Impact of extreme weather events on mental health in South and Southeast Asia: A two decades of systematic review of observational studies

Extreme weather events in South and Southeast Asia exert profound psychosocial impacts, amplifying the prevalence of mental illness. Despite their substantial consequences, there is a dearth of research and representation in the current literature. We conducted a systematic review of observational studies published between January 1, 2000, and January 20, 2024, to examine the impact of extreme weather events on the mental health of the South and Southeast Asian population. Quality assessment of the included studies was conducted using the Newcastle-Ottawa Scale (NOS) quality appraisal checklist. The search retrieved 70 studies that met the inclusion criteria and were included in our review. Most were from India (n = 22), and most used a cross-sectional study design (n = 55). Poor mental health outcomes were associated with six types of extreme weather events: floods, storm surges, typhoons, cyclones, extreme heat, and riverbank erosion. Most studies (n = 41) reported short-term outcome measurements. Findings included outcomes with predictable symptomatology, including post-traumatic stress disorder, depression, anxiety, general psychological distress, emotional distress and suicide. Limited studies on long-term effects showed higher mental disorders after floods and typhoons, while cyclone-exposed individuals had more short-term distress. Notably, the review identified over 50 risk factors influencing mental health outcomes, categorized into six classes: demographic, economic, health, disaster exposure, psychological, and community factors. However, the quantitative evidence linking extreme weather events to mental health was limited due to a lack of longitudinal data, lack of control groups, and the absence of objective exposure measurements. The review found some compelling evidence linking extreme weather events to adverse mental health in the South and Southeast Asia region. Future research should focus on longitudinal study design to identify the specific stressors and climatic factors influencing the relationship between climate extremes and mental health in this region.

Compliance of healthcare workers with the infection prevention and control guidance in tertiary care hospitals: quantitative findings from an explanatory sequential mixed-methods study in Bangladesh

OBJECTIVES

To assess healthcare workers' (HCWs) compliance with the infection prevention and control (IPC) practices and identify the factors influencing this compliance using the Health Belief Model as the theoretical framework.

DESIGN

Quantitative data from an explanatory sequential mixed-methods study were employed in this research.

PARTICIPANTS AND SETTINGS

From 17 May to 30 August 2020, 604 physicians and nurses working at six randomly selected tertiary care facilities in Dhaka City in Bangladesh took part in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Compliance with the WHO's guidance on IPC measures, as well as the associated factors, was the primary outcome.

RESULTS

A mean compliance score of 0.49 (±0.25) was observed on a 0-1 scale. HCWs were most compliant with the medical mask wearing guidelines (81%) and were least compliant with the high-touch surface decontamination regulations (23%). Compliance with the IPC guidance was significantly associated with increasing age, female sex, working as a nurse, having non-communicable diseases and history of exposure to patients with COVID-19. Perceived benefits (B=0.039, 95% CI 0.001 to 0.076), self-efficacy (B=0.101, 95% CI 0.060 to 0.142) and cues to action (B=0.045, 95% CI 0.002 to 0.088) were positively associated with compliance. Compliance with IPC guidance was 0.061 times greater among participants who reported low perceived barriers compared with those with high perceived barriers.

CONCLUSION

Overall, compliance with IPC guidance among HCWs was unsatisfactory. As self-efficacy exerted the greatest contribution to compliance, it should be emphasised in any endeavour to improve HCWs' IPC adherence. Such interventions should also focus on perceived barriers, including unreliability of the information sources, unsafe working places and unavailability of protective equipment and cues to action, including trust in the administration and availability of adequate IPC guidance.

Assessment of risk perception and risk communication regarding COVID-19 among healthcare providers: An explanatory sequential mixed-method study in Bangladesh

Background: Any public health emergency demands adequate risk communication with the vulnerable population along with their optimized perception about the impending risk to ensure proper risk management and crisis control. Hence, we conducted this study to explore healthcare providers’ perceptions regarding risks of coronavirus disease 2019 (COVID-19), as well as how they are being communicated to about the risk, and how they practice risk reduction measures.

Methods: We conducted a two-phased explanatory sequential mixed-method study among physicians and nurses from randomly selected tertiary healthcare facilities in Dhaka, the capital of Bangladesh. In the first phase, we assessed the general pattern and quantifiable measures of risk perception, risk communication, and infection prevention practices quantitatively. We performed multiple linear regression analyses to explore how much variability of risk perception was predicted by risk communication methods and contents. In the second phase, we collected qualitative data for in-depth understanding and exploration of participants’ experiences and insights regarding COVID-19 risk through interviews and document reviews. We manually performed thematic content analysis of the qualitative data. Finally, we triangulated findings from both phases to illustrate the research objectives.

Discussion: Based on the psychometric dimensions of risk perception and psycho-social theory of the health belief model, perceptions of COVID-19 risk among healthcare providers were evaluated in this study. The relationship between risk perception and infection prevention and control practices among healthcare providers were also investigated. The explanatory sequential design of this study is expected to generate hypotheses on how risk perception is being shaped in a time of uncertainty and, thus, will help to build a proper risk communication strategy for the healthcare providers

Children's exposure to psychological abuse and neglect: A population-based study in rural Bangladesh

AIM

We aimed to estimate the prevalence and risk factors of child psychological abuse and neglect in a rural area of Bangladesh.

METHODS

Data were obtained from interviewing 1416 children aged 11-17 years administering the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool for Children between March and April 2017. Linear regression analysis was used to estimate the risks of child psychological abuse and neglect.

RESULTS

The prevalence rates of at least one form of psychological abuse both in the past year and lifetime were more than 97 per cent. Moreover, the rates of at least one form of neglect were about 58 per cent during the past year and 78 per cent over lifetime. Living separately from parents posed children to significant risks of neglect and psychological abuse. Working children and greater number of siblings in a family were risk factors for neglect, whereas witnessing family violence and being bullied were risk factors for psychological abuse. Children with more years of schooling experienced less neglect and psychological abuse.

CONCLUSION

The high prevalence of child psychological abuse and neglect in this study shows child maltreatment as an ignored issue in Bangladesh.

Children's exposure to physical abuse from a child perspective: A population-based study in rural Bangladesh

Background

Although child physical abuse (CPA) is considered as a major global public health problem, it has not yet been recognized as such in Bangladesh. Very few studies have assessed the prevalence and victims’ characteristics of multiple forms of CPA.

Objective

This population-based study assessed the prevalence of CPA committed by adults in a rural area of Bangladesh and examined its association with demographic and socio-contextual factors.

Methods

Data were obtained using ISPCAN Child Abuse Screening Tool for Children (ICAST-C) in a random sample of 1416 children (49% girls, 51% boys) aged 11 to 17 years by face-to-face interviews during March-April 2017. The response rate was 91.5%. To estimate predictors of CPA, physical abuse was categorized into frequent and less frequent groups.

Results

The prevalence of at least one form (≥ 1), two forms (≥2) and three or more forms (≥ 3) of CPA were estimated approximately to 99%, 95% and 83% in their lifetime and 93%, 79%, and 57% in the past year respectively. Hitting (except on buttocks), standing/kneeling and slapping were the most common physical abuse whereas given drugs or alcohol, pinched, burned or scalded, beaten-up and locked up were less reported. Female children were faced severe forms of CPA more than that of males. Male children, younger age groups, witnessing adults using weapons at home, bullied by siblings and low level of maternal education were found to be significant risk factors for both ≥ 1 form and ≥ 2 forms of frequent CPA whereas adding also adult shouting in a frightening way was found as a significant risk factor for ≥ 2 forms of frequent CPA.

Conclusion

Self-reported prevalence of CPA is extremely common in the Bangladeshi rural society. The prevalence was associated with demographic and socio-contextual characteristics of the children such as being younger, witnessing domestic violence and maternal low education. The findings provide evidence to support parents and policy-makers to take effective measures to implement policy and programme on alternative up-bringing methods and creating awareness of negative effects of CM which in turn help Bangladesh to line up with UN Convention on the Rights of the Child, which the country signed in 1990.

Bangladeshi school-age children's experiences and perceptions on child maltreatment: A qualitative interview study

BACKGROUND

Child maltreatment (CM) is a public health problem and is recognized as a huge barrier for child development. Most of the research and definitions on CM are from the perspective of high-income western countries. Because no major studies have been conducted on CM in Bangladesh, the aim of the current study was to explore the experiences of and perceptions on CM in school-age children in rural and urban Bangladesh in order to understand maltreatment in a local context and from a child perspective.

METHODS

Semistructured individual interviews with 24 children (13 boys and 11 girls), between the ages of 9 and 13 years of which 11 were schoolgoing and 13 non-schoolgoing, were conducted during July 2013 and analysed according to qualitative content analysis.

RESULTS

CM was a common and painful experience with serious physical and emotional consequences but highly accepted by the society. Vulnerable groups were especially young children, girls, and poor children. The children's voices were not heard due to their low status and low position in their families, schools, and working places. The main theme that emerged in the analysis was children's subordination, which permeated the five categories: (a) perception of children's situation in society, (b) understanding children's development and needs, (c) CM associated to school achievement, (d) negative impact of CM, and (e) emotional responses.

CONCLUSIONS

Different kinds of abuse are obviously common in Bangladesh, and the schools do not follow the law from 2011 prohibiting corporal punishment at school. The society has to take further steps to live up to the UN Convention on the Rights of the Child, which was ratified already in 1990, to protect the Bangladeshi children from CM.

Age- and sex-specific analysis of homicide mortality as a function of economic development: A cross-national comparison

Aims: This study examined the association between homicide rates and GNP per capita (as a measure of economic development) among all age- and sex-specific groups in 53 countries. Methods: Cross-sectional data on homicide rates by age- and sex- specific groups were obtained for 53 countries from World Health Statistics Annual 1996. The association between homicide rates and economic development was studied by using two methods: (1) with regression analysis and (2) by categorizing the data into four income-based country groups and then comparing the differences in their mean values. Results: Results indicate that there was a negative correlation between homicide rates and economic development. The association between homicide rates and country GNP per capita became stronger with increasing age. Pearson's product moment correlation coefficient was strongest among older age groups (65+year) in both sexes (male, r=-0.77 and female, r=-0.71). The correlation was weakest and positive among 1- to 4-year-old children (males, r=0.17 and females, r=0.07). The homicide rate among females was highest for <1-year-old children in low income countries (LICs) (12.8 per 100,000). Conclusions: Lower middle-income countries are in the stage of high priority where both homicide rates and homicide as percentage of total death are high, and its impact was greatest for young males. However, infanticide as a public health problem seems highly concentrated in the poorest countries, while homicide among small children, 1—4 years old, appears to be a universal phenomenon across all nations.

A comparison of hip fracture incidence rates among elderly in Sweden by latitude and sunlight exposure

Background: Research has shown that hip fracture risk increases with latitude; hypothetically due to reduced sunlight exposure and its effect on bone quality. Sweden, with large differences in latitude and UV radiation, is ideal to study in order to analyse the association between latitude and UV radiation on age- and sex-specific hip fracture rates among elderly. Method: Aggregated (2006–2008) age- and sex-specific hip fracture data was obtained for each Swedish municipality as well as the municipality’s latitudinal coordinates and aggregated (2006–2008) UV radiation levels. Pearson correlations were calculated between hip fracture incidence rates, latitude and UV radiation. Independent t tests were calculated on tertile-categorized latitudinal data in order to investigate the difference in hip fracture risk between these categories. Results: Statistically significant correlations were seen in all groups between hip fracture incidence rates and latitude as well as UV radiation. The independent t tests showed that this correlation was mainly due to high incidence rates in high latitude municipalities. Conclusions: Statistically significant correlations are seen between hip fracture incidence rates and latitude as well as UV radiation in Sweden and the northern parts of Sweden have an increased risk of hip fractures compared to the middle and southern parts. To our knowledge this is the first study using a national discharge register that shows this relationship and provides a starting point for further research to investigate why populations in northern Sweden have a higher risk of hip fractures compared to other Swedish regions.

Fall-related fracture trends among elderly in Sweden--exoring transitions among hospitalized cases

PROBLEM

Fall-related injuries have been a cause of worry during the end of the 20th century with increasing trends among the elderly.

METHOD

Using data from the Swedish National Patient Register (NPR) based on hospital admissions, this study explores the trends in fall-related fractures between 1998 and 2010.

RESULTS

The data shows a decreasing trend in fall-related fractures in all age- and sex-specific groups apart from men 80 years and above. While hip fracture incidence rates decreased in all age- and sex-specific groups, both central fractures and upper extremity fractures have increased in all age- and sex-specific groups apart from women 65-79 years. Lower extremity fractures have increased in the older age groups and decreased in the younger.

DISCUSSION

The differences found between the groups of fractures and by age- and sex-specific groups indicate a possible transition where more serious fractures are decreasing while less serious fractures increase among hospitalized cases.

SUMMARY

Perhaps due to a focus on hip fracture prevention, this study shows that while the incidence rate of hospitalized hip fractures has decreased, other fall-related hospitalized fractures have increased.

IMPACT ON INDUSTRY

Potentially, this could be indicative of a healthier younger elderly, coupled with a frailer older elderly requiring more comprehensive healthcare also for less serious injuries. Further research is needed to confirm our results.

The SELMA study: a birth cohort study in Sweden following more than 2000 mother-child pairs

BACKGROUND

 This paper describes the background, aim and study design for the Swedish SELMA study that aimed to investigate the importance of early life exposure during pregnancy and infancy to environmental factors with a major focus on endocrine disrupting chemicals for multiple chronic diseases/disorders in offspring.

METHODS

The cohort was established by recruiting women in the 10th week of pregnancy. Blood and urine from the pregnant women and the child and air and dust from home environment from pregnancy and infancy period have been collected. Questionnaires were used to collect information on life styles, socio-economic status, living conditions, diet and medical history.

RESULTS

Of the 8394 reported pregnant women, 6658 were invited to participate in the study. Among the invited women, 2582 (39%) agreed to participate. Of the 4076 (61%) non-participants, 2091 women were invited to a non-respondent questionnaire in order to examine possible selection bias. We found a self-selection bias in the established cohort when compared with the non-participant group, e.g. participating families did smoke less (14% vs. 19%), had more frequent asthma and allergy symptoms in the family (58% vs. 38%), as well as higher education among the mothers (51% vs. 36%) and more often lived in single-family houses (67% vs. 60%).

CONCLUSIONS

These findings indicate that the participating families do not fully represent the study population and thus, the exposure in this population. However, there is no obvious reason that this selection bias will have an impact on identification of environmental risk factors.

Trends in hip fracture incidence rates among the elderly in Sweden 1987-2009

BACKGROUND

Previous trend studies have shown large increases in hip fracture incidence rates among the elderly. International research, however, suggests a levelling off, or decline, of hip fracture incidence rates, although for Sweden this remains to be studied.

METHODS

Data were obtained regarding hip fractures among individuals 65 years and above from 1987 to 2009. Analysis was performed in three steps. First, age- and sex-specific trends in hip fracture rates per 100 000 and the mean age when sustaining a hip fracture were analysed. Secondly, the annual percentage change was used to compare time periods that helped to quantify changes in secular trends. Finally, linear and Poisson regression models were used to examine the trend data and observed rates.

RESULTS

The absolute number of hip fractures among the elderly in Sweden has largely remained constant between 1987 and 2009, while incidence rates have decreased for all age- and sex-specific groups, with the largest changes in the younger age groups and among women. The mean age of sustaining a hip fracture has increased for both men and women.

CONCLUSIONS

This study supports other international studies in showing a decrease in hip fracture incidence rates among the elderly, especially since the mid-1990s.

Can we trust cross-sectional studies when studying the risk of moisture-related problems indoor for asthma in children?

Most studies studying dampness as a risk factor for asthma are of a cross-sectional design. The aim of this study was to investigate if the association between moisture-related problems indoor and asthma found in cross-sectional questionnaire data can be confirmed in longitudinal analyses. The Dampness in Building and Health (DBH) study started in 2000 in Värmland, Sweden, with a baseline questionnaire to all children aged 1-5 y (n = 14,077) and five years later a follow-up questionnaire was distributed to children aged 6-8 y (n = 7,509). Moisture-related problems that were associated with asthma in cross-sectional analysis decreased or disappeared in the longitudinal analysis. However, the association between reports of moldy odor in the homes at baseline and incident asthma remained and became stronger. Our results suggest that cross-sectional data showing associations between moisture-related problems in homes and asthma in children partly can be explained by reporting bias.

Levels of endotoxin in 390 Swedish homes: determinants and the risk for respiratory symptoms in children

Endotoxins are microbiological agents which ubiquitously exist in an indoor environment, and are believed to be causal agents for a number of diseases. This study investigated the indoor levels and determinants of endotoxins and their impact on asthma and allergy diseases among Swedish pre-school children. House dust samples from 390 homes of 198 case children with asthma and allergy and 202 healthy control children were collected in the Dampness Building and Health (DBH) study. House dust endotoxin levels in the child's bedroom and living rooms ranged from 479-188,000 EU/g dust and from 138-942,000 EU/g dust, respectively. Pet-keeping and agricultural activities were significantly associated with the higher endotoxin concentration levels in indoor dust. Endotoxins in theindoor environment did not associate to asthma and allergy diseases in the children. However, we found an association between endotoxins and the presence of disease symptoms in the sub-group of families without indoor pets.

Cross-national injury mortality differentials by income level: the possible role of age and ageing

OBJECTIVES

To examine age- and cause-specific injury mortality differentials between low-income (LICs), middle-income (MICs) and high-income countries (HICs), and to discuss their implications in explaining changing injury mortality patterns with economic development against the background of general health transition theory.

STUDY DESIGN

Cross-sectional study.

METHODS

The World Health Organization's mortality database was used as the source of injury mortality data. The grouping into LICs, MICs and HICs was based on data from World Development Indicator.

RESULTS

Unintentional injury mortality (UIM) rates in children and adults are highest in LICs and MICs, respectively. UIM rates in the elderly population, however, increase with higher economic conditions and are highest in HICs.

CONCLUSION

Based on these findings, it is hypothesized that ageing and injury interplay mutually with regard to health transition; declining rates in child UIM with economic development contributes to the ageing process, while increasing UIM among the elderly, in combination with ageing populations, boosts the absolute number of injury deaths in this segment.

Economic development as a determinant of injury mortality - a longitudinal approach

Cross-sectional studies have produced clear inverted U-shaped curves between injury mortality and economic development; yet, this does not mean that single countries will necessarily follow similar curves as they grow richer over time. This study was conducted to examine whether previous cross-sectional findings can be verified using a longitudinal approach. Data for both injury mortality and gross domestic product (GDP) per capita were obtained from an official health database for the member countries of the Organization for Economic Cooperation and Development (OECD) for the period of 1960-1999. Regression models were then used to examine the longitudinal relationship between these two variables. Substantial improvements in injury mortality were observed in all income categories in the selected countries. For higher and middle high-income countries, injury mortality rates (all causes) increased until 1972, peaking in 1972 and then declining. For industrialized countries with relatively low GDP, injury mortality rates increased until 1977 and then declined. Using cubic regression lines for injury mortality rates, for all income categories, injury mortality rates increased up to a GDP per capita of USD 3,000-USD 4,000, then decreased significantly. The rising trends of suicide and homicide rates were observed until countries attained a GDP per capita of around USD 13,000-USD 14,000 for all income categories. It is noteworthy that compared to the intentional injury categories, mortality due to road traffic accidents and injuries from falls declined earlier on in the economic development process. Longitudinal analysis among high-income countries confirms earlier cross-sectional findings; that is, most injury categories seem to follow inverted U-shaped trend lines, with declining trends after peaking at various stages of temporal and economical development. A comparison between time and economy suggests that differences in peaking time between countries for the same injury category is partly a reflection of temporal differences in economic development.

Relationship between economic development and risk of injuries in older adults and the elderly. A global analysis of unintentional injury mortality in an epidemiologic transition perspective

BACKGROUND

Injury is recognized as an important public health problem not only in high-income countries, but also in low- and middle-income countries. Other studies have shown inverse association between economic development and unintentional injury mortality (UIM) among children and young adults. In this study we aimed to examine the association between economic development and UIM rates among 45+ years-old populations within the theoretical framework of epidemiologic transition.

METHODS

The World Health Statistics Annual 1996 was used as the main source of data. The relationship between UIM rates and gross national product (GNP) per capita was studied by using two methods: (i) with regression analysis, and (ii) by categorizing the data in four income-based country groups and the comparison of differences in their mean values. The ages were divided into four sub-groups: 45-54 years, 55-64 years, 65-74 years and 75+ years.

RESULTS

UIM rates were inversely correlated with GNP per capita in 45-54, 55-64 and 65-74 year-olds for both sexes. On the other hand, among the 75+ years populations for both sexes, the association between GNP per capita and UIM rates was positive (male, r = 0.234, and female, r = 0.337).

CONCLUSION

Our study suggests that UIM rates shows deviating patterns across age groups. UIM exhibits declining rates among younger age groups by economic development which is consistent with what could be expected from the epidemiologic transition model, while injuries in older groups appear to increase by economic development. These findings imply that unintentional injury, as a whole, is not a homogeneous phenomenon from an epidemiological transition perspective.

Relationship between economic development and suicide mortality: a global cross-sectional analysis in an epidemiological transition perspective

AIM

The aim of this study was to analyse the relationship between suicide rates and economic development within the theoretical framework of epidemiological transition.

RESULT

A weak positive correlation was found between suicide rates and GNP per capita in both sexes for all ages.

DISCUSSION

According to previous studies, there is a clear decline in deaths due to unintentional injuries with improved economic conditions. This example of a man-made disease that declines during the fourth stage is in agreement with the theory of epidemiological transition. However, our results found the opposite pattern for deaths due to intentional self-inflicted injury.

CONCLUSION

Mortality rates due to unintentional and intentional self-inflicted injury show deviating patterns from an epidemiological transition perspective.