Patrick O Owili | African Population and Health Research Center (original) (raw)

Papers by Patrick O Owili

Research paper thumbnail of Implementation Determinants of Zimbabwe National Occupational Safety and Health Policy in Willowvale Industrial Area, Zimbabwe

International Journal of Environmental Research and Public Health, 2022

Zimbabwe introduced the National Occupational Safety and Health Policy (ZNOSHP) in August 2014 wi... more Zimbabwe introduced the National Occupational Safety and Health Policy (ZNOSHP) in August 2014 with the vision and mission to eliminate occupational accidents, injuries, diseases, and fatalities and to promote Occupational Safety and Health (OSH). This study was therefore aimed at exploring the individual- and organizational-level determinants of ZNOSHP’s implementation. Data were collected from 309 workers in the Willowvale industrial area in Harare, Zimbabwe. Negative binomial regression models were used to explore the determinants of ZNOSHP’s implementation. After adjustment, participant’s knowledge of ZNOSHP (Incidence Rate Ratio, IRR = 1.32; 95% Confidence Interval, CI: 1.19–1.46; p ≤ 0.001), production department (IRR = 1.13; 95% CI: 1.03–1.26; p ≤ 0.05), company years of operation (IRR = 1.33; 95% CI: 1.21–1.46; p ≤ 0.001), participants who identified several implementation barriers (IRR = 1.12; 95% CI: 1.01–1.25; p ≤ 0.001), and agricultural industry were associated with hig...

Research paper thumbnail of Global Health Challenges : Issues in preparing students for developing skills and competencies in global health - a middle range future perspective

Health care professionals are increasingly faced with challenges that require an understanding of... more Health care professionals are increasingly faced with challenges that require an understanding of global health trends, practices and threats. The PubMed search was limited to articles published in the Lancet journal between 2016 and 2017 with a special effort to better understand future perspectives of global health issues and ultimately to plan, reconstruct and develop the curriculum for the next cohort of the Master’s Programme in Global Health Care. The database search identified 102 references of which the abstracts were reviewed more closely. As a result, the most prominent health issues are related to neglected tropical diseases (NTDs) – a diverse group of communicable diseases highlighting the importance of vaccination coverage and adequate sanitation. Organic and inorganic pollutants also pose a challenge in the form of increased burden of disease. Burden of non-communicable diseases, such as diabetes and memory disorders increase globally. Furthermore, the need for prevent...

Research paper thumbnail of Perceptions and Attitudes of Health Professionals in Kenya on National Health Care Resource Allocation Mechanisms: A Structural Equation Modeling

PLOS ONE, 2015

Background Health care resource allocation is key towards attaining equity in the health system. ... more Background Health care resource allocation is key towards attaining equity in the health system. However, health professionals' perceived impact and attitude towards health care resource allocation in Sub-Saharan Africa is unknown; furthermore, they occupy a position which makes them notice the impact of different policies in their health system. This study explored perceptions and attitudes of health professionals in Kenya on health care resource allocation mechanism.

Research paper thumbnail of Real-time Mobile Electrocardiogram Monitoring for Mass Events and Competitions with Difficult-to-Access Locations

Computer Methods and Programs in Biomedicine, 2015

Using mobile wireless technology to monitor ECG in participants of mass events and sports taking ... more Using mobile wireless technology to monitor ECG in participants of mass events and sports taking place in difficult-to-access location could both prevent and easier detect arrhythmias as well as provide real-time monitoring for any type of injury. We assessed the effectiveness of mobile wireless monitoring technology and IT in detecting possible emergencies during a skyscraper race. We attached specially designed wireless surveillance biopatches on 120 individuals participating to monitor their continuous ECG and location during a skyscraper run-up race at Taipei 101 building, Taiwan. The outcomes of interest were detection of abnormal heartbeats and QRS waves indicative of possible cardiac problems and the exact location of participants during the occurrence of emergencies. The devices accurately sent over 50 warnings to our monitoring platform when both, danger limits were reached by competitors (<60 or >195 beats per minute) or competitors stopped moving, proving very effective in quickly detecting abnormities and alerting staff of possible emergencies at exact locations. This efficient and inexpensive monitoring method can also prevent arrhythmias in unscreened competitors, the danger of collision among staff and competitors, and preserves oxygen by eliminating additional on-foot monitoring staff. Additionally, it could have multipurpose usage, especially during disasters and accidents occurring in difficult-to-access locations, in military exercises and personal monitoring.

Research paper thumbnail of Analysis of Pneumonia Occurrence in Relation to Climate Change in Tanga, Tanzania

International Journal of Environmental Research and Public Health, 2021

In 2018, 70% of global fatalities due to pneumonia occurred in about fifteen countries, with Tanz... more In 2018, 70% of global fatalities due to pneumonia occurred in about fifteen countries, with Tanzania being among the top eight countries contributing to these deaths. Environmental and individual factors contributing to these deaths may be multifaceted, but they have not yet been explored in Tanzania. Therefore, in this study, we explore the association between climate change and the occurrence of pneumonia in the Tanga Region, Tanzania. A time series study design was employed using meteorological and health data of the Tanga Region collected from January 2016 to December 2018 from the Tanzania Meteorological Authority and Health Management Information System, respectively. The generalized negative binomial regression technique was used to explore the associations between climate indicators (i.e., precipitation, humidity, and temperature) and the occurrence of pneumonia. There were trend differences in climate indicators and the occurrence of pneumonia between the Tanga and Handeni...

Research paper thumbnail of Impacts of discriminated PM2.5 on global under-five and maternal mortality

Scientific Reports

Globally, it was estimated that maternal and under-five deaths were high in low-income countries ... more Globally, it was estimated that maternal and under-five deaths were high in low-income countries than that of high-income countries. Most studies, however, have focused only on the clinical causes of maternal and under-five deaths, and yet there could be other factors such as ambient particulate matter (PM). The current global estimates indicate that exposure to ambient PM2.5 (with ≤ 2.5 microns aerodynamic diameter) has caused about 7 million deaths and over 100 million disability-adjusted life-years. There are also several health risks that have been linked PM2.5, including mortality, both regionally and globally; however, PM2.5 is a mixture of many compounds from various sources. Globally, there is little evidence of the health effects of various types of PM2.5, which may uniquely contribute to the global burden of disease. Currently, only two studies had estimated the effects of discriminated ambient PM2.5, that is, anthropogenic, biomass and dust, on under-five and maternal mor...

Research paper thumbnail of Trend of Cryptosporidium Infection among Children below 24 Months in an Informal Urban Settlement, Kenya

Open Journal of Medical Microbiology

Research paper thumbnail of Ambient Particulate Matter Exposure and Under-Five and Maternal Deaths in Asia

International Journal of Environmental Research and Public Health

The Asian region is one of the major emission sources of air pollution. Although ambient PM2.5 ha... more The Asian region is one of the major emission sources of air pollution. Although ambient PM2.5 has been linked to several health risks in high-, low-, and middle-income countries, the further analysis of type impact is still rare but significant. The PM2.5 distribution retrieved from MODIS (Moderate Resolution Imaging Spectroradiometer) aerosol optical depth products within 16 years thus explored the associations between under-five and maternal mortality for 45 countries in Asia. Both the nonparametric (Generalized Additive Mixed-Effect) and parametric (Generalized Linear Mixed-Effect) models were employed to analyze the collected datasets. The results show that the levels of PM2.5 in Asian sub-regions were higher than the Global Air Quality Standards. Biomass PM2.5 concentrations was associated with increased the rate of under-five (Incidence Rate Ratio, IRR = 1.29, 95% CI, 1.13–1.47) and maternal (IRR = 1.09, 95% CI: 1.08–1.10) deaths in Asia. Anthropogenic PM2.5 was associated wi...

Research paper thumbnail of Gender Difference in the Association between Environmental Tobacco Smoke and Birth Weight in Africa

International Journal of Environmental Research and Public Health

The adverse health effects of exposure to environmental tobacco smoke (ETS) on children are well-... more The adverse health effects of exposure to environmental tobacco smoke (ETS) on children are well-documented, and yet, gender difference in low birthweight among newborns whose mothers were exposed to ETS during pregnancy still remains contentious. We therefore explored the association between ETS exposure and risk of low birthweight, and further determined the gender difference in the association between exposure to ETS during pregnancy and birth weight in Africa. The Demographic Health Surveys of 23 African countries with information on 208,027 newborns were used. The associations between exposure to ETS and birth weight was estimated using multiple logistic regression models. Exposure to ETS increased the risk of low birthweight in Africa (adjusted odds ratio (OR) = 1.06; 95% Confidence Interval (CI): 1.02-1.10). A stratified analysis, by gender, revealed that male newborns whose mothers were exposed to ETS were 1.08 (95% CI: 1.02-1.14) times more likely to be low in birthweight than those whose mothers were not exposed, with those exposed weekly (adjusted OR = 1.17; 95% CI: 1.01-1.35) and daily (adjusted OR = 1.06; 95% CI: 1.01-1.12) being more likely to have low birthweight. Exposure to ETS is significantly associated with low birthweight in Africa, mainly among male newborns. Gender could possibly be a modifier, and hence, research on biological plausibility is necessary. Moreover, a public health promotion on behavioral changes is likely to have a positive impact on newborns' health.

Research paper thumbnail of Association of lifestyle factors with blood lipids and inflammation in adults aged 40 years and above: a population-based cross-sectional study in Taiwan

Background Lifestyle factors were associated with an increased risk of cardiovascular disease (CV... more Background Lifestyle factors were associated with an increased risk of cardiovascular disease (CVD) occurrence. We explored the associations between lifestyle factors and CVD risk factors, and assessed the interactive effects of lifestyle factors on CVD risk factors. Methods A cross-sectional data of 114,082 (57,680 men and 56,402 women) middle-aged adults and elderly in Taiwan were collected from 2001 to 2010. Logistic regression analysis was used to assess the associations between lifestyle factors and CVD risk factors. The relative excess risk due to interaction (RERI) and the attributable proportion due to interaction were used to explore the interactive effect of lifestyle factors on CVD risk factors. Results The interaction between alcohol consumption and smoking exhibited an excess risk of high triglycerides (RERI = 0.21; 95% CI: 0.14 – 0.29), and that of alcohol consumption and physical activity had an excess risk of high LDL-cholesterol (RERI = 0.11; 95% CI: 0.06 – 0.16) an...

Research paper thumbnail of Perceived Impact of Taiwan’s National Health Insurance Allocation Strategy: Health Professionals’ Perspective

International Journal of Environmental Research and Public Health

Studies on health care demand have indicated high levels of public satisfaction with Taiwan’s Nat... more Studies on health care demand have indicated high levels of public satisfaction with Taiwan’s National Health Insurance (NHI). However, the global budget allocation mechanism (GBAM) used by NHI has led to various adjustments in the providers’ way of practice, quality of care, utilization of care, and health expenditure. Studies focusing on the satisfaction of providers with health care supply, however, remain limited. We therefore explored the provider’s perceived impact of the NHI allocation plan. A cross-sectional data of 299 health professionals was collected at Taipei Medical University Hospitals in April 2012. Perceptions and attitudes were assessed using a validated 5-point Likert-type questionnaire before using a structural equation modeling technique to explore the complex interrelationships of the NHI’s perceived impact. The causal path relationships between the latent variables ‘characteristics of NHI’s allocation plan’ and ‘perceived positive effect’ (β = 0.39), ‘perceive...

Research paper thumbnail of Dietary patterns, gender, and weight status among middle-aged and older adults in Taiwan: a cross-sectional study

BMC Geriatrics

Background: Diet has been associated with differences in weight and nutritional status of an indi... more Background: Diet has been associated with differences in weight and nutritional status of an individual. The prevalence of overweight and obesity increased among adults in Taiwan. Hence, we examined the relationship between dietary patterns and weight status by gender among middle-aged and older adults in Taiwan. Methods: The cross-sectional data of 62,965 participants aged ≥40 years were retrieved from the Mei Jau health screening institutions' database collected from 2001 and 2010. Diet information was evaluated using a food frequency questionnaire, while the dietary patterns were derived using principal component analysis before summing up and dividing into quintiles of consumption. The association between dietary patterns and weight status among adult men and women was explored using multinomial logistic regression models. Three models were analyzed before stratifying data by gender. Results: Two dietary patterns were derived with one reflecting a high consumption of vegetables and fruits (vegetable-fruit dietary pattern) and the other a high consumption of meat and processed foods (meat-processed dietary pattern). After adjustment, highest consumption of vegetables and fruits (Q5) reduced the likelihood of being overweight (OR = 0.91; 95% CI, 0.85-0.97) or obese (OR = 0.85; 95% CI, 0.78-0.92), while highest consumption of meat and processed foods increased the likelihood of being overweight (OR = 1.50; 95% CI, 1.40-1.59) or obese (OR = 1.94; 95% CI, 1.79-2.10). Women were less likely to be overweight or obese with the highest intake of fruits and vegetables (Q5) while both genders were more likely to be overweight or obese with high consumption of meat and processed foods. Conclusions: High intake of vegetables and fruits is associated with lower odds of being overweight or obese, especially among women. But, high intake of meat and processed foods is associated with higher odds of overweight and obesity in both genders.

Research paper thumbnail of Quality of care in six sub-Saharan Africa countries: a provider-based study on adherence to WHO’s antenatal care guideline

International Journal for Quality in Health Care

Objective: Quality of care may help explain the high burden of disease in maternal, newborn and c... more Objective: Quality of care may help explain the high burden of disease in maternal, newborn and child health in low-and middle-income countries even as access to care is improved. We explored the determinants of quality of antenatal care (ANC) in sub-Saharan Africa (SSA). Design: Cross-sectional study. Multilevel Generalized Linear Latent Mixed-Effect models with logit link function were employed to obtain the adjusted odds ratios (AORs) and 95% confidence interval (CI).

Research paper thumbnail of Cooking fuel and risk of under-five mortality in 23 Sub-Saharan African countries: a population-based study

International Journal of Environmental Health Research

Relationship between cooking fuel and under-five mortality has not been adequately established in... more Relationship between cooking fuel and under-five mortality has not been adequately established in Sub-Saharan Africa (SSA). We therefore investigated the association between cooking fuel and risk of under-five mortality in SSA, and further investigated its interaction with smoking. Using the most recent Demographic Health Survey data of 23 SSA countries (n = 783,691), Cox proportional hazard was employed to determine the association between cooking fuel and risk of under-five deaths. The adjusted hazard ratios were 1.21 (95 % CI, 1.10-1.34) and 1.20 (95 % CI, 1.08-1.32) for charcoal and biomass cooking fuel, respectively, compared to clean fuels. There was no positive interaction between biomass cooking fuel and smoking. Use of charcoal and biomass were associated with the risk of under-five mortality in SSA. Disseminating public health information on health risks of cooking fuel and development of relevant public health policies are likely to have a positive impact on a child's survival. Evidence before this study Globally, over 4 million deaths occur yearly due to indoor air pollution resulting from cooking fuel. Studies indicate that the under-five children are the most vulnerable group to pollutant cooking fuels with negative health outcome. Moreover, Sub-Saharan Africa (SSA) is the most affected region because 4 out of 5 of its population use solid biomass for cooking, and this may not decrease any time soon in the Sustainable Development Goals (SDGs) era where reduction of deaths as result of hazardous chemicals in the air, water, and soil is a key target. However, most studies have been country-specific and the effects of cooking fuel have majorly focused on ill-health, and not the fatal consequences. This study seeks to fill this gap in a much wider scale in SSA.

Research paper thumbnail of Indoor secondhand tobacco smoke and risk of under-five mortality in 23 sub-Saharan Africa countries: A population based study and meta-analysis

PLOS ONE

Background Inhalation of secondhand smoke from tobacco results in serious health outcomes among u... more Background Inhalation of secondhand smoke from tobacco results in serious health outcomes among under-five children, and yet, few studies have assessed its effect on under-five mortality. We investigated the association between frequency of exposure to household tobacco smoke and risk of under-five mortality in sub-Saharan Africa (SSA). Methods Demographic Health Survey data of under-five children from 23 SSA countries (n = 787,484) were used. Cox proportional hazard models described the association between exposure to tobacco smoke and the risk of under-five mortality in each country, with age as the time-to-event indicator. Meta-analysis was used to investigate the overall effect of tobacco smoke in SSA. Results The association between tobacco smoke exposure and the risk of under-five mortality attenuated in eight countries (

Research paper thumbnail of Quality of maternity care and its determinants along the continuum in Kenya: A structural equation modeling analysis

PLOS ONE

Background Improving access to delivery services does not guarantee access to quality obstetric c... more Background Improving access to delivery services does not guarantee access to quality obstetric care and better survival, and therefore, concerns for quality of maternal and newborn care in lowand middle-income countries have been raised. Our study explored characteristics associated with the quality of initial assessment, intrapartum, and immediate postpartum and newborn care, and further assessed the relationships along the continuum of care. Methods The 2010 Service Provision Assessment data of Kenya for 627 routine deliveries of women aged 15-49 were used. Quality of care measures were assessed using recently validated quality of care measures during initial assessment, intrapartum, and postpartum periods. Data were analyzed with negative binomial regression and structural equation modeling technique.

Research paper thumbnail of The Associations between Types of Ambient PM2.5 and Under-Five and Maternal Mortality in Africa

International Journal of Environmental Research and Public Health

Exploring the effects of different types of PM 2.5 is necessary to reduce associated deaths, espe... more Exploring the effects of different types of PM 2.5 is necessary to reduce associated deaths, especially in low-and middle-income countries (LMICs). Hence we determined types of ambient PM 2.5 before exploring their effects on under-five and maternal mortality in Africa. The spectral derivate of aerosol optical depth (AOD) from Moderate Resolution Imaging Spectroradiometer (MODIS) products from 2000 to 2015 were employed to determine the aerosol types before using Generalized Linear and Additive Mixed-Effect models with Poisson link function to explore the associations and penalized spline for dose-response relationships. Four types of PM 2.5 were identified in terms of mineral dust, anthropogenic pollutant, biomass burning and mixture aerosols. The results demonstrate that biomass PM 2.5 increased the rate of under-five mortality in Western and Central Africa, each by 2%, and maternal mortality in Central Africa by 19%. Anthropogenic PM 2.5 increased under-five and maternal deaths in Northern Africa by 5% and 10%, respectively, and maternal deaths by 4% in Eastern Africa. Dust PM 2.5 increased under-five deaths in Northern, Western, and Central Africa by 3%, 1%, and 10%, respectively. Mixture PM 2.5 only increased under-five deaths and maternal deaths in Western (incidence rate ratio = 1.01, p < 0.10) and Eastern Africa (incidence rate ratio = 1.06, p < 0.01), respectively. The findings indicate the types of ambient PM 2.5 are significantly associated with under-five and maternal mortality in Africa where the exposure level usually exceeds the World Health Organization's (WHO) standards. Appropriate policy actions on protective and control measures are therefore suggested and should be developed and implemented accordingly.

Research paper thumbnail of Community social capital on the timing of sexual debut and teen birth in Nicaragua: a multilevel approach

BMC Public Health, 2016

Background: Community attributes have been gradually recognized as critical determinants shaping ... more Background: Community attributes have been gradually recognized as critical determinants shaping sexual behaviors in young population; nevertheless, most of the published studies were conducted in high income countries. The study aims to examine the association between community social capital with the time to sexual onset and to first birth in Central America. Methods: Building upon the 2011/12 Demographic and Health Survey conducted in Nicaragua, we identified a sample of 2766 community-dwelling female adolescents aged 15 to 19 years. Multilevel survival analyses were performed to estimate the risks linked with three domains of community social capital (i.e., norms, resource and social network). Results: Higher prevalence of female sexual debut (norms) and higher proportion of secondary school or higher education (resource) in the community are associated with an earlier age of sexual debut by 47 % (p < 0.05) and 16 %, respectively (p < 0.001). Living in a community with a high proportion of females having a child increases the hazard of teen birth (p < 0.001) and resource is negatively associated with teen childbearing (p < 0.05). Residential stability and community religious composition (social network) were not linked with teen-onset sex and birth. Conclusions: The norm and resource aspects of social capital appeared differentially associated with adolescent sexual and reproductive behaviors. Interventions aiming to tackle unfavorable sexual and reproductive outcomes in young people should be devised and implemented with integration of social process.

Research paper thumbnail of Relationship between women’s characteristics and continuum of care for maternal health in Kenya: Complex survey analysis using structural equation modeling

Women & Health, 2016

The objective of this study was to understand and estimate the complex relationships in the conti... more The objective of this study was to understand and estimate the complex relationships in the continuum of care for maternal health to provide information to improve maternal and newborn health outcomes. Women (n = 4,082) aged 15-49 years in the 2008/2009 Kenya Demographic and Health Survey data were used to explore the complex relationships in the continuum of care for maternal health (i.e., before, during, and after delivery) using structural equation modeling. Results showed that the use of antenatal care was significantly positively related to the use of delivery care (β = 0.06; adjusted odds ratio [AOR] = 1.06; 95% confidence interval [CI]: 1.02-1.10) but not postnatal care, while delivery care was associated with postnatal care (β = 0.68; AOR = 1.97; 95% CI: 1.75-2.22). Socioeconomic status was significantly related to all elements in the continuum of care for maternal health; barriers to delivery of care and personal characteristics were only associated with the use of delivery care (β = 0.34; AOR = 1.40; 95% CI: 1.30-1.52) and postnatal care (β = 0.03; AOR = 1.03; 95% CI: 1.01-1.05), respectively. The three periods of maternal health care were related to each other. Developing a referral system of continuity of care is critical in the Sustainable Development Goals era.

Research paper thumbnail of Association between Dietary Patterns and Cardiovascular Risk Factors among Middle-Aged and Elderly Adults in Taiwan: A Population-Based Study from 2003 to 2012

PLOS ONE, 2016

Background Cardiovascular disease (CVD) is one of the leading causes of mortality and loss of dis... more Background Cardiovascular disease (CVD) is one of the leading causes of mortality and loss of disability-adjusted life years in developed countries. This study derived a dietary pattern using an a priori method and additionally derived dietary patterns using a posteriori methods, and assessed the relationship with CVD risk factors in Taiwanese middle-aged and elderly adults. Methods Cross-sectional analyses of 62,965 subjects aged 40 years and above from the Mei Jau (MJ) database collected between 2003 and 2012 in Taiwan. Diet was assessed using a 22 item semi-quantitative food frequency questionnaire. Using this information, three dietary patterns were generated. The a priori diet was labeled the Taiwanese dietary pattern and was derived using hypothesized effect of 22 food groups, while two a posteriori dietary patterns, "vegi-fruits" and "meat-processed", were derived using principal component analysis. The association between dietary patterns and a range of CVD risk factors (i.e. blood lipids, blood glucose and C-reactive protein) was evaluated using linear regression. Results The results showed that high intake (Q5, quintile 5) of Taiwanese diet was negatively associated with CVD risk factors at (p < 0.001, model 3), but not with triacylglycerol. In addition, high intake of vegi-fruit dietary pattern (Q5) was negatively associated with CVD risk factors (p < 0.001), but not with high-density lipoprotein, while high consumption of meat-processed

Research paper thumbnail of Implementation Determinants of Zimbabwe National Occupational Safety and Health Policy in Willowvale Industrial Area, Zimbabwe

International Journal of Environmental Research and Public Health, 2022

Zimbabwe introduced the National Occupational Safety and Health Policy (ZNOSHP) in August 2014 wi... more Zimbabwe introduced the National Occupational Safety and Health Policy (ZNOSHP) in August 2014 with the vision and mission to eliminate occupational accidents, injuries, diseases, and fatalities and to promote Occupational Safety and Health (OSH). This study was therefore aimed at exploring the individual- and organizational-level determinants of ZNOSHP’s implementation. Data were collected from 309 workers in the Willowvale industrial area in Harare, Zimbabwe. Negative binomial regression models were used to explore the determinants of ZNOSHP’s implementation. After adjustment, participant’s knowledge of ZNOSHP (Incidence Rate Ratio, IRR = 1.32; 95% Confidence Interval, CI: 1.19–1.46; p ≤ 0.001), production department (IRR = 1.13; 95% CI: 1.03–1.26; p ≤ 0.05), company years of operation (IRR = 1.33; 95% CI: 1.21–1.46; p ≤ 0.001), participants who identified several implementation barriers (IRR = 1.12; 95% CI: 1.01–1.25; p ≤ 0.001), and agricultural industry were associated with hig...

Research paper thumbnail of Global Health Challenges : Issues in preparing students for developing skills and competencies in global health - a middle range future perspective

Health care professionals are increasingly faced with challenges that require an understanding of... more Health care professionals are increasingly faced with challenges that require an understanding of global health trends, practices and threats. The PubMed search was limited to articles published in the Lancet journal between 2016 and 2017 with a special effort to better understand future perspectives of global health issues and ultimately to plan, reconstruct and develop the curriculum for the next cohort of the Master’s Programme in Global Health Care. The database search identified 102 references of which the abstracts were reviewed more closely. As a result, the most prominent health issues are related to neglected tropical diseases (NTDs) – a diverse group of communicable diseases highlighting the importance of vaccination coverage and adequate sanitation. Organic and inorganic pollutants also pose a challenge in the form of increased burden of disease. Burden of non-communicable diseases, such as diabetes and memory disorders increase globally. Furthermore, the need for prevent...

Research paper thumbnail of Perceptions and Attitudes of Health Professionals in Kenya on National Health Care Resource Allocation Mechanisms: A Structural Equation Modeling

PLOS ONE, 2015

Background Health care resource allocation is key towards attaining equity in the health system. ... more Background Health care resource allocation is key towards attaining equity in the health system. However, health professionals' perceived impact and attitude towards health care resource allocation in Sub-Saharan Africa is unknown; furthermore, they occupy a position which makes them notice the impact of different policies in their health system. This study explored perceptions and attitudes of health professionals in Kenya on health care resource allocation mechanism.

Research paper thumbnail of Real-time Mobile Electrocardiogram Monitoring for Mass Events and Competitions with Difficult-to-Access Locations

Computer Methods and Programs in Biomedicine, 2015

Using mobile wireless technology to monitor ECG in participants of mass events and sports taking ... more Using mobile wireless technology to monitor ECG in participants of mass events and sports taking place in difficult-to-access location could both prevent and easier detect arrhythmias as well as provide real-time monitoring for any type of injury. We assessed the effectiveness of mobile wireless monitoring technology and IT in detecting possible emergencies during a skyscraper race. We attached specially designed wireless surveillance biopatches on 120 individuals participating to monitor their continuous ECG and location during a skyscraper run-up race at Taipei 101 building, Taiwan. The outcomes of interest were detection of abnormal heartbeats and QRS waves indicative of possible cardiac problems and the exact location of participants during the occurrence of emergencies. The devices accurately sent over 50 warnings to our monitoring platform when both, danger limits were reached by competitors (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;60 or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;195 beats per minute) or competitors stopped moving, proving very effective in quickly detecting abnormities and alerting staff of possible emergencies at exact locations. This efficient and inexpensive monitoring method can also prevent arrhythmias in unscreened competitors, the danger of collision among staff and competitors, and preserves oxygen by eliminating additional on-foot monitoring staff. Additionally, it could have multipurpose usage, especially during disasters and accidents occurring in difficult-to-access locations, in military exercises and personal monitoring.

Research paper thumbnail of Analysis of Pneumonia Occurrence in Relation to Climate Change in Tanga, Tanzania

International Journal of Environmental Research and Public Health, 2021

In 2018, 70% of global fatalities due to pneumonia occurred in about fifteen countries, with Tanz... more In 2018, 70% of global fatalities due to pneumonia occurred in about fifteen countries, with Tanzania being among the top eight countries contributing to these deaths. Environmental and individual factors contributing to these deaths may be multifaceted, but they have not yet been explored in Tanzania. Therefore, in this study, we explore the association between climate change and the occurrence of pneumonia in the Tanga Region, Tanzania. A time series study design was employed using meteorological and health data of the Tanga Region collected from January 2016 to December 2018 from the Tanzania Meteorological Authority and Health Management Information System, respectively. The generalized negative binomial regression technique was used to explore the associations between climate indicators (i.e., precipitation, humidity, and temperature) and the occurrence of pneumonia. There were trend differences in climate indicators and the occurrence of pneumonia between the Tanga and Handeni...

Research paper thumbnail of Impacts of discriminated PM2.5 on global under-five and maternal mortality

Scientific Reports

Globally, it was estimated that maternal and under-five deaths were high in low-income countries ... more Globally, it was estimated that maternal and under-five deaths were high in low-income countries than that of high-income countries. Most studies, however, have focused only on the clinical causes of maternal and under-five deaths, and yet there could be other factors such as ambient particulate matter (PM). The current global estimates indicate that exposure to ambient PM2.5 (with ≤ 2.5 microns aerodynamic diameter) has caused about 7 million deaths and over 100 million disability-adjusted life-years. There are also several health risks that have been linked PM2.5, including mortality, both regionally and globally; however, PM2.5 is a mixture of many compounds from various sources. Globally, there is little evidence of the health effects of various types of PM2.5, which may uniquely contribute to the global burden of disease. Currently, only two studies had estimated the effects of discriminated ambient PM2.5, that is, anthropogenic, biomass and dust, on under-five and maternal mor...

Research paper thumbnail of Trend of Cryptosporidium Infection among Children below 24 Months in an Informal Urban Settlement, Kenya

Open Journal of Medical Microbiology

Research paper thumbnail of Ambient Particulate Matter Exposure and Under-Five and Maternal Deaths in Asia

International Journal of Environmental Research and Public Health

The Asian region is one of the major emission sources of air pollution. Although ambient PM2.5 ha... more The Asian region is one of the major emission sources of air pollution. Although ambient PM2.5 has been linked to several health risks in high-, low-, and middle-income countries, the further analysis of type impact is still rare but significant. The PM2.5 distribution retrieved from MODIS (Moderate Resolution Imaging Spectroradiometer) aerosol optical depth products within 16 years thus explored the associations between under-five and maternal mortality for 45 countries in Asia. Both the nonparametric (Generalized Additive Mixed-Effect) and parametric (Generalized Linear Mixed-Effect) models were employed to analyze the collected datasets. The results show that the levels of PM2.5 in Asian sub-regions were higher than the Global Air Quality Standards. Biomass PM2.5 concentrations was associated with increased the rate of under-five (Incidence Rate Ratio, IRR = 1.29, 95% CI, 1.13–1.47) and maternal (IRR = 1.09, 95% CI: 1.08–1.10) deaths in Asia. Anthropogenic PM2.5 was associated wi...

Research paper thumbnail of Gender Difference in the Association between Environmental Tobacco Smoke and Birth Weight in Africa

International Journal of Environmental Research and Public Health

The adverse health effects of exposure to environmental tobacco smoke (ETS) on children are well-... more The adverse health effects of exposure to environmental tobacco smoke (ETS) on children are well-documented, and yet, gender difference in low birthweight among newborns whose mothers were exposed to ETS during pregnancy still remains contentious. We therefore explored the association between ETS exposure and risk of low birthweight, and further determined the gender difference in the association between exposure to ETS during pregnancy and birth weight in Africa. The Demographic Health Surveys of 23 African countries with information on 208,027 newborns were used. The associations between exposure to ETS and birth weight was estimated using multiple logistic regression models. Exposure to ETS increased the risk of low birthweight in Africa (adjusted odds ratio (OR) = 1.06; 95% Confidence Interval (CI): 1.02-1.10). A stratified analysis, by gender, revealed that male newborns whose mothers were exposed to ETS were 1.08 (95% CI: 1.02-1.14) times more likely to be low in birthweight than those whose mothers were not exposed, with those exposed weekly (adjusted OR = 1.17; 95% CI: 1.01-1.35) and daily (adjusted OR = 1.06; 95% CI: 1.01-1.12) being more likely to have low birthweight. Exposure to ETS is significantly associated with low birthweight in Africa, mainly among male newborns. Gender could possibly be a modifier, and hence, research on biological plausibility is necessary. Moreover, a public health promotion on behavioral changes is likely to have a positive impact on newborns' health.

Research paper thumbnail of Association of lifestyle factors with blood lipids and inflammation in adults aged 40 years and above: a population-based cross-sectional study in Taiwan

Background Lifestyle factors were associated with an increased risk of cardiovascular disease (CV... more Background Lifestyle factors were associated with an increased risk of cardiovascular disease (CVD) occurrence. We explored the associations between lifestyle factors and CVD risk factors, and assessed the interactive effects of lifestyle factors on CVD risk factors. Methods A cross-sectional data of 114,082 (57,680 men and 56,402 women) middle-aged adults and elderly in Taiwan were collected from 2001 to 2010. Logistic regression analysis was used to assess the associations between lifestyle factors and CVD risk factors. The relative excess risk due to interaction (RERI) and the attributable proportion due to interaction were used to explore the interactive effect of lifestyle factors on CVD risk factors. Results The interaction between alcohol consumption and smoking exhibited an excess risk of high triglycerides (RERI = 0.21; 95% CI: 0.14 – 0.29), and that of alcohol consumption and physical activity had an excess risk of high LDL-cholesterol (RERI = 0.11; 95% CI: 0.06 – 0.16) an...

Research paper thumbnail of Perceived Impact of Taiwan’s National Health Insurance Allocation Strategy: Health Professionals’ Perspective

International Journal of Environmental Research and Public Health

Studies on health care demand have indicated high levels of public satisfaction with Taiwan’s Nat... more Studies on health care demand have indicated high levels of public satisfaction with Taiwan’s National Health Insurance (NHI). However, the global budget allocation mechanism (GBAM) used by NHI has led to various adjustments in the providers’ way of practice, quality of care, utilization of care, and health expenditure. Studies focusing on the satisfaction of providers with health care supply, however, remain limited. We therefore explored the provider’s perceived impact of the NHI allocation plan. A cross-sectional data of 299 health professionals was collected at Taipei Medical University Hospitals in April 2012. Perceptions and attitudes were assessed using a validated 5-point Likert-type questionnaire before using a structural equation modeling technique to explore the complex interrelationships of the NHI’s perceived impact. The causal path relationships between the latent variables ‘characteristics of NHI’s allocation plan’ and ‘perceived positive effect’ (β = 0.39), ‘perceive...

Research paper thumbnail of Dietary patterns, gender, and weight status among middle-aged and older adults in Taiwan: a cross-sectional study

BMC Geriatrics

Background: Diet has been associated with differences in weight and nutritional status of an indi... more Background: Diet has been associated with differences in weight and nutritional status of an individual. The prevalence of overweight and obesity increased among adults in Taiwan. Hence, we examined the relationship between dietary patterns and weight status by gender among middle-aged and older adults in Taiwan. Methods: The cross-sectional data of 62,965 participants aged ≥40 years were retrieved from the Mei Jau health screening institutions' database collected from 2001 and 2010. Diet information was evaluated using a food frequency questionnaire, while the dietary patterns were derived using principal component analysis before summing up and dividing into quintiles of consumption. The association between dietary patterns and weight status among adult men and women was explored using multinomial logistic regression models. Three models were analyzed before stratifying data by gender. Results: Two dietary patterns were derived with one reflecting a high consumption of vegetables and fruits (vegetable-fruit dietary pattern) and the other a high consumption of meat and processed foods (meat-processed dietary pattern). After adjustment, highest consumption of vegetables and fruits (Q5) reduced the likelihood of being overweight (OR = 0.91; 95% CI, 0.85-0.97) or obese (OR = 0.85; 95% CI, 0.78-0.92), while highest consumption of meat and processed foods increased the likelihood of being overweight (OR = 1.50; 95% CI, 1.40-1.59) or obese (OR = 1.94; 95% CI, 1.79-2.10). Women were less likely to be overweight or obese with the highest intake of fruits and vegetables (Q5) while both genders were more likely to be overweight or obese with high consumption of meat and processed foods. Conclusions: High intake of vegetables and fruits is associated with lower odds of being overweight or obese, especially among women. But, high intake of meat and processed foods is associated with higher odds of overweight and obesity in both genders.

Research paper thumbnail of Quality of care in six sub-Saharan Africa countries: a provider-based study on adherence to WHO’s antenatal care guideline

International Journal for Quality in Health Care

Objective: Quality of care may help explain the high burden of disease in maternal, newborn and c... more Objective: Quality of care may help explain the high burden of disease in maternal, newborn and child health in low-and middle-income countries even as access to care is improved. We explored the determinants of quality of antenatal care (ANC) in sub-Saharan Africa (SSA). Design: Cross-sectional study. Multilevel Generalized Linear Latent Mixed-Effect models with logit link function were employed to obtain the adjusted odds ratios (AORs) and 95% confidence interval (CI).

Research paper thumbnail of Cooking fuel and risk of under-five mortality in 23 Sub-Saharan African countries: a population-based study

International Journal of Environmental Health Research

Relationship between cooking fuel and under-five mortality has not been adequately established in... more Relationship between cooking fuel and under-five mortality has not been adequately established in Sub-Saharan Africa (SSA). We therefore investigated the association between cooking fuel and risk of under-five mortality in SSA, and further investigated its interaction with smoking. Using the most recent Demographic Health Survey data of 23 SSA countries (n = 783,691), Cox proportional hazard was employed to determine the association between cooking fuel and risk of under-five deaths. The adjusted hazard ratios were 1.21 (95 % CI, 1.10-1.34) and 1.20 (95 % CI, 1.08-1.32) for charcoal and biomass cooking fuel, respectively, compared to clean fuels. There was no positive interaction between biomass cooking fuel and smoking. Use of charcoal and biomass were associated with the risk of under-five mortality in SSA. Disseminating public health information on health risks of cooking fuel and development of relevant public health policies are likely to have a positive impact on a child's survival. Evidence before this study Globally, over 4 million deaths occur yearly due to indoor air pollution resulting from cooking fuel. Studies indicate that the under-five children are the most vulnerable group to pollutant cooking fuels with negative health outcome. Moreover, Sub-Saharan Africa (SSA) is the most affected region because 4 out of 5 of its population use solid biomass for cooking, and this may not decrease any time soon in the Sustainable Development Goals (SDGs) era where reduction of deaths as result of hazardous chemicals in the air, water, and soil is a key target. However, most studies have been country-specific and the effects of cooking fuel have majorly focused on ill-health, and not the fatal consequences. This study seeks to fill this gap in a much wider scale in SSA.

Research paper thumbnail of Indoor secondhand tobacco smoke and risk of under-five mortality in 23 sub-Saharan Africa countries: A population based study and meta-analysis

PLOS ONE

Background Inhalation of secondhand smoke from tobacco results in serious health outcomes among u... more Background Inhalation of secondhand smoke from tobacco results in serious health outcomes among under-five children, and yet, few studies have assessed its effect on under-five mortality. We investigated the association between frequency of exposure to household tobacco smoke and risk of under-five mortality in sub-Saharan Africa (SSA). Methods Demographic Health Survey data of under-five children from 23 SSA countries (n = 787,484) were used. Cox proportional hazard models described the association between exposure to tobacco smoke and the risk of under-five mortality in each country, with age as the time-to-event indicator. Meta-analysis was used to investigate the overall effect of tobacco smoke in SSA. Results The association between tobacco smoke exposure and the risk of under-five mortality attenuated in eight countries (

Research paper thumbnail of Quality of maternity care and its determinants along the continuum in Kenya: A structural equation modeling analysis

PLOS ONE

Background Improving access to delivery services does not guarantee access to quality obstetric c... more Background Improving access to delivery services does not guarantee access to quality obstetric care and better survival, and therefore, concerns for quality of maternal and newborn care in lowand middle-income countries have been raised. Our study explored characteristics associated with the quality of initial assessment, intrapartum, and immediate postpartum and newborn care, and further assessed the relationships along the continuum of care. Methods The 2010 Service Provision Assessment data of Kenya for 627 routine deliveries of women aged 15-49 were used. Quality of care measures were assessed using recently validated quality of care measures during initial assessment, intrapartum, and postpartum periods. Data were analyzed with negative binomial regression and structural equation modeling technique.

Research paper thumbnail of The Associations between Types of Ambient PM2.5 and Under-Five and Maternal Mortality in Africa

International Journal of Environmental Research and Public Health

Exploring the effects of different types of PM 2.5 is necessary to reduce associated deaths, espe... more Exploring the effects of different types of PM 2.5 is necessary to reduce associated deaths, especially in low-and middle-income countries (LMICs). Hence we determined types of ambient PM 2.5 before exploring their effects on under-five and maternal mortality in Africa. The spectral derivate of aerosol optical depth (AOD) from Moderate Resolution Imaging Spectroradiometer (MODIS) products from 2000 to 2015 were employed to determine the aerosol types before using Generalized Linear and Additive Mixed-Effect models with Poisson link function to explore the associations and penalized spline for dose-response relationships. Four types of PM 2.5 were identified in terms of mineral dust, anthropogenic pollutant, biomass burning and mixture aerosols. The results demonstrate that biomass PM 2.5 increased the rate of under-five mortality in Western and Central Africa, each by 2%, and maternal mortality in Central Africa by 19%. Anthropogenic PM 2.5 increased under-five and maternal deaths in Northern Africa by 5% and 10%, respectively, and maternal deaths by 4% in Eastern Africa. Dust PM 2.5 increased under-five deaths in Northern, Western, and Central Africa by 3%, 1%, and 10%, respectively. Mixture PM 2.5 only increased under-five deaths and maternal deaths in Western (incidence rate ratio = 1.01, p < 0.10) and Eastern Africa (incidence rate ratio = 1.06, p < 0.01), respectively. The findings indicate the types of ambient PM 2.5 are significantly associated with under-five and maternal mortality in Africa where the exposure level usually exceeds the World Health Organization's (WHO) standards. Appropriate policy actions on protective and control measures are therefore suggested and should be developed and implemented accordingly.

Research paper thumbnail of Community social capital on the timing of sexual debut and teen birth in Nicaragua: a multilevel approach

BMC Public Health, 2016

Background: Community attributes have been gradually recognized as critical determinants shaping ... more Background: Community attributes have been gradually recognized as critical determinants shaping sexual behaviors in young population; nevertheless, most of the published studies were conducted in high income countries. The study aims to examine the association between community social capital with the time to sexual onset and to first birth in Central America. Methods: Building upon the 2011/12 Demographic and Health Survey conducted in Nicaragua, we identified a sample of 2766 community-dwelling female adolescents aged 15 to 19 years. Multilevel survival analyses were performed to estimate the risks linked with three domains of community social capital (i.e., norms, resource and social network). Results: Higher prevalence of female sexual debut (norms) and higher proportion of secondary school or higher education (resource) in the community are associated with an earlier age of sexual debut by 47 % (p < 0.05) and 16 %, respectively (p < 0.001). Living in a community with a high proportion of females having a child increases the hazard of teen birth (p < 0.001) and resource is negatively associated with teen childbearing (p < 0.05). Residential stability and community religious composition (social network) were not linked with teen-onset sex and birth. Conclusions: The norm and resource aspects of social capital appeared differentially associated with adolescent sexual and reproductive behaviors. Interventions aiming to tackle unfavorable sexual and reproductive outcomes in young people should be devised and implemented with integration of social process.

Research paper thumbnail of Relationship between women’s characteristics and continuum of care for maternal health in Kenya: Complex survey analysis using structural equation modeling

Women & Health, 2016

The objective of this study was to understand and estimate the complex relationships in the conti... more The objective of this study was to understand and estimate the complex relationships in the continuum of care for maternal health to provide information to improve maternal and newborn health outcomes. Women (n = 4,082) aged 15-49 years in the 2008/2009 Kenya Demographic and Health Survey data were used to explore the complex relationships in the continuum of care for maternal health (i.e., before, during, and after delivery) using structural equation modeling. Results showed that the use of antenatal care was significantly positively related to the use of delivery care (β = 0.06; adjusted odds ratio [AOR] = 1.06; 95% confidence interval [CI]: 1.02-1.10) but not postnatal care, while delivery care was associated with postnatal care (β = 0.68; AOR = 1.97; 95% CI: 1.75-2.22). Socioeconomic status was significantly related to all elements in the continuum of care for maternal health; barriers to delivery of care and personal characteristics were only associated with the use of delivery care (β = 0.34; AOR = 1.40; 95% CI: 1.30-1.52) and postnatal care (β = 0.03; AOR = 1.03; 95% CI: 1.01-1.05), respectively. The three periods of maternal health care were related to each other. Developing a referral system of continuity of care is critical in the Sustainable Development Goals era.

Research paper thumbnail of Association between Dietary Patterns and Cardiovascular Risk Factors among Middle-Aged and Elderly Adults in Taiwan: A Population-Based Study from 2003 to 2012

PLOS ONE, 2016

Background Cardiovascular disease (CVD) is one of the leading causes of mortality and loss of dis... more Background Cardiovascular disease (CVD) is one of the leading causes of mortality and loss of disability-adjusted life years in developed countries. This study derived a dietary pattern using an a priori method and additionally derived dietary patterns using a posteriori methods, and assessed the relationship with CVD risk factors in Taiwanese middle-aged and elderly adults. Methods Cross-sectional analyses of 62,965 subjects aged 40 years and above from the Mei Jau (MJ) database collected between 2003 and 2012 in Taiwan. Diet was assessed using a 22 item semi-quantitative food frequency questionnaire. Using this information, three dietary patterns were generated. The a priori diet was labeled the Taiwanese dietary pattern and was derived using hypothesized effect of 22 food groups, while two a posteriori dietary patterns, "vegi-fruits" and "meat-processed", were derived using principal component analysis. The association between dietary patterns and a range of CVD risk factors (i.e. blood lipids, blood glucose and C-reactive protein) was evaluated using linear regression. Results The results showed that high intake (Q5, quintile 5) of Taiwanese diet was negatively associated with CVD risk factors at (p < 0.001, model 3), but not with triacylglycerol. In addition, high intake of vegi-fruit dietary pattern (Q5) was negatively associated with CVD risk factors (p < 0.001), but not with high-density lipoprotein, while high consumption of meat-processed