28 research outputs found
Identifikacija izvora onečišćenja podzemnih voda u većim gradovima jugozapadne Nigerije
Groundwater in form of hand-dug wells and boreholes serves as the main source of drinking water to the people of south-western Nigeria. Contamination of this resource has been linked to many ambiguous pollution sources. The aim of this paper is to identify and apportion sources of pollution to groundwater in five major cities in south-western Nigeria using Principal Components Analysis (PCA). Studies on physico-chemical parameters of groundwater from Abeokuta, Ifo, Sango, Ibadan and lagos were adopted from published literatures, and evaluated using a SPSS statistical package. PCA revealed factor ranges between four and eight. Sources identified were bedrock weathering/sea water, nutrient, solids, urban/traffic runoff, industry, hardness, faecal pollution, soil leaching, nutrient, salt-water intrusion and leachate.Kao glavni izvor pitke vode stanovnicima jugozapadne Nigerije služi voda iz kopanih ili bušenih bunara. Njihovo onečišćenje potječe iz mnogih nepoznatih izvora. Cilj ovog rada je odrediti izvore onečišćenja podzemnih voda u pet većih gradova u jugozapadnoj Nigeriji metodom (analizom) glavnih komponenti (PCA). fizikalno-kemijski parametri podzemnih voda u gradovima: Abekuta, Ifo, Sango, Ibadan i lagos preuzeti su iz literature, a evoluirani pomoću statističkog paketa SPSS. Vrijednost faktora dobivenih analizom glavnih komponenti kreće se u rasponu od četiri do osam. Identificirani izvori onečišćenja su: dekompozicija stijena (pod utjecajem morske vode ili u kombinaciji s morskom vodom), nutrienti, krute tvari, urbano-prometna odvodnja, industrija, tvrdoća (otopljeni minerali), fekalno onečišćenje, ispiranje tla, prodor slane vode i procjedna voda
Application of Diatom-Based Indices in River Quality Assessment: A Case Study of Lower Ogun River (Abeokuta, Southwestern Nigeria) Using Epilithic Diatoms
Diatom indices have been extensively applied in the bioassessment of surface waters and wetlands in many countries except Nigeria. This pioneer study aimed at investigating the use of epilithic diatom-based indices in the assessment of the Ogun River quality. Water and epilithic diatom samples were collected fortnightly from four sampling stations for a period of four consecutive months (March–June 2015). Water samples were analysed for pH, temperature, electrical conductivity, total dissolved solids (TDS), dissolved oxygen, chemical oxygen demand (COD), nitrite, nitrate, ammonium, phosphate, sulphide, chloride, iron, manganese, silicate, total alkalinity, total hardness, total suspended solids (TSS), transparency and total organic carbon using standard methods. Epilithic diatom samples were collected by scraping the surfaces of rocks or stones using an 18 mm toothbrush and analysed following the standard methods. Data collected were subjected to descriptive (frequency, mean) and inferential statistics (diatom indices, Pearson correlation) using OMNIDIA and SPSS statistical packages. Results showed that the water quality of the Lower Ogun River ranged between bad and high qualities during the study period. The diatom indices (trophic diatom index (TDI), biological diatom index (IBD), generic salinity index (GSI1), generic trophic index (GTI), generic saprobity index (GTI)) were correlated with physical and chemical parameters, thereby indicating their effectiveness in water quality ranking
CONCENTRATION AND POTENTIAL HEALTH RISK ASSOCIATED WITH DIETARY INTAKE OF SMOKED FISH FROM LAGOS LAGOON
This study assessed the concentration and potential health risk associated with dietary exposure to polycyclic aromatic hydrocarbons (PAHs) in smoked fish products from four fishing communities along Lagos Lagoon, Nigeria. Sixty smoked fish samples obtained from two fish species (Chrysichthys nigrodigitatus and Elops lacerta) which were processed individually with three firewood (Cola nitida, Funtumia elastica and Alchornea cordifolia) were collected from fish processors between October and December, 2018. Samples were subjected to polycyclic aromatic hydrocarbons (PAHs) analysis using gas chromatography-mass spectrometry (GC-MS) and human health risk model analysis. The PAH congeners varied in smoked fish while Pyrene was the most dominant congener in all the fish samples, accounting for more than 70% of the total PAHs. The highest total PAHs levels (2431.85 mg kg-1) was observed in E. lacerta smoked with C. nitida. The Dietary Daily Intake (DDI) values for total and carcinogenic PAHs were higher in E. lacerta smoked with C. nitida and C. nigrodigitatus smoked with A. cordifolia, respectively. Carcinogenic Toxic Equivalent (TEQ) values were lower than the estimated Screening Value (SV) of 12.83 indicating low risk of developing cancer through consumption of assessed smoked fish products. Excess Cancer Risk estimated exceeded the permissible limit (1.0x10−6) set by USEPA. Positive correlations (P<0.01) existed between TEQ and total PAHs, noncarcinogenic PAHs, PAH4, and DDI. This study provides insights into the variation in PAHs level and appropriateness of different fuelwood for smoking similar or dissimilar fish species
Evaluating the potential health risk of organochlorine pesticides in selected protein foods from Abeokuta southwestern Nigeria
This study evaluated the potential health risk of OCPs in selected protein foods. A total of 66 food samples were collected from selected areas in Abeokuta, southwestern Nigeria. Food samples were analyzed for OCPs using the standard method. OCP data were analysed for descriptive and inferential statistics. Health risk assessment was conducted for non-carcinogenic {Hazard Quotient (HQ), Hazard Index (HI) and Cancer Risk (CR)}. The ΣOCP concentration was observed highest in pork (42.20 ± 33.33 mg kg−1) of which methoxychlor and dieldrin represented 63 and 28%, respectively. The HIs of OCPs in protein foods were generally greater than 1.0 indicating adverse effects. The ΣCR data showed carcinogenic effects in protein foods with values greater than the acceptable limit of 1.0 × 10−4
Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis
BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London
Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study
Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world.
Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231.
Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001).
Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Abstract
Background
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries
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Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
Summary
Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally.
Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies
have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of
the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income
countries globally, and identified factors associated with mortality.
Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to
hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis,
exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a
minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical
status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary
intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause,
in-hospital mortality for all conditions combined and each condition individually, stratified by country income status.
We did a complete case analysis.
Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital
diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal
malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome
countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male.
Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3).
Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income
countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups).
Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome
countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries;
p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients
combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11],
p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20
[1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention
(ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety
checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed
(ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of
parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65
[0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality.
Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome,
middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will
be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger
than 5 years by 2030
Receptor modelling of industrial air pollutants
The presence of particulate and gaseous pollutants at elevated concentrations in the atmospheric environment is detrimental to public health. The present study has investigated the impacts of a steelworks complex on the air quality in Port Talbot, South Wales, United Kingdom.
Different offline and online air monitoring instruments were deployed to four sites around the perimeter of the steelworks (at one coastal site (Little Warren LW) and 3 inland sites placed along the length of the steelworks (Fire Station FS, Prince Street PS and Dyffryn School DS) in the study area for a four-week campaign (April 16 to May 16, 2012). Prior to Port Talbot campaign, a separate two week sampling (March 30 to April 12, 2012) was conducted at Elms Road Observatory Site (EROS) for a representation of an urban background.
Gaseous and meteorological data logged during the period of sampling were also collected from the Automatic Urban and Rural Network (AURN) site at Port Talbot Margam (FS site). Hourly and daily data collected were prepared for receptor modelling using Positive Matrix Factorization (PMF) and with the use of Open Air and Lakes Environmental WRPLOT View software, windrose and polar plots were produced to show the directional emissions of particulate and gaseous pollutants. The online sampling instrument of Aerosol Time of Flight Mass Spectrometer (ATOFMS) as well as PMF solutions for Streaker and Partisol were able to identify different processing units of the steelworks responsible for pollutant emissions. The polar plots for most air pollutants revealed the steel industry as the major contributor to air pollution in the study area