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1.
Lancet Glob Health ; 10(1): e114-e123, 2022 01.
Article in English | MEDLINE | ID: covidwho-1630866

ABSTRACT

BACKGROUND: Sierra Leone's child and maternal mortality rates are among the highest in the world. However, little is known about the causes of premature mortality in the country. To rectify this, the Ministry of Health and Sanitation of Sierra Leone launched the Sierra Leone Sample Registration System (SL-SRS) of births and deaths. Here, we report cause-specific mortality from the first SL-SRS round, representing deaths from 2018 to 2020. METHODS: The Countrywide Mortality Surveillance for Action platform established the SL-SRS, which involved conducting electronic verbal autopsies in 678 randomly selected villages and urban blocks throughout the country. 61 surveyors, in teams of four or five, enrolled people and ascertained deaths of individuals younger than 70 years in 2019-20, capturing verbal autopsies on deaths from 2018 to 2020. Centrally, two trained physicians independently assigned causes of death according to the International Classification of Diseases (tenth edition). SL-SRS death proportions were applied to 5-year mortality averages from the UN World Population Prospects (2019) to derive cause-specific death totals and risks of death nationally and in four Sierra Leone regions, with comparisons made with the Western region where Freetown, the capital, is located. We compared SL-SRS results with the cause-specific mortality estimates for Sierra Leone in the 2019 WHO Global Health Estimates. FINDINGS: Between Sept 1, 2019, and Dec 15, 2020, we enrolled 343 000 people and ascertained 8374 deaths of individuals younger than 70 years. Malaria was the leading cause of death in children and adults, nationally and in each region, representing 22% of deaths under age 70 years in 2020. Other infectious diseases accounted for an additional 16% of deaths. Overall maternal mortality ratio was 510 deaths per 100 000 livebirths (95% CI 483-538), and neonatal mortality rate was 31·1 deaths per 1000 livebirths (95% CI 30·4-31·8), both among the highest rates in the world. Haemorrhage was the major cause of maternal mortality and birth asphyxia or trauma was the major cause of neonatal mortality. Excess deaths were not detected in the months of 2020 corresponding to the peak of the COVID-19 pandemic. Half of the deaths occurred in rural areas and at home. If the Northern, Eastern, and Southern regions of Sierra Leone had the lower death rates observed in the Western region, about 20 000 deaths (just over a quarter of national total deaths in people younger than 70 years) would have been avoided. WHO model-based data vastly underestimated malaria deaths and some specific causes of injury deaths, and substantially overestimated maternal mortality. INTERPRETATION: Over 60% of individuals in Sierra Leone die prematurely, before age 70 years, most from preventable or treatable causes. Nationally representative mortality surveys such as the SL-SRS are of high value in providing reliable cause-of-death information to set public health priorities and target interventions in low-income countries. FUNDING: Bill & Melinda Gates Foundation, Canadian Institutes of Health Research, Queen Elizabeth Scholarship Program.


Subject(s)
Cause of Death , Mortality, Premature , Adolescent , Adult , Aged , COVID-19 , Child , Child Mortality , Child, Preschool , Female , Humans , Infant , Infant Mortality , Infant, Newborn , Malaria/mortality , Male , Maternal Mortality , Middle Aged , Sierra Leone/epidemiology
2.
Science ; 375(6581): 667-671, 2022 Feb 11.
Article in English | MEDLINE | ID: covidwho-1605594

ABSTRACT

India's national COVID death totals remain undetermined. Using an independent nationally representative survey of 0.14 million (M) adults, we compared COVID mortality during the 2020 and 2021 viral waves to expected all-cause mortality. COVID constituted 29% (95%CI 28-31%) of deaths from June 2020-July 2021, corresponding to 3.2M (3.1-3.4) deaths, of which 2.7M (2.6-2.9) occurred in April-July 2021 (when COVID doubled all-cause mortality). A sub-survey of 57,000 adults showed similar temporal increases in mortality with COVID and non-COVID deaths peaking similarly. Two government data sources found that, when compared to pre-pandemic periods, all-cause mortality was 27% (23-32%) higher in 0.2M health facilities and 26% (21-31%) higher in civil registration deaths in ten states; both increases occurred mostly in 2021. The analyses find that India's cumulative COVID deaths by September 2021 were 6-7 times higher than reported officially.


Subject(s)
COVID-19/mortality , Health Facilities/statistics & numerical data , Adult , COVID-19/transmission , Cause of Death , Family Characteristics , Female , Hospital Mortality , Humans , India/epidemiology , Male , Mortality
3.
Lancet Reg Health Am ; 2: 100055, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1373179

ABSTRACT

BACKGROUND: Understanding vaccination intention during early vaccination rollout in Canada can help the government's efforts in vaccination education and outreach. METHOD: Panel members age 18 and over from the nationally representative Angus Reid Forum were invited to complete an online survey about their experience with COVID-19, including their intention to get vaccinated. Respondents were asked "When a vaccine against the coronavirus becomes available to you, will you get vaccinated or not?" Having no intention to vaccinate was defined as choosing "No - I will not get a coronavirus vaccination" as a response. Odds ratios and predicted probabilities are reported for no vaccine intentionality in demographic groups. FINDINGS: 14,621 panel members completed the survey. Having no intention to vaccinate against COVID-19 is relatively low overall (9%) with substantial variation among demographic groups. Being a resident of Alberta (predicted probability = 15%; OR 0.58 [95%CI 0.14-2.24]), aged 40-59 (predicted probability = 12%; OR 0.87 [0.78-0.97]), identifying as a visible minority (predicted probability = 15%; OR 0.56 [0.37-0.84]), having some college level education or lower (predicted probability = 14%) and living in households of at least five members (predicted probability = 13%; OR 0.82 [0.76-0.88]) are related to lower vaccination intention. INTERPRETATION: The study identifies population groups with greater and lesser intention to vaccinate in Canada. As the Canadian COVID-19 vaccination effort continues, policymakers may use this information to focus outreach, education, and other efforts on the latter groups, which also have had higher risks for contracting and dying from COVID-19. FUNDING: Pfizer Global Medical, Unity Health Foundation, Canadian COVID-19 Immunity Task Force.

4.
PLoS One ; 15(10): e0240778, 2020.
Article in English | MEDLINE | ID: covidwho-883686

ABSTRACT

Random population-based surveys to estimate prevalence of SARS-CoV2 infection causing coronavirus disease (COVID-19) are useful to understand distributions and predictors of the infection. In April 2020, the first-ever nationally representative survey in Canada polled 4,240 adults age 18 years and older about self-reported COVID experience in March, early in the epidemic. We examined the levels and predictors of COVID symptoms, defined as fever plus difficulty breathing/shortness of breath, dry cough so severe that it disrupts sleep, and/or loss of sense of smell; and testing for SARS-CoV-2 by respondents and/or household members. About 8% of Canadians reported that they and/or one or more household members experienced COVID symptoms. Symptoms were more common in younger than in older adults, and among visible minorities. Overall, only 3% of respondents and/or household members reported testing for SARS-CoV-2. Being tested was associated with having COVID symptoms, Indigenous identity, and living in Quebec. Periodic nationally representative surveys of symptoms, as well as SARS-CoV-2 antibodies, are required in many countries to understand the pandemic and prepare for the future.


Subject(s)
Betacoronavirus/genetics , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Health Surveys/methods , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Self Report , Adolescent , Adult , Aged , COVID-19 , COVID-19 Testing , Coronavirus Infections/virology , Family Characteristics , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/virology , Polymerase Chain Reaction , Prevalence , Quebec/epidemiology , SARS-CoV-2 , Young Adult
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