Incidence and characteristics of bacteremia among children in rural Ghana.

The objective of the study was to describe systemic bacterial infections occurring in acutely ill and hospitalized children in a rural region in Ghana, regarding frequency, incidence, antimicrobial susceptibility patterns and associations with anthropometrical data.Blood cultures were performed in all children below the age of five years, who were admitted to Agogo Presbyterian Hospital (APH), Asante Region, Ghana, between September 2007 and July 2009. Medical history and anthropometrical data were assessed using a standardized questionnaire at admission. Incidences were calculated after considering the coverage population adjusted for village-dependent health-seeking behavior.Among 1,196 hospitalized children, 19.9% (n = 238) were blood culture positive. The four most frequent isolated pathogens were nontyphoidal salmonellae (NTS) (53.3%; n = 129), Staphylococcus aureus (13.2%; n = 32), Streptococcus pneumoniae (9.1%; n = 22) and Salmonella ser. Typhi (7.0%; n = 17). Yearly cumulative incidence of bacteremia was 46.6 cases/1,000 (CI 40.9-52.2). Yearly cumulative incidences per 1,000 of the four most frequent isolates were 25.2 (CI 21.1-29.4) for NTS, 6.3 (CI 4.1-8.4) for S. aureus, 4.3 (CI 2.5-6.1) for S. pneumoniae and 3.3 (CI 1.8-4.9) for Salmonella ser. Typhi. Wasting was positively associated with bacteremia and systemic NTS bloodstream infection. Children older than three months had more often NTS bacteremia than younger children. Ninety-eight percent of NTS and 100% of Salmonella ser. Typhi isolates were susceptible to ciprofloxacin, whereas both tested 100% susceptible to ceftriaxone. Seventy-seven percent of NTS and 65% of Salmonella ser. Typhi isolates were multi-drug resistant (MDR). Systemic bacterial infections in nearly 20% of hospitalized children underline the need for microbiological diagnostics, to guide targeted antimicrobial treatment and prevention of bacteremia. If microbiological diagnostics are lacking, calculated antimicrobial treatment of severely ill children in malaria-endemic areas should be considered

Spatial Analysis of Land Cover Determinants of Malaria Incidence in the Ashanti Region, Ghana

Malaria belongs to the infectious diseases with the highest morbidity and mortality worldwide. As a vector-borne disease malaria distribution is strongly influenced by environmental factors. The aim of this study was to investigate the association between malaria risk and different land cover classes by using high-resolution multispectral Ikonos images and Poisson regression analyses. The association of malaria incidence with land cover around 12 villages in the Ashanti Region, Ghana, was assessed in 1,988 children <15 years of age. The median malaria incidence was 85.7 per 1,000 inhabitants and year (range 28.4–272.7). Swampy areas and banana/plantain production in the proximity of villages were strong predictors of a high malaria incidence. An increase of 10% of swampy area coverage in the 2 km radius around a village led to a 43% higher incidence (relative risk [RR] = 1.43, p<0.001). Each 10% increase of area with banana/plantain production around a village tripled the risk for malaria (RR = 3.25, p<0.001). An increase in forested area of 10% was associated with a 47% decrease of malaria incidence (RR = 0.53, p = 0.029)

Principal component analysis of socioeconomic factors and their association with malaria in children from the Ashanti Region, Ghana

<p>Abstract</p> <p>Background</p> <p>The socioeconomic and sociodemographic situation are important components for the design and assessment of malaria control measures. In malaria endemic areas, however, valid classification of socioeconomic factors is difficult due to the lack of standardized tax and income data. The objective of this study was to quantify household socioeconomic levels using principal component analyses (PCA) to a set of indicator variables and to use a classification scheme for the multivariate analysis of children < 15 years of age presented with and without malaria to an outpatient department of a rural hospital.</p> <p>Methods</p> <p>In total, 1,496 children presenting to the hospital were examined for malaria parasites and interviewed with a standardized questionnaire. The information of eleven indicators of the family's housing situation was reduced by PCA to a socioeconomic score, which was then classified into three socioeconomic status (poor, average and rich). Their influence on the malaria occurrence was analysed together with malaria risk co-factors, such as sex, parent's educational and ethnic background, number of children living in a household, applied malaria protection measures, place of residence and age of the child and the mother.</p> <p>Results</p> <p>The multivariate regression analysis demonstrated that the proportion of children with malaria decreased with increasing socioeconomic status as classified by PCA (p < 0.05). Other independent factors for malaria risk were the use of malaria protection measures (p < 0.05), the place of residence (p < 0.05), and the age of the child (p < 0.05).</p> <p>Conclusions</p> <p>The socioeconomic situation is significantly associated with malaria even in holoendemic rural areas where economic differences are not much pronounced. Valid classification of the socioeconomic level is crucial to be considered as confounder in intervention trials and in the planning of malaria control measures.</p

Associations of Noise and Socioeconomic and -Demographic Status on Cardiovascular and Respiratory Diseases on Borough Level in a Large German City State

Worldwide, cardiovascular and respiratory diseases are increasing. Environmental noise and the socioeconomic and sociodemographic situation are important factors for the diseases. Using borough health claims data from 2011 in the city of Hamburg, ecological analyses with principal component analyses were conducted to describe the relationship of road traffic noise Lden (day, evening, and night) &gt; 65 dB(A), physician density, and social deprivation with regional prevalence rates of heart failure and hypertension (n = 67 boroughs). Additionally, associations between the considered factors with borough prevalence rates of acute bronchitis and asthma in children up to 14 years old were analyzed. The multivariate regression analyses (ANCOVA) indicated that the socioeconomic and sociodemographic borough background might be associated with cardiovascular and respiratory diseases, showing the strongest association among hypertensive female patients with 9.90 percent (p &lt; 0.0001) in the highest social deprivation category, when compared to the group of low social deprivation. However, associations between noise, physician density, and the respective health outcomes were negligible. Results will serve as a basis for further investigations. By using data from two surveys, future studies will focus on individual level data to assess the validity of our model, and to develop strategies to reduce the prevalence of cardiovascular and respiratory diseases

Relation between observed and perceived traffic noise and socio-economic status in urban blocks of different characteristics

Living in cities offers many benefits and thus more and more people are living in urban areas. However, the concentration of human activities also creates environmental stressors with severe influence on people’s health and well-being. Noise is an environmental stressor with known health impact. Despite this, studies investigating small-scale difference in noise exposure and annoyance are lacking. Against this background, this case study investigates environmental justice empirically, focusing on the distribution of road traffic noise and its perception in Hamburg, Germany. The study outlines a methodological approach that takes into account subjective and objective measures of exposure in small-scale residential blocks. The results show that annoyance by noise is clearly related to noise emission. Moreover, different groups are affected by noise pollution in our study area unequally. In particular, younger people and people with lower socio-economic status have higher probabilities to be affected by noise. Additionally, it emerged that participants reporting higher levels of annoyance from noise are on average younger than those feeling less annoyed. Overall, these results show that the current legal noise limits applicable to residential planning processes in German cities are not sufficient to prevent substantial annoyance effects in residential populations

Multi-domain design structure matrix approach applied to urban system modeling

Modeling the urban system for urban health and well-being with the aim of finding ways to optimize the well-being of urban dwellers is a complex task. Different modeling approaches that consider specific parts of the urban system, e.g., environmental stressors, urban society, and urban morphology, need to be integrated. The conceptual model of health-related urban well-being (UrbWellth) has been constructed to provide a structure for an integrated modeling framework. However, interfaces between the different modeling approaches were not sufficiently identified until now. The challenge to specify and operationalize these interfaces is met by using the Design Structure Matrix (DSM) concept, which is widely used in design engineering. It is used here to identify necessary interfaces within the urban system by determining the relevant interface variables and processes. The conceptual model for UrbWellth is used to construct a DSM. The results of a clustering of this UrbWellth-based DSM reveal that the structure of the conceptual model is indeed suitable to serve as a basis for an integrated model. Further, a Multi-Domain DSM (MDDSM), which is an extension of the DSM based on expert knowledge from individual modelers, identified the interface variables for the integrated model components as well as the processes for which different modeling approaches need to be coordinated. Moreover, the approach based on MDDSM identified processes that are not yet covered by the available modeling approaches