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Counted - and then?: trends in child mortality within an Ethiopian demographic surveillance site
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Knowledge of the state of health of a population is necessary for planning for health services for that population. It is  a paradox that the health of populations is most commonly measured by mortality and cause of death patterns, but the absence of medical services available to a majority of the world population has made it unavoidable to equate “state of health” with “cause of death pattern”.

In the absence of population registration, mortality and causes of death must be studied in samples from the population. The research presented in this thesis mainly has been done within such a sample in a collaborative project between Umeå university and the Addis Ababa university in Ethiopia. This research started 1986 and has run continuously since then. The thesis attempts to measure the effect that social and geographical inequalities has had on the mortality of the children in the study population.

Population and Methods

The population that is included in the demographic surveillance is the children under five years of age in nine rural and one urban community in central Ethiopia. Mortality and causes of death among the children have been followed since 1987.

Results

The mortality of the children in the study is high by international comparisons. The most important reason for mortality differences within the population is the difference in living conditions and societal services between the rural and urban areas. Approximately 45% of the child deaths could have been prevented if living conditions and services had been equal to rural and urban children.

Conclusions

Information concerning mortality and cause of death patterns are essential to planning. In order to empower the population, knowledge of the mortality and most common causes of death must be known to them.

Place, publisher, year, edition, pages
Umeå: Folkhälsa och klinisk medicin , 2009. , 69 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1256
Keyword [en]
child mortality, developing countries, demographic surveillance, equity
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-21131ISBN: 978-91-7264-762-6 (print)OAI: oai:DiVA.org:umu-21131DiVA: diva2:210633
Public defence
2009-04-24, Sal 135, Allmänmedicin, Byggnad 9a, Norrlands Universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2009-04-06 Created: 2009-04-02 Last updated: 2010-02-03Bibliographically approved
List of papers
1. Trends in under-five mortality in rural Ethiopia: 18 years of follow-up in the Butajira demographic surveillance
Open this publication in new window or tab >>Trends in under-five mortality in rural Ethiopia: 18 years of follow-up in the Butajira demographic surveillance
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(English)Manuscript (preprint) (Other academic)
Keyword
Child mortality, demographic surveillance, developing countries
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-21129 (URN)
Available from: 2009-04-06 Created: 2009-04-02 Last updated: 2015-04-29Bibliographically approved
2. Indoor air pollution: a poverty related cause of mortality among the children of the world
Open this publication in new window or tab >>Indoor air pollution: a poverty related cause of mortality among the children of the world
2007 (English)In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 132, no 5, 1615-1623 p.Article in journal (Refereed) Published
Abstract [en]

This article reviews the research on the relation between indoor air pollution exposure and acute respiratory infection (ARI) in children in developing countries. ARI is a cause of death globally, causing approximately 19% of all deaths before the age of 5 years, according to a World Health Organization estimate. Indoor air pollution from biomass fuels, which is strongly poverty related, has long been regarded as an important risk factor for ARI morbidity and mortality. The empirical base for this view is comparatively narrow, with few empirical studies in relation to the magnitude of the global public health importance of the problem. Most existing reports consistently indicate that indoor air pollution is indeed a risk factor for ARI, but studies are generally small and use indirect indicators of pollution, such as use of biomass fuel or type of stove. Exposure assessment for indoor air pollution in developing countries is recognized as a major obstacle because of high cost and infrastructural limitations to chemical pollution sampling. Use of proxy indicators without measurement support may increase the risk of both misclassification of exposure and of confounding by other poverty-related factors. The issue of sufficient sample size further underlines the need for decisions to invest in this research field. Areas where further research is needed also include exploring qualitatively options for interventions that are culturally and economically acceptable to local communities.

Keyword
Child mortality, indoor air pollutionacute respiratory infections, child mortality, developing countries, epidemiology, indoor air pollution
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-21126 (URN)10.1378/chest.07-1398 (DOI)
Available from: 2009-04-06 Created: 2009-04-02 Last updated: 2017-12-13Bibliographically approved
3. Use of biomass fuel is related to indicators of ARI among children under five in Ethiopia
Open this publication in new window or tab >>Use of biomass fuel is related to indicators of ARI among children under five in Ethiopia
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(English)Manuscript (preprint) (Other academic)
Keyword
ARI, biomass fuels, indoor air pollution, child morbidity
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-21130 (URN)
Available from: 2009-04-06 Created: 2009-04-02 Last updated: 2015-04-29Bibliographically approved
4. Magnitude of indoor NO2 from biomass fuels in rural settings of Ethiopia
Open this publication in new window or tab >>Magnitude of indoor NO2 from biomass fuels in rural settings of Ethiopia
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2009 (English)In: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 19, 14-21 p.Article in journal (Refereed) Published
Keyword
Indoor air pollution, NO2
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-21127 (URN)
Available from: 2009-04-06 Created: 2009-04-02 Last updated: 2017-12-13Bibliographically approved
5. Vulnerability to episodes of extreme weather: Butajira, Ethiopia, 1998-1999
Open this publication in new window or tab >>Vulnerability to episodes of extreme weather: Butajira, Ethiopia, 1998-1999
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2009 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, 140-148 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: During 1999-2000, great parts of Ethiopia experienced a period of famine which was recognised internationally. The aim of this paper is to characterise the epidemiology of mortality of the period, making use of individual, longitudinal population-based data from the Butajira demographic surveillance site and rainfall data from a local site.

METHODS: Vital statistics and household data were routinely collected in a cluster sample of 10 sub-communities in the Butajira district in central Ethiopia. These were supplemented by rainfall and agricultural data from the national reporting systems.

RESULTS: Rainfall was high in 1998 and well below average in 1999 and 2000. In 1998, heavy rains continued from April into October, in 1999 the small rains failed and the big rains lasted into the harvesting period. For the years 1998-1999, the mortality rate was 24.5 per 1,000 person-years, compared with 10.2 in the remainder of the period 1997-2001. Mortality peaks reflect epidemics of malaria and diarrhoeal disease. During these peaks, mortality was significantly higher among the poorer.

CONCLUSIONS: The analyses reveal a serious humanitarian crisis with the Butajira population during 1998-1999, which met the CDC guideline crisis definition of more than one death per 10,000 per day. No substantial humanitarian relief efforts were triggered, though from the results it seems likely that the poorest in the farming communities are as vulnerable as the pastoralists in the North and East of Ethiopia. Food insecurity and reliance on subsistence agriculture continue to be major issues in this and similar rural communities. Epidemics of traditional infectious diseases can still be devastating, given opportunities in nutritionally challenged populations with little access to health care.

Place, publisher, year, edition, pages
Järfälla, Sweden: CoAction Publishing, 2009
Keyword
climate change, famine, mortality, demographic surveillance, epidemiology
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-30541 (URN)10.3402/gha.v1i0.1829 (DOI)000208160000043 ()20052373 (PubMedID)
Available from: 2010-01-08 Created: 2010-01-08 Last updated: 2017-12-12Bibliographically approved

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