Showing papers by "Mohsen Naghavi published in 2010"

Algorithms for enhancing public health utility of national causes-of-death data

Abstract: Coverage and quality of cause-of-death (CoD) data varies across countries and time. Valid, reliable, and comparable assessments of trends in causes of death from even the best systems are limited by three problems: a) changes in the International Statistical Classification of Diseases and Related Health Problems (ICD) over time; b) the use of tabulation lists where substantial detail on causes of death is lost; and c) many deaths assigned to causes that cannot or should not be considered underlying causes of death, often called garbage codes (GCs). The Global Burden of Disease Study and the World Health Organization have developed various methods to enhance comparability of CoD data. In this study, we attempt to build on these approaches to enhance the utility of national cause-of-death data for public health analysis. Based on careful consideration of 4,434 country-years of CoD data from 145 countries from 1901 to 2008, encompassing 743 million deaths in ICD versions 1 to 10 as well as country-specific cause lists, we have developed a public health-oriented cause-of-death list. These 56 causes are organized hierarchically and encompass all deaths. Each cause has been mapped from ICD-6 to ICD-10 and, where possible, they have also been mapped to the International List of Causes of Death 1-5. We developed a typology of different classes of GCs. In each ICD revision, GCs have been identified. Target causes to which these GCs should be redistributed have been identified based on certification practice and/or pathophysiology. Proportionate redistribution, statistical models, and expert algorithms have been developed to redistribute GCs to target codes for each age-sex group. The fraction of all deaths assigned to GCs varies tremendously across countries and revisions of the ICD. In general, across all country-years of data available, GCs have declined from more than 43% in ICD-7 to 24% in ICD-10. In some regions, such as Australasia, GCs in 2005 are as low as 11%, while in some developing countries, such as Thailand, they are greater than 50%. Across different age groups, the composition of GCs varies tremendously - three classes of GCs steadily increase with age, but ambiguous codes within a particular disease chapter are also common for injuries at younger ages. The impact of redistribution is to change the number of deaths assigned to particular causes for a given age-sex group. These changes alter ranks across countries for any given year by a number of different causes, change time trends, and alter the rank order of causes within a country. By mapping CoD through different ICD versions and redistributing GCs, we believe the public health utility of CoD data can be substantially enhanced, leading to an increased demand for higher quality CoD data from health sector decision-makers.

The burden of injuries in Iranian children in 2005

Abstract: Background: Child injury is recognized as a global health problem. Injuries caused the highest burden of disease among the total population of Iran in 2003. We aimed to estimate the morbidity, mortality, and disease burden caused by child injuries in the 0- to 14-year-old population of Iran in 2005. Methods: We estimated average age- and sex-specific mortality rates for different types of child injuries from 2001 to 2006 using Iran’s death registration data. Incidence rates for nonfatal outcomes of child injuries in 2005 were estimated through a time- and place-limited sample hospital registry study for injuries. We used the World Health Organization’s methods for estimation of years of life lost due to premature mortality and years lived with disability in 2005. Results: Injuries were the most important cause of death in children ages 1 to 14, with 35, 33.4, 24.9, and 22.9 deaths per 100,000 in the 0-14, 1-4, 5-9, and 10-14 age groups respectively. Road transport injuries were responsible for the highest death rate per 100,000 population among all types of injuries in children, with 15.5 for ages 0-14, 16.1 for ages 1-4, 16.3 for ages 5-9, and 13.1 for ages 10-14. Incidence rates of injuries leading to hospitalization were 459, 530, and 439 per 100,000 in the 0-14, 1-4, and 5-14 age groups respectively. Incidence rates of injuries leading to outpatient care were 1,812, 2,390, and 1,650 per 100,000 in the same age groups respectively. Among injury types, falls and burns had the highest hospitalization and outpatient care incidence rates. Conclusions: Injuries, particularly road transport injuries, were the most important health problem of children in Iran in 2003 and 2005. Strong social policy is needed to ensure child survival.

Building momentum: Global progress toward reducing maternal and child mortality.

Abstract: This detailed report includes data on mortality trends for more than 180 countries over two decades. Researchers at IHME working in collaboration with researchers at the University of Queensland gathered vital registration data censuses surveys and other sources to create datasets that were more than twice as large as those available for previous studies on maternal and child mortality. Their findings show surprising progress in reducing maternal and child deaths worldwide especially in countries where declines in mortality have been difficult to achieve. IHME intends to regularly update its estimates of maternal and child mortality to help policymakers decide where to focus health resources part of the Institute’s ongoing effort to work with governments and non-governmental organizations to gather and analyze data and generate the best possible picture of health outcomes.

Epidemiological pattern of non-fatal injuries in Iran.

Abstract: Objectives: To present the incidence rate and distribution of non-fatal injuries in Iran. Methodology: A one- year study was carried out in all 28 provinces of Iran in 2002-3. Overall, 53,6624 individuals (1,11626 households) from all provinces of the country were randomly selected for the study. In each province about 2000 households in urban and 2000 families in rural areas were included in the study. The guardians or heads of the households were interviewed by using a questionnaire that included information about any accidental injuries taken medical cares within the year prior to the date of data collection and some other demographic information. Results: It is estimated that more than 9.2 million injuries with about 8286 deaths and 74379 hospitalizations occurred in Iran each year. The incidence rate of all types of non-fatal injuries was (444.3 per 100,000). The top three causes of non-fatal injuries were transport accidents (237 per 100,000), falls (106.2 per 100,000) and struck by thrown, projected of falling object (69.8 per 100,000). The non-fatal injuries were more common among males than females (8039.6 vs. 2021.7 per 100,000) and nearly equivalent among residence of urban areas compared to those from rural areas (5024.1 vs. 5075.5 per 100,000). Conclusion: In Iran injuries are one of the main leading causes of diseases and hospital admissions in both rural and urban areas, and this figure for transport accidents is quite high in the world.

Fall safety promotion in rural communities. input from injury data and community health workers in Twiserkan, Iran

Abstract: Falls are one of important cause of injury morbidity. Knowledge is limited about fall-related injuries in low- and middle-income countries in general and in Iran in particular. This study aims to document the epidemiology of injuries among rural community and to determine how fall injury control and prevention are conceived by community health workers (known as Behvarzes), given the role that they are expected to play for local health and safety promotion. The study was a 6-month prospective injury data collection (from July 15th 2007 to January 15th 2008) that took place in one Iranian district and focused on severe injuries (leading to hospitalisation over 6 hours or death). Those were investigated by community health workers (Behvarzes) as a special assignment for them all (about 100). They used a pre-determined form (a logbook) for data collection on injuries of various causes, including falls. At the end of data collection Behvarzes were gathered in a number of group sessions to reflect about injury prevention measures and barriers in the community. The questionnaire they have to fill in was self-administered. A total of 23 severe fall injuries (two fatal) were reported during the follow-up period with an annual estimated incidence rate of 8/10 000 (95% CI 6 to 11). The incidence rate of severe falls was significantly higher among males than females (12/10 000 vs 3/10 000 person-years. Fall incidence rates was also higher among people 65 years and over (24/10 000 person-years). Severe falls led commonly to fractures and lower limb was the most common single body region. Most falls were from height, mainly from roof and tree, and about half were work-related. The injury analyses revealed that the Behvarzes often considered that the adoption of safe behaviour/practice could help preventing fall injuries (17 out of 23). Their post follow-up reflection on fall prevention indicates that education, provided by themselves could help prevent fall injuries (71 out of 87) and so could environmental improvement, people training and instruction, and cooperation and consultation by other actors in this field. Also the barriers or risk factors for fall injury prevention identified related mostly to human factors (for all 23 cases) followed by physical environmental factors. At the end of follow-up however, they identified several physical environmental factors (44 out of 87), followed by social and legal environment, and then, individual factors. The case-by-case injury analysis leads to the identification of human errors to a far greater extent than the post-follow up questionnaire session. Community health workers can provide a variety of suggestion for fall injury prevention and highlight potential barriers to their implementation among their catchment area.

The contribution of an injury data registry system to injury surveillance in rural Iran: community health workers and health authorities views and concerns

Abstract: Background Injury prevention and control require that accurate data be continuously gathered, analysed and disseminated. A new injury data registry system has recently been piloted and is in the progress of being implemented in rural areas of Iran. This study aims at highlighting areas of consensus and of differences of opinion between different groups of stakeholders concerning the new registration systems potential for injury surveillance and control. Methods This interview-based study gathered the opinions of stakeholders from national, provincial, and district levels, including community health workers (called Behvarzes) concerning the acceptance, functioning and potential for injury prevention of the new system. The answers provided by all respondents except for the heads of villages are considered (64 Behvarzes and 27 other stakeholders). Attention was paid to the answers provided regarding the acceptance of the injury information system; the weaknesses and strengths identified, and the facilitators and barriers for it to be integrated into the work of the community health workers. Results Most Behvarzes (53 of 64) and about half of the other stakeholders (13 of 27) expressed positive opinions regarding their acceptance of the system. Consensuses between the two groups of respondents were stronger regarding the potential of the system to determine the incidence of specific types of injuries; and also the sex and age related injury distributions. Most interviewees also considered that the system could provide data of interest for future injury control and prevention. The facilitator of the system most frequently mentioned was the Behvarzes, who come from the local community and reside there. Nonetheless, their high workload and multiple tasks in the health house were regarded as likely barriers to their commitment to the system. Behvarzes mentioned that they would appreciate feed back about the information they gather, in the form of for example reports from upper level authorities, in particular about how that information affects injury control and prevention at community level.

The prevention and control of road traffic injuries in rural communities: input from community health workers in rural Twiserkan, Iran

Abstract: This study describes how preventing road traffic injuries (RTIs) in rural areas pose particular challenges. This study highlights potential countermeasures and barriers as identified by health workers responsible for local community health and safety matters. The study enrolled the rural health workers of the Twiserkan district of Iran, all of whom were trained for the purpose of prospectively compiling data on any severe injury occurring in their catchment population over a 6-month period. The health workers were also responsible for proposing preventive measures and identifying potential barriers. The data collection ended with a questionnaire session covering similar issues but addressed in more general terms. The health workers emphasized the adoption of safe behavior/practice as an important means for RTI prevention (90%), with a focus on motorcycle helmet use and compliance with traffic rules. Their suggestions covered the three Es: education, engineering and enforcement. They saw their own contribution as being health and safety educators and promoters and the barriers they identified dealt with both individual and environmental factors. The study showed that health workers are in a good position to identify both a variety of context-relevant countermeasures for RTI control and prevention and also the potential barriers to their implementation and uptake.