Association of household fuel with acute respiratory infection (ARI) under-five years children in Bangladesh

Spatiotemporal clusters of acute respiratory infections associated with socioeconomic, meteorological, and air pollution factors in South Punjab, Pakistan

BACKGROUND

In Pakistan, acute respiratory infections (ARI) continue to be a major public health problem. However, there is still a lack of scholarly work regarding different environmental and socioeconomic influencing factors and how they interact with respiratory infections. Furthermore, we do not know much about geographic variation in this context. Therefore, our study examines the ecological-level spatial and temporal patterns of acute respiratory infection incidence (ARI) and their geographic relationship with selected socio-economic, meteorological, and air pollution factors in Pakistan.

METHODS

We applied the spatiotemporal scan statistics to examine the purely temporal, spatial, and spatiotemporal clusters of ARI in South Punjab, Pakistan for five years (2016-2020). Generalized Linear Model (GLM) and geographically weighted regression (GWR) were also applied to model the linear and non-linear spatial relationships between selected variables and ARI.

RESULTS

Our results indicate that in the central and northern regions of Pakistan, two spatial clusters of ARI were present, accounting for 28.5% of the total cases. A spatiotemporal cluster with a relative risk of 1.57 was discovered in the northeastern area. The results obtained from the season-based GLM highlighted the significance of climatic factors (temperature, fog, dust storms) and air pollutants (NO2) in influencing ARI incidence, while socio-economic variables (rural population, literacy) had limited impact. In addition, GWR revealed that the relationships between predictors and ARI incidence varied across locations, emphasizing the importance of considering local settings. Season-based non-stationary GLM revealed a multifaceted interaction among socio-economic, meteorological, and air pollution factors.

CONCLUSIONS

Our study provides evidence about environmental and socio-economic factors significantly associated with ARI incidence. In addition, this study provides the first baseline of ARI cases in Pakistan to plan for intervention and adaptation strategies and may be replicated in other regions of comparable settings worldwide.

Exploring the impact of child underweight status on common childhood illnesses among children under five years in Bangladesh along with spatial analysis

BACKGROUND

In developing countries like Bangladesh, under-five children are mostly experiencing and suffering from common diseases like fever, cough, diarrhea, and acute respiratory infections (ARI). To mitigate these problems, it's crucial to spot prevalent areas and take proper action. This study investigates the spatial distribution and associated factors of prevalent childhood illnesses across Bangladesh.

METHODS AND FINDINGS

This research comprised 8,306 children's information from the Bangladesh Demographic and Health Survey (BDHS) 2017-18. We performed chi-square, t-tests, binary logistic regression and spatial analyses in this work. BDHS survey data and GPS data were aggregated to identify common childhood illnesses among under-five children. Moran's index first mapped childhood illnesses. Afterward, Getis-Ord Gi* discovered hot and cold spots for illnesses. However, Kriging interpolation predicted child illnesses in unsampled areas. Here, 33.2% (CI: 32.2-34.3), 36% (CI: 35-37.1), 4.7% (CI: 4.3-5.2), and 12.9% (CI: 12.2-13.6) of children under five had fever, cough, diarrhea, and ARI, respectively. In the fortnight before to the survey, 47.3% (CI: 46.2-48.3) of under-5 children were ill. Common childhood illnesses are associated with children's (age, underweight status, etc.), mothers' (age, education, etc.), and household factors (residency, wealth index, etc.). Underweight status is associated with fever, cough and at least one disease. The unsampled north-western and south-western areas of Bangladesh had a higher prevalence of fever, cough, ARI and at least one common disease. Cough was most common in the central-northern region; fever was most common in the lower southern region; and ARI was most common in Bangladesh's south-east. Childhood diseases were more prevalent in Bangladesh's central-northern and southern regions.

CONCLUSIONS

Our research demonstrates the regional clustering of common childhood diseases in Bangladesh. Policymakers should focus on these higher-prevalence regions, and the necessary preventive measures should be taken immediately.

Effect of housing construction material on childhood acute respiratory infection: a hospital based case control study in Bangladesh

Despite several studies conducted to investigate housing factors, the effects of housing construction materials on childhood ARI symptoms in Bangladesh remain unclear. Hence, the study aimed to measure such a correlation among children under the age of five. A hospital-based case-control study was conducted, involving 221 cases and 221 controls from January to April 2023. Bivariate and multivariate binary logistic regression was performed to measure the degree of correlation between housing construction materials and childhood ARI symptoms. Households composed of natural floor materials had 2.7 times (95% confidence interval 1.27-5.57) and households composed of natural roof materials had 1.8 times (95% confidence interval 1.01-3.11) higher adjusted odds of having under-five children with ARI symptoms than household composed of the finished floor and finished roof materials respectively. Households with natural wall type were found protective against ARI symptoms with adjusted indoor air pollution determinants. The study indicates that poor housing construction materials are associated with an increased risk of developing ARI symptoms among under-five children in Bangladesh. National policy regarding replacing poor housing materials with concrete, increasing livelihood opportunities, and behavioral strategies programs encouraging to choice of quality housing construction materials could eliminate a fraction of the ARI burden.

Assessment of the association between health problems and cooking fuel type, and barriers towards clean cooking among rural household people in Bangladesh

BACKGROUND

In low- and middle-income countries, households mainly use solid fuels like wood, charcoal, dung, agricultural residues, and coal for cooking. This poses significant public health concerns due to the emission of harmful particles and gases. To address these issues and support Sustainable Development Goals (SDGs), adopting cleaner cooking fuels like electricity and gas are acknowledged as a viable solution. However, access to these cleaner fuels is limited, especially in rural areas.

METHODS

This study conducted a face-to-face survey with 1240 individuals in rural Bangladesh to explore the link between health issues and cooking fuel type, as well as barriers to transitioning to clean cooking. Using a convenient sampling technique across four divisions/regions, the survey gathered socio-demographic and health data, along with information on clean cooking barriers through a semi-structured questionnaire. Binary and multivariable logistic regression analyses were then employed to identify significant associations between cooking fuel type and health problems.

RESULTS

The study revealed that a majority of participants (73.3%) relied on solid fuel for cooking. The use of solid fuel was significantly correlated with factors such as lower education levels, reduced family income, location of residence, and the experience of health issues such as cough, chest pressure while breathing, eye discomfort, diabetes, asthma, and allergies. Economic challenges emerged as the foremost obstacle to the adoption of clean cooking, accompanied by other contributing factors.

CONCLUSION

The use of solid fuel in rural Bangladeshi households poses substantial health risks, correlating with respiratory, eye, cardiovascular, and metabolic issues. Lower education and income levels, along with specific residential locations, were associated with higher solid fuel usage. Economic challenges emerged as the primary obstacle to adopting clean cooking practices. These findings emphasize the need for implementing strategies to promote clean cooking, address barriers, and contribute to achieving Sustainable Development Goal targets for health and sustainable energy access in Bangladesh.

Impact of antibiotic-coated sutures on surgical site infections: a second-order meta-analysis

BACKGROUND

Surgical site infections (SSIs) pose a global challenge, impacting patients and healthcare expenditures. This second-order meta-analysis endeavors to assess the efficacy of antibiotic sutures in averting SSIs by amalgamating data from various meta-studies.

MATERIALS AND METHODS

This research adhered to the PRISMA 2020 guidelines. The quality and comprehensiveness of the encompassed meta-analyses were assessed through the QUOROM checklist and AMSTAR techniques. The primary study overlap was evaluated via measures such as pairwise intersection heat maps, corrected covered area, and the citation matrix of evidence. The statistical power at the study-level was determined utilizing the meta-meta package. Data synthesis employed random and fixed effects models at a 95% CI. A meta-regression analysis was conducted to explore potential correlations between the CDC classification of SSIs, trial types, and the observed effect sizes in the studies.

RESULTS

This investigation revealed a significant reduction in SSI rates due to antimicrobial-coated sutures, evidenced by a relative risk (RR) of 0.68 (95% CI: 0.59-0.76), with a prediction interval of 0.38-1.19. The analysis encompassed 18 studies with 22 meta-analyses, demonstrating a median QUOROM score of 13.6 out of 18 and an AMSTAR score of 9.1 out of 11. The presence of moderate heterogeneity was noted ( Q =106.611, I2 =54.038%), with nonrandomized controlled trials exhibiting an RR of 0.56 (95% CI: 0.39-0.80), and RCTs displaying an RR of 0.71 (95% CI: 0.63-0.81). Subgroup analysis unveiled variable RR reductions for specific surgical procedures.

CONCLUSION

Antimicrobial-coated sutures offer a promising approach to mitigating SSIs risk. However, their efficacy is optimally realized when employed in conjunction with other robust practices.

Adherence to WHO guidelines on severe pneumonia management in children and its impact on outcome: an observational study at Jinka General Hospital in Ethiopia

Introduction

Poor adherence to guidelines during empirical antibiotic prescription in low-income countries could increase antimicrobial resistance without improving outcomes. Revised World Health Organization (WHO) guidelines published in 2014 on childhood (2-59 months) pneumonia re-defined the classification of severe pneumonia and changed the first-line treatment. The adherence to WHO guidelines in southern Ethiopia at the hospital level is unknown. We sought to determine the adherence to WHO guidelines on severe pneumonia first-line treatment in children in an Ethiopian referral hospital and assess the impact of non-adherence on patient outcomes.

Methods

An observational study was conducted on all children (2-59 months) clinically diagnosed with severe pneumonia and admitted to the Pediatric Ward of Jinka Hospital from 1 June 2021 to 31 May 2022. Exclusion criteria included a known HIV infection, ongoing antibiotic treatment before the event not related to acute pneumonia, or any other severe bacterial infection, confirmed or suspected. Adherence to guidelines was defined as first-line treatment with ampicillin or benzylpenicillin and gentamicin at the recommended dose. We compared the patients treated adherently vs. non-adherently. For categorical variables, the chi-square or Fisher's exact test was used, while for continuous variables, the Mann-Whitney U-test was used. Multivariate logistic regression was used to evaluate the association between adherence and demographic and clinical characteristics.

Results

During the observational period, 266 patients were registered as having severe pneumonia with an age between 2 and 59 months. After excluding 114 patients due to missing charts or other exclusion criteria, a total of 152 patients were included in the analysis. Of these, 78 (51%) were girls with a median age of 10 months (IQR 7-14). Overall, 75 (49%) patients received therapy according to the WHO guidelines. Compared to patients treated adherently to the guidelines, patients not treated adherently had similar outcomes [median length of stay of 3 (IQR 3-5) and 4 (IQR 3-6) days], median duration of oxygen therapy of 2 (IQR 1-3) for both the groups, and self-discharge rates of 5% and 6.5%, respectively).

Conclusion

Adherence to the revised WHO guideline was limited and not associated with outcomes. Efforts should focus on reducing the gap between theory and practice.

Insight into vaccination and meteorological factors on daily COVID-19 cases and mortality in Bangladesh

The ongoing COVID-19 contagious disease caused by SARS-CoV-2 has disrupted global public health, businesses, and economies due to widespread infection, with 676.41 million confirmed cases and 6.77 million deaths in 231 countries as of February 07, 2023. To control the rapid spread of SARS-CoV-2, it is crucial to determine the potential determinants such as meteorological factors and their roles. This study examines how COVID-19 cases and deaths changed over time while assessing meteorological characteristics that could impact these disparities from the onset of the pandemic. We used data spanning two years across all eight administrative divisions, this is the first of its kind--showing a connection between meteorological conditions, vaccination, and COVID-19 incidences in Bangladesh. We further employed several techniques including Simple Exponential Smoothing (SES), Auto-Regressive Integrated Moving Average (ARIMA), Auto-Regressive Integrated Moving Average with explanatory variables (ARIMAX), and Automatic forecasting time-series model (Prophet). We further analyzed the effects of COVID-19 vaccination on daily cases and deaths. Data on COVID-19 cases collected include eight administrative divisions of Bangladesh spanning March 8, 2020, to January 31, 2023, from available online servers. The meteorological data include rainfall (mm), relative humidity (%), average temperature (°C), surface pressure (kPa), dew point (°C), and maximum wind speed (m/s). The observed wind speed and surface pressure show a significant negative impact on COVID-19 cases (-0.89, 95% confidence interval (CI): 1.62 to -0.21) and (-1.31, 95%CI: 2.32 to -0.29), respectively. Similarly, the observed wind speed and surface pressure show a significant negative impact on COVID-19 deaths (-0.87, 95% CI: 1.54 to -0.21) and (-3.11, 95%CI: 4.44 to -1.25), respectively. The impact of meteorological factors is almost similar when vaccination information is included in the model. However, the impact of vaccination in both cases and deaths model is significantly negative (for cases: 1.19, 95%CI: 2.35 to -0.38 and for deaths: 1.55, 95%CI: 2.88 to -0.43). Accordingly, vaccination effectively reduces the number of new COVID-19 cases and fatalities in Bangladesh. Thus, these results could assist future researchers and policymakers in the assessment of pandemics, by making thorough efforts that account for COVID-19 vaccinations and meteorological conditions.

Correlation of Dengue and Meteorological Factors in Bangladesh: A Public Health Concern

Dengue virus (DENV) is an enveloped, single-stranded RNA virus, a member of the Flaviviridae family (which causes Dengue fever), and an arthropod-transmitted human viral infection. Bangladesh is well known for having some of Asia's most vulnerable Dengue outbreaks, with climate change, its location, and it's dense population serving as the main contributors. For speculation about DENV outbreak characteristics, it is crucial to determine how meteorological factors correlate with the number of cases. This study used five time series models to observe the trend and forecast Dengue cases. Current data-based research has also applied four statistical models to test the relationship between Dengue-positive cases and meteorological parameters. Datasets were used from NASA for meteorological parameters, and daily DENV cases were obtained from the Directorate General of Health Service (DGHS) open-access websites. During the study period, the mean of DENV cases was 882.26 ± 3993.18, ranging between a minimum of 0 to a maximum of 52,636 daily confirmed cases. The Spearman's rank correlation coefficient between climatic variables and Dengue incidence indicated that no substantial relationship exists between daily Dengue cases and wind speed, temperature, and surface pressure (Spearman's rho; r = -0.007, p > 0.05; r = 0.085, p > 0.05; and r = -0.086, p > 0.05, respectively). Still, a significant relationship exists between daily Dengue cases and dew point, relative humidity, and rainfall (r = 0.158, p < 0.05; r = 0.175, p < 0.05; and r = 0.138, p < 0.05, respectively). Using the ARIMAX and GA models, the relationship for Dengue cases with wind speed is -666.50 [95% CI: -1711.86 to 378.86] and -953.05 [-2403.46 to 497.36], respectively. A similar negative relation between Dengue cases and wind speed was also determined in the GLM model (IRR = 0.98). Dew point and surface pressure also represented a negative correlation in both ARIMAX and GA models, respectively, but the GLM model showed a positive association. Additionally, temperature and relative humidity showed a positive correlation with Dengue cases (105.71 and 57.39, respectively, in the ARIMAX, 633.86, and 200.03 in the GA model). In contrast, both temperature and relative humidity showed negative relation with Dengue cases in the GLM model. In the Poisson regression model, windspeed has a substantial significant negative connection with Dengue cases in all seasons. Temperature and rainfall are significantly and positively associated with Dengue cases in all seasons. The association between meteorological factors and recent outbreak data is the first study where we are aware of the use of maximum time series models in Bangladesh. Taking comprehensive measures against DENV outbreaks in the future can be possible through these findings, which can help fellow researchers and policymakers.

Variant-specific deleterious mutations in the SARS-CoV-2 genome reveal immune responses and potentials for prophylactic vaccine development

Introduction: Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has had a disastrous effect worldwide during the previous three years due to widespread infections with SARS-CoV-2 and its emerging variations. More than 674 million confirmed cases and over 6.7 million deaths have been attributed to successive waves of SARS-CoV-2 infections as of 29th January 2023. Similar to other RNA viruses, SARS-CoV-2 is more susceptible to genetic evolution and spontaneous mutations over time, resulting in the continual emergence of variants with distinct characteristics. Spontaneous mutations of SARS-CoV-2 variants increase its transmissibility, virulence, and disease severity and diminish the efficacy of therapeutics and vaccines, resulting in vaccine-breakthrough infections and re-infection, leading to high mortality and morbidity rates. Materials and methods: In this study, we evaluated 10,531 whole genome sequences of all reported variants globally through a computational approach to assess the spread and emergence of the mutations in the SARS-CoV-2 genome. The available data sources of NextCladeCLI 2.3.0 (https://clades.nextstrain.org/) and NextStrain (https://nextstrain.org/) were searched for tracking SARS-CoV-2 mutations, analysed using the PROVEAN, Polyphen-2, and Predict SNP mutational analysis tools and validated by Machine Learning models. Result: Compared to the Wuhan-Hu-1 reference strain NC 045512.2, genome-wide annotations showed 16,954 mutations in the SARS-CoV-2 genome. We determined that the Omicron variant had 6,307 mutations (retrieved sequence:1947), including 67.8% unique mutations, more than any other variant evaluated in this study. The spike protein of the Omicron variant harboured 876 mutations, including 443 deleterious mutations. Among these deleterious mutations, 187 were common and 256 were unique non-synonymous mutations. In contrast, after analysing 1,884 sequences of the Delta variant, we discovered 4,468 mutations, of which 66% were unique, and not previously reported in other variants. Mutations affecting spike proteins are mostly found in RBD regions for Omicron, whereas most of the Delta variant mutations drawn to focus on amino acid regions ranging from 911 to 924 in the context of epitope prediction (B cell & T cell) and mutational stability impact analysis protruding that Omicron is more transmissible. Discussion: The pathogenesis of the Omicron variant could be prevented if the deleterious and persistent unique immunosuppressive mutations can be targeted for vaccination or small-molecule inhibitor designing. Thus, our findings will help researchers monitor and track the continuously evolving nature of SARS-CoV-2 strains, the associated genetic variants, and their implications for developing effective control and prophylaxis strategies.

A bibliometric study on Marburg virus research with prevention and control strategies

Marburg virus (MARV) is a pathogenic zoonotic RNA virus etiologic for Marburg virus disease (MVD), a severe hemorrhagic fever. This is a rare disease, with a high fatality rate, that spreads via infected blood or body fluids or indirectly via fomites (contaminated objects and substances such as clothed, beds, personal protective equipment, or medical equipments). A few vaccines to protect against MARV are undergoing clinical trials, but there is not yet an approved vaccine against this disease. Eventually, prevention and control guidelines should be adhered to rigorously to alleviate this infection. This bibliometric analysis aimed to harness narrative evaluation, emphasizing the significance of quantitative approaches and delineating the most thought-provoking concerns for researchers using VOSviewer software (Centre for Science and Technology Studies, Leiden University, the Netherlands). “Marburg Virus” OR “MARV” AND “Diseases” search criteria were used for the analysis of articles published between 1962 and 2022. Co-occurrence analysis was carried out, which characterized different thematic clusters. From this analysis, we found that 1688 published articles, and the number of publications increased across that period annually, with a growth rate of 8.78%. It is also conspicuous that the number of publications in the United States reached its acme during this period (i.e., 714 publications, accounting for 42.29% of the total), and the United States Army Medical Research Institute of Infectious Diseases published the most literature (i.e., 146 papers). Our study found that the three pre-eminent authors of Marburg virus papers were “FELDMANN, HEINZ“ of the National Institute of Allergy and Infectious Diseases, United States, “BECKER, STEPHAN” of the Philipps University of Marburg, Germany, and “GEISBERT, THOMAS W” of the University of Texas Medical Branch, United States. In this study we found that “JOURNAL OF VIROLOGY” has published the most pertinent literature, totaling 88 articles, followed by “The journal of Infectious Diseases”, which published 76 relevant papers, and “VIRUSES”, which published 52 corresponding papers. The most cited paper on the Marburg virus was published in Nature Medicine, with 522 total citations and 29 citations/year. Studies of the changing epidemiology and evolving nature of the virus and its ecological niche are required; breakthrough and implementation of the efficacious vaccine candidate(s), prophylaxis and therapeutic alternatives and supervision strategies, unveiling awareness-raising programs, and developing apposite and timely preparedness, prevention, and proactive control strategies are of utmost importance.

Household polluting cooking fuels and adverse birth outcomes: An updated systematic review and meta-analysis

Background and aim

The current study aimed to clarify the association between household polluting cooking fuels and adverse birth outcomes using previously published articles.

Methods

In this systematic review and meta-analysis, a systematic literature search in PubMed, Embase, Web of Science, and Scopus databases were undertaken for relevant studies that had been published from inception to 16 January 2023. We calculated the overall odds ratio (OR) and 95% confidence interval (CI) for adverse birth outcomes [low birth weight (LBW), small for gestational age (SGA), stillbirth, and preterm birth (PTB)] associated with polluting cooking fuels (biomass, coal, and kerosene). Subgroup analysis and meta-regression were also conducted.

Results

We included 16 cross-sectional, five case-control, and 11 cohort studies in the review. Polluting cooking fuels were found to be associated with LBW (OR: 1.37, 95% CI: 1.24, 1.52), SGA (OR: 1.48, 95% CI: 1.13, 1.94), stillbirth (OR: 1.38, 95% CI: 1.23, 1.55), and PTB (OR: 1.27, 95% CI: 1.19, 1.36). The results of most of the subgroup analyses were consistent with the main results. In the meta-regression of LBW, study design (cohort study: P < 0.01; cross-sectional study: P < 0.01) and sample size (≥ 1000: P < 0.01) were the covariates associated with heterogeneity. Cooking fuel types (mixed fuel: P < 0.05) were the potentially heterogeneous source in the SGA analysis.

Conclusion

The use of household polluting cooking fuels could be associated with LBW, SGA, stillbirth, and PTB. The limited literature, observational study design, exposure and outcome assessment, and residual confounding suggest that further strong epidemiological evidence with improved and standardized data was required to assess health risks from particular fuels and technologies utilized.

Association between Global Monkeypox Cases and Meteorological Factors

The emergence of an outbreak of Monkeypox disease (MPXD) is caused by a contagious zoonotic Monkeypox virus (MPXV) that has spread globally. Yet, there is no study investigating the effect of climatic changes on MPXV transmission. Thus, studies on the changing epidemiology, evolving nature of the virus, and ecological niche are highly paramount. Determination of the role of potential meteorological drivers including temperature, precipitation, relative humidity, dew point, wind speed, and surface pressure is beneficial to understand the MPXD outbreak. This study examines the changes in MPXV cases over time while assessing the meteorological characteristics that could impact these disparities from the onset of the global outbreak. To conduct this data-based research, several well-accepted statistical techniques including Simple Exponential Smoothing (SES), Auto-Regressive Integrated Moving Average (ARIMA), Automatic forecasting time-series model (Prophet), and Autoregressive Integrated Moving Average with Explanatory Variables (ARIMAX) were applied to delineate the correlation of the meteorological factors on global daily Monkeypox cases. Data on MPXV cases including affected countries spanning from 6 May 2022, to 9 November 2022, from global databases and meteorological data were used to evaluate the developed models. According to the ARIMAX model, the results showed that temperature, relative humidity, and surface pressure have a positive impact [(51.56, 95% confidence interval (CI): -274.55 to 377.68), (17.32, 95% CI: -83.71 to 118.35) and (23.42, 95% CI: -9.90 to 56.75), respectively] on MPXV cases. In addition, dew/frost point, precipitation, and wind speed show a significant negative impact on MPXD cases. The Prophet model showed a significant correlation with rising MPXD cases, although the trend predicts peak values while the overall trend increases. This underscores the importance of immediate and appropriate preventive measures (timely preparedness and proactive control strategies) with utmost priority against MPXD including awareness-raising programs, the discovery, and formulation of effective vaccine candidate(s), prophylaxis and therapeutic regimes, and management strategies.