Oral cleaning habits and the copy number of periodontal bacteria in pregnant women and its correlation with birth outcomes: an epidemiological study in Mibilizi, Rwanda.

BACKGROUND: Since 1996, many studies have reported that periodontal disease during pregnancy may be a risk factor for preterm birth and low birth weight; however, in Africa, periodontal disease is considered a non-high-priority disease. In addition, there are few dental facilities in rural Rwanda; thus, the oral condition of pregnant women has not been investigated. The objective of this study was to assess the tooth brushing habits of pregnant women in rural Rwanda and evaluate whether periodontal bacteria in the oral cavity of pregnant women are related to birth outcomes or oral cleaning habits. METHODS: A questionnaire survey and saliva collection were conducted for pregnant women in the catchment area population of Mibilizi Hospital located in the western part of Rwanda. Real-time PCR was performed to quantitatively detect total bacteria and 4 species of periodontal bacteria. The relationship of the copy number of each bacterium and birth outcomes or oral cleaning habits was statistically analyzed. RESULTS: Among the participants, high copy numbers of total bacteria, Tannerella forsythia, and Treponema denticola were correlated with lower birth weight (p = 0.0032, 0.0212, 0.0288, respectively). The sex ratio at birth was higher in women who had high copy numbers of Porphyromonas gingivalis and T. denticola during pregnancy (p = 0.0268, 0.0043). Furthermore, regarding the correlation between oral cleaning habits and the amount of bacteria, the more frequently teeth were brushed, the lower the level of P. gingivalis (p = 0.0061); the more frequently the brush was replaced, the lower the levels of P. gingivalis and T. forsythia (p = 0.0153, 0.0029). CONCLUSIONS: This study suggested that improving tooth brushing habits may reduce the risk of periodontal disease among pregnant women in rural Rwanda. It also indicated that the amount of bacteria is associated with various birth outcomes according to the bacterial species. Both access to dental clinics and the oral cleaning habits of pregnant women should be important considerations in efforts to alleviate reproductive-related outcomes in rural Africa.

Periodontal disease is known to cause many complications. For instance, pregnant women with periodontal disease are at increased risk of preterm birth and delivering low-birth-weight infants. However, the importance of oral care during pregnancy is not an important consideration in rural Africa, where preterm birth rates and low-birth-weight rates are particularly high. Moreover, even the oral hygiene status of pregnant women has not been assessed in such areas. In this study, we focused on the amount of periodontal bacteria that cause periodontal disease and investigated the relationship between the amount of bacteria and birth outcomes. Our findings indicate that tooth brushing guidance for pregnant women and improved access to dental clinics in rural Africa may contribute to reduced rates of preterm birth and low birth weight.

Implications of human activities for (re)emerging infectious diseases, including COVID-19.

Since 1980, the world has been threatened by different waves of emerging disease epidemics. In the twenty-first century, these diseases have become an increasing global concern because of their health and economic impacts in both developed and resource-constrained countries. It is difficult to stop the occurrence of new pathogens in the future due to the interconnection among humans, animals, and the environment. However, it is possible to face a new disease or to reduce the risk of its spread by implementing better early warning systems and effective disease control and prevention, e.g., effective global surveillance, development of technology for better diagnostics, effective treatments, and vaccines, the global political will to respond to any threats and multidisciplinary collaboration involving all sectors in charge of good health maintenance. In this review, we generally describe some factors related to human activities and show how they can play a role in the transmission and spread of infectious diseases by using some diseases as examples. Additionally, we describe and discuss major factors that are facilitating the spread of the new pandemic known as COVID-19 worldwide.

Exposure to particulate matter (PM2.5) and prevalence of diabetes mellitus in Indonesia.

BACKGROUND: Recently emerging evidence suggests an association between particulate matter less than 2.5 µm in diameter (PM2.5) exposure and diabetes risk. However, evidence from Asia is limited. Here, we evaluated the association between PM2.5 exposure and the prevalence of diabetes mellitus in one of the most populated countries in Asia, Indonesia. METHODS: We used the 2013 Indonesia Basic Health Research, which surveyed households in 487 regencies/municipalities in all 33 provinces in Indonesia (n = 647,947). We assigned individual exposure to PM2.5 using QGIS software. Multilevel logistic regression with a random intercept based on village and cubic spline analysis were used to assess the association between PM2.5 exposure and the prevalence of diabetes mellitus. We also assessed the lower exposure at which PM2.5 has potential adverse effects. RESULTS: We included 647,947 subjects with a mean age of 41.9 years in our study. Exposure to PM2.5 levels was associated with a 10-unit increase in PM2.5 (fully adjusted odds ratio: 1.09; 95% confidence interval: 1.05-1.14). The findings were consistent for quartile increases in PM2.5 levels and the cubic spline function. Even when we restricted to those exposed to PM2.5 concentrations of less than 10.0 µg/m3 in accordance with the recommended guidelines for annual exposure to PM2.5 made by the World Health Organization, the association remained elevated, especially among subjects living in the urban areas. Hence, we were unable to establish a safe threshold for PM2.5 and the risk of diabetes. CONCLUSIONS: Our findings suggest a positive association between PM2.5 exposure and prevalence of diabetes mellitus, which is possibly below the current recommended guidelines. Further studies are needed to ascertain the causal association of this finding.