Prenatal and early life exposure to air pollution and the risk of severe lower respiratory tract infections during early childhood: the Espoo Cohort Study.

BACKGROUND: There is inconsistent evidence of the effects of exposure to ambient air pollution on the occurrence of lower respiratory tract infections (LRTIs) in early childhood. We assessed the effects of individual-level prenatal and early life exposure to air pollutants on the risk of LRTIs in early life. METHODS: We studied 2568 members of the population-based Espoo Cohort Study born between 1984 and 1990 and living in 1991 in the City of Espoo, Finland. Exposure assessment was based on dispersion modelling and land-use regression for lifetime residential addresses. The outcome was a LRTI based on data from hospital registers. We applied Poisson regression to estimate the incidence rate ratio (IRR) of LTRIs, contrasting incidence rates in the exposure quartiles to the incidence rates in the first quartile. We used weighted quantile sum (WQS) regression to estimate the joint effect of the studied air pollutants. RESULTS: The risk of LRTIs during the first 2 years of life was significantly related to exposure to individual and multiple air pollutants, measured with the Multipollutant Index (MPI), including primarily sulphur dioxide (SO2), particulate matter with a dry diameter of up to 2.5 µm (PM2.5) and nitrogen dioxide (NO2) exposures in the first year of life, with an adjusted IRR of 1.72 per unit increase in MPI (95% CI 1.20 to 2.47). LRTIs were not related to prenatal exposure. CONCLUSIONS: We provide evidence that ambient air pollution exposure during the first year of life increases the risk of LRTIs during the first 2 years of life. SO2, PM2.5 and NO2 were found to contribute the highest weights on health effects.

Asthma and Respiratory Infections From Birth to Young Adulthood.

We applied data from a population-based prospective study, the Espoo Cohort Study (n = 2,568), to identify the potential susceptibility of persons with asthma to respiratory tract infections (RTIs). Information on the occurrence of asthma and both upper respiratory tract infections (URTIs) and lower respiratory tract infections (LRTIs) was collected with a questionnaire at baseline and at the 6-year and 20-year follow-up studies, and from the Finnish national health registries. We estimated age- and sex-specific incidence rate differences (IRDs) and incidence rate ratios (IRRs) by applying negative binomial regression. Meta-regression was used to summarize the age-specific IRRs from childhood to 27 years of age. Individuals with asthma at any age during the follow-up period had increased risks of both URTIs (adjusted IRD = 72.6 (95% confidence interval (CI): 50.6, 94.7) per 100 person-years; adjusted IRR = 1.27 (95% CI: 1.20, 1.35)) and LRTIs (adjusted IRD = 25.5 (95% CI: 17.9, 33.1); adjusted IRR = 2.87 (95% CI: 2.33, 3.53)) from childhood to young adulthood. In young adulthood, the association between asthma and URTIs was stronger in women than in men, while such an association was not detected for LRTIs. This analysis provides strong evidence that persons with asthma experience more RTIs from preschool age to young adulthood than do those without asthma. Thus, they constitute a susceptible population for RTIs. Women with asthma are at especially high risk.

Effect of cold winters on the risk of new asthma: a case-crossover study in Finland.

BACKGROUND: Cold weather increases respiratory symptoms and provokes exacerbations of asthma, but there are no previous studies on its role in the aetiology of asthma. OBJECTIVE: We tested the hypothesis that a cold winter increases the risk of developing asthma during the following 1 to 2 years. METHODS: We conducted a case-crossover study of 315 newly diagnosed cases of asthma from the population-based Espoo Cohort Study from birth to the age of 27 years. The hazard period constituted 3 winter months preceding the onset of asthma and bidirectional reference periods of 1 year before hazard period and 1 year after onset of asthma. Exposure constituted average ambient temperature during the winter months of December, January and February. The outcome of interest was new doctor-diagnosed asthma. The measure of effect was OR of asthma estimated by conditional logistic regression analysis. RESULTS: The average winter temperature for the study period from winter 1983 to 2010 was -4.4°C (range -10.7 to 0.4). A 1°C decrease in the average winter temperature predicted a 7% increase in the risk of new asthma (OR=1.07, 95% CI 1.02 to 1.13). A cold winter with an average temperature below the climate normal value (-4.5°C; period 1981-2010) increased the risk of new asthma by 41% during the following year (OR: 1.41; 95% CI 1.04 to 1.90). CONCLUSIONS: This case-crossover study provides original evidence that a cold winter with below normal average temperatures increases the risk of developing new asthma during the following 1 to 2 years.

Factors associated with anaemia among women of reproductive age in Ethiopia: Multilevel ordinal logistic regression analysis.

Anaemia has prevailed as a mild to severe public health problem in Ethiopian women of reproductive age. Many studies carried out on anaemia have been limited to subnational assessments and subgroups of women. The effects of potential factors thought to affect anaemia and severity levels of anaemia have not been well considered. Therefore, this study identifies individual, household and community level factors associated with anaemia among women of reproductive age in Ethiopia applying multilevel ordinal logistic regression models. Proportional odds assumption was tested by likelihood ratio test. About 35.6% of the variation on anaemia was due to between household and community level differences. Pregnancy (adjusted odds ratio [AOR] = 2.30, 95% confidence interval [CI]: 1.82, 2.91), HIV (AOR = 2.40, 95% CI: 1.76, 3.25), giving birth once (AOR = 1.2, 95% CI: 1.05, 1.40), giving birth more than once (AOR = 1.4, 95% CI: 1.19, 1.71), living with five or more family members (AOR = 1.24, 95% CI: 1.05, 1.47), living in poorest households (AOR = 1.34, 95% CI: 1.2, 1.61) and rural area (AOR = 1.57, 95% CI: 1.28, 1.92) were associated with greater odds of more severe anaemia compared with their respective counter parts. Secondary and above education (AOR = 0.83, 95% CI: 0.70, 0.97) and use of pills, implants or injectable (AOR = 0.67, 95% CI: 0.59, 0.77) were associated with lower odds of more severe anaemia. Anaemia prevention and control programmes need to be strengthened for women living with HIV/AIDS and during pregnancy. Household poverty reduction and social protection services need to be strengthened and integrated in anaemia prevention and management activities in women.

Magnitude, trend, and causes of under-five mortality from Kilite-Awlaelo health demographic surveillance database, northern Ethiopia, 2009-2017.

BACKGROUND: Globally, neonatal and child mortality remains still high. Under-five mortality accounts for four-fifth of child and young adolescent deaths. In Ethiopia, though there has been a remarkable progress over the past years, under-five mortality is still high. Evidence from population-based longitudinal studies on under-five mortality is limited. Thus, this study aims to investigate the magnitude, trend, and causes of under-five mortality in the Kilite-Awlaelo Health Demographic Surveillance System, Northern Ethiopia. METHODS: Kilite-Awlaelo health and demographic surveillance system was established in 2009 in the northern part of Ethiopia. Population-based longitudinal study design was carried out through extracting data for nine consecutive years (2009-2017). After smoothing the data revealed a visually decreasing trend. Linear, quadratic, exponential, and autoregressive time-series models were checked. Accordingly, the exponential trend model provided the best fit with the lowest standard error of estimate, lowest sum square error and highest adjusted R2 value. Cause-specific mortality was determined by cross tabulating cause of death with specific age death. RESULTS: The overall under-five mortality rate was 35.62 per 1000 livebirths. The under-five mortality rate of rural and urban residents was 37.58 and 12.99 deaths per 1000 livebirths respectively. The exponential trend model showed the under-five mortality rate was declining exponentially. Bacterial sepsis 67(20.6%), prematurity 37(11.08%), intestinal infection disease 30(8.98%), acute lower respiratory infections 26(7.78%), and birth asphyxia 24(7.19%) were the major causes of under-five mortality. CONCLUSION: The overall under-five mortality rate for the surveillance period was comparatively lower. A statistically significant difference in under-five mortality rate was observed between urban and rural residents. A statistically significant declining trend in the under-five mortality rate was observed. Bacterial sepsis, prematurity, intestinal infection disease, acute lower respiratory infections, and birth asphyxia were the major causes of under-five mortality. We recommend the huge discrepancy in under-five mortality rate between urban and rural dwellers could be narrowed to some level by increasing healthcare access for rural residents.

Predictors of teenage pregnancy in Ethiopia: a multilevel analysis.

BACKGROUND: In Ethiopia, pregnancy, and childbearing begin at an early age. Teenage pregnancy has long-term implications for girls, their families, and communities. However, multilevel predictors of teenage pregnancy are not well studied yet. Several studies are focused only on the effects of individual-level characteristics but ignored the community level effect. This, in turn, could result in biased estimation of predictors of teenage pregnancy. Therefore, this study aimed to identify the individual and community level factors that determine teenage pregnancy in Ethiopia. METHOD: The data were extracted from the 2016 Ethiopian Demographic and Health Survey. The study included a sample from 645 clusters of 2679 (weighted) women aged 20-24 years. The data were collected using a two-stage cluster design that includes selection of enumeration areas as a first stage and selection of households as a second stage. A two-level mixed-effect logistic regression model was fitted to determine the individual and community level factors associated with teenage pregnancy. RESULT: The study revealed that 2134(79.6%) of women aged 20-24 years experienced pregnancy during their adolescent stage. Being sexually active before age 15[AOR = 7.9; 95%CI: 4.5, 13.8]; being married before age 15[AOR = 30; 9%CI: 16.7, 53.9] and being a rural dweller [AOR = 2.2; 95%CI: 1.4, 3.6] were positively associated with teenage pregnancy. A woman living in a community with a lower proportion of contraceptive users [AOR = 2.3; 95%CI: 1.5, 3.5]; had also a statistically significant association with teenage pregnancy. CONCLUSIONS AND RECOMMENDATION: Various factors at both the individual and community level determined teenage pregnancy. Therefore, the government should work on the prevention of early marriage, early sexual initiation and on improving the utilization of family planning in the community to protect them from pregnancy that occur at early age.

ERS International Congress 2021: highlights from the Epidemiology and Environment Assembly.

In this article, early career members of the Epidemiology and Environment Assembly of the European Respiratory Society (ERS) summarise a selection of four sessions from the Society's 2021 virtual congress. The topics covered focus on chronic respiratory disease epidemiology, the health effects of tobacco and nicotine, and the respiratory health impact of environmental exposures and climate change. While the burden of chronic respiratory diseases such as COPD is expected to increase in the next decades, research on modifiable risk factors remains key. The tobacco and nicotine research presented here focuses on recent evolutions in cigarette alternatives, including vaping and the use of heated tobacco products, and changes in behaviours related to the coronavirus disease 2019 pandemic. The 2021 World Health Organization air quality guidelines were also a major topic of the congress. Despite their benefits, challenges remain in driving and implementing environmental health policies to take into account the respiratory effects observed at very low air pollution concentrations, as well as the impact of climate change on environmental exposures.

Individual and community-level factors influencing optimal breastfeeding: A multilevel analysis from a national survey study of Ethiopia.

BACKGROUND: Optimal breastfeeding is critical for healthy growth of the child. Globally, 820,000 children and 20,000 women lost due to in appropriate breastfeeding each year. In Ethiopia, 50,000 children lost related to malnutrition with 18% were due to poor breastfeeding habit. Little is known on the determinants of breastfeeding with hierarchical level. Therefore, this study aimed to identify factors influencing optimal breastfeeding among children under six month in Ethiopia using a multilevel analysis. METHODS: The data of this study were obtained from Ethiopian Demographic and health survey conducted from January to June 2016. A total 1,087 children aged 0-5 months were selected using two stage stratified sampling technique. Multilevel logistic regression analysis was done to identify significant explanatory variables. Akaike information criteria were used to select the best model fit. Fixed effect was done to estimate the association between the outcome and explanatory variable and also random effect to measure the variation explained by the higher level. RESULT: Among the total of 1,087 children, 45.4% were optimally breastfeed. Children from the richest wealth index (AOR = 2.87; 95% CI: 1.53-5.43) was positively associated with optimal breastfeeding but, children aged 4-5 months (AOR = 0.19; 95%CI: 0.12-0.27), children born through cesarean section (AOR = 0.18; 955 CI: 0.07-0.51) and residing in Afar region (AOR = 0.13; 95%CI: 0.02-0.92) were found inversely associated with optimal breastfeeding. The random-effects showed that the variation between communities was statistically significant. CONCLUSION: Individual and community level factors play a significant role in shaping optimal breastfeeding. Future strategies and health interventions should be strengthen to target individual and community level factors that enhance optimal breastfeeding.

Effective Clinical Teaching Practice and Associated Factors Among Midwifery Educators in Public Universities of Ethiopia: Institution-Based Cross-Sectional Study.

BACKGROUND: Although effective clinical teaching realistically improves learners to be competent, in Ethiopia only 31.6% of midwifery graduates have passed the national proficiency standard for graduation. Likewise, research evidence is lacking on effective clinical teaching practice of midwifery educators in Ethiopia. OBJECTIVE: This study aimed to assess effective clinical teaching practice and associated factors among midwifery educators in public universities of Ethiopia. METHODS: Institution-based cross-sectional study was conducted in April 2019 on 424 midwifery educators selected by simple random sampling technique. Data were collected through email by using a semi-structured, pretested, self-administered questionnaire, entered into Epi-data version 4.2, and analyzed by SPSS version 23. Bivariate and multivariable logistic regression analyses were done to test the association. The odds ratio at 95% confidence interval (CI) and P-value <0.05 were used to ascertain statistical significance. RESULTS: Only 178 (47.3%) of participants had effective clinical teaching practice. Clinical teaching experience (AOR= 4.72; 95% CI=1.97, 11.29), training on higher diploma in teaching profession (AOR=2.78; 95% CI=1.61, 4.82), clinical teaching workshop (AOR=4; 95% CI=1.98, 8.05), students per clinical unit (AOR= 3.71; 95% CI= 1.66, 8.26), giving objectives of clinical learning for students (AOR= 4.74; 95% CI=2.43, 9.25), using performance-based assessment tool (AOR =1.82; 95% CI=1.04, 3.16) and having good interest in clinical teaching (AOR=8.63; 95% CI=2.91, 25.56) were factors positively associated with effective clinical teaching practice. CONCLUSION: Less than half of midwifery educators of Ethiopian Public Universities had effective clinical teaching practice. The educators' clinical teaching experience, training, and adherence to clinical teaching standards were identified to affect effective clinical teaching positively. Therefore, educators should adhere to the standards for effective clinical teaching and receive training on effective teaching.

Barriers and facilitators of nutrition assessment, counseling, and support for tuberculosis patients: a qualitative study.

BACKGROUND: Nutrition has a substantial role in the prevention, treatment, and cure of tuberculosis. Thus, nutrition assessment, counseling, and support (NACS) have been implemented as part of tuberculosis treatment. However, evidence on the barriers and facilitators (enablers) of its implementation is lacking. OBJECTIVE: To explore barriers and facilitators of implementation of NACS for tuberculosis patients. METHODS: An exploratory qualitative study was conducted in public health facilities and health offices of Mekelle City, Northern Ethiopia. We conducted 17 interviews using purposively selected key informants comprising health professionals (n = 12) and tuberculosis patients (n = 5). Interviews were tape-recorded, transcribed verbatim, and coded and analyzed using a thematic approach in ATLAS.ti 7 software. RESULTS: Barriers were identified at three levels -organization, care provider, and patient levels. Suboptimal nutritional supply, lack of supportive supervision, lack of adequate workforce, staff turn-over, the sudden withdrawal of partners, and weak link with social service were the barriers at the organization level. Lack of commitment was reported as the only barrier at the care provider level, and socioeconomic status of patients, sharing and selling of supplies, perceived improved status, and perceived stigma were identified as the major barriers for the implementation of nutrition assessment, counseling, and support service. While training, availability of measurement and educational tools, the inclusion of nutrition indicators in the tuberculosis register, and the presence of collaborating partners were identified as facilitators at the organizational level. Patients' motivation to know their health status was reported to be a facilitator at the patient level. CONCLUSIONS: Organization, care provider, and patient-level barriers and facilitators were found to influence the implementation of NACS. Hence, multilevel factors should be considered to successfully implement the program and to gain its potential impact.

Factors affecting feeding 6-23 months age children according to minimum acceptable diet in Ethiopia: A multilevel analysis of the Ethiopian Demographic Health Survey.

BACKGROUND: Though infant and young children should be fed according to a minimum acceptable diet to ensure appropriate growth and development, only 7% of Ethiopian 6-23 months age children meet the minimum acceptable dietary standards, which is lower than the national target of 11% set for 2016. Therefore, this study aims to assess the individual and community level factors affecting feeding according to minimum acceptable diet among 6-23 months age children in Ethiopia. METHODS: This study analyzed retrospectively a cross-sectional data on a weighted sample of 2919 children aged 6-23 months nested within 617 clusters after extracting from Ethiopian Demographic and Health Survey 2016 via the link www.measuredhs.com. By employing bi-variate multilevel logistic regression model, variables which were significant at the p-value < 0.25 were included in multivariable multilevel logistic regression analysis. Finally, variables with a p-value < 0.05 were considered as significant predictors of minimum acceptable diet. RESULTS: Only 6.1% of 6-23 months age children feed minimum acceptable diet in Ethiopia. Children 18-23 months age (AOR = 3.7, 95%CI 1.9, 7.2), father's with secondary or higher education (AOR = 2.1, 95%CI 1.2, 3.6), Employed mothers (AOR = 1.7, 95%CI 1.2, 2.5), mothers have access to drinking water (AOR = 1.9, 95%CI 1.2, 2.9), mothers with media exposure (AOR = 2.1 95%CI 1.1, 2.7) were positive individual level predictors. Urban mothers (AOR = 4.8, 95%CI 1.7, 13.2)) and agrarian dominant region (AOR = 5.6, 95%CI 2.2, 14.5) were community level factors that significantly associated with a minimum acceptable diet of 6-23 months age children. CONCLUSION: Both individual and community level factors were significantly associated with a minimum acceptable diet of 6-23 months age children in Ethiopia, suggesting that nutritional interventions designed to improve child health should not only be implemented at the individual level but tailored to community context as well.

Knowledge and practice of Essential Newborn Care among postnatal mothers in Mekelle City, North Ethiopia: A population-based survey.

BACKGROUND: In Ethiopia, neonatal mortality remains high and accounts for about half of the under-five mortality. However, there is limited data on the knowledge and practice of mothers about newborn care at the community level, particularly in urban settings. Therefore, this study aimed to assess knowledge and practice of mothers on Essential Newborn Care in urban communities. METHODS: A population-based cross-sectional study was conducted in December 2016 in Mekelle City, Northern Ethiopia. A total of 456(weighted) postpartum mothers were included in this study. A three-stage cluster sampling was used to select the study subjects in which districts, Kebeles and respondents formed the first, second and third stage, respectively. Postnatal mothers were recruited from each cluster/Kebele until the required sample size was achieved. They were interviewed using a structured questionnaire. Mothers who responded correctly to at least 75% of the knowledge and practice questions were considered to have good knowledge and practice, respectively. Multivariable logistic regression was used to identify factors associated with the knowledge and practice of Essential Newborn Care. RESULTS: In this study, 36.1% of mothers had good knowledge and 81.1% had a good practice on Essential Newborn Care. Newborn care practice was positively associated with those mothers who were educated [Adjusted Odds Ratio (AOR) = 1.94; 95% CI (1.07, 3.50)], counseled during delivery and postpartum [AOR = 4.97; 95% CI (1.93, 12.76)], who had good knowledge of newborn care [AOR = 2.32; 95%CI (1.18, 4.55)] and who had good knowledge of newborn danger signs [AOR = 2.43; 95%CI (1.21, 4.87)]. CONCLUSIONS: A substantial number of postpartum mothers had poor knowledge and practice on Essential Newborn Care in Mekelle City. Therefore, improving quality and access to maternal health services and home visit using the urban health extension workers at the community level should be encouraged.

Individual and community-level factors associated with introduction of prelacteal feeding in Ethiopia.

BACKGROUND: Ethiopia is a country with low optimal breast feeding practice, and prelacteal feeding is still a norm. Introduction of prelacteal feeding is a known barrier for optimal breast feeding practices. However, knowledge on determinants of introduction of prelacteal feeding is minimal. This study aimed to identify the effects of individual and community-level factors in the introduction of prelacteal feeding in Ethiopia. METHODS: Data for this study was extracted from the nationally representative 2011 Ethiopia Demographic and Health Survey (EDHS) and focused on a sample from child data, with a sample from 576 clusters of 7692 children who were last-born in the past five years preceding the survey. The data was collected using two-stage cluster design, in which enumeration areas forming the first stage and households making the second stage. A two-level mixed effect multivariable logistic regression model was fitted to determine the individual and community-level factors associated with introduction of prelacteal feeding. RESULTS: From the total sample of children 28.92 % were fed prelacteals. Butter (n = 1143), plain water (n = 395) and milk-other than breast milk (n = 323) were commonly used prelacteals. In multivariable two-level mixed effect model; caesarean mode of delivery (Adjusted odds ratio (AOR) = 1.87; 95 % CI 1.28, 2.73), and late initiation of breastfeeding (AOR = 5.32; 95 % CI 4.65, 6.09) were both positively associated with the odds of giving prelacteals. Higher economic status 28 % (AOR = 0.72; 95 % CI 0.54, 0.98), giving birth at hand of non-health personnel birth assistance (AOR = 0.68; 95 % CI 0.54, 0.87), large birth size of child (AOR = 0.80; 95 % CI 0.68, 0.95) and high community antenatal care use (AOR = 0.58; 95 % CI 0.38, 0.87) were negatively associated with the odds of giving prelacteals. Significant variation in prelacteal feeding practice was also seen among ethnic and religious groups, and across regions. CONCLUSIONS: The prevalence of prelacteal feeding was high that remained a challenge for optimal breastfeeding in Ethiopia. Not only individual-level factors, but also community-level factors contribute to prelacteal feeding practice. Increasing access to health education through increasing maternal health care service coverage and community involvement is crucial.