International Journal of Environmental Research and Public Health

Research

14 pages, 390 KiB

Open AccessArticle

Perfluorooctanoic Acid and Perfluorooctane Sulfonate in Human Milk: First Survey from Lebanon

by Hussein F. Hassan, Haneen Bou Ghanem, Joelle Abi Kharma, Mohamad G. Abiad, Jomana Elaridi and Maya Bassil

Int. J. Environ. Res. Public Health 2023, 20(1), 821; https://doi.org/10.3390/ijerph20010821 - 1 Jan 2023

Cited by 12 | Viewed by 2901

Abstract

Human milk is the primary source of nutrition for infants in their first year of life. Its potential contamination with perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS), a group of toxic man-made chemicals, is a health concern that may threatens infants’ health. Our [...] Read more.

Human milk is the primary source of nutrition for infants in their first year of life. Its potential contamination with perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS), a group of toxic man-made chemicals, is a health concern that may threatens infants’ health. Our study aims to assess the levels of PFOA and PFOS in the breast milk of Lebanese lactating mothers and the maternal factors associated with their presence. High-performance liquid chromatography (HPLC) coupled with a Micromass Quattro micro API triple quadrupole mass spectrometer was used to detect the level of contamination in 57 collected human milk samples. PFOA and PFOS were present in 82.5% and 85.7% of the samples, respectively, while PFOA levels ranged between 120 and 247 pg/mL with a median of 147 pg/mL, and those of PFOS ranged between 12 and 86 pg/mL with a median of 27.5 pg/mL. The median contamination for PFOA exceeded the threshold set by the European Food Safety Authority (EFSA) (60 pg/mL); however, that of PFOS was below the threshold (73 pg/mL). The consumption of bread, pasta, meat, and chicken more than twice per week and that of white tubers and roots at least once per week was significantly associated with higher levels of PFOA (p < 0.05). No significant association was found between maternal age, BMI, parity, level of education, place of residence, source of water used, and smoking with the levels of PFOA and PFOS in the human milk. Additionally, the consumption of cereals at least twice per week was significantly associated with higher levels of PFOS. These findings call for actions to improve the local environmental and agricultural practices, and the regulations and standards for inspecting imported food. It is important to highlight that the benefits of breastfeeding outweigh the reported contamination with PFOS and PFOA in our study. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

7 pages, 335 KiB

Open AccessArticle

Diagnostic Study to Assess the Performance of a New Urinary Legionella Antigen Test—A National Study in Three Referral University Hospitals in Austria during 2014–2017

by Ziad El-Khatib, Lukas Richter, Jutta Ressler and Bernhard Benka

Int. J. Environ. Res. Public Health 2022, 19(24), 16705; https://doi.org/10.3390/ijerph192416705 - 13 Dec 2022

Cited by 2 | Viewed by 1669

Abstract

Background: We evaluated the performance of a rapid diagnostic antigen test (Coris) as an index test versus the urinary Antigen ELISA (Bartels) as the reference test. Methods: Prospective diagnostic accuracy study (2014–2017) at three university hospitals in Austria. Results: A total of 996 [...] Read more.

Background: We evaluated the performance of a rapid diagnostic antigen test (Coris) as an index test versus the urinary Antigen ELISA (Bartels) as the reference test. Methods: Prospective diagnostic accuracy study (2014–2017) at three university hospitals in Austria. Results: A total of 996 patients were included in the study. Legionellosis was diagnosed in 49/996 (4.9%) using the reference test. The sensitivity and specificity of the Coris test were 75.5% (95% CI 61.1–86.7%) and 100% (95%CI 99.6–100%), respectively. The PPV was 100% and when using the lower 95% CI limit of the estimate for sensitivity, the resulting PPV was 61.1%. The NPV was 98.7% and the accuracy was 98.8%. The index test showed a PPV > 97% during the period of summer and autumn (May through November) and ≥88% during winter (December through February). The NPV was >97% during all of the periods. The median of the monthly incidence in the general population was 0.1 per 100,000 (IQR 0.1; 0.3). Conclusion: The new rapid test gave a high level of diagnostic accuracy in a rapid fashion. The test can be applied at the bedside by non-laboratory staff. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

18 pages, 436 KiB

Open AccessArticle

COVID-19 Case Management Outcomes Amongst Diabetes and Hypertensive Patients in the United Arab Emirates: A Prospective Study

by Aysha Alkhemeiri, Shaikha Al Zaabi, Jeyaseelan Lakshmanan, Ziad El-Khatib and Niyi Awofeso

Int. J. Environ. Res. Public Health 2022, 19(23), 15967; https://doi.org/10.3390/ijerph192315967 - 30 Nov 2022

Cited by 7 | Viewed by 2704

Abstract

The global pandemic of the novel Coronavirus infection 2019 (COVID-19) challenged the care of comorbid patients. The risk imposed by COVID-19 on diabetes patients is multisystemic, exponential, and involves glucose dysregulation. The increased burden for diabetes patients infected with COVID-19 is substantial in [...] Read more.

The global pandemic of the novel Coronavirus infection 2019 (COVID-19) challenged the care of comorbid patients. The risk imposed by COVID-19 on diabetes patients is multisystemic, exponential, and involves glucose dysregulation. The increased burden for diabetes patients infected with COVID-19 is substantial in countries with a high prevalence of diabetics, such as the United Arab Emirates (UAE). This study aims to explore the prevalence of diabetes, clinical characteristic, and outcomes of patients admitted for COVID-19 treatment with or without a concurrent preadmission diagnosis of diabetes. A prospective study was performed on 1199 adults admitted with confirmed COVID-19 from December 2020 to April 2021 to a single hospital in the UAE. The study compared the demographics, clinical characteristics, and outcomes in COVID-19-infected patients with diabetes to patients without diabetes. The study endpoints include the development of new-onset diabetes, admission to ICU, trends in the blood glucose levels, and death. A total of 1199 patients (390 with diabetes) were included in the study. A diabetes prevalence was detected among 9.8% of the study population. Among the diabetes group, 10.8% were morbidly obese, 65.4% had associated hypertension, and 18.9% had coronary artery disease. Diabetes patients showed higher rates of ICU admission (11.1% vs. 7.1%), NIV requirement (9.6% vs. 6.4%), and intubation (5.45% vs. 2%) compared to the non-diabetes group. Advanced age was a predictor of a worsening COVID-19 course, while diabetes (p < 0.050) and hypertension (p < 0.025) were significant predictors of death from COVID-19. Nearly three-fourths (284 (73.4%)) of the diabetic patients developed worsened hyperglycemia as compared to one-fifth (171 (20.9%)) of the nondiabetic patients. New-onset diabetes was detected in 9.8% of COVID-19 patients. COVID-19 severity is higher in the presence of diabetes and is associated with worsening hyperglycemia and poor clinical outcomes. Preexisting hypertension is a predictor of COVID-19 severity and death. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

11 pages, 336 KiB

Open AccessArticle

Exposure Assessment of Aflatoxin B1 through Consumption of Rice in the United Arab Emirates

by Nisreen Alwan, Haneen Bou Ghanem, Hani Dimassi, Layal Karam and Hussein F. Hassan

Int. J. Environ. Res. Public Health 2022, 19(22), 15000; https://doi.org/10.3390/ijerph192215000 - 15 Nov 2022

Cited by 12 | Viewed by 2976

Abstract

Rice is one of the most consumed staple foods worldwide and a major part of the diet for half of the global population. Being primarily cultivated in countries with warm and humid environments increases rice’s susceptibility for mycotoxins contamination, especially the hepatotoxic and [...] Read more.

Rice is one of the most consumed staple foods worldwide and a major part of the diet for half of the global population. Being primarily cultivated in countries with warm and humid environments increases rice’s susceptibility for mycotoxins contamination, especially the hepatotoxic and carcinogenic aflatoxin B1 (AFB1). Since no study was published before on the exposure to AFB1 from consuming rice in the UAE, our study aims to assess the levels of AFB1 in rice marketed in the country and determine the estimated daily exposure of the population for this carcinogenic metabolite and its associated liver cancer risk. All white, brown, and parboiled rice brands available in the retail markets in the UAE were procured twice. Using an enzyme-linked immunosorbent assay (ELISA) method, AFB1 was detected in 48 out of 128 rice samples (38%). The average contamination ± standard deviation of AFB1 among positive samples (above the detection limit) was found to be 1.66 ± 0.89 μg/kg, ranging from 1 μg/kg (detection limit) to 4.69 μg/kg. The contamination level in all the samples was below the limit set by the Gulf Cooperation Council Standardization Organization (≤5 μg/kg), while 10 (20.8%) of the positive samples had a contamination level above the maximum limit set by the European Union (≥2 μg/kg). The moisture content in all the assessed samples was ≤14%. Furthermore, there was a significant difference in AFB1 between samples in both collections (p-value = 0.043). However, the rice type, grain size, packing country, packing season, country of origin, collection season, and packing to purchasing time had no significant effect on AFB1. The calculated mean daily exposure level of the Emirati population to AFB1 from consuming rice was 4.83 ng/kg. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

9 pages, 349 KiB

Open AccessArticle

Exposure to Ochratoxin A from Rice Consumption in Lebanon and United Arab Emirates: A Comparative Study

by Hussein F. Hassan, Alissar Abou Ghaida, Abeer Charara, Hani Dimassi, Hussein Faour, Rayan Nahouli, Layal Karam and Nisreen Alwan

Int. J. Environ. Res. Public Health 2022, 19(17), 11074; https://doi.org/10.3390/ijerph191711074 - 4 Sep 2022

Cited by 12 | Viewed by 3133

Abstract

Our study aims to evaluate the ochratoxin A (OTA) in rice marketed in Lebanon and the United Arab Emirates (UAE), and to determine the exposure to OTA from rice consumption. All brands available in the market were collected twice (total number of collected [...] Read more.

Our study aims to evaluate the ochratoxin A (OTA) in rice marketed in Lebanon and the United Arab Emirates (UAE), and to determine the exposure to OTA from rice consumption. All brands available in the market were collected twice (total number of collected samples: 105 and 127 in Lebanon and the UAE, respectively). Using ELISA, the OTA in 56 (53%) samples in Lebanon and 73 (58%) samples in the UAE were above the limit of quantification (0.8 μg/kg). The average concentrations of the positive samples ± standard deviations were 1.29 ± 0.32 and 1.40 ± 0.42 μg/kg in Lebanon and the UAE, respectively. Only one sample (1%) in Lebanon had a level at the borderline of the European Union (EU) limit, and two samples (1.6%) in the UAE had a level above the EU limit (5 μg/kg). The OTA in brown rice was higher than in white and parboiled rice for both countries, yet the difference was not significant. The packing season, packing country, and country of origin did not have any significant effects. The presence of a food safety certification resulted in lower OTA in the rice, but the difference was significant (p = 0.04) in the UAE only. Long grains had higher OTA than short grains, yet the difference was only significant in Lebanon (p = 0.046). The exposures were calculated as 1.27 ng/kg body weight/day in Lebanon and 1.42 ng/kg body weight/day in the UAE, and no health risk was observed for both the neoplastic and non-neoplastic effects. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

18 pages, 390 KiB

Open AccessArticle

A Social–Ecological Study of Perceptions and Determinants of Sexual Enhancement Drug Use among Men and Women in Ghana

by Padmore Adusei Amoah, Stephen Baffour Adjei and Francis Arthur-Holmes

Int. J. Environ. Res. Public Health 2022, 19(11), 6521; https://doi.org/10.3390/ijerph19116521 - 27 May 2022

Cited by 6 | Viewed by 6904

Abstract

The use and sale of sexual enhancement drugs (particularly unapproved aphrodisiacs) have become a public health concern in Ghana and many other sub-Saharan African countries. While most studies have examined this phenomenon from the level of individual perspectives, this study investigates the multi-dimensional [...] Read more.

The use and sale of sexual enhancement drugs (particularly unapproved aphrodisiacs) have become a public health concern in Ghana and many other sub-Saharan African countries. While most studies have examined this phenomenon from the level of individual perspectives, this study investigates the multi-dimensional and multi-level factors (e.g., individual characteristics and behaviours, interpersonal factors, community norms and practices, institutional and public policy factors) that influence attitudes, perceptions, and use of aphrodisiacs among men and women in Ghana. Using a concurrent mixed-method design, we derived the data from a semi-structured interview and cross-sectional survey conducted across five administrative regions in Ghana. Interpretative phenomenological analysis and logistic regression techniques were used to analyse the qualitative and quantitative (survey) data, respectively. Approximately 12.6% of participants (17.6% among males and 7.2% among females) had used an aphrodisiac in the six months prior to the study. Approximately 23.4% of the participants had more than one partner during the same period. Among men, being religious (B = −0.238, p < 0.05) and having multiple sexual partners (B = 0.481, p < 0.01) were positively associated with the use of aphrodisiacs. For women, being employed (B = −1.539, p < 0.01), engaging in physical activities (exercising) (B = −0.658, p < 0.05), having good health (B = 0.869, p < 0.05), having multiple sexual partners (B = 1.191, p < 0.01), and taking alcohol (B = 1.041, p < 0.01) were associated with use of aphrodisiacs. Although many participants had used aphrodisiacs, women, in particular, held unfavourable views about the drugs due to perceived negative health implications for themselves and their partners. The findings also show that community-level factors (e.g., social norms and expectations), interpersonal factors (e.g., expectations of partners and friends), public policy (e.g., drug-related regulations), and organisational/institutional factors (e.g., health system arrangements about access and use of drugs) were critical to the sale and use of aphrodisiacs among both men and women in Ghana. A multi-level analysis of the use of sexual enhancement drugs among men and women is crucial to formulating social and public health policies that aim to improve public knowledge of these drugs, reduce uncontrolled production, and protect population health and well-being. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

14 pages, 371 KiB

Open AccessArticle

COVID-19 Vaccine Acceptance among Social Media Users: A Content Analysis, Multi-Continent Study

by Ramy Shaaban, Ramy Mohamed Ghazy, Fawzia Elsherif, Nancy Ali, Youssef Yakoub, Maged Osama Aly, Rony ElMakhzangy, Marwa Shawky Abdou, Bonny McKinna, Amira Mohamed Elzorkany, Fatimah Abdullah, Amr Alnagar, Nashwa ElTaweel, Majed Alharthi, Ali Mohsin, Ana Ordóñez-Cruickshank, Bianca Toniolo, Tâmela Grafolin, Thit Thit Aye, Yong Zhin Goh, Ehsan Akram Deghidy, Siti Bahri, Jarntrah Sappayabanphot, Yasir Ahmed Mohammed Elhadi, Salma Mohammed, Ahmed Nour El-Deen, Ismail Ismail, Samar Abd ElHafeez, Iffat Elbarazi, Basema Saddik, Ziad El-Khatib, Hiba Mohsin and Ahmed Kamal Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2022, 19(9), 5737; https://doi.org/10.3390/ijerph19095737 - 8 May 2022

Cited by 14 | Viewed by 6976

Abstract

Vaccine hesitancy (VH) is defined as a delayed in acceptance or refusal of vaccines despite availability of vaccination services. This multinational study examined user interaction with social media about COVID-19 vaccination. The study analyzed social media comments in 24 countries from five continents. [...] Read more.

Vaccine hesitancy (VH) is defined as a delayed in acceptance or refusal of vaccines despite availability of vaccination services. This multinational study examined user interaction with social media about COVID-19 vaccination. The study analyzed social media comments in 24 countries from five continents. In total, 5856 responses were analyzed; 83.5% of comments were from Facebook, while 16.5% were from Twitter. In Facebook, the overall vaccine acceptance was 40.3%; the lowest acceptance rates were evident in Jordan (8.5%), Oman (15.0%), Senegal (20.0%) and Morocco (20.7%) and the continental acceptance rate was the lowest in North America 22.6%. In Twitter, the overall acceptance rate was (41.5%); the lowest acceptance rate was found in Oman (14.3%), followed by USA (20.5%), and UK (23.3%) and the continental acceptance rate was the lowest in North America (20.5%), and Europe (29.7%). The differences in vaccine acceptance across countries and continents in Facebook and Twitter were statistically significant. Regarding the tone of the comments, in Facebook, countries that had the highest number of serious tone comments were Sweden (90.9%), USA (61.3%), and Thailand (58.8%). At continent level, serious comments were the highest in Asia (58.4%), followed by Africa (46.2%) and South America (46.2%). In Twitter, the highest serious tone was reported in Egypt (72.2%) while at continental level, the highest proportion of serious comments was observed in Asia (59.7%), followed by Europe (46.5%). The differences in tone across countries and continents in Facebook and Twitter and were statistically significant. There was a significant association between the tone and the position of comments. We concluded that the overall vaccine acceptance in social media was relatively low and varied across the studied countries and continents. Consequently, more in-depth studies are required to address causes of such VH and combat infodemics. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

9 pages, 967 KiB

Open AccessArticle

Parental Self-Compassion and Child Adjustment: The Mediating Role of Parental Depressive Symptoms

by Rebecca Y. M. Cheung, Zechen Li and Audrey Pui Lam Ho

Int. J. Environ. Res. Public Health 2022, 19(9), 5133; https://doi.org/10.3390/ijerph19095133 - 23 Apr 2022

Cited by 5 | Viewed by 2694

Abstract

Previous research suggests that self-compassion is associated with mental health and well-being. However, little has been done to understand the role of self-compassion in the family context. Hence, the present study investigated the associations between parents’ self-compassion, parent’s depressive symptoms, and child adjustment. [...] Read more.

Previous research suggests that self-compassion is associated with mental health and well-being. However, little has been done to understand the role of self-compassion in the family context. Hence, the present study investigated the associations between parents’ self-compassion, parent’s depressive symptoms, and child adjustment. A total 189 Chinese parents (101 mothers) whose children were 2–8 years old were recruited to complete a questionnaire, including measures of parents’ self-compassion, depressive symptoms, and children’s prosocial behavior, internalizing problems, and externalizing problems. Findings indicated mediation effects, in that parents’ depressive symptoms mediated the association between their self-compassion and child adjustment outcomes, namely children’s internalizing and externalizing problems, after controlling for the effects of monthly family income, child gender, and parent gender. Competing hypothesis suggested that parents’ self-compassion did not moderate between parents’ depressive symptoms and child adjustment outcomes. Hence, the association between parental depressive symptoms and child adjustment was not dependent on the level of parents’ self-compassion. As an implication, researchers and practitioners should be made aware of the benefits of parents’ self-compassion on parents’ mental health and child adjustment. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

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7 pages, 270 KiB

Open AccessCommunication

Caring for Your Child during COVID-19—Utilizing a Light-Touch Parenting Resource during Lockdown in Indonesia

by Aala El-Khani, Ali Yassine, Karin Haar, Narendra Narotama, Lucky Pramitasari, Melvi Rosilawati and Wadih Maalouf

Int. J. Environ. Res. Public Health 2022, 19(7), 4046; https://doi.org/10.3390/ijerph19074046 - 29 Mar 2022

Cited by 3 | Viewed by 2344

Abstract

To tackle the spread of COVID-19 globally, countries around the world have responded by implementing measures such as lockdowns, social distance maintenance, temporary school closures, and remote working and learning. COVID-19 social isolation has been found to increase stress, and potentially have long [...] Read more.

To tackle the spread of COVID-19 globally, countries around the world have responded by implementing measures such as lockdowns, social distance maintenance, temporary school closures, and remote working and learning. COVID-19 social isolation has been found to increase stress, and potentially have long term harmful effects on both mental and physical health. Stress and compromised parenting often place children at risk of violence and abuse. In parallel, times of hardship might also provide an opportunity to build stronger relationships with our children. The United Nations Office on Drugs and Crime (UNODC) joined many other agencies and international organizations in recognizing the threat the pandemic might have on individual and family wellbeing, and has thus availed a number of light-touch parenting resources. One such tool is the ‘Caring for your child in response to the COVID-19 lockdown’ booklet, developed to enhance parenting skills, and to build family harmony as challenged by the COVID-19 context. This short communication reflects on a feasibility study that took place in Indonesia during the implementation of this booklet with 30 parents in five cities. Thematic analysis identified challenges in parenting during COVID-19, as well as reported positive experiences of engaging in the parenting resource. The findings are discussed with regard to the usefulness of light-touch parenting information, adding to the context of the feasibility and global scalability of reaching families. The implications pave the way to the engagement and implication of more intensive parenting information interventions in high-stress contexts. Despite the challenge, there is promising news for families globally, as agencies and policy-makers begin to recognize the importance of supporting families with the appropriate skills to navigate extreme stress contexts with effective strategies. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

12 pages, 2069 KiB

Open AccessArticle

Emotional Dysregulation, Anxiety Symptoms and Insomnia in Individuals with Alcohol Use Disorder

by Dorota Wołyńczyk-Gmaj, Andrzej Jakubczyk, Elisa M. Trucco, Paweł Kobyliński, Justyna Zaorska, Bartłomiej Gmaj and Maciej Kopera

Int. J. Environ. Res. Public Health 2022, 19(5), 2700; https://doi.org/10.3390/ijerph19052700 - 25 Feb 2022

Cited by 12 | Viewed by 4033

Abstract

Alcohol craving is associated with insomnia symptoms, and insomnia is often reported as a reason for alcohol relapse. The current study examined associations between emotional regulation, anxiety, and insomnia among a group of 338 patients with alcohol use disorder (AUD). Because insomnia most [...] Read more.

Alcohol craving is associated with insomnia symptoms, and insomnia is often reported as a reason for alcohol relapse. The current study examined associations between emotional regulation, anxiety, and insomnia among a group of 338 patients with alcohol use disorder (AUD). Because insomnia most often develops after stressful experiences, it was expected that anxiety symptoms would mediate the association between emotional dysregulation and insomnia severity. It was also expected that an insomnia diagnosis would moderate the association between emotional dysregulation and anxiety symptoms, namely that higher anxiety levels would be found in individuals with insomnia than in those without insomnia. Insomnia severity was assessed with a total score based on the Athens Insomnia Scale (AIS). Additionally, an eight-point cut-off score on the AIS was used to classify participants as with (n = 107) or without (n = 231) an insomnia diagnosis. Moreover, participants completed the Emotion Regulation Scale (DERS; total score) and the Brief Symptoms Inventory (BSI; anxiety). Individuals with insomnia did not differ from those without insomnia in age (p = 0.86), duration of problematic alcohol use (p < 0.34), mean days of abstinence (p = 0.17), nor years of education (p = 0.41). Yet, individuals with insomnia endorsed higher anxiety (p < 0.001) and higher emotional dysregulation (p < 0.001). Anxiety symptoms fully mediated the association between emotional dysregulation and insomnia severity (p < 0.001). Furthermore, insomnia diagnosis positively moderated the association between emotional dysregulation and anxiety (p < 0.001). Our results suggest that emotional dysregulation can lead to insomnia via anxiety symptoms. Treating anxiety symptoms and emotional dysregulation could help to prevent or alleviate symptoms of insomnia in people with AUD. Moreover, treating insomnia in people with AUD may also have a positive effect on anxiety symptoms. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

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7 pages, 297 KiB

Open AccessCommunication

Bridging the Gap between the Pressing Need for Family Skills Programmes in Humanitarian Settings and Implementation

by Aala El-Khani, Rachel Calam, Karin Haar and Wadih Maalouf

Int. J. Environ. Res. Public Health 2022, 19(4), 2181; https://doi.org/10.3390/ijerph19042181 - 15 Feb 2022

Cited by 5 | Viewed by 2930

Abstract

A supportive environment with nurturing caregivers is essential for the healthy development of children. For children who have been exposed to extreme stress, such as humanitarian contexts, the need for strong, healthy, nurturing caregiver relationships may assume even greater importance. Much research has [...] Read more.

A supportive environment with nurturing caregivers is essential for the healthy development of children. For children who have been exposed to extreme stress, such as humanitarian contexts, the need for strong, healthy, nurturing caregiver relationships may assume even greater importance. Much research has been building to position family skills interventions as a key tool in encouraging safe and supporting relationships between caregivers and children, thus preventing many problem behaviours and poor mental health. While there is substantial evidence of the effectiveness of family skills interventions in high-income and stable contexts, evidence of interventions that have been tested in humanitarian and challenging settings, such as contexts of refugee and displacement, are far fewer. Despite the role that family skills interventions can play in protecting children from current and future challenges, there is a significant lack of such interventions being utilised in humanitarian settings. We put forward seven likely reasons for this lack of uptake. Furthermore, the Strong Families programme, a UNODC family skills intervention, is presented as an example of an intervention that aims to bridge this gap of interventions that meet the need for humanitarian and contexts of extreme stress. More research is needed to unpack the content, delivery mechanisms and reach of family skills programmes to further aid programme developers in investing in efforts that might provide significant sustained impact for families in humanitarian contexts. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

12 pages, 1467 KiB

Open AccessArticle

Experience of Rwanda on COVID-19 Case Management: From Uncertainties to the Era of Neutralizing Monoclonal Antibodies

by Menelas Nkeshimana, Deborah Igiraneza, David Turatsinze, Otto Niyonsenga, Deborah Abimana, Cyprien Iradukunda, Emmanuel Bizimana, Jean Muragizi, Lise Mumporeze, Laurent Lussungu, Hackim Mugisha, Elizabeth Mgamb, Noella Bigirimana, Edison Rwagasore, Swaibu Gatare, Hassan Mugabo, Olivier Nsekuye, Muhammed Semakula, Augustin Sendegeya, Ephraim Rurangwa, Edgar Kalimba, Sanctus Musafiri, Corneille Ntihabose, Eric Seruyange, Charlotte Bavuma, Theogene Twagirumugabe, Daniel Nyamwasa and Sabin Nsanzimana Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2022, 19(3), 1023; https://doi.org/10.3390/ijerph19031023 - 18 Jan 2022

Cited by 4 | Viewed by 4799

Abstract

The management of COVID-19 in Rwanda has been dynamic, and the use of COVID-19 therapeutics has gradually been updated based on scientific discoveries. The treatment for COVID-19 remained patient-centered and entirely state-sponsored during the first and second waves. From the time of identification [...] Read more.

The management of COVID-19 in Rwanda has been dynamic, and the use of COVID-19 therapeutics has gradually been updated based on scientific discoveries. The treatment for COVID-19 remained patient-centered and entirely state-sponsored during the first and second waves. From the time of identification of the index case in March 2020 up to August 2021, three versions of the clinical management guidelines were developed, with the aim of ensuring that the COVID-19 patients treated in Rwanda were receiving care based on the most recent therapeutic discoveries. As the case load increased and imposed imminent heavy burdens on the healthcare system, a smooth transition was made to enable that the asymptomatic and mild COVID-19 cases could continue to be closely observed and managed while they remained in their homes. The care provided to patients requiring facility-based interventions mainly focused on the provision of anti-inflammatory drugs, anticoagulation, broad-spectrum antibiotic therapy, management of hyperglycemia and the provision of therapeutics with a direct antiviral effect such as favipiravir and neutralizing monoclonal antibodies. The time to viral clearance was observed to be shortest among eligible patients treated with neutralizing monoclonal antibodies (bamlanivimab). Moving forward, as we strive to continue detecting COVID-19 cases as early as possible, and promptly initiate supportive interventions, the use of neutralizing monoclonal antibodies constitutes an attractive and cost-effective therapeutic approach. If this approach is used strategically along with other measures in place (i.e., COVID-19 vaccine roll out, etc.), it will enable us to bring this global battle against the COVID-19 pandemic under full control and with a low case fatality rate. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

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12 pages, 655 KiB

Open AccessArticle

A Lower CD4 Count Predicts Most Causes of Death except Cardiovascular Deaths. The Austrian HIV Cohort Study

by Gisela Leierer, Armin Rieger, Brigitte Schmied, Mario Sarcletti, Angela Öllinger, Elmar Wallner, Alexander Egle, Manfred Kanatschnig, Alexander Zoufaly, Michele Atzl, Michaela Rappold, Ziad El-Khatib, Bruno Ledergerber, Robert Zangerle and on behalf of the Austrian HIV Cohort Study Group

Int. J. Environ. Res. Public Health 2021, 18(23), 12532; https://doi.org/10.3390/ijerph182312532 - 28 Nov 2021

Cited by 5 | Viewed by 3113

Abstract

(1) Objective: To investigate changes in mortality rates and predictors of all-cause mortality as well as specific causes of death over time among HIV-positive individuals in the combination antiretroviral therapy (cART) era. (2) Methods: We analyzed all-cause as well as cause-specific mortality among [...] Read more.

(1) Objective: To investigate changes in mortality rates and predictors of all-cause mortality as well as specific causes of death over time among HIV-positive individuals in the combination antiretroviral therapy (cART) era. (2) Methods: We analyzed all-cause as well as cause-specific mortality among the Austrian HIV Cohort Study between 1997 and 2014. Observation time was divided into five periods: Period 1: 1997–2000; period 2: 2001–2004; period 3: 2005–2008; period 4: 2009–2011; and period 5: 2012–2014. Mortality rates are presented as deaths per 100 person-years (d/100py). Potential risk factors associated with all-cause mortality and specific causes of death were identified by using multivariable Cox proportional hazard models. Models were adjusted for time-updated CD4, age and cART, HIV transmission category, population size of residence area and country of birth. To assess potential nonlinear associations, we fitted all CD4 counts per patient using restricted cubic splines with truncation at 1000 cells/mm³. Vital status of patients was cross-checked with death registry data. (3) Results: Of 6848 patients (59,704 person-years of observation), 1192 died: 380 (31.9%) from AIDS-related diseases. All-cause mortality rates decreased continuously from 3.49 d/100py in period 1 to 1.40 d/100py in period 5. Death due to AIDS-related diseases, liver-related diseases and non-AIDS infections declined, whereas cardiovascular diseases as cause of death remained stable (0.27 d/100py in period 1, 0.10 d/100py in period 2, 0.16 d/100py in period 3, 0.09 d/100py in period 4 and 0.14 d/100py in period 5) and deaths due to non-AIDS-defining malignancies increased. Compared to latest CD4 counts of 500 cells/mm³, lower CD4 counts conferred a higher risk of deaths due to AIDS-related diseases, liver-related diseases, non-AIDS infections and non-AIDS-defining malignancies, whereas no significant association was observed for cardiovascular mortality. Results were similar in sensitivity analyses where observation time was divided into two periods: 1997–2004 and 2005–2014. (4) Conclusions: Since the introduction of cART, risk of death decreased and causes of death changed. We do not find evidence that HIV-positive individuals with a low CD4 count are more likely to die from cardiovascular diseases. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

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38 pages, 2190 KiB

Open AccessArticle

Impact of a Brief Family Skills Training Programme (“Strong Families”) on Parenting Skills, Child Psychosocial Functioning, and Resilience in Iran: A Multisite Controlled Trial

by Karin Haar, Aala El-Khani, Gelareh Mostashari, Mahdokht Hafezi, Atoosa Malek and Wadih Maalouf

Int. J. Environ. Res. Public Health 2021, 18(21), 11137; https://doi.org/10.3390/ijerph182111137 - 23 Oct 2021

Cited by 11 | Viewed by 5165

Abstract

Caregivers have a key role in protecting children’s wellbeing, and, with appropriate skills, can prevent a multitude of negative social outcomes, particularly in challenged or humanitarian settings. Accordingly, the Strong Families programme was designed as a light touch family skills programme, with a [...] Read more.

Caregivers have a key role in protecting children’s wellbeing, and, with appropriate skills, can prevent a multitude of negative social outcomes, particularly in challenged or humanitarian settings. Accordingly, the Strong Families programme was designed as a light touch family skills programme, with a focus of supporting caregiving during stressful situations. To evaluate the short-term impact of the Strong Families programme, we performed a time-convenience, randomized, controlled trial in Iran. A total of 292 families (63% from Iranian decent, 39% from Afghan decent, and 1% other), with children aged eight to twelve years, were recruited through ten centers in Iran and allocated to an intervention (n = 199) or waitlist/control group (n = 93). The two groups did not differ demographically at baseline. We assessed families prospectively, through three scales, PAFAS (parenting and family adjustment scales), SDQ (strengths and difficulties questionnaire), and CYRM-R (child and youth resilience measure). Caregivers in the intervention group improved (highly) statistically significantly on all but one PAFAS subscales (parental consistency, coercive parenting, positive encouragement, parental adjustment, family relationships, and parental teamwork), which was not noted in the waitlist group. On the SDQ, there were (highly) significant positive changes in scores in the intervention group on all sub-scales and the “total difficulty scale“, whereas the waitlist/control group also improved on three (prosocial, conduct problems, and hyperactivity) of the five SDQ subscales. Children originating from Afghanistan improved significantly on the overall resilience scale of the CYRM-R in the intervention group, but not in the waitlist/control group. Overall, all our stratified results of the different scales reflect an accentuated improvement in families with higher levels of problems at baseline. Our comparative results indicated a strong alignment of the strong families programme with its intended short-term impact, per its logical frame on parenting practices and family management skills, children behaviour, caregivers and children mental health, and capacity to cope with stress. We postulate that the potential nudging or diffusion of knowledge (cross-contamination between intervention and waitlist/control group) at the community level could explain improvements in the waitlist/control group on some indicators, however, further research on this is recommend. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

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29 pages, 16010 KiB

Open AccessArticle

Data-Powered Positive Deviance during the SARS-CoV-2 Pandemic—An Ecological Pilot Study of German Districts

by Joshua Driesen, Ziad El-Khatib, Niklas Wulkow, Mitchell Joblin, Iskriyana Vasileva, Andreas Glücker, Valentin Kruspel and Catherine Vogel

Int. J. Environ. Res. Public Health 2021, 18(18), 9765; https://doi.org/10.3390/ijerph18189765 - 16 Sep 2021

Cited by 3 | Viewed by 5099

Abstract

We introduced the mixed-methods Data-Powered Positive Deviance (DPPD) framework as a potential addition to the set of tools used to search for effective response strategies against the SARS-CoV-2 pandemic. For this purpose, we conducted a DPPD study in the context of the early [...] Read more.

We introduced the mixed-methods Data-Powered Positive Deviance (DPPD) framework as a potential addition to the set of tools used to search for effective response strategies against the SARS-CoV-2 pandemic. For this purpose, we conducted a DPPD study in the context of the early stages of the German SARS-CoV-2 pandemic. We used a framework of scalable quantitative methods to identify positively deviant German districts that is novel in the scientific literature on DPPD, and subsequently employed qualitative methods to identify factors that might have contributed to their comparatively successful reduction of the forward transmission rate. Our qualitative analysis suggests that quick, proactive, decisive, and flexible/pragmatic actions, the willingness to take risks and deviate from standard procedures, good information flows both in terms of data collection and public communication, alongside the utilization of social network effects were deemed highly important by the interviewed districts. Our study design with its small qualitative sample constitutes an exploratory and illustrative effort and hence does not allow for a clear causal link to be established. Thus, the results cannot necessarily be extrapolated to other districts as is. However, the findings indicate areas for further research to assess these strategies’ effectiveness in a broader study setting. We conclude by stressing DPPD’s strengths regarding replicability, scalability, adaptability, as well as its focus on local solutions, which make it a promising framework to be applied in various contexts, e.g., in the context of the Global South. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

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20 pages, 1306 KiB

Open AccessArticle

Enhancing Teaching Recovery Techniques (TRT) with Parenting Skills: RCT of TRT + Parenting with Trauma-Affected Syrian Refugees in Lebanon Utilising Remote Training with Implications for Insecure Contexts and COVID-19

by Aala El-Khani, Kim Cartwright, Wadih Maalouf, Karin Haar, Nosheen Zehra, Gökçe Çokamay-Yılmaz and Rachel Calam

Int. J. Environ. Res. Public Health 2021, 18(16), 8652; https://doi.org/10.3390/ijerph18168652 - 16 Aug 2021

Cited by 29 | Viewed by 6049

Abstract

Child psychosocial recovery interventions in humanitarian contexts often overlook the significant effect that caregivers can have on improving children’s future trajectory. We enhanced the well-established, evidenced-based child trauma recovery programme Teaching Recovery Techniques (TRT) intervention with parenting sessions, i.e., TRT + Parenting (TRT [...] Read more.

Child psychosocial recovery interventions in humanitarian contexts often overlook the significant effect that caregivers can have on improving children’s future trajectory. We enhanced the well-established, evidenced-based child trauma recovery programme Teaching Recovery Techniques (TRT) intervention with parenting sessions, i.e., TRT + Parenting (TRT + P), which aims to improve parent mental health and their ability to support their children’s mental health. We describe the findings of a three-arm randomised controlled trial comparing enhanced TRT + P vs. TRT and waitlist. The primary aim was to test if children in the enhanced arm of the programme show improved child and caregiver mental health. We recruited 119 Syrian refugee children and one of their caregivers in Beqaa Valley in Lebanon. They were randomised to the TRT, TRT + P, or waitlist control group. Data were collected at baseline and 2 weeks and 12 weeks post intervention. Training of facilitators was via remote training from the United Kingdom. Results showed a highly consistent pattern, with children in the enhanced TRT + P group showing the greatest levels of improvement in behavioural and emotional difficulties compared to children in the TRT or waitlist control groups. Caregivers in the TRT + P group also reported significant reductions in depression, anxiety, and stress. Findings indicate that the addition of the evidence-based parenting skills components has the potential to enhance the effects of interventions designed to improve children’s mental health in contexts of trauma, conflict, and displacement. Implications for COVID-19 remote learning are also discussed. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

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10 pages, 1673 KiB

Open AccessArticle

Investigation of Four Clusters of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Rwanda, 2020

by Olivier Nsekuye, Edson Rwagasore, Marie Aime Muhimpundu, Ziad El-Khatib, Daniel Ntabanganyimana, Eric Noël Kamayirese, Laurent Ruyange, Angela Umutoni, Adeline Kabeja Adeline, Joseph Ntaganira, Sabin Nsazimana and Jared Omolo

Int. J. Environ. Res. Public Health 2021, 18(13), 7018; https://doi.org/10.3390/ijerph18137018 - 30 Jun 2021

Cited by 7 | Viewed by 3324

Abstract

We reported the findings of the first Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) four clusters identified in Rwanda. Case-investigations included contact elicitation, testing, and isolation/quarantine of confirmed cases. Socio-demographic and clinical data on cases and contacts were collected. A confirmed case was [...] Read more.

We reported the findings of the first Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) four clusters identified in Rwanda. Case-investigations included contact elicitation, testing, and isolation/quarantine of confirmed cases. Socio-demographic and clinical data on cases and contacts were collected. A confirmed case was a person with laboratory confirmation of SARS-CoV-2 infection (PCR) while a contact was any person who had contact with a SARS-CoV-2 confirmed case within 72 h prior, to 14 days after symptom onset; or 14 days before collection of the laboratory-positive sample for asymptomatic cases. High risk contacts were those who had come into unprotected face-to-face contact or had been in a closed environment with a SARS-CoV-2 case for >15 min. Forty cases were reported from four clusters by 22 April 2020, accounting for 61% of locally transmitted cases within six weeks. Clusters A, B, C and D were associated with two nightclubs, one house party, and different families or households living in the same compound (multi-family dwelling). Thirty-six of the 1035 contacts tested were positive (secondary attack rate: 3.5%). Positivity rates were highest among the high-risk contacts compared to low-risk contacts (10% vs. 2.2%). Index cases in three of the clusters were imported through international travelling. Fifteen of the 40 cases (38%) were asymptomatic while 13/25 (52%) and 8/25 (32%) of symptomatic cases had a cough and fever respectively. Gatherings in closed spaces were the main early drivers of transmission. Systematic case-investigations contact tracing and testing likely contributed to the early containment of SARS-CoV-2 in Rwanda. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

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19 pages, 1075 KiB

Open AccessArticle

Assessing the Feasibility of Providing a Family Skills Intervention, “Strong Families”, for Refugee Families Residing in Reception Centers in Serbia

by Aala El-Khani, Karin Haar, Milos Stojanovic and Wadih Maalouf

Int. J. Environ. Res. Public Health 2021, 18(9), 4530; https://doi.org/10.3390/ijerph18094530 - 24 Apr 2021

Cited by 20 | Viewed by 3396

Abstract

War exposure and forced displacement threatens the wellbeing of caregivers and their children, leaving them at risk of negative outcomes, such as elevated rates of anxiety, depression and post-traumatic stress disorder. The importance of engaged, responsive and stable parenting for positive child wellbeing [...] Read more.

War exposure and forced displacement threatens the wellbeing of caregivers and their children, leaving them at risk of negative outcomes, such as elevated rates of anxiety, depression and post-traumatic stress disorder. The importance of engaged, responsive and stable parenting for positive child wellbeing has been documented across diverse cultural and economic backgrounds. Despite the higher need for caregivers to be nurturing in challenging settings, they struggle to provide adequate support for their children due to lack of resources or their inability to deal with their own emotional challenges. A feasibility study was conducted of a new, open-access and light-touch family skills intervention, Strong Families (for families in humanitarian and challenged settings) on refugee families residing in Reception Centers in Serbia. Questionnaires and interviews were completed by participating caregivers and facilitators. Qualitative results indicated that the intervention was feasible to run in this humanitarian context, that caregivers viewed the intervention as culturally acceptable and complemented the quantitative results that showed promise for enhancing child behavior and family functioning tested indicators. Despite being a light intervention, Strong Families indicated improvement on child mental health, parenting practices and parent and family adjustment skills. Prioritizing family mental health and functioning as a primary need that parallels that of accessing physical medical care, sanitation and clean water must be the definitive next step in humanitarian aid. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

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9 pages, 329 KiB

Open AccessArticle

Physical Activity and Plasma Glucose Control among Diabetic Patients Attending Outpatients Clinics in Hanoi, Vietnam

by Tam Ngoc Nguyen, Tam Thi Nguyen, Maria Hagströmer, Thang Pham, Ingeborg van der Ploeg, Carl Johan Sundberg and Huyen Thi Thanh Vu

Int. J. Environ. Res. Public Health 2021, 18(3), 1182; https://doi.org/10.3390/ijerph18031182 - 29 Jan 2021

Cited by 3 | Viewed by 2822

Abstract

Reaching the recommendation on physical activity (PA) for health is highly important to effectively manage blood glucose in patients with type 2 diabetes (T2D). The aims of this study were to assess the level and pattern of PA among T2D outpatients and to [...] Read more.

Reaching the recommendation on physical activity (PA) for health is highly important to effectively manage blood glucose in patients with type 2 diabetes (T2D). The aims of this study were to assess the level and pattern of PA among T2D outpatients and to relate PA levels to glucose control. A cross-sectional study was conducted in outpatient clinics in Hanoi, Vietnam. PA levels were reported using the Global Physical Activity Questionnaire (GPAQ) version 2.0. Participants meeting the WHO recommendations on PA for health or not were respectively categorized as “sufficiently active” and “insufficiently active”. FPG < 7.2 mmol/L was defined as controlled plasma glucose. In total, 407 participants with T2D (55% women, mean (SD) age 61.6 (9.7) years) were included. The fraction of T2D outpatients reporting as insufficiently active was 21%. The lowest amount of energy expenditure was from transport activities (travel from and to places). On multivariate logistic regression, being sufficiently active was associated with a two-fold increased likelihood of having better glycemic control. The findings warrant action plans to increase physical activity in general and in specific active transport for T2D patients in Vietnam. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

15 pages, 1859 KiB

Open AccessArticle

Breaking Barriers to Healthcare Access: A Multilevel Analysis of Individual- and Community-Level Factors Affecting Women’s Access to Healthcare Services in Benin

by Betregiorgis Zegeye, Ziad El-Khatib, Edward Kwabena Ameyaw, Abdul-Aziz Seidu, Bright Opoku Ahinkorah, Mpho Keetile and Sanni Yaya

Int. J. Environ. Res. Public Health 2021, 18(2), 750; https://doi.org/10.3390/ijerph18020750 - 17 Jan 2021

Cited by 33 | Viewed by 8850

Abstract

Background: In low-income countries such as Benin, most people have poor access to healthcare services. There is scarcity of evidence about barriers to accessing healthcare services in Benin. Therefore, we examined the magnitude of the problem of access to healthcare services and its [...] Read more.

Background: In low-income countries such as Benin, most people have poor access to healthcare services. There is scarcity of evidence about barriers to accessing healthcare services in Benin. Therefore, we examined the magnitude of the problem of access to healthcare services and its associated factors. Methods: We utilized data from the 2017–2018 Benin Demographic and Health Survey (n = 15,928). We examined the associations between the demographic and socioeconomic characteristics of women using multilevel logistic regression. The outcome variable for the study was problem of access to healthcare service. Adjusted odds ratios (AORs) with 95% confidence intervals (95% CI) were estimated. Results: Overall, 60.4% of surveyed women had problems in accessing healthcare services. Partner’s education (AOR = 0.70; 95% CI; 0.55–0.89), economic status (AOR = 0.59; 95% CI; 0.47–0.73), marital status (AOR = 0.44; 95% CI; 0.39–0.51), and parity (AOR = 1.85; 95% CI; 1.45–2.35) were significant individual-level factors associated with problem of access to healthcare. Region (AOR = 5.24; 95% CI; 3.18–8.64) and community literacy level (AOR = 0.69; 95% CI; 0.51–0.94) were the main community-level risk factors. Conclusions: Enhancing husband education through adult education programs, economic empowerment of women, enhancing national education coverage, and providing priority for unmarried and multipara women need to be considered. Additionally, there is the need to ensure equity-based access to healthcare services across regions. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

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10 pages, 2305 KiB

Open AccessArticle

Vaccination Status and Attitude among Measles Cluster Cases in Austria, 2019

by Lukasz Henszel, Elisabeth E. Kanitz, Andrea Grisold, Heidemarie Holzmann, Stephan W. Aberle and Daniela Schmid

Int. J. Environ. Res. Public Health 2020, 17(24), 9377; https://doi.org/10.3390/ijerph17249377 - 15 Dec 2020

Cited by 3 | Viewed by 2294

Abstract

On 21 January 2019, public health authorities of two neighboring Austrian provinces reported an increase in measles cases. We investigated this occurrence to identify clusters of epidemiologically linked cases and the associated vaccination status in order to generate hypotheses on those factors explaining [...] Read more.

On 21 January 2019, public health authorities of two neighboring Austrian provinces reported an increase in measles cases. We investigated this occurrence to identify clusters of epidemiologically linked cases and the associated vaccination status in order to generate hypotheses on those factors explaining the size of the measles clusters. Probable cases were residents of the provinces of Styria or Salzburg with clinical presentation of measles after 1 January 2019 who were linked to a confirmed case using RNA virus detection. We collected data on age, rash onset, certificate-based vaccination status and reasons for being unvaccinated. Contact history was used to identify chains of transmission. By 11 March, we identified 47 cases, with 40 (85.1%) in unvaccinated patients. A cluster of 35 cases with a median age of seven years (IQR: 1–11) occurred between 9 January and 20 February in the province of Styria due to one transmission chain with four case generations. Of 31 vaccine-eligible cases, 25 (80.6%) were unvaccinated, of which 13 refused vaccination. Between 10 January and 1 March, we identified 12 cases as part of five unlinked clusters in the province of Salzburg. Each of these five clusters consisted of two generations: the primary case and the successive cases (median age: 22 years, IQR: 11–35). Eleven of 12 cases occurred in unvaccinated patients, with none of the 11 having a vaccination-refusing attitude. An extended measles cluster in a vaccination-refusing community, compared to five short-lived clusters concurrently occurring in the neighboring province, illustrates how vaccine refusal may hamper control of transmission. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

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14 pages, 831 KiB

Open AccessArticle

Patterns and Predictors of Insufficient Antenatal Care Utilization in Nigeria over a Decade: A Pooled Data Analysis Using Demographic and Health Surveys

by Ziad El-Khatib, Emmanuel Kolawole Odusina, Bishwajit Ghose and Sanni Yaya

Int. J. Environ. Res. Public Health 2020, 17(21), 8261; https://doi.org/10.3390/ijerph17218261 - 9 Nov 2020

Cited by 24 | Viewed by 5466

Abstract

This study investigated the patterns of antenatal care (ANC) utilization and insufficient use of ANC as well as its association with some proximate socio-demographic factors. This was a cross-sectional study using pooled data Nigeria Demographic and Health Surveys from years 2008, 2013 and [...] Read more.

This study investigated the patterns of antenatal care (ANC) utilization and insufficient use of ANC as well as its association with some proximate socio-demographic factors. This was a cross-sectional study using pooled data Nigeria Demographic and Health Surveys from years 2008, 2013 and 2018. Participants were 52,654 women of reproductive age who reported at least one birth in the five years preceding the surveys. The outcome variables were late attendance, first contact after first trimester and less than four antenatal visits using multivariable logistic regression analysis. The overall prevalence of late timing was 74.8% and that of insufficient ANC visits was 46.7%. In the multivariable regression analysis; type of residency, geo-political region, educational level, household size, use of contraceptives, distance to health service, exposure to the media and total number of children were found to be significantly associated with both late and insufficient ANC attendance. About half of the pregnant women failed to meet the recommendation of four ANC visits. Investing on programs to improve women’s socio-economic status, addressing the inequities between urban and rural areas of Nigeria in regard to service utilization, and controlling higher fertility rates may facilitate the promotion of ANC service utilization in Nigeria. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

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Review

Jump to: Research, Other

22 pages, 5696 KiB

Open AccessReview

Malaria and Helminthic Co-Infection during Pregnancy in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

by Minyahil Tadesse Boltena, Ziad El-Khatib, Abraham Sahilemichael Kebede, Benedict Oppong Asamoah, Appiah Seth Christopher Yaw, Kassim Kamara, Phénix Constant Assogba, Andualem Tadesse Boltena, Hawult Taye Adane, Elifaged Hailemeskel and Mulatu Biru

Int. J. Environ. Res. Public Health 2022, 19(9), 5444; https://doi.org/10.3390/ijerph19095444 - 29 Apr 2022

Cited by 9 | Viewed by 6028

Abstract

Malaria and helminthic co-infection during pregnancy causes fetomaternal haemorrhage and foetal growth retardation. This study determined the pooled burden of pregnancy malaria and helminthic co-infection in sub-Saharan Africa. CINAHL, EMBASE, Google Scholar, Scopus, PubMed, and Web of Science databases were used to retrieve [...] Read more.

Malaria and helminthic co-infection during pregnancy causes fetomaternal haemorrhage and foetal growth retardation. This study determined the pooled burden of pregnancy malaria and helminthic co-infection in sub-Saharan Africa. CINAHL, EMBASE, Google Scholar, Scopus, PubMed, and Web of Science databases were used to retrieve data from the literature, without restricting language and publication year. The Joanna Briggs Institute’s critical appraisal tool for prevalence studies was used for quality assessment. STATA Version 14.0 was used to conduct the meta-analysis. The I² statistics and Egger’s test were used to test heterogeneity and publication bias. The random-effects model was used to estimate the pooled prevalence at a 95% confidence interval (CI). The review protocol has been registered in PROSPERO, with the number CRD42019144812. In total, 24 studies (n = 14,087 participants) were identified in this study. The pooled analysis revealed that 20% of pregnant women were co-infected by malaria and helminths in sub-Saharan Africa. The pooled prevalence of malaria and helminths were 33% and 35%, respectively. The most prevalent helminths were Hookworm (48%), Ascaris lumbricoides (37%), and Trichuris trichiura (15%). Significantly higher malaria and helminthic co-infection during pregnancy were observed. Health systems in sub-Saharan Africa must implement home-grown innovative solutions to underpin context-specific policies for the early initiation of effective intermittent preventive therapy. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

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15 pages, 373 KiB

Open AccessReview

Experts’ Opinion for Improving Pertussis Vaccination Rates in Adolescents and Adults: A Call to Action

by Giovanni Gabutti, Irene Cetin, Michele Conversano, Claudio Costantino, Paolo Durando and Sandro Giuffrida

Int. J. Environ. Res. Public Health 2022, 19(7), 4412; https://doi.org/10.3390/ijerph19074412 - 6 Apr 2022

Cited by 7 | Viewed by 3694

Abstract

This article highlights the importance of diphtheria-tetanus-acellular pertussis (with reduced antigen content, dTap) vaccination in preventing pertussis, a respiratory infection that is still widespread and easily transmitted. In particular, it highlights the need to receive a booster vaccination throughout life to maintain high [...] Read more.

This article highlights the importance of diphtheria-tetanus-acellular pertussis (with reduced antigen content, dTap) vaccination in preventing pertussis, a respiratory infection that is still widespread and easily transmitted. In particular, it highlights the need to receive a booster vaccination throughout life to maintain high antibody levels, which decrease through time. This document collects the opinions that emerged from the comparison between major Italian experts in the field of vaccination. This working group was created to promote a “call to action”, aimed at raising awareness among all institutions, public health authorities, and health workers involved in the vaccination process, about the importance of dTap vaccine administration and with the mindset of implementing the strategic vaccination plan provided by the National Vaccine Plan (NVP). In fact, despite this vaccine being included in the NVP, there are some issues attributable to the practice of vaccination (local health authorities, vaccination centers, occupational health services, gynecology centers, societies of work). Therefore, it is necessary that the Ministry defines the vaccination coverage objectives, identifies the groups of subjects who should receive the booster vaccine (subjects exposed to greater risk of infection, subjects over 60, pregnant women), and applies all the necessary measures to encourage the implementation of this practice. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

15 pages, 5355 KiB

Open AccessReview

Tuberculosis Treatment Outcome and Predictors in Africa: A Systematic Review and Meta-Analysis

by Melese Yeshambaw Teferi, Ziad El-Khatib, Minyahil Tadesse Boltena, Azeb Tarekegn Andualem, Benedict Oppong Asamoah, Mulatu Biru and Hawult Taye Adane

Int. J. Environ. Res. Public Health 2021, 18(20), 10678; https://doi.org/10.3390/ijerph182010678 - 12 Oct 2021

Cited by 37 | Viewed by 6604

Abstract

This review aimed to summarize and estimate the TB treatment success rate and factors associated with unsuccessful TB treatment outcomes in Africa. Potentially eligible primary studies were retrieved from PubMed and Google Scholar. The risk of bias and quality of studies was assessed [...] Read more.

This review aimed to summarize and estimate the TB treatment success rate and factors associated with unsuccessful TB treatment outcomes in Africa. Potentially eligible primary studies were retrieved from PubMed and Google Scholar. The risk of bias and quality of studies was assessed using The Joanna Briggs Institute’s (JBI) appraisal criteria, while heterogeneity across studies was assessed using Cochran’s Q test and I2 statistic. Publication bias was checked using the funnel plot and egger’s test. The protocol was registered in PROSPERO, numbered CRD42019136986. A total of 26 eligible studies were considered. The overall pooled estimate of TB treatment success rate was found to be 79.0% (95% CI: 76–82%), ranging from 53% (95% CI: 47–58%) in Nigeria to 92% (95% CI: 90–93%) in Ethiopia. The majority of unsuccessful outcomes were attributed to 48% (95% CI: 40–57%) death and 47% (95% CI: 39–55%) of defaulter rate. HIV co-infection and retreatment were significantly associated with an increased risk of unsuccessful treatment outcomes compared to HIV negative and newly diagnosed TB patients with RR of 1.53 (95% CI: 1.36–1.71) and 1.48 (95% CI: 1.14–1.94), respectively. TB treatment success rate was 79% below the WHO defined threshold of 85% with significant variation across countries. Countries need to explore contextual underlining factors and more effort is required in providing TB preventive treatment, improve case screening and linkage for TB treatment among HIV high-risk groups and use confirmatory TB diagnostic modality. Countries in Africa need to strengthen counseling and follow-up, socio-economic support for patients at high risk of loss to follow-up and poor treatment success is also crucial for successful TB control programs. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

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15 pages, 4376 KiB

Open AccessReview

Comorbidity of Geo-Helminthes among Malaria Outpatients of the Health Facilities in Ethiopia: Systematic Review and Meta-Analysis

by Minyahil Tadesse Boltena, Ziad El-Khatib, Abraham Sahlemichael Kebede, Benedict Oppong Asamoah, Andualem Tadesse Boltena, Melese Yeshambaw and Mulatu Biru

Int. J. Environ. Res. Public Health 2021, 18(3), 862; https://doi.org/10.3390/ijerph18030862 - 20 Jan 2021

Cited by 5 | Viewed by 5466

Abstract

Background: Coinfection of malaria and intestinal helminths affects one third of the global population, largely among communities with severe poverty. The spread of these parasitic infections overlays in several epidemiological locations and the host shows different outcomes. This systematic review and meta-analysis determine [...] Read more.

Background: Coinfection of malaria and intestinal helminths affects one third of the global population, largely among communities with severe poverty. The spread of these parasitic infections overlays in several epidemiological locations and the host shows different outcomes. This systematic review and meta-analysis determine the pooled prevalence of malaria and intestinal helminthiases coinfections among malaria suspected patients in Ethiopia. Methods: Primary studies published in English language were retrieved using appropriate search terms on Google Scholar, PubMed/MEDLINE, CINHAL, Scopus, and Embase. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. A pooled statistical meta-analysis was conducted using STATA Version 14.0 software. The heterogeneity and publication bias were assessed using the I2 statistics and Egger’s test, respectively. Duval and Tweedie’s nonparametric trim and fill analysis using the random-effect analysis. The Random effects model was used to estimate the summary prevalence of comorbidity of malaria and soil transmitted helminthiases and the corresponding 95% confidence intervals (CI). The review protocol has registered in PROSPERO number CRD42019144803. Results: We identified ten studies (n = 6633 participants) in this study. The overall pooled result showed 13% of the ambulatory patients infected by malaria and intestinal helminths concurrently in Ethiopia. The pooled prevalence of Plasmodium falciparum and Plasmodium vivax, and mixed infections were 12, 30, and 6%, respectively. The most common intestinal helminth parasites detected were Hookworm, Ascaris lumbricoides, and Tirchuris trichiura. Conclusions: The comorbidity of malaria and intestinal helminths causes lower hemoglobin level leading to maternal anemia, preterm delivery, and still birth in pregnant women and lactating mother. School-aged children and neonates coinfected by plasmodium species and soil transmitted helminths develop cognitive impairment, protein energy malnutrition, low birth weight, small for gestational age, and gross motor delay. The Ministry of Health of Ethiopia and its international partners working on malaria elimination programs should give more emphasis to the effect of the interface of malaria and soil transmitted helminths, which calls for an integrated disease control and prevention. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

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11 pages, 630 KiB

Open AccessStudy Protocol

Early Occupational Therapy Intervention in the Hospital Discharge after Stroke

by Patricia García-Pérez, María del Carmen Rodríguez-Martínez, José Pablo Lara and Carlos de la Cruz-Cosme

Int. J. Environ. Res. Public Health 2021, 18(24), 12877; https://doi.org/10.3390/ijerph182412877 - 7 Dec 2021

Cited by 7 | Viewed by 11672

Abstract

Stroke is the leading cause of acquired disability in adults which is a cerebrovascular disease of great impact in health and social terms, not only due to its prevalence and incidence but also because of its significant consequences in terms of patient dependence [...] Read more.

Stroke is the leading cause of acquired disability in adults which is a cerebrovascular disease of great impact in health and social terms, not only due to its prevalence and incidence but also because of its significant consequences in terms of patient dependence and its consequent impact on the patient and family lives. The general objective of this study is to determine whether an early occupational therapy intervention at hospital discharge after suffering a stroke has a positive effect on the functional independence of the patient three months after discharge—the patient’s level of independence being the main focus of this research. Data will be collected on readmissions to hospitals, mortality, returns to work and returns to driving, as well as an economic health analysis. This is a prospective, randomized, controlled clinical trial. The sample size will be made up of 60 patients who suffered a stroke and were discharged from the neurology unit of a second-level hospital in west Malaga (Spain), who were then referred to the rehabilitation service by the joint decision of the neurology and rehabilitation department. The patients and caregivers assigned to the experimental group were included in an early occupational therapy intervention program and compared with a control group that receives usual care. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

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12 pages, 603 KiB

Open AccessProtocol

The Role of Law Enforcement Officers/Police in Drug Prevention within Educational Settings—Study Protocol for the Development of a Guiding Document Based on Experts’ Opinions

by Ziad El-Khatib, Celina Herrera, Giovanna Campello, Elizabeth Mattfeld and Wadih Maalouf

Int. J. Environ. Res. Public Health 2021, 18(5), 2613; https://doi.org/10.3390/ijerph18052613 - 5 Mar 2021

Cited by 6 | Viewed by 7788

Abstract

The United Nations Office on Drugs and Crime—World Health Organization International Standards on Drug Use Prevention—reflects the value of safe, nurturing and supportive social institutions around the lives of youths to benefit from the prevention of risky behavior extending beyond individually-developed resilience for [...] Read more.

The United Nations Office on Drugs and Crime—World Health Organization International Standards on Drug Use Prevention—reflects the value of safe, nurturing and supportive social institutions around the lives of youths to benefit from the prevention of risky behavior extending beyond individually-developed resilience for healthy adolescent development. Schools are valuable social institutions to this effect and school safety and adolescent health outcomes can be threatened by drug use and violence. As such, collaborative, multi-level, evidence-based, developmentally sensitive, substance use prevention programs are imperative. The International Standards, in their latest version, did not reflect specific evidence of law enforcement officer-based programs with effect on drug use prevention, including in school settings. Nevertheless, the collaboration between law enforcement agencies and school-based substance use prevention programs continue to be the focus of research and policy. In this project, we aim to explore in more detail the role of law enforcement in preventing substance use in schools. We use mixed methods, including three phases: (i) scoping review on the best practices for effective law enforcement in school-based drug and crime prevention; (ii) interviews with experts, using the Delphi method, in substance use prevention and training law enforcement in school-based drug prevention; and iii) developing guidelines for law enforcement based on the findings. Initially, we identified a total of 17 papers that were categorized in four categories based on their results (negative or null effect n = 11 studies, positive effect n = 1 study, mixed effects n = 4 studies and indefinite conclusion n = 1 study). However, the authors of the studies with negative or null effect did recommend being cautious about these results due to the respective studies’ methodological limitations. The actual and perceived roles of police are largely unclear and/or variable. Therefore, clear outlines regarding law enforcement’s role within schools are crucial as one study showed that an officer’s role influences how they respond to student conduct. A secondary emergent theme from this review indicates that there is potential for positively impacting a youth’s perceptions of police through collaborative and engaging school-based programs. Currently the project is gradually moving to Phase II, where we are identifying the key experts based on scientifically published peer reviewed and grey literature/guidelines to investigate elements that make the role of law enforcement officers in school-based prevention more effective. Given the frequency with which policy makers around the world request information about the role of law enforcement in effective prevention efforts, guidelines on their roles within schools is a gap that needs to be filled. Such efforts would improve drug prevention in schools and better orient law enforcement’s role in drug prevention within educational settings. Full article

(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)

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