Effects of time-lagged meteorological variables on attributable risk of leishmaniasis in central region of Afghanistan

Background: Leishmaniasis remains one of the world's most neglected vector-borne diseases, affecting predominantly poor communities mainly in developing countries. Previous studies have shown that the distribution and dynamics of leishmaniasis infections are sensitive to environmental factors, however, there are no studies on the burden of leishmaniasis attributable to time-varying meteorological variables. Methods: This study used data from 3 major leishmaniosis afflicted provinces of Afghanistan, between 2003 and 2009, to provide empirical analysis of change in heat/cold-leishmaniosis association. Non-linear and delayed exposure-lag-response relationship between meteorological variables and leishmaniasis were fitted with a distributed lag non-linear model applying a spline function which describes the dependency along the range of values with a lag of up to 12 months. We estimated the risk of leishmaniasis attributable to high and low temperature. Results: The median monthly mean temperature and rainfall were 16.1 °C and 0.6 in., respectively. Seasonal variations of leishmaniasis were consistent between males and females, however significant differences were observed among different age groups. Temperature effects were immediate and persistent (lag 0–12 months). The cumulative risks were highest at cold temperatures. The cumulative relative risks (logRR) for leishmaniasis were 6.16 (95% CI: 5.74–6.58) and 1.15 (95% CI: 1.32–1.31) associated with the 10th percentile temperature (2.16 °C) and the 90th percentile temperature (28.46 °C). The subgroup analysis showed increased risk for males as well as young and middle aged people at cold temperatures, however, higher risk was observed for the elderly in heat. The overall leishmaniasis-temperature attributable fractions was estimated to be 7.6% (95% CI: 7.5%–7.7%) and mostly due to cold. Conclusion: Findings in this study highlight the non-linearity, delay of effects and magnitude of leishmaniasis risk associated with temperature. The disparity of risk between different subgroups can hopefully advise policy makers and assist in leishmaniasis control program

Spatial modelling of contribution of individual level risk factors for mortality from Middle East respiratory syndrome coronavirus in the Arabian Peninsula.

Middle East respiratory syndrome coronavirus is a contagious respiratory pathogen that is contracted via close contact with an infected subject. Transmission of the pathogen has occurred through animal-to-human contact at first followed by human-to-human contact within families and health care facilities. This study is based on a retrospective analysis of the Middle East respiratory syndrome coronavirus outbreak in the Kingdom of Saudi Arabia between June 2012 and July 2015. A Geoadditive variable model for binary outcomes was applied to account for both individual level risk factors as well spatial variation via a fully Bayesian approach. Out of 959 confirmed cases, 642 (67%) were males and 317 (33%) had died. Three hundred and sixty four (38%) cases occurred in Ar Riyad province, while 325 (34%) cases occurred in Makkah. Individuals with some comorbidity had a significantly higher likelihood of dying from MERS-CoV compared with those who did not suffer comorbidity [Odds ratio (OR) = 2.071; 95% confidence interval (CI): 1.307, 3.263]. Health-care workers were significantly less likely to die from the disease compared with non-health workers [OR = 0.372, 95% CI: 0.151, 0.827]. Patients who had fatal clinical experience and those with clinical and subclinical experiences were equally less likely to die from the disease compared with patients who did not have fatal clinical experience and those without clinical and subclinical experiences respectively. The odds of dying from the disease was found to increase as age increased beyond 25 years and was much higher for individuals with any underlying comorbidities. Interventions to minimize mortality from the Middle East respiratory syndrome coronavirus should particularly focus individuals with comorbidity, non-health-care workers, patients with no clinical fatal experience, and patients without any clinical and subclinical experiences.The authors received no specific funding for this work. All data analyzed in this study were publicly available

Does high public trust amplify compliance with stringent COVID-19 government health guidelines? A multi-country analysis using data from 102,627 individuals

Purpose To examine how public trust mediates the people’s adherence to levels of stringent government health policies and to establish if these effects vary across the political regimes. Methods This study utilizes data from two large-scale surveys: the global behaviors and perceptions at the onset of COVID-19 pandemic and the Oxford COVID-19 Government Response Tracker (OxCGRT). Linear regression models were used to estimate the effects of public trust and strictness of restriction measures on people’s compliance level. The model accounted for individual and daily variations in country-level stringency of preventative measures. Differences in the dynamics between public trust, the stringent level of government health guidelines and policy compliance were also examined among countries based on political regimes. Results We find strong evidence of the increase in compliance due to the imposition of stricter government restrictions. The examination of heterogeneous effects suggests that high public trust in government and the perception of its truthfulness double the impact of policy restrictions on public compliance. Among political regimes, higher levels of public trust significantly increase the predicted compliance as stringency level rises in authoritarian and democratic countries. Conclusion This study highlights the importance of public trust in government and its institutions during public health emergencies such as the COVID-19 pandemic. Our results are relevant and help understand why governments need to address the risks of non-compliance among low trusting individuals to achieve the success of the containment policies

Multi-year trend analysis of childhood immunization uptake and coverage in Nigeria

As a leading indicator of child health, under-five mortality was incorporated in the United Nations Millennium Development Goals with the aim of reducing the rate by two-thirds between 1990 and 2015. Under-five mortality in Nigeria is alarmingly high, and many of the diseases that result in mortality are vaccine preventable. This study evaluates the uptake of childhood immunization in Nigeria from 1990 to 2008. A multi-year trend analysis was carried out using Alternating Logistic Regression on 46,130 children nested within 17,380 mothers in 1938 communities from the Nigerian Demographic and Health Surveys from 1990 to 2008. The findings reveal that mother-level and community-level variability are significantly associated with immunization uptake in Nigeria. The model also indicates that children delivered at private hospitals have a higher chance of being immunized than children who are delivered at home. Children from the poorest families (who are more likely to be delivered at home) have a lower chance of being immunized than those from the richest families (OR = 0.712; 95% CI, 0.641–0.792). Similarly, the chance of children with a mother with no education being immunized is decreased by 17% compared with children whose mother has at least a primary education. In the same way, children of mothers who are gainfully employed and those of older mothers have statistically significantly higher odds of being immunized. Children of households with a female head are less likely to be immunized than those from male-headed households. The statistical significance of the community–survey year interaction term suggests an increase in the odds of a child being immunized over the years and spread over communities. Evidence-based policy should lay more emphasis on mother- and community- level risk factors in order to increase immunization coverage among Nigerian children.Web of Scienc

An exploratory look at associated factors of poverty on educational attainment in Africa and in-depth multilevel modelling for Namibia.

This study examines several indicator variables related to education and poverty in Africa from the Demographic and Health Surveys (DHS). Many have described income and education as one of the fundamental determinants of health and as one of the indicators for socio-economic status. Firstly, data from thirty-six African countries were explored, geographical heterogeneity of the countries were discussed. Secondly, we carried out in-depth multi-level analyses using generating estimating equations on data for 72,230 respondents and from 5,436 households in the Namibia DHS (1992-2006). Results from statistical analyses indicate that age of household head, socioeconomic status of household, parent's level of education, family size and position of a child in the family play a significant role in the educational attainment of household members. We found that these household level characteristics are important predictors of educational attainment. Thus, government policy aimed at reducing household level poverty should be implemented to alleviate the economic power at household level thereby increasing educational attainmentDHE

Delay effect and burden of weather related tuberculosis cases in Rajshahi province, Bangladesh, 2007–2012

Tuberculosis (TB) is a potentially fatal infectious disease that continues to be a public health problem in Bangladesh. Each year in Bangladesh an estimated 70,000 people die of TB and 300,000 new cases are projected. It is important to understand the association between TB incidence and weather factors in Bangladesh in order to develop proper intervention programs. In this study, we examine the delayed effect of weather variables on TB occurrence and estimate the burden of the disease that can be attributed to weather factors. We used generalized linear Poisson regression models to investigate the association between weather factors and TB cases reported to the Bangladesh National TB control program between 2007 and 2012 in three known endemic districts of North-East Bangladesh. The associated risk of TB in the three districts increases with prolonged exposure to temperature and rainfall, and persisted at lag periods beyond 6 quarters. The association between humidity and TB is strong and immediate at low humidity, but the risk decreases with increasing lag. Using the optimum weather values corresponding to the lowest risk of infection, the risk of TB is highest at low temperature, low humidity and low rainfall. Measures of the risk attributable to weather variables revealed that weather-TB cases attributed to humidity is higher than that of temperature and rainfall in each of the three districts. Our results highlight the high linearity of temporal lagged effects and magnitudes of the burden attributable to temperature, humidity, and rainfall on TB endemics. The results can hopefully advise the Bangladesh National TB control program and act as a practical reference for the early warning of TB cases

Are we better-off? The benefits and costs of Australian COVID-19 lockdown

When compared with other countries, Australia has fared much better in COVID-19 outcomes, having experienced low COVID-19 cases, hospitalisations, and deaths. Although it is difficult to know with certainty what and to what degree led to these advantageous outcomes, many attributed this success to the early implementation of strict border closure limiting cross-border transmission and being an Island nation (1–3). Australia has been proceeding with the elimination strategy aiming to contain and crush emerging outbreaks quickly through a suite of public health interventions, with lockdowns playing a central role. However, as vaccination rates continue to rise in Australia, we opine that the lockdowns and other stringent non-pharmaceutical interventions should be phasedown as the cost to the individuals, community, and the economy is likely to outweigh the benefits of these restrictions. At the beginning of the pandemic, most countries followed and defended the implementation of lockdowns, with the early calculations suggesting that benefits far outweigh the costs (3–5). Some empirical studies also observed heterogeneity in the effectiveness of lockdowns and advocated for a careful consideration of demographic, economic, and societal factors before implementing stay-at-home orders, especially in developing countries in which many people rely on day-to-day economic resources (6, 7). However, using more recent data, others provided a different assessment arguing that lockdowns cause more harm than good even in developing countries—with the benefit-cost ratio being significantly overestimated (8, 9). Considering the burden of prolonged lockdown that Sydney and Melbourne have been experiencing and taking into account the increasing vaccination rates across the country, our governments need to carefully consider when and how to lift lockdown and other restrictions, as there is no doubt the cost of getting this wrong is very high. Following a critical review by Allen (10), we discuss the issues associated with the evaluation of lockdown costs and benefits and provide an opinion on lockdowns doing potentially more harm than good as Australia achieves high vaccination rates. This may be useful in timely discussions among the public, media, public health officials, and decision-makers

Tropical Australian health-data linkage shows excess mortality following severe infectious disease is present in the short-term and long-term after hospital discharge

Background: In this study, we aimed to assess the risk factors associated with mortality due to an infectious disease over the short-, medium-, and long-term based on a data-linkage study for patients discharged from an infectious disease unit in North Queensland, Australia, between 2006 and 2011. Methods: Age-sex standardised mortality rates (SMR) for different subgroups were estimated, and the Kaplan-Meier method was used to estimate and compare the survival experience among different groups. Results: Overall, the mortality rate in the hospital cohort was higher than expected in comparison with the Queensland population (SMR: 15.3, 95%CI: 14.9–15.6). The long-term mortality risks were significantly higher for severe infectious diseases than non-infectious diseases for male sex, Indigenous, residential aged care and elderly individuals. Conclusion: In general, male sex, Indigenous status, age and comorbidity were associated with an increased hazard for all-cause death

Hospitalisations related to lower respiratory tract infections in Northern Queensland

Abstract Objective: To investigate the admission characteristics and hospital outcomes for patients admitted with lower respiratory tract infections (LRTI) in Northern Queensland. Methods: We perform a retrospective analysis of the data covering an 11‐year period, 2006–2016. Length of hospital stay (LOS) is modelled by negative binomial regression and heterogeneous effects are checked using interaction terms. Results: A total of 11,726 patients were admitted due to LRTI; 2,430 (20.9%) were of Indigenous descent. We found higher hospitalisations due to LRTI for Indigenous than non‐Indigenous patients, with a disproportionate increase in hospitalisations occurring during winter. The LOS for Indigenous patients was higher by 2.5 days [95%CI: ‐0.15; 5.05] than for non‐Indigenous patients. The average marginal effect of 17.5 [95%CI: 15.3; 29.7] implies that the LOS for a patient, who was admitted to ICU, was higher by 17.5 days. Conclusions: We highlighted the increased burden of LRTIs experienced by Indigenous populations, with this information potentially being useful for enhancing community‐level policy making. Implications for public health: Future guidelines can use these results to make recommendations for preventative measures in Indigenous communities. Improvements in engagement and partnership with Indigenous communities and consumers can help increase healthcare uptake and reduce the burden of respiratory diseases