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Background The actual human cost of the pandemic cannot be viewed through the COVID-19 mortality rates alone, especially when the pandemic is widening the existing health disparities among different subpopulations within the same society. In Kuwait, migrant workers were already disproportionately impacted by COVID-19 and its unintended consequences. The totality of that effect on mortality is yet to be fully understood. Objective To estimate excess deaths in the pandemic year of 2020 among the Kuwaiti and non-Kuwaiti migrant populations. Methods We analyzed publicly available retrospective data in Kuwait on total annual mortality historically (from 2005 to 2019) and in 2020. We fitted a quasi-poisson generalized linear model adjusted for yearly trend and nationality to estimate the expected deaths in 2020 in the absence of the pandemic. We calculated excess deaths as the difference between observed and expected mortality for the year of the pandemic in both Kuwaitis and non-Kuwaitis. Results In the absence of the pandemic, we expected the total mortality in Kuwait to be 6629 (95% CI: 6472 to 6789) deaths. However, the observed total mortality in 2020 was 9975 deaths; about 3346 (3186 to 3503) more deaths above the expected historical trend. Deaths among migrant workers would have been approximately 71.9% (67.8 to 76.0) lower in the absence of the pandemic. On the other hand, deaths among Kuwaitis would have been 32.4% (29.3 to 35.6) lower if the country had not been hit by the pandemic. Conclusion The burden of mortality brought on by the COVID-19 pandemic is substantially higher than what the official tally might suggest. Systematically disadvantaged migrant workers shouldered a larger burden of deaths in the pandemic year. Public health interventions must consider structural and societal determinants that give rise to the health disparities seen among migrant workers.

This descriptive study reveals trends in citations and traffic-related mortality in Kuwait. Secondary data were utilized, where data on road traffic citations were obtained from the traffic police in the Ministry of Interior for the years from 2011 to 2015, and road traffic mortality data for the study period were obtained from the Ministry of Health. Objective: To describe recent trends in data related to road traffic safety in Kuwait over time, which could serve as an important indicator for the level of enforcement of existing traffic regulations. Descriptive summary statistics are presented. Results: There was a total of 24.2 million traffic violations during the study period. The number rose dramatically from 4 million citations in 2011 to nearly 6.5 million in 2015. The indirect method of citation (issued indirectly via surveillance methods) constituted a higher percentage of citations, 70.4%, compared to the direct method of citation (issued directly by the police officer), 29.6%. Furthermore, the top reason for citation was speeding, followed by parking in no parking/handicapped zones, driving with an expired license, and crossing a red light. Road traffic fatalities (RTFs) in Kuwait from 2011 to 2015 totaled 2282. About 450 people die each year in Kuwait from road traffic injuries and a slightly decreasing trend was found. Non-Kuwaitis have RTF counts that are four times higher than Kuwaitis, with 1663 and 263 deaths, respectively. Conclusions: Road traffic safety continues to be a major problem in Kuwait. Increases in citation issuance show a rise in traffic regulation enforcement, yet risky driving behaviors continue to account for most violations issued. Harsher penalties, road safety education, and implementing graduated driving licensing may be warranted to increase the safety of the roads.

The rapid modernization and economic developments in Kuwait, have been accompanied by substantial lifestyle changes such as unhealthy diet and physical inactivity. These modifiable behaviours have contributed to increased rates of non-communicable diseases including diabetes and cardiovascular diseases. Delphi Consensus Method was implemented in the current study to draw stakeholders from all sectors together to develop a consensus on the major public health priorities, barriers and solutions. The process involves administration of a series of questions to selected stakeholders through an iterative process that ends when a consensus has been reached among participants. Results of the iteration process identified obesity, diabetes, cardiovascular diseases along with lack of enforcement of laws and regulation as priority health issues. Results also identified lack of national vision for the development of a public health system, lack of multidisciplinary research investigating sources of disease and methods of prevention and improving efficiency with existing resources in implementation and efficiency as the main barriers identified were. Solutions suggested included investing in healthcare prevention, strengthening communication between all involved sectors through intersectoral collaboration, awareness at the primary healthcare setting and use of electronic health records. The results offer an important opportunity for stakeholders in Kuwait to tackle these priority health issues employing the suggested approaches and solution.

Understanding how the utilization of walkable neighbourhoods to reduce sedentary behaviour is affected by social and demographic factors is important. Therefore, this study examined the moderating influences of active social networks, sedentary social networks and active social networks lost on the association between neighbourhood walkability and sedentary behaviour. Twelve hundred community-dwelling older adults (≥60 years old) in Accra, Ghana, participated in this study. From these, 863 returned completed questionnaires on their social networks and sedentary behaviours and were incorporated into the analysis using Pearson’s correlation and hierarchical linear regression (HLR) models controlling for confounding variables identified using sensitivity analysis. Low neighbourhood walkability was associated with sedentary behaviour after controlling for confounders (β = –0.09; t = –2.7; p < 0.05). The negative influence of neighbourhood walkability on sedentary behaviour was significantly increased by the number of social network members independently of their activity levels. Low neighbourhood walkability was associated with sedentary behaviour, and older adults ought to constantly replenish or at least retain their social networks and active social networks in particular as they age to reduce sedentary behaviour.

Dust is a major component of fine particulate matter (PM

Ozone (O3) and nitrogen dioxide (NO2), indissoluble air pollutants in the atmosphere, have been confirmed in various parts of the world to have detrimental health effects on humans. Currently, such information is lacking in Kuwait. The objectives of this study are to investigate the spatial and temporal variations of O3 and NO2 concentrations in Kuwait during a 4-year period (2014-2017) and to quantify the associated short- and long-term health effects, including all-cause, respiratory, and cardiovascular mortalities and morbidities during the same study period. Exposure assessment showed that the annual levels (22.5-26.4 ppb), SOMO35, and the 8-hour 4-year mean (38 ppb) of O3 were very low and below the World Health Organization (WHO) (50 ppb) and Kuwaiti (70 ppb) regulatory limits. The annual mean levels of NO2 ranged from 30.3 to 43.8 ppb and were significantly higher than both WHO and Kuwait limits (21 ppb). As expected, O3 and NO2 levels showed opposing trends, with higher concentrations of NO2 recorded in early morning and mid-evening, during autumn and winter, and during Saturdays (the so-called weekend effect). Health effects indicated high respiratory diseases due to short-term exposure to NO2. Contrary to the western countries' pollution levels, Kuwait showed lower O3 and higher NO2 levels. There is potential for substantial health improvements in Kuwait by reducing NO2 pollution through stringent control measures of stationary and mobile sources.

The prevalence of diabetes mellitus (DM) is growing enormously worldwide, and actions need to be taken in order to minimize the burden of diabetes mellitus and reduce its complications. Since two-thirds of Kuwait’s population are expatriates, the prevalence of and factors associated with diabetes among migrant workers was assessed as it has a significant impact on migrant workers’ quality of life, health, and productivity. The data used in this study was for all migrant workers who attended Shuaiba Industrial Medical Center (SIMC) for physical examination in the year 2018. Univariate and multivariate regression were used to assess the relationship between diabetes mellitus and the other independent factors where odds ratios with confidence intervals were delineated. Information for a total of 3477 participants was recorded in the dataset for 2018. Of the total participants, 10.1% had diabetes mellitus. About 49% of the participants were overweight. The largest age group of participants was between 31 and 40 years of age. A small percentage of the participants were diagnosed with hypertension at 11.8%. Additionally, 76.1% of the participants reported themselves as non-smokers. Diabetes was positively associated with age, hypertension, and nationalities. However, no association was found between BMI and smoking tobacco. This is the first study in SIMC to assess DM and its associated risk factor among migrants, since migrant workers are neglected subpopulations that need our focus and attention to achieve justice and fairness. The findings revealed that the prevalence of DM among our study population was considerably lower. However, a healthy lifestyle, including a healthy diet and being physically active, need to be introduced to prevent any further damage.

Background Kuwait had its first COVID-19 in late February, and until October 6, 2020 it recorded 108,268 cases and 632 deaths. Despite implementing one of the strictest control measures-including a three-week complete lockdown, there was no sign of a declining epidemic curve. The objective of the current analyses is to determine, hypothetically, the optimal timing and duration of a full lockdown in Kuwait that would result in controlling new infections and lead to a substantial reduction in case hospitalizations. Methods The analysis was conducted using a stochastic Continuous-Time Markov Chain (CTMC), eight state model that depicts the disease transmission and spread of SARS-CoV 2. Transmission of infection occurs between individuals through social contacts at home, in schools, at work, and during other communal activities. Results The model shows that a lockdown 10 days before the epidemic peak for 90 days is optimal but a more realistic duration of 45 days can achieve about a 45% reduction in both new infections and case hospitalizations. Conclusions In the view of the forthcoming waves of the COVID19 pandemic anticipated in Kuwait using a correctly-timed and sufficiently long lockdown represents a workable management strategy that encompasses the most stringent form of social distancing with the ability to significantly reduce transmissions and hospitalizations.

Summary This study aimed to assess the moderating influence of neighborhood walkability on the association between physical activity (PA) and mental health among older African academics aged 50 years or more in cities with social distancing protocols in response to the Coronavirus disease 2019 (COVID-19). A total of 905 volunteer academics participated in the study. A hierarchical linear regression analysis was employed to conduct sensitivity analyses and test the study hypotheses. After controlling for sex, education and age, there was a positive association between PA and mental health. Neighborhood walkability moderated the relationship between PA and mental health, which suggests that during the pandemic PA was associated with higher mental health scores in more walkable neighborhoods. The study concludes that PA was beneficial to mental health in the social distancing context and was associated with higher mental health in more walkable neighborhoods, particularly in a social distancing context.

Background–Although the effect of hearing loss on years lived with disability (YLD) is quite substantial, occupational hearing loss among migrant workers is significantly under-studied. In Kuwait, where nearly two-thirds of the population are migrant workers, the burden of occupational noise-induced hearing loss (ONIHL) is unknown. Objective–To assess the prevalence of ONIHL among migrant workers in Kuwait and explore workplace and individual risk factors that are associated with ONIHL. Subjects and Methods–We obtained data of annual physical exams for the year 2018 conducted by the Shuaiba Industrial Medical Center (SIMC) for all industrial workers in the area. We applied univariate and multivariate logistic regression models to estimate the effects of individual and occupational characteristics on ONIHL. Results–A total of 3,474 industrial workers visited SIMC for an annual exam. The vast majority were men (99%) and non-Kuwaitis (98%) with a median age of 38 years. A total of 710 workers were diagnosed with ONIHL with a prevalence of 20.4%. Age, years of experience, and self-reported exposure to noise were associated with statistically significant higher odds of ONIHL. When adjusted for age, years of experience and other individual level factors, type of industry was not a statistically significant predictor of ONIHL. Conclusions–The study uncovers the significant burden of hearing loss among the migrant workers subpopulation in Kuwait, an area of occupational health that is often underestimated or unrecognized. Although laws and regulations are in place to prevent and control noise in the workplace, local authorities must ensure that industrial workers are provided with the necessary training and controls to reduce noise exposure.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a World Health Organization designated pandemic that can result in severe symptoms and death that disproportionately affects older patients or those with comorbidities. Kuwait reported its first imported cases of COVID-19 on February 24, 2020. Analysis of data from the first three months of community transmission of the COVID-19 outbreak in Kuwait can provide important guidance for decision-making when dealing with future SARS-CoV-2 epidemic wave management. The analysis of intervention scenarios can help to evaluate the possible impacts of various outbreak control measures going forward which aim to reduce the effective reproduction number during the initial outbreak wave. Herein we use a modified susceptible-exposed-asymptomatic-infectious-removed (SEAIR) transmission model to estimate the outbreak dynamics of SARS-CoV-2 transmission in Kuwait. We fit case data from the first 96 days in the model to estimate the basic reproduction number and used Google mobility data to refine community contact matrices. The SEAIR modelled scenarios allow for the analysis of various interventions to determine their effectiveness. The model can help inform future pandemic wave management, not only in Kuwait but for other countries as well.

Kuwait Vision 2035 is an initiative that was launched in 2017 by His Highness the Emir of the State of Kuwait Sheikh Sabah Al-Ahmad Al-Jaber Al-Sabah. This initiative includes the implementation of a detailed development plan aimed at transforming the state of Kuwait into a regional leader in science, technology, and innovation. Health research will arguably prove to be one of the most impactful research arenas when it comes to accomplishing the goals set forth by the Kuwait Vision 2035 Development Plan. The high impact of health research is derived from its capacity to aid in the establishment of a knowledge-based health industry. The state of Kuwait lacks a system for promoting and managing national R&D efforts. At present, the research and development (R&D) expenditure in the state of Kuwait is far below the international standards that have been shown to lead to innovation and the subsequent development of a knowledge-based economy. Improvement of the weak and unstructured existing R&D apparatus in the State of Kuwait is among the most urgent challenges facing the nation as it strives toward innovation and development of a knowledge-based economy. Developing health research capacities in the State of Kuwait can significantly contribute toward improving public health, health promotion, disease prevention and treatment, and overall human welfare. Importantly, the positive impacts of such extensive benefits will not be restricted to the state of Kuwait and its citizens, but may in fact reap benefits for the global society as a whole. This article first analyzes the current status of healthcare services and health science research in the State of Kuwait, and then summarizes some essential R&D design principles that Kuwait needs to implement in order to achieve the milestones set forth in the Kuwait Vision 2035 Development Plan.

As a marginalised subpopulation, migrant workers often fall short from protection by public policies, they take precarious jobs with unsafe working and living conditions and they grapple with cultural and linguistic barriers. In light of the current COVID-19 pandemic, migrant workers are now exposed to additional stressors of the virus and related responses. We applied a comprehensive qualitative cumulative risk assessment framework for migrant workers living in Kuwait. This pandemic could be one of the few examples where the stressors overlap all domains of migrant workers’ lives. No single intervention can solve all the problems; there must be a set of interventions to address all domains. Local authorities and employers must act quickly to stop the spread, ensure easy access to testing and treatment, provide adequate housing and clear communication, encourage wide social support, safeguard financial protection and mental well-being and continuously re-evaluate the situation as more data are collected.

Ozone (O

Background Previous climate change temperature-related health studies have been performed mostly in western countries with relatively cooler temperatures than the Gulf region. Regions that are inherently hot, like Kuwait, are witnessing soaring temperatures unlike ever before. Meanwhile, Kuwait and other Gulf countries are unique in their demographic profiles due to the large number of non-national migrant workers. Objective To examine the associations of hot and cold temperature extremes on the risk of mortality across gender, age groups and nationality in Kuwait. Methods We investigated daily variations of all-cause non-accidental and cardiovascular mortality death counts and ambient temperatures from 2010 to 2016 in a time-series design using a negative binomial distribution. The temperature lag was modeled with distributed lag non-linear models. Results A total of 33,472 all-cause non-accidental deaths happened during the study period. For the extreme hot temperatures and over the entire lag period, comparing the 99th percentile of temperature to the minimum mortality temperature, the risk of dying among males was 2.08 (95% CI: 1.23–3.52). Among non-Kuwaitis, males and working age group (15–64 year) had relative risks of death from extreme hot temperatures of 2.90 (1.42–5.93), and 2.59 (1.20–5.59), respectively. For extreme cold temperatures and over the entire lag period, comparing the 1st percentile of temperature to the minimum mortality temperature, the relative risk of death among Kuwaitis was 2.03 (1.05–3.93). Elderly Kuwaitis (65+ year) exposed to extreme cold temperatures had a relative risk of 2.75 (1.16–6.52). Conclusions Certain subpopulations in Kuwait are vulnerable to extreme temperatures with doubling to tripling risk of mortality. Nationality is an important effect modifier in temperature-related mortality studies in Kuwait and possibly the Gulf region. To the best of our knowledge, we are the first study to examine specific subpopulation vulnerabilities to temperature in this region. Our findings could carry a potential for broader insight into similar hyper-arid and hot regions.

Nationally, racial and ethnic disparities in childhood asthma plateaued from 2005 to 2013. We assessed trends in childhood asthma in Miami, Florida using Youth Risk Behavior Surveillance System (YRBSS) data and emergency department (ED) utilization and hospitalization rates by zip code population characteristics. Asthma prevalence in Miami did not vary significantly by race/ethnicity in YRBSS respondents in 2005 (16.2–17.2%, all groups), but rose in African–Americans and Hispanics and declined in Whites by 2013 to 27.9, 20.9 and 12.6%, respectively (P = 0.02). Median asthma ED visit rates rose from 106.8 (2006–2008) to 138.2 (2011–2013; P = 0.004) per 10,000 children. High-poverty and majority African–American zip codes were 6.3 and 7.3 times more likely to have asthma ED visit rates > 200 than others (P

Despite the tremendous achievement in reducing child mortality and morbidity in the last two decades, diarrhoea is still a major cause of morbidity and mortality among children in many developing countries, including Ethiopia. Hand washing with soap promotion, water quality improvements and improvements in excreta disposal significantly reduces diarrhoeal diseases. The objective of this study was to evaluate the effect of hand washing with soap and water, sanitation and hygiene (WASH) educational Intervention on the incidence of under-five children diarrhoea. A community-based cluster randomized controlled trial was conducted in 24 clusters (sub-Kebelles) in Jigjiga district, Somali region, Eastern Ethiopia from February 1 to July 30, 2015. The trial compared incidence of diarrhoea among under-five children whose primary caretakers receive hand washing with soap and water, sanitation, hygiene educational messages with control households. Generalized estimating equation with a log link function Poisson distribution family was used to compute adjusted incidence rate ratio and the corresponding 95% confidence interval. The results of this study show that the longitudinal adjusted incidence rate ratio (IRR) of diarrhoeal diseases comparing interventional and control households was 0.65 (95% CI 0.57, 0.73) suggesting an overall diarrhoeal diseases reduction of 35%. The results are similar to other trials of WASH educational interventions and hand washing with soap. In conclusion, hand washing with soap practice during critical times and WASH educational messages reduces childhood diarrhoea in the rural pastoralist area., Highlights • Childhood diarrhoea is the third leading cause of mortality in low income countries. • A community based RCT was conducted in the pastoralist Somali region of Ethiopia. • Intervention was hand washing with soap and WASH educational key messages. • Longitudinal adjusted incidence rate ratio (IRR) of diarrhoea was 0.65 (95% CI 0.57). • Intervention reduced childhood diarrhoea by 35% compared to controls communities.

It is well established that respiratory and cardiovascular mortality and morbidity rates are associated with poor air quality as measured by high concentrations of fine particulate matter such as PM

Our study examines the association of the presence of mildew, cockroaches, and pets in homes as well as household dust allergens with the prevalence and/or severity of allergic diseases. No study has concurrently assessed home environment exposures in relation to allergic conditions in the general US population. Data from 5409 participants from the 2005–2006 National Health and Nutrition Examination Survey (NHANES) living in their current homes for ≥one year were analyzed. Multivariate logistic regression analyses between home exposures and allergic diseases prevalence and severity were performed. In adjusted analyses, mildew was associated with higher current asthma, allergies, and allergic rhinitis prevalence, endotoxin, with higher current asthma prevalence, and dust Canis familiaris (Can f) 1, with higher allergic rhinitis prevalence. However, presence of cockroaches and dust Dermatophagoides farinae (Der f) 1 were associated, respectively, with lower current asthma and allergies prevalence. Presence of mildew, dust Der f1, Dermatophagoides pteronyssinus (Der p) 1, Felis domesticus (Fel d) 1, and endotoxin were all associated with asthma and/or wheeze severity. Non-atopic asthma was more frequent with mildew and/or musty smell dust and higher dust Fel d1 concentration, while atopic asthma was more prevalent with higher Can f1 and endotoxin concentrations in dust. This study confirms previous relationships and reports novel associations, generating hypotheses for future research.

The public health field has built a body of literature showing health benefits from improvements in water quality. However, the connection between roof harvested rainwater and health is not well documented especially in developing countries. Understanding the application of locally available treatment methods provides insight into this problem. This paper reports on experimental investigations where rainwater collected from a typical domestic roof in Mekelle, Ethiopia was treated using Moringa stenopetala seed, sand filter and boiling. The quality of the raw and treated roof harvested rainwater were compared against the Ethiopian and World Health Organization drinking water standards to investigate its suitability as a supplement for potable water supply. The pollutants analysed were total coliforms and turbidity. A significant improvement of turbidity and total coliforms was observed. This implies that application of plant coagulant followed by filtration can sufficiently treat rainwater and can ...

Curbing water scarcity problems in semi-arid regions is a top priority for economic and social development. Alternative strategies for sustainable domestic water supply are therefore required to augment water supply with affordable cost and technology. Scant research findings in sub-Saharan Africa have, however, reported inefficiency in adapting to water scarcity problems in the region. Therefore, an investigation of domestic rainwater harvesting (RWH) reliability is important to identify factors affecting the system. We found that rainwater harvesting with the existing traditional RWH systems in Mekelle city was unreliable. Unreliability was attributed to inefficient design (the systems were installed without considering deterministically the stochastic nature of rainfall), family size, water demand, rooftop area and storage tank size.Editor M.C. Acreman; Associate editor S. Kanae

It is estimated that about 1.2 billion people, mostly in arid and semi-arid regions of the Middle East and Africa, live in regions where water is physically scarce. Recently, rainwater harvesting and more effective water storage are suggested as important means for investment to cope against water scarcity and as an adaption to climate change. Cognizant of this fact, contribution of atmospheric deposition contaminant to rainwater harvesting systems, in the semi-arid city of Mekelle was investigated at four locations (industrial, commercial, traffic and residential areas). A total of 24 bulk samples were collected during the rainy season from May to September 2014. Physicochemical water quality analysis was performed following standard protocols. The results revealed that alkaline pH (6.95–10.29) was recorded in all the locations, with a mean pH of 8.11. The major ions analysis indicated the dominance of bicarbonates and carbonate types and to some extent sulfate and chloride type mixtures justifying the source of alkaline pH. Mean concentrations of ions follow the order of SO4 2−> Ca2+ > Mg2+ > CI−> NO3 −> Na+ > NH4 + > K. Correlation between SO4 2− and NO3 − (r = 0.436), and Mg2+ and K+ (r = 0.707) suggested their anthropogenic and crustal origin, respectively, while the correlation between NH4 + with Ca2+ and Mg2+ ascribed their role in alkalization of the rainwater. Moreover, principal component analysis showed spatiotemporal variation of atmospheric bulk components in the study area. Thus, this primary investigation demonstrated that atmospheric bulk deposition might pose public health risk due to poor rainwater quality in Mekelle city. Therefore, development of rainwater harvesting systems for semi-arid urban centers should be supplemented with low-cost water treatment technologies.

Background: Diarrheal disease is a major cause of morbidity and mortality among children in many developing countries, including Ethiopia and is a leading cause of morbidity in Pastoralist Ethiopian-Somali region. Diarrheal disease is not purely medical, but huge part of this should be traced back to the social, economic, environmental and behavioural aspects of the family. Determining these interactions is relevant to prevent and control diarrhoea. Objective: The objective of this study was to measure the prevalence of diarrhoea and describe associated factors relating to diarrheal disease among under-five children in Jigjiga district. Methods: A cross-sectional study was conducted in Jigjiga district from June 12 to 26 in 2014 using a structured and pretested questionnaire. A total of 1807 primary care takers were interviewed. Proportionate to size allocation was done and simple random selection was used to select sample units. Diarrheal morbidity occurred in the under-five children in the past 14 days were registered to determine prevalence. Data were entered using Epi Info version 3.5.3 and analysed in SPSS version 20. Odds ratio with 95% CI in a multivariate logistic regression was employed to control confounding factors. Results: The findings of this study showed that the overall two-week period prevalence of diarrhoea in under-five children was 27.3%: 95% CI (26.9%, 27.4%). Education of the primary caretaker, occupation of the father, birth order of the child, maternal diarrhoea, and hand washing during critical times, water source, type of water storage container, latrine availability, frequency of household solid waste water disposal, availability of liquid waste water drainage system and the type of the kitchen floor material showed as independent predictors of under-five child hood diarrhoea. Conclusion: This study revealed that diarrhoea morbidity was relatively high among children under-five years of age residing in Somali region. Efforts to reduce childhood diarrhoea should focus mainly on water, sanitation and hygiene interventions including health education.

The world is currently facing a serious pandemic of Coronavirus (COVID 19) which started in Wuhan, China, and was then transmitted rapidly to other countries. These countries applied different methods and procedures in an attempt to prevent or reduce and/or control the incident cases and manage prevalent cases. This paper discusses the methods and procedures applied in the State of Kuwait to control this epidemic, and how effective they have been. The State of Kuwait followed the WHO, European CDC, US CDC, and/or other countries’ institutional guidelines, and is still working on containing the disease, given the rising number of cases among Kuwaitis returning from affected areas such as the UK and USA, and migrant workers who bear the highest burden, given their cramped living conditions.

Ambient air pollution in terms of fine and coarse particulate matter (PM2.5 and PM10) has been shown to increase adult and infant mortalities. Most studies have estimated the risk of mortalities through attributable proportions and number of excess cases with no reference to the time lost due to premature mortalities. Disability adjusted life years (DALYs) are necessary to measure the health impact of Ambient particulate matter (PM) over time. In this study, we used life-tables for three years (2014&ndash, 2016) to estimate the years of life lost (YLL), a main component of DALYs, for adult mortalities (age 30+ years) and postneonatal infant mortalities (age 28+ days&ndash, 1 year) associated with PM2.5 exposure and PM10 exposure, respectively. The annual average of PM2.5 and PM10 concentrations were recorded as 87.9 &mu, g/m3 and 167.5 &mu, g/m3, which are 8 times greater than the World Health Organization (WHO) air quality guidelines of 10 &mu, g/m3 and 20 &mu, g/m3, respectively. Results indicated a total of 252.18 (95% CI: 170.69&ndash, 322.92) YLL for all ages with an increase of 27,474.61 (95% CI: 18,483.02&ndash, 35,370.58) YLL over 10 years. The expected life remaining (ELR) calculations showed that 30- and 65-year-old persons would gain 2.34 years and 1.93 years, respectively if the current PM2.5 exposure levels were reduced to the WHO interim targets (IT-1 = 35 &mu, g/m3). Newborns and 1-year old children may live 79.81 and 78.94 years, respectively with an increase in average life expectancy of 2.65 years if the WHO PM10 interim targets were met (IT-1 = 70 &mu, g/m3). Sensitivity analyses for YLL were carried out for the years 2015, 2025, and 2045 and showed that the years of life would increase significantly for age groups between 30 and 85. Life expectancy, especially for the elderly (&ge, 60 years), would increase at higher rates if PM2.5 levels were reduced further. This study can be helpful for the assessment of poor air quality represented by PM2.5 and PM10 exposures in causing premature adult mortalities and postneonatal infant mortalities in developing countries with high ambient air pollution. Information in this article adds insights to the sustainable development goals (SDG 3.9.1 and 11.6.2) related to the reduction of mortality rates attributed to ambient air levels of coarse and fine particulate matter.

Introduction DRC is endowed with enormous mining potential, the exploitation of which promises great hope of economic development. However, the various activities carried out during several years of operation have led to negative environmental and social impacts. The exploitation of mineral deposits has had deleterious effects on the biophysical, socio-economic and health aspects of the surrounding populations. Methods Systematic and impartial assessment of mining activities was conducted in terms of environmental impacts, waste management, implementation of environmental control mitigation measures, and emergency plan, according to national regulations and requirements of The World Bank. Field study required visits to the sites in the Provinces of Katanga, Kasai Oriental and Kasai Occidental, collection of samples of water and soil, collection of health data, and interviews with key personnel including representatives of mining companies, miners and surrounding populations. Result Samples of surface water, groundwater and soil were collected and analysed along with surveys on occupational health and safety issues including noise and observations carried out by the group of experts on the basis of literature in the field. The contaminants that were above the standard included Silver, Arsenic, Copper, Molybdenum, Chromium, Zinc, Manganese, Mercury, Potassium and Sulphur, Nitrites and Nitrates, and suspended organic matter. Resulting population displacements had quite disruptive social effects and serious risks of impoverishment on aboriginal families and residents and damage to the environment. Discussion Issues of waste management, liquid effluents, especially acid mine drainage, and the enormous excavation holes were quite noticeable. The analysis revealed exceedance of the current standards of DRC, WHO or Quebec, concerning the quality of surface and ground water, and soil quality. This mission laid the groundwork for an awareness of the dangers that threaten the environment in general, and especially the populations living in the vicinity of explored mining sites along with mitigation measures.

Background: Blood biomarkers are easily accessible and might reflect chronic obstructive pulmonary disease (COPD) activity. Aim: The aim of this study was to determine whether a panel of blood biomarkers [C‐reactive protein (CRP), neutrophils, eosinophils, albumin and vitamin D] could predict mortality in COPD. Methods: We analyzed data from 431 COPD participants to the 2007‐2010 National Health and Nutrition Examination Surveys who were followed for a median time of 36 months. COPD was defined as post‐bronchodilator forced expiratory volume in 1 second (FEV1) and forced vital capacity ratio

Asthma is the most common chronic pediatric condition (14%) and the leading cause of school absenteeism in the USA. However, little is known about asthma prevalence and distribution in schoolchildren in the Florida Keys region (Monroe County). Thus, the objectives of this study were to assess asthma prevalence, symptoms, cost and distribution in schoolchildren in the Florida Keys region and to pinpoint where asthma management services are most needed.Cross-sectional survey data on asthma prevalence, symptoms and socio-demographics was collected and analyzed by race, sex, grade and zip code. A total of 2313 parents of schoolchildren in the Florida Keys completed the adapted Harlem Empowerment Zone Asthma Initiative Questionnaire. The questionnaire was distributed to school principals, who sent them home with students to be filled out by parents or caregivers. We also analyzed data from the online Monroe County 2012 Florida Youth Tobacco Survey, the 2011 Florida CHARTS, the Medical Expenditures Panel Survey, and emergency departments (ED). Data were analyzed by race, sex, and grade.In total 14.5% of respondents had been told their child had asthma and 9.6% reported their child had wheezing in the last 12 months. The prevalence was higher in the Lower Keys and Key West regions. Parents from households where anyone smoked cigarettes (OR 1.52, 95% CI 1.11-2.09) and those who had a male child (1.53, 1.17-2.00) more often reported that their child had asthma. The rate of asthma-related ED visits for Black non-Hispanic schoolchildren (1202 per 100,000) was substantially higher than the numbers for White (250.2 per 100,000) and Hispanic schoolchildren (325.1 per 100,000). Most of the direct cost of asthma was concentrated in children in grades four through seven ($1236.02-$2147.02 per child).The asthma prevalence in a sample of schoolchildren in the Florida Keys region was comparable to the nationwide prevalence. Black non-Hispanic schoolchildren had more asthma-related ED visits that White and Hispanic schoolchildren. Most of the direct cost of asthma is concentrated in children in late elementary through early middle school grades. Interventions are needed, particularly targeting Black schoolchildren in late elementary through early middle school grades in Lower Keys and Key West region.

Serotonin reuptake variation is linked to a functional polymorphism in the promoter region of the SLC6A4 gene on chromosome 17. It is plausible that variations in genetically determined SLC6A4 activity may modify the risk for alcohol dependence. To determine whether this allele is associated with alcohol dependence, the authors conducted a systematic review and meta-analysis. Twenty-five studies including 8885 participants were reviewed and analyzed. The meta-analysis was carried out using a random-effects model. Overall, the results did not support an association between alcohol dependence and the SLC6A4 promoter polymorphism for the dominant, recessive, and additive genetic risk models, respectively [odds ratio (OR)=0.99 (95% confidence interval (CI): 0.83, 1.18), OR=0.86 (95% CI: 0.71, 1.03), and OR=0.88 (95% CI: 0.69, 1.13)]. When effect modification was tested for sex, race/ethnicity, presence/absence of a psychiatric disorder, year of publication, and diagnostic criteria, none of the factors were found to be significantly associated with alcohol dependence. The findings in this meta-analysis suggest that the SLC6A4 promoter polymorphism is not associated with alcohol dependence.

Background Perceived to be distinct, asthma and chronic obstructive pulmonary disease (COPD) can co-exist and potentially have a worse prognosis than the separate diseases. Yet, little is known about the exact prevalence and the characteristics of the Asthma-COPD overlap (ACO) in the US population. Aims To determine ACO prevalence in the United States, identify ACO predictors, examine ACO association with asthma and COPD severity, and describe distinctive spirometry and laboratory features of ACO. Methods Data on adult participants to the National Health and Nutrition Examination Surveys conducted from 2007 to 2012 was analyzed. ACO was defined as current asthma and post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) Results Overall, 7,570 participants representing 98.58 million Americans were included in our study. From 2007 to 2012, the crude and age-standardized ACO prevalence were, respectively, 0.96% (95% CI: 0.65%-1.26%) and 1.05% (0.74%-1.37%). In asthma, ACO predictors included older age, male gender, and smoking. In COPD, ACO predictors were non-Hispanic Black race/ethnicity and obesity. ACO was associated with increased ER visits for asthma (OR = 3.46, 95% CI: 1.48-8.06]) and oxygen therapy in COPD (OR = 11.17, 95% CI: 5.17-24.12]). In spirometry, FEV1 and peak expiratory flow were lower in ACO than in asthma or COPD alone. Conclusion Age-adjusted prevalence of ACO in the United States was 1.05% in 2007-2012, representing 0.94 (95% CI: 0.62-1.26) million Americans. It is much lower than previously reported. The overlap was associated with higher asthma and COPD severity as well as decreased lung function compared with COPD or asthma alone.

Introduction Childhood diarrhea is a global public health problem that affects both developed and developing countries including Ethiopia. The objective of this study was to assess determinants of childhood diarrhea among children under-five years of age in West Gojjam Zone, northwest Ethiopia. Methods A community-based case control study was conducted in four districts of West Gojjam in the northwest of Ethiopia from July to August, 2015. A randomly selected sample of 118 cases and 351 controls who met the inclusion criteria were included in this study. Data were collected using a structured questionnaire through face to face interview. Independent variables which had p-value less than 0.2 at an unadjusted model were candidate for the final model. Adjusted odds ratio was used to control confounding effects and to determine predictors of an outcome. Results Unimproved water sources (AOR, 1.88; 95 % CI: 1.17-3.03), lack of hand washing at critical times (AOR, 2.38; 95 % CI: 1.42-3.99) and a deepening method to take water from a water storage container (AOR, 2.11; 95 % CI: 1.28-3.47), presence of two or more young siblings (AOR, 4.15; 95 % CI: 2.57-6.70), rural residence (AOR,2.11 95 % CI: 2.21-3.68), and not using latrine for disposal of child feces (AOR, 1.90; 95 % CI: 1.12-3.22) were predictors of diarrhea among children under the age of five. Conclusion The majority of the causes of childhood diarrhea in the study area were preventable. Thus, health extension workers should give tailored health information to mothers or caregivers on the importance of sanitation, personal and environmental hygiene and drinking water handling methods.

Background Inadequate sanitation is one of the leading causes of disease in poor and middle-income countries. Objective The objective of the study was to identify the psychological factors that predict latrine ownership and consistent latrine use in the rural Becho district of central Ethiopia. Method A quantitative, cross-sectional, community based study was conducted. A total of 1047 heads of household were interviewed using a structured questionnaire. Ownership of latrine and consistent latrine use constituted the outcome variable of the study. Data were entered using Epi Info version 3.5.4 and were analyzed using SPSS version 20. Results Of the 1047 households, 73% owned a traditional pit latrine. Among the psychological factors, attitude (AOR 1.70; 95% CI 1.21–2.37) and injunctive norm (AOR 6.18; 95% CI 4.46–10.44) were positively and significantly associated with latrine ownership. Among the demographic factors, having a family size of more than six (AOR = 1.43; 95% CI 1.01–1.97, having a child attending school (AOR = 1.88; 95% CI 1.17–3.02), and having a high school education (AOR = 1.98; 95% CI 1.34–2.87) were significantly associated with latrine ownership. With respect to exposure to communication about sanitation (the cues to action), households that had a family member who took part in Community Led Total Sanitation and Hygiene (CLTSH) triggering were three times more likely to be latrine owners than those who did not participate in CLTSH triggering (95% CI 1.92–4.78.) Results from adjusted logistic regression analysis of potential predictors of consistent latrine use showed that having a positive attitude (AOR 7.00; 95% CI 4.55–10.55), owning of a latrine that had superstructure (AOR 2.3 95% CI 1.47–3.48), having a clean latrine (AOR 1.69 95% CI 1.00–3.00), and having a latrine with a protected door (AOR 1.94; 95% CI 1.10–3.48) were significantly associated with consistent latrine use. Conclusion The study findings showed that attitude and injunctive norm are the psychological predictors of latrine ownership, and consistent latrine use was associated with attitude, cleanliness of the latrine, and its privacy. Hence, sanitation intervention needs to focus on changing societal norms, attitudes, and the promotion of latrine quality.

Cytomegalovirus (CMV) infects 40 % of the world population and has been suggested to be associated with diabetes; however, no prospective study has ever examined diabetes mortality associated with the infection. A cohort of 14,404 non-diabetic adult participants aged 17–90 years from the Third National Health and Nutrition Examination Survey (1988–1994) was prospectively followed for mortality through 2006. CMV immunoglobulin G was measured by enzyme-linked immunosorbent assay and immunofluorescence assay. Diabetes death was assessed with death records from the National Death Index. Cox proportional hazards modeling was used to determine diabetes mortality risk associated with CMV infection, adjusting for socio-demographics, diabetes risk factors, and comorbidities. At baseline, 76.8 % of subjects were CMV seropositive, and after an average follow-up of 13.7 years, diabetes mortality rate per 10,000 person-years was 6.8 (95 % CI 5.7, 8.0). Among seropositive participants, the diabetes death rate (8.4, 95 % CI 7.0, 9.9) was more than four times the rate in seronegative ones (2.0, 95 % CI 1.1, 3.6) (P value for the difference