Bedeutung der Gesetzgebung zur Luftreinhaltung in der Prävention umweltbedingter Erkrankungen

Air pollution, for example from particulate matter, nitrogen oxides or ozone, is harmful to health. Short-term increases in air pollution can lead to exacerbation of existing lung diseases. Long-term air pollution contributes to the development of cardiorespiratory diseases. According to the European Environment Agency, 53,000 people prematurely died in Germany in 2019 due to particulate matter pollution. Air pollution control is a political task with great public health potential. In recent years, it has significantly contributed to improving air quality and thus health. In view of the new more stringent World Health Organization (WHO) air quality guidelines, the authorities and policy makers worldwide are now confronted with the question of adjusting air quality targets and setting standards. In Europe, the EU Directive on air quality standards is passed by the EU Parliament and the Council of the EU and is binding for air quality targets of member states. Member states can be brought to court for failure to achieve the targets. Therefore, there is a risk that achievable and less ambitious air pollution targets will be set. Even now, the EU guideline values are significantly higher than those in the USA or Switzerland. While "only" 11% of the EU population were exposed to levels above the current EU limit for PM10 in 2020, 71% of the population were exposed to hazardous levels of PM10 following the new recommendation by the WHO. Among the most important and successful air pollution control measures is the reduction of air pollutants at the source: emission control. Despite the energy crisis goals regarding air pollution control and climate protection must not be ignored. Importantly, health protection cannot be left to individuals. Health professionals have an important clinical role in advising sensitive patients on how to deal with short-term elevated levels of air pollutants but beyond that their advisory role in policy is very significant

Spatio-temporal modelling of changes in air pollution exposure associated to the COVID-19 lockdown measures across Europe

The lockdown and related measures implemented by many European countries to stop the spread of the SARS-CoV-2 virus (COVID-19) pandemic have altered the economic activities and road transport in many cities. To rigorously evaluate how these measures have affected air quality in Europe, we developed Bayesian spatio-temporal (BST) models that assess changes in the surface nitrogen dioxide (NO2) and fine particulate matter (PM2.5) concentration across the continent. We fitted BST models to measurements of the two pollutants in 2020 using a lockdown indicator covariate, while accounting for the spatial and temporal correlation present in the data. Since other factors, such as weather conditions, local combustion sources and/or land surface characteristics may contribute to the variation of pollutant concentrations, we proposed two model formulations that allowed the differentiation between the variations in pollutant concentrations due to seasonality from the variations associated to the lockdown policies. The first model compares the changes in 2020, with the ones during the same period in the previous five years, by introducing an offset term, which controls for the long-term average concentrations of each pollutant during 2014-2019. The second approach models only the 2020 data, but adjusts for confounding factors. The results indicated that the latter can better capture the lockdown effect. The measures taken to tackle the virus in Europe reduced the average surface concentrations of NO2 and PM2.5 by 29.5% (95% Bayesian credible interval: 28.1%, 30.9%) and 25.9% (23.6%, 28.1%), respectively. To our knowledge, this research is the first to account for the spatio-temporal correlation present in the monitoring data during the pandemic and to assess how it affects estimation of the lockdown effect while accounting for confounding. The proposed methodology improves our understanding of the effect of COVID-19 lockdown policies on the air pollution burden across the continent

Understanding urban inequalities in children's linear growth outcomes: a trend and decomposition analysis of 39,049 children in Bangladesh (2000-2018)

BACKGROUND: Despite significant progress in reducing child undernutrition, Bangladesh remains among the top six countries globally with the largest burden of child stunting and has disproportionately high stunting prevalence among the urban poor. We use population representative data to identify key predictors of child stunting in Bangladesh and assess their contributions to linear growth differences observed between urban poor and non-poor children. METHODS: We combined six rounds of Demographic and Health Survey data spanning 2000-2018 and used official poverty rates to classify the urban population into poor and non-poor households. We identified key stunting determinants using stepwise selection method. Regression-decomposition was used to quantify contributions of these key determinants to poverty-based intra-urban differences in child linear growth status. RESULTS: Key stunting determinants identified in our study predicted 84% of the linear growth difference between urban poor and non-poor children. Child's place of birth (27%), household wealth (22%), maternal education (18%), and maternal body mass index (11%) were the largest contributors to the intra-urban child linear growth gap. Difference in average height-for-age z score between urban poor and non-poor children declined by 0.31 standard deviations between 2000 and 2018. About one quarter of this observed decrease was explained by reduced differentials between urban poor and non-poor in levels of maternal education and maternal underweight status. CONCLUSIONS: Although the intra-urban disparity in child linear growth status declined over the 2000-2018 period, socioeconomic gaps remain significant. Increased nutrition-sensitive programs and investments targeting the urban poor to improve girls' education, household food security, and maternal and child health services could aid in further narrowing the remaining linear growth gap

Change in nutritional status of urban slum children before and after the first COVID-19 wave in Bangladesh: a repeated cross-sectional assessment

The onset of COVID-19 severely disrupted economies and increased acute household food insecurity in developing countries. Consequently, a global rise in childhood undernutrition was predicted, especially among vulnerable populations, but primary evidence on actual changes in nutritional status remained scarce. In this paper, we assessed shifts in nutritional status of urban slum children in Bangladesh pre- and post- the country's first wave of COVID-19 and nationwide lockdown. We used two rounds of cross-sectional data collected before and after the pandemic's first year in two large slum settlements (Korail and Tongi) of Dhaka and Gazipur, Bangladesh (n = 1119). Regression models estimated pre-post changes in: 1) predictors of childhood undernutrition (household income, jobs, food security, dietary diversity, healthcare utilization, and hand hygiene); and 2) under-five children's nutritional status (average height-for-age z-score (HAZ) and weight-for-height z-score (WHZ), stunting, and wasting). Subgroup analysis was done by household migration status and slum area. Over the sample period, average monthly household income dropped 23% from BDT 20,740 to BDT 15,960 (beta = -4.77; 95% CI:-6.40, -3.15), and currently employed fathers slightly declined from 99% to 95% (beta = -0.04; 95% CI:-0.05, -0.02). Average HAZ among the slum children improved 0.13 SD (95% CI: 0.003, 0.26). Among non-migrant children in Tongi, the odds of stunting increased (OR = 2.01, 95% CI: 1.16, 3.48) and average WHZ reduced -0.40 SD (95% CI: -0.74, -0.06). Despite great economic hardship, and differential patterns of representativeness by household geography and migration status, slum children in Bangladesh generally demonstrated resilience to nutritional decline over the first year of the pandemic. While underlying threats to nutritional deterioration persisted, considerable job and income recovery in the post-lockdown period appeared to have cushioned the overall decline. However, as the pandemic continues, monitoring and appropriate actions are needed to avert lasting setbacks to Bangladesh nutritional progress

Improving coverage of antenatal iron and folic acid supplementation and malaria prophylaxis through targeted information and home deliveries in Côte d'Ivoire: a cluster randomised controlled trial

INTRODUCTION: Coverage of antenatal iron and folic acid (IFA) supplementation and malaria chemoprophylaxis remains low in many low-income and middle-income settings. We assessed the effectiveness of personal information (INFO) sessions and personal information session plus home deliveries (INFO+DELIV) to increase coverage of IFA supplementation and intermittent preventive treatment in pregnancy (IPTp), and their effectiveness on postpartum anaemia and malaria infection. METHODS: We included 118 clusters randomised to a control (39), INFO (39) and INFO+DELIV (40) arm, in a trial conducted between 2020 and 2021 with pregnant women (age >/=15 years) in their first or second trimester of pregnancy in Taabo, Cote d'Ivoire. We used generalised linear regression models to assess intervention impact in postpartum anaemia and malaria parasitaemia, and displayed resulting estimates as prevalence ratios. RESULTS: Overall, 767 pregnant women were enrolled and 716 (93.3%) were followed up after delivery. Neither intervention had an impact on postpartum anaemia, with estimated adjusted prevalence ratios (aPRs) of 0.97 (95% CI 0.79 to 1.19, p=0.770) for INFO and 0.87 (95% CI 0.70 to 1.09, p=0.235) for INFO+DELIV. While INFO had no effect on malaria parasitaemia (aPR=0.95, 95% CI 0.39 to 2.31, p=0.915), INFO+DELIV reduced malaria parasitaemia by 83% (aPR=0.17, 95% CI 0.04 to 0.75, p=0.019). No improvements in antenatal care (ANC) coverage (aPR=1.05, 95% CI 0.81 to 1.36, p=0.692), IFA (aPR=2.00, 95% CI 0.89 to 4.46, p=0.093) and IPTp (aPR=1.03, 95% CI 0.87 to 1.21, p=0.728) compliance were found for INFO. INFO+DELIV increased ANC attendance (aPR=1.35, 95% CI 1.02 to 1.78, p=0.037) and compliance with IPTp (aPR=1.60, 95% CI 1.41 to 1.80, p<0.001) and IFA recommendations (aPR=7.06, 95% CI 3.68 to 13.51, p<0.001). CONCLUSIONS: INFO+DELIV can substantially increase compliance with IFA supplementation and improve malaria prevention. However, the increases in IFA supplementation are likely insufficient to address the prevalence of often severe anaemia in this population. TRIAL REGISTRATION NUMBER: NCT04250428

Mental health and resilience among Eritrean refugees at arrival and one-year post-registration in Switzerland: a cohort study

OBJECTIVE: Eritrea is the most frequent country of origin among asylum seekers in Switzerland. On their journey through the desert and across the Mediterranean Sea, Eritrea refugees are often exposed to traumatizing experiences. The aim of this study is to assess the mental health status and resilience of Eritrean migrants in Switzerland upon arrival and one-year post-arrival, using standardized mental health screening and resilience assessment tools. RESULTS: At baseline, 107 refugees (11.2% female, median age 25) were interviewed: 52 (48.6%) screened positive for Post-Traumatic Stress Disorder (score ≥ 30), 10.3% for anxiety (≥ 10) and 15.0% for depression (≥ 10); 17.8% scored as risk/hazardous drinkers (≥ 8). The majority (94.4%) had a high resilience score (≥ 65). For one-year follow-up, 48 asylum seekers could be reached. In interviews 18 (38%) of these reported imprisonment in a transit country and 28 (58%) that they had witnessed the death of a close person along the migration route. At the one year assessment, rates of risky/hazardous alcohol use remained unchanged, rates of positive PTSD screening tended to be lower (50.0% (24/48) at baseline vs 25.0% (12/48) at follow-up), as were rates of positive screening for anxiety (8.3% vs 4.2%) and depression (14.6 vs 6.3%)

Study protocol of a cluster randomized controlled trial of strategies to increase antenatal iron and folic acid supplementation and malaria prophylaxis in rural south-central Côte d'Ivoire

BACKGROUND: Coverage of antenatal iron and folic acid supplementation (IFAS) and intermittent preventive treatment of malaria in pregnancy (IPTp) remains low in many countries. Evidence on the most effective ways to increase both IFASIPTp is mixed overall, with only few studies directly identifying cost-effective ways to increase coverage of both interventions. The proposed study aims to assess the cost, impact and relative cost-effectiveness of two complementary strategies of increasing IFAS and malaria chemoprophylaxis coverage among pregnant women relative to the current default system in a rural low-income setting of sub-Saharan Africa. METHODS/DESIGN: This study will be carried out in the Taabo health and demographic surveillance system (HDSS) in south-central Cote d'Ivoire. This is a cluster-randomized trial targeting 720 consenting pregnant women aged >/=15 years. The 118 clusters constituting the Taabo HDSS monitoring area will be randomly allocated to one of the following three groups with equal probability: a control group, an information only group, and an information plus home delivery group. To assess the relative effectiveness of each strategy, we will conduct an endline survey within the first 2 weeks after delivery. The primary outcomes of the trial will be maternal post-partum anaemia and malaria infection. Anaemia will be assessed using HEMOCUE devices; malaria infections will be assessed using standard rapid diagnostic tests named CareStart Malaria Pf (HRP2) Ag RDT (Multi Kit with capped lancet and inverted cup specimen transfer device). Other outcomes will include self-reported adherence to supplementation and malaria chemoprophylaxis, as well as miscarriages, stillbirths and low birth weight deliveries. DISCUSSION: This study will assess the cost-effectiveness of two alternative strategies to increase antenatal IFAS and malaria chemoprophylaxis coverage among pregnant women in rural Cote d'Ivoire and similar settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT04250428 ; Registered 31 January 2020

Association between mother's work status and child stunting in urban slums: a cross-sectional assessment of 346 child-mother dyads in Dhaka, Bangladesh (2020)

Background A growing literature highlights the increased risk of stunting among children growing up in informal or slum settlements. Despite relatively high rates of female labor force participation in slums, there is limited evidence on relationship between mother's work participation and nutritional outcomes of children in these settings. Methods We conducted a cross-sectional study in two large slums (Korail and Tongi) of Dhaka and Gazipur, Bangladesh to assess the association between maternal work and childhood stunting in a low-income urban context. Logistic regression models estimated unconditional and conditional associations between maternal work status and 1) child stunting, 2) child morbidity and dietary intake, and 3) health and hygiene behaviors. Subgroup analyses were done by type of child care support available. Results After adjusting for variations in individual and household level characteristics, we found that children of working mothers had nearly twice the odds of being stunted than children of non-working mothers (OR 1.84, 95%CI 1.05-3.23). Large differences in stunting were found by available care support: compared to children of non-working mothers, children of working mothers with nuclear-type family support had 4.5 times increased odds of stunting (OR 4.49, 95%CI 1.81-11.12), while no odds differential was found for children of working mothers with an extended-type family support (OR 0.69, 95%CI 0.30-1.59). Conclusions Maternal employment is associated with a substantial increase in the odds of child stunting in the slum areas studied. Given that these effects only appear to arise in the absence of adequate family support, integrating appropriate childcare support measures for low-income urban working mothers might be an effective strategy to help reduce the prevalence of chronic undernutrition among slum children