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Objective To conduct a systematic review of verbal autopsy studies in low- and middle-income countries to estimate the fraction of deaths due to cardiovascular disease. Method We searched MEDLINE[R], Embase[R] and Scopus databases for verbal autopsy studies in low- and middle-income countries that reported deaths from cardiovascular disease. Two reviewers screened the studies, extracted data and assessed study quality. We calculated cause-specific mortality fractions for cardiovascular disease for each study, both overall and according to age, sex, geographical location and type of cardiovascular disease. Findings We identified 42 studies for inclusion in the review. Overall, the cardiovascular disease cause-specific mortality fractions for people aged 15 years and above was 22.9%. This fraction was generally higher for males (24.7%) than females (20.9%), but the pattern varied across World Health Organization regions. The highest cardiovascular disease mortality fraction was reported in the Western Pacific Region (26.3%), followed by the South-East Asia Region (24.1%) and the African Region (12.7%). The cardiovascular disease mortality fraction was higher in urban than rural populations in all regions, except the South-East Asia Region. The mortality fraction for ischaemic heart disease (12.3%) was higher than that for stroke (8.7%). Overall, 69.4% of cardiovascular disease deaths were reported in people aged 65 years and above. Conclusion The burden of cardiovascular disease deaths outside health-care settings in low- and middle-income countries is substantial. Increasing coverage of verbal autopsies in these countries could help fill gaps in cardiovascular disease mortality data and improve monitoring of national, regional and global health goals. Objectif Mener une revue systematique des etudes d'autopsie verbale dans les pays a revenu faible et intermediaire afin d'estimer la part des deces causes par des maladies cardiovasculaires. Methodes Nous avons explore les bases de donnees MEDLINE[R], Embase[R] et Scopus a la recherche d'etudes d'autopsie verbale signalant des deces lies a une maladie cardiovasculaire dans les pays a revenu faible et intermediaire. Deux reviseurs ont passe ces etudes au crible, en ont extrait des informations et ont evalue leur qualite. Pour chaque etude, nous avons calcule la part de mortalite par cause pour les maladies cardiovasculaires, tant de maniere globale qu'en fonction de l'age, du sexe, de la situation geographique et du type de maladie cardiovasculaire. Resultats Nous avons identifie 42 etudes a inclure dans la revue. Dans l'ensemble, la part de mortalite par cause pour les maladies cardiovasculaires s'elevait a 22,9% pour les personnes agees de 15 ans et plus. Cette part etait generalement plus importante chez les hommes (24,7%) que chez les femmes (20,9%), mais le schema variait selon les regions de l'Organisation mondiale de la Sante. C'est dans la Region du Pacifique occidental que le plus haut taux de mortalite cardiovasculaire a ete observe (26,3%), puis dans la Region d'Asie du Sud-Est (24,1%) et dans la Region africaine (12,7%). La part de mortalite due aux maladies cardiovasculaires etait plus grande au sein des populations urbaines plutot que rurales dans toutes les regions, a l'exception de la Region d'Asie du Sud-Est. La part de mortalite liee aux cardiopathies ischemiques (12,3%) etait superieure a celle des AVC (8,7%). Au total, 69,4% des deces cardiovasculaires ont ete constates chez des personnes agees de 65 ans ou plus. Conclusion Limpact des deces causes par une maladie cardiovasculaire en dehors des structures de sante dans les pays a revenu faible et intermediaire est considerable. Etendre la couverture des autopsies verbales dans ces pays pourrait contribuer a combler les lacunes dans les donnees sur la mortalite cardiovasculaire et a ameliorer le suivi des objectifs nationaux, regionaux et mondiaux en matiere de sante. Objetivo Llevar a cabo una revision sistematica de los estudios sobre autopsias verbales de paises con ingresos medios y bajos para estimar la proporcion de fallecimientos causados por enfermedades cardiovasculares. Metodos Buscamos en bases de datos como MEDLINE[R], Embase[R] y Scopus para acceder a estudios sobre autopsias verbales de paises con ingresos medios y bajos que hubieran registrado fallecimientos causados por enfermedades cardiovasculares. Dos revisores analizaron los estudios, extrajeron datos y evaluaron la calidad de dichos estudios. Calculamos las fracciones de mortalidad por enfermedad cardiovascular como causa especifica en cada uno de los estudios, de manera general y segun la edad, el sexo, la u bicacion geografica y el tipo de enfermedad cardiovascular. Resultados Seleccionamos 42 estudios para incluirlos en la revision. En general, las fracciones de mortalidad por enfermedad cardiovascular como causa especifica en personas con una edad de 15 anos o superior fueron del 22,9%. Por lo general, esta fraccion fue mas elevada en el caso de los hombres (24,7%) que en el de las mujeres (20,9%), pero el patron vario entre las diferentes regiones de la Organizacion Mundial de la Salud. La fraccion mas alta de mortalidad por enfermedad cardiovascular se registro en la Region del Pacifico Occidental (26,3%), seguida de la Region de Asia Sudoriental (24,1%) y la Region de Africa (12,7%). La fraccion de mortalidad por enfermedad cardiovascular fue mas elevada en las poblaciones urbanas que en las rurales en todas las regiones, excepto en la Region de Asia Sudoriental. La fraccion de mortalidad por cardiopatia isquemica (12,3%) fue superior a la de ictus (8,7%). En general, el 69,4% de los fallecimientos por enfermedad cardiovascular se registro en personas de 65 anos o mas. Conclusion La carga de fallecimientos por enfermedad cardiovascular fuera de los centros de atencion sanitaria en los paises con ingresos medios y bajos es considerable. El aumento de la cobertura de las autopsias verbales en estos paises podria ayudar a subsanar la falta de datos sobre mortalidad por enfermedad cardiovascular, y mejorar el control de los objetivos de salud a nivel nacional, regional y mundial. [phrase omitted], Introduction Cardiovascular disease is the largest cause of death due to noncommunicable disease globally. Data from the Global Burden of Disease (GBD) indicate that cardiovascular disease caused 18.5 million deaths [...]

Problem Bangladesh has no national system for registering deaths and determining their causes. As a result, policy-makers lack reliable and complete data to inform public health decisions. Approach In 2016, the government of Bangladesh introduced a pilot project to strengthen the civil registration and vital statistics system and generate cause of death data in Kaliganj Upazila. Community- based health workers were trained to notify births and deaths to the civil registrar, and to conduct verbal autopsy interviews with family members of a deceased person. International experts in cause-of-death certification and coding trained master trainers on how to complete the international medical certificate of cause of death. These trainers then trained physicians and coders. Local setting Kaliganj Upazila has an estimated population of 304 600, and 5600 births and 1550 deaths annually. Health assistants and family welfare assistants make regular visits to households to track certain health outcomes. Relevant changes Following the start of the project in 2016, the number of births registered within 45 days rose from 873 to 4630 in 2018. The number of deaths registered within 45 days increased from 458 to 1404. During this period, health assistants conducted 7837 verbal autopsy interviews. Between January 2017 and December 2018, 105 master trainers and more than 7000 physicians were trained to complete the international medical certificate of cause of death and they completed more than 12 000 certificates. Lessons learnt Training community-based health workers, physicians and coders were successful approaches to improve death registration completeness and availability of cause-of-death data. Probleme Le Bangladesh n'est dote d'aucun systeme national pour enregistrer les deces et determiner leurs causes. Les responsables politiques ne disposent done pas de donnees fiables et completes pouvant servir de base a la prise de decisions en matiere de sante publique. Approche En 2016, le gouvernement du Bangladesh a mis en place un projet pilote destine a renforcer le systeme des registres et des statistiques de l'etat civil et a obtenir des donnees sur les causes de deces dans l'upazila de Kaliganj. Des agents sanitaires de proximite ont appris a notifier les naissances et les deces a l'officier de l'etat civil, et a realiser des autopsies verbales aupres des membres de la famille d'une personne decedee. Des experts internationaux de la certification des causes de deces et du codage ont appris a des formateurs principaux a remplir le certificat medical international indiquant la cause du deces. Ces formateurs ont ensuite forme des medecins et des codeurs. Environnement local L'upazila de Kaliganj compte quelque 304 600 habitants et enregistre environ 5600 naissances et 1550 deces par an. Des aides-soignants et des auxiliaires en matiere de protection de la famille effectuent des visites a domicile regulieres pour suivre certains resultats cliniques. Changements significatifs A la suite du lancement du projet en 2016, le nombre de naissances enregistrees en 45 jours est passe de 873 a 4630 en 2018. Le nombre de deces enregistres en 45 jours est passe de 458 a 1404. Au cours de cette periode, les aides-soignants ont realise 7837 autopsies verbales. Entre janvier 2017 et decembre 2018, 105 formateurs principaux et plus de 7000 medecins ont appris a remplir le certificat medical international indiquant la cause du deces, et ils ont rempli plus de 12 000 certificats. Lemons tirees La formation d'agents sanitaires de proximite, de medecins et de codeurs s'est revelee efficace pour ameliorer l'enregistrement des deces et accroitre la disponibilite de donnees sur les causes de deces. Situacion Bangladesh no tiene un sistema nacional para registrar las muertes y determinar sus causas. Como resultado, los responsables de formular politicas carecen de datos fiables y completos que sirvan de base para la toma de decisiones en materia de salud publica. Enfoque En 2016, el gobierno de Bangladesh introdujo un proyecto piloto para fortalecer el registro civil y el sistema de estadisticas vitales y generar datos sobre las causas de muerte en Kaliganj Upazila. Se capacito a los trabajadores sanitarios de la comunidad para que notificaran los nacimientos y las defunciones al registro civil, y para que realizaran entrevistas de autopsia verbal con los familiares de una persona fallecida. Expertos internacionales en la certificacion de la causa de muerte y la codificacion de formadores expertos capacitados sobre como completar el certificado medico internacional de causa de muerte. Estos formadores luego capacitaron a medicos y codificadores. Marco regional Kaliganj Upazila tiene una poblacion estimada de 304 600 habitantes y 5 600 nacimientos y 1 550 defunciones anuales. Los asistentes sanitarios y los asistentes de bienestar familiar realizan visitas periodicas a los hogares para hacer un seguimiento de ciertos resultados sanitarios. Cambios importantes Tras el inicio del proyecto en 2016, el numero de nacimientos registrados en un plazo de 45 dias aumento de 873 a 4 630 en 2018. El numero de muertes registradas en 45 dias aumento de 458 a 1 404. Durante este periodo, los asistentes sanitarios realizaron 7 837 entrevistas de autopsia verbal. Entre enero de 2017 y diciembre de 2018, 105 formadores expertos y mas de 7 000 medicos recibieron capacitacion para completar el certificado medico internacional de causa de defuncion y completaron mas de 12 000 certificados. Lecciones aprendidas La capacitacion de los trabajadores sanitarios, los medicos y los codificadores de la comunidad fueron enfoques exitosos para mejorar la integridad del registro de defunciones y la disponibilidad de datos sobre la causa de la muerte., Introduction In 2018, Bangladesh had a population of approximately 165 million, of these around 104 million (63%) people were living in rural areas and about 48 million (29%) people were [...]

Because infants and young children in many developing countries are deficient in both iron and zinc, and zinc can affect iron metabolism, evaluation of optimum strategies to simultaneously supplement iron and zinc is an important public health priority. This study evaluated the efficacy of weekly supplementation of iron or zinc or both on iron, zinc, and copper status in Bangladeshi infants. In a double-blind, randomized, controlled community trial, 6-mo-old infants were assigned to receive weekly supplements of 1 mg riboflavin (control, n = 82) or 1 mg riboflavin + 20 mg iron (n = 83), 20 mg zinc (n = 83), or both (n = 85) for 6 mo. Hemoglobin, serum ferritin, transferrin receptor, zinc, and copper concentrations were measured at baseline and at the end of intervention. Serum Zn increased in both groups receiving zinc; the increase was greatest among children with low baseline serum zinc concentration. Iron status indicators did not differ among the groups before or after 6 mo of supplementation. Supplementation with either zinc or iron decreased serum copper after 6 mo. Joint supplementation did not alter the individual effects of iron or zinc supplementation in these Bangladeshi children. However, the dosing regimen may not have been adequate to achieve the desired biochemical effects. KEY WORDS: * supplementation * iron * zinc * hemoglobin * copper

Abstract Background Poor neonatal health is a major contributor to under-five mortality in developing countries. A major constraint to effective neonatal survival programme has been the lack of population level data in developing countries. This study investigated the consultation patterns of caregivers during neonatal fatal illness episodes in the rural Matlab sub-district of eastern Bangladesh. Methods Neonatal deaths were identified through a population-based demographic surveillance system in Matlab ICDDR,B maternal and child health (MCH) project area and an adjoining government service area. Trained project staff administered a structured questionnaire on care seeking to mothers at home who had experienced a neonatal death. Univariate, bivariate and binary multivariate logistic regressions were performed to describe care seeking during the fatal illness episode. Results Of the 365 deaths recorded during 2003 and 2004, 84% died in the early (0-7 days) neonatal period, with the remaining deaths occurring over the subsequent 8 to 28 days. The first resort of care by parents was a qualified doctor or paramedic in 37% of cases, followed by traditional and unqualified health care providers in 25%, while 38% sought no care. Thus, almost two thirds (63%) of neonates who died received only traditional and unqualified care or no care at all during their final illness episode. About 22% sought care from more than one provider, including 6% from 3 or more providers. Such plurality in care seeking was more likely among male infants, in the late neonatal period, and in the MCH project area. Conclusions The high proportion of neonatal deaths that had received traditional care or no medical care in a rural area of Bangladesh highlights the need to develop community awareness about prompt medical care seeking for neonatal illnesses and to improve access to effective health care. Integration of traditional care providers into mainstream health programs should also be considered.

Abstract Objective This study assessed the agreement between medical physicians in their interpretation of verbal autopsy (VA) interview data for identifying causes of neonatal deaths in rural Bangladesh. Methods The study was carried out in Matlab, a rural sub-district in eastern Bangladesh. Trained persons conducted the VA interview with the mother or another family member at the home of the deceased. Three physicians and a medical assistant independently reviewed the VA interviews to assign causes of death using the International Classification of Diseases - Tenth Revision (ICD-10) codes. A physician assigned cause was decided when at least two physicians agreed on a cause of death. Cause-specific mortality fraction (CSMF), kappa (k) statistic, sensitivity, specificity, and positive predictive values were applied to compare agreement between the reviewers. Results Of the 365 neonatal deaths reviewed, agreement on a direct cause of death was reached by at least two physicians in 339 (93%) of cases. Physician and medical assistant reviews of causes of death demonstrated the following levels of diagnostic agreement for the main causes of deaths: for birth asphyxia the sensitivity was 84%, specificity 93%, and kappa 0.77. For prematurity/low birth weight, the sensitivity, specificity, and kappa statistics were, respectively, 53%, 96%, and 0.55, for sepsis/meningitis they were 48%, 98%, and 0.53, and for pneumonia they were 75%, 94%, and 0.51. Conclusion This study revealed a moderate to strong agreement between physician- assigned and medical assistant- assigned major causes of neonatal death. A well-trained medical assistant could be considered an alternative for assigning major causes of neonatal deaths in rural Bangladesh and in similar settings where physicians are scarce and their time costs more. A validation study with medically confirmed diagnosis will improve the performance of VA for assigning cause of neonatal death.

Background: In Bangladesh, a poorly functioning national system of registering deaths and determining their causes leaves the country without important information on which to inform health programming, particularly for the 85% of deaths that occur in the community. In 2017, an improved death registration system and automated verbal autopsy (VA) were introduced to 13 upazilas to assess the utility of VA as a routine source of policy-relevant information and to identify leading causes of deaths (COD) in rural Bangladesh.Methods: Data from 22,535 VAs, collected in 12 upazilas between October 2017 and August 2019, were assigned a COD using the SmartVA Analyze 2.0 computer algorithm. The plausibility of the VA results was assessed using a series of demographic and epidemiological checks in the Verbal Autopsy Interpretation, Performance and Evaluation Resource (VIPER) software tool.Results: Completeness of community death reporting was 65%. The vast majority (85%) of adult deaths were due to non-communicable diseases, with ischemic heart disease, stroke and chronic respiratory disease comprising about 60% alone. Leading COD were broadly consistent with Global Burden of Disease study estimates.Conclusions: Routine VA collection using automated methods is feasible, can produce plausible results and provides critical information on community COD in Bangladesh. Routine VA and VIPER have potential application to countries with weak death registration systems. [ABSTRACT FROM AUTHOR]

Introduction: Adult separation anxiety disorder (ASAD) has been reported in the psychiatric literature with lifetime prevalence of 6.6%, which is associated with different comorbidities. Here, we report an adult Bangladeshi female presented with ASAD for her pets with superimposed superstitious beliefs. Case Presentation: A 27 year-old-female presented with excessive unusual preferences and preoccupation with her 2 cats for the last 4 years. She also presented with severe anxiety, fear, and sleep disturbances with bad dreams related to her pets. She had persistent fear of losing her pets and suspected that people including her family members might harm them. She was increasingly unwilling to keep herself away from the cats, resulting in her social isolation and limitation in other activities. She married 2 years ago after long period of affairs, but refused to stay in her in-laws residence without her pets and she even avoided her husband. She behaves with pets as if they are her children and does not want to have children anymore. Conclusions: Extreme pet preference with avoidance of usual family life contrasting the cultural belief encouraged the authors to draw the attention of scientific community. [ABSTRACT FROM AUTHOR]