High HIV prevalence among decedents received by two high-volume mortuaries in Kisumu, western Kenya, 2019.

BACKGROUND: Accurate data on HIV-related mortality are necessary to evaluate the impact of HIV interventions. In low- and middle-income countries (LMIC), mortality data obtained through civil registration are often of poor quality. Though not commonly conducted, mortuary surveillance is a potential complementary source of data on HIV-associated mortality. METHODS: During April-July 2019, we assessed HIV prevalence, the attributable fraction among the exposed, and the population attributable fraction among decedents received by two high-volume mortuaries in Kisumu County, Kenya, where HIV prevalence in the adult population was estimated at 18% in 2019 with high ART coverage (76%). Stillbirths were excluded. The two mortuaries receive 70% of deaths notified to the Kisumu East civil death registry; this registry captures 45% of deaths notified in Kisumu County. We conducted hospital chart reviews to determine the HIV status of decedents. Decedents without documented HIV status, including those dead on arrival, were tested using HIV antibody tests or polymerase chain reaction (PCR) consistent with national HIV testing guidelines. Decedents aged less than 15 years were defined as children. We estimated annual county deaths by applying weights that incorporated the study period, coverage of deaths, and mortality rates observed in the study. RESULTS: The two mortuaries received a total of 1,004 decedents during the study period, of which 95.1% (955/1004) were available for study; 89.1% (851/955) of available decedents were enrolled of whom 99.4% (846/851) had their HIV status available from medical records and post-mortem testing. The overall population-based, age- and sex-adjusted mortality rate was 12.4 per 1,000 population. The unadjusted HIV prevalence among decedents was 28.5% (95% confidence interval (CI): 25.5-31.6). The age- and sex-adjusted mortality rate in the HIV-infected population (40.7/1000 population) was four times higher than in the HIV-uninfected population (10.2/1000 population). Overall, the attributable fraction among the HIV-exposed was 0.71 (95% CI: 0.66-0.76) while the HIV population attributable fraction was 0.17 (95% CI: 0.14-0.20). In children the attributable fraction among the exposed and population attributable fraction were 0.92 (95% CI: 0.89-0.94) and 0.11 (95% CI: 0.08-0.15), respectively. CONCLUSIONS: Over one quarter (28.5%) of decedents received by high-volume mortuaries in western Kenya were HIV-positive; overall, HIV was considered the cause of death in 17% of the population (19% of adults and 11% of children). Despite substantial scale-up of HIV services, HIV disease remains a leading cause of death in western Kenya. Despite progress, increased efforts remain necessary to prevent and treat HIV infection and disease.

A rapidly deployed, interactive, online visualization system to support fatality management during the coronavirus disease 2019 (COVID-19) pandemic.

OBJECTIVE: To create an online visualization to support fatality management in North Carolina. MATERIALS AND METHODS: A web application aggregates online datasets for coronavirus disease 2019 (COVID-19) infection rates and morgue utilization. The data are visualized through an interactive, online dashboard. RESULTS: The web application was shared with state and local public health officials across North Carolina. Users could adjust interactive maps and other statistical charts to view live reports of metrics at multiple aggregation levels (eg, county or region). The application also provides access to detailed tabular data for individual facilities. DISCUSSION: Stakeholders found this tool helpful for providing situational awareness of capacity, hotspots, and utilization fluctuations. Timely reporting of facility and county data were key, and future work can help streamline the data collection process. There is potential to generalize the technology to other use cases. CONCLUSIONS: This dashboard facilitates fatality management by visualizing county and regional aggregate statistics in North Carolina.

Sexual homicides in South Africa: A national cross-sectional epidemiological study of adult women and children.

METHODS: We conducted a retrospective national mortuary based study to identify all adult female homicides (18 years and older) and all child homicides (boys and girls < 18 years) in 2009 in a randomly selected, proportionate sample of mortuaries. Victim, perpetrator and crime data were collected in three processes: from the mortuary register, the autopsy report and from police with the identification of sexual homicides validated across the data collection processes. FINDINGS: Among the 2670 (95% CI: 2311-2979) adult women killed in 2009, 494 (95% CI: 406-574) were identified as sexual homicides which was 19.8% (95% CI: 17.6-22.0) of all adult female homicides and among 1277 (95% CI: 1091-1462) children killed in SA, sexual homicides were found in 104 (95% CI: 77-132) of the child homicides which was 8.7% (95% CI: 10.9-11.2%) of these murders. Strangulation was the most common cause of death for both children and adult females. A distinct age and sex pattern was found among children with only 1% boy child death identified as a sexual homicide and 92% of all the child sexual homicides were among girls. Strangulation was the most common manner of death among children (35.5%) and perpetrators were seldom strangers. However, no difference in the proportion of convictions between the sexual homicides and non-sexual homicides were found for both adult females and children. CONCLUSION: Rape homicide is not a rare event in South Africa, with one in five female homicides and nearly one in ten child homicides identified with an associated sexual crime. These high prevalences are amongst the highest levels reported in the literature with our study among the few reporting on the epidemiology of child sexual homicide. Reducing mortality is an important policy goal for South Africa and for the rest of the world and the prevention of female and child homicide is an important part of attaining this goal.