Impact of floods on undernutrition among children under five years of age in low- and middle-income countries: a systematic review.

BACKGROUND: Weather and climate-related disasters, including floods, impact undernutrition through multiple pathways, including food security, inadequate child care practices, and water and sanitation. This review aimed to provide systematic evidence of the impact of floods on undernutrition in children under five years of age in Low and Middle-income countries (LMICs). METHODS: We searched PubMed, Web of Science, Embase, MEDLINE, CINAHL and Scopus for peer-reviewed articles. Popline, WHO Library database (WHOLIS), the International Disaster database (EM-DAT), Food and Agriculture Organisation (FAO), UNICEF and Eldis were searched for grey literature articles. Database searches were first conducted in 2016 and updated in 2020. We included English language articles that reported the effect of floods on undernutrition outcomes in children under 5 years of age in LMICs, without limitation to study design and year of publication. The quality of selected studies was assessed using the National Institutes of Health (NIH) tool for Observational Cohort and Cross-Sectional Studies. RESULTS: Of the 5701 articles identified, 14 met our inclusion criteria. The review noted stunting as the most frequently reported significant form of undernutrition in flood-affected areas. Severe and recurrent floods showed the greatest impact on undernutrition. Due to weak and limited evidence, the study is inconclusive on the most significant forms within the short-term and intermediate periods following floods. On the other hand, stunting was noted as the most frequently reported significant form of undernutrition in the long-term period following floods. There was generally little evidence of the effect of floods on micronutrient deficiencies. Factors associated with child undernutrition in the flood-affected areas included age, gender, diarrhoea, maternal and paternal education, maternal age, household size, land ownership and socioeconomic status. Overall, the quality of the evidence was fairly weak, with the main challenge lying in the inability of the studies to establish causal pathways for the observed effects. CONCLUSIONS: The review suggests clear plans and strategies for preventing and reducing the long-term impact of floods on undernutrition in children under five years. Future research utilising long-term prospective data is indispensable to provide more robust evidence to guide better prevention measures, response decisions and interventions.

Trends of overweight and obesity among preschool children from 2013 to 2018: a cross-sectional study in Rhine-Neckar County and the City of Heidelberg, Germany.

BACKGROUND: Early childhood overweight and obesity is a growing public health concern worldwide. Few recent studies have addressed how time trends varied by sociodemographic characteristics at the regional level using large and high-quality data. This study determines how time trends vary in the prevalence of early childhood overweight and obesity by age, gender, and migration background at the regional level. METHODS: We used a Kernel-density curve to describe the BMI distribution, and evaluated the trends of overweight and obesity by age, gender, and migration background using logistic regression. RESULTS: Mean BMI and the overall prevalence of overweight and obesity increased among preschool children aged 4-6 years in the Rhine-Neckar County and the City of Heidelberg. After adjusting for age, sex, and migration background, trends of overweight significantly increased only among male children in the age 5 year group with migration background (P < 0.05), and an upward trend of obesity was observed only among male children in the age 5 year group and female children in the age 6 year group with migration background (P < 0.05). CONCLUSIONS: BMI distribution as well as general prevalence of overweight and obesity are still increasing among preschool children. Children with migration backgrounds, particularly male children in the age 5 year groups and female children in the age 6 year group should be prioritized. Health promotion strategies for children with migration backgrounds will help address this challenge.

Associations between BMI and visual impairment of 33 407 preschool children in Germany: a pooled cross-sectional study.

BACKGROUND: Prevalence of overweight and obesity in Germany is increasing. High body weight can affect children's growth and development. This paper aimed to determine the association between body mass index (BMI) and visual impairment among preschool children and explore the potential role of obesity in predicting visual developmental disorder. METHODS: Six consecutive years of data from the School Entry Examination were collected for all preschool children aged from 4 to 6 years residing in Rhine-Neckar County and the City of Heidelberg, Germany from 2013 to 2018. Univariate and multivariate regression were used to analyze the complete data, multiple imputation was used to deal with missing data. RESULTS: Among the group with an immigrant background, children with obesity [OR = 1.20, 99% (1.02-1.42)] were more likely to have visual impairment compared to those with normal body weight (P < 0.01) after adjusting for survey year, age, and gender of children, education and occupation of parents, screen time-frequency, whether a television was in their bedroom, and quality of preschool outdoor environment. CONCLUSION: There were significant associations between obesity and visual impairment among German preschool children with immigrant backgrounds. Strategies to support vulnerable groups were needed across all regional schools.

Socio-demographic characteristics and risk factors for HIV transmission in female bar workers in sub-Saharan Africa: a systematic literature review.

BACKGROUND: Although sex workers are considered a key population in the HIV epidemic in sub-Saharan Africa (SSA), less consideration has been given to female bar workers (FBW), whose primary occupation is not sex work but who often engage in transactional sex. Understanding FBWs' risk profiles is central to designing targeted HIV prevention interventions for them. This systematic review describes the socio-demographic characteristics and risk factors for HIV transmission among FBWs in SSA. METHODS: We searched six databases: PubMed, Google Scholar, Web of Science, Popline, Embase and additionally the World Health Organization's WHOLIS database for grey literature between July and September 2017. Inclusion criteria were reporting (1) primary socio-demographic or behavioral data; on (2) women who sold or delivered drinks to clients; (3) in establishments serving alcohol; (4) in SSA. We excluded studies not presenting separate data on FBWs. We extracted quantitative and qualitative data from the selected studies and conducted a qualitative synthesis of findings. RESULTS: We found 4565 potentially eligible articles, including duplicates. After applying inclusion and exclusion criteria, we retained 19 articles. FBWs often migrated from rural to urban areas due to economic need or social marginalization. They began bar-based transactional sex due to low wages, peer pressure and to increase financial independence. FBWs had high HIV risk awareness but low agency to negotiate condom use, particularly with regular partners or when offered higher prices for condomless sex. FBWs were also vulnerable to violence and stigmatization. CONCLUSIONS: FBWs are a vulnerable population for HIV infection. Despite social stigmatization and elevated risk of contracting STIs, bar work remains attractive because it enables unskilled women to both, make a living and maintain some independence. FBWs face HIV-related risk factors at the individual, community and societal level and may benefit from biomedical, behavioral and structural interventions.

Reduction of malaria vector mosquitoes in a large-scale intervention trial in rural Burkina Faso using Bti based larval source management.

BACKGROUND: Malaria remains one of the most important causes of morbidity and death in sub-Saharan Africa. Along with early diagnosis and treatment of malaria cases and intermittent preventive treatment in pregnancy (IPTp), vector control is an important tool in the reduction of new cases. Alongside the use of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), targeting the vector larvae with biological larvicides, such as Bacillus thuringiensis israelensis (Bti) is gaining importance as a means of reducing the number of mosquito larvae before they emerge to their adult stage. This study presents data corroborating the entomological impact of such an intervention in a rural African environment. METHODS: The study extended over 2 years and researched the impact of biological larviciding with Bti on malaria mosquitoes that were caught indoors and outdoors of houses using light traps. The achieved reductions in female Anopheles mosquitoes were calculated for two different larviciding choices using a regression model. RESULTS: In villages that received selective treatment of the most productive breeding sites, the number of female Anopheles spp. dropped by 61% (95% CI 54-66%) compared to the pre-intervention period. In villages in which all breeding sites were treated, the number of female Anopheles spp. was reduced by 70% (95% CI 64-74%) compared to the pre-intervention period. CONCLUSION: It was shown that malaria vector abundance can be dramatically reduced through larviciding of breeding habitats and that, in many geographical settings, they are a viable addition to current malaria control measures.

Structural, interpersonal, psychosocial, and behavioral risk factors for HIV acquisition among female bar workers in Dar es Salaam, Tanzania.

In sub-Saharan Africa, female bar workers (FBWs) often serve as informal sex workers. Little is known about the prevalence of HIV and HIV-related risk factors among FBWs in Dar es Salaam (DSM), Tanzania. Using an adapted Structural HIV Determinants Framework, we identified structural, interpersonal, psychosocial, and behavioral risk factors for HIV acquisition. We compared the prevalence of HIV and HIV-related risk factors among a random sample of 66 FBWs from DSM to an age-standardized, representative sample of female DSM-residents from the 2016 Demographic and Health and 2011-2012 AIDS Indicator Surveys. Compared to other women in DSM, FBWs had elevated prevalence of all four groups of risk factors. Key risk factors included gender and economic inequalities (structural); sexual violence and challenges negotiating condom use (interpersonal); depression, post-traumatic stress disorder, and low social support (psychosocial); and history of unprotected sex, multiple sex partners, and high alcohol consumption (behavioral). HIV prevalence did not differ between FBWs (7.1%, 95% CI 3.7-13.3%) and survey respondents (7.7%, 95% CI: 5.3-11.1%), perhaps due to FBWs' higher - though sub-optimal - engagement with HIV prevention strategies. Elevated exposure to HIV-related risk factors but low HIV prevalence suggests economic, psychosocial, and biomedical interventions may prevent HIV among FBWs in DSM.

A qualitative study of community perception and acceptance of biological larviciding for malaria mosquito control in rural Burkina Faso.

BACKGROUND: Vector and malaria parasite's rising resistance against pyrethroid-impregnated bed nets and antimalarial drugs highlight the need for additional control measures. Larviciding against malaria vectors is experiencing a renaissance with the availability of environmentally friendly and target species-specific larvicides. In this study, we analyse the perception and acceptability of spraying surface water collections with the biological larvicide Bacillus thuringiensis israelensis in a single health district in Burkina Faso. METHODS: A total of 12 focus group discussions and 12 key informant interviews were performed in 10 rural villages provided with coverage of various larvicide treatments (all breeding sites treated, the most productive breeding sites treated, and untreated control). RESULTS: Respondents' knowledge about the major risk factors for malaria transmission was generally good. Most interviewees stated they performed personal protective measures against vector mosquitoes including the use of bed nets and sometimes mosquito coils and traditional repellents. The acceptance of larviciding in and around the villages was high and the majority of respondents reported a relief in mosquito nuisance and malarial episodes. There was high interest in the project and demand for future continuation. CONCLUSION: This study showed that larviciding interventions received positive resonance from the population. People showed a willingness to be involved and financially support the program. The positive environment with high acceptance for larviciding programs would facilitate routine implementation. An essential factor for the future success of such programs would be inclusion in regional or national malaria control guidelines.

Decreasing child mortality, spatial clustering and decreasing disparity in North-Western Burkina Faso.

Within relatively small areas, there exist high spatial variations of mortality between villages. In rural Burkina Faso, with data from 1993 to 1998, clusters of particularly high child mortality were identified in the population of the Nouna Health and Demographic Surveillance System (HDSS), a member of the INDEPTH Network. In this paper, we report child mortality with respect to temporal trends, spatial clustering and disparity in this HDSS from 1993 to 2012. Poisson regression was used to describe village-specific child mortality rates and time trends in mortality. The spatial scan statistic was used to identify villages or village clusters with higher child mortality. Clustering of mortality in the area is still present, but not as strong as before. The disparity of child mortality between villages has decreased. The decrease occurred in the context of an overall halving of child mortality in the rural area of Nouna HDSS between 1993 and 2012. Extrapolated to the Millennium Development Goals target period 1990-2015, this yields an estimated reduction of 54%, which is not too far off the aim of a two-thirds reduction.

Routine implementation costs of larviciding with Bacillus thuringiensis israelensis against malaria vectors in a district in rural Burkina Faso.

BACKGROUND: The key tools in malaria control are early diagnosis and treatment of cases as well as vector control. Current strategies for malaria vector control in sub-Saharan Africa are largely based on long-lasting insecticide-treated nets (LLINs) and to a much smaller extent on indoor residual spraying (IRS). An additional tool in the fight against malaria vectors, larval source management (LSM), has not been used in sub-Saharan Africa on a wider scale since the abandonment of environmental spraying of DDT. Increasing concerns about limitations of LLINs and IRS and encouraging results from large larvicide-based LSM trials make a strong case for using biological larviciding as a complementary tool to existing control measures. Arguments that are often quoted against such a combined approach are the alleged high implementation costs of LSM. This study makes the first step to test this argument. The implementation costs of larval source management based on Bacillus thuringiensis israelensis (Bti) (strain AM65-52) spraying under different implementation scenarios were analysed in a rural health district in Burkina Faso. METHODS: The analysis draws on detailed cost data gathered during a large-scale LSM intervention between 2013 and 2015. All 127 villages in the study setup were assigned to two treatment arms and one control group. Treatment either implied exhaustive spraying of all available water collections or targeted spraying of the 50 % most productive larval sources via remote-sensing derived and entomologically validated risk maps. Based on the cost reports from both intervention arms, the per capita programme costs were calculated under the assumption of covering the whole district with either intervention scenario. Cost calculations have been generalized by providing an adaptable cost formula. In addition, this study assesses the sensitivity of per capita programme costs with respect to changes in the underlying cost components. RESULTS: The average annual per capita costs of exhaustive larviciding with Bti during the main malaria transmission period (June-October) in the Nouna health district were calculated to be US$ 1.05. When targeted spraying of the 50 % most productive larval sources is used instead, average annual per capita costs decrease by 27 % to US$ 0.77. Additionally, a high sensitivity of per capita programme costs against changes in total surface of potential larval sources and the number of spraying repetitions was found. DISCUSSION: The per capita costs for larval source management interventions with Bti are roughly a third of the annual per capita expenditures for anti-malarial drugs and those for LLINs in Burkina Faso which are US$ 3.80 and 3.00, respectively. The average LSM costs compare to those of IRS and LLINs for sub-Saharan Africa. The authors argue that in such a setting LSM based on Bti spraying is within the range of affordable anti-malarial strategies and, consequently, should deserve more attention in practice. Future research includes a cost-benefit calculation, based on entomological and epidemiological data collected during the research project.

Challenges of implementing a large scale larviciding campaign against malaria in rural Burkina Faso - lessons learned and recommendations derived from the EMIRA project.

BACKGROUND: Recent malaria control and elimination attempts show remarkable success in several parts of sub-Saharan Africa. Vector control via larval source management represents a new and to date underrepresented approach in low income countries to further reduce malaria transmission. Although the positive impact of such campaigns on malaria incidence has been researched, there is a lack of data on which prerequisites are needed for implementing such programs on a routine basis on large scale. Our objectives are to point out important steps in implementing an anti-malaria larviciding campaign in a resource and infrastructure restraint setting and share the lessons learned from our experience during a three-year intervention study in rural Burkina Faso. METHODS: We describe the approaches we followed and the challenges that have been encountered during the EMIRA project, a three-year study on the impact of environmental larviciding on vector ecology and human health. An inventory of all performed work packages and associated problems and peculiarities was assembled. RESULTS: Key to the successful implementation of the larviciding program within a health district was the support and infrastructure from the local research center run by the government. This included availability of trained scientific personnel for local project management, data collection and analysis by medical personnel, entomologists and demographers and teams of fieldworkers for the larviciding intervention. A detailed a priori assessment of the environment and vector breeding site ecology was essential to calculate personnel requirements and the need for larvicide and application apparel. In our case of a three-year project, solid funding for the whole duration was an important issue, which restricted the number of possible donors. We found the acquisition of qualified field personnel in fair numbers not to be always easy and training in application techniques and basic entomologic knowledge required several weeks of theoretical and practical formation. A further crucial point was to establish an effective quality control system that ensured the timely verification of larviciding success and facilitated in time data handling. While the experiences of running a larviciding campaign may vary globally, the experiences gained and the methods used in the Nouna health district may be employed in similar settings. CONCLUSIONS: Our observations highlight important components and strategies that should be taken into account when planning and running a similar larviciding program against malaria in a resource limited setting. A strong local partnership, meticulous planning with the possibility of ad-hoc adaption of project components and a reliable source of funding turned out to be crucial factors to successfully accomplish such a project.

Modeling tools for dengue risk mapping - a systematic review.

INTRODUCTION: The global spread and the increased frequency and magnitude of epidemic dengue in the last 50 years underscore the urgent need for effective tools for surveillance, prevention, and control. This review aims at providing a systematic overview of what predictors are critical and which spatial and spatio-temporal modeling approaches are useful in generating risk maps for dengue. METHODS: A systematic search was undertaken, using the PubMed, Web of Science, WHOLIS, Centers for Disease Control and Prevention (CDC) and OvidSP databases for published citations, without language or time restrictions. A manual search of the titles and abstracts was carried out using predefined criteria, notably the inclusion of dengue cases. Data were extracted for pre-identified variables, including the type of predictors and the type of modeling approach used for risk mapping. RESULTS: A wide variety of both predictors and modeling approaches was used to create dengue risk maps. No specific patterns could be identified in the combination of predictors or models across studies. The most important and commonly used predictors for the category of demographic and socio-economic variables were age, gender, education, housing conditions and level of income. Among environmental variables, precipitation and air temperature were often significant predictors. Remote sensing provided a source of varied land cover data that could act as a proxy for other predictor categories. Descriptive maps showing dengue case hotspots were useful for identifying high-risk areas. Predictive maps based on more complex methodology facilitated advanced data analysis and visualization, but their applicability in public health contexts remains to be established. CONCLUSIONS: The majority of available dengue risk maps was descriptive and based on retrospective data. Availability of resources, feasibility of acquisition, quality of data, alongside available technical expertise, determines the accuracy of dengue risk maps and their applicability to the field of public health. A large number of unknowns, including effective entomological predictors, genetic diversity of circulating viruses, population serological profile, and human mobility, continue to pose challenges and to limit the ability to produce accurate and effective risk maps, and fail to support the development of early warning systems.

Assessment of Heat Exposure and Health Outcomes in Rural Populations of Western Kenya by Using Wearable Devices: Observational Case Study.

BACKGROUND: Climate change increasingly impacts health, particularly of rural populations in sub-Saharan Africa due to their limited resources for adaptation. Understanding these impacts remains a challenge, as continuous monitoring of vital signs in such populations is limited. Wearable devices (wearables) present a viable approach to studying these impacts on human health in real time. OBJECTIVE: The aim of this study was to assess the feasibility and effectiveness of consumer-grade wearables in measuring the health impacts of weather exposure on physiological responses (including activity, heart rate, body shell temperature, and sleep) of rural populations in western Kenya and to identify the health impacts associated with the weather exposures. METHODS: We conducted an observational case study in western Kenya by utilizing wearables over a 3-week period to continuously monitor various health metrics such as step count, sleep patterns, heart rate, and body shell temperature. Additionally, a local weather station provided detailed data on environmental conditions such as rainfall and heat, with measurements taken every 15 minutes. RESULTS: Our cohort comprised 83 participants (42 women and 41 men), with an average age of 33 years. We observed a positive correlation between step count and maximum wet bulb globe temperature (estimate 0.06, SE 0.02; P=.008). Although there was a negative correlation between minimum nighttime temperatures and heat index with sleep duration, these were not statistically significant. No significant correlations were found in other applied models. A cautionary heat index level was recorded on 194 (95.1%) of 204 days. Heavy rainfall (>20 mm/day) occurred on 16 (7.8%) out of 204 days. Despite 10 (21%) out of 47 devices failing, data completeness was high for sleep and step count (mean 82.6%, SD 21.3% and mean 86.1%, SD 18.9%, respectively), but low for heart rate (mean 7%, SD 14%), with adult women showing significantly higher data completeness for heart rate than men (2-sided t test: P=.003; Mann-Whitney U test: P=.001). Body shell temperature data achieved 36.2% (SD 24.5%) completeness. CONCLUSIONS: Our study provides a nuanced understanding of the health impacts of weather exposures in rural Kenya. Our study's application of wearables reveals a significant correlation between physical activity levels and high temperature stress, contrasting with other studies suggesting decreased activity in hotter conditions. This discrepancy invites further investigation into the unique socioenvironmental dynamics at play, particularly in sub-Saharan African contexts. Moreover, the nonsignificant trends observed in sleep disruption due to heat expose the need for localized climate change mitigation strategies, considering the vital role of sleep in health. These findings emphasize the need for context-specific research to inform policy and practice in regions susceptible to the adverse health effects of climate change.

Prevalence of major non-communicable diseases and their associated risk factors in Afghanistan: a systematic review and meta-analysis.

Background: Non-communicable diseases (NCDs) are the leading cause of mortality worldwide, and increasingly so in low- and middle-income countries. Afghanistan is dealing with a double burden of diseases, yet there has been no evidence synthesis on the prevalence of major NCDs and their risk factors. Objective: This study aims to provide a comprehensive synthesis of the existing data on the prevalence of major NCDs and the common related risk factors in Afghanistan. Method: We systematically reviewed scientific articles from 2000 to 2022 that reported the prevalence of diabetes, chronic respiratory diseases (CRDs), cardiovascular diseases (CVDs) or cancer, and their risk factors in Afghanistan. Four online databases (PubMed, Web of Science, Cochrane and Google Scholar) and two local journals in Afghanistan (not indexed online) were systematically searched and screened. Two reviewers independently screened and appraised the quality of the articles. Data extraction and synthesis were performed using tabulated sheets. Results: Among 51 eligible articles, 10 (19.6%) focused on cancer, 10 (19.6%) on diabetes, 4 (7.8%) on CVDs, 4 (7.8%) on CRDs and 23 (45.1%) on risk factors as the primary outcome. Few articles addressed major NCD prevalence; no evidence of CVDs, cancer was 0.15%, asthma ranged between 0.3% and 17.3%, and diabetes was 12%. Pooled prevalence of hypertension and overweight were 31% and 35%, respectively. Central obesity was twice as prevalent in females (76% versus 40%). Similarly, gender differences were observed in smoking and snuff use with prevalence rates of 14% and 25% among males and 2% and 3% among females, respectively. A total of 14% of the population engaged in vigorous activity. Pooled prevalence for physical inactivity, general obesity, fruit and vegetable consumption, dyslipidaemia and alcohol consumption couldn't be calculated due to the heterogeneity of articles. Conclusion: Only little evidence is available on the prevalence of major NCDs in Afghanistan; however, the NCD risk factors are prevalent across the country. The quality of the available data, especially those of the local resources, is poor; therefore, further research should generate reliable evidence in order to inform policymakers on prioritizing interventions for controlling and managing NCDs.

A Systematic Literature Review of the Impact of Climate Change on the Global Demand for Psychiatric Services.

Climate Change (CC) imposes important global health risks, including on mental health (MH). They are related mostly to psychological suffering caused by climate-related events and to the heat-vulnerability caused by psychiatric disorders. This growing burden may press MH services worldwide, increasing demand on public and private systems in low-, middle-, and high-income countries. According to PRISMA, two independent reviewers searched four databases for papers published before May 2022 that associated climate-related events with healthcare demand for psychiatric conditions. Of the 7432 papers retrieved, we included 105. Only 29 were carried out in low- and middle-income countries. Twelve related the admission numbers to (i) extreme events, while 93 to (ii) meteorological factors-mostly heat. Emergency visits and hospitalizations were significantly higher during hot periods for MH disorders, especially until lag 5-7. Extreme events also caused more consultations. Suicide (completed or attempted), substance misuse, schizophrenia, mood, organic and neurotic disorders, and mortality were strongly affected by CC. This high healthcare demand is evidence of the burden patients may undergo. In addition, public and private services may face a shortage of financial and human resources. Finally, the increased use of healthcare facilities, in turn, intensifies greenhouse gas emissions, representing a self-enforcing cycle for CC. Further research is needed to better clarify how extreme events affect MH services and, in addition, if services in low- and middle-income countries are more intensely demanded by CC, as compared to richer countries.

Interventions against Aedes/dengue at the household level: a systematic review and meta-analysis.

BACKGROUND: Because the evidence for the role of structural housing and combinations of interventions (domestic or peri-domestic) against Aedes mosquitoes or dengue is still lacking, this systematic review and meta-analysis aimed to analyse and synthesize research focusing on the household as the unit of allocation. METHODS: We searched MEDLINE, LILACS, and Web of Science databases until February 2023 using three general keyword categories: (1) "Aedes" or "dengue"; (2) structural housing interventions including "house", "water", or "drainage"; and (3) vector control interventions of potential relevance and their combinations. We performed a qualitative content analysis and a meta-analysis for 13 entries on dengue seroconversion data. FINDINGS: 14,272 articles were screened by titles, 615 by abstracts, 79 by full-text. 61 were selected. Satisfactory data quality allowed for detailed content analysis. Interventions at the household level against the immature mosquito stages (21 studies, 34%) showed positive or mixed results in entomological and epidemiological outcomes (86% and 75% respectively). Combined interventions against immature and adult stages (11 studies, 18%) performed similarly (91% and 67%) while those against the adult mosquitoes (29 studies, 48%) performed less well (79%, 22%). A meta-analysis on seroconversion outcomes showed a not-statistically significant reduction for interventions (log odds-ratio: -0.18 [-0.51, 0.14 95% CI]). INTERPRETATION: No basic research on housing structure or modification was eligible for this systematic review but many interventions with clear impact on vector indices and, to a lesser extent, on dengue were described. The small and not-statistically significant effect size of the meta-analysis highlights the difficulty of proving effectiveness against this highly-clustered disease and of overcoming practical implementation obstacles (e.g. efficacy loss, compliance). The long-term success of interventions depends on suitability, community commitment and official support and promotion. The choice of a specific vector control package needs to take all these context-specific aspects into consideration. FUNDING: This work was funded by a grant from the World Health Organization (2021/1121668-0, PO 202678425, NTD/VVE).

Strengthening national public health institutes: a systematic review on institution building in the public sector.

Introduction: Strong and efficient institutions are vital to the development of well-functioning governments and strong societies. The term "institution building" encompasses the creation, support, development, and strengthening of organizations and institutions. Still, there is little aggregated evidence on "institution building" considering a wider system-thinking approach, best practices, or development cooperation specifically in the field of public health. In 2007, the International Association of National Public Health Institutes (IANPHI) created a guiding Framework that countries may use for developing National Public Health Institutes (NPHIs). This Framework is currently being revised. Methods: In this context, we conducted a systematic review to facilitate this revision with recent evidence on institution building and its potential contribution to NPHI. We followed the PRISMA guidelines for systematic reviews, searching for relevant publications in seven scientific databases (Pubmed, VHL/LILACS, EconLit, Google Scholar, Web of Science, World Affairs Online, ECONBIZ) and four libraries (World Bank; European Health for All database of the World Health Organization European Region, WHO; Organization for Economic Cooperation and Development, OECD; and the African Union Common Repository). The search was carried out in October 2021. We used the "framework analysis" tool for systematically processing documents according to key themes. Results: As a result, we identified 3,015 records, of which we included 62 documents in the final review. This systematic review fills a major gap of aggregated information on institution building in the field of public health and National Public Health Institutes. It is to our knowledge the first systematic review of this kind. The overriding result is the identification and definition of six domains of institution building in the health sector: "governance," "knowledge and innovation," "inter-institutional cooperation," "monitoring and control," "participation," and "sustainability and context-specific adaptability." Discussion: Our results show that the described domains are highly relevant to the public health sector, and that managers and the scientific community recognize their importance. Still, they are often not applied consistently when creating or developing NPHIs. We conclude that organizations engaged in institution building of NPHIs, including IANPHI, may greatly benefit from state-of-the-art research on institution building as presented in this study.

Assessing the Effect of Extreme Weather on Population Health Using Consumer-Grade Wearables in Rural Burkina Faso: Observational Panel Study.

BACKGROUND: Extreme weather, including heat and extreme rainfall, is projected to increase owing to climate change, which can have adverse impacts on human health. In particular, rural populations in sub-Saharan Africa are at risk because of a high burden of climate-sensitive diseases and low adaptive capacities. However, there is a lack of data on the regions that are anticipated to be most exposed to climate change. Improved public health surveillance is essential for better decision-making and health prioritization and to identify risk groups and suitable adaptation measures. Digital technologies such as consumer-grade wearable devices (wearables) may generate objective measurements to guide data-driven decision-making. OBJECTIVE: The main objective of this observational study was to examine the impact of weather exposure on population health in rural Burkina Faso using wearables. Specifically, this study aimed to assess the relationship between individual daily activity (steps), sleep duration, and heart rate (HR), as estimated by wearables, and exposure to heat and heavy rainfall. METHODS: Overall, 143 participants from the Nouna health and demographic surveillance system in Burkina Faso wore the Withings Pulse HR wearable 24/7 for 11 months. We collected continuous weather data using 5 weather stations throughout the study region. The heat index and wet-bulb globe temperature (WBGT) were calculated as measures of heat. We used linear mixed-effects models to quantify the relationship between exposure to heat and rainfall and the wearable parameters. Participants kept activity journals and completed a questionnaire on their perception of and adaptation to heat and other weather exposure. RESULTS: Sleep duration decreased significantly (P<.001) with higher heat exposure, with approximately 15 minutes shorter sleep duration during heat stress nights with a heat index value of ≥25 °C. Many participants (55/137, 40.1%) reported that heat affected them the most at night. During the day, most participants (133/137, 97.1%) engaged in outdoor physical work such as farming, housework, or fetching water. During the rainy season, when WBGT was highest, daily activity was highest and increased when the daily maximum WBGT surpassed 30 °C during the rainiest month. In the hottest month, daily activity decreased per degree increase in WBGT for values >30 °C. Nighttime HR showed no significant correlation with heat exposure. Daytime HR data were insufficient for analysis. We found no negative health impact associated with heavy rainfall. With increasing rainfall, sleep duration increased, average nightly HR decreased, and activity decreased. CONCLUSIONS: During the study period, participants were frequently exposed to heat and heavy rainfall. Heat was particularly associated with impaired sleep and daily activity. Essential tasks such as harvesting, fetching water, and caring for livestock expose this population to weather that likely has an adverse impact on their health. Further research is essential to guide interventions safeguarding vulnerable communities.

Secondary vectors of Zika Virus, a systematic review of laboratory vector competence studies.

BACKGROUND: After the unprecedented Zika virus (ZIKV) outbreak in the western hemisphere from 2015-2018, Aedes aegypti and Ae. albopictus are now well established primary and secondary ZIKV vectors, respectively. Consensus about identification and importance of other secondary ZIKV vectors remain. This systematic review aims to provide a list of vector species capable of transmitting ZIKV by reviewing evidence from laboratory vector competence (VC) studies and to identify key knowledge gaps and issues within the ZIKV VC literature. METHODS: A search was performed until 15th March 2022 on the Cochrane Library, Lilacs, PubMed, Web of Science, WHOLIS and Google Scholar. The search strings included three general categories: 1) "ZIKA"; 2) "vector"; 3) "competence", "transmission", "isolation", or "feeding behavior" and their combinations. Inclusion and exclusion criteria has been predefined and quality of included articles was assessed by STROBE and STROME-ID criteria. FINDINGS: From 8,986 articles retrieved, 2,349 non-duplicates were screened by title and abstracts,103 evaluated using the full text, and 45 included in this analysis. Main findings are 1) secondary vectors of interest include Ae. japonicus, Ae. detritus, and Ae. vexans at higher temperature 2) Culex quinquefasciatus was not found to be a competent vector of ZIKV, 3) considerable heterogeneity in VC, depending on the local mosquito strain and virus used in testing was observed. Critical issues or gaps identified included 1) inconsistent definitions of VC parameters across the literature; 2) equivalency of using different mosquito body parts to evaluate VC parameters for infection (mosquito bodies versus midguts), dissemination (heads, legs or wings versus salivary glands), and transmission (detection or virus amplification in saliva, FTA cards, transmission to neonatal mice); 3) articles that fail to use infectious virus assays to confirm the presence of live virus; 4) need for more studies using murine models with immunocompromised mice to infect mosquitoes. CONCLUSION: Recent, large collaborative multi-country projects to conduct large scale evaluations of specific mosquito species represent the most appropriate approach to establish VC of mosquito species.

Utilization of combined remote sensing techniques to detect environmental variables influencing malaria vector densities in rural West Africa.

INTRODUCTION: The use of remote sensing has found its way into the field of epidemiology within the last decades. With the increased sensor resolution of recent and future satellites new possibilities emerge for high resolution risk modeling and risk mapping. METHODS: A SPOT 5 satellite image, taken during the rainy season 2009 was used for calculating indices by combining the image's spectral bands. Besides the widely used Normalized Difference Vegetation Index (NDVI) other indices were tested for significant correlation against field observations. Multiple steps, including the detection of surface water, its breeding appropriateness for Anopheles and modeling of vector imagines abundance, were performed. Data collection on larvae, adult vectors and geographic parameters in the field, was amended by using remote sensing techniques to gather data on altitude (Digital Elevation Model = DEM), precipitation (Tropical Rainfall Measurement Mission = TRMM), land surface temperatures (LST). RESULTS: The DEM derived altitude as well as indices calculations combining the satellite's spectral bands (NDTI = Normalized Difference Turbidity Index, NDWI Mac Feeters = Normalized Difference Water Index) turned out to be reliable indicators for surface water in the local geographic setting. While Anopheles larvae abundance in habitats is driven by multiple, interconnected factors - amongst which the NDVI - and precipitation events, the presence of vector imagines was found to be correlated negatively to remotely sensed LST and positively to the cumulated amount of rainfall in the preceding 15 days and to the Normalized Difference Pond Index (NDPI) within the 500 m buffer zone around capture points. CONCLUSIONS: Remotely sensed geographical and meteorological factors, including precipitations, temperature, as well as vegetation, humidity and land cover indicators could be used as explanatory variables for surface water presence, larval development and imagines densities. This modeling approach based on remotely sensed information is potentially useful for counter measures that are putting on at the environmental side, namely vector larvae control via larviciding and water body reforming.

Factors influencing the uptake of short-term contraceptives among women in Afghanistan.

The aim of this study is to assess factors that influence the uptake of short-term contraceptives among married women aged between 15 and 49 years in Afghanistan. The cross-sectional Afghanistan 2015 Demographic and Health Survey provided the dataset for this analysis. We included 22,974 women and applied multivariable logistic regression to investigate the influencing factors for the uptake of short-term contraceptives. 92% of Afghan women knew at least one type of short-term contraception but only 17% were using short term contraceptives. Short term contraceptive use was most prevalent among women in the age group between 30 and 40 who were educated, employed, and rich. Most of the users were living in the western parts of Afghanistan and women from the Balooch and Pashtun ethnic groups were most likely to use short-term contraceptives. Media exposure and women empowerment were also positively associated with the use of short-term contraceptives. We did not find an association with living in urban or rural settings. Contraception promotion in Afghanistan requires multisectoral efforts, tailored to the needs of women from low and middle socioeconomic strata. Health promotion activities, empowering women, strengthening education, and training of service providers on effective counseling are options that should be considered to improve the current situation.