Road traffic crashes in Ramadan: an observational study.

The aim of this study was to investigate trends in road traffic crashes (RTCs) managed by an emergency service, Rescue 1122, in 2011 in Punjab, Pakistan. RTC data were collected from 35 districts of Punjab and reviewed retrospectively. Data analysis revealed that the service responded to 12 969 RTC emergencies during August 2011 (Ramadan), compared with an average of 11 573 RTCs per month from January to August 2011. The younger age group (11-27 years) was victims in 29% of RTCs; 39% were due to speeding and 43% occurred in peak rush hours (14:00-18:00) before iftar (breakfast).Results of the study showed that Rescue 1122 faced more RTCs during Ramadan compared with the preceding months. Road safety is an important public health issue in Pakistan. Although there have been great improvements in roads in the past few years, much work needs to be done to deal with mounting trends in RTCs. Public awareness, political will and stringent law enforcement are key factors.

Gender differences in the risk of coronary artery disease in iran.

BACKGROUND: Given gender differences in the risk of coronary artery disease (CAD), the present study sought to investigate these dissimilarities amongst patients who underwent angiography at a major, tertiary heart hospital in Iran. METHODS: Between 2005 and 2010, 44,820 patients who underwent coronary angiography were enrolled in a registry. Pre-procedural data such as demographics, CAD risk factors, presenting symptoms, and laboratory tests, as well as post-procedural data were collected. The data were, subsequently, compared between the men and women. RESULTS: Out of the 44,820 patients (16,378 women), who underwent coronary angiography, 37,358 patients (11,995 women) had CAD. Amongst the CAD patients, the females were not only significantly older, less educated, and more overweight than were the males but also had higher levels of triglyceride, cholesterol, low-density lipoprotein, high-density lipoprotein, and fasting blood sugar (P< 0.001). Of all the risk factors, hypertension and diabetes mellitus showed the strongest association in our female CAD patients (OR=3.45, 95%CI: 3.28-3.61 and OR=2.37, 95%CI: 2.26-2.48, respectively). Acute coronary syndrome was more prevalent in the men (76.1% vs. 68.6%, P< 0.001), and chronic stable angina was more frequent in the females (31.4% vs. 23.9%, P< 0.001). With respect to post-procedural recommendations, the frequency of recommendations for non-invasive modalities was higher in the females (20.1% vs. 18.6%, P< 0.001). CONCLUSION: Hypertension and diabetes mellitus had the strongest association with CAD in our female patients. In the extensive CAD patients, medical treatment was recommended to the women more often.

Inequalities in under-five mortality in Mozambique: differentials by region of residence and ethnic affiliation of the mother.

OBJECTIVE: To explore regional and ethnic differentials in under-five mortality in Mozambique in relation to other determinants. DESIGN: Retrospective follow-up study. SETTING: Mozambique. RESULTS: Compared to children of Xitsonga mother's, children of Emakua and Cisena mother's had a mortality risk of 1.47 (CI = 1.06-1.90) and 1.21 (CI = 1.00-1.62) respectively. The excess mortality risks were partly explained by demographic, household environment, socioeconomic factors including region of residence. CONCLUSION: Ethnic affiliation of the mother (measured by the first language the mother spoke) was statistically associated with under-five mortality in Mozambique. Children of mothers of Emakua and Cisena ethnic affiliations and living in the North and Central regions had the worst survival chances. The relation between mother's ethnicity and under-five mortality was largely explained by demographic, socioeconomic and environmental factors.

Contribution of household environment factors to urban childhood mortality in Mozambique.

OBJECTIVES: Household environment factors are known to be associated with child mortality in urban and rural areas of many developing countries. In Mozambique, no study to date has addressed this relationship. This study is aimed to access the contribution of household environment factors to urban childhood mortality in Mozambique. DESIGN: Retrospective follow-up study. SETTING: Urban Mozambique. SUBJECTS: One thousand and forty eight children born in urban areas of Monzambique within five years of the 1997 Demographic and Health Survey. METHODS: Cox regression analysis was performed on a sample of 1048 children born in urban areas of Mozambique within five years of the 1997 Demographic and Health Survey. RESULTS: Children of mother's who lived in households with no toilet facility or with well as a source of drinking water had a high risk of dying compared to children who lived in households with flush toilet and piped water. CONCLUSION: Type of toilet facility and source of drinking water play an important role in the risk of childhood mortality in urban areas of Mozambique and the relationship seems to be mediated partly by demographic and socioeconomic factors.

The burden of disease in Maputo City, Mozambique: registered and autopsied deaths in 1994.

OBJECTIVE: To classify the causes of death in Maputo City, Mozambique, using the methods of the Global Burden of Disease study, in order to provide information for health policy-makers and to obtain a baseline for future studies in Maputo City and provincial capitals. METHODS: Data were taken from the Maputo City death register and autopsy records for 1994. FINDINGS: A total of 9011 deaths were recorded in the death register, representing a coverage of approximately 86%. Of these, 8114 deaths (92%) were classified by cause. Communicable, maternal, perinatal, and nutritional disorders accounted for 5319 deaths; noncommunicable diseases for 1834; and injuries for 961. The 10 leading causes of registered deaths were perinatal disorders (1643 deaths); malaria (928); diarrhoeal diseases (814); tuberculosis (456); lower respiratory infections (416); road-traffic accidents (371); anaemia (269); cerebrovascular diseases (269); homicide (188); and bacterial meningitis (178). CONCLUSIONS: Infectious diseases of all types, injuries, and cerebrovascular disease ranked as leading causes of death, according to both the autopsy records and the city death register. AIDS-related deaths were underreported. With HIV infection increasing rapidly, AIDS will add to the already high burden of infectious diseases and premature mortality in Maputo City. The results of the study indicate that cause of death is a useful outcome indicator for disease control programmes.

Child and maternal mortality during a period of conflict in Beira City, Mozambique.

BACKGROUND: Child mortality rates have been declining in most developing countries. We studied child and maternal mortality risk factors for child mortality in Beira city in July 1993, after a decade of conflict in Mozambique. METHODS: A community-based cluster sample survey of 4609 women of childbearing age was conducted. Indirect techniques were used to estimate child mortality ('children ever born' method and Preceding Birth Techniques (PBT) and maternal mortality (sisterhood method). Deaths among the most recent born child, born since July 1990, were classified as cases (n = 106), and two controls, matched by age and cluster, were selected per case. RESULTS: Indirect estimates of the probability of dying from birth to age 5 (deaths before age 5 years, (5)q(0) per 1000) decreased from 246 in 1977/8 to 212 in 1988/9. The PBT estimate of 1990/91 was 154 (95 percent confidence interval [CI]: 124-184), but recent deaths may have been underreported. Lack of beds in the household (odds ratio [OR] = 2.0, 95 percent CI: 1.1-3.8), absence of the father (OR = 2.4, 95 percent CI : 1.2-4.8), low paternal educational level (OR = 2.1, 95 percent CI: 0.8-5.4), young maternal age (OR = 2.0, 95 percent CI: 1.0-3.7), self-reported maternal illness (OR = 2.4, 95 percent CI : 1.2-4.9), and home delivery of the child (OR = 2.3, 95 percent CI : 1.2-4.5) were associated with increased mortality, but the sensitivity of risk factors was low. Estimated maternal mortality was 410/100 000 live births with a reference date of 1982. CONCLUSIONS: Child mortality decreased slowly over the 1980s in Beira despite poor living conditions caused by the indirect effects of the war. Coverage of health services increased over this period. The appropriateness of a risk approach to maternal-child-health care needs further evaluation.

PIP: In July 1993, public health specialists conducted a cluster sample survey of 4609 women aged 15-49 living in 3190 houses in Beira city to determine child and maternal mortality after 10 years of internal conflict in Mozambique and a nested case control study of risk factors for child mortality. The indirect estimate techniques were child ever born and preceding birth techniques for child mortality and the sisterhood method for maternal mortality. The case control study compared 106 deaths among the most recent born child born since July 1990 with two age- and cluster-matched controls. The proportion of dead sisters who died of pregnancy-related causes was only 10.3% compared to 25-33% in developing countries. In 1982, the estimated maternal mortality ratio was 410/100,000 live births. The lifetime risk of maternal mortality was 263/1000. The preceding birth technique obtained a much lower child mortality estimate than the child ever born technique (154 vs. 212/1000). The child ever born technique analyzed data from 1977-1978 to 1988-1989 and found that the probability of dying from birth to age 5 fell 14% (246-212). During this period, coverage of health services improved. Even though the preceding birth technique is usually more reliable for recent estimates, underreporting of recent child deaths likely contributed to the lower child mortality estimate. Risk factors for child mortality included no beds in the household (odds ratio [OR] = 2.02), absence of the father (OR = 2.43), low paternal educational level (OR = 2.08), young maternal age (OR = 1.96), self-reported maternal illness since birth of child (OR = 2.43), and home delivery (OR = 2.31). Yet the sensitivity of these risk factors was rather low (15-57%). These findings show that child mortality fell slowly during the 1980s despite the poor living conditions brought about by the indirect effects of the civil war. They point to the need to further evaluate the appropriateness of a risk approach to maternal and child health care needs.