Maternal death surveillance efforts: notification and review coverage rates in 30 low-income and middle-income countries, 2015-2019

Objective
Performance of maternal death surveillance and response (MDSR) relies on the system’s ability to identify and notify all maternal deaths and its ability to review all maternal deaths by a committee. Unified definitions for indicators to assess these functions are lacking. We aim to estimate notification and review coverage rates in 30 countries between 2015 and 2019 using standardised definitions.

Design
Repeat cross-sectional surveys provided the numerators for the coverage indicators; United Nations (UN)-modelled expected country maternal deaths provided the denominators.

Setting
30 low-income and middle-income countries responding to the Maternal Health Thematic Fund annual surveys conducted by the UN Population Fund between 2015 and 2019.

Outcome measures
Notification coverage rate () was calculated as the proportion of expected maternal deaths that were notified at the national level annually; review coverage rate () was calculated as the proportion of expected maternal deaths that were reviewed annually.

Results
The average annual for all countries increased from 17% in 2015 to 28% in 2019; the average annual increased from 8% to 13%. Between 2015 and 2019, 22 countries (73%) reported increases in the —with an average increase of 20 (SD 18) percentage points—and 24 countries (80%) reported increases in by 7 (SD 11) percentage points. Low values of contrasts with country-published review rates, ranging from 46% to 51%.

Conclusion
MDSR systems that count and review all maternal deaths can deliver real-time information that could prompt immediate actions and may improve maternal health. Consistent and systematic documentation of MDSR efforts may improve national and global monitoring. Assessing the notification and review functions using coverage indicators is feasible, not affected by fluctuations in data completeness and reporting, and can objectively capture progress.

Leggi
Febbraio 2023

Content analysis of Dutch newspaper coverage of three tobacco control policies, 2017-2019

Objectives
News media coverage can influence support for and implementation of tobacco control policies. This research aims to analyse and compare newspaper coverage of newly implemented policies: a substantial tobacco tax increase, point-of-sale display ban and plain packaging.

Design
We conducted a content analysis of articles covering the three policies from ten national Dutch newspapers. Articles published between November 2017 and November 2019 were coded for type and tone. The policy dystopia model was used to code arguments opposing the policies. Tobacco industry appearances in news articles were also analysed for frequency and type.

Results
A total of 134 news articles were analysed, of which the industry appeared in 28%. The majority of coverage was neutral in tone, although among articles that were coded as expressing a positive or negative tone, plain packaging and the point-of-sale ban were portrayed more negatively than positively. Negative coverage was predominantly accounted for by industry presence. Arguments opposing the policies focused on negative economic consequences, challenging the need for policy and adverse consequences for retailers for tax, plain packaging and the point-of-sale display ban, respectively. We identified six specific new arguments that fit within existing domains of the policy dystopia model.

Conclusions
The tobacco industry and its allies still appear in a substantial proportion of news articles in relation to tobacco policy. This study identifies contemporary industry arguments against tobacco control policies in Europe which, alongside the policy dystopia model, can be used to predict and counter the tobacco industry’s future attempts to oppose policies.

Leggi
Febbraio 2023

Trends in mortality related to unintentional poisoning in the South Asian region from 1990 to 2019: analysis of data from the Global Burden of Disease Study

Objective
This study aimed to estimate the burden of unintentional poisoning in South Asian countries from 1999 to 2019.

Design
An ecological study conducted at the regional level for South Asian countries, based on data from the Global Burden of Disease Study 2019.

Setting
We extracted unintentional poisoning data from the Global Burden of Disease Study data set from 1990 to 2019 to assess trends in mortality, disability-adjusted life-years (DALYs), years of life lost, years lived with disability (YLDs) and causative agents in South Asian countries (Bangladesh, Bhutan, India, Nepal and Pakistan).

Outcome measures
We determined the per cent change and 95% CI for the period between 1990 and 2019 by age, gender and country. We also conducted Poisson regression to measure the percentage change in the rate per year.

Results
The absolute number of deaths due to unintentional poisoning in South Asia decreased (–32.6%) from 10 558 deaths in 1990 to 7112 deaths in 2019. The age standardised death rate from unintentional poisoning in South Asia has seen a downward trend (–55.88%), declining from 0.87 (0.67–1.01) age-standardised per 100 000 population in 1990 to 0.41 (0.34–0.47) in 2019. Among age groups, under 9 years and 10–19 years have seen downward trends for death and DALYs, accounting for –93.5% and –38.3%, respectively. YLDs have seen an upward trend (5.9%), increasing from 10 461.7 per 100 000 in 1990 to 11 084 per 100 000 in 2019. YLDs in women increased by 7.4%, from 11 558.2 per 100 000 to 12 418.3 per 100 000. The incidence rate ratios (IRRs) adjusted by all age groups and gender for DALYs in all South Asian countries has reduced significantly (IRR 0.97, 95% CI 0.96 to 0.97) from 1990 to 2019.

Conclusion
This study showed reduction in death and DALYs due to unintentional poisoning in South Asia except YLDs which is showing an increasing trend. Public health systems should continue efforts to minimise and prevent disabilities arising from unintentional poisoning in South Asia.

Leggi
Febbraio 2023