The relationship between child personal carbon monoxide (CO) exposure and amount of time spent in close proximity to indoor fires in rural North-West Province

Background: Indoor air pollution due to the burning of biomass fuels has been associated with acute respiratory infections amongst children less than five years old in developing countries. Very little is known about the relationship between child indoor pollution exposure and time spent near indoor fires. Aim: To describe the relationship between the amount of time that children spend close to indoor fires and carbon monoxide exposure. Methods: Cross-sectional study based in rural North-West of South Africa. Secondary analysis of caregivers’ estimates of their children’s time-activity budgets and children’s exposure to carbon monoxide (N=100). Results: The time spent by children near indoor fires is non-significantly related to their CO exposure (regression coefficient -0.030 to -0.036) after adjusting for explanatory variables. Conclusion: It is important to be cautious about encouraging caregivers to keep children away from indoor fires at the expense of other established intervention strategies

Verbal autopsy-based cause-specific mortality trends in rural KwaZulu-Natal, South Africa, 2000-2009

<p>Abstract</p> <p>Background</p> <p>The advent of the HIV pandemic and the more recent prevention and therapeutic interventions have resulted in extensive and rapid changes in cause-specific mortality rates in sub-Saharan Africa, and there is demand for timely and accurate cause-specific mortality data to steer public health responses and to evaluate the outcome of interventions. The objective of this study is to describe cause-specific mortality trends based on verbal autopsies conducted on all deaths in a rural population in KwaZulu-Natal, South Africa, over a 10-year period (2000-2009).</p> <p>Methods</p> <p>The study used population-based mortality data collected by a demographic surveillance system on all resident and nonresident members of 12,000 households. Cause of death was determined by verbal autopsy based on the standard INDEPTH/WHO verbal autopsy questionnaire. Cause of death was assigned by physician review and the Bayesian-based InterVA program.</p> <p>Results</p> <p>There were 11,281 deaths over 784,274 person-years of observation of 125,658 individuals between Jan. 1, 2000 and Dec. 31, 2009. The cause-specific mortality fractions (CSMF) for the population as a whole were: HIV-related (including tuberculosis), 50%; other communicable diseases, 6%; noncommunicable lifestyle-related conditions, 15%; other noncommunicable diseases, 2%; maternal, perinatal, nutritional, and congenital causes, 1%; injury, 8%; indeterminate causes, 18%. Over the course of the 10 years of observation, the CSMF of HIV-related causes declined from a high of 56% in 2002 to a low of 39% in 2009 with the largest decline starting in 2004 following the introduction of an antiretroviral treatment program into the population. The all-cause age-standardized mortality rate (SMR) declined over the same period from a high of 174 (95% confidence interval [CI]: 165, 183) deaths per 10,000 person-years observed (PYO) in 2003 to a low of 116 (95% CI: 109, 123) in 2009. The decline in the SMR is predominantly due to a decline in the HIV-related SMR, which declined in the same period from 96 (95% CI: 89, 102) to 45 (95% CI: 40, 49) deaths per 10,000 PYO.</p> <p>There was substantial agreement (79% kappa = 0.68 (95% CI: 0.67, 0.69)) between physician coding and InterVA coding at the burden of disease group level.</p> <p>Conclusions</p> <p>Verbal autopsy based methods enabled the timely measurement of changing trends in cause-specific mortality to provide policymakers with the much-needed information to allocate resources to appropriate health interventions.</p