Waning protection after vaccination and prior infection against COVID-19-related mortality over 18 months.

OBJECTIVES: Evidence on waning patterns in protection from vaccine-induced, infection-induced, and hybrid immunity against death is scarce. The aim of this study is to assess the temporal trends in protection against mortality. METHODS: Population-based case-control study nested in the total population of Scania Region, Sweden using individual-level registry data of COVID-19-related deaths (<30 days after positive SARS-CoV-2 test) between 27 December 2020 and 3 June 2022. Controls were matched for age, sex, and index date. Conditional logistic regression was used to estimate the preventable fraction (PF) from vaccination (PFvac corresponding to vaccine effectiveness; ≥2 vaccine doses vs. 0 doses), prior infection (PFinf), and hybrid immunity (PFhybrid). PF was calculated as one minus odds ratio. Models were adjusted for comorbidities, long-term care facility residence, prior infection (for PFvac), country of birth, socio-economic conditions, and time since last vaccination (for PFinf). RESULTS: In total, 14 936 individuals (1440 COVID-19-related deaths and 13 496 controls) were included in the case-control analyses (45% females, median age: 84 years). PFvac was above 90% during the first month after vaccination, regardless of the number of vaccine doses. After 6 months, PFvac of two doses waned to 34% (95% CI: -30% to 66%). PFinf for people surviving a SARS-CoV-2 infection waned from 88% (-16% to 99%) 3 months after infection to 62% (34-79%) after 9 months. No differences in waning patterns in PFvac were seen between virus variants, gender, and age. DISCUSSION: Given the waning of protection against death, continuous surveillance of population immunity status, particularly among the most vulnerable population groups, could help to further fine-tune vaccination recommendations.

Industrial mining and HIV risk: evidence from 39 mine openings across 16 countries in sub-Saharan Africa.

OBJECTIVES: The aim of this study was to assess the impact of natural resource extraction projects on HIV transmission risks in local communities in sub-Saharan Africa. DESIGN: Difference-in-differences design using repeated cross-sectional data from around newly opened mines. METHODS: We combined data on mine openings with HIV data from the Demographic and Health Surveys (DHS). Using logistic regression models, we compared HIV-related indicators between mining (i.e. up to 10 km distance from the mine) and comparison (i.e. 10-50 km) areas before and after mine opening to identify their impact on HIV prevalence, sexual behavior and HIV knowledge. RESULTS: A total of 33 086 individuals across 39 mine openings were analyzed. Adjusting for baseline differences and temporal trends in the study regions, mine opening increased the odds of HIV infection almost two-fold [odds ratio (OR): 1.93, 95% confidence interval (CI): 1.19-3.14]. Strongest effects were seen in high-prevalence countries and in the 20-29 years age group. In mining communities around operational mines, there was a tendency towards lower HIV knowledge (OR: 0.81, 95% CI: 0.63-1.04). New mine openings increased the odds of risky sexual behaviors, such as having multiple sex partners (OR: 1.61, 95% CI: 1.02-2.55), high-risk sexual partners (OR: 1.45, 95% CI: 1.03-2.05) and unprotected sex with high-risk partners (OR: 1.77, 95% CI: 1.18-2.67). CONCLUSION: The findings suggest that in our sample of households surrounding industrial mines, HIV infection risks substantially increase upon mine opening. Existing strategies for addressing mining-related risks for HIV transmission seem to be insufficient. Further efforts for mitigating and monitoring impacts of mines are needed.

Assessing the effects of mining projects on child health in sub-Saharan Africa: a multi-country analysis.

BACKGROUND: The African continent hosts many industrial mining projects, and many more are planned due to recent prospecting discoveries and increasing demand for various minerals to promote a low-carbon future. The extraction of natural resources in sub-Saharan Africa (SSA) represents an opportunity for economic development but also poses a threat to population health through rapid urbanisation and environmental degradation. Children could benefit from improved economic growth through various channels such as access to high-quality food, better sanitation, and clean water. However, mining can increase food insecurity and trigger local competition over safe drinking water. Child health can be threatened by exposure to mining-related air, noise, and water pollution. To assess the impact of mines on child health, we analyse socio-demographic, health, and mining data before and after several mining projects were commissioned in SSA. RESULTS: Data of 90,951 children living around 81 mining sites in 23 countries in SSA were analysed for child mortality indicators, and 79,962 children from 59 mining areas in 18 SSA countries were analysed for diarrhoea, cough, and anthropometric indicators. No effects of the launch of new mining projects on overall under-five mortality were found (adjusted Odds Ratio (aOR): 0.88; 95% Confidence Interval (CI): 0.68-1.14). However, activation of mining projects reduced the mortality risk among neonates (0-30 days) by 45% (aOR: 0.55; 95% CI: 0.37-0.83) and risk for a child to develop diarrhoeal diseases by 32% (aOR: 0.68; 95% CI: 0,51-0.90). The timing analysis of observed changes showed that there is a significant decline in the risk for childhood diarrhoea (aOR: 0.69; 95% CI: 0.49-0.97), and the mean height-for-age z-scores by 28 percentage points, during the prospection and construction phase; i.e., within four years to the initiation of extraction activity. No effects were found for cough and weight-for-height. CONCLUSION: The results presented suggest that the impacts of mining on child health vary throughout the mine's life cycle. Mining development likely contributes positively to the income and livelihoods of the impacted communities in the initial years of mining operations, particularly the prospection and construction phase; these potential benefits are likely to be at least partially offset by food insecurity and environmental pollution during early and later mining stages, respectively. Further research is warranted to better understand these health impacts and to identify policies that can help sustain the positive initial health impacts of mining projects in the long term.

The Swiss Tropical and Public Health Institute: Past, present and future.

Compared internationally, the history of the Swiss Tropical and Public Health Institute (Swiss TPH) is unusual. Founded in 1944, at a time of utmost isolation, it was a response to specific needs of the government of Switzerland during the Second World War. In 1943, the Swiss Federal Council approached universities in Switzerland and asked them to submit project proposal that had the potential to mitigate possible post-war unemployment and threatening economic isolation. Members of the University of Basel proposed to establish a Swiss Tropical Institute (today: Swiss TPH). With its harbour at the River Rhine, Basel was an important international transport hub. The city was and still is the headquarters of important pharmaceutical companies, such as Novartis Pharma AG and F. Hoffmann-La Roche AG, which were looking for new markets overseas. Last but not least, scientific expeditions to Africa were rather common in the 19th and the beginning of the 20th century for members of Basel's bourgeoisie. Initially, Swiss TPH focused primarily on basic research into diseases of poverty, but over the years it has developed into an important player in public, international and global health. This article sees the development of the institute as a reflection of the visions of its directors from the founder Professor Rudolf Geigy to Professor Jürg Utzinger, who is the current Swiss TPH director. It includes interviews with the four latest of them, discussing their experiences and attempts to adapt the institute to an ever changing global environment. From these lessons learnt we hope to gain insights that could be relevant for today's leaders of scientific institutes; foster public-private partnerships and contribute to solve some of the most pressing global health challenges.

Impact of mining projects on water and sanitation infrastructures and associated child health outcomes: a multi-country analysis of Demographic and Health Surveys (DHS) in sub-Saharan Africa.

BACKGROUND: Access to improved water and sanitation infrastructures are key determinants of health. The sub-Saharan African region in particular is lagging behind the ambitious goal of the 2030 Agenda for Sustainable Development to ensure universal access to improved and reliable water and sanitation for all (Sustainable Development Goal (SDG) 6). Large mining projects can promote economic growth and hence investments in water and sanitation infrastructures, but at the same time lead to rapid population growth and environmental degradation. In turn, these changes can pose risks and opportunities for child health (SDG 3). In this study we aim to quantify the impacts of mining projects on access to water and sanitation infrastructure as well as diarrhea and malnutrition among children using data from 131 Demographic and Health Surveys from sub-Saharan Africa. RESULTS: From a sample of around 1.2 million households, data within the proximity of 52 mine-panels were selected for longitudinal analyses, resulting in 41,896 households and 32,112 children. Improvements in access to modern water and sanitation infrastructures after mine opening were much larger in households near mining sites than in comparison areas located further away (adjusted relative risk ratio (aRRR) water: 18.60, 95 % confidence interval (CI): 13.08-26.46 and aRRR sanitation: 2.56, 95 % CI: 1.32-4.99). However, these associations were weaker among poorer households. In areas close to the mining sites, stunting and underweight prevalence decreased more strongly upon mine opening (adjusted odds ratio (aOR) stunting: 0.62, 95 % CI: 0.43-0.90; aOR underweight: 0.55, 95 % CI: 0.36-0.84). No differential changes were seen for wasting and diarrhea. Large impact heterogeneity was observed both within and across countries. CONCLUSIONS: Our results suggest that the opening of mines is associated with improvements in access to modern water and sanitation infrastructures (SDG 6) as well as in some health outcomes (SDG 3). However, the large impact heterogeneity suggests that the assessment and management of mining-related impacts on communities should have an increased equity-focus, in order to "leave no one behind" in the work towards the 2030 Agenda for Sustainable Development. Overall, the findings of this study underscore that the resource extraction sector has the potential to make positive and substantial contributions towards achieving the SDGs.

Water and health in mining settings in sub-Saharan Africa: A mixed methods geospatial visualization.

Industrial mining transforms local landscapes, including important health determinants like clean water and sanitation. In this paper, we combined macro-level quantitative and micro-level qualitative data to show how mining projects affect water infrastructures and ultimately the health of affected communities. Although we observed a positive trend of water infrastructure in mining settings, surrounding communities are also characterized by water scarcity and degradation of water quality. The video at the core of this publication showcases inter-linkages of the findings obtained at both the macro- and the micro-levels, embedding our results in a geospatial context. While mining projects can have positive impacts on the development of local water infrastructure, improved management of negative impacts of mining projects is needed for promoting 'Good health and well-being' and 'Clean water and sanitation' as promulgated by the Sustainable Development Goals of the 2030 Agenda.

Estimating the mortality burden of large scale mining projects-Evidence from a prospective mortality surveillance study in Tanzania.

We set up a mortality surveillance system around two of the largest gold mines in Tanzania between February 2019 and February 2020 to estimate the mortality impact of gold mines. Death circumstances were collected using a standardized verbal autopsy tool, and causes of death were assigned using the InSilicoVA algorithm. We compared cause-specific mortality fractions in mining communities with other subnational data as well as national estimates. Within mining communities, we estimated mortality risks of mining workers relative to other not working at mines. At the population level, mining communities had higher road-traffic injuries (RTI) (risk difference (RD): 3.1%, Confidence Interval (CI): 0.4%, 5.9%) and non-HIV infectious disease mortality (RD: 5.6%, CI: 0.8%, 10.3%), but lower burden of HIV mortality (RD: -5.9%, CI: -10.2%, -1.6%). Relative to non-miners living in the same communities, mining workers had over twice the mortality risk (relative risk (RR): 2.09, CI: 1.57, 2.79), with particularly large increases for death due to RTIs (RR: 14.26, CI: 4.95, 41.10) and other injuries (RR:10.10, CI: 3.40, 30.02). Our results shows that gold mines continue to be associated with a large mortality burden despite major efforts to ensure the safety in mining communities. Given that most of the additional mortality risk appears to be related to injuries programs targeting these specific risks seem most desirable.

Inclusion of Health in Impact Assessment: A Review of Current Practice in Sub-Saharan Africa.

Natural resource extraction projects, including those in the mining sector, have various effects on human health and wellbeing, with communities in resource-rich areas in sub-Saharan Africa (SSA) being particularly vulnerable. While impact assessments (IA) can predict and mitigate negative effects, it is unclear whether and to what extent health aspects are included in current IA practice in SSA. For collecting IA reports, we contacted 569 mining projects and 35 ministries regulating the mining sector. The reports obtained were complemented by reports identified in prior research. The examination of the final sample of 44 IA reports revealed a heavy focus on environmental health determinants and included health outcomes were often limited to a few aspects, such as HIV, malaria and injuries. The miniscule yield of reports (1.6% of contacted projects) and the low response rate by the contacted mining companies (18%) might indicate a lack of transparency in the IA process of the mining sector in SSA. To address the shortcomings identified, policies regulating IA practice should strengthen the requirements for public disclosure of IA reports and promote a more comprehensive inclusion of health in IA, be it through stand-alone health impact assessment or more rigorous integration of health in other forms of IA.

Investigating Health Impacts of Natural Resource Extraction Projects in Burkina Faso, Ghana, Mozambique, and Tanzania: Protocol for a Mixed Methods Study.

BACKGROUND: Natural resource extraction projects offer both opportunities and risks for sustainable development and health in host communities. Often, however, the health of the community suffers. Health impact assessment (HIA) can mitigate the risks and promote the benefits of development but is not routinely done in the developing regions that could benefit the most. OBJECTIVE: Our study aims to investigate health and health determinants in regions affected by extractive industries in Burkina Faso, Ghana, Mozambique, and Tanzania. The evidence generated in our study will inform a policy dialogue on how HIA can be promoted as a regulatory approach as part of the larger research initiative called the HIA4SD (Health impact assessment for sustainable development) project. METHODS: The study is a concurrent triangulation, mixed methods, multi-stage, multi-focus project that specifically addresses the topics of governance and policy, social determinants of health, health economics, health systems, maternal and child health, morbidity and mortality, and environmental determinants, as well as the associated health outcomes in natural resource extraction project settings across four countries. To investigate each of these health topics, the project will (1) use existing population-level databases to quantify incidence of disease and other health outcomes and determinants over time using time series analysis; (2) conduct two quantitative surveys on mortality and cost of disease in producer regions; and (3) collect primary qualitative data using focus groups and key informant interviews describing community perceptions of the impacts of extraction projects on health and partnership arrangements between the projects and local and national governance. Differences in health outcomes and health determinants between districts with and without an extraction project will be analyzed using matched geographical analyses in quasi-Poisson regression models and binomial regression models. Costs to the health system and to the households from diseases found to be associated with projects in each country will be estimated retrospectively. RESULTS: Fieldwork for the study began in February 2019 and concluded in February 2020. At the time of submission, qualitative data collection had been completed in all four study countries. In Burkina Faso, 36 focus group discussions and 74 key informant interviews were conducted in three sites. In Ghana, 34 focus group discussions and 64 key informant interviews were conducted in three sites. In Mozambique, 75 focus group discussions and 103 key informant interviews were conducted in four sites. In Tanzania, 36 focus group discussions and 84 key informant interviews were conducted in three sites. Quantitative data extraction and collection is ongoing in all four study countries. Ethical approval for the study was received in all four study countries prior to beginning the fieldwork. Data analyses are underway and results are expected to be published in 2020 and 2021. CONCLUSIONS: Disentangling the complex interactions of resource extraction projects with their host communities requires an integrative approach drawing on many methodologies under the HIA umbrella. By using complementary data sources to address the question of population health in project areas from several angles, bias and missing data will be reduced, generating high-quality evidence to aid countries in moving toward sustainable development. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/17138.

Daily variation of heavy metal contamination and its potential sources along the major urban wastewater channel in Kampala, Uganda.

Heavy metal pollution from untreated industrial wastewater has become a major concern to the environment and public health in many rapidly growing cities in low-income countries. Previous studies on heavy metals of urban wastewater systems have focused on long-term (weekly or seasonal) variations, while only few studies investigated short-term (daily) variation to capture potential bulk discharges. To monitor and enforce wastewater discharge regulations and reduce industrial pollution, a better understanding of the short-term variation of these pollutants and industrial discharge practices is needed. The aim of this study is to assess the daily variation of heavy metals and physicochemical parameters along the major urban wastewater system in Kampala, Uganda. Over 1 week, daily water samples were collected at 16 locations and analyzed for lead (Pb), mercury (Hg), copper (Cu), and chromium (Cr) and a range of physicochemical parameters. Additionally, 25 key informant interviews with industries were administered to investigate their potential to contaminate the environment. Among 78 water samples, 29 exceeded the national standards for Pb (> 0.1 mg/L) and one for Hg (> 0.01 mg/L). High daily variation and peak concentrations were detected which are likely due to industries retaining their effluents and discharging them irregularly. Although 24 industries used heavy metals in their manufacturing processes and are likely to discharge heavy metals, only ten industries had a wastewater treatment system in place. Our results show that repeated measurements of heavy metals over short time intervals are needed to capture their high daily variation in an urban wastewater system. Furthermore, there is an urgent need to register industries and to assess their effluent composition in order to select appropriate wastewater management measures.