Individual and Systemic Factors of Under-five Mortality in Nigeria:A Cox Proportional Hazard Model

Despite considerable efforts to reduce under-five mortality nationwide,Nigeria has fallen short of achieving the Millennium Development Goals(MDGs)target of 67 deaths per 1,000 live births by 2015.Of all the documented factors of under-five mortality,little evidence exists on the impact of systemic barriers and individual factors(maternal health-seeking behaviour)on under-five mortality in Nigeria.The study used a nationally representative sample from Nigeria Demographic and Health Survey(NDHS)2013 dataset.The target population was 20,192 women aged 15-59 years who had given birth to 31,480 children five years before the survey.Stata software was used for data analysis.The risk of death was estimated using Cox proportional hazard models and results are presented as hazards ratios(HR)with 95%confidence intervals(CI).Findings from the overall Model I-IV revealed individual factors(maternal health-seeking indicators)as significant factors of under-five deaths(p<0.05).Children whose mothers received antenatal care coverage(ANC)outside health care facilities(HCF)(HR:1.60,CI:1.0-2.4,p<0.05);or delivered outside HCF(HR:1.02,CI:0.7-1.5,p<0.05)had elevated hazard risk of death before age five.Conversely,children who were presented for postnatal check within two weeks of delivery(HR:0.60,CI:0.5-0.8,p<0.05),or delivered within the longer birth interval(HR:0.67,CI:0.6-0.8,p<0.001)had significantly lower hazard risk of death before age five.As part of systemic factors,children whose mothers were covered by health insurance scheme had significantly(HR:0.52,CI:0.2-1.2,p<0.001)lower risk of death when compared with their counterparts without health insurance coverage.The study emphasized the need to revitalize strategies and programs to improve women health seeking behaviour and investment in the health sector through health insurance,infrastructure,and supplies.

Infant and Under-five Mortality in Bangladesh: Discriminant Analysis

Bangladesh is on target for achieving the Millennium Development Goal 4 relating to infant and under-five mortality because of very rapid reduction in mortality in recent years. But this rate of reduction may be difficult to sustain and may hamper the achievement of Millennium Development Goal 4. Therefore, the main objective of this paper is to discuss and compare the dif- ferent covariates of infant and under-five mortality in the context of overall country, urban and rural levels of Bangladesh using discriminant analysis. For this, the data are taken from Bangladesh Demographic and Health Survey, 2004. In discriminant analysis, the stepwise procedure has been picked up and only the significant variables are ranked according to the rank of Wilk's Lambda val- ues. The canonical discriminant function coefficients (unstandard- ized and standardized) for the predictor variables have also been calculated. Both the results show that breastfeeding is the most important variable in discriminating the two groups of mothers, i.e., mothers experiencing to infant mortality or not and mothers experiencing to under-five mortality or not. The related results of discriminant function also indicate that the discriminant func- tion is statistically significant and discriminates well. Therefore, improvements in the health system are essential for promoting the breastfeeding practices (both inclusive and exclusive), which may be the effective strategies to reach families and communities with targeted messages and information.

Housing Correlates of Under-Five Mortality in Urban Ethiopia

Little studies and analysis have been undertaken to investigate the housing determinants of under-five mortality in Ethiopia. This study, therefore, explores the impacts of urban housing variables on the levels and patterns of under-five mortality in the country based on the SPSS （Statistic Package for Social Science） file of the 2005 Ethiopian Demographic and Health Survey （EDHS）. This survey covered a sample of about 4,420 households/housing units of urban Ethiopia. The under-five deaths are computed for women in the age group 15-49 by subtracting the number of children living from children ever born （CEB） and established the proportion dead by dividing deaths by CEB corresponding to the categorical variables of housing structure, facilities, and household durables. The analytical techniques of the study included univariate, bivariate, and multivariate data analysis of the proportional variations of childhood mortality patterns being manifested by ＂bar graphs＂ with respect to housing situations as well as household durables. Amongst the categorical variables of the housing structures, facilities, and household durables with the highest no prevalence of under-five mortality levels are found to be the units of unconventional walls, thatched/leaf/reed roofing, animal dung flooring, shared pit latrine/use of bucket/bush, using kerosene, firewood/straw/charcoal for cooking, unconventional lighting, unprotected water supply, households with no durables.

Social determinants of under-five mortality in Ethiopia: Event history analysis using evidence from Ethiopian Demographic and Health Survey (EDHS)

Background: Under-five mortality is one of the indicators of the millennium development goals (MDGs) for the child mortality reduction goal. Understanding the social determinants of under-five mortality is helpful to narrow the gap between different social classes. Therefore, this study focused on the social determinants of under-five mortality inEthiopiausing EDHS 2011 data. Methods: The data source for this analysis was the 2011 EDHS which was undertaken over a five-month period from 27 December, 2010 to 3 June, 2011. The sample was selected using a stratified, two-stage cluster design. Samples of 16,515 women of reproductive age were interviewed. The questionnaire used to collect information from these women who?had among other things such as?background characteristics of women, birth history of these women and the survival of each birth at the time of the interview. Births that had occurred to women in the last 10 years prior to the date of the?interview were extracted for the analysis. Descriptive statistical methods were used to describe the distribution of the characteristics of the data. Kaplan Meier plots and incidence rates per 1000 person years were used to compare survival across different categories of the risk factors. The effect of the risk factors on survival was analyzed using Cox proportional hazards regression. Data management and analysis were carried out using STATA 10. Results: A total of 23,581 under-five children were included in the study. The under-five mortality incidence rate in Ethiopia for the last ten years was 29.6 per 1000 person years. Maternal education beyond primary level of education reduced the risk of under-five mortality by about half. A significant reduction in risk of under-five mortality was observed among births to mothers residing in richest households. The hazard ratio (HR) was higher for under-five mortality among boys than daughters, twins than singleton, teen age mother than higher ages and short births than optimal. Conclusions: Empowering mothers with education and making them productive for improving their income are important aspects for reducing under-five mortality. Emerging regions were disadvantaged on the incidence of under-five mortality;however, there was a positive result in narrowing the urban-rural under-five mortality risks. Being teenage mother at birth, short birth interval and twin births were identified risk factors for increased under-five mortality in Ethiopia. Interventions targeted at empowering women and much effort in emerging regions are required. Preventing teenage motherhood and promoting optimal birth spacing are also required to reduce under-five mortality in Ethiopia.

Determinants of Under-Five Mortality in Bangladesh

This paper examines determinants of under-five mortality in Bangladesh. The study utilizes the data extracted from the 2007 Bangladesh demographic and health survey. Chi-square test for independence and multivariate proportional hazard analysis reflects that father’s education, place of residence, region of residence, number of children under five years of age, previous death of sibling, mother’s age and breastfeeding have significant influence on under-five mortality. The proximate determinants are found to have stronger influence on under-five mortality than the socioeconomic factors considered in the study do.

Nutrition impacts of non-solid cooking fuel adoption on under-five children in developing countries

This paper examines the nutrition impacts of using non-solid cooking fuel on under-five children in developing countries.We draw on data from more than 1.12 million children in 62 developing countries from the Demographic and Health Surveys(DHS).Results from both fixed effects(FE)and instrumental variable(IV)estimates show that using non-solid cooking fuel significantly improves the nutrition outcomes of under-five children.Compared with their peers from households mainly using solid fuel,children from households mainly using non-solid fuel exhibit a lower probability of experiencing stunting(by 5.9 percentage points)and being underweight(by 1.2 percentage points).Our further investigation provides evidence for several underlying mechanisms,such as improved indoor air quality,induced reduction in children’s respiratory symptoms,benefits on maternal health,and reduction in maternal time spent on fuel collection or cooking.Heterogenous analyses suggest that the nutrition benefits of using non-solid cooking fuel are more prominent among boys,children above three years old,and those from households of lower socioeconomic status,rural areas,and Southeast Asia.

Multimorbidity and mortality among older patients with coronary heart disease in Shenzhen,China

BACKGROUND The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease(CHD)is insufficient.We aimed to assess the association and population-attributable fractions(PAFs)between multimorbidity and mortality among hospitalized older patients who were diagnosed with CHD in Shenzhen,China.METHODS We conducted a retrospective cohort study of older Chinese patients(aged≥65 years)who were diagnosed with CHD.Cox proportional hazards models were used to estimate the associations between multimorbidity and all-cause and cardiovascular disease(CVD)mortality.We also calculated the PAFs.RESULTS The study comprised 76,455 older hospitalized patients who were diagnosed with CHD between January 1,2016,and August 31,2022.Among them,70,217(91.9%)had multimorbidity,defined as the presence of at least one of the predefined 14 chronic conditions.Those with cancer,hemorrhagic stroke and chronic liver disease had the worst overall death risk,with adjusted HRs(95%CIs)of 4.05(3.77,4.38),2.22(1.94,2.53),and 1.85(1.63,2.11),respectively.For CVD mortality,the highest risk was observed for hemorrhagic stroke,ischemic stroke,and chronic kidney disease;the corresponding adjusted HRs(95%CIs)were 3.24(2.77,3.79),1.91(1.79,2.04),and 1.81(1.64,1.99),respectively.All-cause mortality was mostly attributable to cancer,heart failure and ischemic stroke,with PAFs of 11.8,10.2,and 9.1,respectively.As for CVD mortality,the leading PAFs were heart failure,ischemic stroke and diabetes;the corresponding PAFs were 18.0,15.7,and 6.1,respectively.CONCLUSIONS Multimorbidity was common and had a significant impact on mortality among older patients with CHD in Shenzhen,China.Cancer,heart failure,ischemic stroke and diabetes are the primary contributors to PAFs.Therefore,prioritizing improved treatment and management of these comorbidities is essential for the survival prognosis of CHD patients from a holistic public health perspective.

The association of diet quality and physical activity with cardiovascular disease and mortality in 85,545 older Australians:A longitudinal study

Background:A quality diet and an active lifestyle are both important cornerstones of cardiovascular disease(CVD)prevention.However,despite their interlinked effects on metabolic health,the 2 behaviors are rarely considered jointly,particularly within the context of CVD prevention.We examined the independent,interactive,and joint associations of diet and physical activity with CVD hospitalization,CVD mortality,and all-cause mortality.Methods:CVD-free Australian participants aged 4574 years(n=85,545)reported physical activity,diet,sociodemographic,and lifestyle characteristics at baseline(20062009)and follow-up(20122015),and data were linked to hospitalization and death registries(03/31/2019 for CVD hospitalization and all-cause mortality and 12/08/2017 for CVD mortality).Diet quality was categorized as low,medium,and high based on meeting dietary recommendations.Physical activity was operationalized as(a)total moderate-to-vigorous physical activity(MVPA)as per guidelines,and(b)the composition of MVPA as the ratio of vigorous-intensity physical activity(VPA)to total MVPA.We used a left-truncated cause-specific Cox proportional hazards model using time-varying covariates.Results:During a median of 10.7 years of follow-up,6576 participants were admitted to the hospital for CVD and 6581 died from all causes(876 from CVD during 9.3 years).A high-quality diet was associated with a 17%lower risk of all-cause mortality than a low-quality diet,and the highest MVPA category(compared with the lowest)was associated with a 44%and 48%lower risk of CVD and all-cause mortality,respectively.Multiplicative interactions between diet and physical activity were non-significant.For all outcomes,the lowest risk combinations involved a high-quality diet and the highest MVPA categories.Accounting for total MVPA,some VPA was associated with further risk reduction of CVD hospitalization and all-cause mortality.Conclusion:For CVD prevention and longevity,one should adhere to both a healthy diet and an active lifestyle and incorporate some VPA when possible.

Iron and ferritin effects on intensive care unit mortality:A metaanalysis

BACKGROUND The effect of serum iron or ferritin parameters on mortality among critically ill patients is not well characterized.AIM To determine the association between serum iron or ferritin parameters and mortality among critically ill patients.METHODS Web of Science,Embase,PubMed,and Cochrane Library databases were searched for studies on serum iron or ferritin parameters and mortality among critically ill patients.Two reviewers independently assessed,selected,and abstracted data from studies reporting on serum iron or ferritin parameters and mortality among critically ill patients.Data on serum iron or ferritin levels,mortality,and demographics were extracted.RESULTS Nineteen studies comprising 125490 patients were eligible for inclusion.We observed a slight negative effect of serum ferritin on mortality in the United States population[relative risk(RR)1.002;95%CI:1.002-1.004].In patients with sepsis,serum iron had a significant negative effect on mortality(RR=1.567;95%CI:1.208-1.925).CONCLUSION This systematic review presents evidence of a negative correlation between serum iron levels and mortality among patients with sepsis.Furthermore,it reveals a minor yet adverse impact of serum ferritin on mortality among the United States population.

Mortality from Stroke in Young People in Brazzaville

Introduction: Cerebrovascular accidents (CVA) are an absolute neurovascular emergency and the main cause of mortality and acquired disability in adults. In the Congo, stroke is the leading cause of mortality and the leading cardiovascular emergency, with a hospital frequency of between 49.74% and 56.2%. The aim of the study was to identify the mortality factors associated with stroke in young people in Brazzaville. Patients and Methods: This is a longitudinal analytical study conducted from February to period from February to September 2019 in the neurology, general intensive care and medical emergency departments of the Brazzaville University Hospital (CHUB). All subjects aged 18 - 55 years of completed age, admitted for arterial stroke confirmed by brain imaging, were included. Study variables were: age, gender, socioeconomic level, laterality, time to admission and CT scan, vascular risk factors, history of cardiomyopathy, atrial fibrillation, TIA (transient ischemic attack) or stroke, NIHSS (National Institutes of Health Stroke Scale) score, Glasgow score, blood pressure, temperature, heart rate, occurrence or non-occurrence of complications, blood glucose, creatinine, lipid profile and blood count. Data were analyzed using SPSS 21 software. Descriptive analyses were performed using SPSS 21 software. Results: 103 patients were included in the study, of whom 45 (43.7%) had ischemic stroke and 58 (56.3%) with hemorrhagic stroke. Mortality was high at 29.1% in our study, and mainly concerned hemorrhagic strokes (73.7%). Two-week mortality in our study accounted for 63.33% of total lethality. After simple logistic regression, the factors associated with death within two weeks were age between 40 - 44 years (OR (odds ratio) = 2.95;p = 0.01), hemorrhagic stroke (OR = 1.41;p = 0.07), mass effect (OR = 3.26;p < 0.01), ventricular flooding (OR = 2.86;p < 0.001), Glasgow score (OR = 2.95 (0.92 - 9.43);p = 0.06), NIHSS score on admission > 15 (OR = 5.89 (2.90 - 11.95);p < 0.001) and bronchopulmonary infection (OR = 30, 95 (4.04 - 236.88), p < 0.001). From multivariate logistic regression, only NIHSS score on admission > 15 emerged as a predictor of death within two weeks (OR = 5.89 (2.90 - 11.95);p Conclusion: This study confirms the basic data of the African literature concerning stroke, as several factors were identified as independent factors associated with mortality.

Epidemiology of Cardiovascular Mortality in Patients under 60 Years Old in a Cardiology Department in West Africa, Dakar-Senegal

Background: Our study aimed to examine cardiovascular mortality within the working-age population, exploring epidemiological, clinical, and paraclinical features, complications, and identifying etiological factors linked to mortality. Methods: We conducted a descriptive and analytical retrospective study from September 2019 to August 2022 at the General Hospital Idrissa POUYE in Dakar, we reviewed all the medical records of patients from 15 to 60 years old who died while admitted in the cardiology department. Data collected were socioeconomic status, clinical history, type of cardiovascular disaese, length of hospitalization, circumstances and timing of death. The data were analyzed with R. Studio version 2022.12.0 + 353 and Excel 2019, with a P-value Results: The study included 73 patients, indicating a specific mortality rate of 8.8% and a proportional mortality of 39%. Predominantly male (sex ratio 1.2), the average age was 44. Key cardiovascular risk factors identified were sedentarism (76.7%), hypertension (28.8%), and smoking (21.9%). The leading cause for consultation was dyspnea (72.6%). Notable findings included a majority of patients presenting with general condition deterioration (90%) and cardiovascular collapse upon admission (23.3%). Physical exam revealed signs of heart failure in 63%. Echocardiography showed left ventricular ejection fraction impairment (81%) and pulmonary hypertension (78%). Immediate causes of death were primarily cardiogenic shock (45.2%) and septic shock (37%). The analytical study indicates that the data most closely associated with mortality were age, socio-economic level, ischemic heart disease (p = 0.034), rheumatic valvulopathies, pulmonary embolism (p = 0.034), hypertension (HTA) (p = 0.009), smoking (p = 0.011), diabetes (p = 0.011), dyslipidemias, prolonged bedrest (p = 0.001), morbid obesity (p = 0.001), and COVID-19 infection (p = 0.017). Conclusion: The prevalence of ischemic heart diseases, pulmonary embolisms, and valvulopathies in premature mortality statistics underscores the need for enhanced cardiovascular prevention efforts.

Long-Term Mortality of Children with Congenital Heart Disease Admitted to the Departmental University Hospital of Borgou/Alibori from 2011 to 2022

Background: Congenital heart disease is a public health issue due to its incidence and mortality rate. The aim of this study was to investigate the long-term mortality of children with congenital heart disease admitted to the Departmental University Hospital of Borgou/Alibori (CHUD-B/A) from 2011 to 2022. Methods: This descriptive longitudinal study with analytical aims covered 11 years (April 1, 2011 to December 31, 2022). It consisted of a review of the records of children under 15 years of age with echocardiographically confirmed congenital heart disease. This was followed by an interview with the parents to assess the children’s current condition. Data were entered using Kobocollect software and analyzed using R Studio 4.2.2. software. Results: A total of 143 complete files were retained. The median age at diagnosis was 14 months (IIQ: Q1 = 4;Q3 = 60) with a range of 2 days and 175 months, and the sex-ratio (M/F) was 0.96. Left-to-right shunts were the most frequent cardiopathy group (62.9%). Only 35 children (24.5%) benefited from restorative treatment. The mortality rate was 31.5%. Median survival under the maximum bias assumption was 114 months and 216 months under the assumption of minimum bias. Survival was significantly better in children with right-to-left shunts (p = 0.0049) under the assumption of minimum bias. The death risk factors were: age at diagnosis less than 12 months (aHR = 7.58;95% CI = 3.36 - 17.24;p Conclusion: The long-term mortality of congenital heart disease is high and favoured by the absence of restorative treatment. Local correction of congenital heart disease and medical follow-up will help to reduce this mortality.

Trends in mortality among the geriatric population undergoing Surgical aortic valve replacement (SAVR) and potential racial disparities: a 20-year perspective via the National (Nationwide) Inpatient Sample

Background Racial disparities in cardiovascular conditions are well documented.Whether similar race-based discrepancies in health outcomes also exist among elderly patients undergoing surgical aortic valve replacement(SAVR) for aortic stenosis remains understudied.Methods We abstracted data from the National(Nationwide) Inpatient Sample over a 20-year period from 2001 to 2020 using specific ICD-9 and ICD-10 codes.We included patients aged ≥ 60 and ≤ 80 years with races recorded as White,African American,or Hispanic at the time of their hospitalization for surgery.We analyzed and reported the baseline characteristics,risk-adjusted inhospital mortality,and complications stratified by race.Results Of 420,181 patients studied,90.0% identified as White,4.0% as African American and 6.0% as Hispanic.Despite a decrease in overall in-hospital mortality rates from 3.8% between 2001-2005 to 1.8% between 2016-2020,African Americans had higher odds of all-cause in-hospital deaths compared to Whites(a OR = 1.390,P < 0.001).Additionally,they were more likely to experience cardiogenic shock(a OR = 1.241,P < 0.001) and acute kidney injury(a OR = 1.314,P < 0.001) as well as more likely to require organ support such as IABP use(a OR = 1.336,P < 0.001) or invasive mechanical ventilation(a OR = 1.342,P < 0.001).Interestingly,African Americans were less likely to report events of acute ischemic stroke compared to Whites(a OR = 0.852,P < 0.001).Conclusions Despite a reassuring reduction in overall in-hospital mortality rates of geriatric patients undergoing SAVR for aortic stenosis,racial disparities in health outcomes remain pervasive with minorities more likely to report higher in-hospital morbidity and mortality.

The impact of being in the COVID-19 pandemic on in-hospital mortality of non-infected patients aged 80 years and older with ST-elevation myocardial ınfarction

The COVID-19 outbreak in late 2019 was declared a pandemic by the World Health Organization(WHO)on March 12,2020.[1]As of the latest WHO data,COVID-19 has caused over 770 million cases and nearly 7 million deaths worldwide.[2]Hospitalizations due to COVID-19 are correlated with advanced age.[3,4]According to re-ports,individuals over the age of 65 account for 80%of COVID-19-related deaths.[3,4]This is primar-ily due to the increased burden of comorbidity with age.

Occupational physical activity, all-cause, cardiovascular disease, and cancer mortality in 349,248 adults: Prospective and longitudinal analyses of the MJ Cohort

Background:Evidence on the health benefits of occupational physical activity(OPA)is inconclusive.We examined the associations of baseline OPA and OPA changes with all-cause,cardiovascular disease(CVD),and cancer mortality and survival times.Methods:This study included prospective and longitudinal data from the MJ Cohort,comprising adults over 18 years recruited in 1998-2016,349,248 adults(177,314 women)with baseline OPA,of whom 105,715(52,503 women)had 2 OPA measures at 6.3±4.2 years(mean±SD)apart.Exposures were baseline OPA,OPA changes,and baseline leisure-time physical activity.Results:Over a mean mortality follow-up of 16.2±5.5 years for men and 16.4±5.4 years for women,11,696 deaths(2033 of CVD and 4631 of cancer causes)in men and 8980 deaths(1475 of CVD and 3689 of cancer causes)in women occurred.Combined moderately heavy/heavy baseline OPA was beneficially associated with all-cause mortality in men(multivariable-adjusted hazard ratio(HR)=0.93,95%confidence interval(95%CI):0.89-0.98 compared to light OPA)and women(HR=0.86,95%CI:0.79-0.93).Over a mean mortality follow-up of 12.5±4.6 years for men and 12.6±4.6 years for women,OPA decreases in men were detrimentally associated(HR=1.16,95%CI:1.01-1.33)with all-cause mortality,while OPA increases in women were beneficially(HR=0.83,95%CI:0.70-0.97)associated with the same outcome.Baseline or changes in OPA showed no associations with CVD or cancer mortality.Conclusion:Higher baseline OPA was beneficially associated with all-cause mortality risk in both men and women.Our longitudinal OPA analyses partly confirmed the prospective findings,with some discordance between sex groups.

Heterogeneous body compositions and all-cause mortality in acute coronary syndrome patients:a ten-year retrospective cohort study

BACKGROUND The association of different body components,including lean mass and body fat,with the risk of death in acute coronary syndrome(ACS)patients are unclear.METHODS We enrolled adults diagnosed with ACS at our center between January 2011 and December 2012 and obtained fol-low-up outcomes via telephone questionnaires.We used restricted cubic splines(RCS)with the Cox proportional hazards model to analyze the associations between body mass index(BMI),predicted lean mass index(LMI),predicted body fat percentage(BF),and the value of LMI/BF with 10-year mortality.We also examined the secondary outcome of death during hospitalization.RESULTS During the maximum 10-year follow-up of 1398 patients,331 deaths(23.6%)occurred,and a U-shaped relationship was found between BMI and death risk(P_(nonlinearity)=0.03).After adjusting for age and history of diabetes,the overweight group(24≤BMI<28 kg/m^(2))had the lowest mortality(HR=0.53,95%CI:0.29-0.99).Predicted LMI and LMI/BF had an inverse linear relationship with a 10-year death risk(P_(nonlinearity)=0.24 and P_(nonlinearity)=0.38,respectively),while an increase in BF was associ-ated with increased mortality(P_(nonlinearity)=0.64).During hospitalization,31 deaths(2.2%)were recorded,and the associations of the indicators with in-hospital mortality were consistent with the long-term outcome analyses.CONCLUSION Our study provides new insight into the“obesity paradox”in ACS patients,highlighting the importance of considering body composition heterogeneity.Predicted LMI and BF may serve as useful tools for assessing nutritional status and predicting the prognosis of ACS,based on their linear associations with all-cause mortality.

Neonatal Morbidity and Mortality at Hospital Saint Camille de Ouagadougou (HOSCO): A Study from 2017 to 2020

Introduction: Neonatal pathology remains a real public health problem in developing countries. In Burkina Faso, this mortality has declined over the last ten years but remains below compared to the Sustainable Development Goals, which is 12 per 1000 living births at most by 2030. This study aims to identify specific causes of neonatal morbidity and mortality and will contribute to the implementation of preventive and curative measures aimed at reducing neonatal mortality at HOSCO. Method: This was a retrospective study using the records and database of newborns hospitalized from January 1srt, 2017 to December 31srt, 2020. Using logistic regression, the factors associated with mortality were determined. Results: During the study period, 3020 newborns were hospitalized. Most newborns (83.71%) were referred by a peripheral health facility. The average age at admission was 0.3 days ± 0.9 and the sex ratio was 1.2. Prematurity was the leading cause of hospitalization (61.13%) followed by neonatal infection (38.34%) and neonatal suffering (23.88%). The mortality rate was 40.6% with 82.71% cases of death in the early neonatal period. The main causes of death were low birth weight (47.39%), respiratory distress (18.76%), neonatal suffering (17.37%) and neonatal infection (13.87%). Home delivery, gestational age 36 weeks, number of PNC 4, concept of resuscitation, Apgar at the 5th minute 7, birth weight 2000 g and >4000 g, respiratory distress, hypothermia, neurological disorders were factors associated with deaths. Conclusion: Neonatal mortality is influenced by both maternal and fetal factors and many of them are preventable.

Morbidity and Mortality during Anaesthesia in Patients with versus without Diabetes: Single-Centre Cohort Study

Background and objective: Classically, diabetic subjects are at high risk of anaesthesia compared with general population. However, some recent publications have shown contrasting and sometimes contrary results. The aim of our study was to evaluate morbidity and mortality during and after anaesthesia in patients with versus without diabetes operated on at Monkole Hospital over the last ten years. Methods: Retrospective cohort study including all patients who underwent all-comers surgery excluding cardiac surgery between 2011 and 2021. Each diabetic patient was matched to 2 non-diabetic controls on age and sex. The evaluation criterion was the frequency of occurrence of at least one perioperative complication and/or death up to day 30. A multivariate analysis using a Cox model was used to determine the factors associated with the occurrence of this morbidity and mortality. The model was adjusted for comorbidities, preoperative hyperglycaemia, ASA score, type of anaesthesia and severity of surgery. Results: A total of 351 diabetic patients (mean age 53.3 ± 14.18 years) and 701 non-diabetic patients (mean age 53.52 ± 14.7 years) were included and analysed. Preoperatively, hyperglycaemia (blood glucose > 180 mg/dl) was observed in 24.3% of diabetic patients compared with 1.6% of non-diabetic patients. The incidence of overall perioperative complications was 25.6% in diabetic patients compared with 28.6% in non-diabetic patients (p = 0.27). The risk factors associated with this morbidity were general anaesthesia with oro-tracheal intubation vs loco-regional anaesthesia (OR = 3.06 [95%CI: 1.91 - 4.94];p Conclusion: This study shows that there is not significant increase in perioperative morbidity and mortality in diabetic patients compared with non-diabetic ones of similar severity. These results suggest that diabetes itself (excluding associated comorbidities) has only a minor impact on perioperative morbidity and mortality.

Trajectories of depressive symptoms and risk of cardiovascular disease,cancer and mortality:a prospective cohort study

Background Depressive symptoms are established risk factors for various health outcomes.However,previous studies assessed depressive symptoms at a single time point,neglecting individual variations over time.Aims To identify depressive symptoms trajectories through repeated measures and examine their associations with cardiovascular disease(CVD),cancer and mortality.Methods This study included 20634 UK Biobank participants free of CVD and cancer at baseline with two or more assessments of depressive symptoms during 2006-2016.Group-based trajectory modelling identified depressive symptoms trajectories.Incident CVD,cancer and mortality were followed up until 2021 through linked registries.Results Six depressive symptoms trajectories were identified:no symptoms(n=6407),mild-stable(n=11539),moderate-stable(n=2183),severe-decreasing(n=206),moderate-increasing(n=177)and severe-stable(n=122).During a median follow-up of 5.5 years,1471 CVD cases,1275 cancer cases and 503 deaths were documented.Compared with the no symptoms trajectory,the mildstable,moderate-stable and severe-stable trajectories exhibited higher CVD risk,with hazard ratios(HRs)(95%CIs)of 1.19(1.06 to 1.34),1.32(1.08 to 1.34)and 2.99(1.85 to 4.84),respectively.Moderate-increasing and severe-stable trajectories were associated with higher mortality risks,with HRs(95%CIs)of 2.27(1.04 to 4.93)and 3.26(1.55 to 6.88),respectively.However,the severedecreasing trajectory was not associated with higher risks of adverse outcomes.We did not find significant associations between any trajectory and cancer.Conclusions Trajectories related to stable and increasing depressive symptoms,but not the trajectory associated with severe depressive symptoms at the initial assessment but decreasing at the follow-up,were associated with higher risks of CVD and mortality.Alleviating severe depressive symptoms at the initial onset may mitigate CVD and mortality risks.

Morbidity and Mortality of Newborns in a Context of Limited Resources in Tombouctou, Mali

Introduction: Worldwide, 2.3 million children died in the first 20 days after birth in 2022, according to the WHO. In Mali, according to the sixth Demographic and Health Survey, the neonatal mortality rate was estimated at 33% live births in 2018. The Timbuktu region had the highest neonatal mortality rate in the country with 44%. The objective of this work was to study the causes of neonatal morbidity and mortality and related factors in the paediatrics department of Timbuktu hospital. Materials and method: This was a descriptive, cross-sectional study conducted from 1 January to 31 December 2023 in the neonatology unit of the paediatrics department of Timbuktu hospital, including all newborns admitted to hospital. Results: Our study took place over 12 months, during which 618 admissions were made to the paediatric ward, including 244 newborns, i.e. 39.48%. The majority of newborns (86.5%) were admitted in the first week of life. The mean age was 3 days, with a sex ratio of 1.1 for males. Weight under 2500 g was 54.1% for an average weight of 2372 g. The main mode of admission was transfer from the hospital maternity unit (62%). The main reasons for admission were acute foetal distress (27.9%) and prematurity (26.2%). The average age of the mothers was 24, with extremes of 15 and 49. The mothers were housewives (87.3%), uneducated and primiparous (59% and 36.5% respectively);only 40.2% had made more than 3 antenatal care visits. Newborns born by vaginal delivery accounted for 80.7% and those born by caesarean section for 19.3%. The risk of infection was present in 52.5% of cases. The three leading causes of hospitalisation were birth asphyxia (40.2%), neonatal infection (32.4%) and prematurity (25%). The mortality rate was 21.7%. The main causes of death were prematurity (39.6%), birth asphyxia (32.1%) and neonatal infection (24.5%). Conclusion: Neonatal morbidity and mortality remain a concern in Timbuktu. Despite the unfavourable security situation, morbidity and mortality indicators are close to those in some hospitals in Mali. The correct application of Essential Newborn Care and antenatal care remains a major challenge for the hospital and the Timbuktu region.