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Ikejezie J, Adebusoye B, Ekezie W, Langley T, Lewis S, Phalkey R. Modifiable risk factors for diphtheria: A systematic review and meta-analysis. Glob Epidemiol 2023; 5:100100. [PMID: 37638375 PMCID: PMC10445968 DOI: 10.1016/j.gloepi.2023.100100] [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: 07/10/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023] Open
Abstract
Objective To identify modifiable risk factors for diphtheria and assess their strengths of association with the disease. Methods This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Electronic databases and grey literature were searched from inception until January 2023. Studies had to report on diphtheria cases and estimates of association for at least one potential risk factor or sufficient data to calculate these. The quality of non-ecological studies was assessed using the Newcastle-Ottawa Scale (NOS), while the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results The search yielded 37,705 papers, of which 29 were ultimately included. All the non-ecological studies were of moderate to high quality. Meta-analysis of 20 studies identified three factors increasing the risk of diphtheria: incomplete vaccination (<3 doses) (pooled odds ratio (POR) = 2.2, 95% confidence interval (CI) = 1.4-3.4); contact with a person with skin lesions (POR = 4.8, 95% CI = 2.1-10.9); and low knowledge of diphtheria (POR = 2.4, 95% CI = 1.2-4.7). Contact with a case of diphtheria; sharing a bed or bedroom; sharing utensils, cups, and glasses; infrequent bathing; and low parental education were associated with diphtheria in multiple studies. Evidence for other factors was inconclusive. The quality of evidence was low or very low for all the risk factors. Conclusions Findings from the review suggest that countries seeking to control diphtheria need to strengthen surveillance, improve vaccination coverage, and increase people's knowledge of the disease. Future research should focus on understudied or inconclusive risk factors.
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Affiliation(s)
- Juniorcaius Ikejezie
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK
| | - Busola Adebusoye
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK
| | - Winifred Ekezie
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK
| | - Tessa Langley
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK
| | - Sarah Lewis
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK
| | - Revati Phalkey
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK
- Climate Change and Health Unit, UK Health Security Agency, London, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Germany
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2
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Vardavas C, Zisis K, Nikitara K, Lagou I, Marou V, Aslanoglou K, Athanasakis K, Phalkey R, Leonardi-Bee J, Fernandez E, Condell O, Lamb F, Sandmann F, Pharris A, Deogan C, Suk JE. Cost of the COVID-19 pandemic versus the cost-effectiveness of mitigation strategies in EU/UK/OECD: a systematic review. BMJ Open 2023; 13:e077602. [PMID: 37907290 PMCID: PMC10619092 DOI: 10.1136/bmjopen-2023-077602] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/18/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVES The economic burden of COVID-19 pandemic is substantial, with both direct and indirect costs playing a significant role. DESIGN A systematic literature review was conducted to estimate the cost of the COVID-19 pandemic and the cost-effectiveness of pharmaceutical or non-pharmaceutical interventions. All cost data were adjusted to the 2021 Euro, and interventions compared with null. DATA SOURCES Ovid MEDLINE and EMBASE were searched from January 2020 through 22 April 2021. ELIGIBILITY CRITERIA Studies regarding COVID-19 outbreak or public health preparedness measures or interventions with outcome measures related to the direct and indirect costs for disease and preparedness and/or response in countries of the European Union (EU), the European Economic Area (EEA), the UK and the Organisation for Economic Co-operation and Development (OECD) of all relevant epidemiological designs which estimate cost within the selected time frame were considered eligible. DATA EXTRACTION AND SYNTHESIS Studies were searched, screened and coded independently by two reviewers with high measure of inter-rater agreement. Data were extracted to a predefined data extraction sheet. The risk of bias was assessed using the Consensus on Health Economic Criteria checklist. RESULTS We included data from 41 economic studies. Ten studies evaluated the cost of the COVID-19 pandemic, while 31 assessed the cost-benefit of public health surveillance, preparedness and response measures. Overall, the economic burden of the COVID-19 pandemic was found to be substantial. Community screening, bed provision policies, investing in personal-protective-equipment and vaccination strategies were cost-effective. Physical distancing measures were associated with health benefits; however, their cost-effectiveness was dependent on the duration, compliance and the phase of the epidemic in which it was implemented. CONCLUSIONS COVID-19 pandemic is associated with substantial short-term and long-term economic costs to healthcare systems, payers and societies, while interventions including testing and screening policies, vaccination and physical distancing policies were identified as those presenting cost-effective options to deal with the pandemic, dependent on population vaccination and the Re at the stage of the pandemic.
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Affiliation(s)
- Constantine Vardavas
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, USA
| | - Konstantinos Zisis
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Public Health Policy, University of West Attica, Egaleo, Greece
| | | | - Ioanna Lagou
- School of Medicine, University of Crete, Heraklion, Greece
| | - Valia Marou
- School of Medicine, University of Crete, Heraklion, Greece
| | | | | | - Revati Phalkey
- Public Health England, London, UK
- University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Centre for Evidence-Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Esteve Fernandez
- Tobacco Control Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | - Orla Condell
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Favelle Lamb
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Frank Sandmann
- European Centre for Disease Prevention and Control, Solna, Sweden
| | | | - Charlotte Deogan
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control, Solna, Sweden
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3
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Vardavas C, Nikitara K, Aslanoglou K, Lagou I, Marou V, Phalkey R, Leonardi-Bee J, Fernandez E, Vivilaki V, Kamekis A, Symvoulakis E, Noori T, Wuerz A, Suk JE, Deogan C. Social determinants of health and vaccine uptake during the first wave of the COVID-19 pandemic: A systematic review. Prev Med Rep 2023; 35:102319. [PMID: 37564118 PMCID: PMC10410576 DOI: 10.1016/j.pmedr.2023.102319] [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: 11/29/2022] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
Social determinants of health significantly impact population health status. The aim of this systematic review was to examine which social vulnerability factors or determinants of health at the individual or county level affected vaccine uptake within the first phase of the vaccination program. We performed a systematic review of peer-reviewed literature published from January 2020 until September 2021 in Medline and Embase (Bagaria et al., 2022) and complemented the review with an assessment of pre-print literature within the same period. We restricted our criteria to studies performed in the EU/UK/EEA/US that report vaccine uptake in the general population as the primary outcome and included various social determinants of health as explanatory variables. This review provides evidence of significant associations between the early phases of vaccination uptake for SARS-CoV-2 and multiple socioeconomic factors including income, poverty, deprivation, race/ethnicity, education and health insurance. The identified associations should be taken into account to increase vaccine uptake in socially vulnerable groups, and to reduce disparities in uptake, in particular within the context of public health preparedness for future pandemics. While further corroboration is needed to explore the generalizability of these findings across the European setting, these results confirm the need to consider vulnerable groups and social determinants of health in the planning and roll-out of SARS-CoV-2 vaccination programs and within the context of future respiratory pandemics.
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Affiliation(s)
- Constantine Vardavas
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | | | | | - Ioanna Lagou
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Valia Marou
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Revati Phalkey
- Health Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Health Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Esteve Fernandez
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L’Hospitalet de Llobregat (Barcelona), Spain
- Tobacco Control Research Group, Institut d’Investigació Biomèdica de. Ellvitge-IDIBELL, L’Hospitalet de Llobregat (Barcelona), Spain
- School of Medicine and Health Sciences, Campus of Bellvitge, Universitat de Barcelona, Spain
- Centre of Biomedical Research Network on Respiratory Diseases (CIBERES de Enfermedaes Respiratorias), Insituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Teymur Noori
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Andrea Wuerz
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jonathan E. Suk
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Charlotte Deogan
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
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Woodland L, Ratwatte P, Phalkey R, Gillingham EL. Investigating the Health Impacts of Climate Change among People with Pre-Existing Mental Health Problems: A Scoping Review. Int J Environ Res Public Health 2023; 20:ijerph20085563. [PMID: 37107845 PMCID: PMC10138675 DOI: 10.3390/ijerph20085563] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/02/2023] [Accepted: 03/14/2023] [Indexed: 05/11/2023]
Abstract
Climate change is the greatest threat to global public health, although the impacts on mental health are relatively understudied. Furthermore, there is a lack of consensus about the effects of climate change on individuals with pre-existing mental health problems. This review aimed to identify the health impacts of climate change on people with pre-existing mental health problems. The search was conducted across three databases; studies were included if they involved participants who had mental health problem(s) before a climate-driven event and reported on health outcomes post-event. A total of thirty-one studies met the full inclusion criteria. The study characteristics included 6 climate-driven events: heat events, floods, wildfires, wildfire and flood, hurricanes, and droughts, and 16 categories of pre-existing mental health problems, with depression, and non-specified mental health problems being the most common. The majority of the studies (90%, n = 28) suggest an association between the presence of pre-existing mental health problems and the likelihood of adverse health impacts (e.g., increased mortality risk, new symptom presentation, and an exacerbation of symptoms). To mitigate the exacerbation of health inequalities, people with pre-existing mental health problems should be included in adaption guidance and/or plans that mitigate the health impacts of climate change, future policy, reports, and frameworks.
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Affiliation(s)
- Lisa Woodland
- Department of Psychological Medicine, King’s College London, London SE5 9RJ, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King’s College London, London SE5 9RJ, UK
- Correspondence:
| | - Priyanjali Ratwatte
- Climate Change and Health Unit, UK Health Security Agency, Chilton OX11 0RQ, UK
- Behavioural Science and Insights Unit, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Revati Phalkey
- Climate Change and Health Unit, UK Health Security Agency, Chilton OX11 0RQ, UK
| | - Emma L. Gillingham
- Climate Change and Health Unit, UK Health Security Agency, Chilton OX11 0RQ, UK
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5
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Ratwatte P, Wehling H, Phalkey R, Weston D. Prioritising Climate Change Mitigation Behaviours and Exploring Public Health Co-Benefits: A Delphi Study. Int J Environ Res Public Health 2023; 20:5094. [PMID: 36982003 PMCID: PMC10049208 DOI: 10.3390/ijerph20065094] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
Climate change requires urgent action; however, it can be challenging to identify individual-level behaviours that should be prioritised for maximum impact. The study aimed to prioritise climate change mitigation behaviours according to their impacts on climate change and public health, and to identify associated barriers and facilitators-exploring the impact of observed behaviour shifts associated with COVID-19 in the UK. A three-round Delphi study and expert workshop were conducted: An expert panel rated mitigation behaviours impacted by COVID-19 in relation to their importance regarding health impacts and climate change mitigation using a five-point Likert scale. Consensus on the importance of target behaviours was determined by interquartile ranges. In total, seven target behaviours were prioritised: installing double/triple glazing; installing cavity wall insulation; installing solid wall insulation; moving away from meat/emission heavy diets; reducing the number of cars per household; walking shorter journeys; and reducing day/weekend leisure car journeys. Barriers related to the costs associated with performing behaviours and a lack of complementary policy-regulated subsidies. The target behaviours are consistent with recommendations from previous research. To ensure public uptake, interventions should address behavioural facilitators and barriers, dovetail climate change mitigation with health co-benefits and account for the long-term impacts of COVID-19 on these behaviours.
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Affiliation(s)
- Priyanjali Ratwatte
- Behavioural Science and Insights Unit (BSIU), UK Health Security Agency (UKHSA), Porton Down, Wiltshire, Salisbury SP4 0JG, UK
- Climate Change and Health Unit, UK Health Security Agency (UKHSA), Chilton, Oxon OX11 0RQ, UK
- Behavioural Science and Evaluation, Health Protection Research Unit (BSE HPRU), Bristol BS8 2BN, UK
- Environmental Change and Health, Health Protection Research Unit (ECH HPRU), London WC1H 9SH, UK
| | - Helena Wehling
- Behavioural Science and Insights Unit (BSIU), UK Health Security Agency (UKHSA), Porton Down, Wiltshire, Salisbury SP4 0JG, UK
- Behavioural Science and Evaluation, Health Protection Research Unit (BSE HPRU), Bristol BS8 2BN, UK
| | - Revati Phalkey
- Climate Change and Health Unit, UK Health Security Agency (UKHSA), Chilton, Oxon OX11 0RQ, UK
- Environmental Change and Health, Health Protection Research Unit (ECH HPRU), London WC1H 9SH, UK
| | - Dale Weston
- Behavioural Science and Insights Unit (BSIU), UK Health Security Agency (UKHSA), Porton Down, Wiltshire, Salisbury SP4 0JG, UK
- Behavioural Science and Evaluation, Health Protection Research Unit (BSE HPRU), Bristol BS8 2BN, UK
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6
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Gillingham EL, Medlock JM, Macintyre H, Phalkey R. Modelling the current and future temperature suitability of the UK for the vector Hyalomma marginatum (Acari: Ixodidae). Ticks Tick Borne Dis 2023; 14:102112. [PMID: 36634470 DOI: 10.1016/j.ttbdis.2022.102112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/16/2022] [Revised: 10/20/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
Hyalomma marginatum is the main vector of Crimean-Congo haemorrhagic fever virus (CCHFV) and spotted fever rickettsiae in Europe. The distribution of H. marginatum is currently restricted to parts of southern Europe, northern Africa and Asia, and one of the drivers limiting distribution is climate, particularly temperature. As temperatures rise with climate change, parts of northern Europe currently considered too cold for H. marginatum to be able to survive may become suitable, including the United Kingdom (UK), presenting a potential public health concern. Here we use a series of modelling methodologies to understand whether mean air temperatures across the UK during 2000-2019 were sufficient for H. marginatum nymphs to moult into adult stages and be able to overwinter in the UK if they were introduced on migratory birds. We then used UK-specific climate projections (UKCP18) to determine whether predicted temperatures would be sufficient to allow survival in future. We found that spring temperatures in parts of the UK during 2000-2019 were warm enough for predicted moulting to occur, but in all years except 2006, temperatures during September to December were too cold for overwintering to occur. Our analysis of the projections data suggests that whilst temperatures in the UK during September to December will increase in future, they are likely to remain below the threshold required for H. marginatum populations to become established.
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Affiliation(s)
| | - Jolyon M Medlock
- Medical Entomology and Zoonoses Ecology, UK Health Security Agency
| | - Helen Macintyre
- Climate Change and Health, UK Health Security Agency; School of Geography, Earth and Environmental Sciences, University of Birmingham
| | - Revati Phalkey
- Climate Change and Health, UK Health Security Agency; Division of Epidemiology and Public Health, University of Nottingham, UK; Heidelberg Institute for Global Health, University of Germany, Germany
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7
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Shackleton D, Memon FA, Nichols G, Phalkey R, Chen AS. Mechanisms of cholera transmission via environment in India and Bangladesh: state of the science review. Rev Environ Health 2023; 0:reveh-2022-0201. [PMID: 36639850 DOI: 10.1515/reveh-2022-0201] [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] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Cholera has a long history in India and Bangladesh, the region where six out of the past seven global pandemics have been seeded. The changing climate and growing population have led to global cholera cases remaining high despite a consistent improvement in the access to clean water and sanitation. We aim to provide a holistic overview of variables influencing environmental cholera transmission within the context of India and Bangladesh, with a focus on the mechanisms by which they act. CONTENT We identified 56 relevant texts (Bangladesh n = 40, India n = 7, Other n = 5). The results of the review found that cholera transmission is associated with several socio-economic and environmental factors, each associated variable is suggested to have at least one mediating mechanism. Increases in ambient temperature and coastal sea surface temperature support cholera transmission via increases in plankton and a preference of Vibrio cholerae for warmer waters. Increased rainfall can potentially support or reduce transmission via several mechanisms. SUMMARY AND OUTLOOK Common issues in the literature are co-variance of seasonal factors, limited access to high quality cholera data, high research bias towards research in Dhaka and Matlab (Bangladesh). A specific and detailed understanding of the relationship between SST and cholera incidence remains unclear.
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Affiliation(s)
- Debbie Shackleton
- College of Engineering, Mathematics, and Physical Sciences, University of Exeter, Exeter, EX4 4QF, UK
| | - Fayyaz A Memon
- College of Engineering, Mathematics, and Physical Sciences, University of Exeter, Exeter, EX4 4QF, UK
| | - Gordon Nichols
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, UK
- University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Revati Phalkey
- Climate Change and Health Group, UK Health Security Agency, London, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Albert S Chen
- College of Engineering, Mathematics, and Physical Sciences, University of Exeter, Exeter, EX4 4QF, UK
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8
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Vardavas CI, Nikitara K, Aslanoglou K, Kamekis A, Puttige Ramesh N, Symvoulakis E, Agaku I, Phalkey R, Leonardi-Bee J, Fernandez E, Condell O, Lamb F, Deogan C, Suk JE. Systematic review of outbreaks of COVID-19 within households in the European region when the child is the index case. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001718. [PMID: 36649374 PMCID: PMC9835947 DOI: 10.1136/bmjpo-2022-001718] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/07/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES This systematic review aims to identify the secondary attack rates (SAR) to adults and other children when children are the index cases within household settings. METHODS This literature review assessed European-based studies published in Medline and Embase between January 2020 and January 2022 that assessed the secondary transmission of SARS-CoV-2 within household settings. The inclusion criteria were based on the Population, Exposure, Outcome framework for systematic reviews. Thus, the study population was restricted to humans within the household setting in Europe (population), in contact with paediatric index cases 1-17 years old (exposure) that led to the transmission of SARS-CoV-2 reported as either an SAR or the probability of onward infection (outcome). RESULTS Of 1819 studies originally identified, 19 met the inclusion criteria. Overall, the SAR ranged from 13% to 75% in 15 studies, while there was no evidence of secondary transmission from children to other household members in one study. Evidence indicated that asymptomatic SARS-CoV-2 index cases also have a lower SAR than those with symptoms and that younger children may have a lower SAR than adolescents (>12 years old) within household settings. CONCLUSIONS SARS-CoV-2 secondary transmission from paediatric index cases ranged from 0% to 75%, within household settings between January 2020 and January 2022, with differences noted by age and by symptomatic/asymptomatic status of the index case. Given the anticipated endemic circulation of SARS-CoV-2, continued monitoring and assessment of household transmission is necessary.
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Affiliation(s)
- Constantine I Vardavas
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece.,Department of Oral Health Policy and Epidemiology, Harvard University, Cambridge, Massachusetts, USA
| | - Katerina Nikitara
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Katerina Aslanoglou
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Apostolos Kamekis
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Nithya Puttige Ramesh
- Department of Oral Health Policy and Epidemiology, Harvard University, Cambridge, Massachusetts, USA
| | | | - Israel Agaku
- Department of Oral Health Policy and Epidemiology, Harvard University, Cambridge, Massachusetts, USA
| | - Revati Phalkey
- Centre for Evidence Based Healthcare, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, University of Nottingham, Nottingham, UK
| | - Esteve Fernandez
- Tobacco Control Unit, Catalan Institute of Oncology Institut Català d'Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvithe (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,CIBER Respiratory Diseases (CIBERES), Madrid, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Orla Condell
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
| | - Favelle Lamb
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
| | - Charlotte Deogan
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
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9
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Gardner B, Betson M, Cabal Rosel A, Caniça M, Chambers MA, Contadini FM, Gonzalez Villeta LC, Hassan MM, La Ragione RM, de Menezes A, Messina D, Nichols G, Olivença DV, Phalkey R, Prada JM, Ruppitsch W, Santorelli LA, Selemetas N, Tharmakulasingam M, M van Vliet AH, Woegerbauer M, Deza-Cruz I, Lo Iacono G. Mapping the evidence of the effects of environmental factors on the prevalence of antibiotic resistance in the non-built environment: Protocol for a systematic evidence map. Environ Int 2023; 171:107707. [PMID: 36566718 DOI: 10.1016/j.envint.2022.107707] [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] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/09/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Human, animal, and environmental health are increasingly threatened by the emergence and spread of antibiotic resistance. Inappropriate use of antibiotic treatments commonly contributes to this threat, but it is also becoming apparent that multiple, interconnected environmental factors can play a significant role. Thus, a One Health approach is required for a comprehensive understanding of the environmental dimensions of antibiotic resistance and inform science-based decisions and actions. The broad and multidisciplinary nature of the problem poses several open questions drawing upon a wide heterogeneous range of studies. OBJECTIVE This study seeks to collect and catalogue the evidence of the potential effects of environmental factors on the abundance or detection of antibiotic resistance determinants in the outdoor environment, i.e., antibiotic resistant bacteria and mobile genetic elements carrying antibiotic resistance genes, and the effect on those caused by local environmental conditions of either natural or anthropogenic origin. METHODS Here, we describe the protocol for a systematic evidence map to address this, which will be performed in adherence to best practice guidelines. We will search the literature from 1990 to present, using the following electronic databases: MEDLINE, Embase, and the Web of Science Core Collection as well as the grey literature. We shall include full-text, scientific articles published in English. Reviewers will work in pairs to screen title, abstract and keywords first and then full-text documents. Data extraction will adhere to a code book purposely designed. Risk of bias assessment will not be conducted as part of this SEM. We will combine tables, graphs, and other suitable visualisation techniques to compile a database i) of studies investigating the factors associated with the prevalence of antibiotic resistance in the environment and ii) map the distribution, network, cross-disciplinarity, impact and trends in the literature.
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Affiliation(s)
- Brian Gardner
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, Surrey, UK
| | - Martha Betson
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, Surrey, UK
| | | | - Manuela Caniça
- National Institute of Health Dr. Ricardo Jorge, Portugal
| | - Mark A Chambers
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, Surrey, UK; School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, Surrey, UK
| | - Francesca M Contadini
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, Surrey, UK
| | - Laura C Gonzalez Villeta
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, Surrey, UK
| | - Marwa M Hassan
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, Surrey, UK
| | - Roberto M La Ragione
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, Surrey, UK; School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, Surrey, UK
| | | | - Davide Messina
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK
| | | | | | | | - Joaquin M Prada
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, Surrey, UK
| | | | - Lorenzo A Santorelli
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, Surrey, UK
| | - Nick Selemetas
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, Surrey, UK
| | - Mukunthan Tharmakulasingam
- Centre for Vision, Speech and Signal Processing, Faculty of Electronics and Physical Sciences, University of Surrey, Guildford GU2 7XH, Surrey, UK
| | - Arnoud H M van Vliet
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, Surrey, UK
| | | | - Iñaki Deza-Cruz
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, Surrey, UK
| | - Giovanni Lo Iacono
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, Surrey, UK; The Surrey Institute for People-Centred Artificial Intelligence, UK.
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10
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Vardavas CI, Mathioudakis AG, Nikitara K, Stamatelopoulos K, Georgiopoulos G, Phalkey R, Leonardi-Bee J, Fernandez E, Carnicer-Pont D, Vestbo J, Semenza JC, Deogan C, Suk JE, Kramarz P, Lamb F, Penttinen P. Prognostic factors for mortality, intensive care unit and hospital admission due to SARS-CoV-2: a systematic review and meta-analysis of cohort studies in Europe. Eur Respir Rev 2022; 31:220098. [PMID: 36323422 PMCID: PMC9724816 DOI: 10.1183/16000617.0098-2022] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND As mortality from coronavirus disease 2019 (COVID-19) is strongly age-dependent, we aimed to identify population subgroups at an elevated risk for adverse outcomes from COVID-19 using age-/gender-adjusted data from European cohort studies with the aim to identify populations that could potentially benefit from booster vaccinations. METHODS We performed a systematic literature review and meta-analysis to investigate the role of underlying medical conditions as prognostic factors for adverse outcomes due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including death, hospitalisation, intensive care unit (ICU) admission and mechanical ventilation within three separate settings (community, hospital and ICU). Cohort studies that reported at least age and gender-adjusted data from Europe were identified through a search of peer-reviewed articles published until 11 June 2021 in Ovid Medline and Embase. Results are presented as odds ratios with 95% confidence intervals and absolute risk differences in deaths per 1000 COVID-19 patients. FINDINGS We included 88 cohort studies with age-/gender-adjusted data from 6 653 207 SARS-CoV-2 patients from Europe. Hospital-based mortality was associated with high and moderate certainty evidence for solid organ tumours, diabetes mellitus, renal disease, arrhythmia, ischemic heart disease, liver disease and obesity, while a higher risk, albeit with low certainty, was noted for chronic obstructive pulmonary disease and heart failure. Community-based mortality was associated with a history of heart failure, stroke, diabetes and end-stage renal disease. Evidence of high/moderate certainty revealed a strong association between hospitalisation for COVID-19 and solid organ transplant recipients, sleep apnoea, diabetes, stroke and liver disease. INTERPRETATION The results confirmed the strong association between specific prognostic factors and mortality and hospital admission. Prioritisation of booster vaccinations and the implementation of nonpharmaceutical protective measures for these populations may contribute to a reduction in COVID-19 mortality, ICU and hospital admissions.
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Affiliation(s)
- Constantine I Vardavas
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Revati Phalkey
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Dolors Carnicer-Pont
- Catalan Institute of Oncology, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvithe (IDIBELL), Barcelona, Spain
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Jan C Semenza
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Charlotte Deogan
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Piotr Kramarz
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Favelle Lamb
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
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11
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Adebusoye B, Leonardi‐Bee J, Phalkey R, Chattopadhyay K. Barriers and facilitators of physical activity among school attending adolescents in Lagos State, Nigeria: A qualitative study exploring views and experiences of decision-makers in secondary schools. Health Sci Rep 2022; 6:e997. [PMID: 36544616 PMCID: PMC9764406 DOI: 10.1002/hsr2.997] [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: 09/02/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Aims Schools represent a unique setting for promoting lifelong physical activity during critical development stages of life. Opportunities for in-school physical activity largely depend upon school-level policies, practices, and administrative support. A significant information gap exists on the factors influencing adolescents' participation in school-based physical activity programs in Nigeria. This study aimed to identify and explore the barriers and facilitators of physical activity in school-attending adolescents in Lagos State, Nigeria. Methods A qualitative study, using semistructured interviews, was conducted to explore the views and experiences of 21 decision-makers who were responsible for planning the physical and health education curriculum in secondary schools in Lagos State, Nigeria. Data were analyzed using the thematic analysis framework. Results Eight themes were identified and explored. The barriers were (i) students' characteristics, (ii) parental objections, (iii) no prioritization of physical activity, (iv) insufficient resources, and (v) challenges with schools' initiatives. The facilitators were (vi) students' interests, (vii) students' awareness of benefits, and (viii) schools' initiatives. Conclusion Our study findings can help in designing interventions to increase physical activity among school-attending adolescents in Lagos, Nigeria.
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Affiliation(s)
- Busola Adebusoye
- Nottingham Centre for Public Health and Epidemiology, School of Medicine, City Hospital CampusUniversity of NottinghamNottinghamUK
| | - Jo Leonardi‐Bee
- Nottingham Centre for Public Health and Epidemiology, School of Medicine, City Hospital CampusUniversity of NottinghamNottinghamUK,The Nottingham Centre for Evidence‐Based HealthcareUniversity of NottinghamNottinghamUK
| | - Revati Phalkey
- Nottingham Centre for Public Health and Epidemiology, School of Medicine, City Hospital CampusUniversity of NottinghamNottinghamUK,Centre for Climate Change and Health SecurityUK Health Security AgencyLondonUK
| | - Kaushik Chattopadhyay
- Nottingham Centre for Public Health and Epidemiology, School of Medicine, City Hospital CampusUniversity of NottinghamNottinghamUK,The Nottingham Centre for Evidence‐Based HealthcareUniversity of NottinghamNottinghamUK
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12
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Martello E, Gillingham EL, Phalkey R, Vardavas C, Nikitara K, Bakonyi T, Gossner CM, Leonardi-Bee J. Systematic review on the non-vectorial transmission of Tick-borne encephalitis virus (TBEv). Ticks Tick Borne Dis 2022; 13:102028. [PMID: 36030646 DOI: 10.1016/j.ttbdis.2022.102028] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 03/01/2022] [Revised: 07/15/2022] [Accepted: 08/10/2022] [Indexed: 12/30/2022]
Abstract
Tick-borne encephalitis (TBE) is an infection caused by the Tick-borne encephalitis virus (TBEv) and it is common in Europe. The virus is predominantly transmitted by ticks, but other non-vectorial modes of transmission are possible. This systematic review synthesises the epidemiological impact of non-vectorial modes of TBEv transmission in Europe. 41 studies were included comprising of 1308 TBE cases. Alimentary (36 studies), handling infected material (3 studies), blood-borne (1 study), solid organ transplant (1 study) were identified as potential routes of TBEv transmission; however, no evidence of vertical transmission from mother to offspring was reported (2 studies). Consumption of unpasteurised milk/milk products was the most common vehicle of transmission and significantly increased the risk of TBE by three-fold (pooled RR 3.05, 95% CI 1.53 to 6.11; 4 studies). This review also confirms handling infected material, blood-borne and solid organ transplant as potential routes of TBEv transmission. It is important to tracing back to find the vehicle of the viral infection and to promote vaccination as it remains a mainstay for the prevention of TBE.
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Affiliation(s)
- Elisa Martello
- Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK.
| | | | - Revati Phalkey
- Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK; Climate Change and Health Group, UK Health Security Agency, UK
| | - Constantine Vardavas
- School of Medicine, University of Crete, Heraklion, Crete, Greece; Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | | | - Tamas Bakonyi
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Céline M Gossner
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
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13
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Arsyi M, Besral B, Herdayati M, Phalkey R. Antenatal Care Services and Incidence of Low Birth Weight: A Comparison of Demographic and Health Surveys in 4 ASEAN Countries. J Prev Med Public Health 2022; 55:559-567. [PMID: 36475321 DOI: 10.3961/jpmph.22.316] [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: 07/20/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to assess the effect of complete coverage and content of available antenatal care (ANC) on the incidence of low birth weight (LBW) in 4 countries belonging to the Association of Southeast Asian Nations (ASEAN). METHODS Measures of complete coverage and content of ANC services included the frequency of ANC visits and the seven service components (blood pressure measurement, iron supplementation, tetanus toxoid immunization, explanations of pregnancy complications, urine sample test, blood sample test, and weight measurement). The complete coverage and content of ANC services were assessed as high if more than 4 ANC visits and all seven components were delivered. Multivariable logistic regression with complex survey designs was conducted using Demographic Health Survey data from the 4 ASEAN countries in question from 2014 to 2017. RESULTS The proportion of LBW infants was higher in the Philippines (13.8%) than in Indonesia (6.7%), Cambodia (6.7%), or Myanmar (7.5%). Poor ANC services were associated with a 1.30 times higher incidence of LBW than a high level of complete coverage and content of ANC services (adjusted odds ratio [aOR], 1.30; 95% confidence interval [CI], 1.11 to 1.52). In addition, the risk of LBW was higher in the Philippines than in other countries (aOR, 2.25; 95% CI, 2.01 to 2.51) after adjusting for mothers' demographic/socioeconomic factors, health behaviors, and other factors. CONCLUSIONS In sum, complete coverage and content of ANC services were significantly associated with the incidence of LBW in Indonesia, Cambodia, and Myanmar. The Philippines did not show statistically significant results for this relationship, but had a higher risk of LBW with poor ANC.
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Affiliation(s)
- Miftahul Arsyi
- Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Besral Besral
- Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Milla Herdayati
- Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Revati Phalkey
- Heidelberg Institute for Global Health, University of Heidelberg, Heidelberg, Germany.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
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14
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Adebusoye B, Chattopadhyay K, Ekezie W, Phalkey R, Leonardi-Bee J. Association of built environment constructs and physical activity among children and adolescents in Africa: a systematic review and meta-analysis. JBI Evid Synth 2022; 20:2410-2444. [PMID: 36081385 DOI: 10.11124/jbies-21-00295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this review was to synthesize the association between built environment constructs and physical activity among children and adolescents in Africa. INTRODUCTION Previous reviews have found that several built environment constructs, such as residential density, crime safety, and availability of physical activity facilities and infrastructure, are associated with physical activity in children and adolescents; however, these reviews have tended to focus on non-African countries. Therefore, this systematic review synthesized the association between the built environment and physical activity among children and adolescents in Africa. INCLUSION CRITERIA This systematic review included comparative observational studies that assessed the relationship between built environmental constructs and physical activity among children and adolescents (between the ages of 5 and 19 years) in Africa. METHODS Comprehensive electronic searches of MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, Scopus, SPORTDiscus, EThOS, and ProQuest Dissertations and Theses from inception to October 22, 2021, were conducted to identify relevant published and unpublished studies. Two reviewers independently screened papers, assessed the quality of the included studies using the JBI standard critical appraisal tool, and extracted data using a pre-piloted form. Where possible, data were synthesized using random effects meta-analyses, with effect sizes reported as mean differences (MDs) with 95% confidence intervals (CIs). The Grading of Recommendations Assessment, Development and Evaluations (GRADE) was used to assess the certainty of the findings. RESULTS Of the 10,706 identified records, six cross-sectional studies were included, which comprised 4628 children and adolescents. Three of the studies had a high-quality score of 7 or 8 out of 8. Seven built environment constructs were reported within the included studies, namely, residential density, street connectivity, crime safety, availability of physical activity facilities and infrastructure, walkability, esthetics, and traffic safety. Three of the constructs were assessed with objective measures. Results from individual studies found significant associations between physical activity and objective measure of traffic safety (MD 2.63 minutes per day; 95% CI 0.16 to 5.1; one study) and an objective measure of crime safety (MD 2.72 minutes per day; 95% CI 0.07 to 5.37; one study). No significant associations were found between active transportation and any of the built environment constructs. The GRADE evidence for all of the assessed constructs was either low (the built environment constructs may lead to little or no difference in physical activity or active transportation) or very low (it was uncertain whether the built environment constructs affect physical activity). CONCLUSION In African settings, the evidence base for the association between built environment constructs and physical activity is limited, with no consistent evidence of an association. Therefore, further high-quality studies should be conducted before firm conclusions can be drawn. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019133324.
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Affiliation(s)
- Busola Adebusoye
- Division of Epidemiology and Public Health, School of Medicine, The University of Nottingham, Nottingham, UK
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, School of Medicine, The University of Nottingham, Nottingham, UK.,The Nottingham Centre for Evidence-Based Healthcare: A JBI Centre of Excellence, The University of Nottingham, Nottingham, UK
| | - Winifred Ekezie
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Revati Phalkey
- Climate Change and Health Unit, UK Health Security Agency, Oxford, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, School of Medicine, The University of Nottingham, Nottingham, UK.,The Nottingham Centre for Evidence-Based Healthcare: A JBI Centre of Excellence, The University of Nottingham, Nottingham, UK
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15
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Ikejezie J, Langley T, Lewis S, Bisanzio D, Phalkey R. The epidemiology of diphtheria in Haiti, December 2014–June 2021: A spatial modeling analysis. PLoS One 2022; 17:e0273398. [PMID: 35994502 PMCID: PMC9394811 DOI: 10.1371/journal.pone.0273398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Haiti has been experiencing a resurgence of diphtheria since December 2014. Little is known about the factors contributing to the spread and persistence of the disease in the country. Geographic information systems (GIS) and spatial analysis were used to characterize the epidemiology of diphtheria in Haiti between December 2014 and June 2021. Methods Data for the study were collected from official and open-source databases. Choropleth maps were developed to understand spatial trends of diphtheria incidence in Haiti at the commune level, the third administrative division of the country. Spatial autocorrelation was assessed using the global Moran’s I. Local indicators of spatial association (LISA) were employed to detect areas with spatial dependence. Ordinary least squares (OLS) and geographically weighted regression (GWR) models were built to identify factors associated with diphtheria incidence. The performance and fit of the models were compared using the adjusted r-squared (R2) and the corrected Akaike information criterion (AICc). Results From December 2014 to June 2021, the average annual incidence of confirmed diphtheria was 0.39 cases per 100,000 (range of annual incidence = 0.04–0.74 per 100,000). During the study period, diphtheria incidence presented weak but significant spatial autocorrelation (I = 0.18, p<0.001). Although diphtheria cases occurred throughout Haiti, nine communes were classified as disease hotspots. In the regression analyses, diphtheria incidence was positively associated with health facility density (number of facilities per 100,000 population) and degree of urbanization (proportion of urban population). Incidence was negatively associated with female literacy. The GWR model considerably improved model performance and fit compared to the OLS model, as indicated by the higher adjusted R2 value (0.28 v 0.15) and lower AICc score (261.97 v 267.13). Conclusion This study demonstrates that GIS and spatial analysis can support the investigation of epidemiological patterns. Furthermore, it shows that diphtheria incidence exhibited spatial variability in Haiti. The disease hotspots and potential risk factors identified in this analysis could provide a basis for future public health interventions aimed at preventing and controlling diphtheria transmission.
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Affiliation(s)
- Juniorcaius Ikejezie
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- * E-mail:
| | - Tessa Langley
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Sarah Lewis
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Donal Bisanzio
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- RTI International, Washington, District of Columbia, United States of America
| | - Revati Phalkey
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Climate Change and Health Unit, UK Health Security Agency, London, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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16
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Gasparrini A, Masselot P, Scortichini M, Schneider R, Mistry MN, Sera F, Macintyre HL, Phalkey R, Vicedo-Cabrera AM. Small-area assessment of temperature-related mortality risks in England and Wales: a case time series analysis. Lancet Planet Health 2022; 6:e557-e564. [PMID: 35809585 DOI: 10.1016/s2542-5196(22)00138-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Epidemiological literature on the health risks associated with non-optimal temperature has mostly reported average estimates across large areas or specific population groups. However, the heterogeneous distribution of drivers of vulnerability can result in local differences in health risks associated with heat and cold. We aimed to analyse the association between ambient air temperature and all-cause mortality across England and Wales and characterise small scale patterns in temperature-related mortality risks and impacts. METHODS We performed a country-wide small-area analysis using data on all-cause mortality and air temperature for 34 753 lower super output areas (LSOAs) within 348 local authority districts (LADs) across England and Wales between Jan 1, 2000, and Dec 31, 2019. We first performed a case time series analysis of LSOA-specific and age-specific mortality series matched with 1 × 1 km gridded temperature data using distributed lag non-linear models, and then a repeated-measure multivariate meta-regression to pool LAD-specific estimates using area-level climatological, socioeconomic, and topographical predictors. FINDINGS The final analysis included 10 716 879 deaths from all causes. The small-area assessment estimated that each year in England and Wales, there was on average 791 excess deaths (empirical 95% CI 611-957) attributable to heat and 60 573 (55 796-65 145) attributable to cold, corresponding to standardised excess mortality rates of 1·57 deaths (empirical 95% CI 1·21-1·90) per 100 000 person-years for heat and 122·34 deaths (112·90-131·52) per 100 000 person-years for cold. The risks increased with age and were highly heterogeneous geographically, with the minimum mortality temperature ranging from 14·9°C to 22·6°C. Heat-related mortality was higher in urban areas, whereas cold-related mortality showed a more nuanced geographical pattern and increased risk in areas with greater socioeconomic deprivation. INTERPRETATION This study provides a comprehensive assessment of excess mortality related to non-optimal outdoor temperature, with several risk indicators reported by age and multiple geographical levels. The analysis provides detailed risk maps that are useful for designing effective public health and climate policies at both local and national levels. FUNDING Medical Research Council, Natural Environment Research Council, EU Horizon 2020 Programme, National Institute of Health Research.
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Affiliation(s)
- Antonio Gasparrini
- Department of Public Health, Environment, and Society, London School of Hygiene & Tropical Medicine, London, UK; Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK; Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Pierre Masselot
- Department of Public Health, Environment, and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rochelle Schneider
- Department of Public Health, Environment, and Society, London School of Hygiene & Tropical Medicine, London, UK; Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK; Φ-Lab, European Space Agency, Frascati, Italy; Department of Forecasts, European Centre for Medium-Range Weather Forecast, Reading, UK
| | - Malcolm N Mistry
- Department of Public Health, Environment, and Society, London School of Hygiene & Tropical Medicine, London, UK; Department of Economics, Ca' Foscari University of Venice, Venice, Italy
| | - Francesco Sera
- Department of Public Health, Environment, and Society, London School of Hygiene & Tropical Medicine, London, UK; Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy
| | - Helen L Macintyre
- Climate Change and Health Unit, UK Health Security Agency, Chilton, UK; School of Geography, Earth, and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Revati Phalkey
- Climate Change and Health Unit, UK Health Security Agency, Chilton, UK; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham City Hospital, Nottingham, UK; Heidelberg Institute for Global Health, University of Heidelberg, Heidelberg, Germany
| | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
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17
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Petrou G, Hutchinson E, Mavrogianni A, Milner J, Macintyre H, Phalkey R, Hsu SC, Symonds P, Davies M, Wilkinson P. Home energy efficiency under net zero: time to monitor UK indoor air. BMJ 2022; 377:e069435. [PMID: 35534024 PMCID: PMC7615525 DOI: 10.1136/bmj-2021-069435] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | | | | | - James Milner
- London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Macintyre
- UK Health Security Agency, London, UK
- University of Birmingham, Birmingham, UK
| | - Revati Phalkey
- UK Health Security Agency, London, UK
- University of Nottingham, Nottingham, UK
- University of Heidelberg, Heidelberg, Germany
| | | | | | | | - Paul Wilkinson
- London School of Hygiene and Tropical Medicine, London, UK
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18
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Abstract
OBJECTIVES School closures have been used as a core non-pharmaceutical intervention (NPI) during the COVID-19 pandemic. This review aims at identifying SARS-CoV-2 transmission in educational settings during the first waves of the pandemic. METHODS This literature review assessed studies published between December 2019 and 1 April 2021 in Medline and Embase, which included studies that assessed educational settings from approximately January 2020 to January 2021. The inclusion criteria were based on the PCC framework (P-Population, C-Concept, C-Context). The study Population was restricted to people 1-17 years old (excluding neonatal transmission), the Concept was to assess child-to-child and child-to-adult transmission, while the Context was to assess specifically educational setting transmission. RESULTS Fifteen studies met inclusion criteria, ranging from daycare centres to high schools and summer camps, while eight studies assessed the re-opening of schools in the 2020-2021 school year. In principle, although there is sufficient evidence that children can both be infected by and transmit SARS-CoV-2 in school settings, the SAR remain relatively low-when NPI measures are implemented in parallel. Moreover, although the evidence was limited, there was an indication that younger children may have a lower SAR than adolescents. CONCLUSIONS Transmission in educational settings in 2020 was minimal-when NPI measures were implemented in parallel. However, with an upsurge of cases related to variants of concern, continuous surveillance and assessment of the evidence is warranted to ensure the maximum protection of the health of students and the educational workforce, while also minimising the numerous negative impacts that school closures may have on children.
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Affiliation(s)
- Constantine Vardavas
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Oral Health Policy and Epidemiology, Harvard University, Cambridge, Massachusetts, USA
| | | | - Alexander G Mathioudakis
- Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Michele Hilton Boon
- WISE Centre for Economic Justice, Glasgow Caledonian University, Glasgow, UK
| | - Revati Phalkey
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Anastasia Pharris
- Epidemic Prone Diseases, Coronavirus and Influenza, Disease Programmes Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Charlotte Deogan
- Epidemic Prone Diseases, Coronavirus and Influenza, Disease Programmes Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jonathan E Suk
- Emergency Preparedness and Response Support, Public Health Functions Unit, European Centre for Disease Prevention and Control, Solna, Sweden
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19
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Thomson D, Cumpston M, Delgado‐Figueroa N, Ebi KL, Haddaway N, Heijden M, Heyn PC, Lokotola CL, Meerpohl JJ, Metzendorf M, Parker ER, Phalkey R, Tovey D, Elm E, Webster RJ, Wieland SL, Young T. Protecting human health in a time of climate change: how Cochrane should respond. Cochrane Database Syst Rev 2022; 3:ED000156. [PMID: 35353372 PMCID: PMC9052374 DOI: 10.1002/14651858.ed000156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | | | - Patricia C Heyn
- University of Colorado Anschutz Medical CampusMarymount UniversityUSA
| | | | | | | | | | | | | | - Erik Elm
- Université de LausanneSwitzerland
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20
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Pascal M, Phalkey R, Rigal L, Zoonekyndt A, Mathieu A, Gillingham EL, Denys S, Oliver I, Chêne G, Selbie D. Public health institutes and the fight against climate change. The Lancet Public Health 2022; 7:e209. [PMID: 35247351 PMCID: PMC8890770 DOI: 10.1016/s2468-2667(22)00032-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mathilde Pascal
- Department of Environmental and Occupational Health, Santé Publique France, 94 415 Saint Maurice, France.
| | - Revati Phalkey
- Climate Change and Health Unit, UK Health Security Agency, London, UK
| | - Louise Rigal
- International Association of National Public Health Institutes, Saint Maurice, France
| | - Amandine Zoonekyndt
- International Association of National Public Health Institutes, Atlanta, GA, USA
| | - Arnaud Mathieu
- Department of Environmental and Occupational Health, Santé Publique France, 94 415 Saint Maurice, France
| | - Emma L Gillingham
- Climate Change and Health Unit, UK Health Security Agency, London, UK
| | - Sébastien Denys
- Department of Environmental and Occupational Health, Santé Publique France, 94 415 Saint Maurice, France
| | - Isabel Oliver
- Science Group, UK Health Security Agency, London, UK
| | | | - Duncan Selbie
- International Association of National Public Health Institutes, Brussels, Belgium
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21
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Clegg M, Thornes JE, Banerjee D, Mitsakou C, Quaiyoom A, Delgado-Saborit JM, Phalkey R. Intervention of an Upgraded Ventilation System and Effects of the COVID-19 Lockdown on Air Quality at Birmingham New Street Railway Station. Int J Environ Res Public Health 2022; 19:575. [PMID: 35010834 PMCID: PMC8744564 DOI: 10.3390/ijerph19010575] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/20/2021] [Accepted: 12/25/2021] [Indexed: 02/01/2023]
Abstract
High NO2 concentrations (long term average of 383 µg/m3 in 2016/2017) recorded at Birmingham New Street railway station have resulted in the upgrade of the bi-directional fan system to aid wind dispersion within the enclosed platform environment. This paper attempts to examine how successful this intervention has been in improving air quality for both passengers and workers within the station. New air pollution data in 2020 has enabled comparisons to the 2016/2017 monitoring campaign revealing a 23-42% decrease in measured NO2 concentrations. The new levels of NO2 are below the Occupational Health standards but still well above the EU Public Health Standards. This reduction, together with a substantial decrease (up to 81%) in measured Particulate Matter (PM) concentrations, can most likely be attributed to the new fan system effectiveness. Carbon Monoxide levels were well below Occupational and Public Health Standards at all times. The COVID-19 pandemic "initial lockdown" period has also allowed an insight into the resultant air quality at lower rail-traffic intensities, which produced a further reduction in air pollutants, to roughly half the pre-lockdown concentrations. This study shows the scope of improvement that can be achieved through an engineering solution implemented to improve the ventilation system of an enclosed railway station. Further reduction in air pollution would require additional approaches, such as the removal of diesel engine exhaust emissions via the adoption of electric or diesel-electric hybrid powered services.
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Affiliation(s)
- Matt Clegg
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham B15 2TT, UK; (M.C.); (J.M.D.-S.)
| | - John Edward Thornes
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham B15 2TT, UK; (M.C.); (J.M.D.-S.)
- Climate Change and Health Group, Radiation, Chemical and Environmental Hazards, United Kingdom Health Security Agency, Chilton, Oxford OX11 0RQ, UK; (C.M.); (R.P.)
| | | | - Christina Mitsakou
- Climate Change and Health Group, Radiation, Chemical and Environmental Hazards, United Kingdom Health Security Agency, Chilton, Oxford OX11 0RQ, UK; (C.M.); (R.P.)
| | | | - Juana Maria Delgado-Saborit
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham B15 2TT, UK; (M.C.); (J.M.D.-S.)
- School of Health Science, Universitat Jaume I, 12071 Castellon, Spain
| | - Revati Phalkey
- Climate Change and Health Group, Radiation, Chemical and Environmental Hazards, United Kingdom Health Security Agency, Chilton, Oxford OX11 0RQ, UK; (C.M.); (R.P.)
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22
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Elimian KO, Myles PR, Phalkey R, Sadoh A, Pritchard C. Comparing the accuracy of lay diagnosis of childhood malaria and pneumonia with that of the revised IMCI guidelines in Nigeria. J Public Health (Oxf) 2021; 43:772-779. [PMID: 32671386 DOI: 10.1093/pubmed/fdaa103] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 01/14/2020] [Accepted: 06/15/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Improving caregivers' recognition of childhood malaria and pneumonia is crucial to early treatment and improving outcomes. The objective of this study was to assess the accuracy and reliability of caregivers' recognition of malaria and pneumonia (lay diagnosis) as compared to the revised IMCI guidelines. METHODS A cross-sectional study design was used to recruit 903 children aged 2-59 months who were assessed for malaria and pneumonia by health workers at five primary healthcare centres in Benin City, Nigeria. Accuracy of lay diagnosis as compared to the revised IMCI guidelines was assessed using sensitivity, specificity, positive and negative predictive values and area under the receiver operating characteristic curve (AUROC) values. RESULTS The accuracy of caregivers' ability to recognise malaria (AUROC: 0.60; 95% CI: 0.57-0.64) and pneumonia (AUROC: 0.54; 95% CI: 0.50-0.58) was, respectively, moderate and poor as compared to the IMCI guidelines. Caregivers were better able to identify children without than those with malaria and pneumonia. Agreement between caregivers and the IMCI guidelines for malaria and pneumonia diagnosis was poor (k = 0.14, 95% CI: 0.09-0.19; P = 0.0001). CONCLUSION Caregivers' ability to recognise these childhood diseases as compared to the IMCI guidelines was poor overall, which was partly due to the approach used to ascertain lay diagnosis.
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Affiliation(s)
- K O Elimian
- Department of Microbiology, Faculty of Life Sciences, University of Benin, Benin City, Edo State, Nigeria.,Division of Epidemiology & Public Health, University of Nottingham, Nottingham, NG5 1PB, UK
| | - P R Myles
- Department of Microbiology, Faculty of Life Sciences, University of Benin, Benin City, Edo State, Nigeria
| | - R Phalkey
- Department of Microbiology, Faculty of Life Sciences, University of Benin, Benin City, Edo State, Nigeria
| | - A Sadoh
- Institute of Child Health, University of Benin, Benin City, Edo State, Nigeria
| | - C Pritchard
- Department of Microbiology, Faculty of Life Sciences, University of Benin, Benin City, Edo State, Nigeria.,Nottinghamshire County Council, Nottingham, UK
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23
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Nichols GL, Gillingham EL, Macintyre HL, Vardoulakis S, Hajat S, Sarran CE, Amankwaah D, Phalkey R. Coronavirus seasonality, respiratory infections and weather. BMC Infect Dis 2021; 21:1101. [PMID: 34702177 PMCID: PMC8547307 DOI: 10.1186/s12879-021-06785-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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: 10/23/2020] [Accepted: 10/12/2021] [Indexed: 12/23/2022] Open
Abstract
Background The survival of coronaviruses are influenced by weather conditions and seasonal coronaviruses are more common in winter months. We examine the seasonality of respiratory infections in England and Wales and the associations between weather parameters and seasonal coronavirus cases. Methods Respiratory virus disease data for England and Wales between 1989 and 2019 was extracted from the Second-Generation Surveillance System (SGSS) database used for routine surveillance. Seasonal coronaviruses from 2012 to 2019 were compared to daily average weather parameters for the period before the patient’s specimen date with a range of lag periods. Results The seasonal distribution of 985,524 viral infections in England and Wales (1989–2019) showed coronavirus infections had a similar seasonal distribution to influenza A and bocavirus, with a winter peak between weeks 2 to 8. Ninety percent of infections occurred where the daily mean ambient temperatures were below 10 °C; where daily average global radiation exceeded 500 kJ/m2/h; where sunshine was less than 5 h per day; or where relative humidity was above 80%. Coronavirus infections were significantly more common where daily average global radiation was under 300 kJ/m2/h (OR 4.3; CI 3.9–4.6; p < 0.001); where average relative humidity was over 84% (OR 1.9; CI 3.9–4.6; p < 0.001); where average air temperature was below 10 °C (OR 6.7; CI 6.1–7.3; p < 0.001) or where sunshine was below 4 h (OR 2.4; CI 2.2–2.6; p < 0.001) when compared to the distribution of weather values for the same time period. Seasonal coronavirus infections in children under 3 years old were more frequent at the start of an annual epidemic than at the end, suggesting that the size of the susceptible child population may be important in the annual cycle. Conclusions The dynamics of seasonal coronaviruses reflect immunological, weather, social and travel drivers of infection. Evidence from studies on different coronaviruses suggest that low temperature and low radiation/sunlight favour survival. This implies a seasonal increase in SARS-CoV-2 may occur in the UK and countries with a similar climate as a result of an increase in the R0 associated with reduced temperatures and solar radiation. Increased measures to reduce transmission will need to be introduced in winter months for COVID-19. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06785-2.
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Affiliation(s)
- G L Nichols
- Climate Change and Health Group, Centre for Radiation Chemicals and Environmental Hazards, UK Health Security Agency (Formerly Public Health England), Chilton, Oxon, OX11 0RQ, UK. .,European Centre for Environment and Human Health, University of Exeter Medical School, C/O Knowledge Spa RCHT, Truro, Cornwall, TR1 3HD, UK. .,School of Environmental Sciences, UEA, Norwich, NR4 7TJ, UK.
| | - E L Gillingham
- Climate Change and Health Group, Centre for Radiation Chemicals and Environmental Hazards, UK Health Security Agency (Formerly Public Health England), Chilton, Oxon, OX11 0RQ, UK
| | - H L Macintyre
- Climate Change and Health Group, Centre for Radiation Chemicals and Environmental Hazards, UK Health Security Agency (Formerly Public Health England), Chilton, Oxon, OX11 0RQ, UK.,School of Geography Earth and Environmental Sciences, University of Birmingham, Edgbaston, B15 2TT, UK
| | - S Vardoulakis
- European Centre for Environment and Human Health, University of Exeter Medical School, C/O Knowledge Spa RCHT, Truro, Cornwall, TR1 3HD, UK.,National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, 2601, Australia
| | - S Hajat
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - C E Sarran
- Met Office, Fitzroy Road, Exeter, EX1 3PB, UK.,Institute of Health Research, University of Exeter, Saint Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - D Amankwaah
- Climate Change and Health Group, Centre for Radiation Chemicals and Environmental Hazards, UK Health Security Agency (Formerly Public Health England), Chilton, Oxon, OX11 0RQ, UK
| | - R Phalkey
- Climate Change and Health Group, Centre for Radiation Chemicals and Environmental Hazards, UK Health Security Agency (Formerly Public Health England), Chilton, Oxon, OX11 0RQ, UK.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.,Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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24
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Macintyre HL, Heaviside C, Cai X, Phalkey R. Comparing temperature-related mortality impacts of cool roofs in winter and summer in a highly urbanized European region for present and future climate. Environ Int 2021; 154:106606. [PMID: 33971480 PMCID: PMC8214226 DOI: 10.1016/j.envint.2021.106606] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Human health can be negatively impacted by hot or cold weather, which often exacerbates respiratory or cardiovascular conditions and increases the risk of mortality. Urban populations are at particular increased risk of effects from heat due to the Urban Heat Island (UHI) effect (higher urban temperatures compared with rural ones). This has led to extensive investigation of the summertime UHI, its impacts on health, and also the consideration of interventions such as reflective 'cool' roofs to help reduce summertime overheating effects. However, interventions aimed at limiting summer heat are rarely evaluated for their effects in wintertime, and thus their overall annual net impact on temperature-related health effects are poorly understood. In this study we use a regional weather model to simulate the winter 2009/10 period for an urbanized region of the UK (Birmingham and the West Midlands), and use a health impact assessment to estimate the impact of reflective 'cool' roofs (an intervention usually aimed at reducing the UHI in summer) on cold-related mortality in winter. Cool roofs have been shown to be effective at reducing maximum temperatures during summertime. In contrast to the summer, we find that cool roofs have a minimal effect on ambient air temperatures in winter. Although the UHI in summertime can increase heat-related mortality, the wintertime UHI can have benefits to health, through avoided cold-related mortality. Our results highlight the potential annual net health benefits of implementing cool roofs to reduce temperature-related mortality in summer, without reducing the protective UHI effect in winter. Further, we suggest that benefits of cool roofs may increase in future, with a doubling of the number of heat-related deaths avoided by the 2080s (RCP8.5) compared to summer 2006, and with insignificant changes in the impact of cool-roofs on cold-related mortality. These results further support reflective 'cool' roof implementation strategies as effective interventions to protect health, both today and in future.
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Affiliation(s)
- Helen L Macintyre
- Climate Change and Health Group, Centre for Radiation Chemical and Environmental Hazards, Public Health England, Chilton, Oxon OX11 0RQ, UK; School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | - Clare Heaviside
- Institute for Environmental Design and Engineering, University College London, Central House, 14 Woburn Place, London WC1H 0NN, UK
| | - Xiaoming Cai
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Revati Phalkey
- Climate Change and Health Group, Centre for Radiation Chemical and Environmental Hazards, Public Health England, Chilton, Oxon OX11 0RQ, UK; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham City Hospital, Hucknall Road, NG51PB Nottingham, UK; Heidelberg Institute for Global Health, University of Heidelberg, Im Neuenheimer Feld 130.3 69120 Heidelberg, Germany
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25
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Macintyre HL, Heaviside C, Cai X, Phalkey R. The winter urban heat island: Impacts on cold-related mortality in a highly urbanized European region for present and future climate. Environ Int 2021; 154:106530. [PMID: 33895439 PMCID: PMC8543073 DOI: 10.1016/j.envint.2021.106530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/07/2021] [Accepted: 03/14/2021] [Indexed: 06/12/2023]
Abstract
Exposure to heat has a range of potential negative impacts on human health; hot weather may exacerbate cardiovascular and respiratory illness or lead to heat stroke and death. Urban populations are at increased risk due to the Urban Heat Island (UHI) effect (higher urban temperatures compared with rural ones). This has led to extensive investigation of the summertime UHI and its effects, whereas far less research focuses on the wintertime UHI. Exposure to low temperature also leads to a range of illnesses, and in fact, in the UK, annual cold-related mortality outweighs heat-related mortality. It is not clearly understood to what extent the wintertime UHI may protect against cold related mortality. In this study we quantify the UHI intensity in wintertime for a heavily urbanized UK region (West Midlands, including Birmingham) using a regional weather model, and for the first time, use a health impact assessment (HIA) to estimate the associated impact on cold-related mortality. We show that the population-weighted mean winter UHI intensity was +2.3 °C in Birmingham city center, and comparable with that of summer. Our results suggest a potential protective effect of the wintertime UHI, equivalent to 266 cold-related deaths avoided (~15% of total cold-related mortality over ~11 weeks). When including the impacts of climate change, our results suggest that the number of heat-related deaths associated with the summer UHI will increase from 96 (in 2006) to 221 in the 2080s, based on the RCP8.5 emissions pathway. The protective effect of the wintertime UHI is projected to increase only slightly from 266 cold-related deaths avoided in 2009 to 280 avoided in the 2080s. The different effects of the UHI in winter and summer should be considered when assessing interventions in the built environment for reducing summer urban heat, and our results suggest that the future burden of temperature-related mortality associated with the UHI is likely to increase in summer relative to winter.
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Affiliation(s)
- Helen L Macintyre
- Climate Change and Health Group, Centre for Radiation Chemical and Environmental Hazards, Public Health England, Chilton, Oxon OX11 0RQ, UK; School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | - Clare Heaviside
- Institute for Environmental Design and Engineering, University College London, Central House, 14 Woburn Place, London WC1H 0NN, UK
| | - Xiaoming Cai
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Revati Phalkey
- Climate Change and Health Group, Centre for Radiation Chemical and Environmental Hazards, Public Health England, Chilton, Oxon OX11 0RQ, UK; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham City Hospital, Hucknall Road, NG51PB Nottingham, UK; Heidelberg Institute for Global Health, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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26
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Vardavas C, Nikitara K, Zisis K, Athanasakis K, Phalkey R, Leonardi-Bee J, Johnson H, Tsolova S, Ciotti M, Suk JE. Cost-effectiveness of emergency preparedness measures in response to infectious respiratory disease outbreaks: a systematic review and econometric analysis. BMJ Open 2021; 11:e045113. [PMID: 33926982 PMCID: PMC8094385 DOI: 10.1136/bmjopen-2020-045113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Respiratory infectious disease outbreaks pose a threat for loss of life, economic instability and social disruption. We conducted a systematic review of published econometric analyses to assess the direct and indirect costs of infectious respiratory disease outbreaks that occurred between 2003 and 2019. SETTING Respiratory infectious disease outbreaks or public health preparedness measures or interventions responding to respiratory outbreaks in OECD countries (excluding South Korea and Japan) so as to assess studies relevant to the European context. The cost-effectiveness of interventions was assessed through a dominance ranking matrix approach. All cost data were adjusted to the 2017 Euro, with interventions compared with the null. We included data from 17 econometric studies. PRIMARY AND SECONDARY OUTCOME MEASURES Direct and indirect costs for disease and preparedness and/or response or cost-benefit and cost-utility were measured. RESULTS Overall, the economic burden of infectious respiratory disease outbreaks was found to be significant to healthcare systems and society. Indirect costs were greater than direct costs mainly due to losses of productivity. With regard to non-pharmaceutical strategies, prehospitalisation screening and the use of protective masks were identified as both an effective strategy and cost-saving. Community contact reduction was effective but had ambiguous results for cost saving. School closure was an effective measure, but not cost-saving in the long term. Targeted antiviral prophylaxis was the most cost-saving and effective pharmaceutical intervention. CONCLUSIONS Our cost analysis results provide evidence to policymakers on the cost-effectiveness of pharmaceutical and non-pharmaceutical intervention strategies which may be applied to mitigate or respond to infectious respiratory disease outbreaks.
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Affiliation(s)
| | | | | | - Konstantinos Athanasakis
- Department of Public Health Policy, School of Public Health, University of West Attica, Egaleo, Greece
| | - Revati Phalkey
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Helen Johnson
- Epidemiological Methods, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Svetla Tsolova
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Massimo Ciotti
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jonathan E Suk
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
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27
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Dambach P, Traoré I, Sawadogo H, Zabré P, Shukla S, Sauerborn R, Becker N, Phalkey R. Community acceptance of environmental larviciding against malaria with Bacillus thuringiensis israelensis in rural Burkina Faso - A knowledge, attitudes and practices study. Glob Health Action 2021; 14:1988279. [PMID: 34927578 PMCID: PMC8725727 DOI: 10.1080/16549716.2021.1988279] [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] [Indexed: 11/05/2022] Open
Abstract
Background Malaria control is based on early treatment of cases and on vector control. The current measures for malaria vector control in Africa are mainly based on long-lasting insecticidal nets (LLINs) and to a much smaller extent on indoor residual spraying (IRS). While bed net use is widely distributed and its role is intensively researched, Bti-based larviciding is a relatively novel tool in Africa. In this study, we analyze the perception and acceptability of Bti-based larval source management under different larviciding scenarios that were performed in a health district in Burkina Faso. Objective To research people’s perception and acceptance regarding biological larviciding interventions against malaria in their communities. Methods A cross-sectional study was undertaken using a total of 634 administered questionnaires. Data were collected in a total of 36 rural villages and in seven town quarters of the semi-urban town of Nouna. Results Respondents had basic to good knowledge regarding malaria transmission and how to protect oneself against it. More than 90% reported sleeping under a bed net, while other measures such as mosquito coils and insecticides were only used by a minority. The majority of community members reported high perceived reductions in mosquito abundance and the number of malaria episodes. There was a high willingness to contribute financially to larviciding interventions among interviewees. Conclusions This study showed that biological larviciding interventions are welcomed by the population that they are regarded as an effective and safe means to reduce mosquito abundance and malaria transmission. A routine implementation would, despite low intervention costs, require community ownership and contribution.
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Affiliation(s)
- Peter Dambach
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Issouf Traoré
- Centre De Recherche En Santé De Nouna, Nouna, Burkina Faso.,Institut De Formations Initiale Et Continue, Université Thomas Sankara, Ouagadougou, Burkina Faso
| | | | - Pascal Zabré
- Centre De Recherche En Santé De Nouna, Nouna, Burkina Faso
| | - Sharvari Shukla
- Symbiosis Statistical Institute, Symbiosis International (Deemed University)
| | - Rainer Sauerborn
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Norbert Becker
- German Mosquito Control Association (KABS), Speyer, Germany.,Centre for Organismal Studies, University of Heidelberg, Heidelberg, Germany
| | - Revati Phalkey
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.,Epidemiology and Public Health Division, University of Nottingham, Nottingham, UK.,Climate Change and Health Group, Public Health England, Chilton, UK
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28
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Elimian KO, Myles PR, Phalkey R, Sadoh A, Pritchard C. 'Everybody in Nigeria is a doctor…': a qualitative study of stakeholder perspectives on lay diagnosis of malaria and pneumonia in Nigeria. J Public Health (Oxf) 2020; 42:353-361. [PMID: 32100008 DOI: 10.1093/pubmed/fdaa015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/03/2019] [Accepted: 01/10/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lay diagnosis is a widely used diagnostic approach for home management of common illnesses in Nigeria. This study aimed to explore the perspectives of caregivers and healthcare professionals on lay diagnosis of childhood malaria and pneumonia. Aligned to this, the study sought to explore the feasibility of training caregivers in the Integrated Management of Childhood Illness (IMCI) guidelines for improved recognition and treatment of these diseases. METHODS A qualitative study using individual face-to-face semi-structured interviews was conducted in Benin City, Nigeria. Participants included 13 caregivers with children under 5 years and 17 healthcare professionals (HPs). An inductive approach to thematic analysis was used to generate themes and analyses. RESULTS Caregivers relied on lay diagnosis but recognised its limitations. The perceived severity of malaria and pneumonia significantly influenced caregivers' preference for reliance on lay diagnosis practices, health-seeking behaviour and willingness to undertake training in IMCI guidelines for home management of diseases. Safety and potential unintended misuse of medications were recognised by caregivers and HPs as the main challenges. CONCLUSIONS The high level of acceptance among caregivers to receive IMCI training could help improve effective management of childhood malaria and pneumonia at the community level through early recognition and prompt treatment.
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Affiliation(s)
- Kelly O Elimian
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.,Department of Microbiology, Faculty of Life Sciences, University of Benin, P.M.B. 1154, Benin City, Nigeria
| | - Puja R Myles
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Revati Phalkey
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany and Public Health England, CRCE Chilton, OX11 0RQ, UK
| | - Ayebo Sadoh
- Institute of Child Health, University of Benin, P.M.B. 1154, Benin City, Nigeria
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29
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Adebusoye B, Phalkey R, Leonardi-Bee J, Chattopadhyay K. Association of the built environment with physical activity in children and adolescents in Africa: a systematic review protocol. JBI Evid Synth 2020; 18:553-563. [PMID: 32197014 DOI: 10.11124/jbisrir-d-19-00162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this systematic review is to summarize the association between the built environment and physical activity in children and adolescents in Africa. INTRODUCTION Physical activity offers immense benefits to children and adolescents. Some built environment constructs, such as street connectivity and the availability of parks, have been identified to facilitate physical activity in children and adolescents; however, this evidence has come from developed countries. This review will present evidence from Africa on the built environment constructs that facilitate physical activity in children and adolescents. INCLUSION CRITERIA This review will consider quantitative studies that have built environment constructs as one of their exposure variables and physical activity as one of their outcomes and were conducted in children and adolescents aged five to 19 years residing in Africa. METHODS A systematic search of MEDLINE, Embase, Web of Science and other sources will be conducted to locate both published and unpublished studies. There will be no date or language restrictions. Titles, abstracts, and full text of articles retrieved from the search will be screened and read by two reviewers independently for eligibility. Included articles will be critically appraised independently by two reviewers. Data extraction will be performed in two phases, first for information regarding the study characteristics and then to extract specific study findings. Meta-analysis will be used to synthesize the findings from the studies; however, where this is not possible, a narrative synthesis will be performed. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019133324.
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Affiliation(s)
- Busola Adebusoye
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,The Nottingham Centre for Evidence-Based Healthcare: a Joanna Briggs Institute Centre of Excellence
| | - Revati Phalkey
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,The Nottingham Centre for Evidence-Based Healthcare: a Joanna Briggs Institute Centre of Excellence.,UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, United Kingdom
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,The Nottingham Centre for Evidence-Based Healthcare: a Joanna Briggs Institute Centre of Excellence
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Belesova K, Agabiirwe CN, Zou M, Phalkey R, Wilkinson P. Drought exposure as a risk factor for child undernutrition in low- and middle-income countries: A systematic review and assessment of empirical evidence. Environ Int 2019; 131:104973. [PMID: 31400736 DOI: 10.1016/j.envint.2019.104973] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 03/20/2019] [Revised: 06/13/2019] [Accepted: 06/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Droughts affect around 52 million people globally each year, a figure that is likely to increase under climate change. OBJECTIVES To assess the strength of empirical evidence on drought exposure as a risk factor for undernutrition in children <5 years of age in low- and middle-income countries (LMICs). METHODS Systematic review of observational studies published between 1990 and 2018 in English and reporting undernutrition outcomes in children <5 years of age in relation to droughts in LMICs. The search was performed in the Global Health, Medline, Embase, and Scopus databases. We assessed the strength of evidence following the Navigation Guide. RESULTS 27 studies met our inclusion criteria. 12 reported prevalence estimates in drought-affected conditions without comparison to unaffected conditions. These showed high prevalence of chronic and mixed undernutrition and poor to critical levels of acute undernutrition. Only two studies were judged to have low risk of bias. Overall, the strength of evidence of drought as a risk factor was found to be limited, but the two studies with low risk of bias suggested positive associations of drought exposure with children being underweight and having anaemia. CONCLUSION Published evidence suggests high levels of all types of child undernutrition in drought-affected populations in low-income settings, but the extent to which these levels are attributable to drought has not been clearly quantified and may be context specific. This review offers suggestions for enhancing the quality of future studies to strengthen evidence on the potential magnitude, timing, and modifying factors of drought impacts.
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Affiliation(s)
- Kristine Belesova
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
| | - Caroline Noel Agabiirwe
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Margaret Zou
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
| | - Revati Phalkey
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, Heidelberg 69120, Germany.
| | - Paul Wilkinson
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
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Adaji EE, Ekezie W, Clifford M, Phalkey R. Understanding the effect of indoor air pollution on pneumonia in children under 5 in low- and middle-income countries: a systematic review of evidence. Environ Sci Pollut Res Int 2019; 26:3208-3225. [PMID: 30569352 PMCID: PMC6513791 DOI: 10.1007/s11356-018-3769-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 11/15/2018] [Indexed: 04/12/2023]
Abstract
Exposure to indoor air pollution increases the risk of pneumonia in children, accounting for about a million deaths globally. This study investigates the individual effect of solid fuel, carbon monoxide (CO), black carbon (BC) and particulate matter (PM)2.5 on pneumonia in children under 5 in low- and middle-income countries. A systematic review was conducted to identify peer-reviewed and grey full-text documents without restrictions to study design, language or year of publication using nine databases (Embase, PubMed, EBSCO/CINAHL, Scopus, Web of Knowledge, WHO Library Database (WHOLIS), Integrated Regional Information Networks (IRIN), the World Meteorological Organization (WMO)-WHO and Intergovernmental Panel on Climate Change (IPCC). Exposure to solid fuel use showed a significant association to childhood pneumonia. Exposure to CO showed no association to childhood pneumonia. PM2.5 did not show any association when physically measured, whilst eight studies that used solid fuel as a proxy for PM2.5 all reported significant associations. This review highlights the need to standardise measurement of exposure and outcome variables when investigating the effect of air pollution on pneumonia in children under 5. Future studies should account for BC, PM1 and the interaction between indoor and outdoor pollution and its cumulative impact on childhood pneumonia.
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Affiliation(s)
- Enemona Emmanuel Adaji
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham City Hospital, Clinical Sciences Building, Hucknall Road, Nottingham, NG5 1PB, UK.
| | - Winifred Ekezie
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham City Hospital, Clinical Sciences Building, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Michael Clifford
- Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - Revati Phalkey
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham City Hospital, Clinical Sciences Building, Hucknall Road, Nottingham, NG5 1PB, UK
- Climate Change and Human Health Group, Institute for Public Health, University of Heidelberg, Heidelberg, Germany
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Kroll M, Phalkey R, Dutta S, Shukla S, Butsch C, Bharucha E, Kraas F. Involving private healthcare practitioners in an urban NCD sentinel surveillance system: lessons learned from Pune, India. Glob Health Action 2016; 9:32635. [PMID: 27760678 PMCID: PMC5071647 DOI: 10.3402/gha.v9.32635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 06/17/2016] [Revised: 08/22/2016] [Accepted: 08/29/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the rising impact of non-communicable diseases (NCDs) on public health in India, lack of quality data and routine surveillance hampers the planning process for NCD prevention and control. Current surveillance programs focus largely on communicable diseases and do not adequately include the private healthcare sector as a major source of care in cities. OBJECTIVE The objective of the study was to conceptualize, implement, and evaluate a prototype for an urban NCD sentinel surveillance system among private healthcare practitioners providing primary care in Pune, India. DESIGN We mapped all private healthcare providers in three selected areas of the city, conducted a knowledge, attitude, and practice survey with regard to surveillance among 258 consenting practitioners, and assessed their willingness to participate in a routine NCD surveillance system. In total, 127 practitioners agreed and were included in a 6-month surveillance study. Data on first-time diagnoses of 10 selected NCDs alongside basic demographic and socioeconomic patient information were collected onsite on a monthly basis using a paper-based register. Descriptive and regression analyses were performed. RESULTS In total, 1,532 incident cases were recorded that mainly included hypertension (n=622, 41%) and diabetes (n=460, 30%). Dropout rate was 10% (n=13). The monthly reporting consistency was quite constant, with the majority (n=63, 50%) submitting 1-10 cases in 6 months. Average number of submitted cases was highest among allopathic practitioners (17.4). A majority of the participants (n=104, 91%) agreed that the surveillance design could be scaled up to cover the entire city. CONCLUSIONS The study indicates that private primary healthcare providers (allopathic and alternate medicine practitioners) play an important role in the diagnosis and treatment of NCDs and can be involved in NCD surveillance, if certain barriers are addressed. Main barriers observed were lack of regulation of the private sector, cross-practices among different systems of medicine, limited clinic infrastructure, and knowledge gaps about disease surveillance. We suggest a voluntary augmented sentinel NCD surveillance system including public and private healthcare facilities at all levels of care.
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Affiliation(s)
- Mareike Kroll
- Institute of Geography, University of Cologne, Cologne, Germany;
| | - Revati Phalkey
- Institute of Geography, University of Cologne, Cologne, Germany
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Sayani Dutta
- Institute of Environment Education and Research, Bharati Vidyapeeth University, Pune, India
| | - Sharvari Shukla
- Symbiosis Institute of Health Sciences, Symbiosis International Institute, Pune, India
| | - Carsten Butsch
- Institute of Geography, University of Cologne, Cologne, Germany
| | - Erach Bharucha
- Institute of Environment Education and Research, Bharati Vidyapeeth University, Pune, India
| | - Frauke Kraas
- Institute of Geography, University of Cologne, Cologne, Germany
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Sorgho R, Franke J, Simboro S, Phalkey R, Saeurborn R. NUTRItion and CLIMate (NUTRICLIM): investigating the relationship between climate variables and childhood malnutrition through agriculture, an exploratory study in Burkina Faso. Public Health Rev 2016; 37:16. [PMID: 29450058 PMCID: PMC5810100 DOI: 10.1186/s40985-016-0031-6] [Citation(s) in RCA: 2] [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] [Received: 09/15/2016] [Accepted: 09/22/2016] [Indexed: 11/10/2022] Open
Abstract
Malnutrition remains a leading cause of death in children in low- and middle-income countries; this will be aggravated by climate change. Annually, 6.9 million deaths of children under 5 were attributable directly or indirectly to malnutrition. Although these figures have recently decreased, evidence shows that a world with a medium climate (local warming up to 3-4 °C) will create an additional 25.2 million malnourished children. This proof of concept study explores the relationships between childhood malnutrition (more specifically stunting), regional agricultural yields, and climate variables through the use of remote sensing (RS) satellite imaging along with algorithms to predict the effect of climate variability on agricultural yields and on malnutrition of children under 5. The success of this proof of purpose study, NUTRItion and CLIMate (NUTRICLIM), should encourage researchers to apply both concept and tools to study of the link between weather variability, crop yield, and malnutrition on a larger scale. It would also allow for linking such micro-level data to climate models and address the challenge of projecting the additional impact of childhood malnutrition from climate change to various policy relevant time horizons.
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Affiliation(s)
- Raissa Sorgho
- 1Institute of Public Health, Universitats Klinikum, Heidelberg, Germany
| | - Jonas Franke
- Remote Sensing Solution GmBh (RSS), Environmental Consulting, Baierbrunn, Germany
| | - Seraphin Simboro
- 3Centre de Recherche en Santé de Nouna (CRSN), Research Center, INDEPTH Network, HDSS, Nouna, Burkina Faso
| | - Revati Phalkey
- 4Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Rainer Saeurborn
- 1Institute of Public Health, Universitats Klinikum, Heidelberg, Germany
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Louis VR, Phalkey R, Horstick O, Ratanawong P, Wilder-Smith A, Tozan Y, Dambach P. Modeling tools for dengue risk mapping - a systematic review. Int J Health Geogr 2014; 13:50. [PMID: 25487167 PMCID: PMC4273492 DOI: 10.1186/1476-072x-13-50] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/30/2014] [Indexed: 12/04/2022] Open
Abstract
Introduction The global spread and the increased frequency and magnitude of epidemic dengue in the last 50 years underscore the urgent need for effective tools for surveillance, prevention, and control. This review aims at providing a systematic overview of what predictors are critical and which spatial and spatio-temporal modeling approaches are useful in generating risk maps for dengue. Methods A systematic search was undertaken, using the PubMed, Web of Science, WHOLIS, Centers for Disease Control and Prevention (CDC) and OvidSP databases for published citations, without language or time restrictions. A manual search of the titles and abstracts was carried out using predefined criteria, notably the inclusion of dengue cases. Data were extracted for pre-identified variables, including the type of predictors and the type of modeling approach used for risk mapping. Results A wide variety of both predictors and modeling approaches was used to create dengue risk maps. No specific patterns could be identified in the combination of predictors or models across studies. The most important and commonly used predictors for the category of demographic and socio-economic variables were age, gender, education, housing conditions and level of income. Among environmental variables, precipitation and air temperature were often significant predictors. Remote sensing provided a source of varied land cover data that could act as a proxy for other predictor categories. Descriptive maps showing dengue case hotspots were useful for identifying high-risk areas. Predictive maps based on more complex methodology facilitated advanced data analysis and visualization, but their applicability in public health contexts remains to be established. Conclusions The majority of available dengue risk maps was descriptive and based on retrospective data. Availability of resources, feasibility of acquisition, quality of data, alongside available technical expertise, determines the accuracy of dengue risk maps and their applicability to the field of public health. A large number of unknowns, including effective entomological predictors, genetic diversity of circulating viruses, population serological profile, and human mobility, continue to pose challenges and to limit the ability to produce accurate and effective risk maps, and fail to support the development of early warning systems. Electronic supplementary material The online version of this article (doi:10.1186/1476-072X-13-50) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Valérie R Louis
- Institute of Public Health, Heidelberg University Medical School, Heidelberg, Germany.
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Mahendradhata Y, Souares A, Phalkey R, Sauerborn R. Optimizing patient-centeredness in the transitions of healthcare systems in low- and middle-income countries. BMC Health Serv Res 2014; 14:386. [PMID: 25212684 PMCID: PMC4165996 DOI: 10.1186/1472-6963-14-386] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 09/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-centeredness is necessary for quality of care. Wide-spread incorporation of patient-centered practices across the health system is challenging in low and middle income countries (LMICs) given the complexity of scarce resources, competing priorities and rapidly changing social, economic and political landscapes. Health service managers and policy makers in these settings would benefit from a framework that allows comprehension and anticipation of forthcoming challenges for optimizing patient-centeredness in healthcare delivery. We set out to formulate such a framework, based primarily on analysis of general patterns of healthcare system evolution in LMICs and the current literature. DISCUSSION We suggest that optimization of patient-centeredness in LMICs can be thought of as occurring in four phases, in accordance to particular patterns of macro transitions. Phase I is characterized by a deeply fragmented system based on conventional clinical approaches, dealing primarily with simple acute conditions. In phase II, the healthcare systems deal with increasing chronic cases and require redesign of existing acute-oriented services. In phase III, health services are increasingly confronted with multimorbid patients, requiring more coordinated and integrated care. Complex health care needs in individual patients are increasingly the norm in Phase IV, requiring the most optimal form of patient-centered care. This framework helps to identify and map the key challenges and implications for research, policy and practice, associated with the transitions ahead of time. SUMMARY We have developed a framework based on observed patterns of healthcare and related macro-transitions in LMICs. The framework provides insights into critical issues to be considered by health service managers and policy makers.
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Affiliation(s)
- Yodi Mahendradhata
- Center for Health Policy and Management, Faculty of Medicine, Gadjah Mada University, Sekip Utara, Yogyakarta 55281, Indonesia.
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Haque MA, Louis VR, Phalkey R, Sauerborn R. Use of traditional medicines to cope with climate-sensitive diseases in a resource poor setting in Bangladesh. BMC Public Health 2014; 14:202. [PMID: 24568150 PMCID: PMC3974044 DOI: 10.1186/1471-2458-14-202] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to explore the use of traditional medicines to cope with climate sensitive diseases in areas vulnerable to climate change. We assessed the extent to which traditional or alternative medicines were used for the treatment of the climate sensitive diseases by villagers as part of their health-coping strategies. METHODS The study deployed a mixed-method research design to know the health-coping strategies of the people in a resource-poor setting.A cross sectional study was conducted from September 2010 to March 2011 among 450 households selected randomly in the districts of Rajshahi and Khulna, Bangladesh. The elder males or females of each household were interviewed. For qualitative methods, twelve focus group discussions (six with females and six with males) and fifteen key informant interviews were conducted by the research team, using interview guidelines on the use of traditional medicine. RESULTS Univariate analysis showed that the use of traditional medicines has increased among community members of all socio-economic and demographic backgrounds. Due to the increased incidence of disease and sickness respondents had to increase the use of their cultural means to cope with adverse health situations. CONCLUSIONS A systematic collection of knowledge on the use of traditional medicines to cope with climate-sensitive diseases can help the adaptation of communities vulnerable to climate change. In addition it can be instrumental in creating a directory of traditional medicine components used for specific diseases and highlight the effectiveness and relevance of traditional medicines as health-coping strategies. This may be useful for policymakers, researchers, and development partners to adapt existing health care policy in resource-limited contexts. It may also encourage WHO, national and international institutions, such as pharmaceutical companies, to carry out research investigating the effectiveness of these traditional medicines and integrate them with modern medicine. Overall, it could increase the health coping capacity of people in a resource-poor setting and contribute to their adaptation capabilities.
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Affiliation(s)
- Md Aminul Haque
- Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
- Department of Population Sciences, University of Dhaka, Dhaka 1000, Bangladesh
| | - Valérie R Louis
- Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Revati Phalkey
- Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Rainer Sauerborn
- Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
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Yamamoto SS, Phalkey R, Malik AA. A systematic review of air pollution as a risk factor for cardiovascular disease in South Asia: limited evidence from India and Pakistan. Int J Hyg Environ Health 2013; 217:133-44. [PMID: 24064368 DOI: 10.1016/j.ijheh.2013.08.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [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: 11/23/2012] [Revised: 08/06/2013] [Accepted: 08/09/2013] [Indexed: 11/28/2022]
Abstract
Cardiovascular diseases (CVD) are major contributors to mortality and morbidity in South Asia. Chronic exposure to air pollution is an important risk factor for cardiovascular diseases, although the majority of studies to date have been conducted in developed countries. Both indoor and outdoor air pollution are growing problems in developing countries in South Asia yet the impact on rising rates of CVD in these regions has largely been ignored. We aimed to assess the evidence available regarding air pollution effects on CVD and CVD risk factors in lower income countries in South Asia. A literature search was conducted in PubMed and Web of Science. Our inclusion criteria included peer-reviewed, original, empirical articles published in English between the years 1990 and 2012, conducted in the World Bank South Asia region (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka). This resulted in 30 articles. Nine articles met our inclusion criteria and were assessed for this systematic review. Most of the studies were cross-sectional and examined measured particulate matter effects on CVD outcomes and indicators. We observed a bias as nearly all of the studies were from India. Hypertension and CVD deaths were positively associated with higher particulate matter levels. Biomarkers of oxidative stress such as increased levels of P-selection expressing platelets, depleted superoxide dismutase and reactive oxygen species generation as well as elevated levels of inflammatory-related C-reactive protein, interleukin-6 and interleukin-8 were also positively associated with biomass use or elevated particulate matter levels. An important outcome of this investigation was the evidence suggesting important air pollution effects regarding CVD risk in South Asia. However, too few studies have been conducted. There is as an urgent need for longer term investigations using robust measures of air pollution with different population groups that include a wider range of air pollutants and outcomes, including early indicators of CVD. These regions are facing burdens from increasing urbanization, air pollution and populations, generally weaker health infrastructure, aging populations and increased incidence of non-communicable diseases, included CVD. The extent to which the problem of air pollution and CVD will impact these countries will depend largely on the information available to inform policy and programs, which are still lacking, political will as well as social and economic development.
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Affiliation(s)
- S S Yamamoto
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
| | - R Phalkey
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - A A Malik
- Federal Postgraduate Medical Institute, Lahore, Pakistan
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Sudaryo MK, Besral, Endarti AT, Rivany R, Phalkey R, Marx M, Guha-Sapir D. Injury, disability and quality of life after the 2009 earthquake in Padang, Indonesia: a prospective cohort study of adult survivors. Glob Health Action 2012; 5:1-11. [PMID: 22629236 PMCID: PMC3359784 DOI: 10.3402/gha.v5i0.11816] [Citation(s) in RCA: 28] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 04/20/2012] [Accepted: 04/26/2012] [Indexed: 11/21/2022] Open
Abstract
Background On 30 September 2009, a 7.6 magnitude earthquake severely hit the coast of Padang city in West Sumatra, Indonesia leaving about 1,117 people dead and injuring another 3,515. Health consequences such as physical injury, co-morbidity, disability and quality of life over time are seldom reported among survivors after earthquakes. Objectives To investigate the associations between injury, disability and quality of life amongst adult survivors in Padang city after the 2009 earthquake. Design/Methods A prospective cohort study was conducted to compare adult injured (184) and adult non-injured (93) subjects over a 6-month period. Data on physical injury, co-morbidities, disability and quality of life were collected through interviews and measured quantitatively in three phases, i.e. at baseline, end of 3 and 6 months. Results Disability scores were consistently and significantly higher among injured subjects compared to non-injured, even when adjusted for co-morbidities (i.e. acute symptoms and chronic diseases). The highest disability score amongst injured subjects was attributed to ‘feeling discomfort/pain’. Quality of life attribute (QLA) scores, were significantly lower amongst injured people as compared to those non-injured even when adjusted for co-morbidities. The lowest QLA item score amongst the injured was ‘pain, depression and anxiety’. Significant and consistent negative correlations were found between disability and QLA scores in both the injured and non-injured groups. Conclusion Physical injury is significantly correlated with both higher disability and lower quality of life, while disability has significant negative correlation with quality of life. The findings suggest that, through disability, injury may contribute to decreased quality of life. It is therefore recommended to promptly and adequately treat injuries after disasters to prevent any potential for disability and hence restore quality of life.
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Affiliation(s)
- Mondastri K Sudaryo
- Health Research Center for Crisis and Disaster (HRCCD), Faculty of Public Health, Universitas Indonesia, Depok, Indonesia.
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Phalkey R, Dash SR, Mukhopadhyay A, Runge-Ranzinger S, Marx M. Prepared to react? Assessing the functional capacity of the primary health care system in rural Orissa, India to respond to the devastating flood of September 2008. Glob Health Action 2012; 5:10964. [PMID: 22435044 PMCID: PMC3307669 DOI: 10.3402/gha.v5i0.10964] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [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: 10/18/2011] [Revised: 02/03/2012] [Accepted: 02/18/2012] [Indexed: 11/21/2022] Open
Abstract
Background Early detection of an impending flood and the availability of countermeasures to deal with it can significantly reduce its health impacts. In developing countries like India, public primary health care facilities are frontline organizations that deal with disasters particularly in rural settings. For developing robust counter reacting systems evaluating preparedness capacities within existing systems becomes necessary. Objective The objective of the study is to assess the functional capacity of the primary health care system in Jagatsinghpur district of rural Orissa in India to respond to the devastating flood of September 2008. Methods An onsite survey was conducted in all 29 primary and secondary facilities in five rural blocks (administrative units) of Jagatsinghpur district in Orissa state. A pre-tested structured questionnaire was administered face to face in the facilities. The data was entered, processed and analyzed using STATA® 10. Results Data from our primary survey clearly shows that the healthcare facilities are ill prepared to handle the flood despite being faced by them annually. Basic utilities like electricity backup and essential medical supplies are lacking during floods. Lack of human resources along with missing standard operating procedures; pre-identified communication and incident command systems; effective leadership; and weak financial structures are the main hindering factors in mounting an adequate response to the floods. Conclusion The 2008 flood challenged the primary curative and preventive health care services in Jagatsinghpur. Simple steps like developing facility specific preparedness plans which detail out standard operating procedures during floods and identify clear lines of command will go a long way in strengthening the response to future floods. Performance critiques provided by the grass roots workers, like this one, should be used for institutional learning and effective preparedness planning. Additionally each facility should maintain contingency funds for emergency response along with local vendor agreements to ensure stock supplies during floods. The facilities should ensure that baseline public health standards for health care delivery identified by the Government are met in non-flood periods in order to improve the response during floods. Building strong public primary health care systems is a development challenge. The recovery phases of disasters should be seen as an opportunity to expand and improve services and facilities.
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Affiliation(s)
- Revati Phalkey
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
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Phalkey R, Dash SR, Mukhopadhyay A, Runge-Ranzinger S, Marx M. Prepared to react? Assessing the functional capacity of the primary health care system in rural Orissa, India to respond to the devastating flood of September 2008. Glob Health Action 2012. [DOI: 10.3402/gha.v4i0.10964] [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: 11/14/2022] Open
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Affiliation(s)
- Michael Marx
- Institute of Public Health, Medical School, University of Heidelberg, Heidelberg, Germany
| | - Revati Phalkey
- Institute of Public Health, Medical School, University of Heidelberg, Heidelberg, Germany
| | - Debarati Guha-Sapir
- Centre for Research on the Epidemiology of Disasters (CRED), Université Catholique de Louvain, School of Public Health, Brussels, Belgium
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Phalkey R, Reinhardt JD, Marx M. Injury epidemiology after the 2001 Gujarat earthquake in India: a retrospective analysis of injuries treated at a rural hospital in the Kutch district immediately after the disaster. Glob Health Action 2011; 4:7196. [PMID: 21799668 PMCID: PMC3144753 DOI: 10.3402/gha.v4i0.7196] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [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: 04/13/2011] [Revised: 06/30/2011] [Accepted: 07/01/2011] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The number of injured far exceeds those dead and the average injury to mortality ratio in earthquakes stands at 3:1. Immediate effective medical response significantly influences injury outcomes and thus the overall health impact of earthquakes. Inadequate or mismanagement of injuries may lead to disabilities. The lack of precise data from immediate aftermath is seen as a remarkable weak point in disaster epidemiology and warrants evidence generation. OBJECTIVE To analyze the epidemiology of injuries and the treatment imparted at a secondary rural hospital in the Kutch district, Gujarat, India following the January 26, 2001 earthquake. DESIGN/METHODS Discharge reports of patients admitted to the hospital over 10 weeks were analyzed retrospectively for earthquake-related injuries. RESULTS Orthopedic injuries, (particularly fractures of the lower limbs) were predominant and serious injuries like head, chest, abdominal, and crush syndrome were minimal. Wound infections were reported in almost 20% of the admitted cases. Surgical procedures were more common than conservative treatment. The most frequently performed surgical procedures were open reduction with internal fixation and cleaning and debridement of contaminated wounds. Four secondary deaths and 102 transfers to tertiary care due to complications were reported. CONCLUSION The injury epidemiology reported in this study is in general agreement with most other studies reporting injury epidemiology except higher incidence of distal orthopedic injuries particularly to the lower extremities. We also found that young males were more prone to sustaining injuries. These results warrant further research. Inconsistent data reporting procedures against the backdrop of inherent disaster data incompleteness calls for urgent standardization of reporting earthquake injuries for evidence-based response policy planning.
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Affiliation(s)
- Revati Phalkey
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Jan D. Reinhardt
- International Society of Physical and Rehabilitation Medicine – ISPRM, Rehabilitation Disaster Relief Committee, Gent, Belgium
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Michael Marx
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
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