Reduced case fatality among hospitalized children during a war in Guinea-Bissau: a lesson in equity

BackgroundStillbirth rates remain high in many low-income settings, with fresh (intrapartum) stillbirths accounting for a large part due to limited obstetrical care. We aimed to determine the stillbirth rate and identify potentially modifiable factors associated with stillbirth in urban Guinea-Bissau.MethodsThe study was carried out by the Bandim Health Project (BHP), a Health and Demographic Surveillance System site in the capital Bissau. We assessed stillbirth rates in a hospital cohort consisting of all deliveries at the maternity ward at the National Hospital Simão Mendes (HNSM), and in a community cohort, which only included women from the BHP area. Stillbirth was classified as fresh (FSB) if fetal movements were reported on the day of delivery.ResultsFrom October 1 2007 to April 15 2013, a total of 38164 deliveries were registered at HNSM, among them 3762 stillbirths (99/1000 births). Excluding deliveries referred to the hospital from outside the capital (9.6%), the HNSM stillbirth rate was 2786/34490 births (81/1000). During the same period, 15462 deliveries were recorded in the community cohort. Of these, 768 were stillbirths (50/1000).Of 11769 hospital deliveries among women from Bissau with data on fetal movement, 866 (74/1000) were stillbirths, and 609 (70.3%) of these were FSB, i.e. potentially preventable. The hospital FSB rate was highest in the evening from 4 pm to midnight (P = 0.04). In the community cohort, antenatal care (ANC) attendance correlated strongly with stillbirth reduction; the stillbirth rate was 71/1000 if the mother attended no ANC consultations vs. 36/1000 if she attended ≥7 consultations (P<0.001).ConclusionIn Bissau, the stillbirth rate is alarmingly high. The majority of stillbirths are preventable FSB. Improving obstetrical training, labour management (including sufficient intrapartum monitoring and timely intervention) and hospital infrastructure is urgently required. This should be combined with proper community strategies and additional focus on antenatal care.

show abstract

“…At the adjacent paediatric ward, the mere presence of dedicated staff has been associated with lower child mortality[ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Stillbirths in urban Guinea-Bissau: A hospital- and community-based study

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Four studies reported on urban, non-displaced populations living in armed conflict areas, of which one covered the acute emergency period (Bissau, Guinea Bissau, 1998-1999) [45] and three the post-emergency or early recovery period (Kabul [46] and Herat [47], Afghanistan, 2002-2003; Monrovia, Liberia, 2005 [48]).…”

Section: Resultsmentioning

confidence: 99%

“…The highest CFRs were noted among Sudanese refugees in Uganda (>30% in all but the youngest age group). In a paediatric ward in Guinea Bissau, pre-war CFR due to all diseases, and adjusted for various confounders, was higher than during the period of active fighting, possibly due to increased equity of care and availability of free drugs during the ensuing humanitarian response; the pneumonia CFR showed a similar trend (17.2% before the war, 13.1% during) [45]. This is unlikely to be due to self-selection of milder cases, as bed occupancy was actually higher during the war period.…”

Section: Resultsmentioning

confidence: 99%

The burden of acute respiratory infections in crisis-affected populations: a systematic review

et al. 2010

View full text Add to dashboard Cite

Crises due to armed conflict, forced displacement and natural disasters result in excess morbidity and mortality due to infectious diseases. Historically, acute respiratory infections (ARIs) have received relatively little attention in the humanitarian sector. We performed a systematic review to generate evidence on the burden of ARI in crises, and inform prioritisation of relief interventions. We identified 36 studies published since 1980 reporting data on the burden (incidence, prevalence, proportional morbidity or mortality, case-fatality, attributable mortality rate) of ARI, as defined by the International Classification of Diseases, version 10 and as diagnosed by a clinician, in populations who at the time of the study were affected by natural disasters, armed conflict, forced displacement, and nutritional emergencies. We described studies and stratified data by age group, but did not do pooled analyses due to heterogeneity in case definitions. The published evidence, mainly from refugee camps and surveillance or patient record review studies, suggests very high excess morbidity and mortality (20-35% proportional mortality) and case-fatality (up to 30-35%) due to ARI. However, ARI disease burden comparisons with non-crisis settings are difficult because of non-comparability of data. Better epidemiological studies with clearer case definitions are needed to provide the evidence base for priority setting and programme impact assessments. Humanitarian agencies should include ARI prevention and control among infants, children and adults as priority activities in crises. Improved data collection, case management and vaccine strategies will help to reduce disease burden.

show abstract

“…Furthermore, it did not take the quality of the respective health care infrastructure or the health provision efforts of “exogenous” organizations such as the International Committee of the Red Cross (ICRC) or Médecins Sans Frontières (MSF) into consideration. In fact, the presence of organizations providing emergency relief can have major positive effects on human health in armed conflict settings [23].…”

Section: Discussionmentioning

confidence: 99%

“…It should be noted, however, that the complexity of all interactions may lead to counter-intuitive outcomes. For example, a marked decline in case fatality among hospitalized children was reported during a war in Guinea-Bissau, which was partly explained by improved treatment as a result of better access to drugs funded and distributed by humanitarian aid and non-governmental organizations [23].…”

Section: Methodsmentioning

confidence: 99%

Dynamics of Socioeconomic Risk Factors for Neglected Tropical Diseases and Malaria in an Armed Conflict

et al. 2009

View full text Add to dashboard Cite

BackgroundArmed conflict and war are among the leading causes of disability and premature death, and there is a growing share of civilians killed or injured during armed conflicts. A major part of the civilian suffering stems from indirect effects or collateral impact such as changing risk profiles for infectious diseases. We focused on rural communities in the western part of Côte d'Ivoire, where fighting took place during the Ivorian civil war in 2002/2003, and assessed the dynamics of socioeconomic risk factors for neglected tropical diseases (NTDs) and malaria.MethodologyThe same standardized and pre-tested questionnaires were administered to the heads of 182 randomly selected households in 25 villages in the region of Man, western Côte d'Ivoire, shortly before and after the 2002/2003 armed conflict.Principal FindingsThere was no difference in crowding as measured by the number of individuals per sleeping room, but the inadequate sanitation infrastructure prior to the conflict further worsened, and the availability and use of protective measures against mosquito bites and accessibility to health care infrastructure deteriorated. Although the direct causal chain between these findings and the conflict are incomplete, partially explained by the very nature of working in conflict areas, the timing and procedures of the survey, other sources and anecdotal evidence point toward a relationship between an increased risk of suffering from NTDs and malaria and armed conflict.ConclusionNew research is needed to deepen our understanding of the often diffuse and neglected indirect effects of armed conflict and war, which may be worse than the more obvious, direct effects.

show abstract

Reduced case fatality among hospitalized children during a war in Guinea-Bissau: a lesson in equity

Cited by 6 publications

References 6 publications

Stillbirths in urban Guinea-Bissau: A hospital- and community-based study

Stillbirths in urban Guinea-Bissau: A hospital- and community-based study

The burden of acute respiratory infections in crisis-affected populations: a systematic review

Dynamics of Socioeconomic Risk Factors for Neglected Tropical Diseases and Malaria in an Armed Conflict

Contact Info

Product

Resources

About