Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 9 de 9
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
BMC Public Health ; 18(1): 108, 2018 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-29304777

RESUMO

BACKGROUND: Due to a global warming-related increase in heatwaves, it is important to obtain detailed understanding of the relationship between heat and health. We assessed the relationship between heat and urgent emergency room admissions in the Netherlands. METHODS: We collected daily maximum temperature and relative humidity data over the period 2002-2007. Daily urgent emergency room admissions were divided by sex, age group and disease category. We used distributed lag non-linear Poisson models, estimating temperature-admission associations. We estimated the relative risk (RR) for urgent hospital admissions for a range of temperatures compared to a baseline temperature of 21 °C. In addition, we compared the impact of three different temperature scenarios on admissions using the RR. RESULTS: There is a positive relationship between increasing temperatures above 21 °C and the RR for urgent emergency room admissions for the disease categories 'Potential heat-related diseases' and 'Respiratory diseases'. This relationship is strongest in the 85+ group. The RRs are strongest for lag 0. For admissions for 'circulatory diseases', there is only a small significant increase of RRs within the 85+ age group for moderate heat, but not for extreme heat. The RRs for a one-day event with extreme heat are comparable to the RRs for multiple-day events with moderate heat. CONCLUSIONS: Hospitals should adjust the capacity of their emergency departments on warm days, and the days immediately thereafter. The elderly in particular should be targeted through prevention programmes to reduce harmful effects of heat. The fact that this increase in admissions already occurs in temperatures above 21 °C is different from previous findings in warmer countries. Given the similar impact of three consecutive days of moderate heat and one day of extreme heat on admissions, criteria for activation of national heatwave plans need adjustments based on different temperature scenarios.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Transtornos de Estresse por Calor/terapia , Hospitalização/estatística & dados numéricos , Temperatura Alta/efeitos adversos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Calor Extremo/efeitos adversos , Feminino , Transtornos de Estresse por Calor/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Distribuição de Poisson , Risco , Adulto Jovem
2.
Sci Rep ; 7(1): 2212, 2017 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-28526850

RESUMO

Despite the intuitive connection between drought and mortality, we still lack a sound quantitative synthesis of evidence drawn from the available data. In this study, we estimate the pooled under-five death rates (U5DR) and assess the effect of drought on child death in Ethiopia. Small-scale mortality surveys were searched from the Complex Emergency Database and then aggregated spatially and temporally with drought exposure data from the Global Drought Monitor and food insecurity data from the Famine Early Warning Systems Network. A Bayesian Poisson meta-analysis was performed on 88 surveys conducted in Ethiopia between 2009 and 2014, consisting of 55,219 under-five children. The pooled U5DR was estimated at 0.323/10,000/day (95% credible interval, CrI: 0.254-0.397), which is below both the emergency and the baseline death rate thresholds of sub-Saharan Africa. We failed to find a plausible association between drought and U5DR. However, minimal food insecure areas showed elevated U5DR compared to stressed food insecure areas. Furthermore, the U5DR increases as the prevalence of acute malnutrition increases. Targeted interventions to improve the underlying causes of child malnutrition are crucial. Further, revising and updating the existing mortality thresholds, both the baseline and the emergency, is recommended.


Assuntos
Mortalidade da Criança , Secas , Teorema de Bayes , Criança , Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição Infantil/mortalidade , Pré-Escolar , Bases de Dados Factuais , Etiópia/epidemiologia , Abastecimento de Alimentos , Humanos
3.
Bull World Health Organ ; 95(2): 94-102, 2017 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-28250509

RESUMO

OBJECTIVE: To estimate the prevalence of childhood wasting and to investigate the effects of drought and conflict on wasting in crisis-affected areas within Ethiopia. METHODS: We searched the Complex Emergency Database for nutrition surveys carried out in Ethiopia over the period 2000-2013. We extracted data on the prevalence of wasting (weight-for-height z-scores below -2) among children aged 6-59 months for areas of Ethiopia that had sufficient data available. Data on any conflict events (irrespective of magnitude or impact) and episodes of seasonal drought affecting the survey areas were extracted from publicly available data sources. Random-effects Bayesian meta-analysis was used to synthesize the evidence from 231 small-scale surveys. FINDINGS: From the total sample of 175 607 children analysed, the pooled number of children wasted was 21 709. The posterior median prevalence of wasting was 11.0% (95% credible interval, CrI: 10.3-11.7) over the 14-year period. Compared with areas unaffected by drought, the estimated prevalence of wasting was higher in areas affected by moderate levels of drought (posterior odds ratio, OR: 1.34; 95% CrI: 1.05-1.72) but similar in severe drought-affected areas (OR: 0.96; 95% CrI: 0.68-1.35). Although the pooled prevalence of wasting was higher in conflict-affected than unaffected areas, the difference was not plausible (OR: 1.02; 95% CrI: 0.82-1.26). CONCLUSION: Despite an overall declining trend, a wasting problem persists among children in Ethiopia. Conflict events did not have a major impact on childhood wasting. Nutrition interventions should go beyond severe drought-prone areas to incorporate areas where moderate droughts occur.


Assuntos
Conflitos Armados/estatística & dados numéricos , Transtornos da Nutrição Infantil/epidemiologia , Secas/estatística & dados numéricos , Teorema de Bayes , Pré-Escolar , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Masculino , Prevalência , Análise de Regressão
4.
BMC Health Serv Res ; 17(1): 72, 2017 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-28114994

RESUMO

BACKGROUND: Various barriers exist that preclude individuals from undergoing surgical care in low-income countries. Our study assessed the main barriers in Nepal, and identified individuals most at risk for not receiving required surgical care. METHODS: A countrywide survey, using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool, was carried out in 2014, surveying 2,695 individuals with a response rate of 97%. Our study used data from a subset, namely individuals who required surgical care in the last twelve months. Data were collected on individual characteristics, transport characteristics, and reasons why individuals did not undergo surgical care. RESULTS: Of the 2,695 individuals surveyed, 207 individuals needed surgical care at least once in the previous 12 months. The main reasons for not undergoing surgery were affordability (n = 42), accessibility (n = 42) and fear/no trust (n = 34). A factor significantly associated with affordability was having a low education (OR = 5.77 of having no education vs. having secondary education). Living in a rural area (OR = 2.59) and a long travel time to a secondary and tertiary health facility (OR = 1.17 and 1.09, respectively) were some of the factors significantly associated with accessibility. Being a woman was significantly associated with fear/no trust (OR = 3.54). CONCLUSIONS: More than half of the individuals who needed surgical care did not undergo surgery due to affordability, accessibility, or fear/no trust. Providing subsidised transport, introducing mobile surgical clinics or organising awareness raising campaigns are measures that could be implemented to overcome these barriers to surgical care.


Assuntos
Cirurgia Geral , Instalações de Saúde/provisão & distribução , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Cirurgiões/provisão & distribução , Adulto , Estudos Transversais , Países em Desenvolvimento/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Unidades Móveis de Saúde/estatística & dados numéricos , Nepal/epidemiologia , Pobreza/estatística & dados numéricos , Recursos Humanos
5.
PLoS One ; 11(12): e0168820, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27992563

RESUMO

Hosting refugees may represent a drain on local resources, particularly since external aid is frequently insufficient. Between 2004 and 2011, over 100,000 refugees settled in the eastern border of Cameroon. With little known on how refugee influx affects health services of the hosting community, we investigated the impact of refugees on mother and child health (MCH) services in the host community in Cameroon. We used Cameroon's 2004 and 2011 Demographic and Health Surveys to evaluate changes in MCH indicators in the refugee hosting community. Our outcome variables were antenatal care (ANC) coverage, caesarean delivery rate, place of delivery and child vaccination coverage; whereas the exposure variable was residence in the refugee hosting community. We used a difference-in-differences analysis to compare indicators of the refugee hosting community to a control group selected through propensity score matching from the rest of the country. A total of 10,656 women were included in our 2004 analysis and 7.6% (n = 826) of them resided in the refugee hosting community. For 2011, 15,426 women were included and 5.8% (n = 902) of them resided in the hosting community. Between 2004 and 2011, both the proportion of women delivering outside health facilities and children not completing DPT3 vaccination in the refugee hosting community decreased by 9.0% (95% Confidence Interval (CI): 3.9-14.1%) and 9.6% (95% CI: 7.9-11.3%) respectively. However, ANC attendance and caesarean delivery did not show any significant change. Our findings demonstrate that none of the evaluated MCH service indicators deteriorated (in fact, two of them improved: delivery in health facilities and completing DPT3 vaccine) with the presence of refugees. This suggests evidence disproving the common belief that refugees always have a negative impact on their hosting community.


Assuntos
Cuidado da Criança/estatística & dados numéricos , Refugiados/estatística & dados numéricos , Adulto , Camarões , Cesárea/estatística & dados numéricos , Criança , Serviços de Saúde da Criança , Feminino , Acesso aos Serviços de Saúde , Humanos , Serviços de Saúde Materna , Cuidado Pré-Natal , Estudos Retrospectivos , Vacinação/estatística & dados numéricos , Serviços de Saúde da Mulher , Adulto Jovem
6.
Glob Health Action ; 9: 30204, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27388539

RESUMO

BACKGROUND: Women's malnutrition, particularly undernutrition, remains an important public health challenge in Ethiopia. Although various studies examined the levels and determinants of women's nutritional status, the influence of living close to an international border on women's nutrition has not been investigated. Yet, Ethiopian borders are regularly affected by conflict and refugee flows, which might ultimately impact health. OBJECTIVE: To investigate the impact of living close to borders in the nutritional status of women in Ethiopia, while considering other important covariates. DESIGN: Our analysis was based on the body mass index (BMI) of 6,334 adult women aged 20-49 years, obtained from the 2011 Ethiopian Demographic and Health Survey (EDHS). A Bayesian multilevel multinomial logistic regression analysis was used to capture the clustered structure of the data and the possible correlation that may exist within and between clusters. RESULTS: After controlling for potential confounders, women living close to borders (i.e. ≤100 km) in Ethiopia were 59% more likely to be underweight (posterior odds ratio [OR]=1.59; 95% credible interval [CrI]: 1.32-1.90) than their counterparts living far from the borders. This result was robust to different choices of border delineation (i.e. ≤50, ≤75, ≤125, and ≤150 km). Women from poor families, those who have no access to improved toilets, reside in lowland areas, and are Muslim, were independently associated with underweight. In contrast, more wealth, higher education, older age, access to improved toilets, being married, and living in urban or lowlands were independently associated with overweight. CONCLUSIONS: The problem of undernutrition among women in Ethiopia is most worrisome in the border areas. Targeted interventions to improve nutritional status in these areas, such as improved access to sanitation, economic and livelihood support, are recommended.

7.
Risk Manag Healthc Policy ; 9: 113-27, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27354834

RESUMO

BACKGROUND: Stunting is a major public health problem that results from inadequate nutritional intake over a long period of time. Disasters have major implications in poor and vulnerable children. The aim of this study was, therefore, to assess the impact of disasters on child stunting in Nepal. METHOD: A sample consisting of 2,111 children aged 6-59 months was obtained from the 2011 Nepal Demographic and Health Survey. We used bivariate and multivariate analyses to examine moderate and severe stunting against disaster, controlling for all possible confounders. RESULT: Out of the total study sample, 43% were stunted (17.1% severely and 25.9% moderately). The final model, after adjusting for confounders, showed that epidemics have no impact on child stunting (adjusted odds ratio [OR] =1.14, 95% confidence interval [CI]: 0.66, 1.97 and adjusted OR =1.04, 95% CI: 0.66, 1.65 for severe and moderate stunting, respectively). Floods have impact on child stunting (adjusted OR =0.57, 95% CI: 0.31, 0.96 and adjusted OR =0.66, 95% CI: 0.41, 0.94 for severe and moderate stunting, respectively). However, children aged 6-11 months, nonvaccinated children, children of working women, children who live in mountainous areas, and children from the poorest households were more likely to be moderately stunted. Similarly, children aged 36-47 months, Dalit and other ethnic groups, children from rural settings, and children from the poorest households were more likely to be severely stunted. CONCLUSION: This article illustrates the need to rethink about child stunting in Nepal. This study suggests need for further research, integration of disaster data in the Nepal Demography Health Survey, educational interventions, public awareness, promotion of vaccination, and equity in health service delivery.

8.
J Trop Pediatr ; 62(5): 390-408, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27122480

RESUMO

BACKGROUND: Stunting is a major public health problem in Africa and is associated with poor child survival and development. We investigate factors associated to child stunting in three Tanzanian regions. METHODS: A cross-sectional two-stage cluster sampling survey was conducted among children aged 6-59 months. The sample included 1360 children aged 6-23 months and 1904 children aged 24-59 months. Descriptive statistics and binary and multivariate logistic regression analyses were used. RESULTS: Our main results are: in the younger group, stunting was associated with male sex (adjusted odds ratio [AOR]: 2.17; confidence interval [CI]: 1.52-3.09), maternal absence (AOR: 1.93; CI: 1.21-3.07) and household diet diversity (AOR: 0.61; CI: 0.41-0.92). Among older children, stunting was associated with male sex (AOR: 1.28; CI: 1.00-1.64), age of 4 and 5 (AOR: 0.71; CI: 0.54-0.95; AOR: 0.60; CI: 0.44-0.83), access to improved water source (AOR: 0.70; CI: 0.52-0.93) and to a functioning water station (AOR: 0.63; CI: 0.40-0.98) and mother breastfeeding (AOR: 1.97; CI: 1.18-3.29). CONCLUSIONS: Interventions that increase household wealth and improve water and sanitation conditions should be implemented to reduce stunting. Family planning activities and programmes supporting mothers during pregnancy and lactation can positively affect both newborns and older siblings.


Assuntos
Dieta , Abastecimento de Alimentos/estatística & dados numéricos , Transtornos do Crescimento/epidemiologia , Magreza/epidemiologia , Pré-Escolar , Estudos Transversais , Características da Família , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Masculino , Mães , Estado Nutricional , Pobreza , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , Tanzânia/epidemiologia
9.
Int J Environ Res Public Health ; 13(2): 178, 2016 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-26828512

RESUMO

Child undernutrition is a major public health concern in Ethiopia (stunting national prevalence: 44%; wasting: 10%), despite the overall improvement in child health status during the last decade. Hundreds of small-scale surveys are conducted in Ethiopia's emergency pockets under ENCU's supervision. We reviewed the evidence from small-scale surveys conducted between 2008 and 2013 with two objectives: to provide a summary estimate of wasting prevalence from emergency pockets and to examine reasons for variation in prevalence estimates. We created a dataset by combining data from the Complex Emergency Database, the Famine Early Warning System Network and the Armed Conflict Location Event Data. We conducted a meta-analysis of small-scale surveys using a random effects model with known within-study heterogeneity. The influence of survey covariates on estimated prevalence was investigated with meta-regression techniques. We included 158 surveys in the analysis. A high degree of heterogeneity among surveys was observed. The overall estimate of wasting prevalence was 10.6% (95% CI 9.8-11.4), with differences among regions and between residents and refugees. Meta-regression results showed that vaccination coverage, child mortality, diarrhea prevalence and food insecurity are significantly associated with wasting prevalence. Child care and displacement status were not. Aggregated analysis of small-scale surveys provides insights into the prevalence of wasting and factors explaining its variation. It can also guide survey planning towards areas with limited data availability.


Assuntos
Desnutrição/epidemiologia , Síndrome de Emaciação/epidemiologia , Criança , Etiópia/epidemiologia , Inquéritos Epidemiológicos , Humanos , Desnutrição/etiologia , Modelos Estatísticos , Prevalência , Fatores de Risco , Síndrome de Emaciação/etiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...