Modelling the Effects of Fine Particulate Matter Air Pollution and Biothermal Stress on Birth Outcomes in Australia and Ghana

High-quality environmental epidemiological methods were employed. We found that ambient fine particulate matter air pollution (PM2.5) and biothermal stress exposures independently and jointly were associated with increased risks of birth outcomes in both high-income (Australia) and low-income (Ghana) countries. The vulnerable subpopulations and critical susceptible exposure periods of early to mid-gestational periods for PM2.5 and mid to late gestational periods for the biothermal stress were identified to inform public health interventions and further investigations

Longitudinal Study of Type-2-Diabetes: A Profile Analysis at the Ketu-South Municipality

The main purpose of the study is to investigate the change in Fasting Blood Sugar (FBS) level over time and the effect of some plausible factors on this change for Type-2-Diabetes (T2D) patients on treatment. Retrospective data from the Ketu-South Municipal Hospital, Diabetes Unit, in Ghana in which patients’ FBS level and demographic data were monitored regularly every three months was used for the study. Profile analysis was used to study the pattern of change in the FBS level. The MANOVA test of parallelism showed at 5% significance level that religion was not parallel because there was significant differential in the pattern of change of the FBS level. The other covariates: gender, marital status, drug and education did not significantly differ at the 5% significance level and hence their profiles were tested for parallelism. The parallelism tests revealed that they were parallel and equal but deviated from flatnes

Spatial Analysis of Public Health Data in Ghana: a case study of exploratory spatial analysis of Diarrhoea

Background: Diarrhoea is a  public health burden amongst the top five causes of premature death  and disability-adjusted life years in the tropical regions. In Ghana, diarrhoea has been identified as the second most common health problems treated in outpatient visits. Evaluations of diarrhea prevention efforts suggested that the best prevention strategies of diarrhoea may vary by location. For this reason, spatial statistical tools such as Geographical Information System (GIS)  has been applied expansively in health research to improve public health since 1980s. There are, however, extremely few of such studies in Ghana and there had not been any known nationwide study of the spatial distribution of diarrhoea in Ghana. In this study, we aimed to use exploratory spatial analysis techniques of GIS to assess the spatial epidemiological distribution of diarrhoea in Ghana and to locate the hotspot areas that need further focused public health interventions. Method: The outpatient department morbidity data of diarrhoea cases over the periods of 2010 to 2014 was obtained from Ghana Health Service and geo-coded using ArcGIS 10.1 according to the 170 administrative districts of Ghana. Incidence rates were estimated  and spatially smoothen with Empirical Bayesian Smoothing (EBS) technique to avoid unbiased visual interpretation. The EBS rates were mapped and classified using defined interval classification system. Global Moran's I and the Anselin Local Moran's I were computed with ArcGIS to respectively test for the evidence of space-time variation in the incidence of diarrhoea and to identify areas of relatively high and/or low rates. Results: This study described the spatial distribution of  diarrhoeal infection by assessing the global and local occurrence of the incidence rates of diarrhoea at district levels in Ghana. Mapping the smoothed incidence rates of diarrhoea geo-visually pointed spatial patterns and with generally increasing rates over the years 2010 to 2014. Evaluating the observed non-random spatial patterns, the global Moran's I confirmed significant geographical epidemiological patterns with significant spatial clustering (Moran's I > 0, Z > 1.96, p < 0.05). These spatial patterns were decreasing spatio-temporally from 2010 to 2013 but suddenly increased to the highest clustering in 2014. Cluster-outlier analysis with local Moran's Ii spatio-temporally identified a number of areas with statistically significant measures of relatively high and/or low clustering of rates. Conclusion: The results of the exploratory spatial analysis disclosed the grave necessity of spatial analysis to improve  public health, surveillance and disease prevention strategies in Ghana. The rate of diarrhoea still remains very high in Ghana with significant geographical and temporal variations. This suggests possible inequalities in healthcare services and health intervention programmes and relatively more risk factors in some areas. This study also suggests that diarrhea prevention strategies should be location-specific, while considering the neighbouring locations. The few identified hotspot districts with the most likely endemic clusters of diarrhoea cases need extra health intervention programmes and prioritisation. Keywords: Spatial epidemiology, diarrhoea, hotspot, spatial analysis, Geographical Information System (GIS), Moran's I, Ghan

Ambient Air Pollution, Extreme Temperatures and Birth Outcomes: A Protocol for an Umbrella Review, Systematic Review and Meta-Analysis

Prenatal exposure to ambient air pollution and extreme temperatures are among the major risk factors of adverse birth outcomes and with potential long-term effects during the life course. Although low-and middle-income countries (LMICs) are most vulnerable, there is limited synthesis of evidence in such settings. This document describes a protocol for both an umbrella review (Systematic Review 1) and a focused systematic review and meta-analysis of studies from LMICs (Systematic Review 2). We will search from start date of each database to present, six major academic databases (PubMed, CINAHL, Scopus, MEDLINE/Ovid, EMBASE/Ovid and Web of Science Core Collection), systematic reviews repositories and references of eligible studies. Additional searches in grey literature will also be conducted. Eligibility criteria include studies of pregnant women exposed to ambient air pollutants and/or extreme temperatures during pregnancy with and without adverse birth outcomes. The umbrella review (Systematic Review 1) will include only previous systematic reviews while Systematic Review 2 will include quantitative observational studies in LMICs. Searches will be restricted to English language using comprehensive search terms to consecutively screen the titles, abstracts and full-texts to select eligible studies. Two independent authors will conduct the study screening and selection, risk of bias assessment and data extraction using JBI SUMARI web-based software. Narrative and semi-quantitative syntheses will be employed for the Systematic Review 1. For Systematic Review 2, we will perform meta-analysis with two alternative meta-analytical methods (quality effect and inverse variance heterogeneity) as well as the classic random effect model. If meta-analysis is infeasible, narrative synthesis will be presented. Confidence in cumulative evidence and the strength of the evidence will be assessed. This protocol is registered with PROSPERO (CRD42020200387)

Spatial and temporal heterogeneities of district-level typhoid morbidities in Ghana: A requisite insight for informed public health response

Typhoid fever is estimated to cause between 9.9-24.2 million cases and 75,000-208,000 deaths per year globally. Low-income and middle-income countries report the majority of cases, especially those in sub-Saharan Africa. The epidemiology of typhoid fever is poorly understood, particularly in Ghana where there has been no study of the within-country variation. Our objective was to explore and analyze the spatial and temporal patterns of typhoid fever morbidities in Ghana. We used the global and local Moran's indices to uncover the existence of global and local spatial patterns, respectively. Generalized linear autoregressive moving average (glarma) models were developed to explore the overall and regional level temporal patterns of morbidities. The overall index of spatial association was 0.19 (p 0.05) estimates. The yearly estimates were all significant (p < 0.001) and ranged from 0.1-0.19, suggesting spatial clustering of typhoid. The local Moran's maps indicated isolated high contributions of clustering within the Upper West and Western regions. The overall and regional level glarma models indicated significant first and second-order serial correlation as well as quarterly trends. These findings can provide relevant epidemiological insight into the spatial and temporal patterns of typhoid epidemiology and useful to complement the development of control strategies by public health manager

Geo-visual integration of health outcomes and risk factors using excess risk and conditioned choropleth maps: a case study of malaria incidence and sociodemographic determinants in Ghana

Abstract Background Recently, exploratory spatial data analysis is for problem solving, hypothesis generation and knowledge construction. Unless geographically weighted regression, sophisticated spatial regression models best control spatial heterogeneity in outcomes and the associated risk factors but cannot visually display and identify areas of the significant associations. The under-utilised excess risk maps (ERMs) and conditioned choropleth maps (CCMs) are useful to address this issue and simplify epidemiological information to public health stakeholders without much statistical backgrounds. Using malaria and sociodemographic determinants in Ghana as case study, this paper applied ERM and CCM techniques for identification of areas at elevated risk of disease-risk factor co-location. Method We computed and smoothed mean district-specific malaria incidences for the period 2010 to 2014 as a function of sociodemographic determinants. The spatial distribution of malaria was investigated through global and local spatial autocorrelations, and the association with sociodemographic risk factors evaluated with bivariate correlations. ERMs and CCMs were produced for the statistically significant risk factors. Results The incidence of malaria increased over time with cluster locations detected, predominantly at the northern parts but later few spread to the middle parts of the country. Our results suggested that with respect to sociodemographic determinants, district variations in malaria rates might be explained by inequalities in seven sociodemographics, including an unexpected significant negative association with non-religious affiliation. The sociodemographics had positive spatial autocorrelations, exhibited statistically significant interactions and the strongest was observed in urbanisation-basic education correlation (p< 0.01, r = +0.969). The ERMs and CCMs specifically identified locations with lower or higher than expected rates with respect to particular risk factor(s) where improving risk factor(s) such as employment-to-population ratio in rural areas, basic education could have cascade effects to reduce the expected malaria incidence in endemic areas. Conclusion Ghana remains malaria hyperendemic region with district-level spatial heterogeneity. Significant association between malaria and sociodemographics was detected and the ERMs and CCMs geo-visually pinpointed locations of these significant associations. To complement sophisticated spatial regression models, the easily interpretable ERMs and CCMs could be used to specify where disease-risk factor associations are significant, simplifying complex spatial epidemiological information for efficient public health administration

Identifying critical periods of susceptibility for maternal exposure to biothermal stress and the risks of stillbirth and spontaneous preterm birth in Western Australia

A few studies investigated critical periods of temperature and the risks of stillbirth and preterm birth. This study aimed to identify critical periods of composite biothermal stress (Universal Thermal Climate Index, UTCI) for stillbirth and spontaneous preterm birth (sPTB). From the Midwives Notification System, 415,271 singleton births between 1st January 2000 and 31st December 2015 were linked to spatiotemporal UTCI in Western Australia. Covariate-adjusted weekly and monthly distributed lag non-linear Cox regression from twelve weeks before conception to birth were performed. Relative to median exposure (14.2 °C), extreme UTCI levels (1st–10th and 90th–99th centiles) were associated with higher hazards of stillbirth and sPTB, especially stronger at lower than higher exposures. Critical susceptible periods at 1st centile (10.2°C) exposure were found during gestational weeks 21–42 with the strongest hazard of 1.14 (95% CI 1.03, 1.27) in the 42nd week for stillbirth and during gestational weeks 26–36 with the strongest hazard of 1.09 (95% CI 1.06, 1.12) in the 36th week for sPTB. Monthly exposure showed a similar pattern but with greater magnitude. Mid to late gestation showed critical susceptible periods of biothermal stress on the birth outcomes, suggesting further studies and timely climate-related healthcare interventions

Bullying Victimization and Suicidal Behavior among adolescents in 28 Countries and Territories: A Moderated Mediation Model

Background: Previous studies have increasingly shown the adverse effects of being bullied on suicidal behavior among young people, but the mechanisms underlying this association remain unclear. We examined the association between bullying and suicidal behavior among in-school adolescents. We further tested whether loneliness mediated the link between bullying and suicidal behavior and explored the moderated role of parental involvement in this association. Methods: We used cross-sectional school-based data from the Global School-based Student Health Survey among 28 countries and territories. Adjusted, modified Poisson regressions with robust variance relative risks and moderation analyses were used to examine associations among bullying, suicidal behavior, and parental involvement. The mediating effect of loneliness on the bullying-suicidal behavior link was assessed using the generalized decomposition method. Results: A total of 78,558 school-going adolescents participated in this study. Bullying was associated with a 44% increased risk of suicidal behavior after adjusting for potential confounders (relative risk = 1.44; 95% confidence interval = 1.39–1.48). Loneliness partially mediated the association between bullying and suicidal behavior, and parental involvement moderated the association. Conclusions: The findings suggest the need to recognize the dual burden of bullying and loneliness when addressing suicidal behavior and the importance of parental support in adolescents' mental health and well-being

Considering the Cultural Context of Parental Involvement and Loneliness

[Extract] The Authors respond: We have reviewed the letter to the editor by Dewanti et al.1 Their letter was in response to our paper entitled “Bullying Victimization and Suicidal Behavior among Adolescents in 28 Countries and Territories: A Moderated Mediation Model” (Peprah et al.2). In this paper, we reported that bullying was positively associated with suicidal behavior, and loneliness mediated this association, while parental involvement moderated the observed relationship

The international Perinatal Outcomes in the Pandemic (iPOP) study: Protocol

Preterm birth is the leading cause of infant death worldwide, but the causes of preterm birth are largely unknown. During the early COVID-19 lockdowns, dramatic reductions in preterm birth were reported; however, these trends may be offset by increases in stillbirth rates. It is important to study these trends globally as the pandemic continues, and to understand the underlying cause(s). Lockdowns have dramatically impacted maternal workload, access to healthcare, hygiene practices, and air pollution - all of which could impact perinatal outcomes and might affect pregnant women differently in different regions of the world. In the international Perinatal Outcomes in the Pandemic (iPOP) Study, we will seize the unique opportunity offered by the COVID-19 pandemic to answer urgent questions about perinatal health. In the first two study phases, we will use population-based aggregate data and standardized outcome definitions to: 1) Determine rates of preterm birth, low birth weight, and stillbirth and describe changes during lockdowns; and assess if these changes are consistent globally, or differ by region and income setting, 2) Determine if the magnitude of changes in adverse perinatal outcomes during lockdown are modified by regional differences in COVID-19 infection rates, lockdown stringency, adherence to lockdown measures, air quality, or other social and economic markers, obtained from publicly available datasets. We will undertake an interrupted time series analysis covering births from January 2015 through July 2020. The iPOP Study will involve at least 121 researchers in 37 countries, including obstetricians, neonatologists, epidemiologists, public health researchers, environmental scientists, and policymakers. We will leverage the most disruptive and widespread 'natural experiment' of our lifetime to make rapid discoveries about preterm birth. Whether the COVID-19 pandemic is worsening or unexpectedly improving perinatal outcomes, our research will provide critical new information to shape prenatal care strategies throughout (and well beyond) the pandemic