Magnitude and determinants of excess total, age-specific and sex-specific all-cause mortality in 24 countries worldwide during 2020 and 2021: results on the impact of the COVID-19 pandemic from the C-MOR project.

INTRODUCTION: To examine the impact of the COVID-19 pandemic on mortality, we estimated excess all-cause mortality in 24 countries for 2020 and 2021, overall and stratified by sex and age. METHODS: Total, age-specific and sex-specific weekly all-cause mortality was collected for 2015-2021 and excess mortality for 2020 and 2021 was calculated by comparing weekly 2020 and 2021 age-standardised mortality rates against expected mortality, estimated based on historical data (2015-2019), accounting for seasonality, and long-term and short-term trends. Age-specific weekly excess mortality was similarly calculated using crude mortality rates. The association of country and pandemic-related variables with excess mortality was investigated using simple and multilevel regression models. RESULTS: Excess cumulative mortality for both 2020 and 2021 was found in Austria, Brazil, Belgium, Cyprus, England and Wales, Estonia, France, Georgia, Greece, Israel, Italy, Kazakhstan, Mauritius, Northern Ireland, Norway, Peru, Poland, Slovenia, Spain, Sweden, Ukraine, and the USA. Australia and Denmark experienced excess mortality only in 2021. Mauritius demonstrated a statistically significant decrease in all-cause mortality during both years. Weekly incidence of COVID-19 was significantly positively associated with excess mortality for both years, but the positive association was attenuated in 2021 as percentage of the population fully vaccinated increased. Stringency index of control measures was positively and negatively associated with excess mortality in 2020 and 2021, respectively. CONCLUSION: This study provides evidence of substantial excess mortality in most countries investigated during the first 2 years of the pandemic and suggests that COVID-19 incidence, stringency of control measures and vaccination rates interacted in determining the magnitude of excess mortality.

Impact of the COVID-19 pandemic on total, sex- and age-specific all-cause mortality in 20 countries worldwide during 2020: results from the C-MOR project.

BACKGROUND: To understand the impact of the COVID-19 pandemic on mortality, this study investigates overall, sex- and age-specific excess all-cause mortality in 20 countries, during 2020. METHODS: Total, sex- and age-specific weekly all-cause mortality for 2015-2020 was collected from national vital statistics databases. Excess mortality for 2020 was calculated by comparing weekly 2020 observed mortality against expected mortality, estimated from historical data (2015-2019) accounting for seasonality, long- and short-term trends. Crude and age-standardized rates were analysed for total and sex-specific mortality. RESULTS: Austria, Brazil, Cyprus, England and Wales, France, Georgia, Israel, Italy, Northern Ireland, Peru, Scotland, Slovenia, Sweden, and the USA displayed substantial excess age-standardized mortality of varying duration during 2020, while Australia, Denmark, Estonia, Mauritius, Norway, and Ukraine did not. In sex-specific analyses, excess mortality was higher in males than females, except for Slovenia (higher in females) and Cyprus (similar in both sexes). Lastly, for most countries substantial excess mortality was only detectable (Austria, Cyprus, Israel, and Slovenia) or was higher (Brazil, England and Wales, France, Georgia, Italy, Northern Ireland, Sweden, Peru and the USA) in the oldest age group investigated. Peru demonstrated substantial excess mortality even in the <45 age group. CONCLUSIONS: This study highlights that excess all-cause mortality during 2020 is context dependent, with specific countries, sex- and age-groups being most affected. As the pandemic continues, tracking excess mortality is important to accurately estimate the true toll of COVID-19, while at the same time investigating the effects of changing contexts, different variants, testing, quarantine, and vaccination strategies.

Need for sensitization on serious threats of second-hand smoke: Findings from a national study in Mauritius, a small island developing state in the Indian Ocean.

This study had the following objectives: To assess the level of knowledge of Mauritians aged ≥ 20 years on the health effects of Second Hand Smoke (SHS), to investigate their behaviour when exposed to SHS and to look for any association between SHS-related knowledge and behaviour towards exposure. A national cross-sectional online survey was conducted. With the total population of Mauritians above the age of 20 years being 941,719, the calculated sample size was 400. A validated questionnaire was used to collect data among respondents from all 9 districts of the island of Mauritius, with representative district-wise samples. Data analysis was carried out using SPSS version 19.0. Considering the findings of the study, there were 408 respondents: Two-thirds of participants showed good knowledge of the harmful effects of SHS. Participants were aware of the link of SHS to respiratory diseases, nonetheless, they were not aware of its causes for non-respiratory diseases. One out of four participants (25.5%) were not aware that maternal passive smoking causes preterm delivery. More than one-third of the participants (37.3%) did not know that passive smoking causes sudden infant death syndrome. Inadequate levels of knowledge were also revealed by authors in other developing countries. We thus recommend bold sensitization campaigns about the serious threats of SHS. We highlight the pertinence of longitudinal cohort studies with assessment of SHS-related knowledge/behaviour before and after health education campaigns, in Mauritius and other developing countries.

Need to investigate COVID-19 beliefs for tailor-made sensitisation campaigns.

OBJECTIVES: The main objective of this study was to investigate the COVID-19 beliefs of a random sample of Mauritian social media users. STUDY DESIGN: Cross-sectional study. METHODS: This quantitative research was undertaken by means of an online survey instrument, with questions on participants' behaviour towards COVID-19 and their beliefswith respect to susceptibility, barriers, benefits, cues to actions and self-efficacy. RESULTS: In total, 405 participants completed the survey. Participants had a low mean COVID-19 perceived susceptibility and perceived severity. Significant differences in susceptibility were observed among different age groups, places of residence and educational levels. A significant difference in self-efficacy was found between people living in urban and rural areas. Participants aged <39 years showed a significantly lower perceived benefit of staying at home to avoid COVID-19 infection compared with those aged 39-54 years. Multiple linear regression modelling revealed that participants aged 39-65 years and those who were single were the most concerned about the risk of COVID-19 infection. CONCLUSIONS: The findings of this study provide the basis for evidence-based health education programmes that are tailor-made for specific targeted audience. Sensitisation campaigns on the benefits of staying home should be aimed at younger social media users (aged <39 years). Community health centres in rural areas need to be involved in providing educational videos to empowering people towards self-efficacy.

Lived Experience of Mothers Having a Child Diagnosed with Type 1 Diabetes in Mauritius: A Phenomenological Study.

PURPOSE: Since there is no existing qualitative study on Type 1 Diabetes (T1D) in Mauritius, this study was undertaken to explore the lived experience of mothers having a child with T1D in Mauritius. DESIGN AND METHODS: This research work used a phenomenological approach with the interview of a purposeful sample of eleven mothers having a child diagnosed with T1D. Data collected was analyzed by two independent investigators. Ethical clearance was obtained from the Department of Medicine Ethics Committee of the University of Mauritius. RESULTS: The emerging themes were 'Facing disruption in life', 'Experiencing mixed feelings', 'Taking matters in hands' and 'Coping with life'. They put forward the four major components of the lived experience of being the mother of a child diagnosed with T1D. 3 to 4 minor themes. CONCLUSIONS: The study shows that diagnosis of Type 1 Diabetes in a child has a profound psychosocial impact on mother's personal, family and professional lives. There is need to support parents in the delivery of optimal care to their child to avoid unpredictable complications and unnecessary loss of lives. PRACTICE IMPLICATIONS: Both nurses and doctors should be aware of their crucial role in demonstrating empathy towards parents/children affected by T1D. There is a need for training programs to develop a culture where empathy enhances nursing and medical practice.

Lessons to be learnt from the COVID-19 public health response in Mauritius.

OBJECTIVES: This study had the following objectives: (1) To look into the public health response of the country facing the COVID-19 outbreak, and (2) To examine the effectiveness of the measures being undertaken to contain the outbreak. METHODS: The research method used was the analysis of all documents/discourses pertaining to the public health response of Mauritius towards COVID-19. We compiled data over the period of 17 January 2020 to 15 May 2020 as and when they were communicated. RESULTS: This study revealed three main themes: (1) Prevention strategy, (2) Outbreak management strategy and (3) Communication strategy. In light of the qualitative findings and the numerical data provided by the Mauritian authorities, we appraise the public health response of Mauritius. CONCLUSIONS: After demonstrating the effectiveness of the public health strategies undertaken by the Mauritian government, we draw the lessons learnt from the experience of Mauritius. These lessons have implications for practice by middle-income countries and/or small island developing states facing a communicable disease outbreak.

Consumption of Moringa oleifera Lam Leaves Lowers Postprandial Blood Pressure.

Objective: This clinical study monitored the effect of eating cooked Moringa oleifera leaves on the blood pressure (BP) of healthy participants in view of the perception that consumption of Moringa is associated with an increase in blood pressure, which is contradictory to the findings from the literature.Methods: A random sample of 41 healthy participants were enrolled in this prospective, placebo-controlled clinical study. Participants in the case study consumed 120 g of cooked M. oleifera leaves while the control group did not eat Moringa leaves. BP was measured at baseline before the meal and followed up at regular intervals over 24 hours for both groups. Baseline (T0) mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) and postprandial follow-up (T2-T24) were measured for both groups. Participants recorded their diet for a week and this led to an estimation of the total salt consumption per day.Results: A significant difference was observed between DBP at baseline and two hours postprandial (T2) for the case group (p = 0.013). Moreover, in the case group, despite high consumption of salt (7 g/d) during the week preceding the clinical study, there was a significant decrease in both the SBP and DBP. In the control group, participants with prior high consumption of salt (7 g/d) during the week had elevated SBP and DBP.Conclusions: These findings in human subjects indicated the lowering effect of Moringa oleifera leaves consumption on the 2 hours postprandial BP and showed a potential lowering effect on both SBP and DBP despite prior high consumption of salt (7 g/d).

Tobacco industry tactics in response to cigarette excise tax increases in Mauritius.

BACKGROUND: In response to high smoking rates, especially among men, Mauritius launched a National Action Plan on Tobacco Control in 2008. It changed its tax system from a mixed system to a uniform specific system. Despite these interventions, cigarette consumption and smoking prevalence in Mauritius decreased only marginally in the subsequent decade. METHOD: Using publicly available data, we decompose the retail price of cigarettes into tax and net-of-tax components, between 2011 and 2017. We cover premium, popular and economy cigarettes. RESULTS: Since its introduction in 2008, the nominal excise tax was increased six times. Between 2011 and 2017, the real value of the excise tax increased by 47%. Meanwhile, British American Tobacco (BAT) increased the real net-of-tax price of premium cigarettes by 61.8% and of popular cigarettes by 47.2%, thus overshifting the tax increase. On economy cigarettes, BAT decreased the real net-of-tax price by 14.7%, thus undershifting the excise tax increase. CONCLUSION: Through its pricing strategy, BAT has greatly undermined Mauritius's tobacco control policy. However, BAT cannot continue undershifting the excise tax on economy brands, since the net-of-tax proportion of the retail price is very low already. BAT would have little choice but to increase the retail price on economy brands in response to future excise tax increases. The government of Mauritius is encouraged to keep the specific excise tax structure but to increase the rate at which it is levied.