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Item Risk factors and causes of adult deaths in the Ifakara health and demographic surveillance system population, 2003-2007(2011-03-25) Narh-Bana, Solomon AyerteyIntroduction: The achievements of the United Nations’ millennium development goals (MDGs) are not possible in isolation. Adult health and mortality with the exception of maternal health is one of the health issues that were openly missing among the list of MDGs. But eradicating extreme poverty and hunger would not be possible if the economically active population is not supported to be healthy and to live longer. Little has been done on adult health, especially to reduce mortality as compared to child health. Adult mortality is expected to equal or exceed child mortality in sub-Saharan Africa if nothing is done. There are varying factors associated with specific-causes of adult deaths within and among different settings. Obtaining more and better data on adult deaths and understanding issues relating to adult deaths in Africa are crucial for long life and development. Objectives: The study seeks to (i) describe causes of adult mortality, (ii) estimate adult cause-specific mortality rates and trends and (iii) identify risk factors of cause-specific mortality in the Ifakara Health and Demographic Surveillance System (IHDSS) population from 2003 – 2007 among adults aged 15 – 59 years. Methodology: The data for the study was extracted from the database of the Ifakara Health and Demographic Surveillance System (IHDSS) in Tanzania from 2003-2007. It was an open cohort study. The cohort was selected based on age (15-59years) and active residency from 1st January 2003 to 31st December 2007. Survival estimates were computed using Kaplan-Meier survival technique and adult mortality rates were estimated expressed per 1000 person years observed (PYO). Verbal autopsy method was used to ascertain causes of deaths. Cox proportional hazards method was used to identify socio-demographic factors associated with specific-causes of adult deaths. v Findings: A total 65,548 adults were identified and followed up, yielding a total of 184,000 person years. A total of 1,352 deaths occurred during the follow-up. The crude adult mortality rate (AMR) estimated over the period was 7.3/1000PYO. There was an insignificant steady increase in annual AMR over the period. The AMR in 2007 increased by 11% over year 2003. Most people died from HIV/AIDS (20.4%) followed by Malaria (13.2%). The AMR for the period was 2.49 per 1000PYO for communicable disease (CD) causes, 1.21 per 1000PYO for non communicable disease (NCD) causes and 0.53 per 1000PYO for causes related to accidents/injuries. Over the study period, deaths resulting from NCDs increased significantly by 50%. The proportion of deaths due to NCDs in 2003 was 16% increasing to 24% in year 2007. Adult deaths from Accidents/Injuries were significantly higher among men (hazard ratio (HR) = 2.2) after adjusting for socioeconomic status (SES), level of education and household size. For communicable and NCDs, most people died at home while for Accidents/Injuries most people died elsewhere (neither home nor health facility). The risk factors that were found to be associated with adult deaths due to NCDs were age and level of education. An improvement in level of education saw a reduction in the risk of dying from NCDs ((HR(Primary)=0.67, 95%CI:0.49, 0.92) and (HR(beyond Primary)=0.11, 95%CI:0.02, 0.40) after adjusting for age and sex. Age, SES and “entry type” were the factors found to be associated with dying from communicable diseases among the adults. In-migrants were 1.7 times more likely to die from communicable disease causes than residents having adjusted for age, household size, educational level, employment status of the head of household and SES. Conclusion: HIV/AIDS is the leading cause of adult deaths in IHDSS area followed by malaria. Most adult deaths occurred outside health facility in rural areas. This could probably be explained by the health seeking behavior and or health care accessibility in vi the rural area of sub-Saharan Africa. NCDs are increasing as a result of demographic and epidemiological transitions taking place in most African countries including Tanzania. Without preventions the rural community in Tanzania will soon face increased triple disease burden; (CD), NCD and Accident/Injuries. Policies on accident/injury preventions in developing countries will be effective if based on local evidence and research.Item Risk factors associated with TB incidence in an adult population from poorly resourced South African urban communities with a high TB prevalence(2011-03-10) Ncayiyana, Jabulani RonnieIntroduction: Tuberculosis (TB) persists as a serious global public heath problem of a magnitude requiring urgent attention. The increase in new cases of TB in African countries where the prevalence of HIV is relatively low has been associated with other host and environmental factors. There is little or no comparable data on the association between host and environmental related factors and TB incidence in low HIV prevalence regions of South Africa. Objectives: This study aims to investigate host and environmental factors associated with incident TB in one region of South Africa. Methods: 3493 TB-free participants were recruited, and baseline data collected at the beginning of 2003 in the Lung Health Study in Ravensmead and Uitsig, Cape Town, South Africa. The TB register was used to identify new cases among the 3493 participants between 2003 and 2007. Results: Of the 3493 study participants, 109 developed TB; i.e. 57 males and 52 females. The incidence of TB in the Ravensmead and Uitsig study population was 632 per 100 000. Cohabiting, OR= 2.09 (95% CI= 1.05 - 4.17), smoking, OR= 2.19 (95% CI= 1.48 - 4.14), and history of imprisonment OR= 1.88 (95% CI= 1.09 - 3.23) were all statistically associated with TB incidence in multiple logistic regression models. The summary population attributable fraction for these three factors was 53.2%. Conclusions: TB incidence was high in this community. Cigarette smoking was one of the most important predictors of TB incidence, and the proportion of smokers in this population was relatively high. TB control and prevention strategies need to focus on interventions which will reduce or limit the impact of TB risk factors.Item Assessment of risk factors associated with maternal mortality in rural Tanzania(2010-10-14) Illah, Evance OumaBackground Complications of childbirth and pregnancy are leading causes of death among women of reproductive age. Worldwide, developing countries account for ninety-nine percent of maternal deaths. The United Nations’ fifth millennium development goal (MDG-5) is to reduce maternal mortality ratio by three fourths by 2015. Aim The aim of this study is to explore the levels, trends, causes and risk factors associated with maternal mortality as put forward by World Health Organization (WHO) in rural settings of Tanzania. Specific objectives To establish the trend of maternal mortality ratios in Rufiji health and demographic surveillance system (RHDSS) during the period 2002-2006. To determine the main causes of maternal deaths in RHDSS during the period 2002-2006. To determine the risk factors associated with maternal mortality RHDSS during the period 2002-2006. Method Secondary data analysis based on the longitudinal database from Rufiji Health and Demographic Surveillance System was used to study the risk factors and causes of maternal death. Data for a period of 5 years between 2002-2006 was used. A total of 26 427 women v aged 15-49 years were included in the study; 64 died and there were 15 548 live births. Cox proportional hazards regression was used to assess the risk factors associated with maternal deaths. Results Maternal mortality ratio was 412 per 100 000 live births. The main causes of death were haemorrhage (28%), eclampsia (19%) and puerperal sepsis (8%). Maternal age and marital status were associated with maternal mortality. An increased risk of 154% for maternal death was found for women aged 30-39 versus 15-19 years (HR=2.54, 95% CI=1.001- 6.445). Married women had a protective effect of 62% over unmarried ones (HR=0.38, 95% CI=0.176-0.839). These findings were statistically significant at the 5% level. Conclusion This analysis reinforced previous findings pointing to the fact that haemorrhage and eclampsia are the leading causes of maternal mortality in Tanzania and other developing countries. This indicates the need for better antenatal and obstetric care, particularly for women over thirty years of age, as well as implementing health care delivery strategies according to the regional specific risk factors of maternal deaths and not the global factors.Item Is the use of hormonal contraception a risk factor for incident sexually transmitted infections in a cohort of women aged 18 to 35 in Soweto, South Africa?(2010-09-21) Moyes, Jocelyn AnstieIntroduction This secondary data analysis of a prospective cohort study set out to describe the association between the use of hormonal contraception and sexually transmitted infection (STI) acquisition in a cohort of 752 HIV negative women who were followed up for a year. Methods Outcome variables were measured by standard laboratory tests (PCR for Chlamydia trachomatis (CT) and Neiserria gonorrhoea (NG), culture for Trichomonas vaginalis (TV) and gram stain with Nugent score for Bacterial Vaginosis (BV). Exposure variable information was collected by structured interview. Basic descriptive statistics were applied to describe the characteristics of the cohort, including a comparison of women who used contraception and those who did not. A time series analysis including incidence rates for the outcomes (CT, NG, TV and BV), Kaplan Meier curves for time to event measurement and Cox regression models (univariate and multivariate), for the estimation of risk were applied. Results The analysis found no significant difference between women who use hormonal contraception and those who did not with respect to baseline demographic characteristics. Incidence rates per 100 women years to follow up with 95% confidence intervals were: CT 13 (7 to 17), NG 2 (1 to 4), TV 6 (4 to10), BV 72 (63 to 83). Kaplan Meier curves showed no significant difference in time to event between women who used contraception and those who did not. Adjusted hazard ratios for women who used contraception was 1.12 (0.69 to1.82) for CT, 0.47 (0.17 to 1.30) for NG, 1.06 (0.48 to 2.34) for TV and 0.27 (0.05 to 1.52) for BV. Conclusion This analysis did not reveal any significant associations between the use of hormonal contraception and the acquisition of STIs, however the trends in risks follow those reported in the literature.Item Socio economic predictors of HIV infection among 14-35 years old in rural South Africa(2010-04-15T06:51:09Z) Fadahun, Oluwafolajimi OlusesiFocus in public health research is shifting to the role of socio-economic factors in the promotion of health. Hence, an understanding of the roles socio-economic factors plays in improving health and health-seeking behaviour is important for public health policy. This study examined the relationship between socio-economic factors and HIV infection in rural Limpopo Province South Africa, an area characterized by poverty differentials and migration. Various possible social and economic risk factors (such as nationality, education status, marital status, employment status, migration status and socio-economic status) for HIV infection are analysed and discussed. This is secondary data analysis was carried out during the period June 2001 to March 2005 among 2345 14-35 year old residents in eight (8) villages in rural Limpopo. Married participants (OR 0.53 [95%CI 0.28 – 1.00]), those from poor (OR 0.49 [95%CI 0.28-0.85]) and less poor households (0.38 [95%CI 0.21-0.70]) are less likely to contract HIV infection. Noteworthy from these analyses also is the increased risk for HIV infection seen among female participants, those not currently schooling (OR 1.9 [95%CI 1.2 – 3.3]) and non-South African citizens (OR 5.18 [95%CI 1.04-25.8]). Conclusion: Women, out-of school youths and non South African citizens are shown to be high-risk population groups for HIV infection. HIV prevention programs that target identified vulnerable population groups and increased social support for the family may contribute to mitigating the spread of HIV in rural South Africa.Item Risk factors for endometrial cancer among black South African women: a case control study(2010-04-13T11:32:34Z) Ali, Aus TariqIntroduction: Endometrial cancer is a gynaecological cancer that mostly affects women in their sixth and seventh decades of life. It is the fourth most common malignancy in women and ranks eighth among all causes of female cancer in terms of age-adjusted mortality. In developed and numerous developing countries endometrial cancer, as well as other types of cancer in women, is an ever-increasing threat that may be explained, among other reasons, by increased life expectancy and a reduction in fertility or birth rates. Conversely, in South Africa and most other African countries, the previous reasons do not exist, because there is a decline in life expectancy due to increased HIV, low income, and a high fertility rate. International epidemiological studies have established significant relationships between endometrial cancer and risk factors such as the woman’s age, race, early menarche and late menopause, parity, a history of breast or ovarian cancer, the use of endogenous estrogens, concomitant diabetes, family history of breast and ovarian cancer, estrogen therapy, obesity, and the use of tamoxifen. The aim of the study was to identify risk factors associated with endometrial cancer among black South African women. Method: The present case control study comprised black South African women diagnosed with a cancer in Johannesburg, between 1995 and 2005. The study included 592 women aged 27 to 90 years who were admitted to three main public hospitals in the city of Johannesburg with histologically confirmed cancers. 148 cases with endometrial cancer and 444 women with other forms of cancer were analysed. Only newly occurring cases (incident) were included. Women in the control group consisted of those with V cancers not associated with reproductive or hormonal factors, i.e. not cancers of the breast or the female reproductive system. Data handling, cleaning and analysis were done using Stata 9 (STATA). Results: Univariate analysis showed that the risk for endometrial cancer was significantly (P<0.05) affected by: miscarriages, the place of former residence, place of current residence, the use of snuff, wine consumption, age of the youngest child, diabetes, age of menarche, age of menopause, and menstrual status. Smoking was found to be a protective factor for endometrial cancer compared to other cancers. After multivariate adjustment, endometrial cancer risk was significantly (P<0, 05) associated with miscarriages, age at menarche, and earlier completion of childbearing. Smoking remained a protective factor against endometrial cancer. Conclusion: The current study reports similar results to those observed in other international investigations. The risk of endometrial cancer was higher among women who were older, women who experienced miscarriages, and those who fell pregnant early in their reproductive lives. Smoking was a protective factor against endometrial cancer compared to other cancers. However, comparing the cases of endometrial cancer with smoking-associated cancer controls (i.e. lung cancer, oesophageal cancer, and mouth cancer) might have distorted the results. A more appropriate control group for confirming the relationship between smoking and endometrial cancer would be subjects with no cancer. Also, it will be important to evaluate the risk factors for cancer among the other race groups in South Africa.Item Assessment of risk factors and transmission for HIV comparing discordant and concordant couples in Hlabisa Demographic Surveillance System (DSS) site.(2010-03-02T09:05:09Z) Adjei, GeorgeObjective To compare risk factors between HIV-positive concordant and discordant couples. Study design This is a cross-sectional secondary data analysis study using data from Africa Centre Demographic Information System (ACDIS) database (June 2003 to December 2004) and data from the first round of population-based HIV surveillance conducted by the Africa Centre for Health and Population Studies. Methods Eighty-five HIV-positive concordant couples (both partners were HIV-positive) and 73 discordant couples (one partner was HIV-positive and other partner HIV-negative) were identified and selected from the first round of population-based HIV surveillance conducted from June 2003 to December 2004 in Hlabisa Demographic Surveillance System site. Partners health and sexual behaviour data were collected together with the blood sample for HIV test during the same round. Socio-economic and demographic data of partners were obtained from the ACDIS database and were collected within the same period (June 2003 to December 2004). The behavioural, biological, demographic and socio-economic risk factors for HIVpositive concordance and transmission within discordant couples were analysed. Circumcision and area of residence respectively were the biological and demographic factors considered. Number of household assets was used as a proxy for socioeconomic status. The behavioural factors considered were male condom-use, sexual debut (age at first sex), number of lifetime partners and premarital partners. The age and educational level of partners were considered as potential confounders. 5 RESULTS The uncircumcised men were more likely to be in HIV-positive concordant couples than to be in discordant couples (OR =10.8, 95% CI [1.93 – 60.30], p=0.007). Partners living in urban area were 4.7 times more at risk of being in a HIV-positive concordant relationship than to be in discordant relationship (OR=4.7, 95% CI [2.09 - 10.39], p<0.001). Male not using condom on regular basis with female partners, early sexual debut, greater number of premarital partners, household assets and lifetime partners were found not to be significantly associated with HIV-positive concordance. Conclusion There are several biologic, socio-economic, demographic and behavioural risk factors for HIV-positive concordance. However, identifying some of them might be used to address transmission of HIV among discordant couples through intervention programs. Although cross-sectional studies are not ideal for establishing temporality, this study corroborates the findings of other studies that living in urban areas and circumcision are associated with HIV transmission.Item Housing-related risk factors for respiratory disease in low cost housing settlements in Johannesburg, South Africa(2008-10-17T09:34:13Z) Makene, ChristinaRapid migration of people to the urban areas of developing countries resulted in a shortage of housing and the location of people in poor housing and unhealthy environments. Studies have shown that people who live in poor housing are at increased risk of exposure to the determinants of respiratory diseases. Objective: This study investigated the influence of housing conditions on respiratory disease in selected low cost housing settlements in Johannesburg, South Africa. Methodology: Secondary data analysis based on the Health, Environment and Development (HEAD) cross-sectional study were used to explore housing conditions in relation to respiratory health. Results: Black African households comprised (77%) the major population group in the study. The overall mean number of people per household was five with household size ranging from 1 to 22 people permanently living in the household. Most of the households (48%) had an average monthly income of R1001 to R2000. The self reported household prevalence of asthma was highest among households in Riverlea (21%). Households in Riverlea had reported higher levels of asthma 33% relative to households in Bertrams. Hairdressing activities within dwellings increased the risk of asthma (OR: 2.89, 95% CI 1.46-5.73). Tuberculosis was associated with household size (OR 0.9, 95% CI 0.79 – 0.99) and smoking (OR 0.4 CI 0.12 - 0.96) in the univariate analysis. However in the multivariate analysis there was no significant association between tuberculosis with household size (OR 0.92, 95% CI 0.80 - 1.05) or smoking (OR 0.03, 95% CI 0.12 – 1.00). Conclusion: In this study housing quality was an important determinant of respiratory health. More intervention strategies need to be employed to improve the living environment. These include increasing awareness and education to the public and other sectors, source reduction and more guidelines for healthy housing. Finally, more research on housing and health is needed to determine the effect of housing on health.Item Hormonal contraceptives as a risk factor for invasive breast cancer in black women in Johannesburg, South Africa(2008-10-10T11:21:34Z) Rubanzana, WilsonBackground: Black South African women are known to have a high usage rate of injectable contraceptives. Breast cancer is the second leading cancer after malignant cervical neoplasms in black South African women. There is evidence that sex hormones are associated with an increased risk of developing breast cancer. In the Western Cape, investigators suggested that injectable contraceptives, more specifically DMPA, may increase breast cancer risk. In another study conducted in the same province, a weak association between breast cancer and women taking combined oestrogen/progesterone oral contraceptives was found, though no risk associated with injectable progestogen contraceptives (DMPA) was confirmed. Study Objective: This study aimed to determine whether there is an association between hormonal contraceptive use and an increased risk of cancer of the breast. Methods: Data was obtained from an ongoing case control study set up by MRC/Wits/NHLS Cancer Epidemiology Research Group (CERG) in 1995 to investigate risk factors associated with cancer among the black population in Johannesburg. Data was processed using STATA, version8 and analysed using univariate, bivariate and multivariate unmatched logistic regression models. Results: There was evidence that an overall use of oral contraceptives increases the risk of breast cancer; cases (n= 221), controls :( n= 153), OR=2.01 (95% CI:1.45, 2.80), p<0.0001. There was evidence of an association between use of injectable contraception and the risk of breast cancer; cases (n=244), controls (n=202), OR=1.51(CI: 1.14, 2.01),p=0.004 Surprisingly, no other use characteristic of either hormonal contraceptive method was statistically significantly associated with the risk of breast cancer in our dataset. The combined use of both oral and injectable contraception was associated with an increased risk of breast cancer, OR=1.68(1.21, 2.33), p =0.002. There was a strong effect modification (interaction) between oral contraceptive use and injectable progesterone associated with the risk of breast cancer, (p=0.008). Conclusion: After adjusting for all potential risk and confounding factors, as collected in the dataset, there was evidence of an association between combined oral contraceptive use and breast cancer. An association between cancer of the breast and overall use of injectable progesterone use was also established. There was evidence of association between the use of both hormonal contraceptive methods and an increased risk of breast cancer. However, whether these findings reflect the reality in terms of causal relationship or are the result of bias must be ascertained.Item A prospective comparative study of potential risk factors between Ludwig's angina and localised odontogenic abscesses(2008-05-15T07:05:28Z) Chettiar, Thoganthiren PerumalABSTRACT Odontogenic abscesses and Ludwig’s angina are infections commonly seen by maxillofacial surgeons. Both infections have periapical or periodontal origin and caused by oral bacteria. Ludwig’s angina is an aggressive and fast spreading infection compared to odontogenic abscess. The origin and the responsible bacteria of these infections are similar but the development and response is different in patients. There is no comprehensive study that has investigated the bacterial and host factors involved in the development of there infections. The aim of this study was to compare the presence of bacteria and enzymes in to the pus samples collected from patients with odontogenic abscess and Ludwig’s angina. Furthermore, various haematological and immunological tests were also compared between the two study groups. Forty two patients presenting with localized odontogenic abscesses and 15 with Ludwig’s angina were selected. Patient was examined according to standard protocol and history was recorded. Bloods were collected for haematology and immunology tests and pus was collected for microbiology and enzymatic tests. The results showed that highly virulent bacteria such as Staphylococcus aureus and black pigmented bacteroides were prevalent, increase in c-reactive protein, white blood cell count, IL6 and decrease in urea, circulating immune complexes and IgE in patients with Ludwig’s angina. Development of Ludwig’s angina could be due to the aggressive bacteria, their byproducts and low immune response compared to the odontogenic abscesses.