The objective of the study was to describe systemic bacterial infections occurring in acutely ill and hospitalized children in a rural region in Ghana, regarding frequency, incidence, antimicrobial susceptibility patterns and associations with anthropometrical data.Blood cultures were performed in all children below the age of five years, who were admitted to Agogo Presbyterian Hospital (APH), Asante Region, Ghana, between September 2007 and July 2009. Medical history and anthropometrical data were assessed using a standardized questionnaire at admission. Incidences were calculated after considering the coverage population adjusted for village-dependent health-seeking behavior.Among 1,196 hospitalized children, 19.9% (n = 238) were blood culture positive. The four most frequent isolated pathogens were nontyphoidal salmonellae (NTS) (53.3%; n = 129), Staphylococcus aureus (13.2%; n = 32), Streptococcus pneumoniae (9.1%; n = 22) and Salmonella ser. Typhi (7.0%; n = 17). Yearly cumulative incidence of bacteremia was 46.6 cases/1,000 (CI 40.9–52.2). Yearly cumulative incidences per 1,000 of the four most frequent isolates were 25.2 (CI 21.1–29.4) for NTS, 6.3 (CI 4.1–8.4) for S. aureus, 4.3 (CI 2.5–6.1) for S. pneumoniae and 3.3 (CI 1.8–4.9) for Salmonella ser. Typhi. Wasting was positively associated with bacteremia and systemic NTS bloodstream infection. Children older than three months had more often NTS bacteremia than younger children. Ninety-eight percent of NTS and 100% of Salmonella ser. Typhi isolates were susceptible to ciprofloxacin, whereas both tested 100% susceptible to ceftriaxone. Seventy-seven percent of NTS and 65% of Salmonella ser. Typhi isolates were multi-drug resistant (MDR). Systemic bacterial infections in nearly 20% of hospitalized children underline the need for microbiological diagnostics, to guide targeted antimicrobial treatment and prevention of bacteremia. If microbiological diagnostics are lacking, calculated antimicrobial treatment of severely ill children in malaria-endemic areas should be considered.

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BackgroundThe socioeconomic and sociodemographic situation are important components for the design and assessment of malaria control measures. In malaria endemic areas, however, valid classification of socioeconomic factors is difficult due to the lack of standardized tax and income data. The objective of this study was to quantify household socioeconomic levels using principal component analyses (PCA) to a set of indicator variables and to use a classification scheme for the multivariate analysis of children < 15 years of age presented with and without malaria to an outpatient department of a rural hospital.MethodsIn total, 1,496 children presenting to the hospital were examined for malaria parasites and interviewed with a standardized questionnaire. The information of eleven indicators of the family's housing situation was reduced by PCA to a socioeconomic score, which was then classified into three socioeconomic status (poor, average and rich). Their influence on the malaria occurrence was analysed together with malaria risk co-factors, such as sex, parent's educational and ethnic background, number of children living in a household, applied malaria protection measures, place of residence and age of the child and the mother.ResultsThe multivariate regression analysis demonstrated that the proportion of children with malaria decreased with increasing socioeconomic status as classified by PCA (p < 0.05). Other independent factors for malaria risk were the use of malaria protection measures (p < 0.05), the place of residence (p < 0.05), and the age of the child (p < 0.05).ConclusionsThe socioeconomic situation is significantly associated with malaria even in holoendemic rural areas where economic differences are not much pronounced. Valid classification of the socioeconomic level is crucial to be considered as confounder in intervention trials and in the planning of malaria control measures.

In times of rapid urbanization, health and well-being of citizens is increasingly recognized as a challenge. A remarkable amount of research on relations between urban environments and health or well-being has been conducted. To get an insight about the existing measurements on both health combined with well-being, a systematic literature search was conducted using the databases PubMed and ScienceDirect including references until July 2017. To classify the references a conceptual model describing interrelationships between factors that may be associated with health-related urban well-being was used. The keywords "urban", "well-being", and "health" were applied together with factors described in the model. Twenty-four articles met the inclusion criteria. Of these, most studies focused on associations between urban green, health and well-being showing the great importance of green space usage in urban settings to promote better health and well-being. Health was mostly assessed by the General Health Questionnaire (GHQ-12); to measure well-being, the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) was mostly used. There are still only a few studies investigating the great complexity of urban health and well-being. More specifically, there is a lack in interdisciplinary approaches that highlight the complexity of urban structures and dynamics and their possible influence on urban health and well-being.

In October 2009, two–3 months after an outbreak of a febrile disease with joint pain on the eastern coast of Madagascar, we assessed serologic markers for chikungunya virus (CHIKV), dengue virus (DENV), and Rift Valley fever virus (RVFV) in 1,244 pregnant women at 6 locations. In 2 eastern coast towns, IgG seroprevalence against CHIKV was 45% and 23%; IgM seroprevalence was 28% and 5%. IgG seroprevalence against DENV was 17% and 11%. No anti-DENV IgM was detected. At 4 locations, 450–1,300 m high, IgG seroprevalence against CHIKV was 0%–3%, suggesting CHIKV had not spread to higher inland-altitudes. Four women had IgG against RVFV, probably antibodies from a 2008 epidemic. Most (78%) women from coastal locations with CHIKV-specific IgG reported joint pain and stiffness; 21% reported no symptoms. CHIKV infection was significantly associated with high bodyweight. The outbreak was an isolated CHIKV epidemic without relevant DENV co-transmission.

Abstract:In cities, social well-being faces obstacles posed by globalization, demographic and climate change, new forms of social organization, and the fragmentation of lifestyles. These changes affect the vulnerability of city societies and impact their health-related urban well-being (UrbWellth). The conceptual model introduced in this paper systematizes the relevant variables while considering previous research, and establishes the target value UrbWellth. The model differs from existing approaches mainly in the analytical distinctions it suggests. These allow us to group the relevant urban influence variables into four sectors and enable a more general and abstract consideration of health-related urban relations. The introduction of vulnerability as a filter and transfer function acts as an effect modifier between UrbWellth and the various urban variables.

Malaria belongs to the infectious diseases with the highest morbidity and mortality worldwide. As a vector-borne disease malaria distribution is strongly influenced by environmental factors. The aim of this study was to investigate the association between malaria risk and different land cover classes by using high-resolution multispectral Ikonos images and Poisson regression analyses. The association of malaria incidence with land cover around 12 villages in the Ashanti Region, Ghana, was assessed in 1,988 children <15 years of age. The median malaria incidence was 85.7 per 1,000 inhabitants and year (range 28.4–272.7). Swampy areas and banana/plantain production in the proximity of villages were strong predictors of a high malaria incidence. An increase of 10% of swampy area coverage in the 2 km radius around a village led to a 43% higher incidence (relative risk [RR] = 1.43, p<0.001). Each 10% increase of area with banana/plantain production around a village tripled the risk for malaria (RR = 3.25, p<0.001). An increase in forested area of 10% was associated with a 47% decrease of malaria incidence (RR = 0.53, p = 0.029).Distinct cultivation in the proximity of homesteads was associated with childhood malaria in a rural area in Ghana. The analyses demonstrate the usefulness of satellite images for the prediction of malaria endemicity. Thus, planning and monitoring of malaria control measures should be assisted by models based on geographic information systems.

Living in cities offers many benefits and thus more and more people are living in urban areas. However, the concentration of human activities also creates environmental stressors with severe influence on people's health and well-being. Noise is an environmental stressor with known health impact. Despite this, studies investigating small-scale difference in noise exposure and annoyance are lacking. Against this background, this case study investigates environmental justice empirically, focusing on the distribution of road traffic noise and its perception in Hamburg, Germany. The study outlines a methodological approach that takes into account subjective and objective measures of exposure in small-scale residential blocks. The results show that annoyance by noise is clearly related to noise emission. Moreover, different groups are affected by noise pollution in our study area unequally. In particular, younger people and people with lower socio-economic status have higher probabilities to be affected by noise. Additionally, it emerged that participants reporting higher levels of annoyance from noise are on average younger than those feeling less annoyed. Overall, these results show that the current legal noise limits applicable to residential planning processes in German cities are not sufficient to prevent substantial annoyance effects in residential populations.