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Rotejanaprasert C, Malaphone V, Mayxay M, Chindavongsa K, Banouvong V, Khamlome B, Vilay P, Vanisavaeth V, Maude RJ. Spatiotemporal patterns and association with climate for malaria elimination in Lao PDR: a hierarchical modelling analysis with two-step Bayesian model selection. Malar J 2024; 23:231. [PMID: 39098946 PMCID: PMC11298089 DOI: 10.1186/s12936-024-05064-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 07/30/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND The government of Lao PDR has increased efforts to control malaria transmission in order to reach its national elimination goal by 2030. Weather can influence malaria transmission dynamics and should be considered when assessing the impact of elimination interventions but this relationship has not been well characterized in Lao PDR. This study examined the space-time association between climate variables and Plasmodium falciparum and Plasmodium vivax malaria incidence from 2010 to 2022. METHODS Spatiotemporal Bayesian modelling was used to investigate the monthly relationship, and model selection criteria were used to evaluate the performance of the models and weather variable specifications. As the malaria control and elimination situation was spatially and temporally dynamic during the study period, the association was examined annually at the provincial level. RESULTS Malaria incidence decreased from 2010 to 2022 and was concentrated in the southern regions for both P. falciparum and P. vivax. Rainfall and maximum humidity were identified as most strongly associated with malaria during the study period. Rainfall was associated with P. falciparum incidence in the north and central regions during 2010-2011, and with P. vivax incidence in the north and central regions during 2012-2015. Maximum humidity was persistently associated with P. falciparum and P. vivax incidence in the south. CONCLUSIONS Malaria remains prevalent in Lao PDR, particularly in the south, and the relationship with weather varies between regions but was strongest for rainfall and maximum humidity for both species. During peak periods with suitable weather conditions, vector control activities and raising public health awareness on the proper usage of intervention measures, such as indoor residual spraying and personal protection, should be prioritized.
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Affiliation(s)
- Chawarat Rotejanaprasert
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Vilayvone Malaphone
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mayfong Mayxay
- Institute for Research and Education Development, University of Health Sciences, Vientiane, Lao PDR
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | | | - Boualam Khamlome
- Center of Malariology, Parasitology, and Entomology, Vientiane, Lao PDR
| | - Phoutnalong Vilay
- Center of Malariology, Parasitology, and Entomology, Vientiane, Lao PDR
| | | | - Richard J Maude
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- The Open University, Milton Keynes, UK
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Pongsoipetch K, Walshe R, Mukem S, Kamsri T, Singkham N, Sudathip P, Kitchakarn S, Maude RR, Maude RJ. Mapping malaria transmission foci in Northeast Thailand from 2011 to 2021: approaching elimination in a hypoendemic area. Malar J 2024; 23:212. [PMID: 39020432 PMCID: PMC11253324 DOI: 10.1186/s12936-024-05026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/25/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Thailand is approaching local elimination of malaria in the eastern provinces. It has successfully reduced the number of cases over the past decade, but there are persistent transmission hot spots in and around forests. This study aimed to use data from the malaria surveillance system to describe the spatiotemporal trends of malaria in Northeast Thailand and fine-scale patterns in locally transmitted cases between 2011 and 2021. METHODS Case data was stratified based on likely location of infection and parasite species. Annual Parasite Index per 1000 population (API) was calculated for different categories. Time series decomposition was performed to identify trends and seasonal patterns. Statistically significant clusters of high (hot spots) and low (cold spots) API were identified using the Getis-Ord Gi* statistic. The stability of those hot spots and the absolute change in the proportion of API density from baseline were compared by case type. RESULTS The total number of confirmed cases experienced a non-linear decline by 96.6%, from 1061 in 2011 to 36 in 2021. There has been a decline in both Plasmodium vivax and Plasmodium falciparum case numbers, with only four confirmed P. falciparum cases over the last two years-a 98.89% drop from 180 in 2011. API was generally higher in Si Sa Ket province, which had peaks every 2-3 years. There was a large outbreak in Ubon Ratchathani in 2014-2016 which had a high proportion of P. falciparum reported. The proportion of cases classified increased over the study period, and the proportion of cases classed as indigenous to the village of residence increased from 0.2% to 33.3%. There were stable hot spots of indigenous and imported cases in the south of Si Sa Ket and southeast of Ubon Ratchathani. Plasmodium vivax hot spots were observed into recent years, while those of P. falciparum decreased to zero in Ubon in 2020 and emerged in the eastern part in 2021, the same year that P. falciparum hot spots in Si Sa Ket reached zero. CONCLUSIONS There has been a large, non-linear decline in the number of malaria cases reported and an increasing proportion of cases are classed as indigenous to the patient's village of residence. Stable hot spots of ongoing transmission in the forested border areas were identified, with transmission likely persisting because of remote location and high-risk forest-going behaviours. Future efforts should include cross-border collaboration and continued targeting of high-risk behaviours to reduce the risk of imported cases seeding local transmission.
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Affiliation(s)
- Kulchada Pongsoipetch
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rebecca Walshe
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suwanna Mukem
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Tanong Kamsri
- Phibun Mangsahan Hospital, Ubon Ratchathani, Thailand
- Provincial Health Office, Ubon Ratchathani, Thailand
| | | | - Prayuth Sudathip
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, 11000, Thailand
| | - Suravadee Kitchakarn
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, 11000, Thailand
| | | | - Richard James Maude
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
- The Open University, Milton Keynes, UK.
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Mandefro A, Tadele G, Mekonen B, Golassa L. Analysing the six-year malaria trends at Metehara Health Centre in Central Ethiopia: the impact of resurgence on the 2030 elimination goals. Malar J 2024; 23:32. [PMID: 38263087 PMCID: PMC10804523 DOI: 10.1186/s12936-024-04854-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/16/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Despite Ethiopia's concerted efforts to eliminate malaria by 2030, the disease continues to pose a significant public health and socioeconomic challenge in the country. The year 2021 witnessed 2.78 million malaria cases and 8041 associated deaths, emphasizing the persistent threat. Monitoring the prevalence trend of malaria is crucial for devising effective control and elimination strategies. This study aims to assess the trend of malaria prevalence at the Metehara Health Centre in the East Shoa Zone, Ethiopia. METHODS A retrospective study, spanning from February to September 2023, utilized malaria registration laboratory logbooks at Metehara Health Centre to evaluate the prevalence of malaria from 2017/18 to 2022/23. Malaria and related data were collected using a pre-designed data collection sheet. Descriptive statistics were employed for data summarization, presented through graphs and tables. RESULTS Out of 59,250 examined blood films, 17.4% confirmed the presence of Plasmodium infections. Among the confirmed cases, 74.3%, 23.8%, and 1.84% were attributed to Plasmodium falciparum, Plasmodium vivax, and mixed infections, respectively. The trend of malaria exhibited a steady decline from 2017/18 to 2021/22, reaching 9.8% prevalence. However, an abrupt increase to 26.5% was observed in 2022/23. Males accounted for a higher proportion (66%) of cases compared to females (34%). The age group 15-24 years experienced the highest malaria incidence at 42%. Notably, malaria cases peaked during autumn (September to November) at 43% and reached the lowest percentage during spring (March to May) at 13%. CONCLUSION Malaria persists as a significant health challenge in and around Metehara, central Ethiopia, predominantly driven by Plasmodium falciparum. The five-year declining trend was interrupted by a notable upsurge in 2022/23, indicating a resurgence of malaria in the study area. It is imperative to adopt a reverse strategy to sustain the progress achieved by the national malaria control plan.
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Affiliation(s)
- Aynalem Mandefro
- Akililu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Geletta Tadele
- College of Medicine and Health Science, Wollega University, Nekemte, Ethiopia
| | - Bacha Mekonen
- Malaria and NTDs Research Team, Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Lemu Golassa
- Akililu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
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Searle KM, Earland DE, Francisco Bibe A, Novela A, Muhiro V, Ferrão JL. Long-lasting household damage from Cyclone Idai increases malaria risk in rural western Mozambique. Sci Rep 2023; 13:21590. [PMID: 38062239 PMCID: PMC10703775 DOI: 10.1038/s41598-023-49200-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
Cyclone Idai in 2019 was one of the worst tropical cyclones recorded in the Southern Hemisphere. The storm caused catastrophic damage and led to a humanitarian crisis in Mozambique. The affected population suffered a cholera epidemic on top of housing and infrastructure damage and loss of life. The housing and infrastructure damage sustained during Cyclone Idai still has not been addressed in all affected communities. This is of grave concern because storm damage results in poor housing conditions which are known to increase the risk of malaria. Mozambique has the 4th highest malaria prevalence in sub-Saharan Africa and is struggling to control malaria in most of the country. We conducted a community-based cross-sectional survey in Sussundenga Village, Manica Province, Mozambique in December 2019-February 2020. We found that most participants (64%) lived in households that sustained damage during Cyclone Idai. The overall malaria prevalence was 31% measured by rapid diagnostic test (RDT). When controlling for confounding variables, the odds of malaria infection was nearly threefold higher in participants who lived in households damaged by Cyclone Idai nearly a year after the storm. This highlights the need for long-term disaster response to improve the efficiency and success of malaria control efforts.
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Affiliation(s)
- Kelly M Searle
- University of Minnesota School of Public Health, Minneapolis, MN, USA.
| | | | | | - Anísio Novela
- Direcção Distrital de Saúde de Sussundenga, Sussundenga, Manica, Mozambique
| | - Vali Muhiro
- Direcção Distrital de Saúde de Sussundenga, Sussundenga, Manica, Mozambique
| | - João L Ferrão
- Consultores Associados de Manica, Sussundenga, Mozambique
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Opeyemi AA, Obeagu EI. Regulations of malaria in children with human immunodeficiency virus infection: A review. Medicine (Baltimore) 2023; 102:e36166. [PMID: 37986340 PMCID: PMC10659731 DOI: 10.1097/md.0000000000036166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023] Open
Abstract
This comprehensive review explores the intricate relationship between 2 major global health challenges, malaria and HIV, with a specific focus on their impact on children. These diseases, both endemic in sub-Saharan Africa, create a dual burden that significantly elevates the risk of morbidity and mortality, particularly in children with compromised immune systems due to HIV. The review delves into the complex mechanisms by which these infections interact, from heightened clinical malaria frequencies in HIV-infected individuals to the potential impact of antiretroviral therapy on malaria treatment. Different research engines were utilized in writing this paper such as Web of Science, Google Scholar, Pubmed Central, ResearchGate, and Academia Edu. To address this critical health concern, the study identifies and discusses various regulatory and treatment strategies. It emphasizes the importance of daily cotrimoxazole prophylaxis and insecticide-treated nets in preventing malaria in children with HIV. The potential of antiretroviral protease inhibitors and mRNA-based vaccines as innovative solutions is highlighted. Additionally, the study underscores the significance of climate data and artificial intelligence in improving diagnostics and drug development. Furthermore, the review introduces the concept of genetically modified mosquitoes as a novel approach to vector control, offering a promising avenue to protect HIV-positive individuals from mosquito-borne diseases like malaria. Through a comprehensive analysis of these strategies, the study aims to provide a foundation for policymakers, healthcare professionals, and researchers to develop effective regulations and interventions that reduce the dual burden of malaria and HIV in children, improving public health outcomes in endemic regions.
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Fulgheri F, Manca ML, Fernàndez-Busquets X, Manconi M. Analysis of complementarities between nanomedicine and phytodrugs for the treatment of malarial infection. Nanomedicine (Lond) 2023; 18:1681-1696. [PMID: 37955573 DOI: 10.2217/nnm-2023-0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
The use of nanocarriers in medicine, so-called nanomedicine, is one of the most innovative strategies for targeting drugs at the action site and increasing their activity index and effectiveness. Phytomedicine is the oldest traditional method used to treat human diseases and solve health problems. The recent literature on the treatment of malaria infections using nanodelivery systems and phytodrugs or supplements has been analyzed. For the first time, in the present review, a careful look at the considerable potential of nanomedicine in promoting phytotherapeutic efficacy was done, and its key role in addressing a translation through a significant reduction of the current burden of malaria in many parts of the world has been underlined.
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Affiliation(s)
- Federica Fulgheri
- Department of Life & Environmental Sciences, University of Cagliari, University Campus, S.P. Monserrato-Sestu Km 0.700, Monserrato, 09042 CA, Italy
| | - Maria Letizia Manca
- Department of Life & Environmental Sciences, University of Cagliari, University Campus, S.P. Monserrato-Sestu Km 0.700, Monserrato, 09042 CA, Italy
| | - Xavier Fernàndez-Busquets
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Rosselló 1 49-153, 08036 Barcelona, Spain
- Nanomalaria Group, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Baldiri Reixac 10-12, 08028 Barcelona, Spain
- Nanoscience and Nanotechnology Institute (IN2UB), University of Barcelona, Martí i Franquès 1, 08028 Barcelona, Spain
| | - Maria Manconi
- Department of Life & Environmental Sciences, University of Cagliari, University Campus, S.P. Monserrato-Sestu Km 0.700, Monserrato, 09042 CA, Italy
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Yadav CP, Hussain SSA, Mullick R, Rahi M, Sharma A. Climate zones are a key component of the heterogeneous presentation of malaria and should be added as a malariometric for the planning of malaria elimination. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001878. [PMID: 37379340 DOI: 10.1371/journal.pgph.0001878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/25/2023] [Indexed: 06/30/2023]
Abstract
Malaria is a climate-sensitive disease and different climatic conditions affect the propagation of malaria vectors thereby influencing malaria incidence. The present study was undertaken to delineate malaria distribution across different climate types and sub-types in India and assess its significance as a malariometric in the ongoing elimination activities. All Indian districts were classified into three major climatic zones (Tropical, Temperate, and others (Arid, Cold, and Polar) based on the Köppen-Geiger climate classification system. The Annual Parasite Incidence (API) of malaria was analyzed in these climatic zones using the Kruskal Wallis test, and a post hoc comparison was done using the rank-sum test with an adjusted p-value for the level of significance. Further logistic regression was used to investigate the association of these climatic zones with high malaria incidence (i.e., API>1). The majority of Indian districts fall in Temperate (N = 270/692 (39.0%)) and Tropical (N = 260/692 (37.6%)) regions, followed by Arid (N = 140/692 (20.2%)), Polar (N = 13/692 (1.9%)) and Cold (N = 9/692 (1.3%)) regions. Three climate zones: Arid, Polar, and Cold were similar in terms of malaria incidence over the years and thus were grouped into one. It was found that the tropical and temperate zones display a significantly higher burden of malaria as compared to others for the studied years (2016-2021). Future projections of climate suggest a significant expansion of tropical monsoon climate towards central and northern India, along with a growing footprint of tropical wet savannah climate in the northeast of India by 2100, which could increase the risk of malaria transmission in these regions. The heterogeneous climatic zones of India play an important role in malaria transmission and can be used as a malariometric for the stratification of districts destined for malaria elimination.
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Affiliation(s)
- Chander Prakash Yadav
- ICMR-National Institute of Cancer Prevention & Research (NICPR), Noida, UP, India
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Syed Shah Areeb Hussain
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Rajit Mullick
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Manju Rahi
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- Indian Council of Medical Research, New Delhi, India
| | - Amit Sharma
- Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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Woyessa A, Siebert A, Owusu A, Cousin R, Dinku T, Thomson MC. El Niño and other climatic drivers of epidemic malaria in Ethiopia: new tools for national health adaptation plans. Malar J 2023; 22:195. [PMID: 37355627 DOI: 10.1186/s12936-023-04621-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 06/13/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Ethiopia has a history of climate related malaria epidemics. An improved understanding of malaria-climate interactions is needed to inform malaria control and national adaptation plans. METHODS Malaria-climate associations in Ethiopia were assessed using (a) monthly climate data (1981-2016) from the Ethiopian National Meteorological Agency (NMA), (b) sea surface temperatures (SSTs) from the eastern Pacific, Indian Ocean and Tropical Atlantic and (c) historical malaria epidemic information obtained from the literature. Data analysed spanned 1950-2016. Individual analyses were undertaken over relevant time periods. The impact of the El Niño Southern Oscillation (ENSO) on seasonal and spatial patterns of rainfall and minimum temperature (Tmin) and maximum temperature (Tmax) was explored using NMA online Maprooms. The relationship of historic malaria epidemics (local or widespread) and concurrent ENSO phases (El Niño, Neutral, La Niña) and climate conditions (including drought) was explored in various ways. The relationships between SSTs (ENSO, Indian Ocean Dipole and Tropical Atlantic), rainfall, Tmin, Tmax and malaria epidemics in Amhara region were also explored. RESULTS El Niño events are strongly related to higher Tmax across the country, drought in north-west Ethiopia during the July-August-September (JAS) rainy season and unusually heavy rain in the semi-arid south-east during the October-November-December (OND) season. La Niña conditions approximate the reverse. At the national level malaria epidemics mostly occur following the JAS rainy season and widespread epidemics are commonly associated with El Niño events when Tmax is high, and drought is common. In the Amhara region, malaria epidemics were not associated with ENSO, but with warm Tropical Atlantic SSTs and higher rainfall. CONCLUSION Malaria-climate relationships in Ethiopia are complex, unravelling them requires good climate and malaria data (as well as data on potential confounders) and an understanding of the regional and local climate system. The development of climate informed early warning systems must, therefore, target a specific region and season when predictability is high and where the climate drivers of malaria are sufficiently well understood. An El Niño event is likely in the coming years. Warming temperatures, political instability in some regions, and declining investments from international donors, implies an increasing risk of climate-related malaria epidemics.
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Affiliation(s)
- Adugna Woyessa
- Ethiopian Public Health Institute, P.O. Box 1242/5654, Addis Ababa, Ethiopia.
- International Research Institute for Climate and Society, Columbia University, PO Box 1000, Palisades, NY, 10964, USA.
| | - Asher Siebert
- International Research Institute for Climate and Society, Columbia University, PO Box 1000, Palisades, NY, 10964, USA
| | - Aisha Owusu
- College of Atmospheric and Geographical Sciences, Oklahoma University, Norman, OK, USA
| | - Rémi Cousin
- International Research Institute for Climate and Society, Columbia University, PO Box 1000, Palisades, NY, 10964, USA
| | - Tufa Dinku
- International Research Institute for Climate and Society, Columbia University, PO Box 1000, Palisades, NY, 10964, USA
| | - Madeleine C Thomson
- International Research Institute for Climate and Society, Columbia University, PO Box 1000, Palisades, NY, 10964, USA
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Oyegoke OO, Adewumi TS, Aderoju SA, Tsundzukani N, Mabunda E, Adeleke MA, Maharaj R, Okpeku M. Towards malaria elimination: analysis of travel history and case forecasting using the SARIMA model in Limpopo Province. Parasitol Res 2023:10.1007/s00436-023-07870-y. [PMID: 37310511 DOI: 10.1007/s00436-023-07870-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/08/2023] [Indexed: 06/14/2023]
Abstract
Despite various efforts and policy implementation aimed at controlling and eliminating malaria, imported malaria remains a major factor posing challenges in places that have made progress in malaria elimination. The persistence of malaria in Limpopo Province has largely been attributed to imported cases, thus reducing the pace of achieving the malaria-free target by 2025. Data from the Limpopo Malaria Surveillance Database System (2010-2020) was analyzed, and a seasonal auto-regressive integrated moving average (SARIMA) model was developed to forecast malaria incidence based on the incidence data's temporal autocorrelation. The study found that out of 57,288 people that were tested, 51,819 (90.5%) cases were local while 5469 (9.5%) cases were imported. Mozambique (44.9%), Zimbabwe (35.7%), and Ethiopia (8.5%) were the highest contributors of imported cases. The month of January recorded the highest incidence of cases while the least was in August. Analysis of the yearly figures showed an increasing trend and seasonal variation of recorded malaria cases. The SARIMA (3,1,1) X (3,1,0) [12] model used in predicting expected malaria case incidences for three consecutive years showed a decline in malaria incidences. The study demonstrated that imported malaria accounted for 9.5% of all cases. There is a need to re-focus on health education campaigns on malaria prevention methods and strengthening of indoor residual spray programs. Bodies collaborating toward malaria elimination in the Southern Africa region need to ensure a practical delivery of the objectives.
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Affiliation(s)
- Olukunle O Oyegoke
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Taiye S Adewumi
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Samuel A Aderoju
- Department of Mathematics and Statistics, Kwara State University, Ilorin, Nigeria
| | | | - Eric Mabunda
- Limpopo Department of Health, Malaria Control Program, Limpopo, South Africa
| | - Matthew A Adeleke
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Rajendra Maharaj
- Malaria Research Unit, South African Medical Research Council, Durban, South Africa
| | - Moses Okpeku
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa.
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Armando CJ, Rocklöv J, Sidat M, Tozan Y, Mavume AF, Bunker A, Sewes MO. Climate variability, socio-economic conditions and vulnerability to malaria infections in Mozambique 2016-2018: a spatial temporal analysis. Front Public Health 2023; 11:1162535. [PMID: 37325319 PMCID: PMC10267345 DOI: 10.3389/fpubh.2023.1162535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/28/2023] [Indexed: 06/17/2023] Open
Abstract
Background Temperature, precipitation, relative humidity (RH), and Normalized Different Vegetation Index (NDVI), influence malaria transmission dynamics. However, an understanding of interactions between socioeconomic indicators, environmental factors and malaria incidence can help design interventions to alleviate the high burden of malaria infections on vulnerable populations. Our study thus aimed to investigate the socioeconomic and climatological factors influencing spatial and temporal variability of malaria infections in Mozambique. Methods We used monthly malaria cases from 2016 to 2018 at the district level. We developed an hierarchical spatial-temporal model in a Bayesian framework. Monthly malaria cases were assumed to follow a negative binomial distribution. We used integrated nested Laplace approximation (INLA) in R for Bayesian inference and distributed lag nonlinear modeling (DLNM) framework to explore exposure-response relationships between climate variables and risk of malaria infection in Mozambique, while adjusting for socioeconomic factors. Results A total of 19,948,295 malaria cases were reported between 2016 and 2018 in Mozambique. Malaria risk increased with higher monthly mean temperatures between 20 and 29°C, at mean temperature of 25°C, the risk of malaria was 3.45 times higher (RR 3.45 [95%CI: 2.37-5.03]). Malaria risk was greatest for NDVI above 0.22. The risk of malaria was 1.34 times higher (1.34 [1.01-1.79]) at monthly RH of 55%. Malaria risk reduced by 26.1%, for total monthly precipitation of 480 mm (0.739 [95%CI: 0.61-0.90]) at lag 2 months, while for lower total monthly precipitation of 10 mm, the risk of malaria was 1.87 times higher (1.87 [1.30-2.69]). After adjusting for climate variables, having lower level of education significantly increased malaria risk (1.034 [1.014-1.054]) and having electricity (0.979 [0.967-0.992]) and sharing toilet facilities (0.957 [0.924-0.991]) significantly reduced malaria risk. Conclusion Our current study identified lag patterns and association between climate variables and malaria incidence in Mozambique. Extremes in climate variables were associated with an increased risk of malaria transmission, peaks in transmission were varied. Our findings provide insights for designing early warning, prevention, and control strategies to minimize seasonal malaria surges and associated infections in Mozambique a region where Malaria causes substantial burden from illness and deaths.
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Affiliation(s)
- Chaibo Jose Armando
- Department of Public Health and Clinical Medicine, Sustainable Health Section, Umeå University, Umeå, Sweden
| | - Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Sustainable Health Section, Umeå University, Umeå, Sweden
- Heidelberg Institute of Global Health and Interdisciplinary Centre for Scientific Computing, Heidelberg University, Heidelberg, Germany
| | - Mohsin Sidat
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Yesim Tozan
- School of Global Public Health, New York University, New York, NY, United States
| | | | - Aditi Bunker
- Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Maquins Odhiambo Sewes
- Department of Public Health and Clinical Medicine, Sustainable Health Section, Umeå University, Umeå, Sweden
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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11
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Patrick SM, Bendiane MK, Kruger T, Harris BN, Riddin MA, Trehard H, de Jager C, Bornman R, Gaudart J. Household living conditions and individual behaviours associated with malaria risk: a community-based survey in the Limpopo River Valley, 2020, South Africa. Malar J 2023; 22:156. [PMID: 37189177 DOI: 10.1186/s12936-023-04585-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/09/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Over the past decade, implementation of multiple malaria control strategies in most countries has largely contributed to advance the global malaria elimination agenda. Nevertheless, in some regions, seasonal epidemics may adversely affect the health of local populations. In South Africa, Plasmodium falciparum malaria is still present, with the Vhembe District experiencing an incidence rate of 3.79 cases/1000 person-years in 2018, particularly in the Limpopo River Valley, bordering Zimbabwe. To elucidate the complexity of the mechanisms involved in local regular malaria outbreaks, a community-based survey was implemented in 2020 that focused on the relationship between housing conditions and malaria risky behaviours. METHODS The community-based cross-sectional survey was conducted among the population of three study sites in the Vhembe District, which were selected based on malaria incidence rate, social and health characteristics of inhabitants. The household survey used a random sampling strategy, where data were collected through face-to-face questionnaires and field notes; to described the housing conditions (housing questionnaire), and focus on individual behaviours of household members. Statistical analyses were performed combining hierarchical classifications and logistic regressions. RESULTS In this study, 398 households were described, covering a population of 1681 inhabitants of all ages, and 439 adults who participated in community-based survey. The analysis of situations at risk of malaria showed that the influence of contextual factors, particularly those defined by the type of habitat, was significant. Housing conditions and poor living environments were factors of malaria exposure and history, regardless of site of investigation, individual preventive behaviours and personal characteristics of inhabitants. Multivariate models showed that, considering all personal characteristics or behaviours of inhabitants, housing conditions such as overcrowding pressures were significantly associated with individual malaria risk. CONCLUSIONS The results showed the overwhelming weight of social and contextual factors on risk situations. Considering the Fundamental Causes Theory, malaria control policies based on health behaviour prevention, should reinforce access to care or promoting health education actions. Overarching economic development interventions in targeted geographical areas and populations have to be implemented, so that malaria control and elimination strategies can be efficiently and effectively managed.
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Affiliation(s)
- Sean M Patrick
- UP Institute for Sustainable Malaria Control & MRC Collaborating Centre for Malaria Research, School of Health Systems and Public Health, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa.
| | - Marc-Karim Bendiane
- Economics & Social Sciences Applied to Health & Medical Information Processing, Aix Marseille University, INSERM, IRD, ISSPAM, SESSTIM, 13005, Marseille, France
| | - Taneshka Kruger
- UP Institute for Sustainable Malaria Control & MRC Collaborating Centre for Malaria Research, School of Health Systems and Public Health, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa
| | - Bernice N Harris
- UP Institute for Sustainable Malaria Control & MRC Collaborating Centre for Malaria Research, School of Health Systems and Public Health, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa
| | - Megan A Riddin
- UP Institute for Sustainable Malaria Control & MRC Collaborating Centre for Malaria Research, School of Health Systems and Public Health, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa
| | - Helene Trehard
- Economics & Social Sciences Applied to Health & Medical Information Processing, Aix Marseille University, INSERM, IRD, ISSPAM, SESSTIM, 13005, Marseille, France
| | - Christiaan de Jager
- UP Institute for Sustainable Malaria Control & MRC Collaborating Centre for Malaria Research, School of Health Systems and Public Health, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa
| | - Riana Bornman
- UP Institute for Sustainable Malaria Control & MRC Collaborating Centre for Malaria Research, School of Health Systems and Public Health, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa
| | - Jean Gaudart
- Aix Marseille University, INSERM, IRD, APHM, ISSPAM, SESSTIM, UMR1252, Hospital La Timone, BioSTIC, Biostatistics & ICT, 13005, Marseille, France
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12
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Al-Jawaldeh A, Nabhani M, Taktouk M, Nasreddine L. Climate Change and Nutrition: Implications for the Eastern Mediterranean Region. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17086. [PMID: 36554966 PMCID: PMC9779613 DOI: 10.3390/ijerph192417086] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 05/29/2023]
Abstract
The Eastern Mediterranean Region (EMR) is considered among the world's most vulnerable to the dire impacts of climate change. This review paper aims at (1) characterizing climate change in countries of the EMR; (2) examining the potential effects of climate change on the nutritional and health status of the population; and (3) identifying the most vulnerable population groups. The paper explored several climate change indicators including daily temperatures, extreme temperature, daily precipitation, extreme precipitation (flooding, drought, storms, etc.), humidity, CO2 concentrations and sea surface temperature in EMR countries. Findings suggest that climate change will exert a significant adverse effect on water and food security and showed that the nutritional status of the population, which is already characterized by the triple burden of malnutrition, is likely to worsen via three main pathways mediated by climate change, namely, its impact on food security, care and health. Women, infants, children, those living in poor households and those experiencing displacement will be among the most vulnerable to the nutritional impacts of climate change. The paper concludes with a set of recommendations from the Initiative on Climate Action and Nutrition, which can support the region in tackling the critical nexus of climate change and nutrition.
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Affiliation(s)
- Ayoub Al-Jawaldeh
- Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO), Cairo 7608, Egypt
| | - Maya Nabhani
- Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Mandy Taktouk
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
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13
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Affiliation(s)
- Madeleine C Thomson
- From the Climate and Health Challenge Area, the Wellcome Trust, London (M.C.T.); and the Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York (L.R.S.)
| | - Lawrence R Stanberry
- From the Climate and Health Challenge Area, the Wellcome Trust, London (M.C.T.); and the Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York (L.R.S.)
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14
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Systematic Review on Diversity and Distribution of Anopheles Species in Gabon: A Fresh Look at the Potential Malaria Vectors and Perspectives. Pathogens 2022; 11:pathogens11060668. [PMID: 35745522 PMCID: PMC9229970 DOI: 10.3390/pathogens11060668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/14/2022] [Accepted: 05/28/2022] [Indexed: 12/09/2022] Open
Abstract
Gabon is located in the malaria hyper-endemic zone, where data concerning malaria vector distribution remains fragmentary, making it difficult to implement an effective vector control strategy. Thus, it becomes crucial and urgent to undertake entomological surveys that will allow a better mapping of the Anopheles species present in Gabon. In this review, we examined different articles dealing with Anopheles in Gabon from ProQuest, Web of Science, PubMed, and Google scholar databases. After applying the eligibility criteria to 7543 articles collected from four databases, 42 studies were included that covered a 91-year period of study. The review revealed a wide diversity of Anopheles species in Gabon with a heterogeneous distribution. Indeed, our review revealed the presence of 41 Anopheles species, of which the most abundant were members of the Gambiae and Nili complexes and those of the Funestus and Moucheti groups. However, our review also revealed that the major and minor vectors of malaria in Gabon are present in both sylvatic, rural, and urban environments. The observation of human malaria vectors in sylvatic environments raises the question of the role that the sylvatic environment may play in maintaining malaria transmission in rural and urban areas. Ultimately, it appears that knowledge of biodiversity and spatial distribution of Anopheles mosquitoes is fragmentary in Gabon, suggesting that additional studies are necessary to complete and update these entomological data, which are useful for the implementation of vector control strategies.
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15
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Moreira RP, de Oliveira FBB, de Araujo TL, Morais HCC, Cavalcante TF, Gomez MBS, Felício JF, de Oliveira Ferreira G. Health Interventions for Preventing Climate-Sensitive Diseases: Scoping Review. J Urban Health 2022; 99:519-532. [PMID: 35467327 PMCID: PMC9187784 DOI: 10.1007/s11524-022-00631-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 10/18/2022]
Abstract
Climate variations cause public health problems, but the literature is still scarce on studies involving health interventions against climate-sensitive diseases. The objective of this review was to identify health interventions for the prevention of such diseases. We conducted a scoping review using the JBI Methodology. Six large research databases were searched (PubMed, Scopus, Web of Science, Lilacs, Embase, and Cochrane). The following inclusion criterion was used: studies addressing health interventions to prevent climate-sensitive diseases or consequences of climate on people's health. The exclusion criteria consisted of thesis, dissertations, conference proceedings, studies with unclear information/methodology, and studies not addressing climate-related health interventions. No language or date restrictions were applied. Of 733 studies identified and screened by title and abstract, 55 studies underwent full-text screening, yielding 13 studies for review. The health interventions identified were classified into three levels of management. The macro level included the use of epidemiological models, renewable energy, and policies sensitive to climate change. The meso level comprised interventions such as the creation of environmental suitability maps, urban greening, chemoprophylaxis, water security plans, and sanitation projects, among other measures. Some interventions are at the intersection, such as educational campaigns and the modification of artificial larvae sites. Finally, the micro level contained interventions such as the inspection of window screens and the use of light-colored clothing and repellents. The health interventions at the macro, meso, and micro levels and the intersection may serve as a basis for public managers to implement appropriate interventions against climate-sensitive diseases.
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Affiliation(s)
- Rafaella Pessoa Moreira
- Health Sciences Institute, University for International Integration of the Afro-Brazilian Lusophony, s/n José Franco de Oliveira St., Redenção, CE 62790-970, Brazil.
| | - Francisco Breno Barbosa de Oliveira
- Health Sciences Institute, University for International Integration of the Afro-Brazilian Lusophony, s/n José Franco de Oliveira St., Redenção, CE 62790-970, Brazil
| | - Thelma Leite de Araujo
- Nursing Departament, Federal University of Ceará, 1115 Alexandre Baraúna St., Fortaleza, CE 60430-160, Brazil
| | - Huana Carolina Candido Morais
- Health Sciences Institute, University for International Integration of the Afro-Brazilian Lusophony, s/n José Franco de Oliveira St., Redenção, CE 62790-970, Brazil
| | - Tahissa Frota Cavalcante
- Health Sciences Institute, University for International Integration of the Afro-Brazilian Lusophony, s/n José Franco de Oliveira St., Redenção, CE 62790-970, Brazil
| | - Maria Begoña Sanchez Gomez
- School of Nursing, University of La Laguna, Candelaria NS University Hospital, Canary Islands Health Service, 38010, Santa Cruz de Tenerife, Spain
| | - Janiel Ferreira Felício
- Health Sciences Institute, University for International Integration of the Afro-Brazilian Lusophony, s/n José Franco de Oliveira St., Redenção, CE 62790-970, Brazil
| | - Glauciano de Oliveira Ferreira
- Health Sciences Institute, University for International Integration of the Afro-Brazilian Lusophony, s/n José Franco de Oliveira St., Redenção, CE 62790-970, Brazil
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16
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Parihar RS, Bal PK, Saini A, Mishra SK, Thapliyal A. Potential future malaria transmission in Odisha due to climate change. Sci Rep 2022; 12:9048. [PMID: 35641573 PMCID: PMC9156684 DOI: 10.1038/s41598-022-13166-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/12/2022] [Indexed: 11/24/2022] Open
Abstract
Future projections of malaria transmission is made for Odisha, a highly endemic region of India, through numerical simulations using the VECTRI dynamical model. The model is forced with bias-corrected temperature and rainfall from a global climate model (CCSM4) for the baseline period 1975–2005 and for the projection periods 2020s, 2050s, and 2080s under RCP8.5 emission scenario. The temperature, rainfall, mosquito density and entomological inoculation rate (EIR), generated from the VECTRI model are evaluated with the observation and analyzed further to estimate the future malaria transmission over Odisha on a spatio-temporal scale owing to climate change. Our results reveal that the malaria transmission in Odisha as a whole during summer and winter monsoon seasons may decrease in future due to the climate change except in few districts with the high elevations and dense forest regions such as Kandhamal, Koraput, Raygada and Mayurbhanj districts where an increase in malaria transmission is found. Compared to the baseline period, mosquito density shows decrease in most districts of the south, southwest, central, north and northwest regions of Odisha in 2030s, 2050s and 2080s. An overall decrease in malaria transmission of 20–40% (reduction in EIR) is seen during the monsoon season (June-Sept) over Odisha with the increased surface temperature of 3.5–4 °C and with the increased rainfall of 20–35% by the end of the century with respect to the baseline period. Furthermore, malaria transmission is likely to reduce in future over most of the Odisha regions with the increase in future warm and cold nights temperatures.
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Affiliation(s)
- Ruchi Singh Parihar
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi, India.,Graphic Era Deemed to be University, Dehradun, Uttarakhand, India
| | | | - Atul Saini
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi, India.,Delhi School of Climate Change and Sustainability, Institution of Eminence, University of Delhi, Delhi, India
| | - Saroj Kanta Mishra
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi, India
| | - Ashish Thapliyal
- Graphic Era Deemed to be University, Dehradun, Uttarakhand, India
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Nissan H, Simmons W, Downs SM. Building climate-sensitive nutrition programmes. Bull World Health Organ 2022; 100:70-77. [PMID: 35017759 PMCID: PMC8722625 DOI: 10.2471/blt.21.285589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 11/27/2022] Open
Abstract
The food system and climate are closely interconnected. Although most research has focused on the need to adopt a plant-based diet to help mitigate climate change, there is also an urgent need to examine the effects of climate change on food systems to adapt to climate change. A systems approach can help identify the pathways through which climate influences food systems, thereby ensuring that programmes combating malnutrition take climate into account. Although little is known about how climate considerations are currently incorporated into nutrition programming, climate information services have the potential to help target the delivery of interventions for at-risk populations and reduce climate-related disruption during their implementation. To ensure climate services provide timely information relevant to nutrition programmes, it is important to fill gaps in our knowledge about the influence of climate variability on food supply chains. A proposed roadmap for developing climate-sensitive nutrition programmes recommends: (i) research aimed at achieving a better understanding of the pathways through which climate influences diet and nutrition, including any time lags; (ii) the identification of entry points for climate information into the decision-making process for nutrition programme delivery; and (iii) capacity-building and training programmes to better equip public health practitioners with the knowledge, confidence and motivation to incorporate climate resilience into nutrition programmes. With sustained investment in capacity-building, data collection and analysis, climate information services can be developed to provide the data, analyses and forecasts needed to ensure nutrition programmes target their interventions where and when they are most needed.
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Affiliation(s)
- Hannah Nissan
- Grantham Institute for Climate Change and the Environment, London School of Economics and Political Science, London, England
| | - Will Simmons
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, United States of America (USA)
| | - Shauna M Downs
- Department of Urban-Global Public Health, Rutgers School of Public Health, One Riverfront Plaza, Suite 1020, Newark, New Jersey, NJ 07102, USA
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18
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Plasmodium knowlesi, an infectious disease challenge for our times. ADVANCES IN PARASITOLOGY 2021; 113:xiii-xvi. [PMID: 34620387 DOI: 10.1016/s0065-308x(21)00044-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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19
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Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
- Hannah Nissan
- Grantham Research Institute for Climate Change and the Environment, London School of Economics and Political Science, London, UK. .,International Research Institute for Climate and Society, Columbia University, Palisades, NY, USA.
| | - Israel Ukawuba
- Mailman School for Public Health, Columbia University, New York, NY, USA
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