premature (15–64 years) and older (65+ years) NCD mortality. Design: All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. Results: A total of 80,726 adult (over 15 years) deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15–64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality. Conclusions: These findings present important evidence on the distribution of NCD mortality across a wide range of African and Asian settings. This comes against a background of global concern about the burden of NCD mortality, especially among adults aged under 70, and provides an important baseline for future work.P. Kim Streatfield ... Yohannes A. Melaku ... et al

Human malarial disease: a consequence of inflammatory cytokine release

Malaria causes an acute systemic human disease that bears many similarities, both clinically and mechanistically, to those caused by bacteria, rickettsia, and viruses. Over the past few decades, a literature has emerged that argues for most of the pathology seen in all of these infectious diseases being explained by activation of the inflammatory system, with the balance between the pro and anti-inflammatory cytokines being tipped towards the onset of systemic inflammation. Although not often expressed in energy terms, there is, when reduced to biochemical essentials, wide agreement that infection with falciparum malaria is often fatal because mitochondria are unable to generate enough ATP to maintain normal cellular function. Most, however, would contend that this largely occurs because sequestered parasitized red cells prevent sufficient oxygen getting to where it is needed. This review considers the evidence that an equally or more important way ATP deficency arises in malaria, as well as these other infectious diseases, is an inability of mitochondria, through the effects of inflammatory cytokines on their function, to utilise available oxygen. This activity of these cytokines, plus their capacity to control the pathways through which oxygen supply to mitochondria are restricted (particularly through directing sequestration and driving anaemia), combine to make falciparum malaria primarily an inflammatory cytokine-driven disease

A field trial to assess a blood-Stage malaria vaccine

BACKGROUND--Blood-stage malaria vaccines are intended to prevent clinical disease. The malaria vaccine FMP2.1/AS02A, a recombinant protein based on apical membrane antigen 1 (AMA1) from the 3D7 strain of Plasmodium falciparum, has previously been shown to have immunogenicity and acceptable safety in Malian adults and children. METHODS--In a double-blind, randomized trial, we immunized 400 Malian children with either the malaria vaccine or a control (rabies) vaccine and followed them for 6 months. The primary end point was clinical malaria, defined as fever and at least 2500 parasites per cubic millimeter of blood. A secondary end point was clinical malaria caused by parasites with the AMA1 DNA sequence found in the vaccine strain. RESULTS--The cumulative incidence of the primary end point was 48.4% in the malariavaccine group and 54.4% in the control group; efficacy against the primary end point was 17.4% (hazard ratio for the primary end point, 0.83; 95% confidence interval [CI], 0.63 to 1.09; P = 0.18). Efficacy against the first and subsequent episodes of clinical malaria, as defined on the basis of various parasite-density thresholds, was approximately 20%. Efficacy against clinical malaria caused by parasites with AMA1 corresponding to that of the vaccine strain was 64.3% (hazard ratio, 0.36; 95% CI, 0.08 to 0.86; P = 0.03). Local reactions and fever after vaccination were more frequent with the malaria vaccine. CONCLUSIONS--On the basis of the primary end point, the malaria vaccine did not provide significant protection against clinical malaria, but on the basis of secondary results, it may have strain-specific efficacy. If this finding is confirmed, AMA1 might be useful in a multicomponent malaria vaccine

From teaching about the landscape through geography education to educating for the landscape

The study of the landscape is a recurring theme in the teaching of geography during compulsory education. The aim of this article is twofold: firstly it discusses the concept and teaching of landscape mainly through the contributions of the European Convention on landscape promoted by the Council of Europe since 2002. Secondly, the paper presents the City, territory and landscape project, which addresses landscape education as a process of intellectual and emotional education for active citizenship. The project is based on the assumption that the territory of Catalonia is structured and transformed by urban processes and explores twelve landscapes that are in crisis due to urbanization and its impactsL’étude du paysage est un thème récurrent de l’enseignement de la géographie dans l’enseignement obligatoire. Le but de cet article est double: d’abord, il traite du concept et de l’enseignement du paysage, principalement à travers les contributions de la Convention européenne sur le paysage promue par le Conseil de l’Europe depuis 2002. Deuxièmement, l’article présente le projet Ville, territoire et paysage, qui montre une perspective de l’éducation au paysage, c’est-à-dire un processus d’éducation intellectuelle et émotionnelle pour une citoyenneté active. Le projet repose sur l’hypothèse que la ville structure et transforme le territoire de la Catalogne et il explore douze paysages en crise en raison des processus d’urbanisation et de leurs impactsEl estudio del paisaje es un tema recurrente en la impartición de la geografía en la educación obligatoria. El artículo tiene dos objetivos: por una parte, se propone revisar la enseñanza del concepto de paisaje analizando principalmente las aportaciones del Convenio europeo del paisaje, promovido por el Consejo de Europa desde el año 2002. Por otra parte, también se presenta un caso concreto de aplicación de educación en el paisaje, el proyecto Ciudad, territorio y paisaje, que plantea cómo la ciudad estructura i transforma el territorio de Catalunya y cómo esta expansión afecta al aspecto del entorno. El proyecto está orientado a la educación secundaria obligatoria y se centra en doce espacios que entran en crisis por las distintas facetas de la expansión urbana. La finalidad del proyecto es proporcionar una educación en paisaje, entendida como un proceso para la educación intelectual, emocional y para la acciónL’estudi del paisatge és un tema recurrent en la impartició de la geografia a l’educació obligatòria. Aquest article té dos propòsits: d’una banda, pretén revisar l’ensenyament del concepte de paisatge analitzant principalment les aportacions relacionades amb el Conveni europeu del paisatge, que ha estat promogut pel Consell d’Europa des de l’any 2002. D’altra banda, també s’hi presenta un cas concret d’aplicació d’educació en paisatge, el projecte Ciutat, territori i paisatge, que planteja com la ciutat estructura i transforma el territori d’arreu de Catalunya i com aquesta expansió afecta l’aspecte de l’entorn. El projecte està orientat a l’educació secundària i se centra en dotze indrets de qualitat paisatgística que entren en crisi per les diferents facetes de l’expansió de la ciutat. La seva finalitat és proporcionar una educació en paisatge, entesa com un procés per a l’educació intel·lectual, emocional i per a l’acci