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Powers JE, Mureithi M, Mboya J, Campolo J, Swarthout JM, Pajka J, Null C, Pickering AJ. Effects of High Temperature and Heavy Precipitation on Drinking Water Quality and Child Hand Contamination Levels in Rural Kenya. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:6975-6988. [PMID: 37071701 PMCID: PMC10157894 DOI: 10.1021/acs.est.2c07284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Climate change may impact human health through the influence of weather on environmental transmission of diarrhea. Previous studies have found that high temperatures and heavy precipitation are associated with increased diarrhea prevalence, but the underlying causal mechanisms have not been tested and validated. We linked measurements of Escherichia coli in source water (n = 1673), stored drinking water (n = 9692), and hand rinses from children <2 years old (n = 2634) with publicly available gridded temperature and precipitation data (at ≤0.2 degree spatial resolution and daily temporal resolution) by the GPS coordinates and date of sample collection. Measurements were collected over a 3-year period across a 2500 km2 area in rural Kenya. In drinking water sources, high 7-day temperature was associated with a 0.16 increase in log10 E. coli levels (p < 0.001, 95% CI: 0.07, 0.24), while heavy 7-day total precipitation was associated with a 0.29 increase in log10 E. coli levels (p < 0.001, 95% CI: 0.13, 0.44). In household stored drinking water, heavy 7-day precipitation was associated with a 0.079 increase in log10 E. coli levels (p = 0.042, 95% CI: 0.07, 0.24). Heavy precipitation did not increase E. coli levels among respondents who treated their water, suggesting that water treatment can mitigate effects on water quality. On child hands, high 7-day temperature was associated with a 0.39 decrease in log10 E. coli levels (p < 0.001, 95% CI: -0.52, -0.27). Our findings provide insight on how climate change could impact environmental transmission of bacterial pathogens in Kenya. We suggest water treatment is especially important after heavy precipitation (particularly when preceded by dry periods) and high temperatures.
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Affiliation(s)
- Julie E Powers
- University of California, Berkeley, Berkeley, California 94704, United States
| | - Maryanne Mureithi
- Innovations for Poverty Action, Sandalwood Lane, Nairobi 00500, Kenya
| | - John Mboya
- Innovations for Poverty Action, Sandalwood Lane, Nairobi 00500, Kenya
| | - Jake Campolo
- Farmers Business Network, San Carlos, California 94070, United States
| | | | - Joseph Pajka
- Tufts University, Medford, Massachusetts 02155, United States
| | - Clair Null
- Mathematica, Washington, D.C. 20002, United States
| | - Amy J Pickering
- University of California, Berkeley, Berkeley, California 94704, United States
- Chan Zuckerberg Biohub, San Francisco, California 94158, United States
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Anttila-Hughes JK, Jina AS, McCord GC. ENSO impacts child undernutrition in the global tropics. Nat Commun 2021; 12:5785. [PMID: 34642319 PMCID: PMC8511020 DOI: 10.1038/s41467-021-26048-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 08/30/2021] [Indexed: 11/15/2022] Open
Abstract
The El Niño Southern Oscillation (ENSO) is a principal component of global climate variability known to influence a host of social and economic outcomes, but its systematic effects on human health remain poorly understood. We estimate ENSO's association with child nutrition at global scale by combining variation in ENSO intensity from 1986-2018 with children's height and weight from 186 surveys conducted in 51 teleconnected countries, containing 48% of the world's under-5 population. Warmer El Niño conditions predict worse child undernutrition in most of the developing world, but better outcomes in the small number of areas where precipitation is positively affected by warmer ENSO. ENSO's contemporaneous effects on child weight loss are detectable years later as decreases in height. This relationship looks similar at both global and regional scale, and has not appreciably weakened over the last four decades. Results imply that almost 6 million additional children were underweight during the 2015 El Niño compared to a counterfactual of neutral ENSO conditions in 2015. This demonstrates a pathway through which human well-being remains subject to predictable climatic processes.
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Affiliation(s)
| | - Amir S Jina
- Harris School of Public Policy, University of Chicago, Chicago, IL, USA.
- National Bureau of Economic Research, Cambridge, MA, USA.
| | - Gordon C McCord
- School of Global Policy and Strategy, University of California, San Diego, CA, USA
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Delahoy MJ, Cárcamo C, Huerta A, Lavado W, Escajadillo Y, Ordoñez L, Vasquez V, Lopman B, Clasen T, Gonzales GF, Steenland K, Levy K. Meteorological factors and childhood diarrhea in Peru, 2005-2015: a time series analysis of historic associations, with implications for climate change. Environ Health 2021; 20:22. [PMID: 33637108 PMCID: PMC7913169 DOI: 10.1186/s12940-021-00703-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/16/2021] [Indexed: 05/24/2023]
Abstract
BACKGROUND Global temperatures are projected to rise by ≥2 °C by the end of the century, with expected impacts on infectious disease incidence. Establishing the historic relationship between temperature and childhood diarrhea is important to inform future vulnerability under projected climate change scenarios. METHODS We compiled a national dataset from Peruvian government data sources, including weekly diarrhea surveillance records, annual administered doses of rotavirus vaccination, annual piped water access estimates, and daily temperature estimates. We used generalized estimating equations to quantify the association between ambient temperature and childhood (< 5 years) weekly reported clinic visits for diarrhea from 2005 to 2015 in 194 of 195 Peruvian provinces. We estimated the combined effect of the mean daily high temperature lagged 1, 2, and 3 weeks, in the eras before (2005-2009) and after (2010-2015) widespread rotavirus vaccination in Peru and examined the influence of varying levels of piped water access. RESULTS Nationally, an increase of 1 °C in the temperature across the three prior weeks was associated with a 3.8% higher rate of childhood clinic visits for diarrhea [incidence rate ratio (IRR): 1.04, 95% confidence interval (CI): 1.03-1.04]. Controlling for temperature, there was a significantly higher incidence rate of childhood diarrhea clinic visits during moderate/strong El Niño events (IRR: 1.03, 95% CI: 1.01-1.04) and during the dry season (IRR: 1.01, 95% CI: 1.00-1.03). Nationally, there was no evidence that the association between temperature and the childhood diarrhea rate changed between the pre- and post-rotavirus vaccine eras, or that higher levels of access to piped water mitigated the effects of temperature on the childhood diarrhea rate. CONCLUSIONS Higher temperatures and intensifying El Niño events that may result from climate change could increase clinic visits for childhood diarrhea in Peru. Findings underscore the importance of considering climate in assessments of childhood diarrhea in Peru and globally, and can inform regional vulnerability assessments and mitigation planning efforts.
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Affiliation(s)
- Miranda J. Delahoy
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA USA
| | - César Cárcamo
- Department of Public Health, Administration, and Social Sciences, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Avenida Armendáriz 445, Miraflores, Lima, Peru
| | - Adrian Huerta
- Servicio Nacional de Meteorología e Hidrología del Perú (SENAMHI; National Meteorology and Hydrology Service of Peru), Jirón Cahuide 785, Jesús María, Lima, Peru
| | - Waldo Lavado
- Servicio Nacional de Meteorología e Hidrología del Perú (SENAMHI; National Meteorology and Hydrology Service of Peru), Jirón Cahuide 785, Jesús María, Lima, Peru
| | - Yury Escajadillo
- Servicio Nacional de Meteorología e Hidrología del Perú (SENAMHI; National Meteorology and Hydrology Service of Peru), Jirón Cahuide 785, Jesús María, Lima, Peru
| | - Luís Ordoñez
- National Center for Epidemiology, Prevention and Control of Diseases, Ministerio de Salud (MINSA; Ministry of Health), Avenida Salaverry 801, Jesús María, Lima, Peru
| | - Vanessa Vasquez
- Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Avenida Honorio Delgado 430, San Martín de Porres, Lima, Peru
| | - Benjamin Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA USA
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA USA
| | - Gustavo F. Gonzales
- Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Avenida Honorio Delgado 430, San Martín de Porres, Lima, Peru
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA USA
| | - Karen Levy
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA USA
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, 1959 NE Pacific Street, Seattle, Washington USA
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Delahoy MJ, Cárcamo C, Ordoñez L, Vasquez V, Lopman B, Clasen T, Gonzales GF, Steenland K, Levy K. Impact of Rotavirus Vaccination Varies by Level of Access to Piped Water and Sewerage: An Analysis of Childhood Clinic Visits for Diarrhea in Peru, 2005-2015. Pediatr Infect Dis J 2020; 39:756-762. [PMID: 32332220 PMCID: PMC7368830 DOI: 10.1097/inf.0000000000002702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND We conducted a national impact evaluation of routine rotavirus vaccination on childhood diarrhea in Peru, accounting for potential modifying factors. METHODS We utilized a dataset compiled from Peruvian governmental sources to fit negative binomial models investigating the impact of rotavirus vaccination, piped water access, sewerage access and poverty on the rate of diarrhea clinic visits in children under 5 years old in 194 Peruvian provinces. We considered the interaction between these factors to assess whether water access, sanitation access, or poverty modified the association between ongoing rotavirus vaccination and childhood diarrhea clinic visits. We compared the "pre-vaccine" (2005-2009) and "post-vaccine" (2010-2015) eras. RESULTS The rate of childhood diarrhea clinic visits was 7% [95% confidence interval (CI): 3%-10%] lower in the post-vaccine era compared with the pre-vaccine era, controlling for long-term trend and El Niño seasons. No impact of rotavirus vaccination was identified in provinces with the lowest access to piped water (when <40% of province households had piped water) or in the lowest category of sewerage (when <17% of province households had a sewerage connection). Accounting for long-term and El Niño trends, the rate of childhood diarrhea clinic visits was lower in the post-vaccine era by 7% (95% CI: 2%-12%), 13% (95% CI: 7%-19%) and 15% (95% CI: 10%-20%) in the second, third and fourth (highest) quartiles of piped water access, respectively (compared with the pre-vaccine era); results for sewerage access were similar. CONCLUSION Improved water/sanitation may operate synergistically with rotavirus vaccination to reduce childhood clinic visits for diarrhea in Peru.
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Affiliation(s)
- Miranda J. Delahoy
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322 USA
| | - César Cárcamo
- Department of Public Health, Administration, and Social Sciences, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis Ordoñez
- National Center for Epidemiology, Prevention and Control of Diseases, Ministerio de Salud (Ministry of Health), Lima, Peru
| | - Vanessa Vasquez
- Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Benjamin Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322 USA
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322 USA
| | - Gustavo F. Gonzales
- Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322 USA
| | - Karen Levy
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322 USA
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Colston J, Paredes Olortegui M, Zaitchik B, Peñataro Yori P, Kang G, Ahmed T, Bessong P, Mduma E, Bhutta Z, Sunder Shrestha P, Lima A, Kosek M. Pathogen-Specific Impacts of the 2011-2012 La Niña-Associated Floods on Enteric Infections in the MAL-ED Peru Cohort: A Comparative Interrupted Time Series Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E487. [PMID: 31940920 PMCID: PMC7013961 DOI: 10.3390/ijerph17020487] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 12/18/2022]
Abstract
Extreme floods pose multiple direct and indirect health risks. These risks include contamination of water, food, and the environment, often causing outbreaks of diarrheal disease. Evidence regarding the effects of flooding on individual diarrhea-causing pathogens is limited, but is urgently needed in order to plan and implement interventions and prioritize resources before climate-related disasters strike. This study applied a causal inference approach to data from a multisite study that deployed broadly inclusive diagnostics for numerous high-burden common enteropathogens. Relative risks (RRs) of infection with each pathogen during a flooding disaster that occurred at one of the sites-Loreto, Peru-were calculated from generalized linear models using a comparative interrupted time series framework with the other sites as a comparison group and adjusting for background seasonality. During the early period of the flood, increased risk of heat-stable enterotoxigenic E. coli (ST-ETEC) was identified (RR = 1.73 [1.10, 2.71]) along with a decreased risk of enteric adenovirus (RR = 0.36 [0.23, 0.58]). During the later period of the flood, sharp increases in the risk of rotavirus (RR = 5.30 [2.70, 10.40]) and sapovirus (RR = 2.47 [1.79, 3.41]) were observed, in addition to increases in transmission of Shigella spp. (RR = 2.86 [1.81, 4.52]) and Campylobacter spp. (RR = 1.41 (1.01, 1.07). Genotype-specific exploratory analysis reveals that the rise in rotavirus transmission during the flood was likely due to the introduction of a locally atypical, non-vaccine (G2P[4]) strain of the virus. Policy-makers should target interventions towards these pathogens-including vaccines as they become available-in settings where vulnerability to flooding is high as part of disaster preparedness strategies, while investments in radical, transformative, community-wide, and locally-tailored water and sanitation interventions are also needed.
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Affiliation(s)
- Josh Colston
- Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA 22903, USA;
| | | | - Benjamin Zaitchik
- Department of Earth and Planetary Sciences, Johns Hopkins Krieger School of Arts and Sciences, Baltimore, MD 21218, USA;
| | - Pablo Peñataro Yori
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22903, USA;
| | | | - Tahmeed Ahmed
- Nutrition & Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1213, Bangladesh;
| | | | - Esto Mduma
- Haydom Global Health Institute, Haydom P.O. Box 9000, Tanzania;
| | - Zulfiqar Bhutta
- Department of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan;
| | - Prakash Sunder Shrestha
- Department of Child Health, Institute of Medicine of Tribhuvan University, Kirtipur 44618, Nepal;
| | - Aldo Lima
- Federal University of Ceará, Fortaleza 60020-181, Brazil;
| | - Margaret Kosek
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22903, USA;
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Heaney AK, Shaman J, Alexander KA. El Niño-Southern oscillation and under-5 diarrhea in Botswana. Nat Commun 2019; 10:5798. [PMID: 31862873 PMCID: PMC6925142 DOI: 10.1038/s41467-019-13584-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 11/14/2019] [Indexed: 11/09/2022] Open
Abstract
Childhood diarrheal disease causes significant morbidity and mortality in low and middle-income countries, yet our ability to accurately predict diarrhea incidence remains limited. El Niño-Southern Oscillation (ENSO) has been shown to affect diarrhea dynamics in South America and Asia. However, understanding of its effects in sub-Saharan Africa, where the burden of under-5 diarrhea is high, remains inadequate. Here we investigate the connections between ENSO, local environmental conditions, and childhood diarrheal disease in Chobe District, Botswana. Our results demonstrate that La Niña conditions are associated with cooler temperatures, increased rainfall, and higher flooding in the Chobe region during the rainy season. In turn, La Niña conditions lagged 0–5 months are associated with higher than average incidence of under-5 diarrhea in the early rainy season. These findings demonstrate the potential use of ENSO as a long-lead prediction tool for childhood diarrhea in southern Africa. Here, Heaney et al. show that La Niña conditions are associated with higher than average incidence of childhood diarrheal disease in Botswana in the early rainy season. This finding could help to predict childhood diarrhea outbreaks in southern Africa.
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Affiliation(s)
- Alexandra K Heaney
- Environmental Health Sciences Department, University of California Berkeley, Berkeley, USA.
| | - Jeffrey Shaman
- Environmental Health Sciences Department, Columbia University, New York, USA
| | - Kathleen A Alexander
- Department of Fish and Wildlife Conservation, Virginia Tech, USA.,Chobe Research Center, Center for African Resources: Animals Communities and Land use (CARACAL), Kasane, Botswana
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Huicho L, Tavera M, Huayanay-Espinoza CA, Béjar-Díaz M, Rivera-Ch M, Tam Y, Walker N, Black RE. Drivers of the progress achieved by Peru in reducing childhood diarrhoea mortality: a country case study. J Glob Health 2019; 9:020805. [PMID: 31673349 PMCID: PMC6816317 DOI: 10.7189/jogh.09.020805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Childhood diarrhoea mortality has declined substantially in Peru in recent decades. We documented trends in childhood diarrhoea mortality from 1980 to 2015, along with trends in coverage of diarrhoea-related interventions and risk factors, to identify the main drivers of mortality reduction. METHODS We conducted desk reviews on social determinants, policies and programmes, and diarrhoea-related interventions implemented during the study period. We reviewed different datasets on child mortality, and on coverage of diarrhoea-related interventions. We received input from individuals familiar with implementation of diarrhoea-related policies and programmes. We used the Lives Saved Tool (LiST) to help explain the reasons for the decline in diarrhoea mortality from 1980 to 2015 and to predict additional reduction with further scale up of diarrhoea-related interventions by 2030. RESULTS In Peru under-five diarrhoea mortality declined from 23.3 in 1980 to 0.8 per 1000 livebirths in 2015. The percentage of under-five diarrhoea deaths as related to total under-five deaths was reduced from 17.8% in 1980 to 4.9% in 2015. Gross domestic product increased and poverty declined from 1990 to 2015. Access to improved water increased from 56% in 1986 to 79.3% in 2015. Oral rehydrating salts (ORS) use during an episode of diarrhoea increased from 3.6% in 1986 to 32% in 2015. Vertical programmes focused on diarrhoea management with ORS were implemented successfully in the 1980s and 1990s, and were replaced by integrated crosscutting interventions since the early 2000s. LiST analyses showed that about half (53.9%) of the reduction in diarrhoea mortality could be attributed to improved water, sanitation and hygiene, 25.0% to direct diarrhoea interventions and 21.1% to nutrition. The remaining mortality could be reduced by three-quarters by 2030 with improved diarrhoea treatment and further with enhanced breastfeeding practices and reduction in stunting. LiST does not take into account the role of social determinants. CONCLUSIONS The reduction of diarrhoeal under-five mortality in Peru can be explained by a combination of factors, including improvement of social determinants, child nutrition, diarrhoea treatment with ORS and prevention with rotavirus vaccine and increased access to water and sanitation. The already low rate of diarrhoea mortality could be further reduced by a number of interventions, especially additional use of ORS and zinc for diarrhoea treatment. Peru is a remarkable example of a country that was able to reduce childhood diarrhoea mortality by implementing interventions through vertical programmes initially, and afterwards through implementation of integrated multisectoral packages targeting prevalent illnesses and multi-causal problems like stunting.
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Affiliation(s)
- Luis Huicho
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Pediatría, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Carlos A Huayanay-Espinoza
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - María Rivera-Ch
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Yvonne Tam
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, USA
| | - Neff Walker
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, USA
| | - Robert E Black
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, USA
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Choudhary TS, Sinha B, Khera A, Bhandari N, Chu Y, Jackson B, Walker N, Black RE, Merson M, Bhan MK. Factors associated with the decline in under-five diarrhea mortality in India: a LiST analysis. J Glob Health 2019; 9:020804. [PMID: 31673348 PMCID: PMC6816285 DOI: 10.7189/jogh.09.020804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND India has achieved 86% reduction in the number of under-five diarrheal deaths from 1980 to 2015. Nonetheless diarrhea is still among the leading causes of under-five deaths. The aim of this analysis was to study the contribution of factors that led to decline in diarrheal deaths in the country and the effect of scaling up of intervention packages to address the remaining diarrheal deaths. METHODS We assessed the attribution of different factors and intervention packages such as direct diarrhea case management interventions, nutritional factors and WASH interventions which contributed to diarrhea specific under-five mortality reduction (DSMR) during 1980 to 2015 using the Lives Saved Tool (LiST). The potential impact of scaling up different packages of interventions to achieve universal coverage levels by year 2030 on reducing the number of remaining diarrheal deaths were estimated. RESULTS The major factors associated with DSMR reduction in under-fives during 1980 to 2015, were increase in ORS use, reduction in stunting prevalence, improved sanitation, changes in age appropriate breastfeeding practices, increase in the vitamin-A supplementation and persistent diarrhea treatment. ORS use and reduction in stunting were the two key interventions, each accounting for around 32% of the lives saved during this period. Scaling up the direct diarrhea case management interventions from the current coverage levels in 2015 to achieve universal coverage levels by 2030 can save around 82 000 additional lives. If the universal targets for nutritional factors and WASH interventions can be achieved, an additional 23 675 lives can potentially be saved. CONCLUSIONS While it is crucial to improve the coverage and equity in ORS use, an integrated approach to promote nutrition, WASH and direct diarrhea interventions is likely to yield the highest impact on reducing the remaining diarrheal deaths in under-five children.
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Affiliation(s)
- Tarun Shankar Choudhary
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Bireshwar Sinha
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ajay Khera
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Nita Bhandari
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Yue Chu
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, United States
| | - Bianca Jackson
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, United States
| | - Neff Walker
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, United States
| | - Robert E Black
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, United States
| | - Michael Merson
- Duke University, Duke Global Health Institute, Durham, North Carolina, USA
| | - Maharaj Kishan Bhan
- Indian Institute of Technology, New Delhi, India
- Knowledge Integration and Translational Platform (KnIT), Biotechnology Industry Research Assistance Council (BIRAC) New Delhi, India
- Society for Essential Health Action and Training (SEHAT), New Delhi, India
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El Niño Southern Oscillation (ENSO) and Health: An Overview for Climate and Health Researchers. ATMOSPHERE 2018. [DOI: 10.3390/atmos9070282] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The El Niño Southern Oscillation (ENSO) is an important mode of climatic variability that exerts a discernible impact on ecosystems and society through alterations in climate patterns. For this reason, ENSO has attracted much interest in the climate and health science community, with many analysts investigating ENSO health links through considering the degree of dependency of the incidence of a range of climate diseases on the occurrence of El Niño events. Because of the mounting interest in the relationship between ENSO as a major mode of climatic variability and health, this paper presents an overview of the basic characteristics of the ENSO phenomenon and its climate impacts, discusses the use of ENSO indices in climate and health research, and outlines the present understanding of ENSO health associations. Also touched upon are ENSO-based seasonal health forecasting and the possible impacts of climate change on ENSO and the implications this holds for future assessments of ENSO health associations. The review concludes that there is still some way to go before a thorough understanding of the association between ENSO and health is achieved, with a need to move beyond analyses undertaken through a purely statistical lens, with due acknowledgement that ENSO is a complex non-canonical phenomenon, and that simple ENSO health associations should not be expected.
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Temperature Variability and Occurrence of Diarrhoea in Children under Five-Years-Old in Cape Town Metropolitan Sub-Districts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13090859. [PMID: 27589772 PMCID: PMC5036692 DOI: 10.3390/ijerph13090859] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/10/2016] [Accepted: 08/17/2016] [Indexed: 01/15/2023]
Abstract
This paper describes the relationship between temperature change and diarrhoea in under five-year-old children in the Cape Town Metropolitan Area (CTMA) of South Africa. The study used climatic and aggregated surveillance diarrhoea incidence data of two peak periods of seven months each over two consecutive years. A Poisson regression model and a lagged Poisson model with autocorrelation was performed to test the relationship between climatic parameters (minimum and maximum temperature) and incidence of diarrhoea. In total, 58,617 cases of diarrhoea occurred in the CTMA, which is equivalent to 8.60 cases per 100 population under five years old for the study period. The mixed effect overdispersed Poisson model showed that a cluster adjusted effect of an increase of 5 °C in minimum and maximum temperature results in a 40% (Incidence risk ratio IRR: 1.39, 95% CI 1.31–1.48) and 32% (IRR: 1.32, 95% CI: 1.22–1.41) increase in incident cases of diarrhoea, respectively, for the two periods studied. Autocorrelation of one-week lag (Autocorrelation AC 1) indicated that a 5 °C increase in minimum and maximum temperature led to 15% (IRR: 1.46, 95% CI: 1.09–1.20) and 6% (IRR: 1.06, 95% CI: 1.01–1.12) increase in diarrhoea cases, respectively. In conclusion, there was an association between an increase in minimum and maximum temperature, and the rate at which diarrhoea affected children under the age of five years old in the Cape Town Metropolitan Area. This finding may have implications for the effects of global warming and requires further investigation.
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Miranda JJ, Bernabé-Ortiz A, Diez-Canseco F, Málaga G, Cárdenas MK, Carrillo-Larco RM, Lazo-Porras M, Moscoso-Porras M, Pesantes MA, Ponce V, Araya R, Beran D, Busse P, Boggio O, Checkley W, García PJ, Huicho L, León-Velarde F, Lescano AG, Mohr DC, Pan W, Peiris D, Perel P, Rabadán-Diehl C, Rivera-Chira M, Sacksteder K, Smeeth L, Trujillo AJ, Wells JCK, Yan LL, García HH, Gilman RH. Towards sustainable partnerships in global health: the case of the CRONICAS Centre of Excellence in Chronic Diseases in Peru. Global Health 2016; 12:29. [PMID: 27255370 PMCID: PMC4890274 DOI: 10.1186/s12992-016-0170-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 05/18/2016] [Indexed: 11/10/2022] Open
Abstract
Human capital requires opportunities to develop and capacity to overcome challenges, together with an enabling environment that fosters critical and disruptive innovation. Exploring such features is necessary to establish the foundation of solid long-term partnerships. In this paper we describe the experience of the CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Heredia in Lima, Peru, as a case study for fostering meaningful and sustainable partnerships for international collaborative research. The CRONICAS Centre of Excellence in Chronic Diseases was established in 2009 with the following Mission: "We support the development of young researchers and collaboration with national and international institutions. Our motivation is to improve population's health through high quality research." The Centre's identity is embedded in its core values - generosity, innovation, integrity, and quality- and its trajectory is a result of various interactions between multiple individuals, collaborators, teams, and institutions, which together with the challenges confronted, enables us to make an objective assessment of the partnership we would like to pursue, nurture and support. We do not intend to provide a single example of a successful partnership, but in contrast, to highlight what can be translated into opportunities to be faced by research groups based in low- and middle-income countries, and how these encounters can provide a strong platform for fruitful and sustainable partnerships. In defiant contexts, partnerships require to be nurtured and sustained. Acknowledging that all partnerships are not and should not be the same, we also need to learn from the evolution of such relationships, its key successes, hurdles and failures to contribute to the promotion of a culture of global solidarity where mutual goals, mutual gains, as well as mutual responsibilities are the norm. In so doing, we will all contribute to instil a new culture where expectations, roles and interactions among individuals and their teams are horizontal, the true nature of partnerships.
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Affiliation(s)
- J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru.
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Antonio Bernabé-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Francisco Diez-Canseco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Germán Málaga
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Internal Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - María K Cárdenas
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Rodrigo M Carrillo-Larco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - María Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Miguel Moscoso-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - M Amalia Pesantes
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Vilarmina Ponce
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Ricardo Araya
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- University of Geneva, Geneva, Switzerland
| | | | - Oscar Boggio
- Division of Non-Communicable Diseases, Dirección General de Salud de las Personas, Ministerio de Salud, Lima, Peru
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patricia J García
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis Huicho
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Pediatrics, Instituto Nacional de Salud del Niño, Lima, Peru
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Andrés G Lescano
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Parasitology, and Public Health Training Program, USA Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - William Pan
- Division of Environmental Science and Policy, Nicholas School of the Environment, Duke University, Durham, NC, USA
| | - David Peiris
- The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
| | - Pablo Perel
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- World Heart Federation, Geneva, Switzerland
| | - Cristina Rabadán-Diehl
- Office of Global Affairs, U.S. Department of Health & Human Services, Washington, DC, USA
| | | | - Katherine Sacksteder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Antonio J Trujillo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, University College London, London, UK
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Héctor H García
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Center for Global Health - Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Robert H Gilman
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Asociación Benéfica PRISMA, Lima, Peru
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Levy K, Woster AP, Goldstein RS, Carlton EJ. Untangling the Impacts of Climate Change on Waterborne Diseases: a Systematic Review of Relationships between Diarrheal Diseases and Temperature, Rainfall, Flooding, and Drought. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2016; 50:4905-22. [PMID: 27058059 PMCID: PMC5468171 DOI: 10.1021/acs.est.5b06186] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Global climate change is expected to affect waterborne enteric diseases, yet to date there has been no comprehensive, systematic review of the epidemiological literature examining the relationship between meteorological conditions and diarrheal diseases. We searched PubMed, Embase, Web of Science, and the Cochrane Collection for studies describing the relationship between diarrheal diseases and four meteorological conditions that are expected to increase with climate change: ambient temperature, heavy rainfall, drought, and flooding. We synthesized key areas of agreement and evaluated the biological plausibility of these findings, drawing from a diverse, multidisciplinary evidence base. We identified 141 articles that met our inclusion criteria. Key areas of agreement include a positive association between ambient temperature and diarrheal diseases, with the exception of viral diarrhea and an increase in diarrheal disease following heavy rainfall and flooding events. Insufficient evidence was available to evaluate the effects of drought on diarrhea. There is evidence to support the biological plausibility of these associations, but publication bias is an ongoing concern. Future research evaluating whether interventions, such as improved water and sanitation access, modify risk would further our understanding of the potential impacts of climate change on diarrheal diseases and aid in the prioritization of adaptation measures.
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Affiliation(s)
- Karen Levy
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Address correspondence to: Karen Levy, Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322. Telephone: 404.727.4502. Fax: 404.727.8744.
| | - Andrew P. Woster
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Rebecca S. Goldstein
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Elizabeth J. Carlton
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
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Abstract
Rising global temperature is causing major physical, chemical, and ecological changes across the planet. There is wide consensus among scientific organizations and climatologists that these broad effects, known as climate change, are the result of contemporary human activity. Climate change poses threats to human health, safety, and security. Children are uniquely vulnerable to these threats. The effects of climate change on child health include physical and psychological sequelae of weather disasters, increased heat stress, decreased air quality, altered disease patterns of some climate-sensitive infections, and food, water, and nutrient insecurity in vulnerable regions. Prompt implementation of mitigation and adaptation strategies will protect children against worsening of the problem and its associated health effects. This technical report reviews the nature of climate change and its associated child health effects and supports the recommendations in the accompanying policy statement on climate change and children's health.
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Danysh HE, Gilman RH, Wells JC, Pan WK, Zaitchik B, Gonzálvez G, Alvarez M, Checkley W. El Niño adversely affected childhood stature and lean mass in northern Peru. ACTA ACUST UNITED AC 2014. [DOI: 10.1186/s40665-014-0007-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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15
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Jaganath D, Saito M, Gilman RH, Queiroz DMM, Rocha GA, Cama V, Cabrera L, Kelleher D, Windle HJ, Crabtree JE, Checkley W. First detected Helicobacter pylori infection in infancy modifies the association between diarrheal disease and childhood growth in Peru. Helicobacter 2014; 19:272-9. [PMID: 24750275 DOI: 10.1111/hel.12130] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND In endemic settings, Helicobacter pylori infection can occur shortly after birth and may be associated with a reduction in childhood growth. MATERIALS AND METHODS This study investigated what factors promote earlier age of first H. pylori infection and evaluated the role of H. pylori infection in infancy (6-11 months) versus early childhood (12-23 months) on height. We included 183 children near birth from a peri-urban shanty town outside of Lima, Peru. Field-workers collected data on socioeconomic status (SES), daily diarrheal and breast-feeding history, antibiotic use, anthropometrics, and H. pylori status via carbon 13-labeled urea breath test up to 24 months after birth. We used a proportional hazards model to assess risk factors for earlier age at first detected infection and linear mixed-effects models to evaluate the association of first detected H. pylori infection during infancy on attained height. RESULTS One hundred and forty (77%) were infected before 12 months of age. Lower SES was associated with earlier age at first detected H. pylori infection (low vs middle-to-high SES Hazard ratio (HR) 1.59, 95% CI 1.16, 2.19; p = .004), and greater exclusive breast-feeding was associated with reduced likelihood (HR 0.63, 95% CI 0.40, 0.98, p = .04). H. pylori infection in infancy was not independently associated with growth deficits (p = .58). However, children who had their first detected H. pylori infection in infancy (6-11 months) versus early childhood (12-23 months) and who had an average number of diarrhea episodes per year (3.4) were significantly shorter at 24 months (-0.37 cm, 95% CI, -0.60, -0.15 cm; p = .001). DISCUSSION Lower SES was associated with a higher risk of first detected H. pylori infection during infancy, which in turn augmented the adverse association of diarrheal disease on linear growth.
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Affiliation(s)
- Devan Jaganath
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Gonzales GF, Zevallos A, Gonzales-Castañeda C, Nuñez D, Gastañaga C, Cabezas C, Naeher L, Levy K, Steenland K. [Environmental pollution, climate variability and climate change: a review of health impacts on the Peruvian population]. Rev Peru Med Exp Salud Publica 2014; 31:547-556. [PMID: 25418656 PMCID: PMC4351992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 08/06/2014] [Indexed: 06/04/2023] Open
Abstract
This article is a review of the pollution of water, air and the effect of climate change on the health of the Peruvian population. A major air pollutant is particulate matter less than 2.5 μ (PM 2.5). In Lima, 2,300 premature deaths annually are attributable to this pollutant. Another problem is household air pollution by using stoves burning biomass fuels, where excessive indoor exposure to PM 2.5 inside the household is responsible for approximately 3,000 annual premature deaths among adults, with another unknown number of deaths among children due to respiratory infections. Water pollution is caused by sewage discharges into rivers, minerals (arsenic) from various sources, and failure of water treatment plants. In Peru, climate change may impact the frequency and severity of El Niño Southern Oscillation (ENSO), which has been associated with an increase in cases of diseases such as cholera, malaria and dengue. Climate change increases the temperature and can extend the areas affected by vector-borne diseases, have impact on the availability of water and contamination of the air. In conclusion, Peru is going through a transition of environmental risk factors, where traditional and modern risks coexist and infectious and chronic problems remain, some of which are associated with problems of pollution of water and air.
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Affiliation(s)
| | - Alisson Zevallos
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | | | - Denisse Nuñez
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
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