Estimating the economic burden of typhoid in children and adults in Blantyre, Malawi: a costing cohort study

BackgroundTyphoid causes preventable death and disease. The World Health Organizationrecommends Typhoid Conjugate Vaccine for endemic countries, but introductiondecisions depend on cost-effectiveness. We estimated household and healthcareeconomic burdens of typhoid in Blantyre, Malawi.MethodsIn a prospective cohort of culture-confirmed typhoid cases at two primary- and areferral-level health facility, we collected direct medical, non-medical costs (2020 U.S. dollars) to healthcare provider, plus indirect costs to households.ResultsFrom July 2019-March 2020, of 109 cases, 63 (58%) were <15 years old, 44 (40%)were inpatients. Mean hospitalization length was 7.7 days (SD 4.1). For inpatients,mean total household and provider costs were $93.85 (95%CI: 68.87-118.84) and$296.52 (95%CI: 225.79-367.25), respectively. For outpatients, these costs were$19.05 (95%CI: 4.38-33.71) and $39.65 (95%CI: 33.93-45.39), respectively.Household costs were due mainly to direct non-medical and indirect costs, medicalcare was free. Catastrophic illness cost, defined as cost >40% of non-food monthlyhousehold expenditure, occurred in 48 (44%) households.ConclusionsTyphoid can be economically catastrophic for families, despite accessible free medicalcare. Typhoid is costly for government healthcare provision. These data make aneconomic case for TCV introduction in Malawi and the region and will be used to derivevaccine cost-effectiveness.

Vigilância do óbito evitável: comparação entre fetal e neonatal precoce

Comparar características sociodemográficas, assistenciais e epidemiológicas de óbitos fetais e neonatais precoces evitáveis investigados. Estudo transversal, cuja fonte de dados foi a ficha de investigação do óbito fetal, em menor de um ano, preenchida pela vigilância do Recife (PE). Procedeu-se a comparação entre os grupos de óbitos fetais e neonatais precoces evitáveis, utilizando o teste Qui-quadrado de Pearson, com a=5%. Dos 117 óbitos analisados, 94 (80,3%) eram fetais. A avaliação da assistência à saúde evidenciou falhas em 95,6% dos óbitos perinatais, destacando-se a assistência ao pré-natal, com falhas em 75,6% dos fetais e 90% nos neonatais precoces. Os óbitos reduzíveis por adequada atenção à mulher na gestação constituíram o principal grupo de evitabilidade (64,1%). Houve falhas na assistência na quase totalidade dos óbitos. A comparação entre os óbitos perinatais evitáveis permitiu avaliar a qualidade da assistência e pode contribuir com a elaboração de estratégias de redução.Descritores: Mortalidade perinatal, Saúde Materno-infantil, Estatísticas Vitais, Vigilância em Saúde Pública. Preventable death surveillance: a comparison between fetal and neonatalAbstract: To compare sociodemographic, health care and epidemiologic characteristics of investigated preventable fetal and premature neonatal deaths. Cross-sectional study, whose data source was the fetal death investigation form, in less than a year, filled out by Recife’s surveillance (PE). Then, a comparison proceeded between fetal and premature neonatal preventable death groups, utilizing the Pearson’s Chi-square test, with a=5%. From 117 analyzed deaths, 94 (80.3%) were fetal. The evaluation of healthcare presented failures in 95.6% of perinatal deaths, emphasizing the assistance to prenatal, with failures of 75.6% of fetal and 90% in premature neonatal deaths. Deaths reducible by adequate assistance for women during pregnancy were the main preventable group (64.1%). There were deficiencies in the assistance in almost all deaths. The comparison among avoidable perinatal deaths allowed the evaluation of care quality and may enable contributions towards the elaboration of reduction strategies.Descriptors: Perinatal Mortality, Maternal and Child Health, Vital Statistics, Public Health Surveillance. Vigilancia del óbito evitable: comparación entre fetal y neonatal precozResumen: Comparar características sociodemográficas, de auxílio social y epidemiológicas de óbitos fetales y neonatales precoces evitables investigados. Estudio transversal, cuya fuente de datos fue la ficha de investigación del óbito fetal, en menor de un año, rellenada por la vigilancia de Recife (PE). Se procedió a la comparación entre los grupos de óbitos fetales y neonatales precoces evitables, empleando el test Qui-cuadrado de Pearson, con a=5%. De los 117 óbitos analizados, 94 (80,3%) eran fetales. La evaluación de la asistencia a la salud denotó fallos en 95,6% de los óbitos perinatales, destacándose la asistencia prenatal con fallos en el 75,6% de los óbitos perinatales y 90% de los neonatales precoces. Los óbitos reductibles por atención adecuada a la mujer gestante constituyeron el principal grupo de evitabilidad (64,1%). Hubo fallos en la asistencia en la casi totalidad de los óbitos. La comparación entre los óbitos perinatales evitables permitió evaluar la calidad de la asistencia y puede enriquecer la elaboración de estrategias de reducción. Descriptores: Mortalidad perinatal, Salud Materno-Infantil, Estadísticas Vitales, Vigilancia en Salud Pública.

The Factors Related to Death of Trauma Preventable Death Patients in Rajavithi Hospital

Aims: To study the factors related to death of traumatic preventable death patients with probability of survival score more than 0.75 Methodology: A 1:4 case-control study was conducted on traumatic preventable death patients with probability of survival score more than 0.75 who received treatment at the Emergency Department and was admitted in Rajavithi Hospital between 2015 and 2018. Data were retrieved from Rajavithi trauma registry. Statistical analysis using Chi-square test, student t-test, and Multiple logistic regression was employed for factors associated with death of trauma. Results: There were 36 cases (death) and 150 controls (survivors). In cases group, 21 (61.1%) were male with mean age of 61.36±20.23 years. 26 (72.2%) had underlying diseases. 22 (61.10%) of these injuries occurred at home. The cause of accidents are categorized to fall injury occurring 21 (58.3%), and blunt mechanism of injury 35 (97.20%). The mean Injury Severity Score was 17.81±9.66. Factors significantly associated with increased death are age (Adjust OR: 1.05 (1.01-1.08), P = .02), pulse rate (Adjusted OR): 1.05 (1.01-1.08), P = .01), underlying disease (Adjusted OR): 12.0 (2.29-62.88), and Injury Severity Score (Adjusted OR): 1.29 (1.16-1.43), P < .001) Conclusion: The factors related to death of traumatic preventable death patients with probability of survival score more than 0.75 were age, pulse rate, underlying disease, and Injury Severity Score.

Prevalence and Factors Predicting Preventable Trauma Induced Mortality

Introduction: Trauma is one of the most common causes of morbidity and mortality worldwide. Since the definition of preventable death has been described many studies, like current one, were conducted to evaluate this issue.Materials and Methods: This cohort retrospective study investigated archived medical files of trauma victims from 2017 to 2020 in a referral single-center trauma hospital. Registered demographic data, vital signs, Glasgow coma scale (GCS), timing of trauma and death, executed interventions, type and mechanism of trauma in addition to time errors, clinical mismanagements and missed injuries were extracted. Injury severity score (ISS), revised trauma score (RTS) and probability of survival (Ps) based on TRISS method for each case were calculated. Eventually preventable and non-preventable death groups were compared.Results: Finally from the all 413 trauma victims 246(54.9%) files were enrolled. Victims aged from 18 to 95 years. Of all 189(76.8%) were males. Analysis manifested 135(54.9%) of all deaths were potentially and 2(0.08%) were certainly preventable; while the other 49.1% were non-preventable for expiration(p=0.001). Data showed that from all variables systolic blood pressure (SBP) ≥80mmHg, respiratory rate (RR) ≥20 per minute, GCS ≥8, higher RTS, road traffic accidents and control of external bleeding were contribute to prediction of preventable trauma related mortality.Conclusion: This study implied on frequency of trauma related preventable death was regionally high and associated factors that could be lessen the number of these mortalities including of SBP, RR, GCS, RTS, mechanism of trauma and external bleeding of trauma patients should be paid more attention.Trial registration: Retrospectively registered.

Drowning

Drowning is a significant cause of preventable death in children worldwide. Approximately half of all drowning events occur in pools. Roughly half of all infant drownings occur in bathtubs and have a significant association with child neglect or even inflicted injury. Risk factors for drowning include children younger than age 5 years (associated with inadequate supervision or inappropriate barriers) and adolescents and young adults aged 15–25 years (associated with risk-taking behaviors). Many children survive drowning events—some without significant sequelae, whereas others survive neurologically devastated. The challenge for emergency providers is to successfully and adequately resuscitate potential survivors while ensuring an optimal neurological outcome.

Death and preventable death in trauma patients in a level-1 trauma center in Thailand

BackgroundTrauma is a major cause of death in young adults. The mortality rate is one of the key performance indices of trauma centers.ObjectiveTo demonstrate a mortality rate, cause of death, and cause of nonpreventable death in a level-1 trauma center in Thailand.MethodsThere was a retrospective study of the death cases from a trauma registry. The number of trauma deaths during the study period was collected to identify the death rate. The causes of death and a death analysis were obtained from the morbidity and mortality.ResultsThe death rate was 6.6%. The most common cause of overall death was head injury, and exsanguination was the most common cause of death in the first 24 h. The preventable death rate was 2%, and the most common cause of preventable death was exsanguination.ConclusionsThe mortality rate of trauma patients in Thailand was not higher than that in other countries. The majority of deaths were caused from head injury. Therefore, improvement in injury prevention is needed to decrease the number of deaths.