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Objective To investigate whether the key metric for monitoring progress towards sustainable development goal target 3.4 that is measuring premature noncommunicable disease mortality (deaths among people aged 30-69 years), is ageist. Methods To examine the relationship between premature noncommunicable disease mortality and noncommunicable disease mortality in older people, a database of mortality rates for cardiovascular disease, cancer, chronic obstructive pulmonary disease and diabetes in people aged 30 to 69 years and 70 to 89 years was compiled using estimates from the Global Burden of Disease Study 2017. The data covered 195 countries, six time-points and both sexes, giving 2340 instances. The World Health Organization's (WHO's) life-table method for the premature noncommunicable disease mortality metric was applied to the data. Findings There was a strong correlation between noncommunicable disease mortality patterns in the premature and older age groups, which suggests that measuring premature noncommunicable disease mortality is informative about such mortality in later life. Neither time nor geographical location had a substantial effect on this correlation. However, there were female-to-male differences in age-specific probabilities of death due to noncommunicable disease, implying that noncommunicable disease mortality should be assessed using a sex- disaggregated approach. Conclusion As the established WHO metric for premature noncommunicable disease mortality was predictive of noncommunicable disease mortality in older people, the metric should not be construed as ageist. Focusing resources on measuring premature noncommunicable disease mortality will be appropriate, particularly in settings without universal civil death registration. This approach should not prejudice the provision of health services throughout the life-course. Objectif Rechercher si I'indicateur cle permettant de suivre la progression par rapport a la cible 3.4 des Objectifs de developpement durable, qui mesure la mortalite prematuree due a des maladies non transmissibles (deces parmi les personnes de 30 a 69 ans), fait preuve d'agisme. Methodes Afin d'examiner la relation entre la mortalite prematuree due a des maladies non transmissibles et la mortalite de personnes plus agees due a ce meme type de maladies, nous avons etabli une base de donnees repertoriant les taux de mortalite due a des maladies cardiovasculaires, au cancer, a la bronchopneumopathie chronique obstructive et au diabete chez les personnes agees de 30 a 69 ans et de 70 a 89 ans, a l'aide d'estimations de l'etude 2017 sur la charge mondiale de morbidite (Global Burden of Disease Study). Les donnees portaient sur 195 pays, six points temporels ainsi que sur les deux sexes, et donnaient 2340 exemples. La methode des tables de mortalite de l'Organisation mondiale de la Sante (OMS), employee pour l'indicateur de la mortalite prematuree due a des maladies non transmissibles, a ete appliquee a ces donnees. Resultats Il est apparu une forte correlation entre les schemas de mortalite due a des maladies non transmissibles des deux groupes d'age, ce qui suggere que la mesure de la mortalite prematuree due a des maladies non transmissibles renseigne sur la mortalite pour les memes causes a un age plus avance. Ni le temps ni le lieu geographique n'avaient d'effet notable sur cette correlation. En revanche, on a observe des differences entre hommes et femmes dans les probabilites de deces du a des maladies non transmissibles selon l'age, ce qui implique qu'il faudrait evaluer la mortalite due a des maladies non transmissibles en differencial les sexes. Conclusion Etant donne que l'indicateur etabli par l'OMS pour la mortalite prematuree due a des maladies non transmissibles permettait de predire la mortalite des personnes plus agees due a ce meme type de maladies, il conviendrait de ne pas interpreter cet indicateur comme faisant preuve d'agisme. Il sera judicieux de concentrer les ressources sur la mesure de la mortalite prematuree due a des maladies non transmissibles, en particulier dans les regions qui n'ont pas de systeme universel d'enregistrement des deces. Cette demarche ne doit pas nuire a la fourniture de services de soins tout au long de la vie. Objetivo Investigar si el indicador clave para monitorear el progreso hacia la meta 3.4 de desarrollo sostenible, que es la medicion de la mortalidad prematura por enfermedades no transmisibles (muertes entre personas de 30 a 69 anos de edad), es el de la edad. Metodos Para examinar la relacion entre la mortalidad prematura por enfermedades no transmisibles y la mortalidad por enfermedades no transmisibles en las personas mayores, se compilo una base de datos de las tasas de mortalidad por enfermedades cardiovasculares, cancer, enfermedades pulmonares obstructivas cronicas y diabetes en personas de 30 a 69 anos y de 70 a 89 anos de edad, utilizando las estimaciones del Estudio sobre la Carga Mundial de las Enfermedades 2017. Los datos abarcaban 195 paises, seis puntos temporales y ambos sexos, lo que representaba 2 340 casos. Se aplico a los datos el metodo de la tabla de mortalidad prematura por enfermedades no transmisibles de la Organizacion Mundial de la Salud (OMS). Resultados Hubo una fuerte correlacion entre las pautas de mortalidad por enfermedades no transmisibles en los grupos de edad prematura y de edad avanzada, lo que indica que la medicion de la mortalidad prematura por enfermedades no transmisibles es informativa sobre esa mortalidad en etapas posteriores de la vida. Ni el tiempo ni la ubicacion geografica tuvieron un efecto sustancial en esta correlacion. Sin embargo, existen diferencias entre las mujeres y los hombres en cuanto a las probabilidades especificas de muerte por enfermedades no transmisibles, lo que implica que la mortalidad por enfermedades no transmisibles debe evaluarse mediante un enfoque desagregado por sexo. Conclusion Dado que el indicador establecido por la OMS para la mortalidad prematura por enfermedades no transmisibles es predictivo de la mortalidad por enfermedades no transmisibles en las personas de edad, el indicador no debe interpretarse como un indicador de la edad. Sera apropiado centrar los recursos en la medicion de la mortalidad prematura por enfermedades no transmisibles, en particular en los entornos en los que no existe un registro universal de defunciones civiles. Este enfoque no debe perjudicar la prestacion de servicios sanitarios a lo largo de toda la vida., Introduction In recent years, increased attention has been given to the concept of premature mortality, particularly that arising from noncommunicable disease. (1) In 2012, the sixty-fifth World Health Assembly of [...]

OBJECTIVE: Verbal autopsy (VA)- the interviewing of family members or caregivers about the circumstances of a death after the event- is an established tool in areas where routine death registration is non-existent or inadequate. We assessed the performance of a probabilistic model (InterVA) for interpreting community-based VA interviews, in order to investigate patterns of cause-specific mortality in a rural Ethiopian community. We compared results with those obtained after review of the VA by local physicians, with a view to validating the model as a community-based tool. METHODS: Two-hundred and eighty-nine VA interviews were successfully completed; these included most deaths occurring in a defined community over a 1-year period. The VA interviews were interpreted by physicians and by the model, and cause-specific mortality fractions were derived for the whole community and for particular age groups using both approaches. FINDINGS: The results of the two approaches to interpretation correlated well in this example from Ethiopia. Four major cause groups accounted for over 60% of all mortality, and patterns within specific age groups were consistent with expectations for an underdeveloped high-mortality community in sub-Saharan Africa. CONCLUSION: Compared with interpretation by physicians, the InterVA model is much less labour intensive and offers 100% consistency. It is a valuable new tool for characterizing patterns of cause-specific mortality in communities without death registration and for comparing patterns of mortality in different populations.

OBJECTIVE: More than 10 million children die each year mostly from preventable causes and particularly in developing countries. WHO guidelines for the Integrated Management of Childhood Illness (IMCI) are intended to reduce childhood mortality and are being implemented in Ethiopia. As well as specific clinical interventions, the role of the community in understanding and acting on childhood sickness is an important factor in improving survival. This trial sought to assess the effect on survival of community-based health promotion activities. METHODS: Two districts in northern Ethiopia were studied, each with a random sample of more than 4000 children less than 5 years old. Regular six-monthly visits were made to document deaths among children. After the first year, communities in one district were educated about issues of good childcare and caring for sick children while the other district received this information only after the trial ended. FINDINGS: Although overall mortality was higher in the post-intervention period, most of the increase was seen in the control area. A Cox proportional hazards model gave an adjusted hazard ratio of 0.66 (95% confidence interval = 0.46-0.95) for the intervention area compared with the control area in the post-intervention period, with no significant pre-intervention difference. Significant survival advantages were found for females, children of younger fathers, those with married parents, those living in larger households, and those whose nearest health facility was a health centre. For all of the children who died, only 44% of parents or caregivers had sought health care before the child's death. CONCLUSION: This non-specific community-based public health intervention, as an addition to IMCI strategies in local health facilities, appears to have significantly reduced childhood mortality in these communities. The possibility that such interventions may not effectively reach certain social groups (for example single parents) is an important consideration for implementation of similar strategies in future. The synergy between community awareness and the availability of effective peripheral health services is also an issue that needs further exploration.

Author(s): The PLOS Medicine Editors 1,*, Soumya Swaminathan 2, Robin S. Room 3,4, Louise C. Ivers 5,6, Graham Hillis 7,8, Rebecca F. Grais 9, Zulfiqar A. Bhutta 10,11, Peter Byass [...]

Background Verbal autopsy (VA) is a practical method for determining probable causes of death at the population level in places where systems for medical certification of cause of death are weak. VA methods suitable for use in routine settings, such as civil registration and vital statistics (CRVS) systems, have developed rapidly in the last decade. These developments have been part of a growing global momentum to strengthen CRVS systems in low-income countries. With this momentum have come pressure for continued research and development of VA methods and the need for a single standard VA instrument on which multiple automated diagnostic methods can be developed. Methods and findings In 2016, partners harmonized a WHO VA standard instrument that fully incorporates the indicators necessary to run currently available automated diagnostic algorithms. The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality. This VA instrument offers the opportunity to harmonize the automated diagnostic algorithms in the future. Conclusions Despite all improvements in design and technology, VA is only recommended where medical certification of cause of death is not possible. The method can nevertheless provide sufficient information to guide public health priorities in communities in which physician certification of deaths is largely unavailable. The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality., Author(s): Erin K. Nichols 1,*, Peter Byass 2,3, Daniel Chandramohan 4, Samuel J. Clark 3,5,6,7, Abraham D. Flaxman 8, Robert Jakob 9, Jordana Leitao 9, Nicolas Maire 10,11, Chalapati Rao [...]

OBJECTIVE: To examine relationships between gender, literacy and survival among adults in Meskan and Mareko district, Ethiopia. METHODS: On the basis of an established demographic surveillance system, an open-cohort analysis of 172 726 person-years covering the period January 1987 to December 1996 was conducted in 10 randomly selected local communities. FINDINGS: The crude mortality rate was 11.2 per 1000 person-years among adults aged > or = 15 years; the values for males and females were 11.9 and 10.6 per 1000 person-years, respectively. Kaplan - Meier estimates showed that literacy and being female were both favourable for survival throughout adulthood. Cox's regression models showed that age, gender, literacy and area (rural lowland, rural highland and urban) were significant factors in survival: younger, female, literate urban dwellers were the most favoured. Gender differences in mortality were small in the rural areas, possibly because of the harsh living conditions and the marginalization of women. Literacy was a more significant factor for survival in the rural areas, where mortality was highest, while gender was more important in the one urban area studied. The levels of literacy were lowest among rural females. CONCLUSION: Special attention should be given to raising literacy levels among rural women with a view to improving their survival.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2010.05.023 Byline: Lucia D'Ambruoso (a), Peter Byass (a)(b), Siti Nurul Qomariyah (c), Moctar Ouedraogo (d) Abstract: Maternal mortality in developing countries is characterised by disadvantage and exclusion. Women who die whilst pregnant are typically poor and live in low-income and rural settings where access to quality care is constrained and where deaths, within and outside hospitals, often go unrecorded and unexamined. Verbal autopsy (VA) is an established method of determining cause(s) of death for people who die outside health facilities or without proper registration. This study extended VA to investigate socio-cultural factors relevant to outcomes. Interviews were conducted with relatives of 104 women who died during pregnancy, childbirth or postpartum in two rural districts in Indonesia and for 70 women in a rural district in Burkina Faso. Information was collected on medical signs and symptoms of the women prior to death and an extended section collected accounts of care pathways and opinions on preventability and cause of death. Illustrative quantitative and qualitative analyses were performed and the implications for health surveillance and planning were considered. The cause of death profiles were similar in both settings with infectious diseases, haemorrhage and malaria accounting for half the deaths. In both settings, delays in seeking, reaching and receiving care were reported by more than two-thirds of respondents. Relatives also provided information on their experiences of the emergencies revealing culturally-derived systems of explanation, causation and behaviour. Comparison of the qualitative and quantitative results suggested that the quantified delays may have been underestimated. The analysis suggests that broader empirical frameworks can inform more complete health planning by situating medical conditions within the socio-economic and cultural landscapes in which healthcare is situated and sought. Utilising local knowledge, extended VA has potential to inform the relative prioritisation of interventions that improve technical aspects of life-saving services with those that address the conditions that underlie health, for those whom services typically fail to reach. Author Affiliation: (a) Initiative for Maternal Mortality Programme Assessment (Immpact), University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom (b) UmeA[yen] Centre for Global Health Research, Epidemiology and Public Health Sciences, UmeA[yen] University, Sweden (c) Immpact, Center for Family Welfare, Faculty of Public Health, University of Indonesia, G Building, 2nd floor, R.210, Depok, 16424, West Java, Indonesia (d) Groupe de Recherche, d'Expertise et de Formation en Sante pour le Developpement (GREFSaD), 01 BP 298 Bobo-Dioulasso 01, Burkina Faso