G Ahmed

BACKGROUND: The global burden of sepsis, a life-threatening dysregulated host response to infection leading to organ dysfunction, remains challenging to quantify. We aimed to comprehensively estimate the global, regional, and national burden of sepsis, including the impact of the COVID-19 pandemic and underlying causes of sepsis-related deaths with co-occurring infectious syndromes. METHODS: We used multiple cause-of-death, hospital, minimally invasive tissue sampling, and linked death certificate and hospital record data representing 149 million deaths, covering 4290 location-years with mortality estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to capture explicit and implicit sepsis cases and deaths. We estimated age-location-sex-specific fractions of sepsis-related deaths from 195 underlying causes of death and 22 infectious syndromes from 1990 to 2021 using binomial logistic regression models, and estimated sepsis-related deaths using GBD cause-specific mortality estimates. Using 250 million hospital admissions and 7·82 million deaths from hospital data, representing 1310 location-years, we modelled case fatality rates by use of binomial logistic regression, applied to sepsis death estimates to estimate sepsis incidence by age, location, and year. FINDINGS: In 2021, we estimated 166 million (95% uncertainty interval 135-201) sepsis cases and 21·4 million (20·3-22·5) all-cause sepsis-related deaths globally, representing 31·5% of total global deaths. Sepsis-related deaths decreased between 1990 and 2019, followed by a surge in 2020 and 2021. As of 2021, individuals aged 15 years and older experienced increases across incidence (230%) and mortality (26·3%) since 1990. Those aged 70 years and older had the highest sepsis-related mortality in 2021 (9·28 million [8·74-9·86] deaths). Sepsis-related deaths from infectious underlying causes decreased from 11·8 million (11·1-12·5) in 1990 to 8·34 million (7·72-9·01) in 2019, then increased by 86·4% to 15·5 million (14·7-16·4) in 2021. Sepsis-related mortality due to non-infectious underlying causes of death increased from 4·69 million (4·35-5·05) in 1990 to 5·81 million (5·40-6·25) in 2021; the leading non-infectious underlying causes of death with sepsis were stroke, chronic obstructive pulmonary disease, and cirrhosis. In 2021, bloodstream infections inclusive of HIV and malaria (3·08 million [2·83-3·35]) and lower respiratory infections inclusive of COVID-19 (11·33 million [1·20-1·47]) were the most prominent infectious syndromes complicating sepsis-related deaths from non-infectious underlying causes, representing a consistent trend since 1990. INTERPRETATION: The global burden of sepsis increased in 2020 and 2021, reversing progress from 1990. Sepsis incidence and mortality increased in people aged 15 years and older, especially those aged 70 years and older, and as a complication of non-infectious underlying causes of death such as stroke, primarily through bloodstream infections and lower respiratory infections. The global burden of sepsis is substantial, and sepsis is increasingly a complication of non-infectious causes of death. FUNDING: Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.

The article explores the impact of international remittances on the Ethiopian economy as well as the livelihoods and welfare of households. A simple dynamic econometric model, Vector Autoregressive (VAR) model, was used to assess the impact of international remittances on absorption, spending and output. Moreover, we used binary outcome model to test whether remittances have an impact on the welfare of households. Besides, the study made use of macroeconomic data and data from the Ethiopian urban household survey. It was found that remittance shocks positively affect macroeconomic variables; the effect remained to be volatile in the very first periods after the shock. However, the impacts tend to sustain in the years after the fifth period. Moreover, through the positive (but inelastic) relationship between growth and poverty, private remittance inflows have an important implication for poverty in Ethiopia. International remittances significantly reduced the poverty incidence among the urban households in the country. It was also found that female-headed households are more likely to use remittance more effectively than male-headed households are.

Researchers used data from 2 surveys (1987-1987) in Bangladesh and in Botswana to analyze sex differentials in morbidity and mortality. In the 0-11 month olds, mortality rates were greater for males than females in Bangladesh (164 vs. 119) and Botswana (140 vs. 94). This confirmed other research indicating that male infants tend to be ill more often than female infants. Except for 1-4 year old males in Bangladesh, morbidity rates declined as children aged. 1-4 year old females in Bangladesh had the lowest morbidity rates of any other age group in Bangladesh. In Botswana, morbidity was the same for both 1-4 year old males and females (90). 5-14 year old males tended to have higher morbidity than females in Botswana (69 vs. 53). In Bangladesh, morbidity for both sexes was essentially the same, but higher than morbidity in Botswana. In 15-44 year olds, females were healthier than males in Botswana (135 vs. 95), but both sexes in Bangladesh were healthier than those in Botswana and morbidity for them was about the same (mean, 84). Females tended to be less health in summer in Botswana than in Bangladesh (187 vs. 153), but the situation reversed in winter (126 vs. 173). In Botswana, overall mortality differential between males (14.2 rate) and females (6.8 rate) was quite high (7.4), even though Botswana females tended to be more ill than males. This differential was only .4 in Bangladesh. The male mortality rates were identical in both countries, but Bangladesh women were more likely to die than Botswana women (13.8 vs. 6.8). In Botswana, male infants (31) had a higher mortality rate than females (16). Mortality rates of both sexes in the older groups did not show such a large differential. In Bangladesh, 1-4 year old females (20.51) died more often than males (34.8) indicating neglect of females. In conclusion, overall females tended to be ill more often than males, but males tended to die more frequently than females even though morbidity usually comes before mortality.

Over 5000 married persons with the wife between 18-37 years were successfully interviewed in 1983 to collect information on 5 selected explanations of the Bangladesh gap defined as that apparent discrepancy between high and increasing sales or distribution versus low reported use of condoms. The 5 explanations were: wives may underreport contraceptive use especially of a male method like condoms; some couples may receive free condoms or may buy condoms but then fail to use them; the annual supplies needed by condom users are greater than the approximately 100 pieces assumed by the family planning social marketing program as the standard couple year of protection; some couples may use condoms so irregularly that they do not consider themselves to be condom users; and that a significant number of condoms are used for noncontraceptive purpose e.g. balloons. 2747 of the sample lived in affluent urban areas and 2527 in semi-rural areas. There was clear evidence that women in semi-rural areas substantially underreport condom use. Only 2.8% of individual females in the semi-rural areas reported that they and their husbands correctly used condoms. This figure contrasted with 4.1% reported by individual males 4.5% by wives and 7% by their husbands. If only the couples in the semi-rural samples were considered and the couple was counted as using condoms if 1 or both of the partners reported current use of condoms the prevalence rose to 8.1%. For urban affluent couples the rate increased to 34% from around 30% reported individually by couples. In the affluent urban samples 5-6% reported getting condoms free some time in the past compared with 2-4% in the semi-rural areas. Another 2-3% of urban and semi-rural never users could not remember receiving any condoms. Estimates of need for condoms ranged from 126-146 annually for current regular users in affluent urban areas with fewer 104-118 for semi-rural respondents. Mens estimates were generally higher than womens. Despite continued uncertainties about annual needs it was established that urban users reported higher needs than rural users that men gave higher estimates than women and that regular users needed more than irregular users. There was no question that not all users used condoms regularly. 61-64% of all urban current condom users reported that they used condoms every time; another 17-29% said they used them some of the time. Very irregular use was reported by 4-6%. More irregular use was reported by rural male respondents. To obtain a rough indication of the frequency of misuse respondents werre asked about instances of misuse observed in the previous month. In the urban samples 6-8% of the women and 21-25% of the men reported seeing misuse. Based on the survey findings underreporting by wives especially in semi-rural areas appeared to be the most significant explanation of the gap. The 2nd most plausible explanation was that annual supply requirements are over 100.