Death Notification in Italian Critical Care Unites and Emergency Services. A Qualitative Study with Physicians, Nurses and Relatives

This qualitative study was conducted in critical care units and emergency services and was aimed at considering the death notification (DN) phenomenology among physicians (notifiers), patient relatives (receivers) and those who work between them (nurses). Through the qualitative method, a systemic perspective was adopted to recognise three different categories of representation: 23 clinicians, 13 nurses and 11 family members of COVID-19 victims were interviewed, totalling 47 people from all over Italy (25 females, mean age: 46,36; SD: 10,26). With respect to notifiers, the following themes emerged: the changes in the relational dimension, protective factors and difficulties related to DN. With respect to receivers, the hospital was perceived as a prison, bereavement between DN, lost rituals and continuing bonds. Among nurses, changes in the relational dimension, protective factors and the impact of the death. Some common issues between physicians and nurses were relational difficulties in managing distancing and empathy and the support of relatives and colleagues. The perspective of receivers showed suffering related to loss and health care professionals’ inefficacy in communication. Specifically, everyone considered DNs mismanaged because of the COVID-19 emergency. Some considerations inherent in death education for DN management among health professionals were presented.

Barriers and facilitators to reporting deaths following Ebola surveillance in Sierra Leone: implications for sustainable mortality surveillance based on an exploratory qualitative assessment

ObjectivesTo understand the barriers contributing to the more than threefold decline in the number of deaths (of all causes) reported to a national toll free telephone line (1-1-7) after the 2014–2016 Ebola outbreak ended in Sierra Leone and explore opportunities for improving routine death reporting as part of a nationwide mortality surveillance system.DesignAn exploratory qualitative assessment comprising 32 in-depth interviews (16 in Kenema district and 16 in Western Area). All interviews were audio-recorded, transcribed and analysed using qualitative content analysis to identify themes.SettingParticipants were selected from urban and rural communities in two districts that experienced varying levels of Ebola cases during the outbreak. All interviews were conducted in August 2017 in the post-Ebola-outbreak context in Sierra Leone when the Sierra Leone Ministry of Health and Sanitation was continuing to mandate reporting of all deaths.ParticipantsFamily members of deceased persons whose deaths were not reported to the 1-1-7 system.ResultsDeath reporting barriers were driven by the lack of awareness to report all deaths, lack of services linked to reporting, negative experiences from the Ebola outbreak including prohibition of traditional burial rituals, perception that inevitable deaths do not need to be reported and situations where prompt burials may be needed. Facilitators of future willingness to report deaths were largely influenced by the perceived communicability and severity of the disease, unexplained circumstances of the death that need investigation and the potential to leverage existing death notification practices through local leaders.ConclusionsSocial mobilisation and risk communication efforts are needed to help the public understand the importance and benefits of sustained and ongoing death reporting after an Ebola outbreak. Localised practices for informal death notification through community leaders could be integrated into the formal reporting system to capture community-based deaths that may otherwise be missed.

Zaczątki sylwetki w prasie. Uwagi historyka języka

The beginnings of the profile in the press. Comments of a language historian Summary The author of the analysis tries to establish the beginnings of a press profile and indicate its main specific features. The basis for the analysis are the press articles published in the Warsaw press. The research showed that the first articles that were to present a person and her or his achievements appeared in the context of death notifications. Those were the profiles of well-known people (representatives of the church hierarchy, high-ranking civil servants, members of noble families). A death notification consisted of several parts: an information about the death of a certain person (time, place, circumstances of death, age), a presentation of this person and her or his achievements (forms of occupation, position, merits, advantages of character; religious practices – especially in reference to women), an information about the funeral mass. That type of a press article shows a significant affinity with other funeral forms, that is with the memorial note and obituary, and can be (from the diachronic perspective) classified to those genres.

Mortality surveillance and verbal autopsy strategies: experiences, challenges and lessons learnt in Papua New Guinea

Full notification of deaths and compilation of good quality cause of death data are core, sequential and essential components of a functional civil registration and vital statistics (CRVS) system. In collaboration with the Government of Papua New Guinea (PNG), trial mortality surveillance activities were established at sites in Alotau District in Milne Bay Province, Tambul-Nebilyer District in Western Highlands Province and Talasea District in West New Britain Province.Provincial Health Authorities trialled strategies to improve completeness of death notification and implement an automated verbal autopsy methodology, including use of different notification agents and paper or mobile phone methods. Completeness of death notification improved from virtually 0% to 20% in Talasea, 25% and 75% using mobile phone and paper notification strategies, respectively, in Alotau, and 69% in Tambul-Nebilyer. We discuss the challenges and lessons learnt with implementing these activities in PNG, including logistical considerations and incentives.Our experience indicates that strategies to maximise completeness of notification should be tailored to the local context, which in PNG includes significant geographical, cultural and political diversity. We report that health workers have great potential to improve the CRVS programme in PNG through managing the collection of notification and verbal autopsy data. In light of our findings, and in consultation with the main government CRVS stakeholders and the National CRVS Committee, we make recommendations regarding the requirements at each level of the health system to optimise mortality surveillance in order to generate the essential health intelligence required for policy and planning.

Monitoring for outbreak associated excess mortality in an African city: Detection limits in Antananarivo, Madagascar

Quantitative estimates of the impact of infectious disease outbreaks are required to develop measured policy responses. In many low- and middle-income countries, inadequate surveillance and incompleteness of death registration are important barriers. Here, we characterize how large an impact on mortality would have to be to be detectable using the uniquely detailed mortality notification data from the city of Antananarivo in Madagascar, with application to a recent measles outbreak. The weekly mortality rate of children during the 2018-2019 measles outbreak was 154% above the expected value at its peak, and the signal can be detected earlier in children than in the general population. This approach to detecting anomalies from expected baseline mortality allows us to delineate the prevalence of COVID-19 at which excess mortality would be detectable with the existing death notification system in the capital of Madagascar. Given current age-specific estimates of the COVID-19 fatality ratio and the age structure of the population in Antananarivo, we estimate that as few as 11 deaths per week in the 60-70 years age group (corresponding to an infection rate of approximately 1%) would detectably exceed the baseline. Data from 2020 will undergo necessary processing and quality control in the coming months. Our results provide a baseline for interpreting this information.