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  • 1.
    Egondi, Thaddaeus
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ettarh, R
    Kyobutungi, C
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Child morbidity and mortality associated with exposure to inhalable particles (PM2.5) among the urban poor in Nairobi, KenyaArtikel i tidskrift (Refereegranskat)
  • 2.
    Egondi, Thaddaeus
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kyobutungi, Catherine
    Kovats, Sari
    Muindi, Kanyiva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ettarh, Remare
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Time-series analysis of weather and mortality patterns in Nairobi's informal settlements2012Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, s. 23-32Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Many studies have established a link between weather (primarily temperature) and daily mortality in developed countries. However, little is known about this relationship in urban populations in sub-Saharan Africa. Objectives: The objective of this study was to describe the relationship between daily weather and mortality in Nairobi, Kenya, and to evaluate this relationship with regard to cause of death, age, and sex. Methods: We utilized mortality data from the Nairobi Urban Health and Demographic Surveillance System and applied time-series models to study the relationship between daily weather and mortality for a population of approximately 60,000 during the period 2003-2008. We used a distributed lag approach to model the delayed effect of weather on mortality, stratified by cause of death, age, and sex. Results: Increasing temperatures (above 75th percentile) were significantly associated with mortality in children and non-communicable disease (NCD) deaths. We found all-cause mortality of shorter lag of same day and previous day to increase by 3.0% for a 1 degree decrease from the 25th percentile of 18 degrees C (not statistically significant). Mortality among people aged 50+ and children aged below 5 years appeared most susceptible to cold compared to other age groups. Rainfall, in the lag period of 0-29 days, increased all-cause mortality in general, but was found strongest related to mortality among females. Low temperatures were associated with deaths due to acute infections, whereas rainfall was associated with all-cause pneumonia and NCD deaths. Conclusions: Increases in mortality were associated with both hot and cold weather as well as rainfall in Nairobi, but the relationship differed with regard to age, sex, and cause of death. Our findings indicate that weather-related mortality is a public health concern for the population in the informal settlements of Nairobi, Kenya, especially if current trends in climate change continue.

  • 3.
    Egondi, Thaddaeus
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kyobutungi, Catherine
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Muindi, Kanyiva
    Oti, Samuel
    van de Vijver, Steven
    Ettarh, Remare
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Community perceptions of air pollution and related health risks in Nairobi slums2013Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 10, nr 10, s. 4851-4868Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Air pollution is among the leading global risks for mortality and responsible for increasing risk for chronic diseases. Community perceptions on exposure are critical in determining people's response and acceptance of related policies. Therefore, understanding people' perception is critical in informing the design of appropriate intervention measures. The aim of this paper was to establish levels and associations between perceived pollution and health risk perception among slum residents. A cross-sectional study of 5,317 individuals aged 35+ years was conducted in two slums of Nairobi. Association of perceived score and individual characteristics was assessed using linear regression. Spatial variation in the perceived levels was determined through hot spot analysis using ArcGIS. The average perceived air pollution level was higher among residents in Viwandani compared to those in Korogocho. Perceived air pollution level was positively associated with perceived health risks. The majority of respondents were exposed to air pollution in their place of work with 66% exposed to at least two sources of air pollution. Less than 20% of the respondents in both areas mentioned sources related to indoor pollution. The perceived air pollution level and related health risks in the study community were low among the residents indicating the need for promoting awareness on air pollution sources and related health risks.

  • 4.
    Egondi, Thaddaeus
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. African Populat & Hlth Res Ctr, Nairobi, Kenya.
    Kyobutungi, Catherine
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Temperature variation and heat wave and cold spell impacts on years of life lost among the urban poor population of Nairobi, Kenya2015Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 12, nr 3, s. 2735-2748Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Weather extremes are associated with adverse health outcomes, including mortality. Studies have investigated the mortality risk of temperature in terms of excess mortality, however, this risk estimate may not be appealing to policy makers assessing the benefits expected for any interventions to be adopted. To provide further evidence of the burden of extreme temperatures, we analyzed the effect of temperature on years of life lost (YLL) due to all-cause mortality among the population in two urban informal settlements. YLL was generated based on the life expectancy of the population during the study period by applying a survival analysis approach. Association between daily maximum temperature and YLL was assessed using a distributed lag nonlinear model. In addition, cold spell and heat wave effects, as defined according to different percentiles, were investigated. The exposure-response curve between temperature and YLL was J-shaped, with the minimum mortality temperature (MMT) of 26 °C. An average temperature of 21 °C compared to the MMT was associated with an increase of 27.4 YLL per day (95% CI, 2.7-52.0 years). However, there was no additional effect for extended periods of cold spells, nor did we find significant associations between YLL to heat or heat waves. Overall, increased YLL from all-causes were associated with cold spells indicating the need for initiating measure for reducing health burdens.

  • 5.
    Egondi, Thaddaeus
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. African Population and Health Research Center, P.O. Box 10787-00100, Nairobi, Kenya.
    Muindi, Kanyiva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. African Population and Health Research Center, P.O. Box 10787-00100, Nairobi, Kenya.
    Kyobutungi, C
    Gatari, M
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Measuring exposure levels of inhalable airborne particles (PM2.5) in two socially deprived areas of Nairobi, Kenya2016Ingår i: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 148, s. 500-506Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Ambient air pollution is a growing global health concern tightly connected to the rapid global urbanization. Health impacts from outdoor air pollution exposure amounts to high burdens of deaths and disease worldwide. However, the lack of systematic collection of air pollution and health data in many low-and middle-income countries remains a challenge for epidemiological studies in the local environment. This study aimed to provide a description of the particulate matter (PM2.5) concentration in the poorest urban residential areas of Nairobi, Kenya. Methods: Real-time measurements of (PM2.5) were conducted in two urban informal settlements of Nairobi City, Kenya"s Capital, from February 2013 to October 2013. The measurements were conducted using DustTrak II 8532 hand-held samplers at a height of about 1.5 m above ground level with a resolution of 1-min logging. Sampling took place from early morning to evenings according to a fixed route of measurement within areas including fixed geographical checkpoints. Results: The study period average concentration of PM2.5 was 166 mu g/m(3) in the Korogocho area and 67 mu g/m(3) in the Viwandani area. The PM2.5 levels in both areas reached bimodal daily peaks in the morning and evening. The average peak value of morning concentration in Korogocho was 214 mu g/m(3), and 164 mu g/m(3) in the evening and in Viwandani was 76 mu g/m(3) and 82 mu g/m(3) respectively. The daily midday average low observed during was 146 mu g/m(3) in Korogocho and 59 mu g/m(3) in Viwandani. Conclusion: The results show that residents in both slums are continuously exposed to PM2.5 levels exceeding hazardous levels according to World Health Organization guidelines. The study showed a marked disparity between the two slum areas situated only 7 km apart indicating the local situation and sources to be very important for exposure to PM2.5.

  • 6.
    Egondi, Thaddaeus
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. African Population and Health Research Center (APHRC), Nairobi, Kenya.
    Oyolola, Maharouf
    Mutua, Martin Kavao
    Elung'ata, Patricia
    Determinants of immunization inequality among urban poor children: evidence from Nairobi's informal settlements2015Ingår i: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 14, artikel-id 24Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Despite the relentless efforts to reduce infant and child mortality with the introduction of the National Expanded Programmes on Immunization (EPI) in 1974, major disparities still exist in immunizations coverage across different population sub-groups. In Kenya, for instance, while the proportion of fully immunized children increased from 57% in 2003 to 77% in 2008-9 at national level and 73% in Nairobi, only 58% of children living in informal settlement areas are fully immunized. The study aims to determine the degree and determinants of immunization inequality among the urban poor of Nairobi.

    Method: We used data from the Nairobi Cross-Sectional Slum Survey of 2012 and the health outcome was full immunization status among children aged 12-23 months. The wealth index was used as a measure of social economic position for inequality analysis. The potential determinants considered included sex of the child and mother's education, their occupation, age at birth of the child, and marital status. The concentration index (CI) was used to quantify the degree of inequality and decomposition approach to assess determinants of inequality in immunization.

    Results: The CI for not fully immunized was -0.08 indicating that immunization inequality is mainly concentrated among children from poor families. Decomposition of the results suggests that 78% of this inequality is largely explained by the mother's level of education.

    Conclusion: There exists immunization inequality among urban poor children in Nairobi and efforts to reduce this inequality should aim at targeting mothers with low level of education during immunization campaigns.

  • 7.
    Egondi, Thaddaeus Wandera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Making visible the invisible: Health risks from environmental exposures among socially deprived populations of Nairobi, Kenya2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: Most countries of sub-Saharan Africa (SSA) are experiencing a high rate of ur­banization accompanied with unplanned development resulting into sprawl of slums. The weath­er patterns and air pollution sources in most urban areas are changing with significant effects on health. Studies have established a link between environmental exposures, such as weather variation and air pollution, and adverse health outcomes. However, little is known about this relationship in urban populations of SSA where more than half the population reside in slums, or slum like conditions. A major reason for this is the lack of systematic collection of data on exposure and health outcomes. High quality prospective data collection and census registers still remain a great challenge. However, within small and spatially defined areas, dynamic cohorts have been established with continuous monitoring of health outcomes. Collection of environmental exposure data can complement cohort studies to investigate health effects in relation to environmental exposures. The objective of this research was to study the health effects of selected environmental exposure among the urban poor population in Nairobi, Kenya.

    Methods: We used the platform of the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), including two nested research studies, to provide data on mortality and mor­bidity. The NUHDSS was established in two areas of Nairobi, Korogocho and Viwandani, in 2003 and provides a unique opportunity for access to longitudinal population data. In addition, we conducted real-time measurements of particulate matter (PM2.5) in the areas from February to October in 2013. We obtained meteorological measurements from the Moi Air Base and Nairobi airport weather stations for the study period. We also conducted a cross-sectional survey to estab­lish the communities’ perceptions about air pollution and its related health risks. Time series re­gression models with a distributed lag approach were used to model the relationship between weather and mortality. A semi-ecological study with group level exposure assignment to individuals was used to assess the relationship between child health (morbidity and mortality) and the extent of PM2.5 exposure.

    Results: There was a significant association between daily mean temperature and all-cause mor­tality with minimum mortality temperature (MMT) in the range of 18 to 20 °C. Both mortality risk and years of life lost analysis showed risk increases in relation to cold temperatures, with pronounced effect among children under-five. Overall, mortality risks were found to be high during cold periods of the year, rising with lower temperature from MMT to about 40% in the 0–4 age group, and by about v 20% among all ages. The results from air pollution assessment showed high levels of PM2.5 concentration exceeding World Health Organization (WHO) guideline limits in the two study ar­eas. The air pollution concentration showed similar seasonal and diurnal variation in the two slums. The majority of community residents reported to be exposed to air pollution at work, with 66% reporting to be exposed to different sources of air pollution. Despite the observed high level of exposure, residents had poor perception of air pollution levels and associated health risks. Children in the high-pollution areas (PM2.5≥ 25 μg⁄m3) were at significantly higher risk for morbidity (OR = 1.30, 95% CI: 1.13-1.48) and cough as the only form of morbidity (OR = 1.33, 95% CI: 1.15-1.53) compared to those in low-pollution areas. In addition, exposure to high levels of pollution was associated with high child mortality from all-causes (IRR=1.15, 95% CI: 1.03-1.28), and indicated a positive association to respiratory related mortality (IRR=1.10, 95% CI: 0.91-1.33).

    Conclusion: The study findings extend our knowledge on health impacts related to environmental exposure by providing novel evidence on the risks in disadvantaged urban populations in Af­rica. More specifically, the study illustrates the invisible health burden that the urban poor population are facing in relation to weather and air pollution exposures. The effect of cold on population is preventable. This is manifested by the effective adaptation to cold conditions in high-latitude Nordic countries by housing standards and clothing, as well as a well-functioning health system. Further, awareness and knowledge of consequences, and reductions in exposure to air pollution, are necessary to improve public health in the slum areas. In conclusion, adverse health impacts caused by environmental stressors are critical to assess further in disadvantaged populations, and should be followed by development of mitigation measures leading to improved health and well being in SSA.

  • 8.
    Muindi, Kanyiva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Egondi, Thaddaeus
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kimani-Murage, Elizabeth
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    "We are used to this": a qualitative assessment of the perceptions of and attitudes towards air pollution amongst slum residents in Nairobi2014Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, s. 226-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: People's perceptions of and attitudes towards pollution are critical for reducing exposure among people and can also influence the response to interventions that are aimed at encouraging behaviour change. This study assessed the perceptions and attitudes of residents in two slums in Nairobi regarding air pollution. Methods: We conducted focus group discussions with residents aged 18 years and above using an emergent design in the formulation of the study guide. A thematic approach was used in data analysis. Results: The discussions revealed that the two communities experience air pollution arising mainly from industries and dump sites. There was an apparent disconnect between knowledge and practice, with individuals engaging in practices that placed them at high risk of exposure to air pollution. Residents appear to have rationalized the situation in which they live in and were resigned to these conditions. Consequently, they expressed lack of agency in addressing prevalent air pollution within their communities. Conclusions: Community-wide education on air pollution and related health effects together with the measures needed to reduce exposure to air pollution are necessary towards reducing air pollution impacts. A similar city-wide study is recommended to enable comparison of perceptions along socio-economic groups and neighbourhoods.

  • 9. Oti, Samuel Oji
    et al.
    Mutua, Michael
    Mgomella, George S.
    Egondi, Thaddaeus
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ezeh, Alex
    Kyobutungi, Catherine
    HIV mortality in urban slums of Nairobi, Kenya 2003-2010: a period effect analysis2013Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, s. 588-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: It has been almost a decade since HIV was declared a national disaster in Kenya. Antiretroviral therapy (ART) provision has been a mainstay of HIV treatment efforts globally. In Kenya, the government started ART provision in 2003 with significantly scale-up after 2006. This study aims to demonstrate changes in population-level HIV mortality in two high HIV prevalence slums in Nairobi with respect to the initiation and subsequent scale-up of the national ART program.

    Methods: We used data from 2070 deaths of people aged 15-54 years that occurred between 2003 and 2010 in a population of about 72,000 individuals living in two slums covered by the Nairobi Urban Health and Demographic Surveillance System. Only deaths for which verbal autopsy was conducted were included in the study. We divided the analysis into two time periods: the "early" period (2003-2006) which coincides with the initiation of ART program in Kenya, and the "late" period (2007-2010) which coincides with the scale up of the program nationally. We calculated the mortality rate per 1000 person years by gender and age for both periods. Poisson regression was used to predict the risk of HIV mortality in the two periods while controlling for age and gender.

    Results: Overall, HIV mortality declined significantly from 2.5 per 1,000 person years in the early period to 1.7 per 1,000 person years in the late period. The risk of dying from HIV was 53 percent less in the late period compared to the period before, controlling for age and gender. Women experienced a decline in HIV mortality between the two periods that was more than double that of men. At the same time, the risk of non-HIV mortality did not change significantly between the two time periods.

    Conclusions: Population-level HIV mortality in Nairobi's slums was significantly lower in the approximate period coinciding with the scale-up of ART provision in Kenya. However, further studies that incorporate ART coverage data in mortality estimates are needed. Such information will enhance our understanding of the full impact of ART scale-up in reducing adult mortality among marginalized slum populations in Kenya.

  • 10. Xuan, Le Thi Thanh
    et al.
    Egondi, Thaddaeus
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. African Population and Health Research Center, Nairobi, Kenya.
    Ngoan, Le Tran
    Toan, Do Thi Thanh
    Huong, Le Thi
    Seasonality in mortality and its relationship to temperature among the older population in Hanoi, Vietnam2014Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, artikel-id 23115Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Several studies have established a relationship between temperature and mortality. In particular, older populations have been shown to be vulnerable to temperature effects. However, little information exists on the temperature-mortality relationship in Vietnam. OBJECTIVES: This article aims to examine the monthly temperature-mortality relationship among older people in Hanoi, Vietnam, over the period between 2005 and 2010, and estimate seasonal patterns in mortality. METHODS: We employed Generalized Additive Models, including smooth functions, to model the temperature-mortality relationships. A quasi-Poisson distribution was used to model overdispersion of death counts. Temporal trends, seasonality, and population size were adjusted for while estimating changes in monthly mortality over the study period. A cold month was defined as a month with a mean temperature below 19 degrees C. RESULTS: This study found that the high peak of mortality coincided with low temperatures in the month of February 2008, during which the mean temperature was the lowest in the whole study period. There was a significant relationship between mean monthly temperature and mortality among the older people (pB0.01). Overall, there was a significant decrease in the number of deaths in the year 2009 during the study period. There was a 21% increase in the number of deaths during the cold season compared to the warm season. The increase in mortality during the cold period was higher among females compared to males (female: IRR [incidence relative risk] = 1.23; male: IRR = 1.18). CONCLUSIONS: Cold temperatures substantially increased mortality among the older population in Hanoi, Vietnam, and there were gender differences. Necessary preventive measures are required to mitigate temperature effects with greater attention to vulnerable groups.

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