Psychosocial and obstetric determinants of women signalling distress during Edinburgh Postnatal Depression Scale (EPDS) screening in Sydney, Australia.

BACKGROUND AND OBJECTIVES: The perinatal period presents a high-risk time for development of mood disorders. Australia-wide universal perinatal care, including depression screening, make this stage amenable to population-level preventative approaches. In a large cohort of women receiving public perinatal care in Sydney, Australia, we examined: (1) the psychosocial and obstetric determinants of women who signal distress on EPDS screening (scoring 10-12) compared with women with probable depression (scoring 13 or more on EPDS screening); and (2) the predictive ability of identifying women experiencing distress during pregnancy in classifying women at higher risk of probable postnatal depression. METHODS: We analysed routinely collected perinatal data from all live-births within public health facilities from two health districts in Sydney, Australia (N = 53,032). Perinatal distress was measured using the EPDS (scores of 10-12) and probable perinatal depression was measured using the EPDS (scores of 13 or more). Logistic regression models that adjusted for confounding variables were used to investigate a range of psychosocial and obstetric determinants and perinatal distress and depression. RESULTS: Eight percent of this cohort experienced antenatal distress and about 5 % experienced postnatal distress. Approximately 6 % experienced probable antenatal depression and 3 % experienced probable postnatal depression. Being from a culturally and linguistically diverse background (AOR = 2.0, 95% CI 1.8-2.3, P < 0.001), a lack of partner support (AOR = 2.9, 95% CI 2.3-3.7) and a maternal history of childhood abuse (AOR = 1.9, 95% CI 1.6-2.3) were associated with antenatal distress. These associations were similar in women with probable antenatal depression. Women who scored 10 to12 on antenatal EPDS assessment had a 4.5 times higher odds (95% CI 3.4-5.9, P < 0.001) of experiencing probable postnatal depression compared with women scoring 9 or less. CONCLUSION: Antenatal distress is more common than antenatal depressive symptoms and postnatal distress or depression. Antenatal maternal distress was associated with probable postnatal depression. Scale properties of the EPDS allows risk-stratification of women in the antenatal period, and earlier intervention with preventively focused programs. Prevention of postnatal depression could address a growing burden of illness and long-term complications for mothers and their infants.

Potential Impacts of Modifiable Behavioral and Environmental Exposures on Reducing Burden of Under-five Mortality Associated with Household Air Pollution in Nepal.

Objectives Household air pollution (HAP) is one of the leading causes of respiratory illness and deaths among young children in low and lower-middle income countries. This study examines for the first time trends in the association between HAP from cooking fuel and under-five mortality and measures the potential impact of interventions to reduce HAP using Nepal Demographic and Health Survey datasets (2001-2011). Methods A total of 17,780 living children across four age-groups (neonatal 0-28 days, post-neonatal 1-11 months, child 12-59 months and under-five 0-59 months) were included and multi-level logistic regression models were used for analyses. Population attributable fractions of key risk factors and potential impact fractions assessing the impact of previous interventions to reduce exposure prevalence were also calculated. Results Use of cooking fuel was associated with total under-five mortality (OR 2.19, 95% CI 1.37-3.51, P = 0.001) in Nepal, with stronger associations evident for sub-group analyses of neonatal mortality (OR 2.67, 95% CI 1.47-4.82, P = 0.001). Higher association was found in rural areas and for households without a separate kitchen using polluting fuel for cooking, and in women who had never breastfed for all age-groups of children. PIF estimates, assuming a 63% of reduction of HAP based on previously published interventions in Nepal, suggested that a burden of 40% of neonatal and 33% of under-five mortality cases associated with an indoor kitchen using polluting fuel could be avoidable. Conclusion Improved infrastructure and behavioral interventions could help reduce the pollution from cooking fuel in the household resulting in further reduction in under-five mortality in Nepal.

Household air pollution and under-five mortality in India (1992-2006).

BACKGROUND: Household air pollution (HAP) - predominantly from cooking fuel is a major public health hazard and one of the leading causes of respiratory illness and deaths among children under-five years in India. This study investigates the association between HAP from cooking fuel and under-five mortality using India's National Family and Health Survey (NFHS) datasets over the period 1992-2006 (total of 166,382 children), and the extent to which the association differed by environmental and behavioral factors affecting level of exposure. METHODS: The association between HAP and under-five mortality of three age-groups (neonatal age between 0-28 days, post-neonatal age between 1-11 months and children aged between 12-59 months) was examined using multi-level logistic regression models. RESULTS: HAP was associated with mortality among children aged under-five (OR = 1.30, 95%CI = 1.18-1.43, P < 0.001) and was more strongly associated in sub-group analyses of post-neonatal mortality (OR = 1.42, 95%CI = 1.19-1.71, P < 0.001) and child mortality (OR = 1.42, 95%CI = 1.05-1.91, P = 0.021) than neonatal mortality (OR = 1.23, 95%CI = 1.09-1.39, P = 0.001). The association was stronger for households in rural areas and for households without a separate kitchen using polluting fuel, and in women who had never breastfed for all age-groups. CONCLUSION: Use of cooking fuel in the household is associated with increased risk of mortality in children aged under-five years. Factors relating to access to clean fuels, improvements in infrastructure and household design and behavioral factors are discussed, and can result in further declines in under-five mortality in India.

Factors affecting the soil arsenic bioavailability, accumulation in rice and risk to human health: a review.

Arsenic (As), a class one carcinogen, reflects a disastrous environmental threat due to its presence in each and every compartment of the environment. The high toxicity of As is notably present in its inorganic forms. Irrigation with As contaminated groundwater in rice fields increases As concentration in topsoil and its bioavailability for rice crops. However, most of the As in paddy field topsoils is present as As(III) form, which is predominant in rice grain. According to the OECD-FAO, rice is the second most extensively cultivated cereal throughout the world. This cereal is a staple food for a large number of populations in most of the developing countries in sub-Saharan Africa, Latin America, South and South-east Asia. Rice consumption is one of the major causes of chronic As diseases including cancer for Asian populations. Thus, this review provides an overview concerning the conditions involved in soil that leads to As entrance into rice crops, phytotoxicity and metabolism of As in rice plants. Moreover, the investigations of the As uptake in raw rice grain are compiled, and the As biotransfer into the human diet is focused. The As uptake by rice crop represents an important pathway of As exposure in countries with high rice and rice-based food consumption because of its high (more than the hygienic level) As levels found in edible plant part for livestock and humans.

Biohydrogen production from Euglena acus microalgae available in Bangladesh.

Hydrogen is generally considered as an ideal non-polluting future energy carrier because it releases energy and water as a byproduct on combustion. Besides, hydrogen possesses the highest energy density on mass basis compared to any other fuel. However, hydrogen production in a sustainable and environmentally friendly way still remains a challenge. Recently, biohydrogen production from green microalgae has gained significant attention due to availability of the feedstock, which are environmentally friendly and renewable. Biohydrogen production from photosynthetic microalgae is attractive, however in the current context, it has a low yield, and an optimization of the affecting parameters including algae concentration, light intensity, culture medium, etc. is critical. In this study, biohydrogen was produced in laboratory from Euglena acus microalgae as it was locally available in Bangladesh.•The effect of two different culture mediums (i.e. sulfur-rich and sulfur-deprived TAP mediums) for microalgae cultivation and biohydrogen yield were studied.•Depending on the concentration of microalgae (50% and 75% by weight) in the medium solution ∼3 ml to 5 ml biohydrogen was obtained.

Perinatal Distress and Depression in Culturally and Linguistically Diverse (CALD) Australian Women: The Role of Psychosocial and Obstetric Factors.

Perinatal distress and depression can have significant impacts on both the mother and baby. The present study investigated psychosocial and obstetric factors associated with perinatal distress and depressive symptoms among culturally and linguistically diverse (CALD) Australian women in Sydney, New South Wales. The study used retrospectively linked maternal and child health data from two Local Health Districts in Australia (N = 25,407). Perinatal distress was measured using the Edinburgh Postnatal Depression Scale (EPDS, scores of 10-12) and depressive symptoms, with EPDS scores of 13 or more. Multivariate multinomial logistic regression models were used to investigate the association between psychosocial and obstetric factors with perinatal distress and depressive symptoms. The prevalence of perinatal distress and depressive symptoms among CALD Australian women was 10.1% for antenatal distress; 7.3% for antenatal depressive symptoms; 6.2% for postnatal distress and 3.7% for postnatal depressive symptoms. Antenatal distress and depressive symptoms were associated with a lack of partner support, intimate partner violence, maternal history of childhood abuse and being known to child protection services. Antenatal distress and depressive symptoms were strongly associated with postnatal distress and depressive symptoms. Higher socioeconomic status had a protective effect on antenatal and postnatal depressive symptoms. Our study suggests that current perinatal mental health screening and referral for clinical assessment is essential, and also supports a re-examination of perinatal mental health policy to ensure access to culturally responsive mental health care that meets patients' needs.

Determinants of Exclusive Breastfeeding Cessation in the Early Postnatal Period among Culturally and Linguistically Diverse (CALD) Australian Mothers.

There are limited epidemiological data on exclusive breastfeeding (EBF) among culturally and linguistically diverse (CALD) Australian mothers to advocate for targeted and/or culturally-appropriate interventions. This study investigated the determinants of EBF cessation in the early postnatal period among CALD Australian mothers in Sydney, Australia. The study used linked maternal and child health data from two local health districts in Australia (N = 25,407). Prevalence of maternal breastfeeding intention, skin-to-skin contact, EBF at birth, discharge, and the early postnatal period (1-4 weeks postnatal), were estimated. Multivariate logistic regression models were used to investigate determinants of EBF cessation in the early postnatal period. Most CALD Australian mothers had the intention to breastfeed (94.7%). Skin-to-skin contact (81.0%), EBF at delivery (91.0%), and at discharge (93.0%) were high. EBF remained high in the early postnatal period (91.4%). A lack of prenatal breastfeeding intention was the strongest determinant of EBF cessation (adjusted odds ratio [aOR] = 23.76, 95% CI: 18.63-30.30, for mothers with no prenatal breastfeeding intention and aOR = 6.15, 95% CI: 4.74-7.98, for those undecided). Other significant determinants of EBF cessation included a lack of partner support, antenatal and postnatal depression, intimate partner violence, low socioeconomic status, caesarean birth, and young maternal age (<20 years). Efforts to improve breastfeeding among women of CALD backgrounds in Australia should focus on women with vulnerabilities to maximise the benefits of EBF.

Attributable risk and potential impact of interventions to reduce household air pollution associated with under-five mortality in South Asia.

BACKGROUND: Solid fuel use is the major source of household air pollution (HAP) and accounts for a substantial burden of morbidity and mortality in low and middle income countries. To evaluate and compare childhood mortality attributable to HAP in four South Asian countries. METHODS: A series of Demographic and Health Survey (DHS) datasets for Bangladesh, India, Nepal and Pakistan were used for analysis. Estimates of relative risk and exposure prevalence relating to use of cooking fuel and under-five mortality were used to calculate population attributable fractions (PAFs) for each country. Potential impact fractions (PIFs) were also calculated assessing theoretical scenarios based on published interventions aiming to reduce exposure prevalence. RESULTS: There are an increased risk of under-five mortality in those exposed to cooking fuel compared to those not exposed in the four South Asian countries (OR = 1.30, 95% CI = 1.07-1.57, P = 0.007). Combined PAF estimates for South Asia found that 66% (95% CI: 43.1-81.5%) of the 13,290 estimated cases of under-five mortality was attributable to HAP. Joint PIF estimates (assuming achievable reductions in HAP reported in intervention studies conducted in South Asia) indicates 47% of neonatal and 43% of under-five mortality cases associated with HAP could be avoidable in the four South Asian countries studied. CONCLUSIONS: Elimination of exposure to use of cooking fuel in the household targeting valuable intervention strategies (such as cooking in separate kitchen, improved cook stoves) could reduce substantially under-five mortality in South Asian countries.

The association between infant and young child feeding practices and diarrhoea in Tanzanian children.

BACKGROUND: Diarrhoea is a leading cause of child mortality in Tanzania. The association between optimal infant feeding practices and diarrhoea has been reported elsewhere, but the evidence has been limited to promote and advocate for strategic interventions in Tanzania. This study examined the association between infant and young child feeding (IYCF) practices and diarrhoea in Tanzanian children under 24 months. METHODS: The study used the Tanzania Demographic and Health Survey data to estimate the prevalence of diarrhoea stratified by IYCF practices. Using multivariable logistic regression modelling that adjusted for confounding factors and cluster variability, the association between IYCF practices and diarrhoea among Tanzanian children was investigated. RESULTS: Diarrhoea prevalence was lower in infants aged 0-5 months whose mothers engaged in exclusive breastfeeding (EBF) and predominant breastfeeding (PBF) compared to those who were not exclusively and predominantly breastfed. Infants aged 6-8 months who were introduced to complementary foods had a higher prevalence of diarrhoea compared to those who received no complementary foods, that is, infants who were exclusively breastfed at 6-8 months. Infants who were exclusively and predominantly breastfed were less likely to experience diarrhoea compared to those who were not exclusively and predominantly breastfed [adjusted odds ratio (AOR) 0.31, 95% confidence interval (CI) 0.16-0.59, P < 0.001 for EBF and AOR = 0.30, 95% CI 0.10-0.89, P = 0.031 for PBF]. In contrast, infants aged 6-8 months who were introduced to complementary foods were more likely to experience diarrhoea compared to those who received no complementary foods (AOR = 2.91, 95% CI 1.99-4.27, P < 0.001). CONCLUSIONS: The study suggests that EBF and PBF were protective against diarrhoeal illness in Tanzanian children, while the introduction of complementary foods was associated with the onset of diarrhoea. Strengthening IYCF (facility- and community-based) programmes would help to improve feeding behaviours of Tanzanian women and reduce diarrhoea burden in children under 2 years.

Household air pollution from use of cooking fuel and under-five mortality: The role of breastfeeding status and kitchen location in Pakistan.

Household air pollution (HAP) mainly from cooking fuel is one of the major causes of respiratory illness and deaths among young children in low and middle-income countries like Pakistan. This study investigates for the first time the association between HAP from cooking fuel and under-five mortality using the 2013 Pakistan Demographic and Health Survey (PDHS) data. Multi-level logistic regression models were used to examine the association between HAP and under-five mortality in a total of 11,507 living children across four age-groups (neonatal aged 0-28 days, post-neonatal aged 1-11 months, child aged 12-59 months and under-five aged 0-59 months). Use of cooking fuel was weakly associated with total under-five mortality (OR = 1.22, 95%CI = 0.92-1.64, P = 0.170), with stronger associations evident for sub-group analyses of children aged 12-59 months (OR = 1.98, 95%CI = 0.75-5.25, P = 0.169). Strong associations between use of cooking fuel and mortality were evident (ORs >5) in those aged 12-59 months for households without a separate kitchen using polluting fuels, and in children whose mother never breastfed. The results of this study suggest that HAP from cooking fuel is associated with a modest increase in the risk of death among children under five years of age in Pakistan, but particularly in those aged 12-59 months, and those living in poorer socioeconomic conditions. To reduce exposure to cooking fuel which is a preventable determinant of under-five mortality in Pakistan, the challenge remains to promote behavioural interventions such as breastfeeding in infancy period, keeping young children away from the cooking area, and improvements in housing and kitchen design.

Household Air Pollution and Under-Five Mortality in Bangladesh (2004-2011).

Household air pollution (HAP) is one of the leading causes of respiratory illness and deaths among children under five years in Bangladesh. This study investigates the association between HAP from cooking fuel and under-five mortality using Bangladesh Demographic and Health Survey (BDHS) datasets over the period 2004-2011 (n = 18,308 children), and the extent to which this association differed by environmental and behavioral factors affecting level of exposure. The association between HAP and neonatal (age between 0-28 days), infant (age between 0 and 11 months) and under-five (age between 0 and 59 months) mortality was examined using multilevel logistic regression models. HAP was not strongly associated with overall neonatal (OR = 1.49, 95% CI = 1.01-2.22, p = 0.043), infant (OR = 1.27, 95% CI = 0.91-1.77, p = 0.157) or under-five mortality (OR = 1.14, 95% CI = 0.83-1.55, p = 0.422) in the context of overall decreasing trends in under-five mortality. The association was stronger for households with an indoor kitchen using polluting fuels, and in women who had never breastfed. Reductions in exposure to pollution from cooking fuel, given it is a ubiquitous and modifiable risk factor, can result in further declines in under-five mortality with household design and behavioural interventions.