Deaths from acute abdominal conditions and geographical access to surgical care in India: a nationally representative spatial analysis

Background Few population-based studies quantify mortality from surgical conditions and relate mortality to access to surgical care in low-income and middle-income countries. Methods We linked deaths from acute abdominal conditions within a nationally representative, population-based mortality survey of 1·1 million households in India to nationally representative facility data. We calculated total and age-standardised death rates for acute abdominal conditions. Using 4064 postal codes, we undertook a spatial clustering analysis to compare geographical access to well-resourced government district hospitals (24 h surgical and anaesthesia services, blood bank, critical care beds, basic laboratory, and radiology) in high-mortality or low-mortality clusters from acute abdominal conditions. Findings 923 (1·1%) of 86 806 study deaths at ages 0–69 years were identifi ed as deaths from acute abdominal conditions, corresponding to 72 000 deaths nationally in 2010 in India. Most deaths occurred at home (71%) and in rural areas (87%). Compared with 567 low-mortality geographical clusters, the 393 high-mortality clusters had a nine times higher age-standardised acute abdominal mortality rate and signifi cantly greater distance to a well-resourced hospital. The odds ratio (OR) of being a high-mortality cluster was 4·4 (99% CI 3·2–6·0) for living 50 km or more from well-resourced district hospitals (rising to an OR of 16·1 [95% CI 7·9–32·8] for >100 km). No such relation was seen for deaths from non-acute surgical conditions (ie, oral, breast, and uterine cancer). Interpretation Improvements in human and physical resources at existing government hospitals are needed to reduce deaths from acute abdominal conditions in India. Full access to well-resourced hospitals within 50 km by all of India’s population could have avoided about 50 000 deaths from acute abdominal conditions, and probably more from other emergency surgical conditions

The Summary Index of Malaria Surveillance (SIMS): a stable index of malaria within India

<p>Abstract</p> <p>Background</p> <p>Malaria in India has been difficult to measure. Mortality and morbidity are not comprehensively reported, impeding efforts to track changes in disease burden. However, a set of blood measures has been collected regularly by the National Malaria Control Program in most districts since 1958.</p> <p>Methods</p> <p>Here, we use principal components analysis to combine these measures into a single index, the Summary Index of Malaria Surveillance (SIMS), and then test its temporal and geographic stability using subsets of the data.</p> <p>Results</p> <p>The SIMS correlates positively with all its individual components and with external measures of mortality and morbidity. It is highly consistent and stable over time (1995-2005) and regions of India. It includes measures of both <it>vivax </it>and <it>falciparum </it>malaria, with <it>vivax </it>dominant at lower transmission levels and <it>falciparum </it>dominant at higher transmission levels, perhaps due to ecological specialization of the species.</p> <p>Conclusions</p> <p>This measure should provide a useful tool for researchers looking to summarize geographic or temporal trends in malaria in India, and can be readily applied by administrators with no mathematical or scientific background. We include a spreadsheet that allows simple calculation of the index for researchers and local administrators. Similar principles are likely applicable worldwide, though further validation is needed before using the SIMS outside India.</p

Snakebite Mortality in India: A Nationally Representative Mortality Survey

Earlier hospital based reports estimate about 1,300 to 50,000 annual deaths from snakebites per year in India. Here, we present the first ever direct estimates from a national mortality survey of 1.1 million homes in 2001–03. Full-time, non-medical field workers interviewed living respondents about all deaths. The underlying causes were independently coded by two of 130 trained physicians. The study found 562 deaths (0.47% of total deaths) were assigned to snakebites, mostly in rural areas, and more commonly among males than females and peaking at ages 15–29. Snakebites also occurred more often during the rainy monsoon season. This proportion represents about 45,900 annual snakebite deaths nationally (99% CI 40,900 to 50,900) or an annual age-standardised rate of 4.1/100,000 (99% CI 3.6–4.5), with higher rates in rural areas (5.4) and with the highest rate in the state of Andhra Pradesh (6.2). Annual snakebite deaths were greatest in the states of Uttar Pradesh (8,700), Andhra Pradesh (5,200), and Bihar (4,500). Thus, snakebite remains an underestimated cause of accidental death in modern India, causing about one death for every two HIV-related deaths. Because a large proportion of global totals of snakebites arise from India, global snakebite totals might also be underestimated. Effective interventions involving education and antivenom provision would reduce snakebite deaths in India

Snakebite mortality in India: a nationally representative mortality survey. PLoS Neglected Trop. Dis

Abstract Background: India has long been thought to have more snakebites than any other country. However, inadequate hospitalbased reporting has resulted in estimates of total annual snakebite mortality ranging widely from about 1,300 to 50,000. We calculated direct estimates of snakebite mortality from a national mortality survey

Snakebite mortality in India: a nationally representative mortality survey. PLoS Neglected Trop. Dis

Abstract Background: India has long been thought to have more snakebites than any other country. However, inadequate hospitalbased reporting has resulted in estimates of total annual snakebite mortality ranging widely from about 1,300 to 50,000. We calculated direct estimates of snakebite mortality from a national mortality survey

Seasonality pattern of snakebite mortality and rainfall in states with high prevalence of snakebite deaths (2001–03).

<p>Rainfall amount (mm) is cumulative daily rainfall for the past 24 hours measured by the India Meteorological Department <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001018#pntd.0001018-Rajeevan1" target="_blank">[22]</a>, <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001018#pntd.0001018-Srivastava1" target="_blank">[23]</a>. Maximum and minimum temperatures are also measured daily and presented as monthly averages across the 13 snakebite high prevalence states. Pearson correlation coefficients between snakebite mortality and weather were: (i) rainfall; 0.93 (p<0.0001); (ii) minimum temperature: 0.80 (p = 0.0017); (iii) maximum temperature: 0.35 (p = 0.2585).</p

Estimated snakebite deaths in the Indian states with a high prevalence of snakebite deaths, 2005.

<p>States are listed in descending order of death rates. Death rates are standardised to 2005 UN national estimates for India.</p><p>*States with a high-prevalence of snakebite deaths are defined as those with more than 10 million people where the annual snakebite death rate exceeds 3 per 100,000 population.</p

Snakebite deaths in the present study, 2001–03 and estimated national totals, by age.

<p>The overall study death total of 122,848 includes 8.7% senility, unspecified or ill defined deaths, which were not assigned to any specific disease categories.</p><p>*Proportional snakebite mortality per 1,000 after applying sample weights to adjust urban-rural probability of selection.</p>†<p>United Nations 2005 estimates for India.</p

Deaths from acute abdominal conditions and geographical access to surgical care in India: a nationally representative spatial analysis

Background: Few population-based studies quantify mortality from surgical conditions and relate mortality to access to surgical care in low-income and middle-income countries. Methods: We linked deaths from acute abdominal conditions within a nationally representative, population-based mortality survey of 1·1 million households in India to nationally representative facility data. We calculated total and age-standardised death rates for acute abdominal conditions. Using 4064 postal codes, we undertook a spatial clustering analysis to compare geographical access to well-resourced government district hospitals (24 h surgical and anaesthesia services, blood bank, critical care beds, basic laboratory, and radiology) in high-mortality or low-mortality clusters from acute abdominal conditions. Findings: 923 (1·1%) of 86 806 study deaths at ages 0–69 years were identified as deaths from acute abdominal conditions, corresponding to 72 000 deaths nationally in 2010 in India. Most deaths occurred at home (71%) and in rural areas (87%). Compared with 567 low-mortality geographical clusters, the 393 high-mortality clusters had a nine times higher age-standardised acute abdominal mortality rate and significantly greater distance to a well-resourced hospital. The odds ratio (OR) of being a high-mortality cluster was 4·4 (99% CI 3·2–6·0) for living 50 km or more from well-resourced district hospitals (rising to an OR of 16·1 [95% CI 7·9–32·8] for >100 km). No such relation was seen for deaths from non-acute surgical conditions (ie, oral, breast, and uterine cancer). Interpretation: Improvements in human and physical resources at existing government hospitals are needed to reduce deaths from acute abdominal conditions in India. Full access to well-resourced hospitals within 50 km by all of India's population could have avoided about 50 000 deaths from acute abdominal conditions, and probably more from other emergency surgical conditions. Funding: Bill & Melinda Gates Foundation, Dalla Lana School of Public Health, Canadian Institute of Health Research

Selected risk factors for snakebite mortality in India (study deaths 2001–03).

<p>Odds ratio after adjusting for age, gender and states with a high prevalence of snakebite deaths (see definition in <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001018#pntd-0001018-t002" target="_blank">Table 2</a>). Occupation ‘Other’ includes students and house wives.</p