Do social support and community engagement act as mechanisms in the association between neighbourhood income inequality and the mental health of mothers in Calgary, Canada? A mediation analysis.

PURPOSE: According to the social determinants of health framework, income inequality is a potential risk factor for adverse mental health. However, few studies have explored the mechanisms suspected to mediate this relationship. The current study addresses this gap through a mediation analysis to determine if social support and community engagement act as mediators linking neighbourhood income inequality to maternal anxiety and depressive symptoms within a cohort of new mothers living in the City of Calgary, Canada. METHODS: Data collected at three years postpartum from mothers belonging to the All Our Families (AOF) cohort were used in the current study. Maternal data were collected between 2012 and 2015 and linked to neighbourhood socioeconomic data from the 2006 Canadian Census. Income inequality was measured using Gini coefficients derived from 2006 after-tax census data. Generalized structural equation models were used to quantify the associations between income inequality and mental health symptoms, and to assess the potential direct and indirect mediating effects of maternal social support and community engagement. RESULTS: Income inequality was not significantly associated with higher depressive symptoms (ß = 0.32, 95%CI = -0.067, 0.70), anxiety symptoms (ß = 0.11, 95%CI = -0.39, 0.60), or lower social support. Income inequality was not associated with community engagement. For the depression models, higher social support was significantly associated with lower depressive symptoms (ß = -0.13, 95%CI = -0.15, -0.097), while community engagement was not significantly associated with depressive symptoms (ß = 0.059, 95%CI = -0.15, 0.27). Similarly, for the anxiety models, lower anxiety symptoms were significantly associated with higher levels of social support (ß = -0.17, 95%CI = -0.20, -0.13) but not with higher levels of community engagement (ß = 0.14, 95%CI = -0.14, 0.41). CONCLUSION: The current study did not find clear evidence for social support or community engagement mediating the relationship between neighbourhood income inequality and maternal mental health. Future investigations should employ a broader longitudinal approach to capture changes in income inequality, potential mediators, and mental health symptomatology over time.

Biomass smoke in Burkina Faso: what is the relationship between particulate matter, carbon monoxide, and kitchen characteristics?

In Burkina Faso where cooking with biomass is very common, little information exists regarding kitchen characteristics and their impact on air pollutant levels. The measurement of air pollutants such as respirable particulate matter (PM10), an important component of biomass smoke that has been linked to adverse health outcomes, can also pose challenges in terms of cost and the type of equipment needed. Carbon monoxide could potentially be a more economical and simpler measure of air pollution. The focus of this study was to first assess the association of kitchen characteristics with measured PM10 and CO levels and second, the relationship of PM10 with CO concentrations, across these different kitchen characteristics in households in Nouna, Burkina Faso. Twenty-four-hour concentrations of PM10 (area) were measured with portable monitors and CO (area and personal) estimated using color dosimeter tubes. Data on kitchen characteristics were collected through surveys. Most households used both wood and charcoal burned in three-stone and charcoal stoves. Mean outdoor kitchen PM10 levels were relatively high (774 µg/m(3), 95 % CI 329-1,218 µg/m(3)), but lower than indoor concentrations (Satterthwaite t value, -6.14; p < 0.0001). In multivariable analyses, outdoor kitchens were negatively associated with PM10 (OR = 0.06, 95 % CI 0.02-0.16, p value <0.0001) and CO (OR = 0.03, 95 % CI 0.01-0.11, p value <0.0001) concentrations. Strong area PM10 and area CO correlations were found with indoor kitchens (Spearman's r = 0.82, p < 0.0001), indoor stove use (Spearman's r = 0.82, p < 0.0001), and the presence of a smoker in the household (Spearman's r = 0.83, p < 0.0001). Weak correlations between area PM10 and personal CO levels were observed with three-stone (Spearman's r = 0.23, p = 0.008) and improved stoves (Spearman's r = 0.34, p = 0.003). This indicates that the extensive use of biomass fuels and multiple stove types for cooking still produce relatively high levels of exposure, even outdoors, suggesting that both fuel subsidies and stove improvement programs are likely necessary to address this problem. These findings also indicate that area CO color dosimeter tubes could be a useful measure of area PM10 concentrations when levels are influenced by strong emission sources or when used in indoors. The weaker correlation observed between area PM10 and personal CO levels suggests that area exposures are not as useful as proxies for personal exposures, which can vary widely from those recorded by stationary monitors.

A systematic review of air pollution as a risk factor for cardiovascular disease in South Asia: limited evidence from India and Pakistan.

Cardiovascular diseases (CVD) are major contributors to mortality and morbidity in South Asia. Chronic exposure to air pollution is an important risk factor for cardiovascular diseases, although the majority of studies to date have been conducted in developed countries. Both indoor and outdoor air pollution are growing problems in developing countries in South Asia yet the impact on rising rates of CVD in these regions has largely been ignored. We aimed to assess the evidence available regarding air pollution effects on CVD and CVD risk factors in lower income countries in South Asia. A literature search was conducted in PubMed and Web of Science. Our inclusion criteria included peer-reviewed, original, empirical articles published in English between the years 1990 and 2012, conducted in the World Bank South Asia region (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka). This resulted in 30 articles. Nine articles met our inclusion criteria and were assessed for this systematic review. Most of the studies were cross-sectional and examined measured particulate matter effects on CVD outcomes and indicators. We observed a bias as nearly all of the studies were from India. Hypertension and CVD deaths were positively associated with higher particulate matter levels. Biomarkers of oxidative stress such as increased levels of P-selection expressing platelets, depleted superoxide dismutase and reactive oxygen species generation as well as elevated levels of inflammatory-related C-reactive protein, interleukin-6 and interleukin-8 were also positively associated with biomass use or elevated particulate matter levels. An important outcome of this investigation was the evidence suggesting important air pollution effects regarding CVD risk in South Asia. However, too few studies have been conducted. There is as an urgent need for longer term investigations using robust measures of air pollution with different population groups that include a wider range of air pollutants and outcomes, including early indicators of CVD. These regions are facing burdens from increasing urbanization, air pollution and populations, generally weaker health infrastructure, aging populations and increased incidence of non-communicable diseases, included CVD. The extent to which the problem of air pollution and CVD will impact these countries will depend largely on the information available to inform policy and programs, which are still lacking, political will as well as social and economic development.

Does recent contact with a health care provider make a difference in malaria knowledge?

Knowledge and practices with respect to malaria are aspects that need to be considered as part of effective malaria programs. We assessed and compared malaria practices and knowledge among those who had recently visited a health care provider and those who had not. A matched, population-based case-control study was conducted among 338 women between 15 and 45 years of age and caretakers of children ≤ 9 years of age in Nouna, Burkina Faso. Little difference was found in the reported responses between the cases and controls, which indicates that recent visits to health care providers may not have an effect on malaria risk or knowledge. Differences were noted in malaria practices, which could suggest that health care providers are consulted only after home treatments fail. Therefore, programs and policies targeted to health care providers aimed at improving the dissemination of information may be of some benefit.