Snakebite mortality in India: a nationally representative mortality survey

Background

India has long been thought to have more snakebites than any other country. However, inadequate hospital-based reporting has resulted in estimates of total annual snakebite mortality ranging widely from about 1,300 to 50,000. We calculated direct estimates of snakebite mortality from a national mortality survey.

Methods and Findings

We conducted a nationally representative study of 123,000 deaths from 6,671 randomly selected areas in 2001–03. Full-time, non-medical field workers interviewed living respondents about all deaths. The underlying causes were independently coded by two of 130 trained physicians. Discrepancies were resolved by anonymous reconciliation or, failing that, by adjudication.A total of 562 deaths (0.47% of total deaths) were assigned to snakebites. Snakebite deaths occurred mostly in rural areas (97%), were more common in males (59%) than females (41%), and peaked at ages 15–29 years (25%) and during the monsoon months of June to September. This proportion represents about 45,900 annual snakebite deaths nationally (99% CI 40,900 to 50,900) or an annual age-standardised rate of 4.1/100,000 (99% CI 3.6–4.5), with higher rates in rural areas (5.4/100,000; 99% CI 4.8–6.0), and with the highest state rate in Andhra Pradesh (6.2). Annual snakebite deaths were greatest in the states of Uttar Pradesh (8,700), Andhra Pradesh (5,200), and Bihar (4,500).

Conclusions

Snakebite remains an underestimated cause of accidental death in modern India. Because a large proportion of global totals of snakebites arise from India, global snakebite totals might also be underestimated. Community education, appropriate training of medical staff and better distribution of antivenom, especially to the 13 states with the highest prevalence, could reduce snakebite deaths in India.     

Respiratory tract mortality in cement workers: a proportionate mortality study

Background

The evidence regarding the association between lung cancer and occupational exposure to cement is controversial. This study investigated causes of deaths from cancer of respiratory tract among cement workers.

Methods

The deaths of the Greek Cement Workers Compensation Scheme were analyzed covering the period 1969-1998. All respiratory, lung, laryngeal and urinary bladder cancer proportionate mortality were calculated for cement production, maintenance, and office workers in the cement industry. Mortality from urinary bladder cancer was used as an indirect indicator of the confounding effect of smoking.

Results

Mortality from all respiratory cancer was significantly increased in cement production workers (PMR?=?1.91; 95% CI 1.54 to 2.33). The proportionate mortality from lung cancer was significantly elevated (PMR?=?2.05; 95% CI 1.65 to 2.52). A statistically significant increase in proportionate mortality due to respiratory (PMR?=?1.7; 95% CI 1.2 to 2.34). and lung cancer (PMR?=?1.67;95% CI?=?1.15-2.34) among maintenance workers has been observed. The PMR among the three groups of workers (production, maintenance, office) did differ significantly for lung cancer (p?=?0.001), while the PMR for urinary bladder cancer found to be similar among the three groups of cement workers.

Conclusion

Cement production, and maintenance workers presented increased lung and respiratory cancer proportionate mortality, and this finding probably cannot be explained by the confounding effect of smoking alone. Further research including use of prospective cohort studies is needed in order to establish a causal association between occupational exposure to cement and risk of lung cancer.     

Infant mortality in Sri Lanka

Infant mortality in Sri Lanka declined substantially between 1961 and 1980, the reduction being higher during the post-natal period. 3 distinct phases were identified: 1) a declining trend in the face of several fluctuations; 2) a sharp reversal of the trend and then an increase; and 3) a more consistent decline. Between the periods 1961-65 and 1976-80, deaths from exogenous and endogenous causes were reduced considerably and nearly equally. The probabilities of survival increased in every age group, proportionally more in the 1st week of life. There was no evidence that changes in national income or total food supply were factors, but protein calorie availability appeared to affect the rate. Distribution of free supplementary food, increase in public health personnel, more immunization, and a rise in the number of institutional births appeared to have initiated and sustained the more recent decline in infant mortality. Increasing levels of female education also augmented these developments. Further efforts to improve living conditions, access to safe water and flush or water-seal toilets, and motivating women to deliver in institutions and extend their postnatal stay, would probably result in a further decline, as well as general strategies such as integrating public health and medical services and improving health education programs.     

Childhood cancer mortality in Australia

Aim: To determine current rates of childhood cancer mortality at a national level for Australia and to evaluate recent trends. Methods: Using population-based data from the Australian Paediatric Cancer Registry, we calculated cancer-related mortality counts and rates for the 3-year period 2006-2008 and trends between 1998 and 2008 by sex, age group, and cause of death (defined according to the International Classification of Childhood Cancers, third edition). Rates were directly age-standardised to the 2000 World Standard Population, and linear regression was used to determine the magnitude and significance of trends. The standardised mortality ratio for non-cancer deaths among children with cancer was also estimated. Results: A total of 282 children (23 per million per year) died from cancer in Australia between 2006 and 2008. Large decreases were observed in cancer mortality rates over the study period, particularly for boys (-5.5% per year; p<0.001), children aged 10-14 years old (-5.5% per year; p=0.001), and leukaemia patients (-9.4% per year; p<0.001). However, there was no significant change in mortality due to tumours of the central nervous system. Children with cancer were twice as likely to die from non-cancer causes compared to other children (SMR=2.06; p=0.001). Conclusions: While ongoing improvements in childhood cancer mortality in Australia are generally encouraging, of concern is the lack of a corresponding decrease in mortality among children with certain types of tumours of the central nervous system during the past decade. The results also highlight the need for intensive monitoring of childhood cancer patients for other serious diseases that may subsequently arise.     

Sibling mortality correlation in Kenya

This paper examines whether infant and child mortality risks among successive siblings are closely correlated, and if so, whether the survival status of the preceding child is an important factor affecting infant and child mortality in Kenya. The data were drawn from the 1988/89 Kenya Demographic and Health Survey. Logistic regression was used as the major method of data analysis. The results show that both infant and child mortality rates are significantly higher among subsequent children whose preceding siblings had died in infancy than for those whose preceding sibling had survived through infancy. The effect of the survival status of the preceding child on infant mortality was statistically strong, even after a large number of control variables were taken into account. However, its effect on child mortality appears to be spurious since it was rendered statistically insignificant when just a few control variables were introduced into the analysis. The results provide empirical evidence that infant and child mortality risks among successive siblings are closely correlated in Kenyan families, and that the effect of the survival status of the preceding child is important in determining infant mortality but not child mortality.     

Mormon mortality rates in Canada

Abstract

In the United States, Mormons have been shown to have lower incidence and mortality rates of cancer and other diseases than the general population, a fact which has been attributed to the life style prescribed by the Mormon Church, including abstinence from tobacco, alcohol, coffee, and tea. This study examines Mormon cause‐specific mortality rates in Alberta, Canada, compared to rates for the general population of Alberta and of all Canada. Mormon death rates for most causes were lower than those for Alberta, which are themselves lower than Canadian rates. Mormon death rates for males were higher than for females for most causes, but male and female death rates were more similar among Mormons than in the general population. Causes of death for which Mormons have an average or higher than average risk are either less frequent causes or are less clearly related to dietary habits. Mormons have disproportionately low death rates for many causes which are not clearly related to the use of tobacco, alcohol, coffee, or tea. Further research is needed on the specific effects of different life‐style components and on the possible biological selectivity of the group.