scholarly journals Representative estimates of COVID-19 infection fatality rates from four locations in India: cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e050920
Author(s):  
Rebecca Cai ◽  
Paul Novosad ◽  
Vaidehi Tandel ◽  
Sam Asher ◽  
Anup Malani
Keyword(s):  
Low Income ◽  
Tamil Nadu ◽  
Large Population ◽  
Cross Sectional Study ◽  
High Income ◽  
Income Country ◽  
Secondary Outcome ◽  
Sectional Study ◽  
Cross Sectional ◽  
Increased Risk

ObjectivesTo estimate age-specific and sex-specific mortality risk among all SARS-CoV-2 infections in four settings in India, a major lower-middle-income country and to compare age trends in mortality with similar estimates in high-income countries.DesignCross-sectional study.SettingIndia, multiple regions representing combined population >150 million.ParticipantsAggregate infection counts were drawn from four large population-representative prevalence/seroprevalence surveys. Data on corresponding number of deaths were drawn from official government reports of confirmed SARS-CoV-2 deaths.Primary and secondary outcome measuresThe primary outcome was age-specific and sex-specific infection fatality rate (IFR), estimated as the number of confirmed deaths per infection. The secondary outcome was the slope of the IFR-by-age function, representing increased risk associated with age.ResultsAmong males aged 50–89, measured IFR was 0.12% in Karnataka (95% CI 0.09% to 0.15%), 0.42% in Tamil Nadu (95% CI 0.39% to 0.45%), 0.53% in Mumbai (95% CI 0.52% to 0.54%) and an imprecise 5.64% (95% CI 0% to 11.16%) among migrants returning to Bihar. Estimated IFR was approximately twice as high for males as for females, heterogeneous across contexts and rose less dramatically at older ages compared with similar studies in high-income countries.ConclusionsEstimated age-specific IFRs during the first wave varied substantially across India. While estimated IFRs in Mumbai, Karnataka and Tamil Nadu were considerably lower than comparable estimates from high-income countries, adjustment for under-reporting based on crude estimates of excess mortality puts them almost exactly equal with higher-income country benchmarks. In a marginalised migrant population, estimated IFRs were much higher than in other contexts around the world. Estimated IFRs suggest that the elderly in India are at an advantage relative to peers in high-income countries. Our findings suggest that the standard estimation approach may substantially underestimate IFR in low-income settings due to under-reporting of COVID-19 deaths, and that COVID-19 IFRs may be similar in low-income and high-income settings.

scholarly journals 4086 HIV-Associated Myocardial Diastolic Dysfunction and Soluble ST2 Concentration in Tanzanian Adults: A Cross-Sectional Study

2020 ◽  
Vol 4 (s1) ◽  
pp. 96-96
Author(s):  
Justin Kingery ◽  
Rahul Hosalli ◽  
Bernard Desdarius ◽  
Fredrick Kalokola ◽  
Edmund Damas ◽  
...  
Keyword(s):  
Diastolic Dysfunction ◽  
Large Population ◽  
Cross Sectional Study ◽  
Sub Saharan Africa ◽  
Secondary Outcome ◽  
Level Shift ◽  
Sectional Study ◽  
Cross Sectional ◽  
Baseline Serum ◽  
Soluble St2

OBJECTIVES/GOALS: To determine the prevalence of myocardial diastolic dysfunction (DD) and association of serum concentration of the cardiac biomarker serum soluble ST2 in HIV-infected as compared to uninfected Tanzanian adults at the time of HIV diagnosis. METHODS/STUDY POPULATION: In this cross-sectional study we consecutively enrolled HIV-infected participants and uninfected controls at a large, referral HIV clinic in Mwanza, Tanzania. Standardized history, physical examination, echocardiography and serum samples were obtained. The primary outcome was prevalence of myocardial diastolic dysfunction in HIV-infected as compared to uninfected adults. The secondary outcome was the association of baseline serum sST2 concentration with diastolic dysfunction prevalence. Regression models were used to quantify the associations. RESULTS/ANTICIPATED RESULTS: We enrolled 388 HIV-infected, ART naïve and 461 HIV-uninfected controls. Participants with HIV had a higher prevalence of DD (OR = 2.44, p = 0.001, controlled for age, sex, hypertension and BMI) and more severe dysfunction (66.7% vs 42.5%, p = 0.056) at an earlier age. Baseline serum sST2 concentration was significantly associated with DD in HIV-infected but not uninfected participants (p = 0.04 and 0.90, respectively). More HIV-infected adults with concurrent DD exceeded the threshold of 35ng/mL as compared to controls (15.7% vs 5.3%, p<0.0001). Additionally, a significant population level shift to higher sST2 concentration was observed in HIV-infected adults with dysfunction as compared to both HIV-infected without and HIV-uninfected adults with dysfunction (Kolmogrov-Smirnov test: p = 0.02 and 0.04). DISCUSSION/SIGNIFICANCE OF IMPACT: In a large population of HIV-infected adults in sub-Saharan Africa, HIV infection is associated with myocardial diastolic dysfunction. This dysfunction is associated with higher sST2 concentrations. Therefore, we conclude that the sST2 pathway may provide insight into the pathophysiologic mechanisms of dysfunction in HIV-infected adults.

scholarly journals Income-based inequalities in self-reported moderate-to-vigorous physical activity among adolescents in England and the United States: a cross-sectional study

2020 ◽  
Author(s):  
Shaun Scholes ◽  
Jennifer S Mindell
Keyword(s):  
Physical Activity ◽  
Low Income ◽  
Vigorous Physical Activity ◽  
The United States ◽  
Cross Sectional Study ◽  
High Income ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Us ◽  
Low Income Households

Objective: Quantify inequalities in self-reported moderate-to-vigorous physical activity (MVPA) in England and the United States (US). Design: Population-based cross-sectional study. Participants: 4019 adolescents aged 11-15 years in England (Health Survey for England 2008, 2012, 2015) and 4312 aged 12-17 years in the US (National Health and Nutrition Examination Survey 2007-16). Main outcome measures: Three aspects of MVPA: (1) doing any, (2) average min/day (MVPA: including those who did none), and (3) average min/day conditional on participation (MVPA-active). Using hurdle models, we quantified inequalities (average marginal effects: AMEs) using the absolute difference in marginal means. Results: In England, adolescents in high-income households were more likely than those in low-income households to have done any formal sports/exercise in the last seven days (boys: 11%; 95% CI: 4% to 17%; girls: 13%; 95% CI: 6% to 20%); girls in high-income households did more than their low-income counterparts (MVPA: 6 min/day, 95% CI: 2 to 9). Girls in low-income households spent more time in informal activities than girls in high-income households (MVPA: 21 min/day; 95% CI: 10 to 33), whilst boys in low-income versus high-income households spent longer in active travel (MVPA: 21 min/week; 95% CI: 8 to 34). In the US, in a typical week, recreational activity was greater among high-income versus low-income households (boys: 15 min/day; 95% CI: 6 to 24 min/day; girls: 19 min/day; 95% CI: 12 to 27). In contrast, adolescents in low-income versus high-income households were more likely to travel actively (boys: 11%; 95% CI: 3% to 19%; girls: 10%; 95% CI: 3% to 17%) and do more. Conclusions: Policy actions and interventions are required to increase MVPA across all income groups in England and the US. Differences in formal sports/exercise (England) and recreational (US) activities suggest that additional efforts are required to reduce inequalities.

scholarly journals Parental acceptance and knowledge of varicella vaccination in relation to socioeconomics in Sweden: A cross-sectional study

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0256642
Author(s):  
Lisen Arnheim-Dahlström ◽  
Natalie Zarabi ◽  
Karin Hagen ◽  
Goran Bencina
Keyword(s):  
Low Income ◽  
Varicella Vaccine ◽  
Cross Sectional Study ◽  
High Income ◽  
Parental Acceptance ◽  
Varicella Vaccination ◽  
Sectional Study ◽  
Varicella Infection ◽  
Cross Sectional ◽  
Mild Disease

Varicella infection is a highly contagious disease which, whilst mild in most cases, can cause severe complications. Varicella vaccination is available privately in Sweden and is currently being reviewed for inclusion in the Swedish Public Health Agency’s national immunisation program (NIP). A cross-sectional study of parents of Swedish children aged 1–8 years (n = 2212) was conducted to understand parental acceptance, beliefs and knowledge around varicella infection and vaccination. Respondents generally viewed varicella infection as a mild disease, with only a small proportion aware of potential severe complications. While 65% of respondents were aware of the vaccine, only 15% had started the course of vaccination as of February 2019. Further, 43% of parents did not intend to vaccinate, most commonly due to lack of inclusion in the NIP, but also due to perception of mild disease. Nevertheless, if offered within the NIP, 85% of parents would be highly likely to vaccinate their child. A number of statistically significant differences in awareness and behaviours were observed between sociodemographic subgroups. In general, women were more aware of vaccination (72%) compared to men (58%). Among unemployed or respondents with elementary school education, awareness was below 43%, and among respondents with high income the awareness was above 75%. Similarly, among unemployed or respondents with a low income the vaccination rate was as low as 30% compared with at least 57% among respondents with a high income. Respondents from metropolitan areas, those with university degrees and respondents with a higher income were more likely to be aware of the varicella vaccine and to have vaccinated their child. Whilst inclusion in the NIP is clearly the main driver for uptake, these identified knowledge gaps should inform educational efforts to ensure that all parents are informed of the availability and benefits of the varicella vaccine independent of socioeconomic status.

scholarly journals Quality of pediatric anesthesia: A cross-sectional study of a university hospital in a low-income country

PLoS ONE ◽  
2018 ◽  
Vol 13 (4) ◽  
pp. e0194622
Author(s):  
Oskar Andersson ◽  
Peter Radell ◽  
Victor Ringo ◽  
Moses Mulungu ◽  
Tim Baker
Keyword(s):  
Low Income ◽  
Pediatric Anesthesia ◽  
Cross Sectional Study ◽  
Income Country ◽  
University Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Low Income Country

scholarly journals Prevalence of psoriasis and associated risk factors in China: protocol of a nationwide, population-based, cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e027685 ◽  
Author(s):  
Jing Li ◽  
Meiwen Yu ◽  
Ya-wen Wang ◽  
Jia-an Zhang ◽  
Mei Ju ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Income ◽  
Sampling Design ◽  
Population Based ◽  
Cross Sectional Study ◽  
World Health ◽  
Sectional Study ◽  
Cross Sectional ◽  
World Health Assembly Resolution ◽  
Increased Risk

IntroductionPsoriasis is a chronic inflammatory skin disease which could lead to serious complications and increased risk of cardiovascular diseases. Psoriasis was recognised as a serious non-communicable disease with important public health impact by member states in the World Health Assembly resolution in 2014. However, data on psoriasis epidemiology are scarce worldwide, especially from low-income and middle-income countries. Only a few epidemiological studies on psoriasis have been conducted in parts of China, mostly without appropriate sampling design and data analysis.AimThis study aims to obtain the prevalence of psoriasis in China and relevant risk factors through a nationwide, population-based study with adequate statistical design.Methods and analysisThis is a cross-sectional study to be conducted in 60 sites across China. A multistage, cluster random sampling design is used. Participants should have local household registration or be residing in the survey area for at least 6 months during the past year. The presence of psoriasis is ascertained independently by two certified dermatologists. If any discrepancies in the diagnosis occur, consensus will be met via discussion. All participants will be interviewed with a questionnaire to collect sociodemographic and disease information. The field survey will be implemented from October 2018 to June 2019. All statistical analyses will be conducted using survey procedures in SAS V.9.2 software to adjust for the complex sample design.Ethics and disseminationThe study has been reviewed and approved by the ethics committee of the Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College (Nanjing, China). A written informed consent will be obtained from all participants before the questionnaire survey. Findings of the study will be disseminated through publications in peer-reviewed journals.

scholarly journals Incidence and associated factors of extrauterine growth restriction (EUGR) in preterm infants, a cross-sectional study in selected NICUs in Ethiopia

2020 ◽  
Vol 4 (1) ◽  
pp. e000765
Author(s):  
Netsanet Workneh Gidi ◽  
Robert L Goldenberg ◽  
Assaye K Nigussie ◽  
Elizabeth McClure ◽  
Amha Mekasha ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Low Income ◽  
Associated Factors ◽  
Cross Sectional Study ◽  
Growth Restriction ◽  
Sectional Study ◽  
Cross Sectional ◽  
Increased Risk ◽  
Extrauterine Growth Restriction

BackgroundPreterm infants have high risk of developing growth restriction and long-term complications. Enteral feeding is often delayed in neonatal intensive care units (NICUs) for the fear of feeding intolerance and the associated necrotising enterocolitis, and recent advances in nutritional support are unavailable in low-income countries.ObjectiveThe aim of this study was to assess the incidence and associated factors of extrauterine growth restriction (EUGR) among preterm infants in selected NICUs in Ethiopia.MethodThis was a cross-sectional study involving a subgroup analysis of preterm infants admitted to hospitals, from a multicentre descriptive study of cause of illness and death in preterm infants in Ethiopia, conducted from 2016 to 2018. EUGR was defined as weight at discharge Z-scores <−1.29 for corrected age. Clinical profiles of the infants were analysed for associated factors. SPSS V.23 software was used for analysis with a significance level of 5% and 95% CI.ResultFrom 436 preterm infants included in the analysis, 223 (51%) were male, 224 (51.4%) very low birth weight (VLBW) and 185 (42.4%) small for gestational age (SGA). The mean (SD) of weight for corrected age Z-score at the time of discharge was −2.5 (1.1). The incidence of EUGR was 86.2%. Infants who were SGA, VLBW and longer hospital stay over 21 days had increased risk of growth restriction (p-value<0.01). SGA infants had a 15-fold higher risk of developing EUGR at the time of discharge from hospital than those who were appropriate or large for gestational age (OR (95% CI)=15.2 (4.6 to 50.1).ConclusionThe majority of the infants had EUGR at the time of discharge from the hospital, which indicates suboptimal nutrition. Revision of national guidelines for preterm infants feeding and improvement in clinical practice is highly required.

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