Improving quality of medical certification of causes of death in health facilities in Tanzania 2014-2019

BACKGROUND: Monitoring medically certified causes of death is essential to shape national health policies, track progress to Sustainable Development Goals, and gauge responses to epidemic and pandemic disease. The combination of electronic health information systems with new methods for data quality monitoring can facilitate quality assessments and help target quality improvement. Since 2015, Tanzania has been upgrading its Civil Registration and Vital Statistics system including efforts to improve the availability and quality of mortality data. METHODS: We used a computer application (ANACONDA v4.01) to assess the quality of medical certification of cause of death (MCCD) and ICD-10 coding for the underlying cause of death for 155,461 deaths from health facilities from 2014 to 2018. From 2018 to 2019, we continued quality analysis for 2690 deaths in one large administrative region 9 months before, and 9 months following MCCD quality improvement interventions. Interventions addressed governance, training, process, and practice. We assessed changes in the levels, distributions, and nature of unusable and insufficiently specified codes, and how these influenced estimates of the leading causes of death. RESULTS: 9.7% of expected annual deaths in Tanzania obtained a medically certified cause of death. Of these, 52% of MCCD ICD-10 codes were usable for health policy and planning, with no significant improvement over 5 years. Of certified deaths, 25% had unusable codes, 17% had insufficiently specified codes, and 6% were undetermined causes. Comparing the before and after intervention periods in one Region, codes usable for public health policy purposes improved from 48 to 65% within 1 year and the resulting distortions in the top twenty cause-specific mortality fractions due to unusable causes reduced from 27.4 to 13.5%. CONCLUSION: Data from less than 5% of annual deaths in Tanzania are usable for informing policy. For deaths with medical certification, errors were prevalent in almost half. This constrains capacity to monitor the 15 SDG indicators that require cause-specific mortality. Sustainable quality assurance mechanisms and interventions can result in rapid improvements in the quality of medically certified causes of death. ANACONDA provides an effective means for evaluation of such changes and helps target interventions to remaining weaknesses

State of the climate in 2013

In 2013, the vast majority of the monitored climate variables reported here maintained trends established in recent decades. ENSO was in a neutral state during the entire year, remaining mostly on the cool side of neutral with modest impacts on regional weather patterns around the world. This follows several years dominated by the effects of either La Niña or El Niño events. According to several independent analyses, 2013 was again among the 10 warmest years on record at the global scale, both at the Earths surface and through the troposphere. Some regions in the Southern Hemisphere had record or near-record high temperatures for the year. Australia observed its hottest year on record, while Argentina and New Zealand reported their second and third hottest years, respectively. In Antarctica, Amundsen-Scott South Pole Station reported its highest annual temperature since records began in 1957. At the opposite pole, the Arctic observed its seventh warmest year since records began in the early 20th century. At 20-m depth, record high temperatures were measured at some permafrost stations on the North Slope of Alaska and in the Brooks Range. In the Northern Hemisphere extratropics, anomalous meridional atmospheric circulation occurred throughout much of the year, leading to marked regional extremes of both temperature and precipitation. Cold temperature anomalies during winter across Eurasia were followed by warm spring temperature anomalies, which were linked to a new record low Eurasian snow cover extent in May. Minimum sea ice extent in the Arctic was the sixth lowest since satellite observations began in 1979. Including 2013, all seven lowest extents on record have occurred in the past seven years. Antarctica, on the other hand, had above-average sea ice extent throughout 2013, with 116 days of new daily high extent records, including a new daily maximum sea ice area of 19.57 million km2 reached on 1 October. ENSO-neutral conditions in the eastern central Pacific Ocean and a negative Pacific decadal oscillation pattern in the North Pacific had the largest impacts on the global sea surface temperature in 2013. The North Pacific reached a historic high temperature in 2013 and on balance the globally-averaged sea surface temperature was among the 10 highest on record. Overall, the salt content in nearsurface ocean waters increased while in intermediate waters it decreased. Global mean sea level continued to rise during 2013, on pace with a trend of 3.2 mm yr-1 over the past two decades. A portion of this trend (0.5 mm yr-1) has been attributed to natural variability associated with the Pacific decadal oscillation as well as to ongoing contributions from the melting of glaciers and ice sheets and ocean warming. Global tropical cyclone frequency during 2013 was slightly above average with a total of 94 storms, although the North Atlantic Basin had its quietest hurricane season since 1994. In the Western North Pacific Basin, Super Typhoon Haiyan, the deadliest tropical cyclone of 2013, had 1-minute sustained winds estimated to be 170 kt (87.5 m s-1) on 7 November, the highest wind speed ever assigned to a tropical cyclone. High storm surge was also associated with Haiyan as it made landfall over the central Philippines, an area where sea level is currently at historic highs, increasing by 200 mm since 1970. In the atmosphere, carbon dioxide, methane, and nitrous oxide all continued to increase in 2013. As in previous years, each of these major greenhouse gases once again reached historic high concentrations. In the Arctic, carbon dioxide and methane increased at the same rate as the global increase. These increases are likely due to export from lower latitudes rather than a consequence of increases in Arctic sources, such as thawing permafrost. At Mauna Loa, Hawaii, for the first time since measurements began in 1958, the daily average mixing ratio of carbon dioxide exceeded 400 ppm on 9 May. The state of these variables, along with dozens of others, and the 2013 climate conditions of regions around the world are discussed in further detail in this 24th edition of the State of the Climate series. © 2014, American Meteorological Society. All rights reserved

Mortality of neurological disorders in Tanzania: analysis of baseline data from sample vital registration with verbal autopsy (SAVVY)

Background: Neurological disorders (ND) have a profound consequence on human productivity, quality of life and survival. There are limited data on the burden of ND in Tanzania due to insufficient coverage of civil and vital registration systems. Objectives: This study was conducted to estimate mortality of ND in all ages in Tanzania using data from the Sample Vital Registration with Verbal Autopsy (SAVVY) study. Methods: Multistage random sampling was employed to select 23 districts, 1397 census enumeration areas and 154,603 households. During the baseline survey conducted between 2011 and 2014, deaths which occurred 12 months prior to the baseline survey were documented followed by verbal autopsy interviews. Causes of death were certified using International Classification of Diseases. Results: The baseline survey enrolled a total of 650,864 residents. A total of 6645 deaths were reported to have occurred 12 months before the date of survey. Death certification was available for 5225 (79%) deaths. The leading causes of death were cerebrovascular diseases with a cause-specific mortality fraction (CSMF) of 1.64% (95% CI: 1.30–1.99) and 3.82% (95% CI: 2.92–4.72) in all ages and adults older than 50 years, respectively. Stroke accounted for 92% of all cerebrovascular deaths. Mortality of epilepsy was estimated with a CSMF of 0.94% (95% CI: 0.68–1.20); meningitis with a CSMF of 0.80% (95% CI: 0.56–1.04); cerebral palsy and other paralytic syndromes with a CSMF of 0.46% (95% CI: 0.27–0.65); and intrauterine hypoxia in neonates with a CSMF of 2.06% (95% CI: 1.12–3.01). Overall, mortality of ND was estimated with a CSMF of 4.99% (95% CI: 4.40–5.58). Conclusions: The SAVVY survey provides estimates of mortality burden of ND in Tanzania. The study provides a basis for monitoring trends of ND and contributes to advancing knowledge of the burden of diseases. Integrating morbidities measures into the SAVVY design will provide comprehensive measures of burden of ND taking into account lifetime disabilities created by ND.</p

Analysis of climate variability, perceptions and coping strategies of Tanzanian coastal forest dependent communities

Climate variability and change are among the biggest challenges of the 21st century. Like in many other areas globally, the coastal communities of Tanzania have always been facing climatic variability at various time scales. Using focus group discussion and a household survey, this study analyzes the perceptions of climate variability and change and the strategies for coping and adaptation by the selected coastal rural and peri-urban communities in Tanzania. The perception of climate variability and change is complemented with the time-series analysis of rainfall and temperature data from Julius Nyerere International Airport Met. station and Kisarawe using Instant Statistical Software. Results indicate that households are aware of climate variability and identify indicators of climate change and variability as being decreasing rainfall trends, increasing incidences of droughts, unpredictable rainfall patterns, disappearance of wetlands and failure to predict on-set of rainy season using traditional knowledge. Households primarily attribute reduced crop yields to changes in rainfall pattern and increasing incidences of drought leading to soil moisture stress. The implications are that the agriculture dependent households are now food insecure. As a way of coping to the observed changes, the coastal communities among others have shifted to production of high value horticultural crops and use of forest resources. Nevertheless, the increased use of forest resources is threatening the existence of coastal forests and contributes to the decline of forest resources and disappearance of wildlife in the forest reserves. It is concluded that the communities studied are aware of climate issues as revealed from perceived indicators of climate variability and changes. The results from statistical analysis of 30 years climatic data are consistent with community’s perception of climate variability and change. The study recommends examining the present coping strategies for the sustainability of the coastal forests and in designing of alternative adaptive strategies such as alternative energy options, crop diversification and environmental friendly activities such as beekeeping.This article is available at http://dx.doi.org/10.4236/ajcc.2014.32020NORAD funded research programme—Climate Change Impacts, Adaptation and Mitigation (CCIAM

Dynamics of land use and land cover changes in the Pugu and Kazimzumbwi forest reserves

Urban growth contributes to land use and land cover changes in protected forest reserves primarily through conversion of peri-urban areas into settlements, agriculture and unsustainable harvesting of ecosystem services to meet demands of the population in the peri-urban and urban areas. It has been widely argued that increased anthropogenic activities have altered the forest cover for Pugu and Kazimzumbwi Forest Reserves. Nonetheless, these arguments are little supported by quantitative data. A study on the dynamics of land use and cover changes in the Pugu and Kazimzumbwi Forest Reserves therefore investigated long-term changes that have occurred as a result of human activities in the areas for the periods 1985-1995 and 1995-2010. Landsat TM and ETM+ images were used to locate and quantify the changes using remote sensing and GIS techniques. Perceptions of local people on historical changes and drivers for the changes were also collected from three neighbouring villages and integrated in the assessment. The analysis was augmented by statistical analysis of 30 years historical rainfall and temperature records from Dar es Salaam and Kisarawe Climatic Stations. The study revealed remarkable decline in closed forest area in the latter period at -1.7 ha/year for Kazimzumbwi Forest Reserve (KFR) and -1.53 ha/year for Pugu Forest Reserve. The woodland variably decreased during the 1985 and 1995 period for both PFR and KFR but increased for PFR and decreased for KFR in the latter period. Unlike for closed forest and woodland, the cultivated land and built up area increased between the two periods for both forests reserves, while other covers variably increased or decreased between the years. The peoples’ perceptions and drivers for the changes are presented and discussed together with the land use and land cover change analysis. The study concludes that, there has been remarkable changes in land use and cover in the catchment and these require concerted actions to reverse the changes and enable the forest reserves contribute to REDD initiatives.CCIA

Premature mortality of epilepsy in low- and middle-income countries: A systematic review from the Mortality Task Force of the International League Against Epilepsy.

Objectives To determine the magnitude, risk factors and causes of premature mortality associated with epilepsy in low and middle income countries (LMIC). Methods We conducted a systematic search of the literature reporting mortality and epilepsy in the World Bank-defined LMIC. We assessed the quality of the studies based upon representativeness, ascertainment of cases, diagnosis, and mortality, and extracted data on standardized mortality ratios (SMR) and mortality rates in people with epilepsy. We examined risk factors and causes of death. Results The annual mortality rate was estimated at 19.8 (range 9.7-45.1) deaths per 1000 people with epilepsy with a weighted median SMR of 2.6 (range 1.3-7.2) among higher-quality population-based studies. Clinical cohort studies yielded 7.1 (range 1.6-25.1) deaths per 1000 people. The weighted median SMRs were 5.0 in males and 4.5 in females; relatively higher SMRs within studies were measured among children and adolescents, those with symptomatic epilepsies, and those reporting less adherence to treatment. The main causes of death in people with epilepsy living in LMICs include those directly attributable to epilepsy, which yield a mean proportional mortality ratio (PMR) of 27.3% (range 5%-75.5%) derived from population-based studies. These direct causes comprise status epilepticus, with reported PMRs ranging from 5%-56.6%, and sudden unexpected death in epilepsy, with reported PMRs ranging from 1%-18.9%. Important causes of mortality indirectly related to epilepsy include drowning, head injury, and burns. Significance Epilepsy in LMIC has a significantly greater premature mortality, as in high-income countries, but in LMIC the excess mortality is more likely to be associated with causes attributable to lack of access to medical facilities such as status epilepticus, and preventable causes such as drowning, head injuries and burns. This excess premature mortality could be substantially reduced with education about the risk of death and improved access to treatments, including AEDs. </p

Climate change and total factor productivity in the Tanzanian economy

The paper analyses the economic impacts of climate change-induced adjustments on the performance of the Tanzanian economy, using a country-wide computable general equilibrium model. The effect of overall climate change on agricultural productivity (modeled as reduced land productivity) is projected to be relatively limited until approximately 2030 and become worse thereafter. Our simulation results indicate that despite the projected reduction in agricultural productivity, the negative impacts can potentially be quite limited. This is because the time scales involved and the low starting point of the economy leave ample space for factor substitutability and increased overall productivity. This indicates that policies that give farmers opportunity to invest in autonomous climate adaptation, as well as policies that improve the overall performance of the economy, can be as important for reducing the impacts of climate change in the economy as direct government policies for climate adaptation