Volume 178 - Issue 1
eMJA: In other journals - 6 January 2003
Med J Aust 2003; 178 (1): 42. || doi: 10.5694/j.1326-5377.2003.tb05042.x
Published online: 6 January 2003
Published online: 6 January 2003
| A world of risk | |
Lancet 2002; 360: 1347-1360 |
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| Gender and mortality | |
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In the rural Malawian community of Lungwena, 1–2-year-old boys are twice as likely to die as girls of the same age. A prospective study followed 795 pregnant women until their children turned three. Of 767 live births, 100 infants and 47 1–2-year-olds died during follow-up (mortality rate of 202/1000 in the first three years). After controlling for possible confounders such as maternal age and HIV status, family wealth, proximity to a health centre, immunisation status and nutritional status, the relative risk of a boy dying between the ages of nine and 35 months was 2.0. Causes of post-infancy death included malnutrition (14 of 47 children), malaria or anaemia (10), respiratory infections (4), diarrhoea (4) and a possible accident (1). The researchers said sex biases in child mortality have not previously been thought to be a big issue in sub-Saharan Africa, possibly because larger studies have masked male-biased mortality in some regions and female-biased in others. Arch Dis Child 2002; 87: 386-387 |
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| Birth and death | |
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The traditional cut-off point of six weeks postpartum for defining pregnancy-related death may need to be extended following the findings of a Nepalese study. Researchers analysed prospective data on 6101 women who had 7325 pregnancies while in the placebo group of a micronutrient supplementation trial in Sarlahi, Nepal, between 1994 and 1997. The women’s relative risk of death was highest during labour and the week after giving birth (37.02). During pregnancy and the first six weeks postpartum the relative risk was 2.21, and extending the period out to 12 weeks produced similar results (RR, 2.26). This suggests that many pregnancy-related deaths are not being counted as such and that WHO figures for maternal mortality (515 000 annually, mainly in the developing world) may be an underestimate. Bull World Health Org 2002; 80: 887-891 It’s curtains for sandfliesA study conducted in Venezuela suggests that controlling cutaneous leishmaniasis in urban areas may be a matter of window dressing! The disease is common in Venezuelan cities, where woodland and domestic animals act as reservoirs, and sandflies are the vectors. In the city of Trujillo (2913 inhabitants in 569 households), intervention houses received polyester mesh curtains impregnated with lambdacyhalothrin (12.5 mg/m2) to hang loosely at the windows. Control houses received non-impregnated curtains. After the impregnated curtains were hung, the numbers of sandflies caught in overnight light traps was markedly reduced (a mean of 13 less sandflies per night in intervention than control households). The incidence rate of cutaneous leishmaniasis changed from 4% overall in the 12 months before the study to zero in the intervention group and 8% in the control group in the 12 months after the curtains were hung. BMJ 2002; 325: 810-813 Iron and infection While the developmental effects of iron-deficiency anaemia have a devastating effect globally, some studies have suggested that children given iron develop more infections. A recent systematic review found that this is not the case. The researchers identified 28 randomised-controlled trials of iron supplementation in a review limited by methodological heterogeneity and non-uniform definitions of clinical outcomes. The occurrence of malaria and other infectious illnesses was not affected by iron administration, but children given iron did have a slightly increased risk of diarrhoea (0.05 more episodes/child year). The diarrhoea was not thought to pose a major public health problem and the study could not determine if it was of infective or irritative in origin. BMJ 2002; 325: 1142-1152 |
The world should focus far more of its health efforts on preventive activities, say researchers from the World Health Organization’s Comparative Risk Assessment Collaborating Group. The group undertook the mammoth task of comprehensively reviewing data from published studies and other sources (eg, government reports and international databases) on 26 potentially modifiable risk factors for disease, splitting the entire world into 14 epidemiological regions based on geography and adult and child mortality. The contribution of each risk factor to mortality and disease burden (expressed as disability-adjusted life-years [DALY]) was calculated. Results differed with epidemiological area, but overall, the leading causes of global burden of disease were childhood and maternal underweight (9.5% of the total DALY), unsafe sex (6.3%), high blood pressure (4.4%), tobacco (4.1%) and alcohol (4%). The researchers said the contribution of these risk factors is much higher than has been previously thought, and targeting them will produce substantial health gains.