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Noormal AS, Winkler V, Bhusari SB, Horstick O, Louis VR, Deckert A, Antia K, Wasko Z, Rai P, Mocruha AF, Dambach P. Prevalence of major non-communicable diseases and their associated risk factors in Afghanistan: a systematic review and meta-analysis. Ther Adv Chronic Dis 2024; 15:20406223241229850. [PMID: 38362254 PMCID: PMC10868487 DOI: 10.1177/20406223241229850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/10/2024] [Indexed: 02/17/2024] Open
Abstract
Background Non-communicable diseases (NCDs) are the leading cause of mortality worldwide, and increasingly so in low- and middle-income countries. Afghanistan is dealing with a double burden of diseases, yet there has been no evidence synthesis on the prevalence of major NCDs and their risk factors. Objective This study aims to provide a comprehensive synthesis of the existing data on the prevalence of major NCDs and the common related risk factors in Afghanistan. Method We systematically reviewed scientific articles from 2000 to 2022 that reported the prevalence of diabetes, chronic respiratory diseases (CRDs), cardiovascular diseases (CVDs) or cancer, and their risk factors in Afghanistan. Four online databases (PubMed, Web of Science, Cochrane and Google Scholar) and two local journals in Afghanistan (not indexed online) were systematically searched and screened. Two reviewers independently screened and appraised the quality of the articles. Data extraction and synthesis were performed using tabulated sheets. Results Among 51 eligible articles, 10 (19.6%) focused on cancer, 10 (19.6%) on diabetes, 4 (7.8%) on CVDs, 4 (7.8%) on CRDs and 23 (45.1%) on risk factors as the primary outcome. Few articles addressed major NCD prevalence; no evidence of CVDs, cancer was 0.15%, asthma ranged between 0.3% and 17.3%, and diabetes was 12%. Pooled prevalence of hypertension and overweight were 31% and 35%, respectively. Central obesity was twice as prevalent in females (76% versus 40%). Similarly, gender differences were observed in smoking and snuff use with prevalence rates of 14% and 25% among males and 2% and 3% among females, respectively. A total of 14% of the population engaged in vigorous activity. Pooled prevalence for physical inactivity, general obesity, fruit and vegetable consumption, dyslipidaemia and alcohol consumption couldn't be calculated due to the heterogeneity of articles. Conclusion Only little evidence is available on the prevalence of major NCDs in Afghanistan; however, the NCD risk factors are prevalent across the country. The quality of the available data, especially those of the local resources, is poor; therefore, further research should generate reliable evidence in order to inform policymakers on prioritizing interventions for controlling and managing NCDs.
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Affiliation(s)
- Ahmad Siyar Noormal
- Ministry of Public Health, Sehat-e-Ama Square, Wazir Akbar khan Road, 1001, Kabul, Afghanistan
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Heidelberg 69120, Germany
| | - Volker Winkler
- Heidelberg Institute of Global Health, Heidelberg, Germany
| | | | - Olaf Horstick
- Heidelberg Institute of Global Health, Heidelberg, Germany
| | | | | | - Khatia Antia
- Heidelberg Institute of Global Health, Heidelberg, Germany
| | - Zahia Wasko
- Heidelberg Institute of Global Health, Heidelberg, Germany
| | - Pratima Rai
- Heidelberg Institute of Global Health, Heidelberg, Germany
| | | | - Peter Dambach
- Heidelberg Institute of Global Health, Heidelberg, Germany
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Koch M, Matzke I, Huhn S, Sié A, Boudo V, Compaoré G, Maggioni MA, Bunker A, Bärnighausen T, Dambach P, Barteit S. Assessing the Effect of Extreme Weather on Population Health Using Consumer-Grade Wearables in Rural Burkina Faso: Observational Panel Study. JMIR Mhealth Uhealth 2023; 11:e46980. [PMID: 37938879 PMCID: PMC10666008 DOI: 10.2196/46980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/25/2023] [Accepted: 09/15/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Extreme weather, including heat and extreme rainfall, is projected to increase owing to climate change, which can have adverse impacts on human health. In particular, rural populations in sub-Saharan Africa are at risk because of a high burden of climate-sensitive diseases and low adaptive capacities. However, there is a lack of data on the regions that are anticipated to be most exposed to climate change. Improved public health surveillance is essential for better decision-making and health prioritization and to identify risk groups and suitable adaptation measures. Digital technologies such as consumer-grade wearable devices (wearables) may generate objective measurements to guide data-driven decision-making. OBJECTIVE The main objective of this observational study was to examine the impact of weather exposure on population health in rural Burkina Faso using wearables. Specifically, this study aimed to assess the relationship between individual daily activity (steps), sleep duration, and heart rate (HR), as estimated by wearables, and exposure to heat and heavy rainfall. METHODS Overall, 143 participants from the Nouna health and demographic surveillance system in Burkina Faso wore the Withings Pulse HR wearable 24/7 for 11 months. We collected continuous weather data using 5 weather stations throughout the study region. The heat index and wet-bulb globe temperature (WBGT) were calculated as measures of heat. We used linear mixed-effects models to quantify the relationship between exposure to heat and rainfall and the wearable parameters. Participants kept activity journals and completed a questionnaire on their perception of and adaptation to heat and other weather exposure. RESULTS Sleep duration decreased significantly (P<.001) with higher heat exposure, with approximately 15 minutes shorter sleep duration during heat stress nights with a heat index value of ≥25 °C. Many participants (55/137, 40.1%) reported that heat affected them the most at night. During the day, most participants (133/137, 97.1%) engaged in outdoor physical work such as farming, housework, or fetching water. During the rainy season, when WBGT was highest, daily activity was highest and increased when the daily maximum WBGT surpassed 30 °C during the rainiest month. In the hottest month, daily activity decreased per degree increase in WBGT for values >30 °C. Nighttime HR showed no significant correlation with heat exposure. Daytime HR data were insufficient for analysis. We found no negative health impact associated with heavy rainfall. With increasing rainfall, sleep duration increased, average nightly HR decreased, and activity decreased. CONCLUSIONS During the study period, participants were frequently exposed to heat and heavy rainfall. Heat was particularly associated with impaired sleep and daily activity. Essential tasks such as harvesting, fetching water, and caring for livestock expose this population to weather that likely has an adverse impact on their health. Further research is essential to guide interventions safeguarding vulnerable communities.
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Affiliation(s)
- Mara Koch
- Heidelberg Institute of Global Health, Faculty of Medicine, University Hospital, Heidelberg University, Heidelberg, Germany
| | - Ina Matzke
- Heidelberg Institute of Global Health, Faculty of Medicine, University Hospital, Heidelberg University, Heidelberg, Germany
| | - Sophie Huhn
- Heidelberg Institute of Global Health, Faculty of Medicine, University Hospital, Heidelberg University, Heidelberg, Germany
| | - Ali Sié
- Heidelberg Institute of Global Health, Faculty of Medicine, University Hospital, Heidelberg University, Heidelberg, Germany
- Centre de Recherche en Santé, Nouna, Burkina Faso
| | | | | | - Martina Anna Maggioni
- Charité - Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Aditi Bunker
- Heidelberg Institute of Global Health, Faculty of Medicine, University Hospital, Heidelberg University, Heidelberg, Germany
- Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine, University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Peter Dambach
- Heidelberg Institute of Global Health, Faculty of Medicine, University Hospital, Heidelberg University, Heidelberg, Germany
| | - Sandra Barteit
- Heidelberg Institute of Global Health, Faculty of Medicine, University Hospital, Heidelberg University, Heidelberg, Germany
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Bisia M, Montenegro-Quinoñez CA, Dambach P, Deckert A, Horstick O, Kolimenakis A, Louis VR, Manrique-Saide P, Michaelakis A, Runge-Ranzinger S, Morrison AC. Secondary vectors of Zika Virus, a systematic review of laboratory vector competence studies. PLoS Negl Trop Dis 2023; 17:e0011591. [PMID: 37651473 PMCID: PMC10499269 DOI: 10.1371/journal.pntd.0011591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/13/2023] [Accepted: 08/14/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND After the unprecedented Zika virus (ZIKV) outbreak in the western hemisphere from 2015-2018, Aedes aegypti and Ae. albopictus are now well established primary and secondary ZIKV vectors, respectively. Consensus about identification and importance of other secondary ZIKV vectors remain. This systematic review aims to provide a list of vector species capable of transmitting ZIKV by reviewing evidence from laboratory vector competence (VC) studies and to identify key knowledge gaps and issues within the ZIKV VC literature. METHODS A search was performed until 15th March 2022 on the Cochrane Library, Lilacs, PubMed, Web of Science, WHOLIS and Google Scholar. The search strings included three general categories: 1) "ZIKA"; 2) "vector"; 3) "competence", "transmission", "isolation", or "feeding behavior" and their combinations. Inclusion and exclusion criteria has been predefined and quality of included articles was assessed by STROBE and STROME-ID criteria. FINDINGS From 8,986 articles retrieved, 2,349 non-duplicates were screened by title and abstracts,103 evaluated using the full text, and 45 included in this analysis. Main findings are 1) secondary vectors of interest include Ae. japonicus, Ae. detritus, and Ae. vexans at higher temperature 2) Culex quinquefasciatus was not found to be a competent vector of ZIKV, 3) considerable heterogeneity in VC, depending on the local mosquito strain and virus used in testing was observed. Critical issues or gaps identified included 1) inconsistent definitions of VC parameters across the literature; 2) equivalency of using different mosquito body parts to evaluate VC parameters for infection (mosquito bodies versus midguts), dissemination (heads, legs or wings versus salivary glands), and transmission (detection or virus amplification in saliva, FTA cards, transmission to neonatal mice); 3) articles that fail to use infectious virus assays to confirm the presence of live virus; 4) need for more studies using murine models with immunocompromised mice to infect mosquitoes. CONCLUSION Recent, large collaborative multi-country projects to conduct large scale evaluations of specific mosquito species represent the most appropriate approach to establish VC of mosquito species.
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Affiliation(s)
- Marina Bisia
- Laboratory of Insects and Parasites of Medical Importance, Scientific Directorate of Entomology and Agricultural Zoology, Benaki Phytopathological Institute, Athens, Greece
| | - Carlos Alberto Montenegro-Quinoñez
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Instituto de Investigaciones, Centro Universitario de Zacapa, Universidad de San Carlos de Guatemala, Zacapa, Guatemala
| | - Peter Dambach
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Andreas Deckert
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Olaf Horstick
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Antonios Kolimenakis
- Laboratory of Insects and Parasites of Medical Importance, Scientific Directorate of Entomology and Agricultural Zoology, Benaki Phytopathological Institute, Athens, Greece
| | - Valérie R. Louis
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Pablo Manrique-Saide
- Unidad Colaborativa para Bioensayos Entomológicos (UCBE), Universidad Autónoma de Yucatán, Mérida, México
| | - Antonios Michaelakis
- Laboratory of Insects and Parasites of Medical Importance, Scientific Directorate of Entomology and Agricultural Zoology, Benaki Phytopathological Institute, Athens, Greece
| | - Silvia Runge-Ranzinger
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Amy C. Morrison
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California Davis, Davis, California, United States of America
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Montenegro-Quiñonez CA, Louis VR, Horstick O, Velayudhan R, Dambach P, Runge-Ranzinger S. Interventions against Aedes/dengue at the household level: a systematic review and meta-analysis. EBioMedicine 2023; 93:104660. [PMID: 37352828 PMCID: PMC10333437 DOI: 10.1016/j.ebiom.2023.104660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Because the evidence for the role of structural housing and combinations of interventions (domestic or peri-domestic) against Aedes mosquitoes or dengue is still lacking, this systematic review and meta-analysis aimed to analyse and synthesize research focusing on the household as the unit of allocation. METHODS We searched MEDLINE, LILACS, and Web of Science databases until February 2023 using three general keyword categories: (1) "Aedes" or "dengue"; (2) structural housing interventions including "house", "water", or "drainage"; and (3) vector control interventions of potential relevance and their combinations. We performed a qualitative content analysis and a meta-analysis for 13 entries on dengue seroconversion data. FINDINGS 14,272 articles were screened by titles, 615 by abstracts, 79 by full-text. 61 were selected. Satisfactory data quality allowed for detailed content analysis. Interventions at the household level against the immature mosquito stages (21 studies, 34%) showed positive or mixed results in entomological and epidemiological outcomes (86% and 75% respectively). Combined interventions against immature and adult stages (11 studies, 18%) performed similarly (91% and 67%) while those against the adult mosquitoes (29 studies, 48%) performed less well (79%, 22%). A meta-analysis on seroconversion outcomes showed a not-statistically significant reduction for interventions (log odds-ratio: -0.18 [-0.51, 0.14 95% CI]). INTERPRETATION No basic research on housing structure or modification was eligible for this systematic review but many interventions with clear impact on vector indices and, to a lesser extent, on dengue were described. The small and not-statistically significant effect size of the meta-analysis highlights the difficulty of proving effectiveness against this highly-clustered disease and of overcoming practical implementation obstacles (e.g. efficacy loss, compliance). The long-term success of interventions depends on suitability, community commitment and official support and promotion. The choice of a specific vector control package needs to take all these context-specific aspects into consideration. FUNDING This work was funded by a grant from the World Health Organization (2021/1121668-0, PO 202678425, NTD/VVE).
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Affiliation(s)
- Carlos Alberto Montenegro-Quiñonez
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany; Instituto de Investigaciones, Centro Universitario de Zacapa, Universidad de San Carlos de Guatemala, Guatemala.
| | - Valérie R Louis
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany.
| | - Olaf Horstick
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany.
| | - Raman Velayudhan
- Department of Control of Neglected Tropical Diseases (NTD), World Health Organization, Switzerland.
| | - Peter Dambach
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany.
| | - Silvia Runge-Ranzinger
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany.
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Kurtz M, Kawka H, Horstick O, Brenner S, Deckert A, Louis VR, Winkler V, Lowery Wilson M, Bärnighausen T, Dambach P. The prevalence of emotional abuse in children living in Sub-Saharan Africa - A systematic review. Child Abuse Negl 2023; 140:106155. [PMID: 37004459 DOI: 10.1016/j.chiabu.2023.106155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES This study is meant to put a focus on the prevalence of emotional abuse in low-income states like the Sub-Saharan region. METHODOLOGY Searching PubMed, Google scholar, and web of science during February and April 2021 a total of 2264 articles were identified, 27 met the inclusion criteria. We added the results of 13 VAC (Violence Against Children and Youth) studies, conducted by UNICEF capturing information about experienced sexual, physical, or emotional violence in 13-24-year-olds, as well as 56 MIC (Multiple Indicator Cluster) studies, conducted by the CDC to research the disciplinary methods used with children aged 1-14 years in the past month by older household members. Finally, in a meta-analytic approach, we aimed to calculate a pooled estimate of the prevalence. RESULTS The included studies depicted a wide range in prevalence rates across countries. For example, while the VAC study in Lesotho in 2018 showed low incidence rates of emotional violence (6.9 % Females, 3.8 % Males), the average prevalence recorded by the MIC study was as high as 57.8 % for females and 59.2 % for males. On average, the MIC studies displayed a higher incidence and the discrepancy of prevalence of emotional abuse between females and males was small. Calculating a pooled estimate of the prevalence was not possible, due to the heterogeneity of the data. CONCLUSIONS In general countries displayed a high prevalence. A standardized use of a uniform definition of emotional abuse might help to display a more homogenous data set in the future, giving the opportunity for pooled estimates of prevalence.
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Affiliation(s)
- M Kurtz
- University Heidelberg, Germany.
| | - H Kawka
- University Heidelberg, Germany
| | - O Horstick
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Germany
| | - S Brenner
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Germany
| | - A Deckert
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Germany
| | - V R Louis
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Germany
| | - V Winkler
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Germany
| | - M Lowery Wilson
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Germany
| | - T Bärnighausen
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Germany
| | - P Dambach
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Germany
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Brugnara L, Jaramillo C, Olarte-Peña M, Karl L, Deckert A, Marx M, Horstick O, Dambach P, Fehr A. Strengthening national public health institutes: a systematic review on institution building in the public sector. Front Public Health 2023; 11:1146655. [PMID: 37275484 PMCID: PMC10232799 DOI: 10.3389/fpubh.2023.1146655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/18/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Strong and efficient institutions are vital to the development of well-functioning governments and strong societies. The term "institution building" encompasses the creation, support, development, and strengthening of organizations and institutions. Still, there is little aggregated evidence on "institution building" considering a wider system-thinking approach, best practices, or development cooperation specifically in the field of public health. In 2007, the International Association of National Public Health Institutes (IANPHI) created a guiding Framework that countries may use for developing National Public Health Institutes (NPHIs). This Framework is currently being revised. Methods In this context, we conducted a systematic review to facilitate this revision with recent evidence on institution building and its potential contribution to NPHI. We followed the PRISMA guidelines for systematic reviews, searching for relevant publications in seven scientific databases (Pubmed, VHL/LILACS, EconLit, Google Scholar, Web of Science, World Affairs Online, ECONBIZ) and four libraries (World Bank; European Health for All database of the World Health Organization European Region, WHO; Organization for Economic Cooperation and Development, OECD; and the African Union Common Repository). The search was carried out in October 2021. We used the "framework analysis" tool for systematically processing documents according to key themes. Results As a result, we identified 3,015 records, of which we included 62 documents in the final review. This systematic review fills a major gap of aggregated information on institution building in the field of public health and National Public Health Institutes. It is to our knowledge the first systematic review of this kind. The overriding result is the identification and definition of six domains of institution building in the health sector: "governance," "knowledge and innovation," "inter-institutional cooperation," "monitoring and control," "participation," and "sustainability and context-specific adaptability." Discussion Our results show that the described domains are highly relevant to the public health sector, and that managers and the scientific community recognize their importance. Still, they are often not applied consistently when creating or developing NPHIs. We conclude that organizations engaged in institution building of NPHIs, including IANPHI, may greatly benefit from state-of-the-art research on institution building as presented in this study.
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Affiliation(s)
- Lucia Brugnara
- evaplan GmbH at the University Hospital Heidelberg, Heidelberg, Germany
- Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | | | | | - Larissa Karl
- Faculty of Natural and Social Sciences, Heidelberg University of Education, Heidelberg, Germany
| | - Andreas Deckert
- Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Marx
- evaplan GmbH at the University Hospital Heidelberg, Heidelberg, Germany
- Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Olaf Horstick
- Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Peter Dambach
- Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Angela Fehr
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
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Corvetto JF, Helou AY, Dambach P, Müller T, Sauerborn R. A Systematic Literature Review of the Impact of Climate Change on the Global Demand for Psychiatric Services. Int J Environ Res Public Health 2023; 20:1190. [PMID: 36673946 PMCID: PMC9858749 DOI: 10.3390/ijerph20021190] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
Climate Change (CC) imposes important global health risks, including on mental health (MH). They are related mostly to psychological suffering caused by climate-related events and to the heat-vulnerability caused by psychiatric disorders. This growing burden may press MH services worldwide, increasing demand on public and private systems in low-, middle-, and high-income countries. According to PRISMA, two independent reviewers searched four databases for papers published before May 2022 that associated climate-related events with healthcare demand for psychiatric conditions. Of the 7432 papers retrieved, we included 105. Only 29 were carried out in low- and middle-income countries. Twelve related the admission numbers to (i) extreme events, while 93 to (ii) meteorological factors-mostly heat. Emergency visits and hospitalizations were significantly higher during hot periods for MH disorders, especially until lag 5-7. Extreme events also caused more consultations. Suicide (completed or attempted), substance misuse, schizophrenia, mood, organic and neurotic disorders, and mortality were strongly affected by CC. This high healthcare demand is evidence of the burden patients may undergo. In addition, public and private services may face a shortage of financial and human resources. Finally, the increased use of healthcare facilities, in turn, intensifies greenhouse gas emissions, representing a self-enforcing cycle for CC. Further research is needed to better clarify how extreme events affect MH services and, in addition, if services in low- and middle-income countries are more intensely demanded by CC, as compared to richer countries.
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Affiliation(s)
- Julia Feriato Corvetto
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, 69120 Heidelberg, Germany
| | - Ammir Yacoub Helou
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-900, Brazil
| | - Peter Dambach
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, 69120 Heidelberg, Germany
| | - Thomas Müller
- Private Clinic Meiringen, 3860 Meiringen, Switzerland
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
| | - Rainer Sauerborn
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, 69120 Heidelberg, Germany
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Rosas-Jiménez C, Tercan E, Horstick O, Igboegwu E, Dambach P, Louis VR, Winkler V, Deckert A. Prevalence of anemia among Indigenous children in Latin America: a systematic review. Rev Saude Publica 2022; 56:99. [PMID: 36515311 DOI: 10.11606/s1518-8787.2022056004360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/02/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To describe the prevalence pattern of anemia among Indigenous children in Latin America. METHODS PRISMA guidelines were followed. Records were identified from the databases PubMed, Google Scholar, and Lilacs by two independent researchers between May and June 2021. Studies were included if the following criteria were met: a) studied Indigenous people b) was about children (from 0 to 12 years old); c) reported a prevalence estimate of anemia; d) had been conducted in any of the countries of Latin America; e) was published either in English, Portuguese, or Spanish; f) is a peer-reviewed article; and g) was published at any date. RESULTS Out of 2,401 unique records retrieved, 42 articles met the inclusion criteria. A total of 39 different Indigenous communities were analyzed in the articles, and in 21 of them (54.0%) child anemia was a severe public health problem (prevalence ≥ 40%). Those communities were the Aymara (Bolivia); Aruak, Guaraní, Kamaiurá, Karapotó, Karibe, Kaxinanuá, Ma-cro-Jê, Suruí, Terena, Xavante (Brazil); Cabécar (Costa Rica), Achuar, Aguaruna, Awajún, Urarina, Yomybato (Peru); Piaroa and Yucpa (Venezuela); and Quechua (Peru and Bolivia). Children below two years had the highest prevalence of anemia (between 16.2% and 86.1%). Among Indigenous people, risk factors for anemia include nutrition, poor living conditions, access to health services, racism, and discrimination. Bolivia and Guatemala are scarcely studied, despite having the highest proportion of Indigenous communities in Latin America. CONCLUSIONS Anemia constitutes a poorly documented public health problem among Indigenous children in 21 Indigenous communities in Bolivia, Brazil, Colombia, Costa Rica, Ecuador, Guatemala, Mexico, and Peru. In all Indigenous communities included in this study child anemia was an issue, especially in younger children.
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Affiliation(s)
- Carlos Rosas-Jiménez
- Heidelberg University. Heidelberg Institute for Global Health. Heidelberg, Baden-Württemberg, Germany
| | - Engin Tercan
- Heidelberg University. Heidelberg Institute for Global Health. Heidelberg, Baden-Württemberg, Germany
| | - Olaf Horstick
- Heidelberg University. Heidelberg Institute for Global Health. Heidelberg, Baden-Württemberg, Germany
| | - Ekeoma Igboegwu
- Heidelberg University. Heidelberg Institute for Global Health. Heidelberg, Baden-Württemberg, Germany
| | - Peter Dambach
- Heidelberg University. Heidelberg Institute for Global Health. Heidelberg, Baden-Württemberg, Germany
| | - Valérie R Louis
- Heidelberg University. Heidelberg Institute for Global Health. Heidelberg, Baden-Württemberg, Germany
| | - Volker Winkler
- Heidelberg University. Heidelberg Institute for Global Health. Heidelberg, Baden-Württemberg, Germany
| | - Andreas Deckert
- Heidelberg University. Heidelberg Institute for Global Health. Heidelberg, Baden-Württemberg, Germany
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Starck T, Dambach P, Rouamba T, Tinto H, Osier F, Oldenburg CE, Adam M, Bärnighausen T, Jaenisch T, Bulstra CA. The effect of malaria on childhood anemia in a quasi-experimental study of 7,384 twins from 23 Sub-Saharan African countries. Front Public Health 2022; 10:1009865. [PMID: 36561861 PMCID: PMC9766366 DOI: 10.3389/fpubh.2022.1009865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/18/2022] [Indexed: 12/12/2022] Open
Abstract
Background Young children in Sub-Saharan Africa (SSA), particularly those from resource-limited settings, are heavily burdened by anemia and malaria. While malaria infected children frequently become anemic (hemoglobin < 110 g/L), anemia is a strongly multifactorial disease with many other risk factors than malaria. Due to the complex and often overlapping contributors to anemia, it remains challenging to isolate the true impact of malaria on population level hemoglobin concentrations. Methods We quantified the malaria-induced effect on hemoglobin levels in children under 5 years of age, leveraging data from 7,384 twins and other multiples, aged 6 to 59 months, from 57 nationally representative Demographic and Health Surveys (DHSs) from 23 SSA countries from 2006 to 2019. The quasi-experimental twin fixed-effect design let us minimize the impact of potential confounders that do not vary between twins. Results Our analyses of twins revealed a malaria-induced hemoglobin decrease in infected twins of 9 g/L (95% CI -10; -7, p<0.001). The relative risk of severe anemia was higher (RR = 3.01, 95% CI 1.79; 5.1, p<0.001) among malaria positive children, compared to malaria negative children. Conversely, malaria positive children are only half as likely to be non-anemic (RR = 0.51, 95% CI 0.43; 0.61, p<0.001). Conclusion Even after rigorous control for confounding through a twin fixed-effects study design, malaria substantially decreased hemoglobin levels among SSA twins, rendering them much more susceptible to severe anemia. This effect reflects the population-level effect of malaria on anemia.
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Affiliation(s)
- Tim Starck
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany,*Correspondence: Tim Starck
| | - Peter Dambach
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Toussaint Rouamba
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Faith Osier
- Centre for Infectious Diseases, Parasitology, Heidelberg University Hospital, Heidelberg, Germany,KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Catherine E. Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, United States,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Maya Adam
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany,Deptartment of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States,Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Thomas Jaenisch
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany,Center for Global Health, Colorado School of Public Health, Aurora, CO, United States,Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States
| | - Caroline A. Bulstra
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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10
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Tyllack L, Renz A, Runge Ranzinger S, Louis VR, Deckert A, Dambach P, Horstick O, Lowery Wilson M. Prevalence of unnecessary antibiotic use in European hospitals – a systematic review. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Antibiotics (AB) are essential to modern day medicine as prophylaxis and therapy. Yet, unnecessary use has various negative effects on individual and global health, such as antimicrobial resistance (AMR) and contribution to high greenhouse gas (GHG) emissions of the healthcare sector. This systematic review provides an overview of unnecessary AB use in European hospitals in order to present possible ways forward.
Methods
The systematic review followed PRISMA guidelines, included as databases were: Embase, ProQuest Environmental Science Collection, PubMed, ScienceDirect, Scopus and Web of Science. Studies conducted among adult in-patients in EU/EEA countries were included if they provided assessment methodology, included a clear standard of measurement and chart reviews were used as evaluation basis.
Results
Fifty-six included studies were categorised into the following three groups: (1) Studies using an established evaluation method; 20 studies belong to this group, 18 used the same, established approach. Eleven of these studies performed an observational audit, while the interventions in the remaining studies were of educational or advisory nature. Unnecessary AB use ranged from 1.5% to 51% of all observed prescriptions. Outcomes of interventions showed great variation of effects on unnecessary use (-34.7% - +11.6). (2) Studies using a newly developed, clearly stated evaluation method (4 studies); (3) Studies which conform with established evaluation methods but the processes were not specified (32 studies). Results are subject to further analysis.
Conclusions
The studies included reported a great range of unnecessary AB use in adult in-patients, for both prophylactic and therapeutic indications. Evaluation methods of unnecessary AB use vary greatly between studies. In future research, comprehensive application of established approaches is essential for better overview and identification of key areas for AMR and GHG emission reduction activities.
Key messages
• Unnecessary antibiotic use varies greatly among studies conducted in European adult in-patients.
• In future research, wider application of established evaluation methods will improve comparability and targeting of interventions.
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Affiliation(s)
- L Tyllack
- Research to Practice Group, Heidelberg Institute of Global Health , Heidelberg, Germany
| | - A Renz
- Research to Practice Group, Heidelberg Institute of Global Health , Heidelberg, Germany
| | - S Runge Ranzinger
- Research to Practice Group, Heidelberg Institute of Global Health , Heidelberg, Germany
| | - VR Louis
- Research to Practice Group, Heidelberg Institute of Global Health , Heidelberg, Germany
| | - A Deckert
- Research to Practice Group, Heidelberg Institute of Global Health , Heidelberg, Germany
| | - P Dambach
- Research to Practice Group, Heidelberg Institute of Global Health , Heidelberg, Germany
| | - O Horstick
- Research to Practice Group, Heidelberg Institute of Global Health , Heidelberg, Germany
| | - M Lowery Wilson
- Research to Practice Group, Heidelberg Institute of Global Health , Heidelberg, Germany
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11
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Koch M, Matzke I, Huhn S, Gunga HC, Maggioni MA, Munga S, Obor D, Sié A, Boudo V, Bunker A, Dambach P, Bärnighausen T, Barteit S. Wearables for Measuring Health Effects of Climate Change–Induced Weather Extremes: Scoping Review. JMIR Mhealth Uhealth 2022; 10:e39532. [PMID: 36083624 PMCID: PMC9508665 DOI: 10.2196/39532] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Although climate change is one of the biggest global health threats, individual-level and short-term data on direct exposure and health impacts are still scarce. Wearable electronic devices (wearables) present a potential solution to this research gap. Wearables have become widely accepted in various areas of health research for ecological momentary assessment, and some studies have used wearables in the field of climate change and health. However, these studies vary in study design, demographics, and outcome variables, and existing research has not been mapped.
Objective
In this review, we aimed to map existing research on wearables used to detect direct health impacts and individual exposure during climate change–induced weather extremes, such as heat waves or wildfires.
Methods
We conducted a scoping review according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework and systematically searched 6 databases (PubMed [MEDLINE], IEEE Xplore, CINAHL [EBSCOhost], WoS, Scopus, Ovid [MEDLINE], and Google Scholar). The search yielded 1871 results. Abstracts and full texts were screened by 2 reviewers (MK and IM) independently using the inclusion and exclusion criteria. The inclusion criteria comprised studies published since 2010 that used off-the-shelf wearables that were neither invasive nor obtrusive to the user in the setting of climate change–related weather extremes. Data were charted using a structured form, and the study outcomes were narratively synthesized.
Results
The review included 55,284 study participants using wearables in 53 studies. Most studies were conducted in upper–middle-income and high-income countries (50/53, 94%) in urban environments (25/53, 47%) or in a climatic chamber (19/53, 36%) and assessed the health effects of heat exposure (52/53, 98%). The majority reported adverse health effects of heat exposure on sleep, physical activity, and heart rate. The remaining studies assessed occupational heat stress or compared individual- and area-level heat exposure. In total, 26% (14/53) of studies determined that all examined wearables were valid and reliable for measuring health parameters during heat exposure when compared with standard methods.
Conclusions
Wearables have been used successfully in large-scale research to measure the health implications of climate change–related weather extremes. More research is needed in low-income countries and vulnerable populations with pre-existing conditions. In addition, further research could focus on the health impacts of other climate change–related conditions and the effectiveness of adaptation measures at the individual level to such weather extremes.
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Affiliation(s)
- Mara Koch
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Ina Matzke
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Sophie Huhn
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Hanns-Christian Gunga
- Charité - Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environment Berlin, Berlin, Germany
| | - Martina Anna Maggioni
- Charité - Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environment Berlin, Berlin, Germany
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | | | - David Obor
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Ali Sié
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Centre de Recherche en Santé, Nouna, Burkina Faso
| | | | - Aditi Bunker
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Peter Dambach
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Sandra Barteit
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
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12
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Gnugesser E, Chwila C, Brenner S, Deckert A, Dambach P, Steinert JI, Bärnighausen T, Horstick O, Antia K, Louis VR. The economic burden of treating uncomplicated hypertension in Sub-Saharan Africa: a systematic literature review. BMC Public Health 2022; 22:1507. [PMID: 35941626 PMCID: PMC9358363 DOI: 10.1186/s12889-022-13877-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background and Objectives Hypertension is one of the leading cardiovascular risk factors with high numbers of undiagnosed and untreated patients in Sub Saharan Africa (SSA). The health systems and affected people are often overwhelmed by the social and economic burden that comes with the disease. However, the research on the economic burden and consequences of hypertension treatment remains scare in SSA. The objective of our review was to compare different hypertension treatment costs across the continent and identify major cost drivers. Material and Methods Systematic literature searches were conducted in multiple databases (e.g., PubMed, Web of Science, Google Scholar) for peer reviewed articles written in English language with a publication date from inception to Jan. 2022. We included studies assessing direct and indirect costs of hypertension therapy in SSA from a provider or user perspective. The search and a quality assessment were independently executed by two researchers. All results were converted to 2021 US Dollar. Results Of 3999 results identified in the initial search, 33 were selected for data extraction. Costs differed between countries, costing perspectives and cost categories. Only 25% of the SSA countries were mentioned in the studies, with Nigeria dominating the research with a share of 27% of the studies. We identified 15 results each from a user or provider perspective. Medication costs were accountable for the most part of the expenditures with a range from 1.70$ to 97.06$ from a patient perspective and 0.09$ to 193.55$ from a provider perspective per patient per month. Major cost drivers were multidrug treatment, inpatient or hospital care and having a comorbidity like diabetes. Conclusion Hypertension poses a significant economic burden for patients and governments in SSA. Interpreting and comparing the results from different countries and studies is difficult as there are different financing methods and cost items are defined in different ways. However, our results identify medication costs as one of the biggest cost contributors. When fighting the economic burden in SSA, reducing medication costs in form of subsidies or special interventions needs to be considered. Trial registration Registration: PROSPERO, ID CRD42020220957. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13877-4.
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Affiliation(s)
- E Gnugesser
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - C Chwila
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - S Brenner
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - A Deckert
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - P Dambach
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - J I Steinert
- TUM School of Social Sciences and Technology, Technical University of Munich, Munich, Germany
| | - T Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - O Horstick
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - K Antia
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - V R Louis
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany.
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13
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Liu W, He MZ, Dambach P, Schwertz R, Chen S, Yu F, Marx M. Trends of overweight and obesity among preschool children from 2013 to 2018: a cross-sectional study in Rhine-Neckar County and the City of Heidelberg, Germany. BMC Public Health 2022; 22:941. [PMID: 35538526 PMCID: PMC9092815 DOI: 10.1186/s12889-022-13302-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/20/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Early childhood overweight and obesity is a growing public health concern worldwide. Few recent studies have addressed how time trends varied by sociodemographic characteristics at the regional level using large and high-quality data. This study determines how time trends vary in the prevalence of early childhood overweight and obesity by age, gender, and migration background at the regional level. METHODS We used a Kernel-density curve to describe the BMI distribution, and evaluated the trends of overweight and obesity by age, gender, and migration background using logistic regression. RESULTS Mean BMI and the overall prevalence of overweight and obesity increased among preschool children aged 4-6 years in the Rhine-Neckar County and the City of Heidelberg. After adjusting for age, sex, and migration background, trends of overweight significantly increased only among male children in the age 5 year group with migration background (P < 0.05), and an upward trend of obesity was observed only among male children in the age 5 year group and female children in the age 6 year group with migration background (P < 0.05). CONCLUSIONS BMI distribution as well as general prevalence of overweight and obesity are still increasing among preschool children. Children with migration backgrounds, particularly male children in the age 5 year groups and female children in the age 6 year group should be prioritized. Health promotion strategies for children with migration backgrounds will help address this challenge.
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Affiliation(s)
- Weina Liu
- grid.7700.00000 0001 2190 4373Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health (HIGH), Heidelberg University, Im Neuenheimer Feld 130, Heidelberg, Germany ,Jiangsu Province Center for Disease Control and Prevention, Nanjing, China
| | - Mike Z. He
- grid.59734.3c0000 0001 0670 2351Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Peter Dambach
- grid.7700.00000 0001 2190 4373Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health (HIGH), Heidelberg University, Im Neuenheimer Feld 130, Heidelberg, Germany
| | - Rainer Schwertz
- Public Health Authority of Rhein-Neckar-Kreis, Heidelberg, Germany
| | - Simiao Chen
- grid.7700.00000 0001 2190 4373Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health (HIGH), Heidelberg University, Im Neuenheimer Feld 130, Heidelberg, Germany ,grid.506261.60000 0001 0706 7839Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengyun Yu
- grid.7700.00000 0001 2190 4373Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health (HIGH), Heidelberg University, Im Neuenheimer Feld 130, Heidelberg, Germany ,grid.506261.60000 0001 0706 7839Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Michael Marx
- grid.7700.00000 0001 2190 4373Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health (HIGH), Heidelberg University, Im Neuenheimer Feld 130, Heidelberg, Germany
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14
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Wasko Z, Dambach P, Kynast-Wolf G, Stieglbauer G, Zabré P, Bagagnan C, Schoeps A, Souares A, Winkler V. Ethnic diversity and mortality in northwest Burkina Faso: An analysis of the Nouna health and demographic surveillance system from 2000 to 2012. PLOS Glob Public Health 2022; 2:e0000267. [PMID: 36962189 PMCID: PMC10021188 DOI: 10.1371/journal.pgph.0000267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/30/2022] [Indexed: 11/18/2022]
Abstract
Ethnic diversity has been a topic of contention across the globe, contrasted with economic development, social security, and political stability. The link between health and ethnic diversity is not yet well established especially in low-middle- income countries. Our study aims to explore the association between ethnic diversity and all-cause mortality in rural areas of Burkina Faso. We used data from the Nouna Health & Demographic Surveillance System (HDSS) collected between 2000 and 2012. To derive Standardized Mortality Ratios (SMR), the observed number of deaths was compared to the expected deaths based on the entire HDSS taking into account sex, age, rainy season, calendar year, and village. SMR were calculated for ethnic and religious diversity on a village level (using the Simpson Index), sub-region, wealth, and distance to Healthcare Facilities (HCF). Furthermore, we modeled SMR with a multilevel random intercept Poisson regression considering individual ethnic and religious groups in addition to the above-mentioned village-level information. Village wealth (poorest fifth: SMR 1.07; 95% CI: 1.02-1.13, richest fifth: SMR 0.85; 95% CI: 0.82-0.88), distance to HCF (within the village: SMR 0.88; 95% CI: 0.85-0.91, further than 5km: SMR 1.13; 95% CI: 1.10-1.16), and sub-region showed significant associations with overall mortality. Villages belonging to the third with the highest ethnic diversity had lowered SMR (0.86; 95% CI: 0.84-0.89) compared to the entire HDSS, while those belonging to the lowest diversity third yielded elevated SMR (1.13; 95% CI: 1.09-1.17). The multilevel model confirmed the association. Our study showed that historically established ethnic diversity in rural areas of Burkina Faso was associated with lower all-cause mortality. Generally, the literature suffers from a lack of standardization in defining ethnic diversity, along with measuring it. More research is needed to understand this relation and to establish it in different settings.
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Affiliation(s)
- Zahia Wasko
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Baden Württemberg, Germany
| | - Peter Dambach
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Baden Württemberg, Germany
| | - Gisela Kynast-Wolf
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Baden Württemberg, Germany
| | - Gabriele Stieglbauer
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Baden Württemberg, Germany
| | - Pascal Zabré
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Baden Württemberg, Germany
- Health & Demographic Surveillance System, Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Cheik Bagagnan
- Health & Demographic Surveillance System, Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Anja Schoeps
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Baden Württemberg, Germany
| | - Aurélia Souares
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Baden Württemberg, Germany
| | - Volker Winkler
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Baden Württemberg, Germany
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15
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Mahanani MR, Abderbwih E, Wendt AS, Deckert A, Antia K, Horstick O, Dambach P, Kohler S, Winkler V. Long-Term Outcomes of in Utero Ramadan Exposure: A Systematic Literature Review. Nutrients 2021; 13:nu13124511. [PMID: 34960063 PMCID: PMC8704584 DOI: 10.3390/nu13124511] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 11/21/2022] Open
Abstract
Health outcomes of in utero Ramadan exposure have been reported in a systematic literature review; however, the available literature on long-term effects were not fully covered. Our study aims to specifically review the long-term outcomes of in utero Ramadan exposure. We searched for original research articles analyzing any long-term outcome of in utero Ramadan exposure, excluding maternal and perinatal outcomes. Sixteen studies from 8304 non-duplicate search results were included. Most studies suggest negative consequences from in utero Ramadan exposure on health, as well as on economic outcomes later in adulthood. Higher under-five mortality rate, higher mortality under three months, and under one year, shorter stature, lower body mass index, increased incidence of vision, hearing and learning disabilities, lower mathematics, writing and reading scores, as well as a lower probability to own a home were associated with Ramadan exposure during conception or the first trimester of pregnancy. Furthermore, age and sex seem to play a pivotal role on the association. Existing studies suggest that in utero Ramadan exposure may adversely impact long-term health and economic well-being. However, evidence is limited. Meanwhile, increasing awareness of the potential risks of Ramadan fasting during pregnancy should be raised among pregnant women and clinicians and other antenatal care workers should promote better maternal healthcare.
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Affiliation(s)
- Melani R. Mahanani
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.R.M.); (E.A.); (A.D.); (K.A.); (O.H.); (P.D.); (S.K.)
| | - Eman Abderbwih
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.R.M.); (E.A.); (A.D.); (K.A.); (O.H.); (P.D.); (S.K.)
| | - Amanda S. Wendt
- Potsdam Institute for Climate Impact Research, Member of the Leibniz Association, P.O. Box 601203, 14412 Potsdam, Germany;
| | - Andreas Deckert
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.R.M.); (E.A.); (A.D.); (K.A.); (O.H.); (P.D.); (S.K.)
| | - Khatia Antia
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.R.M.); (E.A.); (A.D.); (K.A.); (O.H.); (P.D.); (S.K.)
| | - Olaf Horstick
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.R.M.); (E.A.); (A.D.); (K.A.); (O.H.); (P.D.); (S.K.)
| | - Peter Dambach
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.R.M.); (E.A.); (A.D.); (K.A.); (O.H.); (P.D.); (S.K.)
| | - Stefan Kohler
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.R.M.); (E.A.); (A.D.); (K.A.); (O.H.); (P.D.); (S.K.)
| | - Volker Winkler
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.R.M.); (E.A.); (A.D.); (K.A.); (O.H.); (P.D.); (S.K.)
- Correspondence: ; Tel.: +49-6221-56-5031
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16
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Mahanani MR, Abderbwih E, Wendt AS, Deckert A, Antia K, Horstick O, Dambach P, Kohler S, Winkler V. Long-term outcomes of in utero Ramadan exposure: a systematic review. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Previous systematic reviews have documented perinatal health effects of in utero Ramadan exposure on children. Our study aims to review possible long-term consequences.
Methods
Following PRISMA guideline, we searched PubMed, PsycINFO, EconLit, Index Islamicus, Web of Science, Cochrane Library, WHO Global Index Medicus, WHO Virtual Health Library and Google Scholar for original research articles analysing any long-term outcome of in utero Ramadan exposure, excluding maternal and perinatal outcomes.
Results
Fourteen studies from 4874 non-duplicate search results were included. Most studies suggest negative consequences from in utero Ramadan exposure on health as well as on economic outcomes later in adulthood. Higher under-five mortality rate, higher mortality under three months and under one year, shorter stature, lower body mass index, increased incidence of vision, hearing and learning disabilities, lower math, writing and reading scores, as well as lower probability to own a home were associated with Ramadan exposure during conception or first trimester of pregnancy. Further, age and sex of the child seem to play a pivotal role on the association.
Conclusions
Existing studies suggest that in utero Ramadan exposure may adversely impact long-term health and economic well-being. However, evidence is limited. Meanwhile, increasing awareness of the potential risks of Ramadan fasting during pregnancy should be raised among pregnant women and clinicians and other antenatal care workers should promote better maternal healthcare.
Key messages
In utero Ramadan exposure may adversely impact long-term health and economic well-being. Some negative effects are observed particularly when Ramadan occurred during the first trimester of pregnancy.
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Affiliation(s)
- MR Mahanani
- Heidelberg Institute of Global Health, Heidelberg, Germany
| | - E Abderbwih
- Heidelberg Institute of Global Health, Heidelberg, Germany
| | - AS Wendt
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - A Deckert
- Heidelberg Institute of Global Health, Heidelberg, Germany
| | - K Antia
- Heidelberg Institute of Global Health, Heidelberg, Germany
| | - O Horstick
- Heidelberg Institute of Global Health, Heidelberg, Germany
| | - P Dambach
- Heidelberg Institute of Global Health, Heidelberg, Germany
| | - S Kohler
- Heidelberg Institute of Global Health, Heidelberg, Germany
| | - V Winkler
- Heidelberg Institute of Global Health, Heidelberg, Germany
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17
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Wasko Z, Dambach P, Kynsat-Wolf G, Steiglbauer G, Zabré P, Bagagnan CH, Schoeps A, Souares A, Winkler V. Ethnic diversity and mortality in northwestern Burkina Faso: a cohort analysis from 2000 to 2012. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Ethnic diversity has been a topic of contention across the globe, contrasted with economic development, social security, and political stability. The link between health and ethnic diversity is not yet well established. This study aims to explore the association between ethnic diversity and all-cause mortality.
Methods
We used data from the Nouna Health & Demographic Surveillance System (HDSS) collected between 2000 and 2012. To derive Standardized Mortality Ratios (SMR), the observed number of deaths for each village was compared to the expected deaths based on the whole HDSS accounting for sex, age, rainy season, calendar year, and village. SMR were calculated on a village level for ethnic diversity (using the Simpson Index), geographical region, wealth, distance to Healthcare Facility (HCF), and religious diversity (Simpson Index). Also, we modeled SMR with a multilevel random intercept Poisson model considering individual ethnic and religious groups in addition to the above-mentioned village-level information.
Results
Village wealth (poorest quintile: SMR 1.07; 95% CI: 1.02-1.13, richest quintile: SMR 0.85; 95% CI: 0.82-0.88), distance to HCF (within the village: SMR 0.88; 95% CI: 0.85-0.91, further than 5km: SMR 1.13; 95% CI: 1.10-1.16), and village geographical region showed significant associations with overall mortality. Villages in the high ethnic diversity tertile had a lowered SMR (0.86; 95% CI: 0.84-0.89) compared to the overall HDSS, while those with low diversity yielded an elevated SMR (1.13; 95% CI: 1.09-1.17). The multivariable model including all co-variables confirmed the association.
Conclusions
This study shows a link between ethnic diversity and health. Historically established ethnic diversity in rural areas of Burkina Faso is associated with lower all-cause mortality. A lack of standardization exists in defining and measuring ethnic diversity. More research is needed to understand this relation and to establish it in different settings.
Key messages
Ethnic diversity is potentially linked to health. Further studies in different settings are needed to fully understand the relation between ethnic diversity and health.
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Affiliation(s)
- Z Wasko
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - P Dambach
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - G Kynsat-Wolf
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - G Steiglbauer
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - P Zabré
- Demography and Data Management, Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - C H Bagagnan
- Demography and Data Management, Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - A Schoeps
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - A Souares
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - V Winkler
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
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18
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Agbaria N, Petzold S, Deckert A, Henschke N, Veronese G, Dambach P, Jaenisch T, Horstick O, Winkler V. Prevalence of post-traumatic stress disorder among Palestinian children and adolescents exposed to political violence: A systematic review and meta-analysis. PLoS One 2021; 16:e0256426. [PMID: 34437595 PMCID: PMC8389374 DOI: 10.1371/journal.pone.0256426] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 08/06/2021] [Indexed: 11/19/2022] Open
Abstract
Objective We undertook a systematic review of the literature to explore the prevalence of post-traumatic stress disorder (PTSD) in Palestinian children and adolescents exposed to political violence. This is the first systematic review and meta-analysis of the prevalence of PTSD in this population. Methods PubMed, Embase, PsycInfo, Google Scholar and Cochrane library were searched until June 2020. To estimate the prevalence of PTSD, sub-group and meta-analysis were conducted. Results The search resulted in 2786 studies, of which 28 articles representing 32 samples with a total of 15,121 participants from Gaza Strip and West Bank met either the DSM-4 or DSM-5 criteria and were included. The pooled prevalence of PTSD was 36% (95% CI 30–41%; I2 98.6%) and ranged from 6% to 70%. Sub-group analysis showed that the PTSD prevalence did not differ according to region (West Bank, Gaza Strip) and tended to decrease after including only studies using a representative sample (p<0.001), and among those with low risk of bias (p<0.001). Visual inspection of the included studies revealed significant discrepancies in study design and assessment measures. Conclusion We identified high prevalence of PTSD among Palestinian children and adolescents exposed to political violence. However, the pooled results should be interpreted with caution, due to the high heterogeneity and risk of bias in the included studies. These limitations also reflect the challenge in conceptualizing and measuring PTSD in the Palestinian context with a background of continuous and cumulative trauma. Understanding the contextual factors and developing locally adapted survey measures are of relevance to future research, public health planning, and the provision of mental healthcare in Palestine.
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Affiliation(s)
- Nisreen Agbaria
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
- * E-mail:
| | - Stephanie Petzold
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
| | - Andreas Deckert
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
| | - Nicholas Henschke
- Institute for Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Guido Veronese
- Department of Human Sciences & Education, University of Milano-Bicocca, Milan, Italy
| | - Peter Dambach
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
| | - Thomas Jaenisch
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
- Section Clinical Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Centre for Global Health, Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Olaf Horstick
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
| | - Volker Winkler
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
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19
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Brown Wilson J, Deckert A, Shah R, Kyei N, Copeland Dahn L, Doe-Rogers R, Hinneh AB, Johnson LW, Natt GD, Verdier JA, Vosper A, Louis VR, Dambach P, Thomas-Connor I. COVID-19-related knowledge, attitudes and practices: a mixed-mode cross-sectional survey in Liberia. BMJ Open 2021; 11:e049494. [PMID: 34315797 PMCID: PMC8318717 DOI: 10.1136/bmjopen-2021-049494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To examine the knowledge, attitudes and practices (KAP) of COVID-19 of rural and urban residents in Liberia to inform the development of local social and behaviour change communication strategies. DESIGN Cross-sectional, mixed-mode (online and telephone) survey using non-probability sampling. SETTING All 15 counties in Liberia with a focus on Maryland County. PARTICIPANTS From 28 May to 28 June 2020, data were collected from a total of 431 adults aged 18 years and older (telephone 288 (66.8%); online 143 (33.2%)) out of a total of 741 contacts. MAIN OUTCOME MEASURES KAP scores. Frequencies and proportions were calculated, followed by univariate and multivariable analyses to examine the association between KAP scores and the sociodemographic variables. RESULTS Around 69% of the online survey respondents were younger than 35 years of age, compared with 56% in the telephone interviews. The majority (87%) of online respondents had completed tertiary education, compared with 77% of the telephone respondents. Male participants, on average, achieved higher knowledge (52%) and attitude scores (72%), in contrast to females (49% and 67%, respectively). Radio (71%) was the most cited source for COVID-19 information, followed by social media (63%). After controlling for sociodemographic variables, adaptive regression modelling revealed that survey mode achieved 100% importance for predicting knowledge and practice levels with regard to COVID-19. CONCLUSIONS The survey population demonstrated moderate COVID-19 knowledge, with significant differences between survey mode and educational level. Correct knowledge of COVID-19 was associated with appropriate practices in Maryland County. Generalisation of survey findings must be drawn carefully owing to the limitations of the sampling methods. Yet, given the differences in knowledge gaps between survey modes, sex, education, occupation and place of residence, it is recommended that information is tailored to different audiences.
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Affiliation(s)
| | - Andreas Deckert
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Rupal Shah
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Nicholas Kyei
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | | | | | | | | | - Gudgy Dweh Natt
- Public Health, William VS Tubman University, Harper, Liberia
| | | | | | - Valérie R Louis
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Peter Dambach
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
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20
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Liu W, Schwertz R, Welker A, Welker J, Chen S, Dambach P, Marx M. Associations between BMI and visual impairment of 33 407 preschool children in Germany: a pooled cross-sectional study. Eur J Public Health 2021; 31:105-111. [PMID: 33111144 DOI: 10.1093/eurpub/ckaa185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Prevalence of overweight and obesity in Germany is increasing. High body weight can affect children's growth and development. This paper aimed to determine the association between body mass index (BMI) and visual impairment among preschool children and explore the potential role of obesity in predicting visual developmental disorder. METHODS Six consecutive years of data from the School Entry Examination were collected for all preschool children aged from 4 to 6 years residing in Rhine-Neckar County and the City of Heidelberg, Germany from 2013 to 2018. Univariate and multivariate regression were used to analyze the complete data, multiple imputation was used to deal with missing data. RESULTS Among the group with an immigrant background, children with obesity [OR = 1.20, 99% (1.02-1.42)] were more likely to have visual impairment compared to those with normal body weight (P < 0.01) after adjusting for survey year, age, and gender of children, education and occupation of parents, screen time-frequency, whether a television was in their bedroom, and quality of preschool outdoor environment. CONCLUSION There were significant associations between obesity and visual impairment among German preschool children with immigrant backgrounds. Strategies to support vulnerable groups were needed across all regional schools.
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Affiliation(s)
- Weina Liu
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.,Jiangsu Province Center for Disease Control and Prevention, Nanjing, China
| | - Rainer Schwertz
- Public Health Authority of Rhein-Neckar-Kreis, Heidelberg, Germany
| | - Andreas Welker
- Public Health Authority of Rhein-Neckar-Kreis, Heidelberg, Germany
| | - Judith Welker
- Public Health Authority of Rhein-Neckar-Kreis, Heidelberg, Germany
| | - Simiao Chen
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peter Dambach
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Michael Marx
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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21
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Dambach P, Bärnighausen T, Yadouleton A, Dambach M, Traoré I, Korir P, Ouedraogo S, Nikiema M, Sauerborn R, Becker N, Louis VR. Is biological larviciding against malaria a starting point for integrated multi-disease control? Observations from a cluster randomized trial in rural Burkina Faso. PLoS One 2021; 16:e0253597. [PMID: 34143831 PMCID: PMC8213177 DOI: 10.1371/journal.pone.0253597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/08/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives To evaluate the impact of anti-malaria biological larviciding with Bacillus thuringiensis israelensis on non-primary target mosquito species in a rural African setting. Methods A total of 127 villages were distributed in three study arms, each with different larviciding options in public spaces: i) no treatment, ii) full or iii) guided intervention. Geographically close villages were grouped in clusters to avoid contamination between treated and untreated villages. Adult mosquitoes were captured in light traps inside and outside houses during the rainy seasons of a baseline and an intervention year. After enumeration, a negative binomial regression was used to determine the reductions achieved in the different mosquito species through larviciding. Results Malaria larviciding interventions showed only limited or no impact against Culex mosquitoes; by contrast, reductions of up to 34% were achieved against Aedes when all detected breeding sites were treated. Culex mosquitoes were captured in high abundance in semi-urban settings while more Aedes were found in rural villages. Conclusions Future malaria larviciding programs should consider expanding onto the breeding habitats of other disease vectors, such as Aedes and Culex and evaluate their potential impact. Since the major cost components of such interventions are labor and transport, other disease vectors could be targeted at little additional cost.
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Affiliation(s)
- Peter Dambach
- Institute for Global Health, University Hospital Heidelberg, Heidelberg, Germany
- * E-mail:
| | - Till Bärnighausen
- Institute for Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Anges Yadouleton
- Centre de Recherche Entomologique de Cotonou (CREC), Cotonou, Benin
| | - Martin Dambach
- Institute of Zoology, University of Cologne, Cologne, Germany
| | - Issouf Traoré
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Patricia Korir
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | | | | | - Rainer Sauerborn
- Institute for Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Norbert Becker
- German Mosquito Control Association (KABS), Speyer, Germany
| | - Valérie R. Louis
- Institute for Global Health, University Hospital Heidelberg, Heidelberg, Germany
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22
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Schnieders E, Ünal E, Winkler V, Dambach P, Louis VR, Horstick O, Neuhann F, Deckert A. Performance of alternative COPD case-finding tools: a systematic review and meta-analysis. Eur Respir Rev 2021; 30:30/160/200350. [PMID: 34039672 DOI: 10.1183/16000617.0350-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/20/2021] [Indexed: 11/05/2022] Open
Abstract
RATIONALE Guidelines recommend pre-/post-bronchodilator spirometry for diagnosing COPD, but resource constraints limit the availability of spirometry in primary care in low- and middle-income countries. Although spirometry is the diagnostic gold standard, we shall assess alternative tools for settings without spirometry. METHODS A systematic literature review and meta-analysis was conducted, utilising Cochrane, CINAHL, Google Scholar, PubMed and Web of Science (search cut-off was May 01, 2020). Published studies comparing the accuracy of diagnostic tools for COPD with post-bronchodilator spirometry were considered. Studies without sensitivity/specificity data, without a separate validation sample and outside of primary care were excluded. Sensitivity, specificity and area under the curve (AUC) were assessed. RESULTS Of 7578 studies, 24 were included (14 635 participants). Hand devices yielded a larger AUC than questionnaires. The meta-analysis included 17 studies and the overall AUC of micro-spirometers (0.84, 95% CI 0.80-0.89) was larger when compared to the COPD population screener (COPD-PS) questionnaire (0.77, 95% CI 0.63-0.85) and the COPD diagnostic questionnaire (CDQ) (0.72, 95% CI 0.64-0.78). However, only the difference between micro-spirometers and the CDQ was significant. CONCLUSIONS The CDQ and the COPD-PS questionnaire were approximately equally accurate tools. Questionnaires ensured testing of symptomatic patients, but micro-spirometers were more accurate. A combination could increase accuracy but was not evaluated in the meta-analysis.
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Affiliation(s)
- Elena Schnieders
- Research to Practice Group, HIGH - Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Elyesa Ünal
- Research to Practice Group, HIGH - Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Volker Winkler
- Research to Practice Group, HIGH - Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Dambach
- Research to Practice Group, HIGH - Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Valérie R Louis
- Research to Practice Group, HIGH - Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Olaf Horstick
- Research to Practice Group, HIGH - Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Florian Neuhann
- Research to Practice Group, HIGH - Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany.,School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Andreas Deckert
- Research to Practice Group, HIGH - Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
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23
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Dambach P, Winkler V, Bärnighausen T, Traoré I, Ouedraogo S, Sié A, Sauerborn R, Becker N, Louis VR. Biological larviciding against malaria vector mosquitoes with Bacillus thuringiensis israelensis (Bti) - Long term observations and assessment of repeatability during an additional intervention year of a large-scale field trial in rural Burkina Faso. Glob Health Action 2021; 13:1829828. [PMID: 33028158 PMCID: PMC7580761 DOI: 10.1080/16549716.2020.1829828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The first line of malaria vector control to date mainly relies on the use of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS). For integrated vector management, targeting the vector larvae with biological larvicides such as Bacillus thuringiensis israelensis (Bti) can be an effective additional mainstay. This study presents data from the second intervention year of a large-scale trial on biological larviciding with Bti that was carried out in 127 rural villages and a semi-urban town in Burkina Faso. Here we present the reductions in malaria mosquitoes that were achieved by continuing the initial interventions for an additional year, important to assess sustainability and repeatability of the results from the first intervention year. Larviciding was performed applying two different larviciding choices ((a) treatment of all environmental breeding sites, and (b) selective treatment of those that were most productive for Anopheles larvae indicated by remote sensing based risk maps). Adult Anopheles spp. mosquito abundance was reduced by 77.4% (full treatment) and 63.5% (guided treatment) compared to the baseline year. The results showed that malaria vector abundance can be dramatically reduced using biological larviciding and that this effect can be achieved and maintained over several consecutive transmission seasons.
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Affiliation(s)
- Peter Dambach
- Institute of Global Health, University Hospital Heidelberg , Heidelberg, Germany
| | - Volker Winkler
- Institute of Global Health, University Hospital Heidelberg , Heidelberg, Germany
| | - Till Bärnighausen
- Institute of Global Health, University Hospital Heidelberg , Heidelberg, Germany
| | - Issouf Traoré
- Centre de Recherche en Santé de Nouna , Nouna, Burkina Faso
| | | | - Ali Sié
- Centre de Recherche en Santé de Nouna , Nouna, Burkina Faso
| | - Rainer Sauerborn
- Institute of Global Health, University Hospital Heidelberg , Heidelberg, Germany
| | - Norbert Becker
- German Mosquito Control Association (KABS) , Speyer, Germany
| | - Valérie R Louis
- Institute of Global Health, University Hospital Heidelberg , Heidelberg, Germany
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24
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Dambach P, Traoré I, Sawadogo H, Zabré P, Shukla S, Sauerborn R, Becker N, Phalkey R. Community acceptance of environmental larviciding against malaria with Bacillus thuringiensis israelensis in rural Burkina Faso - A knowledge, attitudes and practices study. Glob Health Action 2021; 14:1988279. [PMID: 34927578 PMCID: PMC8725727 DOI: 10.1080/16549716.2021.1988279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Malaria control is based on early treatment of cases and on vector control. The current measures for malaria vector control in Africa are mainly based on long-lasting insecticidal nets (LLINs) and to a much smaller extent on indoor residual spraying (IRS). While bed net use is widely distributed and its role is intensively researched, Bti-based larviciding is a relatively novel tool in Africa. In this study, we analyze the perception and acceptability of Bti-based larval source management under different larviciding scenarios that were performed in a health district in Burkina Faso. Objective To research people’s perception and acceptance regarding biological larviciding interventions against malaria in their communities. Methods A cross-sectional study was undertaken using a total of 634 administered questionnaires. Data were collected in a total of 36 rural villages and in seven town quarters of the semi-urban town of Nouna. Results Respondents had basic to good knowledge regarding malaria transmission and how to protect oneself against it. More than 90% reported sleeping under a bed net, while other measures such as mosquito coils and insecticides were only used by a minority. The majority of community members reported high perceived reductions in mosquito abundance and the number of malaria episodes. There was a high willingness to contribute financially to larviciding interventions among interviewees. Conclusions This study showed that biological larviciding interventions are welcomed by the population that they are regarded as an effective and safe means to reduce mosquito abundance and malaria transmission. A routine implementation would, despite low intervention costs, require community ownership and contribution.
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Affiliation(s)
- Peter Dambach
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Issouf Traoré
- Centre De Recherche En Santé De Nouna, Nouna, Burkina Faso.,Institut De Formations Initiale Et Continue, Université Thomas Sankara, Ouagadougou, Burkina Faso
| | | | - Pascal Zabré
- Centre De Recherche En Santé De Nouna, Nouna, Burkina Faso
| | - Sharvari Shukla
- Symbiosis Statistical Institute, Symbiosis International (Deemed University)
| | - Rainer Sauerborn
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Norbert Becker
- German Mosquito Control Association (KABS), Speyer, Germany.,Centre for Organismal Studies, University of Heidelberg, Heidelberg, Germany
| | - Revati Phalkey
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.,Epidemiology and Public Health Division, University of Nottingham, Nottingham, UK.,Climate Change and Health Group, Public Health England, Chilton, UK
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25
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Antia K, Boucsein J, Deckert A, Dambach P, Racaite J, Surkiene G, Jaenisch T, Horstick O, Winkler V. Impacts of international labor migration on the mental health and well-being of left-behind children. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Labor migration is a challenge for the globalised world due to its long-term effects such as the formation of transnational families with the particularly vulnerable groups of left-behind children (LBC). These families, where family members of migrant workers are 'left-behind' are becoming common practice in many developing countries. In this systematic literature review, we aimed to investigate the impacts of parental labor migration on the mental health and well-being of their LBC.
Methods
Following the PRISMA guidelines, we performed a systematic literature search in English using PubMed, PsychINFO, Web of Science, Cochrane Library and Google Scholar for studies, investigating mental health and well-being among LBC who live in transnational families. Case-reports, qualitative studies as well as opinion papers were excluded. We summarized the evidence and additionally compared quantitative results.
Results
25 studies were selected for the final analysis. We found that mental health and well-being outcomes of LBC differ across regions and sometimes even within regions. Only studies conducted in South America and South Asia observed purely negative effects. Overall, LBC show abnormal SDQ (Strengths and Difficulties Questionnaire) scores and report higher levels of depression and loneliness, than children who do not live in transnational families. Evidence suggests that gender of migrant parent, culture and other transnational family characteristics such as family arrangement, the role of the mother and the role of the father contribute to the well-being and psychological health of LBC.
Conclusions
International migration of parents has more negative than positive effects (e.g. through remittances) on the mental health and well-being of LBC. However, the effects strongly depend on family arrangements and care giving practices in migrants' sending countries.
Key messages
Further research utilizing longitudinal data is needed to better explore the complex and long-term effects of parental migration on LBC. Multidimensional family characteristics are crucial and should be better explored when examining the impacts of migratory separation on left-behind children.
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Affiliation(s)
- K Antia
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - J Boucsein
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - A Deckert
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - P Dambach
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - J Racaite
- Institute of Public Health, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - G Surkiene
- Institute of Public Health, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - T Jaenisch
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - O Horstick
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - V Winkler
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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26
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Antia K, Boucsein J, Deckert A, Dambach P, Račaitė J, Šurkienė G, Jaenisch T, Horstick O, Winkler V. Effects of International Labour Migration on the Mental Health and Well-Being of Left-Behind Children: A Systematic Literature Review. Int J Environ Res Public Health 2020; 17:ijerph17124335. [PMID: 32560443 PMCID: PMC7345580 DOI: 10.3390/ijerph17124335] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/04/2020] [Accepted: 06/15/2020] [Indexed: 01/23/2023]
Abstract
Labour migration is a challenge for the globalised world due to its long-term effects such as the formation of transnational families. These families, where family members of migrant workers are “left-behind”, are becoming a common phenomenon in many low- and middle-income countries. Our systematic literature review investigated the effects of international parental labour migration on the mental health and well-being of left-behind children. Following the PRISMA guidelines, we performed searches in PubMed, PsychINFO, Web of Science, Cochrane Library and Google Scholar, resulting in 30 finally included studies. We found that mental health and well-being outcomes of left-behind children differed across and sometimes even within regions. However, only studies conducted in the Americas and South Asia observed purely negative effects. Overall, left-behind children show abnormal Strengths and Difficulties Questionnaire scores and report higher levels of depression and loneliness than children who do not live in transnational families. Evidence from the studies suggests that gender of the migrant parent, culture and other transnational family characteristics contribute to the well-being and mental health of left-behind children. Further research utilising longitudinal data is needed to better understand the complex and lasting effects on left-behind children.
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Affiliation(s)
- Khatia Antia
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (J.B.); (A.D.); (P.D.); (T.J.); (O.H.); (V.W.)
- Correspondence: ; Tel.: +49-15227857798
| | - Johannes Boucsein
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (J.B.); (A.D.); (P.D.); (T.J.); (O.H.); (V.W.)
| | - Andreas Deckert
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (J.B.); (A.D.); (P.D.); (T.J.); (O.H.); (V.W.)
| | - Peter Dambach
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (J.B.); (A.D.); (P.D.); (T.J.); (O.H.); (V.W.)
| | - Justina Račaitė
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, M. K. Čiurlionio str. 21, LT-03101 Vilnius, Lithuania; (J.R.); (G.Š.)
| | - Genė Šurkienė
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, M. K. Čiurlionio str. 21, LT-03101 Vilnius, Lithuania; (J.R.); (G.Š.)
| | - Thomas Jaenisch
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (J.B.); (A.D.); (P.D.); (T.J.); (O.H.); (V.W.)
| | - Olaf Horstick
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (J.B.); (A.D.); (P.D.); (T.J.); (O.H.); (V.W.)
| | - Volker Winkler
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (J.B.); (A.D.); (P.D.); (T.J.); (O.H.); (V.W.)
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Dambach P, Mahenge B, Mashasi I, Muya A, Barnhart DA, Bärnighausen TW, Spiegelman D, Harling G. Socio-demographic characteristics and risk factors for HIV transmission in female bar workers in sub-Saharan Africa: a systematic literature review. BMC Public Health 2020; 20:697. [PMID: 32414352 PMCID: PMC7227324 DOI: 10.1186/s12889-020-08838-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 05/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Although sex workers are considered a key population in the HIV epidemic in sub-Saharan Africa (SSA), less consideration has been given to female bar workers (FBW), whose primary occupation is not sex work but who often engage in transactional sex. Understanding FBWs’ risk profiles is central to designing targeted HIV prevention interventions for them. This systematic review describes the socio-demographic characteristics and risk factors for HIV transmission among FBWs in SSA. Methods We searched six databases: PubMed, Google Scholar, Web of Science, Popline, Embase and additionally the World Health Organization’s WHOLIS database for grey literature between July and September 2017. Inclusion criteria were reporting (1) primary socio-demographic or behavioral data; on (2) women who sold or delivered drinks to clients; (3) in establishments serving alcohol; (4) in SSA. We excluded studies not presenting separate data on FBWs. We extracted quantitative and qualitative data from the selected studies and conducted a qualitative synthesis of findings. Results We found 4565 potentially eligible articles, including duplicates. After applying inclusion and exclusion criteria, we retained 19 articles. FBWs often migrated from rural to urban areas due to economic need or social marginalization. They began bar-based transactional sex due to low wages, peer pressure and to increase financial independence. FBWs had high HIV risk awareness but low agency to negotiate condom use, particularly with regular partners or when offered higher prices for condomless sex. FBWs were also vulnerable to violence and stigmatization. Conclusions FBWs are a vulnerable population for HIV infection. Despite social stigmatization and elevated risk of contracting STIs, bar work remains attractive because it enables unskilled women to both, make a living and maintain some independence. FBWs face HIV-related risk factors at the individual, community and societal level and may benefit from biomedical, behavioral and structural interventions.
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Affiliation(s)
- Peter Dambach
- Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
| | | | - Irene Mashasi
- Management and Development for Health (MDH), Dar es Salaam City Council, Dar es Salaam, Tanzania
| | - Aisa Muya
- Management and Development for Health (MDH), Dar es Salaam City Council, Dar es Salaam, Tanzania
| | - Dale A Barnhart
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Till W Bärnighausen
- Institute of Global Health, University of Heidelberg, Heidelberg, Germany.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Donna Spiegelman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Biostatistics and Nutrition Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Center for Methods of Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA.,Department of Biostatistics and Center for Methods on Implementation and Prevention Science, Yale University, New Haven, USA
| | - Guy Harling
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Africa Health Research Institute, KwaZulu-Natal, South Africa.,Institute for Global Health, University College London, London, UK.,MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
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Dambach P, Baernighausen T, Traoré I, Ouedraogo S, Sié A, Sauerborn R, Becker N, Louis VR. Reduction of malaria vector mosquitoes in a large-scale intervention trial in rural Burkina Faso using Bti based larval source management. Malar J 2019; 18:311. [PMID: 31521176 PMCID: PMC6744650 DOI: 10.1186/s12936-019-2951-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/07/2019] [Indexed: 11/21/2022] Open
Abstract
Background Malaria remains one of the most important causes of morbidity and death in sub-Saharan Africa. Along with early diagnosis and treatment of malaria cases and intermittent preventive treatment in pregnancy (IPTp), vector control is an important tool in the reduction of new cases. Alongside the use of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), targeting the vector larvae with biological larvicides, such as Bacillus thuringiensis israelensis (Bti) is gaining importance as a means of reducing the number of mosquito larvae before they emerge to their adult stage. This study presents data corroborating the entomological impact of such an intervention in a rural African environment. Methods The study extended over 2 years and researched the impact of biological larviciding with Bti on malaria mosquitoes that were caught indoors and outdoors of houses using light traps. The achieved reductions in female Anopheles mosquitoes were calculated for two different larviciding choices using a regression model. Results In villages that received selective treatment of the most productive breeding sites, the number of female Anopheles spp. dropped by 61% (95% CI 54–66%) compared to the pre-intervention period. In villages in which all breeding sites were treated, the number of female Anopheles spp. was reduced by 70% (95% CI 64–74%) compared to the pre-intervention period. Conclusion It was shown that malaria vector abundance can be dramatically reduced through larviciding of breeding habitats and that, in many geographical settings, they are a viable addition to current malaria control measures.
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Affiliation(s)
- Peter Dambach
- Institute of Public Health, University Hospital Heidelberg, 69120, Heidelberg, Germany.
| | - Till Baernighausen
- Institute of Public Health, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Issouf Traoré
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Rainer Sauerborn
- Institute of Public Health, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Norbert Becker
- German Mosquito Control Association (KABS), 67346, Speyer, Germany
| | - Valérie R Louis
- Institute of Public Health, University Hospital Heidelberg, 69120, Heidelberg, Germany
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Barnhart DA, Harling G, Muya A, Ortblad KF, Mashasi I, Dambach P, Ulenga N, Mboggo E, Oldenburg CE, Bärnighausen TW, Spiegelman D. Structural, interpersonal, psychosocial, and behavioral risk factors for HIV acquisition among female bar workers in Dar es Salaam, Tanzania. AIDS Care 2019; 31:1096-1105. [PMID: 31079476 PMCID: PMC6657807 DOI: 10.1080/09540121.2019.1612018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
Abstract
In sub-Saharan Africa, female bar workers (FBWs) often serve as informal sex workers. Little is known about the prevalence of HIV and HIV-related risk factors among FBWs in Dar es Salaam (DSM), Tanzania. Using an adapted Structural HIV Determinants Framework, we identified structural, interpersonal, psychosocial, and behavioral risk factors for HIV acquisition. We compared the prevalence of HIV and HIV-related risk factors among a random sample of 66 FBWs from DSM to an age-standardized, representative sample of female DSM-residents from the 2016 Demographic and Health and 2011-2012 AIDS Indicator Surveys. Compared to other women in DSM, FBWs had elevated prevalence of all four groups of risk factors. Key risk factors included gender and economic inequalities (structural); sexual violence and challenges negotiating condom use (interpersonal); depression, post-traumatic stress disorder, and low social support (psychosocial); and history of unprotected sex, multiple sex partners, and high alcohol consumption (behavioral). HIV prevalence did not differ between FBWs (7.1%, 95% CI 3.7-13.3%) and survey respondents (7.7%, 95% CI: 5.3-11.1%), perhaps due to FBWs' higher - though sub-optimal - engagement with HIV prevention strategies. Elevated exposure to HIV-related risk factors but low HIV prevalence suggests economic, psychosocial, and biomedical interventions may prevent HIV among FBWs in DSM.
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Affiliation(s)
- Dale A Barnhart
- a Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , USA
| | - Guy Harling
- a Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , USA
- b Institute for Global Health , University College London , London , UK
- c Africa Health Research Institute , KwaZulu-Natal , South Africa
| | - Aisa Muya
- d Amref Health Africa , Dar es Salaam , Tanzania
- e Management and Development for Health , Dar es Salaam , Tanzania
| | - Katrina F Ortblad
- f Department of Global Health , University of Washington , Seattle , USA
| | - Irene Mashasi
- e Management and Development for Health , Dar es Salaam , Tanzania
| | - Peter Dambach
- g Institute of Public Health , University of Heidelberg , Heidelberg , Germany
| | - Nzovu Ulenga
- e Management and Development for Health , Dar es Salaam , Tanzania
| | - Eric Mboggo
- e Management and Development for Health , Dar es Salaam , Tanzania
| | - Catherine E Oldenburg
- h Francis I. Proctor Foundation , University of California , San Francisco , USA
- i Department of Ophthalmology , University of California , San Francisco , USA
- j Department of Epidemiology and Biostatistics , University of California , San Francisco , USA
| | - Till W Bärnighausen
- c Africa Health Research Institute , KwaZulu-Natal , South Africa
- g Institute of Public Health , University of Heidelberg , Heidelberg , Germany
- k Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , USA
| | - Donna Spiegelman
- l Departments of Epidemiology, Biostatistics, Nutrition, and Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , USA
- m Center for Methods in Implementation and Prevention Science , Yale School of Public Health , New Haven , USA
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Harling G, Muya A, Ortblad KF, Mashasi I, Dambach P, Ulenga N, Barnhart D, Mboggo E, Oldenburg CE, Bärnighausen T, Spiegelman D. HIV risk and pre-exposure prophylaxis interest among female bar workers in Dar es Salaam: cross-sectional survey. BMJ Open 2019; 9:e023272. [PMID: 30898799 PMCID: PMC6475445 DOI: 10.1136/bmjopen-2018-023272] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Female bar workers (FBW) in East Africa often conduct sex work to supplement their incomes, and may be vulnerable to HIV acquisition. Pre-exposure prophylaxis (PrEP) offers protection against HIV acquisition. However, there is little research on FBW's sexual health. Our objective was to determine HIV risk behaviours and interest in PrEP among FBW in the largest city in East Africa. DESIGN Cross-sectional survey covering respondents' work and personal lives, including social and behavioural risk factors for HIV. The survey aimed to determine the feasibility of working with FBW and HIV prevalence estimates. Those who did not report being HIV positive were asked about their knowledge of and interest in PrEP. All women were offered free on-site HIV testing and counselling (HTC). SETTING Eight randomly selected workplaces, that is, bars, in Kinondoni district, Dar es Salaam (DSM). PARTICIPANTS 66 FBW (≥18 years) selected at random from all women working in selected bars on the day of visit. RESULTS Half of respondents reported having had sex for money: 20% with bar clients only, 15% with other men only and 15% with both. Almost all (98%) reported ≥1 non-commercial partners in the past 12 months; only 30% reported using condoms with these partners. 85% of respondents had ever been pregnant; 44% had had an unintended pregnancy. Only 5% of respondents had ever heard of PrEP. However, 54% were somewhat/very interested in daily-pill PrEP and 79% were somewhat/very interested in long-acting injectable PrEP. When asked to rank modalities, long-acting injectable PrEP was the most preferred. Seven per cent of the 56 respondents who completed HTC tested HIV positive. CONCLUSIONS FBW in DSM have elevated risk factors for HIV acquisition, and PrEP appears highly acceptable. Studies developing PrEP delivery models and assessing PrEP initiation and adherence in FBW appear warranted.
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Affiliation(s)
- Guy Harling
- Institute for Global Health, University College London, London, UK
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Aisa Muya
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Katrina F Ortblad
- International Clinical Research Center, University of Washington, Seattle, Washington, USA
| | - Irene Mashasi
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Peter Dambach
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Dale Barnhart
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Eric Mboggo
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Departments of Ophthalmology & Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Till Bärnighausen
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Donna Spiegelman
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, USA
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Dambach P, Schleicher M, Korir P, Ouedraogo S, Dambach J, Sié A, Dambach M, Becker N. Nightly Biting Cycles of Anopheles Species in Rural Northwestern Burkina Faso. J Med Entomol 2018; 55:1027-1034. [PMID: 29635478 PMCID: PMC6025195 DOI: 10.1093/jme/tjy043] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Indexed: 06/08/2023]
Abstract
The biting behavior of anophelines is an important determinant of malaria transmission. Understanding the local vector host-seeking behavior, its outdoor/ indoor biting preference, and nocturnal biting periods is essential for effectively applying and improving vector control methods, such as Long Lasting Insecticidal Nets (LLINs) and personal protective measures. To better understand the biting and host-seeking patterns of Anopheles mosquitoes in Northwestern Burkina Faso, we performed biweekly Human Landing Catches (HLC) in six villages during the period of highest mosquito abundance and malaria transmission. We applied a negative binomial regression framework to statistically analyze the host-seeking activities of Anopheles species and test for differences across hours, months, and villages, as well as for differences between indoor and outdoor capture points. Anopheles gambiae s.l. was identified as the main malaria vector in this region, representing about 90% of the total anopheline population. Biting activity was significantly different across hours and showed a peaked plateau between 2000 and 0200 hours. Differences in the pattern of biting cycles were observed between the early and late rainy season. This study shows that anopheline biting activity in Northwest Burkina Faso is high throughout the night, at indoor and outdoor posts alike. Consequently, bed nets alone may not provide sufficient protection against early biting anophelines and should be complemented with additional strategies such as indoor residual spraying (IRS) and larval source management (LSM) to meet the WHO's ambitious goals that are reflected in the global technical malaria strategy for 2030.
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Affiliation(s)
- Peter Dambach
- Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld Heidelberg, Germany
| | - Michael Schleicher
- Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld Heidelberg, Germany
| | - Patricia Korir
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | | | | | - Ali Sié
- Zoological Research Museum Alexander Koenig, Bonn, Germany
| | - Martin Dambach
- Institute for Zoology, Department of Biology, University of Cologne, Cologne, Germany
| | - Norbert Becker
- German Mosquito Control Association (KABS), Speyer, Germany
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Dambach P, Traoré I, Kaiser A, Sié A, Sauerborn R, Becker N. Challenges of implementing a large scale larviciding campaign against malaria in rural Burkina Faso - lessons learned and recommendations derived from the EMIRA project. BMC Public Health 2016; 16:1023. [PMID: 27686125 PMCID: PMC5041282 DOI: 10.1186/s12889-016-3587-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 08/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent malaria control and elimination attempts show remarkable success in several parts of sub-Saharan Africa. Vector control via larval source management represents a new and to date underrepresented approach in low income countries to further reduce malaria transmission. Although the positive impact of such campaigns on malaria incidence has been researched, there is a lack of data on which prerequisites are needed for implementing such programs on a routine basis on large scale. Our objectives are to point out important steps in implementing an anti-malaria larviciding campaign in a resource and infrastructure restraint setting and share the lessons learned from our experience during a three-year intervention study in rural Burkina Faso. METHODS We describe the approaches we followed and the challenges that have been encountered during the EMIRA project, a three-year study on the impact of environmental larviciding on vector ecology and human health. An inventory of all performed work packages and associated problems and peculiarities was assembled. RESULTS Key to the successful implementation of the larviciding program within a health district was the support and infrastructure from the local research center run by the government. This included availability of trained scientific personnel for local project management, data collection and analysis by medical personnel, entomologists and demographers and teams of fieldworkers for the larviciding intervention. A detailed a priori assessment of the environment and vector breeding site ecology was essential to calculate personnel requirements and the need for larvicide and application apparel. In our case of a three-year project, solid funding for the whole duration was an important issue, which restricted the number of possible donors. We found the acquisition of qualified field personnel in fair numbers not to be always easy and training in application techniques and basic entomologic knowledge required several weeks of theoretical and practical formation. A further crucial point was to establish an effective quality control system that ensured the timely verification of larviciding success and facilitated in time data handling. While the experiences of running a larviciding campaign may vary globally, the experiences gained and the methods used in the Nouna health district may be employed in similar settings. CONCLUSIONS Our observations highlight important components and strategies that should be taken into account when planning and running a similar larviciding program against malaria in a resource limited setting. A strong local partnership, meticulous planning with the possibility of ad-hoc adaption of project components and a reliable source of funding turned out to be crucial factors to successfully accomplish such a project.
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Affiliation(s)
- Peter Dambach
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
| | - Issouf Traoré
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Achim Kaiser
- German Mosquito Control Association (KABS), Speyer, Germany
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Rainer Sauerborn
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Norbert Becker
- German Mosquito Control Association (KABS), Speyer, Germany.,Centre for Organismal Studies, University of Heidelberg, Heidelberg, Germany
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Ratanawong P, Kittayapong P, Olanratmanee P, Wilder-Smith A, Byass P, Tozan Y, Dambach P, Quiñonez CAM, Louis VR. Spatial Variations in Dengue Transmission in Schools in Thailand. PLoS One 2016; 11:e0161895. [PMID: 27669170 PMCID: PMC5036884 DOI: 10.1371/journal.pone.0161895] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/12/2016] [Indexed: 12/03/2022] Open
Abstract
Background Dengue is an important neglected tropical disease, with more than half of the world’s population living in dengue endemic areas. Good understanding of dengue transmission sites is a critical factor to implement effective vector control measures. Methods A cohort of 1,811 students from 10 schools in rural, semi-rural and semi-urban Thailand participated in this study. Seroconversion data and location of participants’ residences and schools were recorded to determine spatial patterns of dengue infections. Blood samples were taken to confirm dengue infections in participants at the beginning and the end of school term. Entomological factors included a survey of adult mosquito density using a portable vacuum aspirator during the school term and a follow up survey of breeding sites of Aedes vectors in schools after the school term. Clustering analyses were performed to detect spatial aggregation of dengue infections among participants. Results A total of 57 dengue seroconversions were detected among the 1,655 participants who provided paired blood samples. Of the 57 confirmed dengue infections, 23 (40.0%) occurred in students from 6 (6.8%) of the 88 classrooms in 10 schools. Dengue infections did not show significant clustering by residential location in the study area. During the school term, a total of 66 Aedes aegypti mosquitoes were identified from the 278 mosquitoes caught in 50 classrooms of the 10 schools. In a follow-up survey of breeding sites, 484 out of 2,399 water containers surveyed (20.2%) were identified as active mosquito breeding sites. Discussion and Conclusion Our findings suggest that dengue infections were clustered among schools and among classrooms within schools. The schools studied were found to contain a large number of different types of breeding sites. Aedes vector densities in schools were correlated with dengue infections and breeding sites in those schools. Given that only a small proportion of breeding sites in the schools were subjected to vector control measures (11%), this study emphasizes the urgent need to implement vector control strategies at schools, while maintaining efforts at the household level.
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Affiliation(s)
- Pitcha Ratanawong
- Institute of Public Health, Heidelberg University Medical School, Heidelberg, Germany
- Center of Excellence for Vectors and Vector-Borne Diseases, Faculty of Science, Mahidol University at Salaya, Nakhon Pathom, Thailand
- * E-mail: (PK); (PR)
| | - Pattamaporn Kittayapong
- Center of Excellence for Vectors and Vector-Borne Diseases, Faculty of Science, Mahidol University at Salaya, Nakhon Pathom, Thailand
- * E-mail: (PK); (PR)
| | - Phanthip Olanratmanee
- Faculty of Science and Technology, Rajabhat Rajanagarindra University, Chachoengsao, Thailand
| | - Annelies Wilder-Smith
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå 90187, Sweden
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Peter Byass
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå 90187, Sweden
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Yesim Tozan
- Institute of Public Health, Heidelberg University Medical School, Heidelberg, Germany
- College of Global Public Health, New York University, New York, New York, United States of America
| | - Peter Dambach
- Institute of Public Health, Heidelberg University Medical School, Heidelberg, Germany
| | | | - Valérie R. Louis
- Institute of Public Health, Heidelberg University Medical School, Heidelberg, Germany
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Dambach P, Schleicher M, Stahl HC, Traoré I, Becker N, Kaiser A, Sié A, Sauerborn R. Routine implementation costs of larviciding with Bacillus thuringiensis israelensis against malaria vectors in a district in rural Burkina Faso. Malar J 2016; 15:380. [PMID: 27449023 PMCID: PMC4957841 DOI: 10.1186/s12936-016-1438-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/12/2016] [Indexed: 11/25/2022] Open
Abstract
Background The key tools in malaria control are early diagnosis and treatment of cases as well as vector control. Current strategies for malaria vector control in sub-Saharan Africa are largely based on long-lasting insecticide-treated nets (LLINs) and to a much smaller extent on indoor residual spraying (IRS). An additional tool in the fight against malaria vectors, larval source management (LSM), has not been used in sub-Saharan Africa on a wider scale since the abandonment of environmental spraying of DDT. Increasing concerns about limitations of LLINs and IRS and encouraging results from large larvicide-based LSM trials make a strong case for using biological larviciding as a complementary tool to existing control measures. Arguments that are often quoted against such a combined approach are the alleged high implementation costs of LSM. This study makes the first step to test this argument. The implementation costs of larval source management based on Bacillus thuringiensis israelensis (Bti) (strain AM65-52) spraying under different implementation scenarios were analysed in a rural health district in Burkina Faso. Methods The analysis draws on detailed cost data gathered during a large-scale LSM intervention between 2013 and 2015. All 127 villages in the study setup were assigned to two treatment arms and one control group. Treatment either implied exhaustive spraying of all available water collections or targeted spraying of the 50 % most productive larval sources via remote-sensing derived and entomologically validated risk maps. Based on the cost reports from both intervention arms, the per capita programme costs were calculated under the assumption of covering the whole district with either intervention scenario. Cost calculations have been generalized by providing an adaptable cost formula. In addition, this study assesses the sensitivity of per capita programme costs with respect to changes in the underlying cost components. Results The average annual per capita costs of exhaustive larviciding with Bti during the main malaria transmission period (June–October) in the Nouna health district were calculated to be US$ 1.05. When targeted spraying of the 50 % most productive larval sources is used instead, average annual per capita costs decrease by 27 % to US$ 0.77. Additionally, a high sensitivity of per capita programme costs against changes in total surface of potential larval sources and the number of spraying repetitions was found. Discussion The per capita costs for larval source management interventions with Bti are roughly a third of the annual per capita expenditures for anti-malarial drugs and those for LLINs in Burkina Faso which are US$ 3.80 and 3.00, respectively. The average LSM costs compare to those of IRS and LLINs for sub-Saharan Africa. The authors argue that in such a setting LSM based on Bti spraying is within the range of affordable anti-malarial strategies and, consequently, should deserve more attention in practice. Future research includes a cost-benefit calculation, based on entomological and epidemiological data collected during the research project. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1438-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peter Dambach
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
| | | | | | - Issouf Traoré
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Norbert Becker
- German Mosquito Control Association (KABS), Speyer, Germany.,Centre for Organismal Studies, University of Heidelberg, Heidelberg, Germany
| | - Achim Kaiser
- German Mosquito Control Association (KABS), Speyer, Germany
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Rainer Sauerborn
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
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Becher H, Müller O, Dambach P, Gabrysch S, Niamba L, Sankoh O, Simboro S, Schoeps A, Stieglbauer G, Yé Y, Sié A. Decreasing child mortality, spatial clustering and decreasing disparity in North-Western Burkina Faso. Trop Med Int Health 2016; 21:546-55. [PMID: 26821122 DOI: 10.1111/tmi.12673] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Within relatively small areas, there exist high spatial variations of mortality between villages. In rural Burkina Faso, with data from 1993 to 1998, clusters of particularly high child mortality were identified in the population of the Nouna Health and Demographic Surveillance System (HDSS), a member of the INDEPTH Network. In this paper, we report child mortality with respect to temporal trends, spatial clustering and disparity in this HDSS from 1993 to 2012. Poisson regression was used to describe village-specific child mortality rates and time trends in mortality. The spatial scan statistic was used to identify villages or village clusters with higher child mortality. Clustering of mortality in the area is still present, but not as strong as before. The disparity of child mortality between villages has decreased. The decrease occurred in the context of an overall halving of child mortality in the rural area of Nouna HDSS between 1993 and 2012. Extrapolated to the Millennium Development Goals target period 1990-2015, this yields an estimated reduction of 54%, which is not too far off the aim of a two-thirds reduction.
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Affiliation(s)
- Heiko Becher
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Public Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Olaf Müller
- Institute of Public Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Dambach
- Institute of Public Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Sabine Gabrysch
- Institute of Public Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Louis Niamba
- Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Osman Sankoh
- Institute of Public Health, University Hospital Heidelberg, Heidelberg, Germany.,INDEPTH Network, Accra, Ghana.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Faculty of Public Health, Hanoi Medical School, Hanoi, Vietnam
| | - Seraphin Simboro
- Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Anja Schoeps
- Institute of Public Health, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Ali Sié
- Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
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Nana Yakam A, Noeske J, Dambach P, Bowong S, Fono LA, Ngatchou-Wandji J. Spatial analysis of tuberculosis in Douala, Cameroon: clustering and links with socio-economic status. Int J Tuberc Lung Dis 2015; 18:292-7. [PMID: 24670564 DOI: 10.5588/ijtld.13.0573] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Douala, the economic capital of Cameroon, with a network of 20 diagnostic and treatment centres for tuberculosis (TB). OBJECTIVE To describe the spatial distribution of smear-positive pulmonary tuberculosis (PTB) cases in Douala, Cameroon, and to evaluate links between PTB incidence and patients' socio-economic status (SES). DESIGN Between May 2011 and April 2012, demographic clinical characteristics and global positioning system coordinates for the residence of each consenting PTB case were collected. Spatial scan statistic was used to identify spatial clusters of tuberculosis. SES data were collected by interview during home visits. PTB patients' SES data were compared with those available for the whole urban population from a recent demographic and health survey. The correlation between PTB incidence and the mean SES of the PTB patients was examined by health area (HA). RESULTS In total, 2132 (84%) diagnosed PTB cases were identified and interviewed. Three statistically significant spatial clusters were identified. High PTB incidence was predominantly found in HAs characterised by low SES. CONCLUSION There is evidence of clustering of PTB cases in Douala. Clusters are mainly found in neighbourhoods of low SES. Systematic use of cluster detection techniques for regular TB surveillance in Cameroon might aid in the effective deployment of National TB Programme resources.
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Affiliation(s)
- A Nana Yakam
- Faculty of Economy and Applied Management, University of Douala, Douala, Cameroon
| | - J Noeske
- Independent Consultant, Yaoundé, Cameroon
| | - P Dambach
- Department of Tropical Hygiene and Public Health, University of Heidelberg, Germany
| | - S Bowong
- Faculty of Science, University of Douala, Cameroon
| | - L A Fono
- Faculty of Science, University of Douala, Cameroon
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Louis VR, Phalkey R, Horstick O, Ratanawong P, Wilder-Smith A, Tozan Y, Dambach P. Modeling tools for dengue risk mapping - a systematic review. Int J Health Geogr 2014; 13:50. [PMID: 25487167 PMCID: PMC4273492 DOI: 10.1186/1476-072x-13-50] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/30/2014] [Indexed: 12/04/2022] Open
Abstract
Introduction The global spread and the increased frequency and magnitude of epidemic dengue in the last 50 years underscore the urgent need for effective tools for surveillance, prevention, and control. This review aims at providing a systematic overview of what predictors are critical and which spatial and spatio-temporal modeling approaches are useful in generating risk maps for dengue. Methods A systematic search was undertaken, using the PubMed, Web of Science, WHOLIS, Centers for Disease Control and Prevention (CDC) and OvidSP databases for published citations, without language or time restrictions. A manual search of the titles and abstracts was carried out using predefined criteria, notably the inclusion of dengue cases. Data were extracted for pre-identified variables, including the type of predictors and the type of modeling approach used for risk mapping. Results A wide variety of both predictors and modeling approaches was used to create dengue risk maps. No specific patterns could be identified in the combination of predictors or models across studies. The most important and commonly used predictors for the category of demographic and socio-economic variables were age, gender, education, housing conditions and level of income. Among environmental variables, precipitation and air temperature were often significant predictors. Remote sensing provided a source of varied land cover data that could act as a proxy for other predictor categories. Descriptive maps showing dengue case hotspots were useful for identifying high-risk areas. Predictive maps based on more complex methodology facilitated advanced data analysis and visualization, but their applicability in public health contexts remains to be established. Conclusions The majority of available dengue risk maps was descriptive and based on retrospective data. Availability of resources, feasibility of acquisition, quality of data, alongside available technical expertise, determines the accuracy of dengue risk maps and their applicability to the field of public health. A large number of unknowns, including effective entomological predictors, genetic diversity of circulating viruses, population serological profile, and human mobility, continue to pose challenges and to limit the ability to produce accurate and effective risk maps, and fail to support the development of early warning systems. Electronic supplementary material The online version of this article (doi:10.1186/1476-072X-13-50) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Valérie R Louis
- Institute of Public Health, Heidelberg University Medical School, Heidelberg, Germany.
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Dambach P, Traoré I, Becker N, Kaiser A, Sié A, Sauerborn R. EMIRA: Ecologic Malaria Reduction for Africa--innovative tools for integrated malaria control. Glob Health Action 2014; 7:25908. [PMID: 25377345 PMCID: PMC4223283 DOI: 10.3402/gha.v7.25908] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 10/13/2014] [Accepted: 10/13/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Malaria control is based on early treatment of cases and on vector control. The current measures for malaria vector control in Africa are mainly based on long-lasting insecticide treated nets (LLINs) and to a much smaller extent on indoor residual spraying (IRS). A third pillar in the fight against the malaria vector, larval source management (LSM), has virtually not been used in Africa since the ban of DDT in the 1960s. Within the light of recent WHO recommendations for Bacillus thuringiensis israelensis (Bti) use against malaria and other vector species, larval source management could see a revival in the upcoming years. In this project we analyze the ecologic and health impacts as well as the cost effectiveness of larval source management under different larviciding scenarios in a health district in Burkina Faso. METHODS The project is designed as prospective intervention study with duration of three years (2013-2015). Its spatial scale includes three arms of interventions and control, comprising a total of 127 villages and the district capital Nouna in the extended HDSS (Health Demographic Surveillance System) of the Kossi province. Baseline data on mosquito abundance, parasitemia in U5 children, and malaria related morbidity and mortality are gathered over the project duration. Besides the outcome on ecologic and health parameters, the economic costs are seized and valued against the achieved health benefits. CONCLUSIONS Risk map based, guided larvicide application might be a possibility to further decrease economic cost of LSM and facilitate its faster incorporation to integrated malaria control programs. Given the limited resources in many malaria endemic countries, it is of utmost importance to relate the costs of novel strategies for malaria prevention to their effect on the burden of the disease. Occurring costs and the impact on the health situation will be made comparable to other, existing intervention strategies, allowing stakeholders and policymakers decision making.
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Affiliation(s)
- Peter Dambach
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany;
| | - Issouf Traoré
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Norbert Becker
- German Mosquito Control Association (KABS), Speyer, Germany; Centre for Organismal Studies, University of Heidelberg, Heidelberg, Germany
| | - Achim Kaiser
- German Mosquito Control Association (KABS), Speyer, Germany
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Rainer Sauerborn
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
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Dambach P, Louis VR, Kaiser A, Ouedraogo S, Sié A, Sauerborn R, Becker N. Efficacy of Bacillus thuringiensis var. israelensis against malaria mosquitoes in northwestern Burkina Faso. Parasit Vectors 2014; 7:371. [PMID: 25128297 PMCID: PMC4262221 DOI: 10.1186/1756-3305-7-371] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/29/2014] [Indexed: 11/28/2022] Open
Abstract
Background In Sub Saharan Africa malaria remains one of the major health problems and its control represents an important public health measure. Integrated malaria control comprises the use of impregnated mosquito nets and indoor residual spraying. The use of drugs to treat patients can create additional pressure on the equation of malaria transmission. Vector control may target the adult mosquitoes or their aquatic larval stages. Biological larvicides such as Bacillus thuringiensis israelensis (Bti) represent a promising approach to support malaria control programs by creating additional pressure on the equation of malaria transmission. Methods In this study we examined the efficacy of a water-dispersible granule formulation (WDG) of the biological larvicide Bti (VectoBac®) against wild Anopheles spp. larvae. Different concentrations of the larvicide were tested in standardized plastic tubs in the field against untreated controls. In weekly intervals tubs were treated with fixed concentrations of larvicide and the percentage reduction of larvae and pupae was calculated. Results All used concentrations successfully killed 100 percent of the larvae within 24 hours, while the higher concentrations showed a slightly prolonged residual effect. Natural reconolization of larvae took place after two and three days respectively, late instar larvae were not found before 5 days after treatment. For the higher concentrations, up to three days no new larvae were found, implicating that the residual effect of WDG in tropical conditions is approximately one to two days. The overall pupae reduction in treated tubs was 98.5%. Conclusions Biological larviciding with Bti can be a promising, additional tool in the fight against malaria in Africa. Environmental particularities in tropical Africa, first and foremost the rapid development of mosquitoes from oviposition to imago have to be taken into account before implementing such counter measures in national or international vector control programs. Nonetheless biological larviciding seems to be an appropriate measure for selected conditions, offering a significant contribution to the future of malaria control.
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Affiliation(s)
- Peter Dambach
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
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Dambach P, Machault V, Lacaux JP, Vignolles C, Sié A, Sauerborn R. Utilization of combined remote sensing techniques to detect environmental variables influencing malaria vector densities in rural West Africa. Int J Health Geogr 2012; 11:8. [PMID: 22443452 PMCID: PMC3331805 DOI: 10.1186/1476-072x-11-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 03/23/2012] [Indexed: 11/10/2022] Open
Abstract
Introduction The use of remote sensing has found its way into the field of epidemiology within the last decades. With the increased sensor resolution of recent and future satellites new possibilities emerge for high resolution risk modeling and risk mapping. Methods A SPOT 5 satellite image, taken during the rainy season 2009 was used for calculating indices by combining the image's spectral bands. Besides the widely used Normalized Difference Vegetation Index (NDVI) other indices were tested for significant correlation against field observations. Multiple steps, including the detection of surface water, its breeding appropriateness for Anopheles and modeling of vector imagines abundance, were performed. Data collection on larvae, adult vectors and geographic parameters in the field, was amended by using remote sensing techniques to gather data on altitude (Digital Elevation Model = DEM), precipitation (Tropical Rainfall Measurement Mission = TRMM), land surface temperatures (LST). Results The DEM derived altitude as well as indices calculations combining the satellite's spectral bands (NDTI = Normalized Difference Turbidity Index, NDWI Mac Feeters = Normalized Difference Water Index) turned out to be reliable indicators for surface water in the local geographic setting. While Anopheles larvae abundance in habitats is driven by multiple, interconnected factors - amongst which the NDVI - and precipitation events, the presence of vector imagines was found to be correlated negatively to remotely sensed LST and positively to the cumulated amount of rainfall in the preceding 15 days and to the Normalized Difference Pond Index (NDPI) within the 500 m buffer zone around capture points. Conclusions Remotely sensed geographical and meteorological factors, including precipitations, temperature, as well as vegetation, humidity and land cover indicators could be used as explanatory variables for surface water presence, larval development and imagines densities. This modeling approach based on remotely sensed information is potentially useful for counter measures that are putting on at the environmental side, namely vector larvae control via larviciding and water body reforming.
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Affiliation(s)
- Peter Dambach
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
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Dambach P, Sié A, Lacaux JP, Vignolles C, Machault V, Sauerborn R. Using high spatial resolution remote sensing for risk mapping of malaria occurrence in the Nouna district, Burkina Faso. Glob Health Action 2009; 2. [PMID: 20052428 PMCID: PMC2799258 DOI: 10.3402/gha.v2i0.2094] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 09/21/2009] [Accepted: 09/21/2009] [Indexed: 11/21/2022] Open
Abstract
Introduction Malaria control measures such as early diagnosis and treatment, intermittent treatment of pregnant women, impregnated bed nets, indoor spraying and larval control measures are difficult to target specifically because of imprecise estimates of risk at a small-scale level. Ways of estimating local risks for malaria are therefore important. Methods A high-resolution satellite view from the SPOT 5 satellite during 2008 was used to generate a land cover classification in the malaria endemic lowland of North-Western Burkina Faso. For the area of a complete satellite view of 60 × 60 km, a supervised land cover classification was carried out. Ten classes were built and correlated to land cover types known for acting as Anopheles mosquito breeding sites. Results According to known correlations of Anopheles larvae presence and surface water-related land cover, cultivated areas in the riverine vicinity of Kossi River were shown to be one of the most favourable sites for Anopheles production. Similar conditions prevail in the South of the study region, where clayey soils and higher precipitations benefit the occurrence of surface water. Besides pools, which are often directly detectable, rice fields and occasionally flooded crops represent most appropriate habitats. On the other hand, forests, elevated regions on porous soils, grasslands and the dryer, sandy soils in the north-western part turned out to deliver fewer mosquito breeding opportunities. Conclusions Potential high and low risks for malaria at the village level can be differentiated from satellite data. While much remains to be done in terms of establishing correlations between remotely sensed risks and malaria disease patterns, this is a potentially useful approach which could lead to more focused disease control programmes.
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Affiliation(s)
- Peter Dambach
- Department of Tropical Hygiene and Public Health, University of Heidelberg, Heidelberg, Germany
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