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Santosa, A. & Byass, P. (2016). Diverse empirical evidence on epidemiological transition in low- and middle-income countries: population-based findings from INDEPTH Network data. PLoS ONE, 11(5), Article ID e0155753.
Open this publication in new window or tab >>Diverse empirical evidence on epidemiological transition in low- and middle-income countries: population-based findings from INDEPTH Network data
2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 5, e0155753Article in journal (Refereed) Published
Abstract [en]

Background Low-and middle-income countries are often described as being at intermediate stages of epidemiological transition, but there is little population-based data with reliable cause of death assignment to examine the situation in more detail. Non-communicable diseases are widely seen as a coming threat to population health, alongside receding burdens of infection. The INDEPTH Network has collected empirical population data in a number of health and demographic surveillance sites in low-and middle-income countries which permit more detailed examination of mortality trends over time.

Objective To examine cause-specific mortality trends across all ages at INDEPTH Network sites in Africa and Asia during the period 1992-2012. Emphasis is given to the 15-64 year age group, which is the main focus of concern around the impact of the HIV pandemic and emerging non-communicable disease threats.

Methods INDEPTH Network public domain data from 12 sites that each reported at least five years of cause-specific mortality data were used. Causes of death were attributed using standardised WHO verbal autopsy methods, and mortality rates were standardised for comparison using the INDEPTH standard population. Annual changes in mortality rates were calculated for each site.

Results A total of 96,255 deaths were observed during 9,487,418 person years at the 12 sites. Verbal autopsies were completed for 86,039 deaths (89.4%). There were substantial variations in mortality rates between sites and over time. HIV-related mortality played a major part at sites in eastern and southern Africa. Deaths in the age group 15-64 years accounted for 43% of overall mortality. Trends in mortality were generally downwards, in some cases quite rapidly so. The Bangladeshi sites reflected populations at later stages of transition than in Africa, and were largely free of the effects of HIV/AIDS.

Conclusions To some extent the patterns of epidemiological transition observed followed theoretical expectations, despite the impact of the HIV pandemic having a major effect in some locations. Trends towards lower overall mortality, driven by decreasing infections, were the general pattern. Low-and middle-income country populations appear to be in an era of rapid transition.

Keyword
mortality transition, premature mortality, non-communicable disease, low- and middle incom countries, INDEPTH Network
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-103276 (URN)10.1371/journal.pone.0155753 (DOI)000376282300065 ()
Available from: 2015-05-19 Created: 2015-05-19 Last updated: 2017-12-04Bibliographically approved
Tissera, H., Amarasinghe, A., Gunasena, S., DeSilva, A. D., Yee, L. W., Sessions, O., . . . Wilder-Smith, A. (2016). Laboratory-Enhanced Dengue Sentinel Surveillance in Colombo District, Sri Lanka: 2012-2014. PLoS Neglected Tropical Diseases, 10(2), Article ID e0004477.
Open this publication in new window or tab >>Laboratory-Enhanced Dengue Sentinel Surveillance in Colombo District, Sri Lanka: 2012-2014
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2016 (English)In: PLoS Neglected Tropical Diseases, ISSN 1935-2727, E-ISSN 1935-2735, Vol. 10, no 2, e0004477Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Dengue has emerged as a significant public health problem in Sri Lanka. Historically surveillance was passive, with mandatory dengue notifications based on clinical diagnosis with only limited laboratory confirmation. To obtain more accurate data on the disease burden of dengue, we set up a laboratory-based enhanced sentinel surveillance system in Colombo District. Here we describe the study design and report our findings of enhanced surveillance in the years 2012-2014.

METHODS: Three outpatient clinics and three government hospitals in Colombo District that covered most of the Colombo metropolitan area were selected for the sentinel surveillance system. Up to 60 patients per week presenting with an undifferentiated fever were enrolled. Acute blood samples from each patient were tested by dengue specific PCR, NS1 ELISA and IgM ELISA. A sub-set of samples was sent to Duke-NUS Singapore for quality assurance, virus isolation and serotyping. Trained medical research assistants used a standardized case report form to record clinical and epidemiological data. Clinical diagnoses by the clinicians-in-charge were recorded for hospitalized cases.

RESULTS: Of 3,127 febrile cases, 43.6% were PCR and/or NS1 positive for dengue. A high proportion of lab confirmed dengue was observed from inpatients (IPD) (53.9%) compared to outpatient (clinics in hospitals and general practice) (7.6%). Dengue hemorrhagic fever (DHF) was diagnosed in 11% of patients at the time of first contact, and the median day of illness at time of presentation to the sentinel sites was 4. Dengue serotype 1 was responsible for 85% of the cases and serotype 4 for 15%. The sensitivity and specificity of the clinicians' presumptive diagnosis of dengue was 84% and 34%, respectively.

CONCLUSION: DENV-1, and to a lesser degree DENV-4, infection were responsible for a high proportion of febrile illnesses in Colombo in the years 2012 to 2014. Clinicians' diagnoses were associated with high sensitivity, but laboratory confirmation is required to enhance specificity.

Place, publisher, year, edition, pages
Public library science, 2016
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-117587 (URN)10.1371/journal.pntd.0004477 (DOI)000372567300076 ()26927901 (PubMedID)
Available from: 2016-03-02 Created: 2016-03-02 Last updated: 2017-11-30Bibliographically approved
Mee, P., Kahn, K., Kabudula, C., Wagner, R., Gómez-Olivé, F. X., Madhavan, S., . . . Byass, P. (2016). The development of a localised HIV epidemic and the associated excess mortality burden in a rural area of South Africa. Global Health, Epidemiology and Genomics, 1(e7).
Open this publication in new window or tab >>The development of a localised HIV epidemic and the associated excess mortality burden in a rural area of South Africa
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2016 (English)In: Global Health, Epidemiology and Genomics, E-ISSN 2054-4200, Vol. 1, no e7Article in journal (Refereed) Published
Abstract [en]

The human immunodeficiency virus (HIV) epidemic in South Africa rapidly developed into a major pandemic. Here we analyse the development of the epidemic in a rural area of the country. The data used were collected between 1992 and 2013 in a longitudinal population survey, the Agincourt Health and Demographic Surveillance Study, in the northeast of the country. Throughout the period of study mortality rates were similar in all villages, suggesting that there were multiple index cases evenly spread geographically. These were likely to have been returning migrant workers. For those aged below 39 years the HIV mortality rate was higher for women, above this age it was higher for men. This indicates the protective effect of greater access to HIV testing and treatment among older women. The recent convergence of mortality rates for Mozambicans and South Africans indicates that the former refugee population are being assimilated into the host community. More than 60% of the deaths occurring in this community between 1992 and 2013 could be attributed directly or indirectly to HIV. Recently there has been an increasing level of non-HIV mortality which has important implications for local healthcare provision. This study demonstrates how evidence from longitudinal analyses can support healthcare planning.

Keyword
AIDS, epidemic, epidemiology, HIV, mortality, South Africa, Agincourt
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-108613 (URN)10.1017/gheg.2016.3 (DOI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2006–1512Wellcome trust, 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z
Note

Originally published in manuscript form.

Available from: 2015-09-14 Created: 2015-09-14 Last updated: 2017-02-01Bibliographically approved
Wilder-Smith, A. & Byass, P. (2016). The elusive global burden of dengue. Lancet. Infectious diseases (Print), 16(6), 629-631.
Open this publication in new window or tab >>The elusive global burden of dengue
2016 (English)In: Lancet. Infectious diseases (Print), ISSN 1473-3099, E-ISSN 1474-4457, Vol. 16, no 6, 629-631 p.Article in journal, Editorial material (Other academic) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-122558 (URN)10.1016/S1473-3099(16)00076-1 (DOI)000376476500008 ()
Available from: 2016-06-22 Created: 2016-06-20 Last updated: 2017-11-28Bibliographically approved
Byass, P. (2016). Uncounted causes of death [Letter to the editor]. The Lancet, 387(10013), 26-27.
Open this publication in new window or tab >>Uncounted causes of death
2016 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 387, no 10013, 26-27 p.Article in journal, Letter (Refereed) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-114564 (URN)10.1016/S0140-6736(15)01292-1 (DOI)000367457300018 ()
Available from: 2016-02-10 Created: 2016-01-25 Last updated: 2017-11-30Bibliographically approved
Byass, P. & Wilder-Smith, A. (2016). Utilising additional sources of information on microcephaly [Letter to the editor]. The Lancet, 387(10022), 940-941.
Open this publication in new window or tab >>Utilising additional sources of information on microcephaly
2016 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 387, no 10022, 940-941 p.Article in journal, Letter (Refereed) Published
Keyword
Zika virus
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-118776 (URN)10.1016/S0140-6736(16)00519-5 (DOI)000371644200018 ()26921912 (PubMedID)
Available from: 2016-05-25 Created: 2016-04-04 Last updated: 2017-11-30Bibliographically approved
Godefay, H., Kinsman, J., Admasu, K. & Byass, P. (2015). A national programme of freely-available ambulance transportation for women in labour halves maternal mortality in Ethiopia: an operational analysis from Tigray Region. Paper presented at The 9th European Congress on Tropical Medicine and International Health (ECTMIH), Basel, Switzerland, September 6-10, 2015. Tropical medicine & international health, 20(Suppl. 1), 72-72.
Open this publication in new window or tab >>A national programme of freely-available ambulance transportation for women in labour halves maternal mortality in Ethiopia: an operational analysis from Tigray Region
2015 (English)In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, 72-72 p.Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Introduction: One of the challenges for maternal health services across Africa is physically getting women to health facilities for delivery at the appropriate time. A lack of transportation has often been cited as a major obstacle. The Ethiopian Federal Ministry of Health implemented a national programme of freely available ambulance transportation in every District from 2012, and this operational analysis investigated the effects of the ambulance programme on maternal mortality.

Methods: Maternal mortality was measured in a survey of six randomly selected districts in Tigray Region over a 1-year period in 2012/13. For the same time period, data from ambulance log books from the same six Districts were captured and ambulance trips associated with deliveries extracted. Data on month, distance to health facility and mobile network coverage at local area level were included.

Results: The survey identified 51 maternal deaths and 19 179 live births, corresponding to an overall maternal mortality ratio (MMR) of 266 per 100 000 live births. Districts using ambulances for at least 25% of deliveries had an MMR of 116 per 100 000 compared with 407 per 100 000 elsewhere. Distance from home to facility, the availability of a mobile telephone network and utilisation of ambulances were all independently associated with maternal mortality. When all these factors competed in a multivariable model at local area level, only utilisation of ambulances persisted as a significant factor, with a maternal mortality rate ratio of 0.51. One maternal death was estimated to have been averted for every 5000 ambulance-kilometres driven.

Conclusions: Freely available ambulance transport in Ethiopia was associated with significant reductions in maternal mortality, although this was a strategy requiring substantial investment. Similar results could probably be achieved elsewhere given sufficient investment in vehicles and operational infrastructure.

Acknowledgements: The Tigray Regional Health Bureau funded this operational assessment, including the maternal mortality survey and capturing the ambulance data. A collaboration grant from the Swedish Research Council facilitated analysis.

Disclosure: Hagos Godefay is the Head of Tigray Regional Bureau and Kesetebirhan Admasu is the Minister of Health, Federal Democratic Republic of Ethiopia.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-109923 (URN)000360758800175 ()
Conference
The 9th European Congress on Tropical Medicine and International Health (ECTMIH), Basel, Switzerland, September 6-10, 2015
Available from: 2015-10-16 Created: 2015-10-09 Last updated: 2017-12-01Bibliographically approved
Kittayapong, P., Olarantmanee, P., Maskao, P., Byass, P., Lohr, W., Gubler, D. & Wilder-Smith, A. (2015). A school-based intervention trial using insecticide-treated school uniforms to reduce dengue infections in school-aged children. Paper presented at The 9th European Congress on Tropical Medicine and International Health (ECTMIH), Basel, Switzerland, September 6-10, 2015. Tropical medicine & international health, 20(Suppl. 1), 114-114.
Open this publication in new window or tab >>A school-based intervention trial using insecticide-treated school uniforms to reduce dengue infections in school-aged children
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2015 (English)In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, 114-114 p.Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: There is an urgent need to enhance our armamentarium to prevent dengue infections in children. Since dengue vectors (Aedes mosquitoes) are active mainly during the day, a potential target for control should be schools where children spend a considerable amount of their day. School uniforms are the cultural norm in most developing countries, worn throughout the day. We hypothesized that insecticide-treated school uniforms will  reduce the incidence of dengue infection in school-aged children. Our objective was to determine the impact of impregnated school uniforms on dengue incidence.

Methods: A randomised controlled trial was conducted in 10 schools in eastern Thailand in 2012. Pre-fabricated school uniforms were commercially treated to ensure consistent high quality of insecticide impregnation with permethrin. The 1-h-knock-down effect and 24 h mortality of Aedes mosquitoes by the impregnated cloth was tested at baseline and then once per month using WHOPES cone test. Blood samples were taken at baseline and at the end of the school-term for the hemagglutination-inhibition assay to identify serologically confirmed dengue infections during the study period. Students were randomized into intervention schools (all students wearing impregnated uniforms) versus control schools (uniforms had the same appearance and odor, but were not impregnated).

Results: A total of 1808 students in 10 schools were enrolled, mean age 10.07 years. Of these, 1651 had paired blood samples taken, which showed an incidence of new dengue infection of 3.3 % over the school term (5  months). There was no difference in the incidence of dengue infections in intervention versus control schools. Both the knock-down and mortality at baseline were close to 100%, but rapidly waned after only 8 washes to 20% e.g. after only 1 month of wearing the uniform.

Conclusion: Although the results of mosquitoes’ knock-down and mortality of impregnated schools looked very promising, we did not see a protective effect of impregnated uniforms on reducing dengue infections in this school-based trial. The most likely reason for the apparent failure was the rapid waning efficacy of impregnation after washing. New technologies need to be developed to overcome rapid waning efficacy of impregnated clothing.

Disclosure: This research was funded by the European Commission 7th Framework and was conducted by ‘DengueTools’ partners.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-109944 (URN)000360758800278 ()
Conference
The 9th European Congress on Tropical Medicine and International Health (ECTMIH), Basel, Switzerland, September 6-10, 2015
Available from: 2015-10-15 Created: 2015-10-09 Last updated: 2017-12-01Bibliographically approved
Byass, P., Kabudula, C. W., Mee, P., Ngobeni, S., Silaule, B., Gomez-Olive, F. X., . . . Kahn, K. (2015). A Successful Failure: missing the MDG4 Target for Under-Five Mortality in South Africa. PLoS Medicine, 12(12), Article ID e1001926.
Open this publication in new window or tab >>A Successful Failure: missing the MDG4 Target for Under-Five Mortality in South Africa
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2015 (English)In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 12, no 12, e1001926Article in journal (Refereed) Published
Place, publisher, year, edition, pages
PloS, 2015
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-116757 (URN)10.1371/journal.pmed.1001926 (DOI)000368451100016 ()26694732 (PubMedID)
Note

PB is a member of the PLOS Medicine Editorial Board. The authors have declared that no other competing interests exist.

Available from: 2016-02-17 Created: 2016-02-11 Last updated: 2017-11-30Bibliographically approved
Byass, P. (2015). A transition towards a healthier global population?. The Lancet, 386(10009), 2121-2122.
Open this publication in new window or tab >>A transition towards a healthier global population?
2015 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, no 10009, 2121-2122 p.Article in journal, Editorial material (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2015
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-110447 (URN)10.1016/S0140-6736(15)61476-3 (DOI)000365992600009 ()26318267 (PubMedID)
Available from: 2015-10-21 Created: 2015-10-21 Last updated: 2017-12-01Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-5474-4361

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