Verification of Neonatal Tetanus Surveillance Systems in Katsina State, Nigeria.

BACKGROUND: The incidence and mortality rates of neonatal tetanus (NNT) remain underreported in Nigeria. The goal of the study was to compare the NNT prevalence and the mortality rates from the existing surveillance system and active surveillance of health facility records in 7 selected health facilities from 2010 to 2014 in Katsina State, Nigeria. METHODS: The study is a retrospective record review using extracted data from NNT records and analyzed using descriptive statistics. RESULTS: The prevalence of NNT and mortality rate were 336 cases and 3.4 deaths per 100 000 population, respectively, whereas the prevalence of NNT and mortality rate reported through the Integrated Disease Surveillance and Response (IDSR) system were 111 cases and 1.0 death per 100 000 population, respectively. CONCLUSION: The study shows underreporting of NNT in the existing IDSR system. IMPLICATIONS: Active surveillance is a good strategy for verifying underreporting of NNT in the surveillance system. The IDSR system should be strengthened with the capacity to detect events associated with a disease toward global elimination.

Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990-2013: findings from the Global Burden of Disease Study 2013.

OBJECTIVES: We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR). METHODS: The burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs). RESULTS: For musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3-1703.4) in 1990 to 1606.0 (95% UI 1141.2-2130.4) in 2013. During 1990-2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7-3.0) in 1990 to 4.7% (95% UI 3.6-5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2-136.0 for low back pain, 27.3-49.7 for neck pain, 9.7-37.3 for osteoarthritis (OA), 0.6-2.2 for rheumatoid arthritis and 0.1-0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries. CONCLUSIONS: This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness.

Predictors of Neonatal Tetanus Mortality in Katsina State, Northwestern Nigeria.

BACKGROUND: The mortality rate of neonatal tetanus (NNT) remains high in Nigeria. The study was guided by Mosley and Chen's model for the elements of child survival in developing countries. The goal of the study was to assess the associations between selected NNT risk factors, number of maternal tetanus toxoid injections, frequency of antenatal visits, place of delivery, and cord care with neonatal mortality as the outcome variable. METHODS: The study is a retrospective record review using data from 332 NNT records and analyzed using a logistic regression model. FINDINGS: Neonates whose mothers had 1 dose of tetanus toxoid vaccine were found to be 4% less prone to NNT mortality compared to neonates whose mothers did not have any dose of tetanus toxoid vaccine during pregnancy (P < .05, odds ratio = 4.12, 95% confidence interval = 1.04-16.29. Frequency of antenatal visits, place of delivery, and cord care were all not significant predictors of NNT mortality. CONCLUSION: The study shows that there is association between NNT risk factors and neonatal mortality, hence the need to further strengthen the NNT surveillance system for early detection of potential risk factors. This would help develop specific public health interventions aimed at improving the outcome of NNT. IMPLICATIONS: The identification and analysis of NNT mortality risk factors and promoting tetanus toxoid vaccination among pregnant women are effective strategies toward attaining NNT elimination goals in Nigeria.

Burden of Diarrhea in the Eastern Mediterranean Region, 1990-2013: Findings from the Global Burden of Disease Study 2013.

Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden.

Comparing Stage at Diagnosis Among Patients With Breast Cancer Served by Military and Civilian Medical Care Systems.

BACKGROUND: Breast cancer (BC) remains one of the top causes of cancer-related deaths in women in the United States, and little is known about the differences in access to health care between military and civilians. This study compared the differences in access to health care between military and civilian female patients with BC. In particular, this study examined whether patients with BC, in an equal access health care system such as the military, are diagnosed at an earlier stage of disease process in comparison to the patients with BC in the civilian health care system. METHODS: Independent variables included military versus civilian care and demographic variables. Dependent variable was the stage of cancer at diagnosis. This cross-sectional study of 2 groups included data from 2198 women with BC (439 military and 1759 civilian) for years 2004 through 2008. Multiple logistic regression was used to analyze the data. RESULTS: There was no difference in the early BC stage (0, I, and II) diagnosis prevalence rate between the military and the civilian groups (95% confidence interval [CI], P = .15). The logistic regression analysis indicated that both the health systems had equal performance with respect to the stage at diagnosis indicator but found that black patients had higher odds of being in the late stage (III and IV) BC group at diagnosis (1.62 OR, 1.14-2.30 CI, P = .0068) than white patients. CONCLUSIONS: Although no difference was found between the performance of the 2 health systems in the early (0, I, and II) versus late stage (III and IV) at diagnosis indicator, this study further confirms the existence of racial disparities in late-stage BC regardless of whether the patient was diagnosed in the civilian or military health system. More research is needed to further investigate the potential explanations of racial disparities other than just differences in access to health care.

Management of central venous catheters in patients with cancer and candidemia.

To determine the need and appropriate timing of catheter removal in patients with candidemia, the records for 404 patients with cancer and central venous catheters (CVCs) who developed candidemia during the period of 1993-1998 were retrospectively reviewed. Of the total 404 cases of candidemia, 241 (60%) were due to a primary source, 111 (27%) were catheter related, and 52 (13%) were secondary cases of candidemia caused by a source other than the catheter. Multivariate analysis showed that catheter removal < or =72 h after onset improved response to antifungal therapy exclusively in patients with catheter-related candidemia (P=.04). Clinical characteristics that suggested a noncatheter source for the candidemia were disseminated infection (P<.01), previous chemotherapy (P<.01), previous corticosteroid therapy (P=.02), and poor response to antifungal therapy (P<.03). CVC removal < or =72 h after onset should be considered in patients with suspected catheter-related candidemia who have no evidence of dissemination, recent corticosteroid therapy, or chemotherapy.