Diarrheal disease and associations with water access and sanitation in Indigenous Shawi children along the Armanayacu River basin in Peru.

INTRODUCTION: Diarrheal disease, particularly in children under 5 years old, remains a global health challenge due to its high prevalence and chronic health consequences. Public health interventions that reduce diarrheal disease risk include improving access to water, sanitation, and hygiene. Although Peru achieved the 2015 Millennium Development Goal (MDG) indicators for water access, less progress was achieved on sanitation. Furthermore, many Indigenous Peoples were overlooked in the MDG indicators, resulting in a prioritization of Indigenous Peoples in the 2030 Sustainable Development Goals (SDGs). This study aimed to estimate the prevalence of childhood diarrhea, characterize access to water and sanitation, and determine the association of childhood diarrhea with water access and sanitation indicators in 10 Shawi Indigenous communities along the Armanayacu River in the Peruvian Amazon. METHODS: A cross-sectional survey (n=82) that captured data on diarrheal disease, sociodemographic variables, and water and sanitation exposures was conducted in 10 Shawi communities. Nutritional status of children under 5 was also assessed via physical examination. Descriptive and comparative statistics were conducted. RESULTS: A small proportion (n=7; 8.54%) of participating children reported an episode of diarrhea in the previous month. Almost half (46.30%) of participating children had stunting, wasting, or both. Although not statistically significant, children living in households that used latrines were 4.29 times (95% confidence interval (CI) 1.01-18.19) more likely to report an episode of diarrhea than children living in households that practiced open defecation. Although not statistically significant, children living in households that used water treatment methods were 4.25 times (95%CI 0.54-33.71) more likely to report an episode of diarrhea than children living in households that did not. CONCLUSION: The prevalence of childhood diarrhea was lower for Shawi than for other Amazon areas. The higher prevalence of childhood diarrhea in households that used latrines and water treatments warrants further investigation into local risk and protective factors. These Shawi communities scored low for the WHO/UNICEF Joint Monitoring Programme indicators for water and sanitation, indicating that they should be prioritized in future water, sanitation, and hygiene initiatives. Research will be required to understand and incorporate local Indigenous values and cultural practices into water, sanitation, and hygiene initiatives to maximize intervention uptake and effectiveness.

Do socio-demographic factors modify the effect of weather on malaria in Kanungu District, Uganda?

BACKGROUND: There is concern in the international community regarding the influence of climate change on weather variables and seasonality that, in part, determine the rates of malaria. This study examined the role of sociodemographic variables in modifying the association between temperature and malaria in Kanungu District (Southwest Uganda). METHODS: Hospital admissions data from Bwindi Community Hospital were combined with meteorological satellite data from 2011 to 2014. Descriptive statistics were used to describe the distribution of malaria admissions by age, sex, and ethnicity (i.e. Bakiga and Indigenous Batwa). To examine how sociodemographic variables modified the association between temperature and malaria admissions, this study used negative binomial regression stratified by age, sex, and ethnicity, and negative binomial regression models that examined interactions between temperature and age, sex, and ethnicity. RESULTS: Malaria admission incidence was 1.99 times greater among Batwa than Bakiga in hot temperature quartiles compared to cooler temperature quartiles, and that 6-12 year old children had a higher magnitude of association of malaria admissions with temperature compared to the reference category of 0-5 years old (IRR = 2.07 (1.40, 3.07)). DISCUSSION: Results indicate that socio-demographic variables may modify the association between temperature and malaria. In some cases, such as age, the weather-malaria association in sub-populations with the highest incidence of malaria in standard models differed from those most sensitive to temperature as found in these stratified models. CONCLUSION: The effect modification approach used herein can be used to improve understanding of how changes in weather resulting from climate change might shift social gradients in health.

Climate change is impacting mental health in North America: A systematic scoping review of the hazards, exposures, vulnerabilities, risks and responses.

As climate change progresses, it is crucial that researchers and policymakers understand the ways in which climate-mental health risks arise through interactions between climate hazards, human exposure and social vulnerabilities across time and location. This scoping review systematically examined the nature, range and extent of published research in North America that investigates climate-mental health interactions. Five electronic databases were searched and two independent reviewers applied pre-determined criteria to assess the eligibility of articles identified in the search. Eighty-nine articles were determined to be relevant and underwent data extraction and analysis. The published literature reported on numerous exposure pathways through which acute and chronic climate hazards interacted with social vulnerabilities to increase mental health risks, including wellbeing, trauma, anxiety, depression, suicide and substance use. This review also highlights important gaps within the North American climate-mental health evidence base, including minimal research conducted in Mexico, as well as a lack of studies investigating climate-mental health adaptation strategies and projected future mental health risks. Further research should support effective preparation for and adaptation to the current and future mental health impacts of climate change. Such strategies could reduce health risks and the long-term mental health impacts that individuals and communities experience in a changing climate.

Antenatal Care Research in East Africa During the Millennium Development Goals Initiative: A Scoping Review.

INTRODUCTION: The global burden of maternal mortality remains high and inequitably distributed between countries. Antenatal care (ANC) was identified as critical component in achieving the Millennium Development Goal of improving maternal health. This scoping review aimed to summarize trends and critically explore research about ANC attendance for East African women conducted during the Millennium Development Goals initiative, with a specific focus on barriers to ANC access. METHODS: Using a scoping review methodology, aggregator databases were searched for relevant articles. Articles were screened by independent reviewers using a priori inclusion criteria. Eligible articles were retained for data charting and analysis. RESULTS: Following screening, 211 articles were analyzed. The number of relevant articles increased over time; utilized primarily quantitative methods; and involved authors with affiliations from various African countries. Many interrelated physical, social, and cultural factors influenced women's seeking, reaching, and receiving of quality ANC. The extent of studies identified suggest that ANC is a priority research area, yet key gaps in the literature exist. Limited qualitative research, and few articles examining ANC experiences of women from vulnerable groups (e.g. adolescents, women with a disability, and Indigenous women) were identified. DISCUSSION: These context-specific findings are important considering the Sustainable Development Goals aim to nearly triple the maternal mortality reductions by 2030. In order to achieve this goal, interventions should focus on improving the quality of ANC care and patient-provider interactions. Furthermore, additional qualitative research examining vulnerable populations of women and exploring the inclusion of men in ANC would help inform interventions intended to improve ANC attendance in East Africa.

Evidence-informed policy for tackling adverse climate change effects on health: Linking regional and global assessments of science to catalyse action.

Robin Fears and co-authors discuss evidence-informed regional and global policy responses to health impacts of climate change.

Temperature and place associations with Inuit mental health in the context of climate change.

BACKGROUND: Climate change has important implications for mental health globally. Yet, few studies have quantified the magnitude and direction of associations between weather and mental health-related factors, or assessed the geographical distribution of associations, particularly in areas experiencing rapid climatic change. This study examined the associations between air temperature variables and mental health-related community clinic visits across Nunatsiavut, Labrador, Canada, and the place-specific attributes of these associations. METHODS: Daily de-identified community clinic visit data were collected from the provincial electronic health recording system and linked to historical weather data (2012-2018). A multilevel, multivariable negative binomial regression model was fit to investigate associations between temperature variables and mental health-related community clinic visits across the region, adjusting for seasonality as a fixed effect and community as a random effect. A multivariable negative binomial model was then fit for each Nunatsiavut community, adjusting for seasonality. RESULTS: Mental health-related visits contributed to 2.4% of all 228,104 visit types across the study period; this proportion ranged from 0.6% to 11.3% based on community and year. Regionally, the incidence rate of mental health-related community clinic visits was greater after two weeks of warm average (i.e. above -5ᵒC) temperatures compared to temperatures below -5ᵒC (IRR-5≤5ᵒC = 1.47, 95% CI = 1.21-1.78; IRR6≤15ᵒC = 2.24, 95% CI = 1.66-3.03; IRR>15ᵒC = 1.73, 95% CI = 1.02-2.94), and the incidence rate of mental health-related clinic visits was lower when the number of consecutive days within -5 to 5ᵒC ranges (i.e. temperatures considered to be critical to land use) increased (IRR = 0.96; 95% CI = 0.94-0.99), adjusting for seasonal and community effects. Community-specific models, however, revealed that no two communities had the same association between meteorological conditions and the incidence rate of daily mental health-related visits. DISCUSSION: Regionally, longer periods of warm temperatures may burden existing healthcare resources and shorter periods of temperatures critical to land use (i.e. -5 to 5ᵒC) may present enjoyable or opportunistic conditions to access community and land-based resources. The heterogeneity found in temperature and mental health-related clinic visits associations across Nunatsiavut communities demonstrates that place quantitatively matters in the context of Inuit mental health and climate change. This evidence underscores the importance of place-based approaches to health policy, planning, adaptation, and research related to climate change, particularly in circumpolar regions such as Nunatsiavut where the rate of warming is one of the fastest on the planet.

Kaniuwatewara (when we get sick): understanding health-seeking behaviours among the Shawi of the Peruvian Amazon.

BACKGROUND: Detailed qualitative information regarding Indigenous populations' health-seeking behaviours within Peru's plural healthcare system is lacking. Such context-specific information is prerequisite to developing evidence-based health policies and programs intended to improve health outcomes for Indigenous populations. To this end, this study aimed to characterize health-seeking behaviours, factors affecting health-seeking behaviours, and barriers to obtaining healthcare in two Indigenous Shawi communities in Peru. METHODS: Community-based approaches guided this work, and included 40 semi-structured interviews and a series of informal interviews. Data were analysed thematically, using a constant comparative method; result authenticity and validity were ensured via team debriefing, member checking, and community validation. RESULTS: Shawi health-seeking behaviours were plural, dynamic, and informed by several factors, including illness type, perceived aetiology, perceived severity, and treatment characteristics. Traditional remedies were preferred over professional biomedical healthcare; however, the two systems were viewed as complementary, and professional biomedical healthcare was sought for illnesses for which no traditional remedies existed. Barriers impeding healthcare use included distance to healthcare facilities, costs, language barriers, and cultural insensitivity amongst professional biomedical practitioners. Nevertheless, these barriers were considered within a complex decision-making process, and could be overridden by certain factors including perceived quality or effectiveness of care. CONCLUSIONS: These findings emphasize the importance of acknowledging and considering Indigenous culture and beliefs, as well as the existing traditional medical system, within the professional healthcare system. Cultural competency training and formally integrating traditional healthcare into the official healthcare system are promising strategies to increase healthcare service use, and therefore health outcomes.

"Sewing Is Part of Our Tradition": A Case Study of Sewing as a Strategy for Arts-Based Inquiry in Health Research With Inuit Women.

In this article, we present a case study of sewing as a strategy for arts-based inquiry in health research, situated within a broader project that highlighted Nunavut Inuit women's childbirth experiences. Five focus groups were hosted as sewing sessions with pregnant women (N = 19) in Iqaluit, Nunavut (2017-2018). Women's reflections on the sessions, and the significance of sewing to Inuit, were integrated with researchers' critical reflections to examine the value of sewing as a strategy for arts-based inquiry within a focus group method: results related to the flexibility of the sessions; how collective sewing created space for voicing, sharing, and relating; sewing as a tactile and place-specific practice tied to Inuit knowledge and tradition; and lessons learned. Our results underscore the possibilities of arts-based approaches, such as sewing, to enhance data gathering within a focus group method and to contribute to more locally appropriate, place-based methods for Indigenous health research.

Factors influencing antenatal care attendance for Bakiga and Indigenous Batwa women in Kanungu District, Southwestern Uganda.

INTRODUCTION: The number of maternal deaths remains high in sub-Saharan Africa. Effective antenatal care (ANC) reduces maternal morbidity and mortality; therefore, provision of improved antenatal care services has been prioritised across sub-Saharan Africa. Yet, research is limited on the ANC experiences of Indigenous women in sub-Saharan Africa. This study characterised ANC attendance patterns at a hospital, and characterised factors influencing attendance among Bakiga and Indigenous Batwa women in Kanungu District, Uganda. METHODS: A community-based, mixed-methods approach was used. Quantitative data were collected from a local hospital (records for 2299 ANC visits) and analysed by using descriptive statistics and multivariable regression analysis. Qualitative data from eight key informant interviews (n=9 healthcare providers) and 16 focus group discussions (n=120 Batwa and Bakiga women) were analysed by thematic analysis. RESULTS: Most ANC patients attended between one and three ANC visits per pregnancy (n=1259; 92.57%), and few attended the recommended four or more visits (n=101; 7.43%). Distance from a woman's home to the hospital was significantly associated with lower ANC attendance (p<0.05, 95% confidence interval 0.01-0.96), after adjusting for maternal age and number of previous pregnancies. The qualitative data revealed that many factors influenced ANC attendance for both Batwa and Bakiga: long distances from the home to a health centre, high direct and indirect costs of ANC, lack of power in household decision-making, and poor interactions with healthcare providers. While the types of barriers were similar among Batwa and Bakiga, some were more pronounced for Indigenous Batwa women. CONCLUSION: This study partnered with and collected in-depth data with Indigenous Peoples who remain underrepresented in the literature. The findings indicated that Indigenous Batwa continue to face unique and more pronounced barriers to accessing ANC in Kanungu District, Uganda. Ensuring access to ANC for these populations requires an in-depth understanding of their experiences within the local healthcare context. To reduce health inequities that Indigenous Peoples experience, policy-makers and healthcare workers need to adequately understand, effectively address, and appropriately prioritise factors influencing ANC attendance.

Integrating climate in Ugandan health and subsistence food systems: where diverse knowledges meet.

BACKGROUND: The effects of food insecurity linked to climate change will be exacerbated in subsistence communities that are dependent upon food systems for their livelihoods and sustenance. Place-and community-based forms of surveillance are important for growing an equitable evidence base that integrates climate, food, and health information as well as informs our understanding of how climate change impacts health through local and Indigenous subsistence food systems. METHODS: We present a case-study from southwestern Uganda with Batwa and Bakiga subsistence communities in Kanungu District. We conducted 22 key informant interviews to map what forms of monitoring and knowledge exist about health and subsistence food systems as they relate to seasonal variability. A participatory mapping exercise accompanied key informant interviews to identify who holds knowledge about health and subsistence food systems. Social network theory and analysis methods were used to explore how information flows between knowledge holders as well as the power and agency that is involved in knowledge production and exchange processes. RESULTS: This research maps existing networks of trusted relationships that are already used for integrating diverse knowledges, information, and administrative action. Narratives reveal inventories of ongoing and repeated cycles of observations, interpretations, evaluations, and adjustments that make up existing health and subsistence food monitoring and response. These networks of local health and subsistence food systems were not supported by distinct systems of climate and meteorological information. Our findings demonstrate how integrating surveillance systems is not just about what types of information we monitor, but also who and how knowledges are connected through existing networks of monitoring and response. CONCLUSION: Applying conventional approaches to surveillance, without deliberate consideration of the broader contextual and relational processes, can lead to the re-marginalization of peoples and the reproduction of inequalities in power between groups of people. We anticipate that our findings can be used to inform the initiation of a place-based integrated climate-food-health surveillance system in Kanungu District as well as other contexts with a rich diversity of knowledges and existing forms of monitoring and response.

Acute gastrointestinal illness in an African Indigenous population: the lived experience of Uganda's Batwa.

INTRODUCTION: Indigenous populations in low-income regions are often the most acutely affected by social gradients that impact health, including high burdens of infectious disease. Using a mixed methods approach, this study characterized the lived experience of acute gastrointestinal illness (AGI) in an Indigenous Batwa population in south-western Uganda. METHODS: Quantitative data analyses were conducted on data from three cross-sectional census surveys of Batwa conducted in January 2013 (n=583), January 2014 (n=569) and April 2014 (n=540). Using a 14-day recall period, cases of AGI were defined as three or more loose stools or any vomiting in a 24-hour period. These analyses were supplemented by qualitative data from key informant interviews (n=11 interviews) and Batwa focus group discussions (n=61 participants). RESULTS: From the surveys, episodes of diarrhea and episodes of vomiting lasted on average 3.6 (95%CI 2.3-4.3) and 3.0 (95%CI 2.1-3.9) days, and individuals experienced an average of 4.3 (95%CI 3.9-4.8) and 2.6 (95%CI 2.1-3.1) loose stools and vomiting episodes in 24 hours. Focus group participants and key informants indicated that episodes of AGI for Batwa were not limited to symptom-based consequences for the individual, but also had economic, social and nutritional impacts. CONCLUSION: Despite efforts to increase health literacy in disease transmission dynamics, risks and prevention measures, the perceived barriers and a lack of benefits still largely underscored adopting positive AGI prevention behaviors. This study moved beyond surveillance and provided information on the broader community-level burden of AGI and highlighted the current challenges and opportunities for improved uptake of AGI prevention measures for the Batwa.

Weather, environmental conditions, and waterborne Giardia and Cryptosporidium in Iqaluit, Nunavut.

Indigenous communities in the Arctic often face unique drinking water quality challenges related to inadequate infrastructure and environmental contamination; however, limited research exists on waterborne parasites in these communities. This study examined Giardia and Cryptosporidium in untreated surface water used for drinking in Iqaluit, Canada. Water samples (n = 55) were collected weekly from June to September 2016 and tested for the presence of Giardia and Cryptosporidium using microscopy and polymerase chain reaction (PCR). Exact logistic regressions were used to examine associations between parasite presence and environmental exposure variables. Using microscopy, 20.0% of samples tested positive for Giardia (n = 11) and 1.8% of samples tested positive for Cryptosporidium (n = 1). Low water temperatures (1.1 to 6.7 °C) and low air temperatures (-0.1 to 4.5 °C) were significantly associated with an increased odds of parasite presence (p = 0.047, p = 0.041, respectively). These results suggest that surface water contamination with Giardia and Cryptosporidium may be lower in Iqaluit than in other Canadian regions; however, further research should examine the molecular characterization of waterborne parasites to evaluate the potential human health implications in Northern Canada.

Seasonal variation of food security among the Batwa of Kanungu, Uganda.

OBJECTIVE: Climate change is projected to increase the burden of food insecurity (FI) globally, particularly among populations that depend on subsistence agriculture. The impacts of climate change will have disproportionate effects on populations with higher existing vulnerability. Indigenous people consistently experience higher levels of FI than their non-Indigenous counterparts and are more likely to be dependent upon land-based resources. The present study aimed to understand the sensitivity of the food system of an Indigenous African population, the Batwa of Kanungu District, Uganda, to seasonal variation. DESIGN: A concurrent, mixed methods (quantitative and qualitative) design was used. Six cross-sectional retrospective surveys, conducted between January 2013 and April 2014, provided quantitative data to examine the seasonal variation of self-reported household FI. This was complemented by qualitative data from focus group discussions and semi-structured interviews collected between June and August 2014. SETTING: Ten rural Indigenous communities in Kanungu District, Uganda. SUBJECTS: FI data were collected from 130 Indigenous Batwa Pygmy households. Qualitative methods involved Batwa community members, local key informants, health workers and governmental representatives. RESULTS: The dry season was associated with increased FI among the Batwa in the quantitative surveys and in the qualitative interviews. During the dry season, the majority of Batwa households reported greater difficulty in acquiring sufficient quantities and quality of food. However, the qualitative data indicated that the effect of seasonal variation on FI was modified by employment, wealth and community location. CONCLUSIONS: These findings highlight the role social factors play in mediating seasonal impacts on FI and support calls to treat climate associations with health outcomes as non-stationary and mediated by social sensitivity.

How does the media portray drinking water security in Indigenous communities in Canada? An analysis of Canadian newspaper coverage from 2000-2015.

BACKGROUND: Drinking water insecurity and related health outcomes often disproportionately impact Indigenous communities internationally. Understanding media coverage of these water-related issues can provide insight into the ways in which public perceptions are shaped, with potential implications for decision-making and action. This study aimed to examine the extent, range, and nature of newspaper coverage of drinking water security in Canadian Indigenous communities. METHODS: Using ProQuest database, we systematically searched for and screened newspaper articles published from 2000 to 2015 from Canadian newspapers: Windspeaker, Toronto Star, The Globe and Mail, and National Post. We conducted descriptive quantitative analysis and thematic qualitative analysis on relevant articles to characterize framing and trends in coverage. RESULTS: A total of 1382 articles were returned in the search, of which 256 articles were identified as relevant. There was limited coverage of water challenges for Canadian Indigenous communities, especially for Métis (5%) and Inuit (3%) communities. Most stories focused on government responses to water-related issues, and less often covered preventative measures such as source water protection. Overall, Indigenous peoples were quoted the most often. Double-standards of water quality between Indigenous and non-Indigenous communities, along with conflict and cooperation efforts between stakeholders were emphasized in many articles. CONCLUSION: Limited media coverage could undermine public and stakeholder interest in addressing water-related issues faced by many Canadian Indigenous communities.

Food insecurity and food consumption by season in households with children in an Arctic city: a cross-sectional study.

BACKGROUND: High rates of food insecurity are documented among Inuit households in Canada; however, data on food insecurity prevalence and seasonality for Inuit households with children are lacking, especially in city centres. This project: (1) compared food consumption patterns for households with and without children, (2) compared the prevalence of food insecurity for households with and without children, (3) compared food consumption patterns and food insecurity prevalence between seasons, and (4) identified factors associated with food insecurity in households with children in Iqaluit, Nunavut, Canada. METHODS: Randomly selected households were surveyed in Iqaluit in September 2012 and May 2013. Household food security status was determined using an adapted United States Department of Agriculture Household Food Security Survey Module. Univariable logistic regressions were used to examine unconditional associations between food security status and demographics, socioeconomics, frequency of food consumption, and method of food preparation in households with children by season. RESULTS: Households with children (n = 431) and without children (n = 468) participated in the survey. Food insecurity was identified in 32.9% (95% CI: 28.5-37.4%) of households with children; this was significantly higher than in households without children (23.2%, 95% CI: 19.4-27.1%). The prevalence of household food insecurity did not significantly differ by season. Demographic and socioeconomic characteristics of the person responsible for food preparation, including low formal education attainment (ORSept = 4.3, 95% CI: 2.3-8.0; ORMay = 3.2, 95% CI: 1.8-5.8), unemployment (ORSept = 1.1, 95% CI: 1.1-1.3; ORMay = 1.3, 95% CI: 1.1-1.5), and Inuit identity (ORSept = 8.9, 95% CI: 3.4-23.5; ORMay = 21.8, 95% CI: 6.6-72.4), were associated with increased odds of food insecurity in households with children. Fruit and vegetable consumption (ORSept = 0.4, 95% CI: 0.2-0.8; ORMay = 0.5, 95% CI: 0.2-0.9), as well as eating cooked (ORSept = 0.5, 95% CI: 0.3-1.0; ORMay = 0.5, 95% CI: 0.3-0.9) and raw (ORSept = 1.7, 95% CI: 0.9-3.0; ORMay = 1.8, 95% CI: 1.0-3.1) fish were associated with decreased odds of food insecurity among households with children, while eating frozen meat and/or fish (ORSept = 2.6, 95% CI: 1.4-5.0; ORMay = 2.0, 95% CI: 1.1-3.7) was associated with increased odds of food insecurity. CONCLUSIONS: Food insecurity is high among households with children in Iqaluit. Despite the partial subsistence livelihoods of many Inuit in the city, we found no seasonal differences in food security and food consumption for households with children. Interventions aiming to decrease food insecurity in these households should consider food consumption habits, and the reported demographic and socioeconomic determinants of food insecurity.

Plasmodium falciparum malaria parasitaemia among indigenous Batwa and non-indigenous communities of Kanungu district, Uganda.

BACKGROUND: The indigenous Batwa of southwestern Uganda are among the most highly impoverished populations in Uganda, yet there is negligible research on the prevalence of malaria in this population. Plasmodium falciparum malaria parasitaemia prevalence was estimated in an indigenous Batwa and a non-indigenous neighbouring population, and an exploration of modifiable risk factors was carried out to identify potential entry points for intervention. Additionally, evidence of zooprophylaxis was assessed, hypothesizing that livestock ownership may play a role in malaria risk. METHODS: Two cross-sectional surveys of Batwa and non-Batwa communities were carried out in Kanungu District, Uganda in July 2013 and April 2014 based on a census of adult Batwa and a two-stage systematic random sample of adult non-Batwa in ten Local Councils where Batwa settlements are located. A community-based questionnaire and antigen rapid diagnostic test for P. falciparum were carried out in the cross-sectional health surveys. A multivariable logistic regression model was built to identify risk factors associated with positive malaria diagnostic test. A subset analysis of livestock owners tested for zooprophylaxis. RESULTS: Batwa experienced higher prevalence of malaria parasitaemia than non-Batwa (9.35 versus 4.45 %, respectively) with over twice the odds of infection (OR 2.21, 95 % CI 1.23-3.98). Extreme poverty (OR 1.96, 95 % CI 0.98-3.94) and having an iron sheet roof (OR 2.54, 95 % CI 0.96-6.72) increased the odds of infection in both Batwa and non-Batwa. Controlling for ethnicity, wealth, and bed net ownership, keeping animals inside the home at night decreased the odds of parasitaemia among livestock owners (OR 0.29, 95 % CI 0.09-0.94). CONCLUSION: A health disparity exists between indigenous Batwa and non-indigenous community members with Batwa having higher prevalence of malaria relative to non-Batwa. Poverty was associated with increased odds of malaria infection for both groups. Findings suggest that open eaves and gaps in housing materials associated with iron sheet roofing represent a modifiable risk factor for malaria, and may facilitate mosquito house entry; larger sample sizes will be required to confirm this finding. Evidence for possible zooprophylaxis was observed among livestock owners in this population for those who sheltered animals inside the home at night.

Climate-sensitive health priorities in Nunatsiavut, Canada.

BACKGROUND: This exploratory study used participatory methods to identify, characterize, and rank climate-sensitive health priorities in Nunatsiavut, Labrador, Canada. METHODS: A mixed method study design was used and involved collecting both qualitative and quantitative data at regional, community, and individual levels. In-depth interviews with regional health representatives were conducted throughout Nunatsiavut (n = 11). In addition, three PhotoVoice workshops were held with Rigolet community members (n = 11), where participants took photos of areas, items, or concepts that expressed how climate change is impacting their health. The workshop groups shared their photographs, discussed the stories and messages behind them, and then grouped photos into re-occurring themes. Two community surveys were administered in Rigolet to capture data on observed climatic and environmental changes in the area, and perceived impacts on health, wellbeing, and lifestyles (n = 187). RESULTS: Climate-sensitive health pathways were described in terms of inter-relationships between environmental and social determinants of Inuit health. The climate-sensitive health priorities for the region included food security, water security, mental health and wellbeing, new hazards and safety concerns, and health services and delivery. CONCLUSIONS: The results highlight several climate-sensitive health priorities that are specific to the Nunatsiavut region, and suggest approaching health research and adaptation planning from an EcoHealth perspective.

Place, displacement, and health-seeking behaviour among the Ugandan Batwa: A qualitative study.

For many Indigenous Peoples, relationships to the land are inherent in identity and culture, and to all facets of health and wellbeing, physically, emotionally, psychologically, and spiritually. The Batwa are Indigenous Peoples of rural, southwest Uganda who have experienced tremendous social and economic upheaval, due to relatively recent forced displacement and land dispossession. This loss of physical connection to their ancestral lands has significantly impacted Batwa health, and also affected available healthcare options for Batwa. This exploratory study (1) identified and characterized factors that influence Batwa health-seeking behaviour, using acute gastrointestinal illness, a critical public health issue, as a focal point for analysis; and (2) explored possible intersections between the Batwa's connection to place-and displacement-and their health-seeking behaviour for acute gastrointestinal illness. Twenty focus group discussions, stratified by gender, were conducted in ten Batwa settlements in Kanungu District, Uganda and eleven semi-structured interviews were conducted with primary healthcare workers, community health coordinators, clinical officers, and development program coordinators. Qualitative data were thematically analyzed using a constant comparative method. Batwa identified several significant motivators to engage with Indigenous and/or biomedical forms of healthcare, including transition to life outside the forest and their reflections on health in the forest; 'intellectual access' to care and generational knowledge-sharing on the use of Indigenous medicines; and Batwa identity and way of life. These nuanced explanations for health-seeking behaviour underscore the significance of place-and displacement-to Batwa health and wellbeing, and its relationship to their health-seeking behaviour for acute gastrointestinal illness. As such, the results of this study can be used to inform healthcare practice and policy and support the development of a culturally- and contextually-appropriate healthcare system, as well as to reduce the burden of acute gastrointestinal illness among Batwa.

Estimating climate change and mental health impacts in Canada: A cross-sectional survey protocol.

Climate change has severe and sweeping impacts on mental health. Although research is burgeoning on mental health impacts following climate and weather extremes, less is known about how common these impacts are outside of extreme events. Existing research exploring the prevalence of psychosocial responses to climate change primarily examines university students and uses non-random sampling methods. Herein, our protocol outlines an approach to data collection, processing, and analysis to estimate the population prevalence, magnitude, and distribution of mental health responses to climate change in Canada. A cross-sectional survey of youth and adults aged 13 years and older in Canada will be administered over the course of one year. The questionnaire will take approximately 10 minutes to complete orally and will be administered in English, French, and Inuktitut. The survey will consist of six sections: (1) self-reported past experiences of climate change; (2) self-reported climate-related emotions; (3) self-reported past and current impacts, anticipatory impacts, and vicarious experiences; (4) self-reported subclinical outcomes; (5) self-reported behavioural responses; and (6) demographics. A multi-stage, multi-stratified random probability sampling method will be used to obtain a sample representative of the Canadian population. We will use two different modes of recruitment: an addressed letter sent by postal mail or a telephone call (landlines and cellular). Population-weighted descriptive statistics, principal component analysis, and weighted multivariable regression will be used to analyse the data. The results of this survey will provide the first national prevalence estimates of subclinical mental health responses to climate change outcomes of people living in Canada.