OBJECTIVES
Cholera is an easily treatable disease, but many people are still unnecessarily dying from it. To improve current case management practices and prevent mortality requires a comprehensive understanding of who is at higher risk of dying. To identify the most common risk factors, a scoping review was undertaken, to explore the literature and summarise the evidence on cholera mortality and reported risk factors.
METHODS
Following the scoping review framework proposed by Arksey and O'Malley (2005), Pubmed, EMBASE, Web of Science, LILACS, Scielo, Cochrane and Open Grey and African Journals Online were searched on 24 November 2021, without restrictions in language or date. After screening and assessing the records across predefined criteria, we performed a thematic analysis on mortality.
RESULTS
A total of 77 studies were included in the final review. The potential reasons explaining the observed mortality were classified in the following categories: Patient characteristics; Healthcare; and Health‐seeking behaviour. The identified risk factors were multi‐dimensional, inter‐dependent and context‐specific. When exploring the patients' characteristics, the available data suggested that in many contexts, case fatality ratios were higher among males and older people, especially those aged 50 or above. Twelve studies reported the place of death, with the percentage of community deaths ranging from 23% to 96%. Evidence on comorbidities and cholera deaths was too scarce for analysis.
CONCLUSIONS
Cholera has been a disease of global importance for more than two centuries. Despite this, our review highlighted that there has been limited published evidence about factors that increase the risk of cholera‐related death. Collecting, reporting and analysing baseline characteristics such as age, sex and predisposing conditions can improve our understanding of cholera mortality risk factors and guide improvements in future case management recommendations.
BACKGROUND
Deaths occurring during the neonatal period contribute close to half of under-five mortality rate (U5MR); over 80% of these deaths occur in low- and middle-income countries (LMICs). Poor maternal antepartum and perinatal health predisposes newborns to low birth weight (LBW), birth asphyxia, and infections which increase the newborn's risk of death.
METHODS
The objective of the study was to assess the association between abnormal postpartum maternal temperature and early infant outcomes, specifically illness requiring hospitalisation or leading to death between birth and six weeks' age. We prospectively studied a cohort of neonates born at Mbarara Regional Referral Hospital in Uganda to mothers with abnormal postpartum temperature and followed them longitudinally through early infancy. We performed a logistic regression of the relationship between maternal abnormal temperature and six-week infant hospitalization, adjusting for gestational age and 10-minute APGAR score at birth.
RESULTS
Of the 648 postpartum participants from the parent study who agreed to enroll their neonates in the sub-study, 100 (15%) mothers had abnormal temperature. The mean maternal age was 24.6 (SD 5.3) years, and the mean parity was 2.3 (SD 1.5). There were more preterm babies born to mothers with abnormal maternal temperature (10%) compared to 1.1% to mothers with normal temperature (p=˂0.001). While the majority of newborns (92%) had a 10-minute APGAR score > 7, 14% of newborns whose mothers had abnormal temperatures had APGAR score ˂7 compared to 7% of those born to mothers with normal postpartum temperatures (P = 0.02). Six-week outcome data was available for 545 women and their infants. In the logistic regression model adjusted for gestational age at birth and 10-minute APGAR score, maternal abnormal temperature was not significantly associated with the composite adverse infant health outcome (being unwell or dead) between birth and six weeks' age (aOR = 0.35, 95% CI 0.07-1.79, P = 0.21). The 10-minute APGAR score was significantly associated with adverse six-week outcome (P < 0.01).
CONCLUSIONS
While our results do not demonstrate an association between abnormal maternal temperature and newborn and early infant outcomes, good routine neonate care should be emphasized, and the infants should be observed for any abnormal findings that may warrant further assessment.
BACKGROUND
Fighting erupted on 15 April 2023 in Sudan between the army and the paramilitary Rapid Support Forces. By September 2023, more than 420,000 people had fled to Chad. To describe the health status of the displaced populations in camps in eastern Chad, several surveys were realised. We describe retrospective crude and under five mortality rates, reported causes of death and frequency and type of violence events experienced by displaced populations in three camps in eastern Chad.
METHODS
Cross-sectional surveys were carried out in August and September 2023 in Toumtouma, Ourang and Arkoum camps. Each survey included retrospective mortality and frequency and type of violent events experienced. All surveys considered a pre-crisis and crisis phase.
RESULTS
In all sites, the crude mortality rate (CMR) was significantly higher in the crisis phase than in the pre-crisis phase. The CMR was particularly elevated in Ourang camp (CMR: 2.25 deaths/10,000 people/day [95% CI: 1.77 - 2.74] in the crisis phase versus CMR: 0.11 deaths/10,000 people/day [95% CI: 0.02 - 0.20] in the pre-crisis phase). Violence was the leading self-reported cause of death in all sites. Among households in Ourang, more than 90 percent originating from El Geneina, more than 1 in 10 of all men aged 30 and over died of violent causes. In Toumtouma, Ourang and Arkoum camps, the overall frequency of violence among households was 3.3%, 11.7% and 4.4% respectively, with beatings and shooting most frequently cited.
CONCLUSIONS
In the three camps investigated, excess mortality was observed among households during the crisis phase, with excess mortality primarily linked to violence among men. The population in Ourang camp, largely from El Geneina, appears to have been particularly affected by the violence, with CMR 20 times higher than in the pre-crisis period and mortality rates exceeding the standard emergency threshold (1 death/10,000 people/day).
KEY MESSAGE
Several cross-sectional surveys were carried out among displaced populations arriving in Chad. We provide epidemiological evidence of the high rates of mortality and violence since the start of the conflict in Sudan.
BACKGROUND
Haiti faces chronic instability for decades, but recent years have seen exacerbation following the assassination of president Juvenel Moise in 2021. Over 95 armed gangs are battling for control of Port-au-Prince and constant clashes paralyze infrastructure and medical assistance. Data on mortality and violence are virtually non-existent. To address this information gap, we conducted two retrospective mortality surveys, one among MSF national staff and another in the Cité Soleil commune population in Port-au-Prince.
METHODS
The first cross-sectional survey was conducted in April 2023 among the MSF-OCP, OCA and OCB national staff and their families. All 1545 MSF Haitian employees were eligible. The second took place in August 2023 in the Cité Soleil commune, where a spatial sample of 1400 households was randomly selected. Indicators included crude mortality rate, causes of death, and experiences of violence.
RESULTS
The MSF staff survey interviewed 819 members representing 3977 individuals, while the Cité Soleil survey interviewed 1669 households representing 8202 individuals. Mortality was low in the MSF staff, with only 6 deaths, in Cité Soleil, 176 deaths were reported, translating into a crude mortality rate of 0.63/10000/day [95% CI: 0.54- 0.73]. Violence accounted for 40% of deaths, with an estimated age-standardized number of homicides of 2,300. Nearly half of MSF Staff family members and Cité Soleil participants experienced some form of violence.
CONCLUSION
Our findings confirm the alarming levels of violence experienced by the Haitian population. In 2022-2023, Haiti was one of the most dangerous countries in the world for civilians. Urgent action is needed to strengthen humanitarian access, healthcare provision and civilian protection. Two surveys conducted by Epicentre/MSF in 2023 in Haiti confirm the extreme violence the population is suffering. Urgent action is needed to improve healthcare access and civilian protection.
KEY MESSAGE
Two surveys conducted by Epicentre/MSF in 2023 in Haiti confirm the extreme violence the population is suffering. Urgent action is needed to improve healthcare access and civilian protection.