Summary Background Most malaria deaths occur in rural areas. Rapid progression from illness to death can be interrupted by prompt, effective medication. Antimalarial treatment cannot rescue ...terminally ill patients but could be effective if given earlier. If patients who cannot be treated orally are several hours from facilities for injections, rectal artesunate can be given before referral and acts rapidly on parasites. We investigated whether this intervention reduced mortality and permanent disability. Methods In Bangladesh, Ghana, and Tanzania, patients with suspected severe malaria who could not be treated orally were allocated randomly to a single artesunate (n=8954) or placebo (n=8872) suppository by taking the next numbered box, then referred to clinics at which injections could be given. Those with antimalarial injections or negative blood smears before randomisation were excluded, leaving 12 068 patients (6072 artesunate, 5996 placebo) for analysis. Primary endpoints were mortality, assessed 7–30 days later, and permanent disability, reassessed periodically. All investigators were masked to group assignment. Analysis was by intention to treat. This study is registered in all three countries, numbers ISRCTN83979018, 46343627, and 76987662. Results Mortality was 154 of 6072 artesunate versus 177 of 5996 placebo (2·5% vs 3·0%, p=0·1). Two versus 13 (0·03% vs 0·22%, p=0·0020) were permanently disabled; total dead or disabled: 156 versus 190 (2·6% vs 3·2%, p=0·0484). There was no reduction in early mortality (56 vs 51 deaths within 6 h; median 2 h). In patients reaching clinic within 6 h (median 3 h), pre-referral artesunate had no significant effect on death after 6 h or permanent disability (71/4450 1·6% vs 82/4426 1·9%, risk ratio 0·86 95% CI 0·63–1·18, p=0·35). In patients still not in clinic after more than 6 h, however, half were still not there after more than 15 h, and pre-referral rectal artesunate significantly reduced death or permanent disability (29/1566 1·9% vs 57/1519 3·8%, risk ratio 0·49 95% CI 0·32–0·77, p=0·0013). Interpretation If patients with severe malaria cannot be treated orally and access to injections will take several hours, a single inexpensive artesunate suppository at the time of referral substantially reduces the risk of death or permanent disability. Funding UNICEF/UNDP/World Bank Special Programme for Research and Training in Tropical Diseases (WHO/TDR); WHO Global Malaria Programme (WHO/GMP); Sall Family Foundation; the European Union (QLRT-2000-01430); the UK Medical Research Council; USAID; Irish Aid; the Karolinska Institute; and the University of Oxford Clinical Trial Service Unit (CTSU).
Cardiovascular disease is a leading cause of death in Canada, but how the major cardiovascular risk factors vary across ethnicity and immigration status has yet to be examined.
Using data from the ...Canadian Community Health Surveys, national trends in health conditions (hypertension, diabetes, high blood cholesterol level, and obesity) and health behaviours (smoking, activity levels, and alcohol consumption) were estimated for the period 2001-2018. In this cross-sectional study, the trends were then compared across sex, age, ethnicity, and immigration status.
A total of 1,065,391 respondents were examined, for the period 2001-2018. During the study period, the prevalence of the following risk factors increased in Canada over time, as follows: diabetes by 54.5%; hypertension by 23.4%; and obesity by 32.3%. For health behaviours, smoking prevalence decreased overall, especially in racialized populations. Heavy drinking was most prevalent for nonracialized and non-Indigenous Canadian-born populations, and was of lowest prevalence among racialized immigrants. Physical inactivity was most prevalent for racialized immigrant populations. The prevalence of self-reported heart disease decreased by 21.0%, except for racialized established immigrants (≥ 10 years since immigration to Canada), who had a 4.2% increase.
During this study period, decreases occurred in the prevalences of smoking and physical inactivity, along with increases in obesity, diabetes, and hypertension prevalences. By migration-group status, established immigrants in Canada had a higher prevalence of cardiovascular disease risk factors compared to that among their Canadian-born counterparts. Migration gaps should be considered in future interventions targeted at reducing these cardiovascular risk factors in Canada.
Les maladies cardiovasculaires sont une cause majeure de décès au Canada, mais la manière dont les principaux facteurs de risque cardiovasculaire varient en fonction de l’origine ethnique et du statut d’immigration n’a encore jamais été évaluée.
Des tendances nationales dans certains problèmes de santé (hypertension, diabète, hypercholestérolémie et obésité) et certains comportements liés à la santé (tabagisme, niveaux d’activité et consommation d’alcool) ont été dégagées à partir des données de l’Enquête sur la santé dans les collectivités canadiennes pour la période de 2001 à 2018. Ces tendances ont ensuite été comparées en fonction du sexe, de l’âge, de l’origine ethnique et du statut d’immigration dans le cadre de la présente étude transversale.
Au total, 1 065 391 répondants ont été examinés pour la période de 2001 à 2018. Durant la période de l’étude, la prévalence des facteurs de risque suivants a graduellement augmenté au Canada : diabète, de 54,5 %; hypertension, de 23,4 %; obésité, de 32,3 %. Dans le cas des comportements liés à la santé, la prévalence du tabagisme a globalement diminué, surtout dans les populations racialisées. La consommation excessive d’alcool était plus fréquente dans les populations non racialisées et non autochtones d’origine canadienne, et moins fréquente chez les immigrants racialisés. L’inactivité physique était particulièrement répandue dans les populations immigrantes racialisées. La prévalence des maladies cardiaques auto-déclarées a diminué de 21,0 %, sauf chez les immigrants établis racialisés (≥ 10 ans depuis l’arrivée au Canada), qui a connu une hausse de 4,2 %.
Durant la période de l’étude, la prévalence du tabagisme et de l’inactivité physique a diminué tandis que celle de l’obésité, du diabète et de l’hypertension a augmenté. D’après le statut du groupe de migration, la prévalence des facteurs de risque de maladies cardiovasculaires était plus élevée chez les immigrants établis au Canada que chez leurs homologues nés au Canada. Il convient de prendre en considération les différences liées à la migration dans les interventions futures visant à réduire ces facteurs de risque cardiovasculaire au Canada.
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