1
|
Asiamah N, Agyemang SM, Vieira ER, Khan HTA, Gasana J. Sedentary behaviour among older adults residing in flat and hilly neighbourhoods and its association with frailty and chronic disease status. BMC Public Health 2023; 23:2083. [PMID: 37875861 PMCID: PMC10599026 DOI: 10.1186/s12889-023-17029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/20/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Living in hilly neighbourhoods can be associated with sedentary behaviour, but no study has compared sedentary behaviour and its associations with frailty, chronic diseases, and poor health between flat and hilly neighbourhoods among older adults. This study, therefore, compared older adults' sedentary behaviour and its association with frailty, poor health, and chronic disease status between low and hilly neighbourhoods. METHODS This study utilised a STROBE-compliant cross-sectional design with sensitivity analyses and a common methods bias assessment. The participants were 1,209 people aged 50+ years who resided in flat (Ablekuma North, n = 704) and hilly (Kwahu East, n = 505) neighbourhoods in Ghana. The data were analysed with the independent samples t-test and hierarchical linear regression. RESULTS Older adults in the hilly neighbourhood were more sedentary than those in the flat neighbourhood. The association between sedentary behaviour and chronic disease status was significant in both neighbourhoods, but this relationship was stronger in the hilly neighbourhood. Older adults in the flat neighbourhood reported lower sedentary behaviour at higher frailty (β = -0.18; t = -3.2, p < 0.001), but those in the hilly neighbourhood reported higher sedentary behaviour at higher frailty (β = 0.16; t = 3.54, p < 0.001). CONCLUSIONS Older adults living in the hilly neighbourhood reported higher sedentary behaviour. In the hilly neighbourhood, sedentary behaviour was more strongly associated with frailty and chronic disease status. Older adults in hilly neighbourhoods may need extra support to avoid sedentary behaviour.
Collapse
Affiliation(s)
- Nestor Asiamah
- School of Health and Social Care, Division of Interdisciplinary Research and Practice, University of Essex, Colchester, Essex, CO4 3SQ, UK.
| | - Simon Mawulorm Agyemang
- Department of Science/Health, Physical Education and Sports, Abetifi Presbyterian College of Education, P.O. Box 19, Abetifi - Kwahu, E/R, Ghana
| | - Edgar Ramos Vieira
- Department of Physical Therapy, Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, FL, USA
| | - Hafiz T A Khan
- College of Nursing, Midwifery, and Healthcare, University of West London, Paragon House, Boston Manor Road, Brentford, TW8 9GB, UK
| | - Janvier Gasana
- Department of Community Health, Kuwait University, Kuwait City, Kuwait
| |
Collapse
|
2
|
Gasana J, O'Keeffe T, Withers TM, Greaves CJ. A systematic review and meta-analysis of the long-term effects of physical activity interventions on objectively measured outcomes. BMC Public Health 2023; 23:1697. [PMID: 37660119 PMCID: PMC10474717 DOI: 10.1186/s12889-023-16541-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 08/16/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Although physical activity interventions are frequently reported to be effective, long-term changes are needed to generate meaningful health benefits. There are criticisms that evaluations of physical activity interventions mostly report short-term outcomes and that these are often self-reported rather than measured objectively. This study therefore aimed to assess the long-term (at least 24 month) effectiveness of behavioural interventions on objectively measured physical activity. METHODS We conducted a systematic review with a meta-analysis of effects on objectively measured physical activity. We searched: Cochrane CENTRAL, EMBASE, PsychInfo, CINAHL and Pubmed up to 10th January 2022. Studies were included if they were in English and included a physical intervention that assessed physical activity in the long-term (defined as at least 24 months). RESULTS Eight studies with 8480 participants were identified with data suitable for meta-analysis. There was a significant effect of interventions on daily steps 24 months post baseline (four studies, SMD: 0.15, 95% CI: 0.02 to 0.28) with similar results at 36 to 48 months of follow up (four studies, SMD: 0.17, 95% CI: 0.07 to 0.27). There was a significant effect of interventions on moderate-to-vigorous physical activity 24 months post baseline (four studies, SMD: 0.18 95% CI: 0.07 to 0.29) and at 36 to 48 months (three studies, SMD: 0.16 95% CI: 0.09 to 0.23). The mean effect size was small. However, the changes in moderate-to-vigorous physical activity and steps per day were clinically meaningful in the best-performing studies. CONCLUSION This review suggests that behavioural interventions can be effective in promoting small, but clinically meaningful increases in objectively measured physical activity for up to 48 months. There is therefore a need to develop interventions that can achieve greater increases in long-term physical activity with greater efficiency.
Collapse
Affiliation(s)
- J Gasana
- School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, P.O Box 3286, Kigali, Rwanda
| | - T O'Keeffe
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - T M Withers
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
| | - C J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| |
Collapse
|
3
|
Tafesse N, Porcelli M, Hirpessa BB, Gasana J, Padhi R, Robele S, Ambelu A. Trihalomethanes and physicochemical quality of drinking water in Addis Ababa, Ethiopia. Heliyon 2023; 9:e19446. [PMID: 37809755 PMCID: PMC10558591 DOI: 10.1016/j.heliyon.2023.e19446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023] Open
Abstract
Background Trihalomethanes (THMs) are the most dominant fraction of all the byproducts formed during chlorination of water. Disinfection by product (DBP) formation in water is a function of numerous factors, including pH, temperature, residual chlorine, source water characteristics, and organic matter. No study has determined the THM level in the drinking water supply of Addis Ababa, Ethiopia. Methods A cross-sectional design was conducted to collect water samples in the water supply distribution networks of Addis Ababa, Ethiopia. Twenty-one (21) sampling stations yielded a total of one hundred twenty (120) samples of drinking water. The sample handling and collection procedures were carried out in accordance with USEPA guidelines. A DB-5 capillary column was used to separate the THMs, which were detected using GC-ECD (gas chromatography-electron capture detector). Spectrophotometric and in situ methods were used for physicochemical parameters. Redundancy analysis (RDA) was used for data analysis of trihalomethanes and environmental variables using CANOCO 4.5. Results The mean concentration of total trihalomethanes in drinking water in Addis Ababa was 76.3 μg/L. The concentration of chloroform in the drinking water supply in Addis Ababa, Ethiopia, ranged between 4.03 and 79.4 μg/L. The mean total THMs in the Legedadi and Gefersa water supply systems were 77.4 μg/L and 69.66 μg/L, respectively. The residual chlorine, phosphates, UV absorbance at 254 nm, and combined chlorine had positive correlations with THM formation. However, electron conductivity had a negative correlation with THM formation. Conclusions Chloroform contributed the most to TTHMs in nearly all samples. The residual chlorine, UV absorbance, phosphate and hardness as calcium, and electron conductivity were found to be the main predictors determining the abundance and distribution of trihalomethanes. The monitoring and regulation of the THMs is required on a regular basis to analyse trends and guide the water treatment and distribution system.
Collapse
Affiliation(s)
- Nebiyou Tafesse
- Department of Water and Public Health, Ethiopian Institute of Water Resources, Addis Ababa University, P.O. Box: 56402, Addis Ababa, Ethiopia
- Menelik II Medical and Health Sciences College, Addis Ababa Health Bureau, Addis Ababa, Ethiopia
| | - Massimiliano Porcelli
- Kuwait Institute for Scientific Research Quality, Health, Safety & Work Environment Department P.O. Box: 2622, Safat, 13136 Kuwait City, Kuwait
| | - Belachew Bacha Hirpessa
- Belachew Bacha Hirpessa, Ethiopian Agriculture Authority (EAA), Quality and Safety Assessment Centre, Physicochemical Lab. Services Division, P.O. Box: 31303 Addis Ababa, Ethiopia
| | - Janvier Gasana
- Past Inaugural Head of the Dept. of Environmental & Occupational Health (EOH), Director of Postgraduate Programme & MPH-EOH Advisor, College of Public Health Sciences Centre, Kuwait University, Shadadiya, Kuwait
| | - R.K. Padhi
- Materials Chemistry and Metal Fuel Cycle Group, Indira Gandhi Centre for Atomic Research, Kalpakkam, 603102 India
| | - Sirak Robele
- Department of Water and Public Health, Ethiopian Institute of Water Resources, Addis Ababa University, P.O. Box: 56402, Addis Ababa, Ethiopia
| | - Argaw Ambelu
- Department of Water and Public Health, Ethiopian Institute of Water Resources, Addis Ababa University, P.O. Box: 56402, Addis Ababa, Ethiopia
| |
Collapse
|
4
|
Alhadlaq HW, Ateeq A, Shayea AMF, Gasana J. Occupational Asthma Prevalence among Migrant Workers Attending Shuaiba Industrial Medical Center in Kuwait. Healthcare (Basel) 2023; 11:2021. [PMID: 37510462 PMCID: PMC10379107 DOI: 10.3390/healthcare11142021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Specific work environments, such as exposure to chemicals emitted during industrial processes, are related to occupational asthma. From 1985 to 2012, Kuwait was expected to have the highest asthma prevalence rate among Middle East nations, at 15%. This cross-sectional study was conducted using secondary data from occupational health physicians' records in the Shuaiba Industrial Medical Center (SIMC) extracted and analyzed using SPSS. Chi-square test and logistic regression were used to check the association between risk factors and bronchial asthma (BA). The data sample size was 3478 in 2018 and 3807 in 2019. In 2018, BA had a significant relationship with age categories, work year groups, and determinants of fitness. Migrant workers above 51 years of age had a high risk of developing BA (p-value = 0.012). There was a high risk of developing BA in workers who worked > 21 years (p-value < 0.001) and in workers who worked between 11 and 20 years (p-value = 0.042). Overweight workers had a risk of developing BA (p-value = 0.042). In 2019, BA had an associated relationship with age categories and determinants of fitness. Workers above 51 years of age had about a 39% risk of developing BA (p-value = 0.009). Otherwise, the BMI, working year groups, marital status, and smoking status had no association with BA. In conclusion, BA is prevalent among migrant workers at the SIMC. Long hours, low income, and a lack of PPE are just a few of the issues that migrant workers have been exposed to, raising their risk of poor health.
Collapse
Affiliation(s)
- Hussah Waleed Alhadlaq
- Department of Environmental and Occupational Health, College of Public Health, Kuwait University, Safat 13110, Kuwait
| | - Alanoud Ateeq
- Shuaiba Medical Industrial Center, Occupational Health Department, Ministry of Health, Ahmadi 47005, Kuwait
| | - Abdulaziz M F Shayea
- Departments of Occupational Therapy, Faculty of Allied Health Science, Kuwait University, Kuwait City 12037, Kuwait
- Departments of Molecular Biology, Faculty of Graduate Studies, Kuwait University, Kuwait City 12037, Kuwait
| | - Janvier Gasana
- Department of Environmental and Occupational Health, College of Public Health, Kuwait University, Safat 13110, Kuwait
| |
Collapse
|
5
|
Tafesse N, Porcelli M, Hirpessa BB, Gasana J, Padhi RK, Garie SR, Ambelu A. Exposure and carcinogenic risk assessment of trihalomethanes (THMs) for water supply consumers in Addis Ababa, Ethiopia. Toxicol Rep 2023; 10:261-268. [PMID: 36876027 PMCID: PMC9976571 DOI: 10.1016/j.toxrep.2023.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
Background Trihalomethanes (THMs), a class of DBPs (disinfection byproducts) that includes chloroform, bromodichloromethane (BDCM), chlorodibromomethane (CDBM), and bromoform. To the best of authors' knowledge, no study has addressed the relationship between the concentration of THMs and lifetime cancer risks (LCR) in drinking water supply system in Addis Ababa, Ethiopia. Therefore, this study aimed to determine the lifetime cancer risks of exposure to THMs in Addis Ababa, Ethiopia. Method A total of 120 duplicate water samples were collected from 21 sampling points in Addis Ababa, Ethiopia. The THMs were separated by a DB-5 capillary column and detected by an electron capture detector (ECD). Cancer and non-cancer risk assessments were performed. Results The average total THMs (TTHMs)concentration in Addis Ababa, Ethiopia, was 76.3 μg/L. Chloroform was the most dominant THM species identified. The total cancer risk for males was higher than that for females. The average LCR for TTHMs via ingestion in drinking water in this study was unacceptably high risk 93.4 × 10 - 2 . An average LCR through dermal routes was also of unacceptably high risk 4.3 × 10 - 2 . The LCR by chloroform contributes the highest (72%) of the total risk, followed by BDCM (14%), DBCM (10%) and bromoform (4%). Conclusions The cancer risk of drinking water due to THMs in Addis Ababa was higher than the level recommended by the USEPA. The total LCR from the targeted THMs was higher via the three exposure routes. Males were at higher THM cancer risk than females. The hazard index (HI) indicated that the dermal route caused higher HI values than the ingestion route. It is essential to apply alternatives to chlorine, i.e., chlorine dioxide (ClO2), ozone and ultraviolet radiation, in Addis Ababa, Ethiopia. The monitoring and regulation of the THMs is required on a regular basis to analyse the trends and guide the water treatment and distribution system. Availability of data and materials The datasets generated for this analysis are available from the corresponding author upon reasonable request.
Collapse
Affiliation(s)
- Nebiyou Tafesse
- Department of Water and Public Health , Ethiopian Institute of Water Resources, Addis Ababa University, P.O. Box: 56402, Addis Ababa, Ethiopia
| | - Massimiliano Porcelli
- Kuwait Institute for Scientific Research, Quality, Health, Safety & Work Environment Department, P.O. Box: 2622, Safat 13136, Kuwait City, Kuwait
| | - Belachew Bacha Hirpessa
- Ethiopian Agricultural Authority (EAA), Animal products and Inputs Quality Testing Center, physicochemical Lab. Services division, P.O. Box: 31303, Addis Ababa, Ethiopia
| | - Janvier Gasana
- Past Inaugural Head of the Dept. of Environmental & Occupational Health (EOH), Director of Postgraduate Programme & MPH-EOH Advisor, College of Public Health Sciences Center, Kuwait University, Shadadiya, Kuwait
| | - R K Padhi
- Materials Chemistry and Metal Fuel Cycle Group, Indira Gandhi Centre for Atomic Research, Kalpakkam, India
| | - Sirak Robele Garie
- Department of Water and Public Health , Ethiopian Institute of Water Resources, Addis Ababa University, P.O. Box: 56402, Addis Ababa, Ethiopia
| | - Argaw Ambelu
- Department of Water and Public Health , Ethiopian Institute of Water Resources, Addis Ababa University, P.O. Box: 56402, Addis Ababa, Ethiopia
| |
Collapse
|
6
|
Gasana J, Albahar S, Alkhalidi M, Al-Mekhled Q, El Reda D, Al-Sharbati M. Risky Roads in Kuwait: An Uneven Toll on Migrant Workers. Int J Environ Res Public Health 2022; 19:9726. [PMID: 35955082 PMCID: PMC9368245 DOI: 10.3390/ijerph19159726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED This descriptive study reveals trends in citations and traffic-related mortality in Kuwait. Secondary data were utilized, where data on road traffic citations were obtained from the traffic police in the Ministry of Interior for the years from 2011 to 2015, and road traffic mortality data for the study period were obtained from the Ministry of Health. OBJECTIVE To describe recent trends in data related to road traffic safety in Kuwait over time, which could serve as an important indicator for the level of enforcement of existing traffic regulations. Descriptive summary statistics are presented. RESULTS There was a total of 24.2 million traffic violations during the study period. The number rose dramatically from 4 million citations in 2011 to nearly 6.5 million in 2015. The indirect method of citation (issued indirectly via surveillance methods) constituted a higher percentage of citations, 70.4%, compared to the direct method of citation (issued directly by the police officer), 29.6%. Furthermore, the top reason for citation was speeding, followed by parking in no parking/handicapped zones, driving with an expired license, and crossing a red light. Road traffic fatalities (RTFs) in Kuwait from 2011 to 2015 totaled 2282. About 450 people die each year in Kuwait from road traffic injuries and a slightly decreasing trend was found. Non-Kuwaitis have RTF counts that are four times higher than Kuwaitis, with 1663 and 263 deaths, respectively. CONCLUSIONS Road traffic safety continues to be a major problem in Kuwait. Increases in citation issuance show a rise in traffic regulation enforcement, yet risky driving behaviors continue to account for most violations issued. Harsher penalties, road safety education, and implementing graduated driving licensing may be warranted to increase the safety of the roads.
Collapse
Affiliation(s)
- Janvier Gasana
- Department of Environmental and Occupational Health, College of Public Health, Kuwait University, P.O. Box 24923, Kuwait City 13110, Kuwait
| | - Soad Albahar
- Department of Environmental and Occupational Health, College of Public Health, Kuwait University, P.O. Box 24923, Kuwait City 13110, Kuwait
| | - Mahareb Alkhalidi
- Department of Community Medicine and Behavioral Sciences, College of Medicine, Kuwait University, P.O. Box 24923, Kuwait City 13110, Kuwait
| | - Qout Al-Mekhled
- Department of Social and Behavioral Sciences, College of Public Health, Kuwait University, P.O. Box 24923, Kuwait City 13110, Kuwait
| | - Darline El Reda
- Division of Public Health, Michigan State University, East Lansing, MI 48824, USA
| | - Marwan Al-Sharbati
- Department of Social and Behavioral Sciences, College of Public Health, Kuwait University, P.O. Box 24923, Kuwait City 13110, Kuwait
| |
Collapse
|
7
|
Ibrahimou B, Sun N, Burchfield S, Shrestha P, Veitzman F, Bursac Z, Salihu H, Dagne G, Gasana J, Guilarte TR. Race as a moderator of the association between ethnicity, preeclampsia and neonatal respiratory distress syndrome. World J Pediatr 2022; 18:568-573. [PMID: 35650375 PMCID: PMC10574812 DOI: 10.1007/s12519-022-00571-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Boubakari Ibrahimou
- Department of Biostatistics, Florida International University, Robert Stempel College of Public Health and Social Work, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA.
| | - Ning Sun
- Department of Biostatistics, Florida International University, Robert Stempel College of Public Health and Social Work, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA
| | - Shelbie Burchfield
- Department of Biostatistics, Florida International University, Robert Stempel College of Public Health and Social Work, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA
| | - Priyanka Shrestha
- Department of Biostatistics, Florida International University, Robert Stempel College of Public Health and Social Work, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA
| | - Fernanda Veitzman
- Department of Biostatistics, Florida International University, Robert Stempel College of Public Health and Social Work, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA
| | - Zoran Bursac
- Department of Biostatistics, Florida International University, Robert Stempel College of Public Health and Social Work, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA
| | - Hamisu Salihu
- Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, One Baylor Plaza MS: 411, Houston, TX, 77030, USA
| | - Getachew Dagne
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Janvier Gasana
- Faculty of Public Health, Department of Environmental and Occupational Health, Kuwait University, Block 7 Street 32013119, PO Box 24923, Safat, Hawally, Kuwait
| | - Tomas R Guilarte
- Department of Environmental Health Sciences, Florida International University, Robert Stempel College of Public Health and Social Work, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA
| |
Collapse
|
8
|
Albahar S, Li J, Al-Zoughool M, Al-Hemoud A, Gasana J, Aldashti H, Alahmad B. Air Pollution and Respiratory Hospital Admissions in Kuwait: The Epidemiological Applicability of Predicted PM2.5 in Arid Regions. IJERPH 2022; 19:ijerph19105998. [PMID: 35627536 PMCID: PMC9140349 DOI: 10.3390/ijerph19105998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 01/27/2023]
Abstract
Dust is a major component of fine particulate matter (PM2.5) in arid regions; therefore, concentrations of this pollutant in countries such as Kuwait exceed air quality standards. There is limited understanding on the impact and burden of high PM2.5 concentrations on morbidity in these countries. In this study, we explore the association of PM2.5 and the risk of respiratory hospital admissions in Kuwait. A time-series regression model was used to investigate daily variations in respiratory admissions and PM2.5 concentrations from 2010 to 2018. Due to the lack of historical air quality sampling in Kuwait, we used estimated daily PM2.5 levels from a hybrid PM2.5 prediction model. Individual and cumulative lag effects of PM2.5 over a 5-day period were estimated using distributed lag linear models. Associations were stratified by sex, age, and nationality. There were 218,749 total respiratory admissions in Kuwait during the study period. Results indicate that for every 10 μg/m3 increase in PM2.5, a 1.61% (95% CI = 0.87, 2.35%) increase in respiratory admissions followed over a 5-day cumulative lag. Our estimates show that a 10 μg/m3 reduction in average exposure will potentially avert 391 yearly respiratory admissions (95% CI = 211,571), with 265 fewer admissions among Kuwaitis (95% CI = 139,393) and 262 fewer admissions among children under 15 years of age (95% CI = 125,351). Different strata of the Kuwaiti population are vulnerable to respiratory hospitalization with short-term exposure to PM2.5, especially those under 15 years of age. The findings are informative for public health authorities in Kuwait and other dust-prone countries.
Collapse
Affiliation(s)
- Soad Albahar
- Environmental and Occupational Health Department, College of Public Health, Kuwait University, Shadadiya 13110, Kuwait; (M.A.-Z.); (J.G.); (B.A.)
- Correspondence: (S.A.); (J.L.)
| | - Jing Li
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100871, China
- Correspondence: (S.A.); (J.L.)
| | - Mustafa Al-Zoughool
- Environmental and Occupational Health Department, College of Public Health, Kuwait University, Shadadiya 13110, Kuwait; (M.A.-Z.); (J.G.); (B.A.)
| | - Ali Al-Hemoud
- Environment and Life Sciences Research Center, Kuwait Institute of Scientific Research, Kuwait City 13109, Kuwait;
| | - Janvier Gasana
- Environmental and Occupational Health Department, College of Public Health, Kuwait University, Shadadiya 13110, Kuwait; (M.A.-Z.); (J.G.); (B.A.)
| | - Hassan Aldashti
- Meteorological Department, Directorate General of Civil Aviation, Kuwait City 13001, Kuwait;
| | - Barrak Alahmad
- Environmental and Occupational Health Department, College of Public Health, Kuwait University, Shadadiya 13110, Kuwait; (M.A.-Z.); (J.G.); (B.A.)
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| |
Collapse
|
9
|
Ali A, Alfajjam S, Gasana J. Diabetes Mellitus and Its Risk Factors among Migrant Workers in Kuwait. Int J Environ Res Public Health 2022; 19:ijerph19073943. [PMID: 35409622 PMCID: PMC8997920 DOI: 10.3390/ijerph19073943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/01/2022] [Accepted: 03/16/2022] [Indexed: 12/14/2022]
Abstract
The prevalence of diabetes mellitus (DM) is growing enormously worldwide, and actions need to be taken in order to minimize the burden of diabetes mellitus and reduce its complications. Since two-thirds of Kuwait's population are expatriates, the prevalence of and factors associated with diabetes among migrant workers was assessed as it has a significant impact on migrant workers' quality of life, health, and productivity. The data used in this study was for all migrant workers who attended Shuaiba Industrial Medical Center (SIMC) for physical examination in the year 2018. Univariate and multivariate regression were used to assess the relationship between diabetes mellitus and the other independent factors where odds ratios with confidence intervals were delineated. Information for a total of 3477 participants was recorded in the dataset for 2018. Of the total participants, 10.1% had diabetes mellitus. About 49% of the participants were overweight. The largest age group of participants was between 31 and 40 years of age. A small percentage of the participants were diagnosed with hypertension at 11.8%. Additionally, 76.1% of the participants reported themselves as non-smokers. Diabetes was positively associated with age, hypertension, and nationalities. However, no association was found between BMI and smoking tobacco. This is the first study in SIMC to assess DM and its associated risk factor among migrants, since migrant workers are neglected subpopulations that need our focus and attention to achieve justice and fairness. The findings revealed that the prevalence of DM among our study population was considerably lower. However, a healthy lifestyle, including a healthy diet and being physically active, need to be introduced to prevent any further damage.
Collapse
Affiliation(s)
- Anwar Ali
- Public Health Department, Ministry of Health, P.O. Box 5, Kuwait City 12009, Kuwait;
| | - Shaikhah Alfajjam
- Occupational Health Department, Ministry of Health, P.O. Box 5, Kuwait City 12009, Kuwait;
| | - Janvier Gasana
- Department of Environmental and Occupational Health, Faculty of Public Health, Kuwait University, P.O. Box 24923, Kuwait City 13110, Kuwait
- Correspondence:
| |
Collapse
|
10
|
Al-Zoughool M, Oraby T, Vainio H, Gasana J, Longenecker J, Al Ali W, AlSeaidan M, Elsaadany S, Tyshenko MG. Using a stochastic continuous-time Markov chain model to examine alternative timing and duration of the COVID-19 lockdown in Kuwait: what can be done now? Arch Public Health 2022; 80:22. [PMID: 34998438 PMCID: PMC8742165 DOI: 10.1186/s13690-021-00778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 12/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Kuwait had its first COVID-19 in late February, and until October 6, 2020 it recorded 108,268 cases and 632 deaths. Despite implementing one of the strictest control measures-including a three-week complete lockdown, there was no sign of a declining epidemic curve. The objective of the current analyses is to determine, hypothetically, the optimal timing and duration of a full lockdown in Kuwait that would result in controlling new infections and lead to a substantial reduction in case hospitalizations. Methods The analysis was conducted using a stochastic Continuous-Time Markov Chain (CTMC), eight state model that depicts the disease transmission and spread of SARS-CoV 2. Transmission of infection occurs between individuals through social contacts at home, in schools, at work, and during other communal activities. Results The model shows that a lockdown 10 days before the epidemic peak for 90 days is optimal but a more realistic duration of 45 days can achieve about a 45% reduction in both new infections and case hospitalizations. Conclusions In the view of the forthcoming waves of the COVID19 pandemic anticipated in Kuwait using a correctly-timed and sufficiently long lockdown represents a workable management strategy that encompasses the most stringent form of social distancing with the ability to significantly reduce transmissions and hospitalizations. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00778-y.
Collapse
Affiliation(s)
- Mustafa Al-Zoughool
- Department of Environmental and Occupational Health Faculty of Public Health, University of Kuwait, Kuwait City, Kuwait.
| | - Tamer Oraby
- School of Mathematical and Statistical Sciences, University of Texas Rio Grande Valley, Edinburg, TX, 78539, USA
| | - Harri Vainio
- Department of Environmental and Occupational Health Faculty of Public Health, University of Kuwait, Kuwait City, Kuwait
| | - Janvier Gasana
- Department of Environmental and Occupational Health Faculty of Public Health, University of Kuwait, Kuwait City, Kuwait
| | - Joseph Longenecker
- Department of Environmental and Occupational Health Faculty of Public Health, University of Kuwait, Kuwait City, Kuwait
| | - Walid Al Ali
- Department of Epidemiology and Biostatistics, Faculty of Public Health, University of Kuwait, 13110, Safat, Kuwait
| | - Mohammad AlSeaidan
- Department of Occupational Health, Ministry of Health, Kuwait City, Kuwait
| | - Susie Elsaadany
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8M5, Canada
| | - Michael G Tyshenko
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| |
Collapse
|
11
|
Gasana J. Occupational health challenges in developing countries in the chemical and other sectors and opportunity for OH capacity building using e-learning. Saf Health Work 2022. [DOI: 10.1016/j.shaw.2021.12.842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
12
|
Rushton A, Jadhakhan F, Bini E, Gasana J, Masson A, Staal J, Verra M, Emms A, Reddington M, Cole A, Willems P, Benneker L, Heneghan N, Soundy A. Qualitative analysis of the patient journey following lumbar spinal fusion surgery in real-time as lived: Insights to inform rehabilitation. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
13
|
Asiamah N, Vieira ER, Kouveliotis K, Gasana J, Awuviry-Newton K, Eduafo R. Associations between older African academics' physical activity, walkability and mental health: a social distancing perspective. Health Promot Int 2021; 37:6372832. [PMID: 34543431 PMCID: PMC8500010 DOI: 10.1093/heapro/daab093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This study aimed to assess the moderating influence of neighborhood walkability on the association between physical activity (PA) and mental health among older African academics aged 50 years or more in cities with social distancing protocols in response to the Coronavirus disease 2019 (COVID-19). A total of 905 volunteer academics participated in the study. A hierarchical linear regression analysis was employed to conduct sensitivity analyses and test the study hypotheses. After controlling for sex, education and age, there was a positive association between PA and mental health. Neighborhood walkability moderated the relationship between PA and mental health, which suggests that during the pandemic PA was associated with higher mental health scores in more walkable neighborhoods. The study concludes that PA was beneficial to mental health in the social distancing context and was associated with higher mental health in more walkable neighborhoods, particularly in a social distancing context.
Collapse
Affiliation(s)
- Nestor Asiamah
- School of Health and Care Professions, University of Portsmouth, Winston Churchill Ave, Portsmouth PO1 2UP, UK
| | - Edgar Ramos Vieira
- Department of Physical Therapy, Nicole Wertheim College of Nursing & Health Sciences, Florida International University, USA
| | - Kyriakos Kouveliotis
- Department of Health Management, Berlin School of Business and Innovation, Berlin, Germany
| | - Janvier Gasana
- Faculty of Public Health, Department of Environmental and Occupational Health, Kuwait University, Kuwait
| | - Kofi Awuviry-Newton
- Faculty of Health and Medicine, Priority Research Centre for Generational Health and Ageing, University of Newcastle, Australia
| | - Richard Eduafo
- Africa Centre for Epidemiology, Gerontology and Geriatric Care, Accra North, Ghana
| |
Collapse
|
14
|
Alahmad B, AlMekhled D, Odeh A, Albloushi D, Gasana J. Disparities in excess deaths from the COVID-19 pandemic among migrant workers in Kuwait. BMC Public Health 2021; 21:1668. [PMID: 34521360 PMCID: PMC8438289 DOI: 10.1186/s12889-021-11693-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/29/2021] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The actual human cost of the pandemic cannot be viewed through the COVID-19 mortality rates alone, especially when the pandemic is widening the existing health disparities among different subpopulations within the same society. In Kuwait, migrant workers were already disproportionately impacted by COVID-19 and its unintended consequences. The totality of that effect on mortality is yet to be fully understood. OBJECTIVE To estimate excess deaths in the pandemic year of 2020 among the Kuwaiti and non-Kuwaiti migrant populations. METHODS We analyzed publicly available retrospective data in Kuwait on total annual mortality historically (from 2005 to 2019) and in 2020. We fitted a quasi-poisson generalized linear model adjusted for yearly trend and nationality to estimate the expected deaths in 2020 in the absence of the pandemic. We calculated excess deaths as the difference between observed and expected mortality for the year of the pandemic in both Kuwaitis and non-Kuwaitis. RESULTS In the absence of the pandemic, we expected the total mortality in Kuwait to be 6629 (95% CI: 6472 to 6789) deaths. However, the observed total mortality in 2020 was 9975 deaths; about 3346 (3186 to 3503) more deaths above the expected historical trend. Deaths among migrant workers would have been approximately 71.9% (67.8 to 76.0) lower in the absence of the pandemic. On the other hand, deaths among Kuwaitis would have been 32.4% (29.3 to 35.6) lower if the country had not been hit by the pandemic. CONCLUSION The burden of mortality brought on by the COVID-19 pandemic is substantially higher than what the official tally might suggest. Systematically disadvantaged migrant workers shouldered a larger burden of deaths in the pandemic year. Public health interventions must consider structural and societal determinants that give rise to the health disparities seen among migrant workers.
Collapse
Affiliation(s)
- Barrak Alahmad
- Department of Environmental and Occupational Health, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait.,Environmental Health Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Dawoud AlMekhled
- School of Biomedical Sciences, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Australia
| | - Ayah Odeh
- Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait
| | - Dalia Albloushi
- Mubarak Al-Kabeer Hospital, Ministry of Health, Hawalli, Kuwait
| | - Janvier Gasana
- Department of Environmental and Occupational Health, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait.
| |
Collapse
|
15
|
Gasana J, Vainio H, Longenecker J, Loney T, Ádám B, Al-Zoughool M. Identification of public health priorities, barriers, and solutions for Kuwait using the modified Delphi method for stakeholder consensus. Int J Health Plann Manage 2021; 36:1830-1846. [PMID: 34176157 DOI: 10.1002/hpm.3270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/05/2022] Open
Abstract
The rapid modernization and economic developments in Kuwait, have been accompanied by substantial lifestyle changes such as unhealthy diet and physical inactivity. These modifiable behaviours have contributed to increased rates of non-communicable diseases including diabetes and cardiovascular diseases. Delphi Consensus Method was implemented in the current study to draw stakeholders from all sectors together to develop a consensus on the major public health priorities, barriers and solutions. The process involves administration of a series of questions to selected stakeholders through an iterative process that ends when a consensus has been reached among participants. Results of the iteration process identified obesity, diabetes, cardiovascular diseases along with lack of enforcement of laws and regulation as priority health issues. Results also identified lack of national vision for the development of a public health system, lack of multidisciplinary research investigating sources of disease and methods of prevention and improving efficiency with existing resources in implementation and efficiency as the main barriers identified were. Solutions suggested included investing in healthcare prevention, strengthening communication between all involved sectors through intersectoral collaboration, awareness at the primary healthcare setting and use of electronic health records. The results offer an important opportunity for stakeholders in Kuwait to tackle these priority health issues employing the suggested approaches and solution.
Collapse
Affiliation(s)
- Janvier Gasana
- Department of Environmental and Occupational Health, Faculty of Public Health, Kuwait University, Kuwait, Kuwait
| | - Harri Vainio
- Department of Environmental and Occupational Health, Faculty of Public Health, Kuwait University, Kuwait, Kuwait
| | - Joseph Longenecker
- Department of Epidemiology, Faculty of Public Health, Kuwait University, Kuwait, Kuwait
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University for Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Balázs Ádám
- Department of Public Health and Preventive Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mustafa Al-Zoughool
- Department of Environmental and Occupational Health, Faculty of Public Health, Kuwait University, Kuwait, Kuwait
| |
Collapse
|
16
|
Buqammaz M, Gasana J, Alahmad B, Shebl M, Albloushi D. Occupational Noise-Induced Hearing Loss among Migrant Workers in Kuwait. Int J Environ Res Public Health 2021; 18:ijerph18105295. [PMID: 34065730 PMCID: PMC8156043 DOI: 10.3390/ijerph18105295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/08/2021] [Accepted: 05/14/2021] [Indexed: 12/20/2022]
Abstract
Although the effect of hearing loss on years lived with disability (YLD) is quite substantial, occupational hearing loss among migrant workers is significantly under-studied. In Kuwait, where nearly two-thirds of the population are migrant workers, the burden of occupational noise-induced hearing loss (ONIHL) is unknown. The objective of the study was to assess the prevalence of ONIHL among migrant workers in Kuwait and explore workplace and individual risk factors that are associated with ONIHL. We obtained data of annual physical exams for the year 2018 conducted by the Shuaiba Industrial Medical Center (SIMC) for all industrial workers in the area. We applied univariate and multivariate logistic regression models to estimate the effects of individual and occupational characteristics on ONIHL. A total of 3474 industrial workers visited the SIMC for an annual exam. The vast majority were men (99%) and non-Kuwaitis (98%) with a median age of 38 years. A total of 710 workers were diagnosed with ONIHL with a prevalence of 20.4%. Age, years of experience, and self-reported exposure to noise were associated with statistically significant higher odds of ONIHL. When adjusted for age, years of experience, and other individual level factors, type of industry was not a statistically significant predictor of ONIHL. The study uncovers the significant burden of hearing loss among the migrant worker subpopulation in Kuwait, an area of occupational health that is often underestimated or unrecognized. Although laws and regulations are in place to prevent and control noise in the workplace, the onus is on local authorities to ensure the necessary training and controls aimed to reduce noise exposure.
Collapse
Affiliation(s)
- Mariam Buqammaz
- Department of Environmental & Occupational Health, Faculty of Public Health, Kuwait University, Hawalli 13110, Kuwait; (J.G.); (B.A.)
- Correspondence:
| | - Janvier Gasana
- Department of Environmental & Occupational Health, Faculty of Public Health, Kuwait University, Hawalli 13110, Kuwait; (J.G.); (B.A.)
| | - Barrak Alahmad
- Department of Environmental & Occupational Health, Faculty of Public Health, Kuwait University, Hawalli 13110, Kuwait; (J.G.); (B.A.)
| | - Mohammed Shebl
- Department of Occupational Health, Ministry of Health, Shuwaiba Industrial Medical Center, Ahmadi 60000, Kuwait;
| | - Dalia Albloushi
- Mubarak Al-Kabeer Hospital (MKH), Ministry of Health, Hawalli 47060, Kuwait;
| |
Collapse
|
17
|
Gasana J, Ibrahimou B, Albatineh AN, Al-Zoughool M, Zein D. Exposures in the Indoor Environment and Prevalence of Allergic Conditions in the United States of America. Int J Environ Res Public Health 2021; 18:ijerph18094945. [PMID: 34066511 PMCID: PMC8124238 DOI: 10.3390/ijerph18094945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 11/24/2022]
Abstract
Our study examines the association of the presence of mildew, cockroaches, and pets in homes as well as household dust allergens with the prevalence and/or severity of allergic diseases. No study has concurrently assessed home environment exposures in relation to allergic conditions in the general US population. Data from 5409 participants from the 2005–2006 National Health and Nutrition Examination Survey (NHANES) living in their current homes for ≥one year were analyzed. Multivariate logistic regression analyses between home exposures and allergic diseases prevalence and severity were performed. In adjusted analyses, mildew was associated with higher current asthma, allergies, and allergic rhinitis prevalence; endotoxin, with higher current asthma prevalence; and dust Canis familiaris (Can f) 1, with higher allergic rhinitis prevalence. However, presence of cockroaches and dust Dermatophagoides farinae (Der f) 1 were associated, respectively, with lower current asthma and allergies prevalence. Presence of mildew, dust Der f1, Dermatophagoides pteronyssinus (Der p) 1, Felis domesticus (Fel d) 1, and endotoxin were all associated with asthma and/or wheeze severity. Non-atopic asthma was more frequent with mildew and/or musty smell dust and higher dust Fel d1 concentration, while atopic asthma was more prevalent with higher Can f1 and endotoxin concentrations in dust. This study confirms previous relationships and reports novel associations, generating hypotheses for future research.
Collapse
Affiliation(s)
- Janvier Gasana
- Department of Environmental and Occupational Health, Faculty of Public Health, Kuwait University, Hawally P.O. Box 24923, Safat 13119, Kuwait; (M.A.-Z.); (D.Z.)
- Correspondence:
| | - Boubakari Ibrahimou
- Department of Biostatistics, Stempel School of Public Health, Florida International University, Miami, FL 33199, USA;
| | - Ahmed N. Albatineh
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Jabriya P.O. Box 46300, Safat 13119, Kuwait;
| | - Mustafa Al-Zoughool
- Department of Environmental and Occupational Health, Faculty of Public Health, Kuwait University, Hawally P.O. Box 24923, Safat 13119, Kuwait; (M.A.-Z.); (D.Z.)
| | - Dina Zein
- Department of Environmental and Occupational Health, Faculty of Public Health, Kuwait University, Hawally P.O. Box 24923, Safat 13119, Kuwait; (M.A.-Z.); (D.Z.)
| |
Collapse
|
18
|
Tyshenko MG, Oraby T, Longenecker J, Vainio H, Gasana J, Alali WQ, AlSeaidan M, ElSaadany S, Al-Zoughool M. Analysis of intervention effectiveness using early outbreak transmission dynamics to guide future pandemic management and decision-making in Kuwait. Infect Dis Model 2021; 6:693-705. [PMID: 33898885 PMCID: PMC8054527 DOI: 10.1016/j.idm.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/25/2021] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a World Health Organization designated pandemic that can result in severe symptoms and death that disproportionately affects older patients or those with comorbidities. Kuwait reported its first imported cases of COVID-19 on February 24, 2020. Analysis of data from the first three months of community transmission of the COVID-19 outbreak in Kuwait can provide important guidance for decision-making when dealing with future SARS-CoV-2 epidemic wave management. The analysis of intervention scenarios can help to evaluate the possible impacts of various outbreak control measures going forward which aim to reduce the effective reproduction number during the initial outbreak wave. Herein we use a modified susceptible-exposed-asymptomatic-infectious-removed (SEAIR) transmission model to estimate the outbreak dynamics of SARS-CoV-2 transmission in Kuwait. We fit case data from the first 96 days in the model to estimate the effective reproduction number and used Google mobility data to refine community contact matrices. The SEAIR modelled scenarios allow for the analysis of various interventions to determine their effectiveness. The model can help inform future pandemic wave management, not only in Kuwait but for other countries as well.
Collapse
Affiliation(s)
- Michael G. Tyshenko
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Tamer Oraby
- School of Mathematical and Statistical Sciences, The University of Texas Rio Grande Valley, Edinburg, TX, 78539, USA
| | | | - Harri Vainio
- Faculty of Public Health, University of Kuwait, Kuwait
| | | | - Walid Q. Alali
- Department of Epidemiology and Biostatistics, Faculty of Public Health, University of Kuwait, Safat, 13110, Kuwait
| | | | - Susie ElSaadany
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8M5, Canada
| | | |
Collapse
|
19
|
Al-Hemoud A, Gasana J, Alajeel A, Alhamoud E, Al-Shatti A, Al-Khayat A. Ambient exposure of O 3 and NO 2 and associated health risk in Kuwait. Environ Sci Pollut Res Int 2021; 28:14917-14926. [PMID: 33222061 DOI: 10.1007/s11356-020-11481-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/29/2020] [Indexed: 06/11/2023]
Abstract
Ozone (O3) and nitrogen dioxide (NO2), indissoluble air pollutants in the atmosphere, have been confirmed in various parts of the world to have detrimental health effects on humans. Currently, such information is lacking in Kuwait. The objectives of this study are to investigate the spatial and temporal variations of O3 and NO2 concentrations in Kuwait during a 4-year period (2014-2017) and to quantify the associated short- and long-term health effects, including all-cause, respiratory, and cardiovascular mortalities and morbidities during the same study period. Exposure assessment showed that the annual levels (22.5-26.4 ppb), SOMO35, and the 8-hour 4-year mean (38 ppb) of O3 were very low and below the World Health Organization (WHO) (50 ppb) and Kuwaiti (70 ppb) regulatory limits. The annual mean levels of NO2 ranged from 30.3 to 43.8 ppb and were significantly higher than both WHO and Kuwait limits (21 ppb). As expected, O3 and NO2 levels showed opposing trends, with higher concentrations of NO2 recorded in early morning and mid-evening, during autumn and winter, and during Saturdays (the so-called weekend effect). Health effects indicated high respiratory diseases due to short-term exposure to NO2. Contrary to the western countries' pollution levels, Kuwait showed lower O3 and higher NO2 levels. There is potential for substantial health improvements in Kuwait by reducing NO2 pollution through stringent control measures of stationary and mobile sources.
Collapse
Affiliation(s)
- Ali Al-Hemoud
- Crisis Decision Support Program, Environment and Life Sciences Research Center, Crisis Decision Support Program, Kuwait Institute for Scientific Research, P. O. Box 24885, 13109, Safat, Kuwait.
| | - Janvier Gasana
- Faculty of Public Health, Kuwait University, P. O. Box 24923, 13110, Safat, Kuwait
| | | | - Ebrahim Alhamoud
- Faculty of Law, Kuwait University, P. O. Box 5475, 13055, Safat, Kuwait
| | | | - Ahmed Al-Khayat
- Techno-Economics Division, Kuwait Institute for Scientific Research, P. O. Box 24885, 13109, Safat, Kuwait
| |
Collapse
|
20
|
Alahmad B, Shakarchi AF, Khraishah H, Alseaidan M, Gasana J, Al-Hemoud A, Koutrakis P, Fox MA. Extreme temperatures and mortality in Kuwait: Who is vulnerable? Sci Total Environ 2020; 732:139289. [PMID: 32438154 DOI: 10.1016/j.scitotenv.2020.139289] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND Previous climate change temperature-related health studies have been performed mostly in western countries with relatively cooler temperatures than the Gulf region. Regions that are inherently hot, like Kuwait, are witnessing soaring temperatures unlike ever before. Meanwhile, Kuwait and other Gulf countries are unique in their demographic profiles due to the large number of non-national migrant workers. OBJECTIVE To examine the associations of hot and cold temperature extremes on the risk of mortality across gender, age groups and nationality in Kuwait. METHODS We investigated daily variations of all-cause non-accidental and cardiovascular mortality death counts and ambient temperatures from 2010 to 2016 in a time-series design using a negative binomial distribution. The temperature lag was modeled with distributed lag non-linear models. RESULTS A total of 33,472 all-cause non-accidental deaths happened during the study period. For the extreme hot temperatures and over the entire lag period, comparing the 99th percentile of temperature to the minimum mortality temperature, the risk of dying among males was 2.08 (95% CI: 1.23-3.52). Among non-Kuwaitis, males and working age group (15-64 year) had relative risks of death from extreme hot temperatures of 2.90 (1.42-5.93), and 2.59 (1.20-5.59), respectively. For extreme cold temperatures and over the entire lag period, comparing the 1st percentile of temperature to the minimum mortality temperature, the relative risk of death among Kuwaitis was 2.03 (1.05-3.93). Elderly Kuwaitis (65+ year) exposed to extreme cold temperatures had a relative risk of 2.75 (1.16-6.52). CONCLUSIONS Certain subpopulations in Kuwait are vulnerable to extreme temperatures with doubling to tripling risk of mortality. Nationality is an important effect modifier in temperature-related mortality studies in Kuwait and possibly the Gulf region. To the best of our knowledge, we are the first study to examine specific subpopulation vulnerabilities to temperature in this region. Our findings could carry a potential for broader insight into similar hyper-arid and hot regions.
Collapse
Affiliation(s)
- Barrak Alahmad
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Environmental and Occupational Health Department, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait.
| | - Ahmed F Shakarchi
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Haitham Khraishah
- Cardiovascular Research Center, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mohammad Alseaidan
- Environmental Health Department, Public Health Administration, Ministry of Health, Kuwait
| | - Janvier Gasana
- Environmental and Occupational Health Department, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait
| | - Ali Al-Hemoud
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Kuwait
| | - Petros Koutrakis
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Mary A Fox
- Department of Health Policy and Management and Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
21
|
Alahmad B, Kurdi H, Colonna K, Gasana J, Agnew J, Fox MA. COVID-19 stressors on migrant workers in Kuwait: cumulative risk considerations. BMJ Glob Health 2020; 5:e002995. [PMID: 32641292 PMCID: PMC7348320 DOI: 10.1136/bmjgh-2020-002995] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 01/06/2023] Open
Abstract
As a marginalised subpopulation, migrant workers often fall short from protection by public policies, they take precarious jobs with unsafe working and living conditions and they grapple with cultural and linguistic barriers. In light of the current COVID-19 pandemic, migrant workers are now exposed to additional stressors of the virus and related responses. We applied a comprehensive qualitative cumulative risk assessment framework for migrant workers living in Kuwait. This pandemic could be one of the few examples where the stressors overlap all domains of migrant workers' lives. No single intervention can solve all the problems; there must be a set of interventions to address all domains. Local authorities and employers must act quickly to stop the spread, ensure easy access to testing and treatment, provide adequate housing and clear communication, encourage wide social support, safeguard financial protection and mental well-being and continuously re-evaluate the situation as more data are collected.
Collapse
Affiliation(s)
- Barrak Alahmad
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States
- Department of Environmental and Occupational Health, , Faculty of Public Health, Kuwait University, Hawalli, Kuwait
| | - Hussam Kurdi
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States
| | - Kyle Colonna
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States
| | - Janvier Gasana
- Department of Environmental and Occupational Health, , Faculty of Public Health, Kuwait University, Hawalli, Kuwait
| | - Jacqueline Agnew
- Department of Environmental Health and Engineering and Johns Hopkins Education and Research Center for Occupational Safety and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Mary A Fox
- Department of Health Policy and Management and Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| |
Collapse
|
22
|
Al-Hemoud A, Gasana J, Al-Dabbous A, Alajeel A, Al-Shatti A, Behbehani W, Malak M. Exposure levels of air pollution (PM 2.5) and associated health risk in Kuwait. Environ Res 2019; 179:108730. [PMID: 31550597 DOI: 10.1016/j.envres.2019.108730] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/28/2019] [Accepted: 09/05/2019] [Indexed: 06/10/2023]
Abstract
It is well established that respiratory and cardiovascular mortality and morbidity rates are associated with poor air quality as measured by high concentrations of fine particulate matter such as PM2.5 parameters. Since such information is lacking for the State of Kuwait, this study examined the exposure levels of PM2.5 and the associated health risk as evaluated by five mortality measures embodied in ischemic heart disease, stroke, lung cancer, chronic obstructive pulmonary disease and acute lower respiratory infection as well as two morbidity outcomes related to both cardiovascular and respiratory diseases. The measurement models utilized in this investigation followed the WHO guidelines. Over a span of a four-year period (2014-2017), the annual PM2.5 concentration levels ranged from 38.0 μg/m3 to 75.2 μg/m3. In general, exposure levels tended to fluctuate throughout the day with the higher levels recorded during rush hours (early morning and early evening), weekends (particularly Saturdays), and summer (i.e., August and September). The highest number of excess cases and attributable proportions of premature mortalities were related to ischemic heart disease and stroke at 352 (95% CI 275-426) and 70.8% (95% CI 39.7-85.2), respectively. In general, respiratory diseases showed a higher number of excess cases and attributable proportions than cardiovascular diseases. Relative to other findings on the global stage, the results emanating from Kuwait are emerging on the higher side. The study outcomes suggest that control strategies are in dire need to bend the pollution levels in Kuwait.
Collapse
Affiliation(s)
- Ali Al-Hemoud
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, P.O. Box 24885, 13109, Safat, Kuwait.
| | - Janvier Gasana
- Faculty of Public Health, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait
| | - Abdullah Al-Dabbous
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, P.O. Box 24885, 13109, Safat, Kuwait
| | | | | | - Weam Behbehani
- Techno-Economics Division, Kuwait Institute for Scientific Research, P.O. Box 24885, 13109, Safat, Kuwait
| | - Mariam Malak
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, P.O. Box 24885, 13109, Safat, Kuwait
| |
Collapse
|
23
|
Beck-Sague CM, Arrieta A, Pinzon-Iregui MC, Ortiz B, Dean AG, Cuddihy A, Gasana J. Trends in Racial and Ethnic Disparities in Childhood Asthma in Miami, Florida: 2005-2013. J Immigr Minor Health 2019; 20:1429-1437. [PMID: 29290019 DOI: 10.1007/s10903-017-0686-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nationally, racial and ethnic disparities in childhood asthma plateaued from 2005 to 2013. We assessed trends in childhood asthma in Miami, Florida using Youth Risk Behavior Surveillance System (YRBSS) data and emergency department (ED) utilization and hospitalization rates by zip code population characteristics. Asthma prevalence in Miami did not vary significantly by race/ethnicity in YRBSS respondents in 2005 (16.2-17.2%, all groups), but rose in African-Americans and Hispanics and declined in Whites by 2013 to 27.9, 20.9 and 12.6%, respectively (P = 0.02). Median asthma ED visit rates rose from 106.8 (2006-2008) to 138.2 (2011-2013; P = 0.004) per 10,000 children. High-poverty and majority African-American zip codes were 6.3 and 7.3 times more likely to have asthma ED visit rates > 200 than others (P < 0.001). In high-poverty zip codes, majority African-American population was not associated with significantly higher ED utilization. In low-poverty zip codes, the association became stronger. Greater poverty explains much, but not all of Miami African-Americans' higher asthma risk.
Collapse
Affiliation(s)
- Consuelo M Beck-Sague
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA. .,Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8 Street, AHC 5-410, Miami, FL, 33199, USA.
| | - Alejandro Arrieta
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - M Claudia Pinzon-Iregui
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Benjamin Ortiz
- Columbia University Medical Center, New York, NY, USA.,Harlem Hospital Center, New York, NY, USA.,Immunology and Inflammation Medical Unit, Sanofi, East Hanover, NJ, USA
| | | | - Andrew Cuddihy
- South Florida Asthma Consortium, Ft. Lauderdale, FL, USA
| | - Janvier Gasana
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.,South Florida Asthma Consortium, Ft. Lauderdale, FL, USA.,Department of EOH, Kuwait University, Kuwait City, Kuwait
| |
Collapse
|
24
|
Mendy A, Forno E, Niyonsenga T, Carnahan R, Gasana J. Prevalence and features of asthma-COPD overlap in the United States 2007-2012. Clin Respir J 2018; 12:2369-2377. [PMID: 29873189 DOI: 10.1111/crj.12917] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/27/2018] [Accepted: 05/06/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Perceived to be distinct, asthma and chronic obstructive pulmonary disease (COPD) can co-exist and potentially have a worse prognosis than the separate diseases. Yet, little is known about the exact prevalence and the characteristics of the Asthma-COPD overlap (ACO) in the US population. AIMS To determine ACO prevalence in the United States, identify ACO predictors, examine ACO association with asthma and COPD severity, and describe distinctive spirometry and laboratory features of ACO. METHODS Data on adult participants to the National Health and Nutrition Examination Surveys conducted from 2007 to 2012 was analyzed. ACO was defined as current asthma and post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) <0.7. RESULTS Overall, 7,570 participants representing 98.58 million Americans were included in our study. From 2007 to 2012, the crude and age-standardized ACO prevalence were, respectively, 0.96% (95% CI: 0.65%-1.26%) and 1.05% (0.74%-1.37%). In asthma, ACO predictors included older age, male gender, and smoking. In COPD, ACO predictors were non-Hispanic Black race/ethnicity and obesity. ACO was associated with increased ER visits for asthma (OR = 3.46, 95% CI: 1.48-8.06]) and oxygen therapy in COPD (OR = 11.17, 95% CI: 5.17-24.12]). In spirometry, FEV1 and peak expiratory flow were lower in ACO than in asthma or COPD alone. CONCLUSION Age-adjusted prevalence of ACO in the United States was 1.05% in 2007-2012, representing 0.94 (95% CI: 0.62-1.26) million Americans. It is much lower than previously reported. The overlap was associated with higher asthma and COPD severity as well as decreased lung function compared with COPD or asthma alone.
Collapse
Affiliation(s)
- Angelico Mendy
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Theophile Niyonsenga
- Faculty of Health, Centre for Research and Action in Public Health, University of Canberra, Canberra, Australia
| | - Ryan Carnahan
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Janvier Gasana
- Department of Environmental & Occupational Health, Faculty of Public Health, Kuwait University, Jabriya, Kuwait
| |
Collapse
|
25
|
Al-Hemoud A, Gasana J, Al-Dabbous AN, Al-Shatti A, Al-Khayat A. Disability Adjusted Life Years (DALYs) in Terms of Years of Life Lost (YLL) Due to Premature Adult Mortalities and Postneonatal Infant Mortalities Attributed to PM 2.5 and PM 10 Exposures in Kuwait. Int J Environ Res Public Health 2018; 15:ijerph15112609. [PMID: 30469450 PMCID: PMC6265960 DOI: 10.3390/ijerph15112609] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/14/2018] [Accepted: 11/17/2018] [Indexed: 12/31/2022]
Abstract
Ambient air pollution in terms of fine and coarse particulate matter (PM2.5 and PM10) has been shown to increase adult and infant mortalities. Most studies have estimated the risk of mortalities through attributable proportions and number of excess cases with no reference to the time lost due to premature mortalities. Disability adjusted life years (DALYs) are necessary to measure the health impact of Ambient particulate matter (PM) over time. In this study, we used life-tables for three years (2014⁻2016) to estimate the years of life lost (YLL), a main component of DALYs, for adult mortalities (age 30+ years) and postneonatal infant mortalities (age 28+ days⁻1 year) associated with PM2.5 exposure and PM10 exposure, respectively. The annual average of PM2.5 and PM10 concentrations were recorded as 87.9 μg/m³ and 167.5 μg/m³, which are 8 times greater than the World Health Organization (WHO) air quality guidelines of 10 μg/m³ and 20 μg/m³, respectively. Results indicated a total of 252.18 (95% CI: 170.69⁻322.92) YLL for all ages with an increase of 27,474.61 (95% CI: 18,483.02⁻35,370.58) YLL over 10 years. The expected life remaining (ELR) calculations showed that 30- and 65-year-old persons would gain 2.34 years and 1.93 years, respectively if the current PM2.5 exposure levels were reduced to the WHO interim targets (IT-1 = 35 μg/m³). Newborns and 1-year old children may live 79.81 and 78.94 years, respectively with an increase in average life expectancy of 2.65 years if the WHO PM10 interim targets were met (IT-1 = 70 μg/m³). Sensitivity analyses for YLL were carried out for the years 2015, 2025, and 2045 and showed that the years of life would increase significantly for age groups between 30 and 85. Life expectancy, especially for the elderly (≥60 years), would increase at higher rates if PM2.5 levels were reduced further. This study can be helpful for the assessment of poor air quality represented by PM2.5 and PM10 exposures in causing premature adult mortalities and postneonatal infant mortalities in developing countries with high ambient air pollution. Information in this article adds insights to the sustainable development goals (SDG 3.9.1 and 11.6.2) related to the reduction of mortality rates attributed to ambient air levels of coarse and fine particulate matter.
Collapse
Affiliation(s)
- Ali Al-Hemoud
- Crisis Decision Support Program, Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, P.O. Box 24885, 13109 Safat, Kuwait.
| | - Janvier Gasana
- Faculty of Public Health, Health Sciences Center, Kuwait University, P.O. Box 24923, 13110 Hawalli, Kuwait.
| | - Abdullah N Al-Dabbous
- Crisis Decision Support Program, Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, P.O. Box 24885, 13109 Safat, Kuwait.
| | - Ahmad Al-Shatti
- Occupational Health Department, Kuwait Ministry of Health, P.O. Box 51360, 53454 Riqqa, Kuwait.
| | - Ahmad Al-Khayat
- Techno-Economics Division, Kuwait Institute for Scientific Research, P.O. Box 24885, 13109 Safat, Kuwait.
| |
Collapse
|
26
|
Girma M, Gobena T, Medhin G, Gasana J, Roba KT. Determinants of childhood diarrhea in West Gojjam, Northwest Ethiopia: a case control study. Pan Afr Med J 2018; 30:234. [PMID: 30574253 PMCID: PMC6295292 DOI: 10.11604/pamj.2018.30.234.14109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 05/23/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction Childhood diarrhea is a global public health problem that affects both developed and developing countries including Ethiopia. The objective of this study was to assess determinants of childhood diarrhea among children under-five years of age in West Gojjam Zone, northwest Ethiopia. Methods A community-based case control study was conducted in four districts of West Gojjam in the northwest of Ethiopia from July to August, 2015. A randomly selected sample of 118 cases and 351 controls who met the inclusion criteria were included in this study. Data were collected using a structured questionnaire through face to face interview. Independent variables which had p-value less than 0.2 at an unadjusted model were candidate for the final model. Adjusted odds ratio was used to control confounding effects and to determine predictors of an outcome. Results Unimproved water sources (AOR, 1.88; 95 % CI: 1.17-3.03), lack of hand washing at critical times (AOR, 2.38; 95 % CI: 1.42-3.99) and a deepening method to take water from a water storage container (AOR, 2.11; 95 % CI: 1.28-3.47), presence of two or more young siblings (AOR, 4.15; 95 % CI: 2.57-6.70), rural residence (AOR,2.11 95 % CI: 2.21-3.68), and not using latrine for disposal of child feces (AOR, 1.90; 95 % CI: 1.12-3.22) were predictors of diarrhea among children under the age of five. Conclusion The majority of the causes of childhood diarrhea in the study area were preventable. Thus, health extension workers should give tailored health information to mothers or caregivers on the importance of sanitation, personal and environmental hygiene and drinking water handling methods.
Collapse
Affiliation(s)
- Meskerem Girma
- Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfaye Gobena
- College of Health and Medical Science, Haramaya University, Dire Dawa, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Janvier Gasana
- Kuwait University Health Sciences Center Faculty of Public Health, Kuwait
| | - Kedir Teji Roba
- College of Health and Medical Science, Haramaya University, Dire Dawa, Ethiopia
| |
Collapse
|
27
|
Alemu F, Kumie A, Medhin G, Gasana J. The role of psychological factors in predicting latrine ownership and consistent latrine use in rural Ethiopia: a cross-sectional study. BMC Public Health 2018; 18:229. [PMID: 29422034 PMCID: PMC5806365 DOI: 10.1186/s12889-018-5143-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 02/01/2018] [Indexed: 01/01/2023] Open
Abstract
Background Inadequate sanitation is one of the leading causes of disease in poor and middle-income countries. Objective The objective of the study was to identify the psychological factors that predict latrine ownership and consistent latrine use in the rural Becho district of central Ethiopia. Method A quantitative, cross-sectional, community based study was conducted. A total of 1047 heads of household were interviewed using a structured questionnaire. Ownership of latrine and consistent latrine use constituted the outcome variable of the study. Data were entered using Epi Info version 3.5.4 and were analyzed using SPSS version 20. Results Of the 1047 households, 73% owned a traditional pit latrine. Among the psychological factors, attitude (AOR 1.70; 95% CI 1.21–2.37) and injunctive norm (AOR 6.18; 95% CI 4.46–10.44) were positively and significantly associated with latrine ownership. Among the demographic factors, having a family size of more than six (AOR = 1.43; 95% CI 1.01–1.97, having a child attending school (AOR = 1.88; 95% CI 1.17–3.02), and having a high school education (AOR = 1.98; 95% CI 1.34–2.87) were significantly associated with latrine ownership. With respect to exposure to communication about sanitation (the cues to action), households that had a family member who took part in Community Led Total Sanitation and Hygiene (CLTSH) triggering were three times more likely to be latrine owners than those who did not participate in CLTSH triggering (95% CI 1.92–4.78.) Results from adjusted logistic regression analysis of potential predictors of consistent latrine use showed that having a positive attitude (AOR 7.00; 95% CI 4.55–10.55), owning of a latrine that had superstructure (AOR 2.3 95% CI 1.47–3.48), having a clean latrine (AOR 1.69 95% CI 1.00–3.00), and having a latrine with a protected door (AOR 1.94; 95% CI 1.10–3.48) were significantly associated with consistent latrine use. Conclusion The study findings showed that attitude and injunctive norm are the psychological predictors of latrine ownership, and consistent latrine use was associated with attitude, cleanliness of the latrine, and its privacy. Hence, sanitation intervention needs to focus on changing societal norms, attitudes, and the promotion of latrine quality.
Collapse
Affiliation(s)
- Fikralem Alemu
- Ethiopian Institute of Water Resources, Water and Health Program, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Abera Kumie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Janvier Gasana
- Kuwait University, Faculty of Public Health, Department of Environmental & Occupational Health, Safat 13110, Kuwait, Kuwait
| |
Collapse
|
28
|
Abstract
To examine the association of colonization by Staphylococcus aureus and general population mortality, we followed 10,598 adults for 8.5 years on average. Methicillin-susceptible S. aureus colonization was not associated with death. Methicillin-resistant S. aureus carriage predicted death in a crude analysis but not after adjustment for socioeconomic status and co-morbidities.
Collapse
|
29
|
Mendy A, Forno E, Niyonsenga T, Gasana J. Blood biomarkers as predictors of long-term mortality in COPD. Clin Respir J 2018; 12:1891-1899. [PMID: 29227024 DOI: 10.1111/crj.12752] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/22/2017] [Accepted: 12/05/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Blood biomarkers are easily accessible and might reflect chronic obstructive pulmonary disease (COPD) activity. AIM The aim of this study was to determine whether a panel of blood biomarkers [C-reactive protein (CRP), neutrophils, eosinophils, albumin and vitamin D] could predict mortality in COPD. METHODS We analyzed data from 431 COPD participants to the 2007-2010 National Health and Nutrition Examination Surveys who were followed for a median time of 36 months. COPD was defined as post-bronchodilator forced expiratory volume in 1 second (FEV1) and forced vital capacity ratio <0.70. Weibull survival analysis adjusted for covariates was performed to calculate the risk of mortality associated with the biomarkers, and C-statistics was used to assess their added predictive value. RESULTS During follow-up, 38 of the 431 participants died. Participants with high CRP, eosinophil count <2%, hypoalbuminemia and hypovitaminosis D had worse baseline FEV1 and subsequently higher mortality compared to controls. In adjusted analysis, increasing CRP [hazard ratio (HR): 4.45, 95% CI: 1.91-10.37] and neutrophil count (HR: 1.07, 95% CI: 1.03-1.11) as well as decreasing eosinophil count (HR: 7.03, 95% CI: 2.05-24.01) were associated with an increased risk of mortality. The addition of CRP with eosinophil and/or neutrophil count significantly improved a base model for the prediction of mortality which included age, gender, race/ethnicity, body mass index, smoking, poverty income ratio, asthma, diabetes, hypertension and history of stroke or myocardial infarction. CONCLUSION High CRP and neutrophils as well as low eosinophils are predictive of poor COPD prognosis. They also add significant value to prediction models of mortality in COPD.
Collapse
Affiliation(s)
- Angelico Mendy
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Theophile Niyonsenga
- Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Janvier Gasana
- Department of Environmental & Occupational Health, Faculty of Public Health, Kuwait University, Jabriya, Kuwait
| |
Collapse
|
30
|
Hashi A, Kumie A, Gasana J. Hand washing with soap and WASH educational intervention reduces under-five childhood diarrhoea incidence in Jigjiga District, Eastern Ethiopia: A community-based cluster randomized controlled trial. Prev Med Rep 2017; 6:361-368. [PMID: 28507890 PMCID: PMC5425344 DOI: 10.1016/j.pmedr.2017.04.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/22/2017] [Accepted: 04/23/2017] [Indexed: 11/29/2022] Open
Abstract
Despite the tremendous achievement in reducing child mortality and morbidity in the last two decades, diarrhoea is still a major cause of morbidity and mortality among children in many developing countries, including Ethiopia. Hand washing with soap promotion, water quality improvements and improvements in excreta disposal significantly reduces diarrhoeal diseases. The objective of this study was to evaluate the effect of hand washing with soap and water, sanitation and hygiene (WASH) educational Intervention on the incidence of under-five children diarrhoea. A community-based cluster randomized controlled trial was conducted in 24 clusters (sub-Kebelles) in Jigjiga district, Somali region, Eastern Ethiopia from February 1 to July 30, 2015. The trial compared incidence of diarrhoea among under-five children whose primary caretakers receive hand washing with soap and water, sanitation, hygiene educational messages with control households. Generalized estimating equation with a log link function Poisson distribution family was used to compute adjusted incidence rate ratio and the corresponding 95% confidence interval. The results of this study show that the longitudinal adjusted incidence rate ratio (IRR) of diarrhoeal diseases comparing interventional and control households was 0.65 (95% CI 0.57, 0.73) suggesting an overall diarrhoeal diseases reduction of 35%. The results are similar to other trials of WASH educational interventions and hand washing with soap. In conclusion, hand washing with soap practice during critical times and WASH educational messages reduces childhood diarrhoea in the rural pastoralist area.
Collapse
Affiliation(s)
- Abdiwahab Hashi
- Ethiopian Institute of Water resources, Addis Ababa University, Ethiopia
| | - Abera Kumie
- School of Public Health, Addis Ababa University, Ethiopia
| | - Janvier Gasana
- Faculty of Public Health, Kuwait University, Jabriya, Kuwait
| |
Collapse
|
31
|
Vieira ER, Mendy A, Prado CM, Gasana J, Albatineh AN. Falls, physical limitations, confusion and memory problems in people with type II diabetes, undiagnosed diabetes and prediabetes, and the influence of vitamins A, D and E. J Diabetes Complications 2015; 29:1159-64. [PMID: 26344725 DOI: 10.1016/j.jdiacomp.2015.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/06/2015] [Accepted: 08/07/2015] [Indexed: 11/16/2022]
Abstract
AIMS To examine the association between type II diabetes, prediabetes and undiagnosed diabetes with falls, physical limitations, confusion and memory problems, and to evaluate the effects of vitamins A, D and E levels on the associations. METHODS Data from 37,973 participants of the National Health and Nutrition Examination Survey was analyzed. RESULTS The participants' mean age was 46±17years, 20% had diabetes of which 17% were unaware of their condition (undiagnosed diabetes), and 21% had prediabetes. Diabetes was significantly associated with falls, difficulties in stooping, crouching, kneeling, completing house chores, getting in and out bed, standing and sitting for long periods, reaching over head, grasping, holding objects, and attending social events. The association between diabetes and confusion or memory problems was stronger for those diagnosed before age 40. Memory problems were reported only by people with diabetes with lower vitamin D levels. Vitamin A and E levels did not modify the association between diabetes and falls or any of the physical functions, confusion or memory problems. Prediabetes was only associated with difficulty standing for long periods. CONCLUSIONS Diabetes was associated with falls, difficulties in physical functioning and attending social events. Vitamin D levels modified the effects on confusion and memory problems.
Collapse
Affiliation(s)
- Edgar R Vieira
- Departments of Physical Therapy & Neuroscience, Florida International University, Miami, Florida, US.
| | - Angelico Mendy
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, US
| | - Carla M Prado
- Department of Agricultural, Food & Nutritional Science, & Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada
| | - Janvier Gasana
- South Florida Asthma Consortium, Fort Lauderdale, Florida, US
| | - Ahmed N Albatineh
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait
| |
Collapse
|
32
|
Gasana J, Gibson-Young L, Ibrahimou B, Weiss-Randall D, Arrieta A, Beck-Sagué C, Sivén J, Torok D. Asthma in schoolchildren in Monroe county, Florida: school-based needs assessment. J Asthma 2015; 53:330-8. [PMID: 26364659 DOI: 10.3109/02770903.2015.1081939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Asthma is the most common chronic pediatric condition (14%) and the leading cause of school absenteeism in the USA. However, little is known about asthma prevalence and distribution in schoolchildren in the Florida Keys region (Monroe County). Thus, the objectives of this study were to assess asthma prevalence, symptoms, cost and distribution in schoolchildren in the Florida Keys region and to pinpoint where asthma management services are most needed. METHODS Cross-sectional survey data on asthma prevalence, symptoms and socio-demographics was collected and analyzed by race, sex, grade and zip code. A total of 2313 parents of schoolchildren in the Florida Keys completed the adapted Harlem Empowerment Zone Asthma Initiative Questionnaire. The questionnaire was distributed to school principals, who sent them home with students to be filled out by parents or caregivers. We also analyzed data from the online Monroe County 2012 Florida Youth Tobacco Survey, the 2011 Florida CHARTS, the Medical Expenditures Panel Survey, and emergency departments (ED). Data were analyzed by race, sex, and grade. RESULTS In total 14.5% of respondents had been told their child had asthma and 9.6% reported their child had wheezing in the last 12 months. The prevalence was higher in the Lower Keys and Key West regions. Parents from households where anyone smoked cigarettes (OR 1.52, 95% CI 1.11-2.09) and those who had a male child (1.53, 1.17-2.00) more often reported that their child had asthma. The rate of asthma-related ED visits for Black non-Hispanic schoolchildren (1202 per 100,000) was substantially higher than the numbers for White (250.2 per 100,000) and Hispanic schoolchildren (325.1 per 100,000). Most of the direct cost of asthma was concentrated in children in grades four through seven ($1236.02-$2147.02 per child). CONCLUSIONS The asthma prevalence in a sample of schoolchildren in the Florida Keys region was comparable to the nationwide prevalence. Black non-Hispanic schoolchildren had more asthma-related ED visits that White and Hispanic schoolchildren. Most of the direct cost of asthma is concentrated in children in late elementary through early middle school grades. Interventions are needed, particularly targeting Black schoolchildren in late elementary through early middle school grades in Lower Keys and Key West region.
Collapse
Affiliation(s)
- Janvier Gasana
- a Department of Environmental & Occupational Health , Robert Stempel College of Public Health & Social Work, Florida International University , Miami , FL , USA
| | - Linda Gibson-Young
- b College of Nursing and Health Sciences, Texas A & M University , Corpus Christi , TX , USA
| | - Boubakari Ibrahimou
- c Department of Biostatistics , Robert Stempel College of Public Health & Social Work, Florida International University , Miami , FL , USA
| | - Debra Weiss-Randall
- d Department of Higher Education Leadership and Research Methodology , College of Education, Florida Atlantic University , Boca Raton , FL , USA
| | - Alejandro Arrieta
- e Department of Health Policy and Management , Robert Stempel College of Public Health & Social Work, Florida International University, Miami , FL , USA
| | - Consuelo Beck-Sagué
- f Department of Health Promotion and Disease Prevention , Robert Stempel College of Public Health & Social Work, Florida International University , Miami , FL , USA
| | - Jacqueline Sivén
- g Department of Anthropology , University of South Florida , Tampa , FL , USA , and
| | - Don Torok
- h College of Education, Florida Atlantic University , Davie , FL , USA
| |
Collapse
|
33
|
Mendy A, Vieira ER, Albatineh AN, Gasana J. Immediate rather than delayed memory impairment in older adults with latent toxoplasmosis. Brain Behav Immun 2015; 45:36-40. [PMID: 25499468 DOI: 10.1016/j.bbi.2014.12.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/25/2014] [Accepted: 12/04/2014] [Indexed: 12/01/2022] Open
Abstract
The neurotropic parasite Toxoplasma gondii infects one third of the world population, but its effect on memory remains ambiguous. To examine a potential relationship of the infection with immediate and delayed memory, a population-based study was conducted in 4485 participants of the Third National Health and Nutrition Examination Survey aged 60years and older. Serum anti-Toxoplasma IgG antibodies were measured by enzyme immune assay and verbal memory was assessed using the Mini-Mental State Examination and the East Boston Memory Test. The prevalence of latent toxoplasmosis was 41%; in one way analysis of variance, anti-Toxoplasma IgG antibody levels significantly differed across tertiles for immediate (P=0.006) but not delayed memory scores (P=0.22). In multinomial logistic regression adjusting for covariates, Toxoplasma seropositivity was associated with lower immediate memory performance (OR: 0.65, 95% CI: 0.44, 0.97 for medium tertile and OR: 0.61, 95% CI: 0.37, 0.98 for highest tertile in reference to the lowest tertile), especially in non-Hispanic Whites (OR: 0.56, 95% CI: 0.36, 0.88 for medium tertile and OR: 0.51, 95% CI: 0.30, 0.87 for highest tertile in reference to the lowest tertile). However, no relationship with delayed memory was observed. In conclusion, latent toxoplasmosis is widespread in older adults and may primarily affect immediate rather than delayed memory, particularly in White Americans.
Collapse
Affiliation(s)
- Angelico Mendy
- Department of Epidemiology, College of Public Health, University of Iowa, S161 CPHB 105 River Street, Iowa City, IA 52242, USA.
| | - Edgar R Vieira
- Department of Physical Therapy, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Ahmed N Albatineh
- Department of Biostatistics, Robert Stempel School of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Janvier Gasana
- Department of Occupational and Environmental Health, Robert Stempel School of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| |
Collapse
|
34
|
Mendy A, Albatineh AN, Vieira ER, Gasana J. Higher specificity of tuberculin skin test compared with QuantiFERON-TB Gold for detection of exposure to Mycobacterium tuberculosis. Clin Infect Dis 2014; 59:1188-9. [PMID: 24997053 DOI: 10.1093/cid/ciu516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Angelico Mendy
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | | | | | - Janvier Gasana
- Department of Occupational and Environmental Health, Florida International University, Miami
| |
Collapse
|
35
|
Mendy A, Gasana J, Vieira ER, Diallo H. Prospective study of cytomegalovirus seropositivity and risk of mortality from diabetes. Acta Diabetol 2014; 51:723-9. [PMID: 24633860 DOI: 10.1007/s00592-014-0573-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/17/2014] [Indexed: 12/26/2022]
Abstract
Cytomegalovirus (CMV) infects 40 % of the world population and has been suggested to be associated with diabetes; however, no prospective study has ever examined diabetes mortality associated with the infection. A cohort of 14,404 non-diabetic adult participants aged 17-90 years from the Third National Health and Nutrition Examination Survey (1988-1994) was prospectively followed for mortality through 2006. CMV immunoglobulin G was measured by enzyme-linked immunosorbent assay and immunofluorescence assay. Diabetes death was assessed with death records from the National Death Index. Cox proportional hazards modeling was used to determine diabetes mortality risk associated with CMV infection, adjusting for socio-demographics, diabetes risk factors, and comorbidities. At baseline, 76.8 % of subjects were CMV seropositive, and after an average follow-up of 13.7 years, diabetes mortality rate per 10,000 person-years was 6.8 (95 % CI 5.7, 8.0). Among seropositive participants, the diabetes death rate (8.4, 95 % CI 7.0, 9.9) was more than four times the rate in seronegative ones (2.0, 95 % CI 1.1, 3.6) (P value for the difference <0.001). In the adjusted Cox proportional hazards analysis, CMV seropositivity more than doubled the risk of diabetes mortality (HR 2.06, 95 % CI 1.05, 4.06). CMV infection may thus predict future mortality from diabetes in non-diabetic people.
Collapse
Affiliation(s)
- Angelico Mendy
- Department of Epidemiology, University of Iowa, S161 CPHB 105 River Street, Iowa City, IA, 52242, USA,
| | | | | | | |
Collapse
|
36
|
Mendy A, Vieira ER, Albatineh AN, Nnadi AK, Gasana J. Response to letter to the editor: regarding "copper deficiency and neuropathology related to the petrous bone". Ann Epidemiol 2014; 24:490-1. [PMID: 24731698 DOI: 10.1016/j.annepidem.2014.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Angelico Mendy
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Edgar R Vieira
- Department of Physical Therapy, Florida International University, Miami, FL
| | - Ahmed N Albatineh
- Department of Biostatistics, Florida International University, Miami, FL
| | | | | |
Collapse
|
37
|
Abstract
Lead is often present in our environment, but its effect on thyroid function is still unclear. In this study, multiple linear regressions were performed between log-transformed blood lead levels and thyroid function parameters of 4652 adults from the 2007-2008 National Health and Nutrition Examination Survey. The models were adjusted for age, gender, race/ethnicity, smoking, alcohol consumption, body mass index, physical activity, iodine intake, medications, and bone mineral density. Blood lead concentrations (mean: 1.52 ± 1.20 μg/dL [range 0.18-33.12]) were inversely associated with total thyroxine (regression coefficients [β]: -0.22 [95% CI: -0.34, -0.09] in the general population, but were not correlated with thyroid stimulating hormone, total or free triiodothyronine, nor free thyroxine. Blood lead may have no effect on the thyroid function; however, it could be associated with decreased concentrations in thyroid-binding proteins.
Collapse
Affiliation(s)
- Angelico Mendy
- a Epidemiology , Florida International University , Miami , USA
| | | | | |
Collapse
|
38
|
Abstract
BACKGROUND AND OBJECTIVE Probiotics may reduce the risk of atopy and asthma in children. However, results from clinical trials have been conflicting, and several of them may have been underpowered. We performed a meta-analysis of randomized, placebo-controlled trials to assess the effects of probiotic supplementation on atopic sensitization and asthma/wheeze prevention in children. METHODS Random-effects models were used to calculate pooled risk estimates. Meta-regression was conducted to examine the effect of potential factors on probiotics efficacy. RESULTS Probiotics were effective in reducing total immunoglobulin E (IgE) (mean reduction: -7.59 U/mL [95% confidence interval (CI): -14.96 to -0.22]; P = .044). Meta-regression showed that the reduction in IgE was more pronounced with longer follow-up. Probiotics significantly reduced the risk of atopic sensitization when administered prenatally (relative risk: 0.88 [95% CI: 0.78 to 0.99]; P = .035 for positive result on the skin prick test and/or elevated specific IgE to common allergens) and postnatally (relative risk: 0.86 [95% CI: 0.75 to 0.98]; P = .027 for positive result on skin prick test). Administration of Lactobacillus acidophilus, compared with other strains, was associated with an increased risk of atopic sensitization (P = .002). Probiotics did not significantly reduce asthma/wheeze (relative risk: 0.96 [95% CI: 0.85 to 1.07]). CONCLUSIONS Prenatal and/or early-life probiotic administration reduces the risk of atopic sensitization and decreases the total IgE level in children but may not reduce the risk of asthma/wheeze. Follow-up duration and strain significantly modified these effects. Future trials for asthma prevention should carefully select probiotic strain and consider longer follow-up.
Collapse
Affiliation(s)
- Nancy Elazab
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Miami, Miami, FL, USA
| | | | | | | | | | | |
Collapse
|
39
|
Reiter J, Demirel N, Mendy A, Gasana J, Vieira ER, Colin AA, Quizon A, Forno E. Macrolides for the long-term management of asthma--a meta-analysis of randomized clinical trials. Allergy 2013; 68:1040-9. [PMID: 23895667 DOI: 10.1111/all.12199] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Macrolide antibiotics, which have anti-inflammatory and immune modulatory effects, have been studied as adjuncts for the management of asthma. However, results have been contradictory and trials underpowered. We therefore sought to conduct a meta-analysis of randomized controlled trials (RCT). METHODS All RCT of prolonged macrolides (3+ weeks) for asthma treatment, published up to January 2013 in MEDLINE, Scopus, CINAHL, Highwire, and The Cochrane Collaboration Library, were included. Fixed- or random-effects models were used to calculate pooled weighted or standard mean differences (WMD or SMD, respectively). RESULTS A total of 12 studies were included for analysis. The pooled effect of macrolides on FEV1 (eight trials, 381 subjects) was not significant (SMD 0.05, 95% CI -0.14-0.25), but there was a significant increase in peak expiratory flow (four trials, 419 subjects; WMD 6.7, 95% CI 1.35-12.06). Pooled analysis also showed significant improvements in symptom scores (eight studies, 478 subjects; WMD -0.46, 95% CI -0.60 to -0.32), quality of life (five trials, 346 subjects; WMD 0.18, 95% CI 0.001-0.37), and airway hyper-reactivity (two trials, 131 subjects; SMD 1.99, 95% CI 0.46-3.52). Post hoc evaluation showed limited statistical power to detect significant differences in FEV1. CONCLUSIONS Macrolide administration for asthma for three or more weeks was not associated with improvement in FEV1, but produced significant improvements in peak expiratory flow, symptoms, quality of life, and airway hyper-reactivity. Macrolides may therefore be beneficial as adjunct asthma therapy. Future trials, focusing on long-term safety and effectiveness, should use standardized outcomes and procedures.
Collapse
Affiliation(s)
| | | | - A. Mendy
- Department of Epidemiology; College of Public Health; University of Iowa; Iowa City; IA; USA
| | - J. Gasana
- South Florida Asthma Consortium; Ft Lauderdale; FL; USA
| | - E. R. Vieira
- Department of Physical Therapy; Florida International University; Miami; FL; USA
| | - A. A. Colin
- Division of Pediatric Pulmonology; Department of Pediatrics; University of Miami; Miami; FL; USA
| | - A. Quizon
- Division of Pediatric Pulmonology; Department of Pediatrics; University of Miami; Miami; FL; USA
| | - E. Forno
- Division of Pulmonary Medicine; Department of Pediatrics; Children's Hospital of Pittsburgh of UPMC; Pittsburgh; PA; USA
| |
Collapse
|
40
|
Page TF, Beck-Sague CM, Pinzon-Iregui MC, Cuddihy A, Tyler T, Forno E, Dean AG, Siven J, Pottinger S, Gasana J. Asthma in underserved schoolchildren in Miami, Florida: results of a school- and community-based needs assessment. J Asthma 2013; 50:480-7. [PMID: 23544421 DOI: 10.3109/02770903.2013.790416] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Asthma is the most common chronic condition in childhood and disproportionately impacts the poorer and ethnic minorities. The objectives of the study were to estimate the prevalence of asthma in Miami-Dade County (MDC) schoolchildren to aid case-finding and linkage to care. METHODS We used the CDC Youth Risk Behavior Surveillance System (YRBSS) definition of possible asthma ("Ever told by a doctor or nurse that they had asthma and still had asthma") and analyzed data from four sources. These included the: (1)-MDC YRBSS 2009, (2)-MDC Health Connect Asthma Survey of school nurses (>2008), (3)-parents' survey in the five HealthConnect survey elementary schools with highest asthma prevalence, and (4)-focus group with parents of asthmatic children. RESULTS (1)-MDC YRBSS data showed that 21.3% of high- and 21.4% of middle-school students had been diagnosed with possible asthma. Prevalence was the highest in African-American middle-school girls (26.9%). (2)-HealthConnect survey responders reported that 4.9% of the students in 131 MDC schools had possible asthma. Asthma prevalence was higher in elementary schools (median = 7.1%) and in low-income MDC zip codes. (3)-Of the parent survey responders, 24.9% indicated that their child had possible asthma, and 19.2% reported that their children had no usual source of care. (4)-Focus group participants reported frequent loss of Medicaid coverage for their children, landlords' indifference to the role of poorly maintained housing in asthma, and unmet needs regarding knowledge of health system navigation. CONCLUSIONS Asthma may be common in MDC schoolchildren, particularly in poor communities. Formidable structural factors limit the caregivers' abilities to manage childhood asthma.
Collapse
Affiliation(s)
- Timothy F Page
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Gasana J, Dillikar D, Mendy A, Forno E, Ramos Vieira E. Motor vehicle air pollution and asthma in children: a meta-analysis. Environ Res 2012; 117:36-45. [PMID: 22683007 DOI: 10.1016/j.envres.2012.05.001] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 04/27/2012] [Accepted: 05/09/2012] [Indexed: 05/28/2023]
Abstract
BACKGROUND Asthma affects more than 17 million people in the United States;1/3 of these are children. Children are particularly vulnerable to airborne pollution because of their narrower airways and because they generally breathe more air per pound of body weight than adults, increasing their exposure to air pollutants. However, the results from previous studies on the association between motor vehicle emissions and the development of childhood wheeze and asthma are conflicting. Therefore, we conducted a meta-analysis to clarify their potential relationship. METHODS MEDLINE, Highwire, and The Cochrane Library databases were searched for relevant studies. Adjusted odds ratio (OR) with corresponding 95% confidence interval (CI) for the association between traffic air pollutants and wheeze or asthma were retrieved from individual studies and pooled to generate summary effect estimates (meta-OR) in STATA 11.1. RESULTS Nineteen studies were included in the meta-analysis. Exposure to nitrogen dioxide (meta-OR: 1.05, 95% CI: 1.00-1.11), nitrous oxide (meta-OR: 1.02, 95% CI: 1.00-1.04), and carbon monoxide (meta-OR: 1.06, 95% CI: 1.01-1.12) were positively associated with a higher prevalence of childhood asthma. Exposure to sulfur dioxide (meta-OR: 1.04, 95% CI: 1.01-1.07) was positively associated with a higher prevalence of wheeze in children. Exposure to nitrogen dioxide was positively associated with a higher incidence of childhood asthma (meta-OR: 1.14, 95% CI: 1.06-1.24), and exposures to particulate matter was positively associated with a higher incidence of wheeze in children (meta-OR: 1.05, 95% CI: 1.04-1.07). CONCLUSIONS Living or attending schools near high traffic density roads exposes children to higher levels of motor vehicle air pollutants, and increases the incidence and prevalence of childhood asthma and wheeze.
Collapse
Affiliation(s)
- Janvier Gasana
- South Florida Asthma Consortium, Ft. Lauderdale, FL, USA.
| | | | | | | | | |
Collapse
|
42
|
Abstract
Health effects of heavy metals have been widely investigated, but further evaluation is required to comprehensively delineate their toxicity. Using data from the 2007-2008 National Health and Nutrition Examination Survey, a multivariate logistic regression analysis was performed on 1,857 adults to examine the relationship between urinary heavy metals and various medical conditions. Cardiovascular diseases were correlated to cadmium (OR: 4.94, 95% CI: 1.48-16.56) and lead (OR: 5.32, 95% CI: 1.08-26.21). Asthma was related to tungsten (OR: 1.72, 95% CI: 1.15-2.59) and uranium (OR: 1.52, 95% CI: 1.01-2.28). Hepatotoxicity was associated with molybdenum (OR: 3.09, 95% CI: 1.24-7.73) and uranium (OR: 4.79, 95% CI: 1.74-13.19). Surprising inverse relationships occurred for excessive weight with lead (OR: 0.72, 95% CI: 0.52-0.98), reduced visual acuity with cobalt (OR: 0.65, 95% CI: 0.44-0.95) and cesium (OR: 0.52, 95% CI: 0.35-0.77). This study supports some previous evidence of potential relationships and provides insights for future research.
Collapse
Affiliation(s)
- Angelico Mendy
- Department of Epidemiology & Biostatistics, Robert Stempel School of Public Health, Florida International University, Miami, FL, USA
| | | | | |
Collapse
|
43
|
Mendy A, Gasana J, Vieira ER, Forno E, Patel J, Kadam P, Ramirez G. Endotoxin exposure and childhood wheeze and asthma: a meta-analysis of observational studies. J Asthma 2011; 48:685-93. [PMID: 21732750 DOI: 10.3109/02770903.2011.594140] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Exposure to endotoxin has been widely investigated as a potential factor for asthma and associated symptoms in children with different results. To clarify a potential relationship, we performed the present meta-analysis to integrate the results of studies examining the association of endotoxin exposure with wheeze and asthma in children. METHODS A search for relevant studies and reviews was conducted in MEDLINE, Highwire, CINAHL, and The Cochrane Library databases. Adjusted odds ratio (OR) with corresponding 95% confidence interval (CI) for endotoxin exposure and wheeze or asthma were retrieved and pooled to generate summary effect estimates in STATA 11.1. RESULTS Nineteen studies were included in the meta-analysis. The summary estimates suggested that endotoxin was positively associated with wheeze in infants and toddlers (meta-OR: 1.48, 95% CI: 1.10-1.98), but negatively related to asthma in school-aged children (meta-OR: 0.82, 95% CI: 0.69-0.97 for endotoxin concentration and 0.68, 95% CI: 0.50-0.93 for endotoxin load). CONCLUSIONS Based on the studies evaluated, endotoxin is a risk factor for wheeze in younger children, but a protective factor for asthma in older children. Thus, this study supports the "hygiene hypothesis."
Collapse
Affiliation(s)
- Angelico Mendy
- Robert Stempel School of Public Health, Florida International University, Miami, FL 33199, USA
| | | | | | | | | | | | | |
Collapse
|
44
|
Gasana J, Hlaing WM, Siegel KA, Chamorro A, Niyonsenga T. Blood lead levels in children and environmental lead contamination in Miami inner city, Florida. Int J Environ Res Public Health 2006; 3:228-34. [PMID: 16968968 PMCID: PMC3807515 DOI: 10.3390/ijerph2006030027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies have shown that the environmental conditions of the home are important predictors of health, especially in low-income communities. Understanding the relationship between the environment and health is crucial in the management of certain diseases. One health outcome related to the home environment among urban, minority, and low-income children is childhood lead poisoning. The most common sources of lead exposure for children are lead paint in older, dilapidated housing and contaminated dust and soil produced by accumulated residue of leaded gasoline. Blood lead levels (BLL) as low as 10 microg/dL in children are associated with impaired cognitive function, behavior difficulties, and reduced intelligence. Recently, it is suggested that the standard for intervention be lowered to BLL of 5 microg/dl. The objectives of our report were to assess the prevalence of lead poisoning among children under six years of age and to quantify and test the correlations between BLL in children and lead exposure levels in their environment. This cross-sectional analysis was restricted to 75 children under six years of age who lived in 6 zip code areas of inner city Miami. These locations exhibited unacceptably high levels of lead dust and soil in areas where children live and play. Using the 5 microg/dL as the cutoff point, the prevalence of lead poisoning among the study sample was 13.33%. The study revealed that lead levels in floor dust and window sill samples were positively and significantly correlated with BLL among children (p < 0.05). However, the correlations between BLL and the soil, air, and water samples were not significant. Based on this pilot study, a more comprehensive environmental study in surrounding inner city areas is warranted. Parental education on proper housecleaning techniques may also benefit those living in the high lead-exposed communities of inner city Miami.
Collapse
Affiliation(s)
- Janvier Gasana
- Stempel School of Public Health, College of Health & Urban Affairs, Florida International University, 11200 SW 8th St. (HLS 595), Miami, Florida, USA.
| | | | | | | | | |
Collapse
|
45
|
Gasana J, Morin J, Ndikuyeze A, Kamoso P. Impact of water supply and sanitation on diarrheal morbidity among young children in the socioeconomic and cultural context of Rwanda (Africa). Environ Res 2002; 90:76-88. [PMID: 12483797 DOI: 10.1006/enrs.2002.4394] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
This project studied the frequency and intensity of water contamination at the source, during transportation, and at home to determine the causes of contamination and its impact on the health of children aged 0 to 5 years. The methods used were construction of the infrastructure for three sources of potable water, administration of a questionnaire about socioeconomic status and sanitation behavior, anthropometric measurement of children, and analysis of water and feces. The contamination, first thought to be only a function of rainfall, turned out to be a very complex phenomenon. Water in homes was contaminated (43.4%) with more than 1100 total coliforms/100 ml due to the use of unclean utensils to transport and store water. This socioeconomic and cultural problem should be addressed with health education about sanitation. The latrines (found in 43.8% of families) presented a double-edged problem. The extremely high population density reduced the surface area of land per family, which resulted in a severe nutritional deficit (15% of the children) affecting mainly young children, rendering them more susceptible to diarrhea (three episodes/child/year).
Collapse
Affiliation(s)
- Janvier Gasana
- Florida International University, Department of Public Health, North Miami, Florida, USA
| | | | | | | |
Collapse
|
46
|
Abstract
OBJECTIVES The purpose of the study was to evaluate the magnitude of environmental lead contamination in the downtown area of Miami. METHODS Lead inspections took place at 121 homes in Little Haiti and Liberty City and involved the collection of representative samples from floors, window wells, tap water, soil and air. Community health workers (CHWs) trained in interview and safety techniques went from door to door to enlist participation. On-site investigations were tailored to areas most utilized by children under the age of 6 years. The presence of lead-containing paint was also investigated in situ via X-ray fluorescence (XRF) analysis. RESULTS Of the sampling areas, the window wells area had the most abundant occurrence of lead. On analysis, 24% of sites returned window well samples with lead levels above Department of Housing and Urban Development (HUD) guidelines. Of the soil samples, the playgrounds around the house had the highest concentration of lead. Soil sampling demonstrated that 27.5% of sites returned samples with lead levels (400 to 1600 ppm) in excess of HUD/Environmental Protection Agency (EPA) standards. Positive XRF readings in one or more components were returned by 18% of sites. CONCLUSIONS More than half of the houses in these two neighborhoods exhibited unacceptably high levels of lead dust and soil in areas where children live and play. Limitations of this study did not allow the assessment of how many children in this area are affected. A more comprehensive study including other areas of Miami-Dade County with older housing stock is recommended.
Collapse
Affiliation(s)
- Janvier Gasana
- Department of Public Health, Florida International University, 3000 NE 151 St., ACI 394H, North Miami, Florida 33181, USA.
| | | |
Collapse
|
47
|
Gasana J, Twagilimana L, Hallenbeck W, Brenniman G. Industrial discharges of metals in Kigali, Rwanda, and the impact on drinking water quality. Bull Environ Contam Toxicol 1997; 58:523-526. [PMID: 9060368 DOI: 10.1007/s001289900366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- J Gasana
- Department of Public Health, College of Health, Florida International University 33181-3600, USA
| | | | | | | |
Collapse
|