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High mortality in Carnot city Central African Republic January-July 2012 ESCAIDE, 6 November 2013. Nelly Fournet, EPIET cohort 2011. Economical and geographical background. CAR: 4 millions inhabitants 80% of population < 2 $ / day 45% of adults are illiterate

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high mortality in carnot city central african republic january july 2012 escaide 6 november 2013

High mortality in Carnot city Central African RepublicJanuary-July 2012ESCAIDE, 6 November 2013

Nelly Fournet, EPIET cohort 2011

economical and geographical background
Economical and geographical background
  • CAR: 4 millions inhabitants
  • 80% of population < 2 $ / day
  • 45% of adults are illiterate
  • Political instability / Isolated
  • Life of expectancy: 48 years
carnot city
Carnot city
  • 61 790 inhabitants
  • Agriculture replaced progressively by diamond mining
  • 2009 : diamond mining restricted → crisis

→ MSF opened a programme for acute malnutrition in children

    • 2010 : MSF opened an HIV programme
health situation in carnot city
Health situation in Carnot city
  • January-July 2011 : retrospective mortality survey
  • Crude Death Rate 3x higher than emergency threshold*:
    • CDR = 3.7/10,000/day (CI95% 3.0 – 4.6)
    • 0-5 DR = 7.0/10,000/day (CI95% 5.3 – 9.,3)

→ MSF actions:

→ Primary health care

→ Paediatric ward

→ Measles mass vaccination campaign

→ Mortality surveillance system

*CDR = 1 death / 10,000 inhabitants / day

0-5 DR = 2 deaths / 10,000 children <5 y / day

objectives
Objectives

Main objective:

  • Estimate the crude death rate (CDR) and the specific death rate among children <5y (0-5 DR) in Carnot city between January and July 2012

Secondary objective:

  • Estimate the main causes of deaths

→ In order to re-adjust MSF interventions

study design
Study design
  • Cross-sectional retrospective survey
  • Recall period: January 2012 – July 2012
  • Information collected:
    • Number of persons in the household at the date of the survey
    • Number of deaths / births / who joined / left the household + dates
    • Cause of death (simplified verbal autopsy)
    • Study population:
      • Population: all persons living more than 1 month in Carnot
      • Household: all persons sharing the same meal and under the responsibility of the same person
methods
Methods
  • Two-stage cluster sampling
    • Stage one: selection of the neighbourhoods (clusters) proportional to population size
    • Stage two: within each cluster, selection of the households with the EPI method
  • Sample size:
    • Sample size: 3,717 persons = 710 households
    • 30 clusters selected: 24 households per cluster
  • Survival analysis:
    • CDR and 0-5 DR estimations and CI95%
    • Trends over the time
death rates
Death Rates

2011:

  • CDR = 3.7/10,000/day (CI95% 3.0 – 4.6)
  • Emergency threshold: CDR = 1/10,000/day
  • 0-5 DR = 7.0/10,000/day (CI95% 5.3 – 9.,3)
  • Emergency threshold: 0-5 DR = 2/10,000/day
trends over the recall period
Trends over the recall period

Specific death rate among children <5 years from January to July 2012, Carnot city, CAR

main causes of deaths
Main causes of deaths
  • Children <5 years
    • 35% malaria
    • 10% neonatal deaths (without associated causes)
    • 7% diarrhoea
  • Adults >15 years
    • 30% HIV
    • 13% malaria
    • 10% accident (poisoning, trauma, bite…)
conclusion
Conclusion
  • Limitations:
    • Recall bias
    • Cause of deaths reported by verbal autopsy
    • Results specific to Carnot City, not generalize to CAR
  • Crude death rate and the specific death rate among children <5y decreased half compared to 2011
  • Above emergency threshold
  • Main cause of death: HIV among adults and malaria among children
recommendations
Recommendations

-> Strengthen collaboration with health local authorities

-> Improve access and coverage of health care centres

-> Improve paediatric and neonatal health care

-> Improve malaria and HIV diagnosis, treatment and prevention

  • March 2013 : rebellion in Bangui (capital)

→ Overthrow of the government

→ Priority: care of injured persons

acknowledgement
Acknowledgement
  • Carnot city population
  • All Interviewers from CAR
  • MSF team in Carnot City
  • Sandra Cohuet, Epicentre, Paris
  • KlaudiaPorten, Epicentre, Paris
  • Susan Hahné, RIVM, the Netherlands
definition of the main causes of deaths
Definition of the main causes of deaths
  • Duration of the illness
  • Death linked with the pregnancy / the delivery
  • Neonatal death (<28 days)
  • Diarrhoea
  • Coughing / Respiratory troubles
  • Neurologic troubles
  • Malaria
  • Isolated fever
  • Measles
  • Trauma, injury
  • Pain in the mouth / difficulty to eat
  • Cutaneous problems / permanent scratching
  • Major loss of weight
  • Other
case definition of hiv and tb
Case definition of HIV and TB*

HIV

  • Duration of the illness > 2 months before death
  • Associated with:
    • diarrhoea >1 month
    • or difficulty to eat
    • or cutaneous problems
    • or major loss of weight
  • Without associated TB diagnosis

TB

  • Duration of the illness > 2 months before death
  • Associated with coughing > 1 month and loss of weigh

*Tassie JM, Savignoni Alexia et al. Retrospective mortality survey in Rusinga Island, Suba district, Nyanza province, Kenya. Avril 2002. Rapport final In. Paris: Epicentre; 2002.

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