Lower socioeconomic status strengthens the effect of cooking fuel use on anemia risk and anemia-related parameters: Findings from the Henan Rural Cohort

Association between exposure to smoke from cooking fuels and anaemia among women of reproductive age in Ghana

In low- and middle-income countries, indoor air pollution (IAP) is a serious public health concern, especially for women and children who cook with solid fuels. IAP exposure has been linked to a number of medical conditions, including pneumonia, ischemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), lung cancer, and anaemia. Around 500 million women of reproductive age (WRA) suffer from anaemia globally, with an estimated 190 million cases in sub-Saharan Africa (SSA). This study, which is based on prior research, investigates the relationship between IAP exposure and anaemia among WRA in Ghana. A diverse sample of 2,406 WRA living in Ghana were interviewed, of which 58.06% were anaemic and used high-pollutant fuels for cooking. Age, place of residence, region, education level, religion, ethnicity, wealth index, type of drinking water, type of toilet facility, and type of cooking fuels were all found to be significantly linked with anaemic state by bivariate analysis. Type of cooking fuels utilized, age, region of residence, and the type of residence were shown to be significant predictors of anaemia status using sequential binary logit regression models. The results emphasise the critical need for efforts to promote the usage of clean cooking fuel in an attempt to lower anaemia prevalence in Ghana. To reduce dependency on solid fuels for cooking, initiatives should promote the use of cleaner cooking fuels and enhance the socioeconomic status of households. These interventions could have significant public health effects by reducing the burden of anaemia and improving maternal and child health outcomes due to the prevalence of anaemia among WRA. Overall, this study sheds light on the relationship between IAP exposure and anaemia in Ghana and highlights the demand for focused public health initiatives to address this serious health problem.

Factors Affecting Anemia among Women of Reproductive Age in Mexico: A Mixed-Methods Country Case Study

BACKGROUND

In Mexico, anemia prevalence among women of reproductive age (WRA) decreased from 16.4% in 2006 to 11.6% in 2012, only to increase to 18.3% in 2016. The factors associated with this fluctuation are uncertain.

OBJECTIVE

We conducted a systematic in-depth assessment of the quantitative and qualitative determinants of anemia among WRA in Mexico between 2006 and 2018.

METHODS

Using multivariate stepwise linear regression, we analyzed Mexico's Encuesta Nacional de Salud y Nutrición (ENSANUT) surveys from 2006, 2012, and 2018 to identify determinants of WRA anemia. We also conducted a review of anemia-relevant programs and policies, including financing documents, and conducted in-depth interviews and focus group discussions with key stakeholders in Mexico.

RESULTS

Among non-pregnant women (NPW) 15-49 years, mean hemoglobin (Hb) increased from 13.8 g/dL in 2006 to 14.0 g/dL in 2012, decreasing to 13.2 g/dL in 2018 (p<0.001). Inequities by geographical region and household wealth persisted throughout this period, with household wealth, urban residence and gravidity emerging as significant predictors of Hb among NPW. Qualitative analyses generally supported these findings. The most discussed program was Progresa-Oportunidades-Prospera (POP), where most resources for health were invested and most participants acknowledged that its cancellation in 2019 would lead to worsening in health and nutrition among the poor. Financing analyses showed a drop of funding for nutrition-related programs between 2014 and 2018. Cultural norms around gender roles were still prevalent, along with increasing rates of teenage pregnancy.

CONCLUSIONS

Anemia prevention efforts need to refocus on poverty alleviation, continuity of adequate coverage and financing of nutrition programs, especially with safety nets, and increase in uptake of family planning, especially among adolescent girls.

Prevalence and associated factors of severity levels of anemia among women of reproductive age in sub-Saharan Africa: a multilevel ordinal logistic regression analysis

Background

Sub-Saharan Africa is the most anemia-prone region, with several of the sub-region's countries having a substantial prevalence of the anemia among women of reproductive age. Nonetheless, no adequate study has been conducted to illustrate severity levels and associated factors of anemia among women of reproductive age. Therefore, this study presents the most recent estimates on the prevalence and severity levels of anemia and its associated factors among women of reproductive age in 21 Sub-Saharan Africa countries.

Methods

This study used the most recent Demographic Health Survey (DHS) datasets, which were collected in 21 sub-Saharan African countries between 2015 and 2022. A total of 171,348 women of reproductive age were included in the analysis. Multilevel (three-level) ordinal logistic regression was done to identify factors associated with severity levels of anemia.

Results

The pooled prevalence of anemia was 41.74%. The pooled prevalence of mild, moderate and severe anemia was 23.45, 17.05 and 1.24, respectively. Women who were living at distance to a health facility (AOR = 1.07), women living in the poorest households (AOR = 1.49), women living in the households with unimproved toilet (AOR = 1.12) and in households that were using solid cooking fuel (AOR = 1.10), pregnant women (AOR = 1.72) and those who have given birth to more than one children within 3 years (AOR = 1.43) had greater odds of higher levels of anemia as compared to their counterparts. Women who were in the age groups of 20-24 (AOR = 0.81), 25-29 (AOR = 0.78), 30-34 (AOR = 0.79), 35-39 (AOR = 0.88), and 45-49 (AOR = 0.89), women who have attended primary school (AOR = 0.50), secondary (AOR = 0.57) and higher education (AOR = 0.76) and who were living in rural area (AOR = 1.07) had lower odds of higher levels of anemia as compared to their counterparts.

Conclusion

Considering individual, household and community contexts is necessary while formulating and implementing anemia prevention and control policies. Adolescent women, and women who did not attend education and at a distance to a health facility should get especial attention while implementing anemia prevention and control programs.

Multi-omics approaches reveal the molecular mechanisms underlying the interaction between Clonorchis sinensis and mouse liver

Introduction

Clonorchiasis remains a serious global public health problem, causing various hepatobiliary diseases. However, there is still a lack of overall understanding regarding the molecular events triggered by Clonorchis sinensis (C. sinensis) in the liver.

Methods

BALB/c mouse models infected with C. sinensis for 5, 10, 15, and 20 weeks were constructed. Liver pathology staining and observation were conducted to evaluate histopathology. The levels of biochemical enzymes, blood routine indices, and cytokines in the blood were determined. Furthermore, alterations in the transcriptome, proteome, and metabolome of mouse livers infected for 5 weeks were analyzed using multi-omics techniques.

Results

The results of this study indicated that adult C. sinensis can cause hepatosplenomegaly and liver damage, with the most severe symptoms observed at 5 weeks post-infection. However, as the infection persisted, the Th2 immune response increased and symptoms were relieved. Multi-omics analysis of liver infected for 5 weeks identified 191, 402 and 232 differentially expressed genes (DEGs), proteins (DEPs) and metabolites (DEMs), respectively. Both DEGs and DEPs were significantly enriched in liver fibrosis-related pathways such as ECM-receptor interaction and cell adhesion molecules. Key molecules associated with liver fibrosis and inflammation (Cd34, Epcam, S100a6, Fhl2, Itgax, and Retnlg) were up-regulated at both the gene and protein levels. The top three metabolic pathways, namely purine metabolism, arachidonic acid metabolism, and ABC transporters, were associated with liver cirrhosis, fibrosis, and cholestasis, respectively. Furthermore, metabolites that can promote liver inflammation and fibrosis, such as LysoPC(P-16:0/0:0), 20-COOH-leukotriene E4, and 14,15-DiHETrE, were significantly up-regulated.

Conclusion

Our study revealed that the most severe symptoms in mice infected with C. sinensis occurred at 5 weeks post-infection. Moreover, multi-omics analysis uncovered predominant molecular events related to fibrosis changes in the liver. This study not only enhances our understanding of clonorchiasis progression but also provides valuable insights into the molecular-level interaction mechanism between C. sinensis and its host liver.

Effect modification of socioeconomic status on the association of exposure to famine in early life with osteoporosis in women

BACKGROUND

The present study aimed to explore the effect of modification of socioeconomic status (SES) on the association between famine exposure in early life and osteoporosis in adulthood via the baseline data from the Henan Rural cohort study.

METHODS

A total of 2669 exposed to famine participants were selected from the Henan Rural cohort, and the questionnaires, physical examination and bone mineral density measurement were completed. Specific birth years were used to define five groups: the fetal exposed group, early-childhood exposed group, mid-childhood exposed group, late-childhood exposed group and unexposed group. And the age-matched control group was a combination of the unexposed group and late-childhood exposed group. Multivariable logistic regression models were utilised to analyse the association of famine exposure in early life with osteoporosis in adulthood.

RESULTS

The prevalence rates of osteoporosis of participants exposed to famine during the fetal period, early-childhood, mid-childhood and the age-matched group were 21.67%, 25.76%, 23.90% and 18.14%, respectively. The adjusted odds ratios (95% confidence interval) of participants suffering from famine during the fetal period, early-childhood and mid-childhood versus age-matched group were 1.19 (0.82-1.73), 1.40 (1.04-1.88) and 1.57 (1.16-2.13), respectively. The female participants yielded consistent results. The risk of osteoporosis was higher in more severe famine eara. Moreover, an attenuated effect of early life famine exposure on osteoporosis was observed in female participants with high SES.

CONCLUSIONS

Exposure to famine in early life showed a sex-specific association with an increased risk of osteoporosis in adulthood and the severity of famine may exacerbate this association. In addition, the risk could be modified by SES.

Kitchen ventilation attenuated the associations of solid fuel use and long duration for cooking with the increased prevalence of normocytic anemia

Evidence on the potential risk factors of normocytic anemia, the most prevalent morphology subtype of anemia, was scarce to date. The purpose of this study is to investigate the association of cooking fuel use or daily cooking duration with normocytic anemia and further explore the modification effect of mechanical ventilation. Participants totaling 29,448 from the Henan Rural Cohort were included in this study. Normocytic anemia was defined by hemoglobin (based on the World Health Organization criteria) and mean corpuscular volume. Cooking-related data was collected by questionnaire, and the average daily cooking duration was calculated by the weekly cooking frequency and the cooking duration of each meal. Logistic regression models were employed to derive the combined and independent associations of cooking fuel type and daily cooking duration with normocytic anemia and the modification effect of ventilation. Compared with people who never cooked, both clean fuel and solid fuel users were significantly associated with increased prevalent normocytic anemia [OR (95% CI) = 1.196 (1.014, 1.411) and 1.335 (1.105, 1.614), respectively], and the effect estimates on normocytic anemia risk were 1.260 (1.043, 1.523), 1.320 (1.104, 1.578), and 1.310 (1.081, 1.587) in participants who daily cooked < 1 h/day, 1-2 h/day, and ≥ 2 h/day, respectively. These relationships were attenuated in subjects with mechanical ventilation (All P < 0.05). Cooking with solid fuel or for a long duration are independently associated with prevalent normocytic anemia in rural population, and mechanical ventilation could attenuate these associations. Future efforts to reduce the burden of anemia could target the universal use of ventilation and solid fuel use or cooking duration reduction.Clinical trial registration: The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 06 July, 2015. http://www.chictr.org.cn/showproj.aspx?proj=11375.

Trend and factors associated with anemia among women reproductive age in Ethiopia: A multivariate decomposition analysis of Ethiopian Demographic and Health Survey

BACKGROUND

In developing countries like Ethiopia, anemia is a public health problem. Unfortunately, the progress of anemia reduction has been slow. Although the issue of anemia has received considerable critical attention nowadays, trends and factors associated with anemia among women of reproductive age have not been explored in Ethiopia.

OBJECTIVE

This study aimed to determine trends and factors associated with anemia among women of reproductive age in Ethiopia from 2005 to 2016.

METHOD

Data from three consecutive Ethiopian Demographic and Health Survey (EDHS) from 2005-2016 were analyzed in this study. EDHS is a two-stage cluster sampling survey. Data were weighted to correct sampling bias in all surveys. A total of 46,268 samples were analyzed using a fixed effect model. For a measure of proportion, differences and slopes were computed. Bivariate and multivariable logistic regression analyses were done to identify predictors of the trend of anemia among women. Adjusted odds ratio (AOR) with a 95% Confidence Interval(CI) was computed, and the p-value < 0.05 is considered significant.

RESULT

Prevalence of anemia among women was 68%, 20.3%, and 27.3% in 2005, 2011 and 2016, respectively. The trend of anemia was reduced by 47.7 percentage points from 2005 to 2011; however, it increased by 7% points again from 2011 in 2016. Lack of mobile phones (AOR = 1.4, 95%CI, 1.2,1.6), Afar women (AOR = 1.5, 95%CI, 1.1,2.3) and Somali women (AOR = 1.5, 95%CI, 1.1,1.9) were associated with anaemia among women. On the contrary, the history of heavy menstruation in the last six months (AOR = 0.9; 95%CI, 0.85,0.98) was a factor negatively associated with anemia in 2005. In 2011, single women (AOR = 0.8,95%CI,0.7,0.9), watching TV less than once per wk (AOR = 0.9,95%CI,0.7,0.95), watching TV at least once per week (AOR = 0.8,95%CI,0.7,0.98) were variables associated with anemia. On the contrary, widowed women (AOR = 1.7,95%CI,1.4,2.0) were affected by anemia. In 2016, the richest women (AOR = 0.7, 95%CI, 0.6,0.8) and single (AOR = 0.8, 95%CI, 0.7,0.9) were affected little by anemia. Women of traditional belief followers (AOR = 2.2,95%CI,1.6,2.9) were more highly influenced by anemia than their counterparts.

CONCLUSION

The prevalence of anemia declined rapidly from 2005 to 2011, and increased from 2011 to 2016. Stakeholders should develop policies and programs to enhance the socio-demographic status of women and basic infrastructure for the community. Furthermore, they should design strategies for extensive media coverage of the prevention of anemia. The federal government should balance the proportion of anemia among regions by ensuring health equality.