Association of greenness with COVID-19 deaths in India: An ecological study at district level.

BACKGROUND: The world has witnessed a colossal death toll due to the novel coronavirus disease-2019 (COVID-19). A few environmental epidemiology studies have identified association of environmental factors (air pollution, greenness, temperature, etc.) with COVID-19 incidence and mortality, particularly in developed countries. India, being one of the most severely affected countries by the pandemic, still has a dearth of research exploring the linkages of environment and COVID-19 pandemic. OBJECTIVES: We evaluate whether district-level greenness exposure is associated with a reduced risk of COVID-19 deaths in India. METHODS: We used average normalized difference vegetation index (NDVI) from January to March 2019, derived by Oceansat-2 satellite, to represent district-level greenness exposure. COVID-19 death counts were obtained through May 1, 2021 (around the peak of the second wave) from an open portal: covid19india.org. We used hierarchical generalized negative binomial regressions to check the associations of greenness with COVID-19 death counts. Analyses were adjusted for air pollution (PM2.5), temperature, rainfall, population density, proportion of older adults (50 years and above), sex ratio over age 50, proportions of rural population, household overcrowding, materially deprived households, health facilities, and secondary school education. RESULTS: Our analyses found a significant association between greenness and reduced risk of COVID-19 deaths. Compared to the districts with the lowest NDVI (quintile 1), districts within quintiles 3, 4, and 5 have respectively, around 32% [MRR = 0.68 (95% CI: 0.51, 0.88)], 39% [MRR = 0.61 (95% CI: 0.46, 0.80)], and 47% [MRR = 0.53 (95% CI: 0.40, 0.71)] reduced risk of COVID-19 deaths. The association remains consistent for analyses restricted to districts with a rather good overall death registration (>80%). CONCLUSION: Though cause-of-death statistics are limited, we confirm that exposure to greenness was associated with reduced district-level COVID-19 deaths in India. However, material deprivation and air pollution modify this association.

Errors in reported ages and dates in surveys of adult mortality: A record linkage study in Niakhar (Senegal).

Sibling survival histories are a major source of adult mortality estimates in countries with incomplete death registration. We evaluate age and date reporting errors in sibling histories collected during a validation study in the Niakhar Health and Demographic Surveillance System (Senegal). Participants were randomly assigned to either the Demographic and Health Survey questionnaire or a questionnaire incorporating an event history calendar, recall cues, and increased probing strategies. We linked 60-62 per cent of survey reports of siblings to the reference database using manual and probabilistic approaches. Both questionnaires showed high sensitivity (>96 per cent) and specificity (>97 per cent) in recording siblings' vital status. Respondents underestimated the age of living siblings, and age at and time since death of deceased siblings. These reporting errors introduced downward biases in mortality estimates. The revised questionnaire improved reporting of age of living siblings but not of age at or timing of deaths.

A comparative analysis of disability measures in Cameroonian surveys.

BACKGROUND: Although identifying vulnerable groups is an important step in shaping appropriate and efficient policies for targeting populations of disabled people, it remains a challenge. This study aims to evaluate for the first time the comparability of the different disability measurements used in Cameroon. This is done by comparing them with the international standards proposed by the Washington Group (WG). It also evaluates the consistency of the association between the disability as measured by these surveys and the sociodemographic characteristics. METHOD: We used data from the third Cameroonian Population and Housing Census (3RGPH) of 2005, the third Cameroonian Household survey (ECAM3) of 2007, the Demographic Health and Multiple Indicator Cluster Survey (DHS-MICS) of 2011 and a survey conducted on adults in Yaoundé (HandiVIH) in 2015 with the WG tool. The proportion and their confidence intervals, chi-square tests and multivariate logistic regressions are used for analyses. RESULTS: In the city of Yaoundé and for the 15-49 age group, disability prevalence was estimated at 3.6% (CI = [2.5, 5.1]), 2.7% CI = [2.1, 3.5]), 2.6% (CI = [2.4, 2.7]) and 1.0% (CI = [1.0, 1.10]), according to DHS-MICS, ECAM3, HandiVIH and 3RGPH, respectively. The prevalence of severe motor and mental disabilities in DHS-MICS (0.4% CI = [0.2, 0.8], 1.1% CI = [0.7, 1.8] and 0.5% CI = [0.2, 1.1], respectively) are not significantly different from the findings of HandiVIH (0.3% CI = [0.2, 0.3], 0.8% CI = [0.7, 0.9] and 0.5% CI = [0.5, 0.6], respectively). Only motor disability prevalence in ECAM3 (0.8%, CI = [0.5, 1.2]) is not different from that of HandiVIH. When the WG screening tool is used in HandiVIH, disability is positively associated with age, negatively associated with educational level, being in a union and socioeconomic status (SES) and it is not associated with sex. Severe disability, for its part, is not associated with SES and is positively associated with being a male. A different association trend is observed with 3RGPH, ECAM3 and DHS-MICS. CONCLUSION: None of the instruments used in the nationally representative Cameroonian surveys produced both disability prevalence and association trends that are exactly similar to those obtained when using the WG disability screening tool, thus highlighting the necessity to include the WG questions in nationally representative surveys.

Returning home to die or leaving home to seek health care? Location of death of urban and rural residents in Burkina Faso and Senegal.

BACKGROUND: In sub-Saharan Africa, the literature on end of life is limited and focuses on place of death as an indicator of access and utilization of health-care resources. Little is known about population mobility at the end of life. OBJECTIVE: To document the magnitude, motivations and associated factors of short-term mobility before death among adults over 15 years of age in Burkina Faso and Senegal. METHODS: The study was based on deaths of adult residents reported in three Health and Demographic Surveillance System (HDSS) sites in urban (Ouagadougou) and semi-rural areas (Kaya) of Burkina Faso, and rural areas of Senegal (Mlomp). After excluding deaths from external causes, the analysis covered, respectively, 536 and 695 deaths recorded during the period 2012-2015 in Ouagadougou and Kaya. The period was extended to 2000-2015 in Mlomp, with a sample of 708 deaths. Binary logistic regressions were used to examine the effects of socio-demographic characteristics on place of death (health facility or not) and location of death (within or outside the HDSS). RESULTS: In Mlomp, Kaya and Ouagadougou, respectively 20.6%, 5.3% and 5.9% of adults died outside the HDSS site. In Mlomp and Kaya, these deaths were more likely to occur in a health facility than deaths that occurred within the site. The reverse situation was found in Ouagadougou. Age is the strongest determinant of mobility before death in Mlomp and Kaya. In Mlomp, young adults (15-39) were 10 times more likely to die outside the site than adults in the 60-79 age group. In Ouagadougou, non-natives were three times more likely to die outside the city than natives. CONCLUSIONS: At the end of life, some rural residents move to urban areas for medical treatment while some urban dwellers return to their village for supportive care. These movements of dying individuals may affect the estimation of urban/rural mortality differentials.

Adult mortality patterns in the former Soviet Union's southern tier: Armenia and Georgia in comparative perspective.

BACKGROUND: While the health crisis in the former USSR has been well-documented in the case of Russia and other northern former Soviet republics, little is known about countries located in the southern tier of the region, i.e., the Caucasus and Central Asia. OBJECTIVE: This paper presents new mortality information from two Caucasian countries, Georgia and Armenia. Results are compared with information from two relevant countries previously examined in the literature, Kyrgyzstan and Russia. METHODS: Using official statistics (with adjustments when necessary), we compare adult mortality patterns in the four countries since 1979, for all causes and by cause for the recent period. For Kyrgyzstan results are presented by ethnicity, as its mortality levels have been impacted by its large Slavic population. RESULTS: Adult mortality patterns in Armenia and Georgia have been more favorable than in Russia. This appears to be due to a large extent to lower mortality from alcohol-related causes. Mortality patterns in these Caucasian republics resemble those observed in Kyrgyzstan, especially when considering the native portion of the population. CONCLUSIONS: As far as mortality is concerned, Armenia and Georgia have weathered the collapse of the Soviet Union better than Russia. These results document a distinct southern tier pattern of adult mortality in the former Soviet Union. CONTRIBUTION: This article enriches our understanding of the health crisis in the former Soviet Union by bringing new information from two lesser-known countries and further documenting the scale of heterogeneity in mortality experiences across this vast region.

Mental health and urban living in sub-Saharan Africa: major depressive episodes among the urban poor in Ouagadougou, Burkina Faso.

BACKGROUND: In sub-Saharan African cities, the epidemiological transition has shifted a greater proportion of the burden of non-communicable diseases, including mental and behavioral disorder, to the adult population. The burden of major depressive disorder and its social risk factors in the urban sub-Saharan African population are not well understood and estimates vary widely. We conducted a study in Ouagadougou, Burkina Faso, in order to estimate the prevalence of major depressive episodes among adults in this urban setting. METHODS: The Ouagadougou Health and Demographic System Site (HDSS) has followed the inhabitants of five outlying neighborhoods of the city since 2008. In 2010, a representative sample of 2,187 adults (aged 15 and over) from the Ouaga HDSS was interviewed in depth regarding their physical and mental health. Using criteria from the Mini International Neuropsychiatric Interview (MINI), we identified the prevalence of a major depressive episode at the time of the interview among respondents and analyzed its association with demographic, socioeconomic, and health characteristics through a multivariate analysis. RESULTS: Major depressive episode prevalence was 4.3 % (95 % CI: 3.1-5.5 %) among the survey respondents. We found a strong association between major depressive episode and reported chronic health problems, functional limitations, ethnicity and religion, household food shortages, having been recently a victim of physical violence and regularly drinking alcohol. Results show a U-shaped association of the relationship between major depressive episode and standard of living, with individuals in both the poorest and richest groups most likely to suffer from major depressive disorder than those in the middle. Though, the poorest group remains the most vulnerable one, even when controlling by health characteristics. CONCLUSIONS: Major depressive disorder is a reality for many urban residents in Burkina Faso and likely urbanites throughout sub-Saharan Africa. Countries in the region should incorporate aspects of mental health prevention and treatment as part of overall approaches to improving health among the region's growing urban populations.

Improving survey data on pregnancy-related deaths in low-and middle-income countries: a validation study in Senegal.

OBJECTIVE: In low- and middle-income countries (LMICs), siblings' survival histories (SSH) are often used to estimate maternal mortality, but SSH data on causes of death at reproductive ages have seldom been validated. We compared the accuracy of two SSH instruments: the standard questionnaire used during the demographic and health surveys (DHS) and the siblings' survival calendar (SSC), a new questionnaire designed to improve survey reports of deaths among women of reproductive ages. METHODS: We recruited 1189 respondents in a SSH survey in Niakhar, Senegal. Mortality records from a health and demographic surveillance system (HDSS) constituted the reference data set. Respondents were randomly assigned to an interview with the DHS or SSC questionnaires. A total of 164 respondents had a sister who died at reproductive ages over the past 15 years before the survey according to the HDSS. RESULTS: The DHS questionnaire led to selective omissions of deaths: DHS respondents were significantly more likely to report their sister's death if she had died of pregnancy-related causes than if she had died of other causes (96.4% vs. 70.9%, P < 0.007). Among reported deaths, both questionnaires had high sensitivity (>90%) in recording pregnancy-related deaths. But the DHS questionnaire had significantly lower specificity than the SSC (79.5% vs. 95.0%, P = 0.015). The DHS questionnaire overestimated the proportion of deaths due to pregnancy-related causes, whereas the SSC yielded unbiased estimates of this parameter. CONCLUSION: Statistical models informed by SSH data collected using the DHS questionnaire might exaggerate maternal mortality in Senegal and similar settings. A new questionnaire, the SSC, could permit better tracking progress towards the reduction in maternal mortality.

Non-Communicable Disease Mortality and Risk Factors in Formal and Informal Neighborhoods, Ouagadougou, Burkina Faso: Evidence from a Health and Demographic Surveillance System.

The expected growth in NCDs in cities is one of the most important health challenges of the coming decades in Sub-Saharan countries. This paper aims to fill the gap in our understanding of socio-economic differentials in NCD mortality and risk in low and middle income neighborhoods in urban Africa. We use data collected in the Ouagadougou Health and Demographic Surveillance System. 409 deaths were recorded between 2009-2011 among 20,836 individuals aged 35 years and older; verbal autopsies and the InterVA program were used to determine the probable cause of death. A random survey asked in 2011 1,039 adults aged 35 and over about tobacco use, heavy alcohol consumption, lack of physical activity and measured their weight, height, and blood pressure. These data reveal a high level of premature mortality due to NCDs in all neighborhoods: NCD mortality increases substantially by age 50. NCD mortality is greater in formal neighborhoods, while adult communicable disease mortality remains high, especially in informal neighborhoods. There is a high prevalence of risk factors for NCDs in the studied neighborhoods, with over one-fourth of the adults being overweight and over one-fourth having hypertension. Better-off residents are more prone to physical inactivity and excessive weight, while vulnerable populations such as widows/divorced individuals and migrants suffer more from higher blood pressure. Females have a significantly lower risk of being smokers or heavy drinkers, while they are more likely to be physically inactive or overweight, especially when married. Muslim individuals are less likely to be smokers or heavy drinkers, but have a higher blood pressure. Everything else being constant, individuals living in formal neighborhoods are more often overweight. The data presented make clear the pressing need to develop effective programs to reduce NCD risk across all types of neighborhoods in African cities, and suggest several entry points for community-based prevention programs.

Improving the quality of adult mortality data collected in demographic surveys: validation study of a new siblings' survival questionnaire in Niakhar, Senegal.

BACKGROUND: In countries with limited vital registration, adult mortality is frequently estimated using siblings' survival histories (SSHs) collected during Demographic and Health Surveys (DHS). These data are affected by reporting errors. We developed a new SSH questionnaire, the siblings' survival calendar (SSC). It incorporates supplementary interviewing techniques to limit omissions of siblings and uses an event history calendar to improve reports of dates and ages. We hypothesized that the SSC would improve the quality of adult mortality data. METHODS AND FINDINGS: We conducted a retrospective validation study among the population of the Niakhar Health and Demographic Surveillance System in Senegal. We randomly assigned men and women aged 15-59 y to an interview with either the DHS questionnaire or the SSC. We compared SSHs collected in each group to prospective data on adult mortality collected in Niakhar. The SSC reduced respondents' tendency to round reports of dates and ages to the nearest multiple of five or ten ("heaping"). The SSC also had higher sensitivity in recording adult female deaths: among respondents whose sister(s) had died at an adult age in the past 15 y, 89.6% reported an adult female death during SSC interviews versus 75.6% in DHS interviews (p = 0.027). The specificity of the SSC was similar to that of the DHS questionnaire, i.e., it did not increase the number of false reports of deaths. However, the SSC did not improve the reporting of adult deaths among the brothers of respondents. Study limitations include sample selectivity, limited external validity, and multiple testing. CONCLUSIONS: The SSC has the potential to collect more accurate SSHs than the questionnaire used in DHS. Further research is needed to assess the effects of the SSC on estimates of adult mortality rates. Additional validation studies should be conducted in different social and epidemiological settings. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN06849961

Reporting errors in siblings' survival histories and their impact on adult mortality estimates: results from a record linkage study in Senegal.

Estimates of adult mortality in countries with limited vital registration (e.g., sub-Saharan Africa) are often derived from information about the survival of a respondent's siblings. We evaluated the completeness and accuracy of such data through a record linkage study conducted in Bandafassi, located in southeastern Senegal. We linked at the individual level retrospective siblings' survival histories (SSH) reported by female respondents (n = 268) to prospective mortality data and genealogies collected through a health and demographic surveillance system (HDSS). Respondents often reported inaccurate lists of siblings. Additions to these lists were uncommon, but omissions were frequent: respondents omitted 3.8 % of their live sisters, 9.1 % of their deceased sisters, and 16.6 % of their sisters who had migrated out of the DSS area. Respondents underestimated the age at death of the siblings they reported during the interview, particularly among siblings who had died at older ages (≥45 years). Restricting SSH data to person-years and events having occurred during a recent reference period reduced list errors but not age and date errors. Overall, SSH data led to a 20 % underestimate of 45 q 15 relative to HDSS data. Our study suggests new quality improvement strategies for SSH data and demonstrates the potential use of HDSS data for the validation of "unconventional" demographic techniques.

Suicide among male prisoners in France: a prospective population-based study.

BACKGROUND: Suicide rates are high among prisoners but little is known about the precise weight of each risk factor. METHODS: We collected data on the periods of imprisonment of all adult males incarcerated in France between 1 January, 2006 and 15 July, 2009. We used survival analyses from the incarceration to its end, censored by the observation period. We calculated suicide rates and performed a Cox model to assess the link between prisoners' imprisonment characteristics and suicide risk. RESULTS: Overall, 301,611 periods of imprisonment were observed and 353 suicides were recorded. The suicide rate was 17.9 suicides per 10,000 person-years (95% CI: 16.1-19.9). The hazard ratio (HR) of suicide risk was high for placements in a disciplinary cell (15.7, 95% CI: 10.6-23.5) and varied depending on the main offence (homicide: 7.6, 95% CI: 5.3-10.9, rape: 4.6, 95% CI: 3.2-6.6, other sexual assault: 2.9, 95% CI: 1.9-4.6, other violent offence: 2.1, 95% CI: 1.5-2.8, compared with other offences). HR was lower when visits from relatives were observed (0.4, 95% CI: 0.3-0.5) and higher if a hospitalization was observed (1.6, 95% CI: 1.3-2.0). After conviction, HR halved with respect to the remand period, but there was no difference by sentence length. HR was higher if incarceration occurred after age 30 (1.4, 95% CI: 1.1-1.7). Foreigners tended to have lower risks than French prisoners, with the exception of those incarcerated for rape. CONCLUSIONS: The suicide rate in prison is generally much higher than in the general population. This study has replicated previous international findings, highlighting the impact of the type of offence on suicide risk. Suicide prevention programmes must consider the high risk associated with incarceration for a criminal offence against a person. With regard to the impact of visits from relatives and placements in a disciplinary cell, further work should be conducted from a psychological perspective to examine the effects of physical and social isolation.

Misclassification of pregnancy-related deaths in adult mortality surveys: case study in Senegal.

OBJECTIVE: In countries with limited vital registration data, maternal mortality levels are often estimated using siblings' survival histories (SSH) collected during retrospective adult mortality surveys. We explored how accurately adult deaths can be classified as pregnancy related using such data. METHOD: The study was conducted in a rural area of south-eastern Senegal with high maternal mortality, Bandafassi. We used data from a demographic surveillance system (DSS) in this area to identify deaths of women at reproductive ages between 2003 and 2009 and to locate the surviving adult sisters of the deceased and interview them. Siblings' survival histories were linked at the individual level to death records, and verbal autopsy data obtained by the demographic surveillance system. We compared the classification of adult female deaths as pregnancy related or not in interviews and DSS records. RESULTS: There were 91 deaths at reproductive ages in the Bandafassi DSS between 2003 and 2009, but only 59 had known surviving sisters. Some deaths were omitted by respondents, or reported as alive or as having occurred during childhood (n = 8). Among deaths reported both in the SSH and DSS data, 94% of deaths classified as pregnancy related in the DSS data were also classified as such by siblings' survival histories. Only 70% of deaths classified as not pregnancy related in the DSS data were also classified as such by siblings' survival histories. CONCLUSION: Misclassifications of pregnancy-related deaths in retrospective adult mortality surveys may affect estimates of pregnancy-related mortality rates.

No improvement in weight-for-age of young children in southern Senegal, 1969-1992, despite a drastic reduction in mortality. Evidence from a growth monitoring programme.

BACKGROUND: Undernutrition is associated with an increased risk of death among young children in developing countries. Infant and child nutritional status and mortality were monitored in a rural area of Casamance, Senegal. METHODS: Analysis of weight measurements taken at 3-24 months of age during routine growth monitoring in the community's private dispensary 1969-1992 (3912 children, 4642 child-years) and of mortality rates of children estimated from maternal recall for 1960-1985 and yearly census 1985-1995. RESULTS: Between 1960-1964 and 1990-1994, under-5 and child (1-4 years) mortality rates decreased from 312 to 127 and from 201 to 68 per 1000, respectively. About 90% of resident children attended growth monitoring in 1985-1992. Mean weight-for-age was at a minimum at 15 months of age (-1.60 z-scores [SD: 0.95]); the prevalence of underweight was 33.2% (95% CI: 31.5, 34.9). The latter increased significantly over time, both when comparing all years of follow-up (P for trend <0.01) and over three pre-defined time periods (28.6, 34.6, and 35.0% in 1969-1974, 1975-1984, and 1985-1992, respectively, P for trend <0.05). Mean weight-for-age decreased over time in infancy and in the second year of life. CONCLUSION: No improvement in nutritional status was found among young children 1969-1992 despite a drastic decrease in mortality. Focused public health interventions such as vaccinations and malaria prevention probably did not enhance weight-for-age. Paradoxically, growth monitoring may have been more helpful in improving health than growth.