Environmental Health Insights最新文献

Background: Low-income countries such as Ethiopia face significant food safety challenges due to weak regulatory enforcement, limited infrastructure, and rapid urbanization. In addition, the rising incidence of foodborne illnesses and emerging bioterrorism threats underscore the urgent need for robust legislation, effective regulation, and coordinated food safety measures.

Objectives: This review aimed to assess the food safety regulatory framework, standards implementation, and on-the-ground practices in the context of Ethiopia.

Methods: This scoping review included peer-reviewed articles and gray literature, such as institutional reports and unpublished documents. Data were retrieved from Google Scholar, Scopus, PubMed, and relevant organizational websites. The review was conducted in accordance with the PRISMA-ScR 2020 checklist, with document selection guided by the SPIDER framework.

Results: Ethiopia has adopted a multi-agency food safety governance model involving several sectoral institutions, notably the Ethiopian Food and Drug Authority and the Ministries of Health, Trade and Industry, and Agriculture. Despite this institutional architecture, implementation is constrained by weak enforcement, poor intersectoral coordination, limited adoption of internationally recognized food safety certification systems, and inadequate foodborne disease surveillance, resulting in persistent deficiencies in food safety and handling practices across the food supply chain.

Conclusion: Despite the presence of food and nutrition policies, food safety regulations, standards, and a formal regulatory framework, this scoping review, among the first to comprehensively map Ethiopia's food safety governance, identifies a substantial gap between policy design and practical implementation. Although government and non-governmental organizations have provided training on good hygiene practices, good manufacturing practices, and hazard analysis and critical control points, these efforts have not produced sustained improvements due to weak enforcement, fragmented institutional coordination, and limited surveillance capacity. The findings underscore the need to shift from policy development to implementation-focused reforms, strengthened accountability, and integrated regulatory action to improve food safety outcomes in Ethiopia and similar low-income settings.

Introduction: Workplaces are vital for Occupational Safety and Health (OSH) knowledge dissemination. This study examines OSH knowledge, attitudes, and practices among formal and informal sector workers in Freetown, Sierra Leone, and their associations with workplace characteristics.

Methods: A cross-sectional survey was conducted using a validated, semi-structured questionnaire to collect data on sociodemographic characteristics, workplace safety factors, and occupational safety indicators. The survey assessed 3 primary outcomes variable adequate knowledge, good attitude, and good practice. Multivariable analyses were used at significant level (P < .05) to examined associations between independent and outcomes variables.

Results: The study included 516 respondents, predominantly were male (84.3%). Educational attainment varied, with 23.6% having tertiary education and 4.7% non-formal education. Literacy rates showed 76.6% were literate. Significant disparities emerged between sectors: formal sector workers demonstrated higher rates of adequate knowledge (60.7%), good attitudes (54.9%), and good practices (77.3%) compared to informal workers. Formal sector employment was significantly associated with better OSH outcomes, including knowledge (aOR = 2.4, 95%CI: 1.43-4.15, P < .001) and practices (aOR = 16.2, 95%CI: 2.80-95.81, P < .002). These findings highlight substantial sector-based differences in occupational safety and health indicators.

Conclusion: This study reveals substantial and significant disparities in occupational safety and health (OSH) between formal and informal sector workers. Formal sectors employment is strongly associated with better OSH outcomes, particularly safer practices, thus, underscoring an urgent need for targeted policy, tailored training programmes, gender-sensitive interventions, and regulatory interventions to protect vulnerable informal workers.

Environmental exposure to heavy metals during pregnancy may adversely impact fetal development, particularly in low- and middle-income countries (LMICs) with limited environmental regulation. This study aimed to assess the relationship between maternal exposure to lead (Pb), cadmium (Cd), and mercury (Hg) and fetal growth parameters in an Indonesian population. A cross-sectional study of 127 pregnant women in their second trimester was conducted. Maternal characteristics and exposure sources were obtained via structured questionnaires. Blood concentrations of Pb, Cd, and Hg were measured using inductively coupled plasma mass spectrometry (ICP-MS). Fetal biometry was assessed by ultrasonography, and z-scores were calculated. Generalized additive models (GAMs) and linear mixed models (LMMs) with restricted cubic splines (RCS) were used to evaluate non-linear associations, adjusting for maternal age and secondhand smoke exposure. Among the 127 pregnant women, the median age was 30 years (range: 20-40 years), and the median blood concentrations of Pb, Cd, and Hg were 6.6, 0.022, and 0.021 µg/L, respectively. Fetal growth Z-scores were as follows: BPD_z = -0.48 (range: -2.5 to 2.5), HC_z = -0.38 (range: -2.0 to 2.0), AC_z = -0.56 (range: -2.5 to 2.0), FL_z = -0.62 (range: -2.5 to 2.5), and EFW_z = -0.75 (range: -3.0 to 2.0). Using linear mixed models with restricted cubic splines (RCS), Cd and Hg exposures were significantly associated with increased fetal Z-scores (Cd: β = 1.48, P < .001; Hg: β = .99, P < .001), while Pb showed a negative association (β = -.93, P < .001). Non-smokers exhibited more favorable fetal growth responses compared to those exposed to secondhand smoke. Maternal exposure to heavy metals showed non-linear effects on fetal growth. The findings underscore the need for environmental health monitoring and preventive measures during pregnancy.

Background: Atrial fibrillation (AF) is the most common arrhythmia globally and is increasingly recognized as being influenced by environmental exposures. While air pollution is a well-established risk factor for cardiovascular disease, its specific relationship to AF remains undetermined. This systematic review aims to synthesize current evidence on the association between air pollution and AF, identifying key pollutants, exposure patterns, and population vulnerabilities.

Methods: Following PRISMA guidelines, a comprehensive search of PubMed, Embase, CINAHL, Web of Science, and other databases was conducted to identify cohort, case-crossover, and time-series studies examining the effects of ambient air pollutants (PM_2.5, PM₁₀, NO₂, SO₂, CO, and O₃) on AF outcomes in adults. Data on study design, pollutant levels, AF metrics, and population characteristics were extracted and the Joanna Briggs Institute Critical Appraisal Checklist was used to evaluate the selected study quality.

Results: Thirty-one studies met inclusion criteria, encompassing over 63 million participants across North America, Europe, and Asia. PM_2.5 was the most studied and most consistently associated pollutant, with 21 of 29 studies showing significant positive associations with AF risk. Several studies identified elevated AF incidence even at pollutant levels below WHO air quality guidelines. Subgroup analyses revealed that individuals with comorbidities (eg, diabetes, obesity, hypertension), women, and older adults may be more vulnerable to pollution-related AF. Study methodologies varied widely in terms of pollutant measurement, AF detection, and temporal resolution, affecting comparability.

Conclusions: This review affirms a significant association between air pollution, particularly PM_2.5 and NO₂, and the risk of atrial fibrillation. The findings suggest that even pollutant concentrations deemed "safe" may increase AF risk, particularly in vulnerable populations. Future research should standardize exposure assessment and explore understudied pollutants and effect modifiers. These results underscore the importance of air quality regulations as a public health intervention to reduce AF burden and support cardiovascular health.

Valorisation of cashew apples (Anacardium occidentale L.) offers an opportunity to address food waste in Ghana, where approximately 90% of these edible fruits remain unutilised despite the country's position among global leaders in cashew production. This study examined the development of mycotoxins in cashew apple-wheat composite flour systems during ambient tropical storage (25°C ± 2°C, 65 ± 5% RH) over 14 days. Three composite flour formulations were prepared for subsequent bread production, with cashew apple flour substituting wheat flour at 5%, 10%, and 15% (w/w) levels. The storage stability of these pre-mixed flour blends was evaluated, as they represent the critical phase when processors store prepared formulations prior to baking. Monitoring of moisture content, fungal growth, and aflatoxin B1 levels was conducted using standardised AOAC and ISO methods. An increase in moisture was observed across all formulations, with the 5% substitution reaching a moisture content of 13.21% by day 14. Fungal populations increased exponentially (10²-10⁴ CFU/g) and showed a strong positive correlation with moisture content (r = .87, P < .001). Aflatoxin B1 was detected on day 7, rising to 8.7 μg/kg in the 5% formulation by day 14, exceeding European Union safety limits (2 μg/kg) for cereal-based products. However, higher cashew apple substitution (15%) demonstrated dose-dependent antimicrobial effects, resulting in significantly lower fungal counts (6.8 × 10³ CFU/g) and aflatoxin levels (4.1 μg/kg), likely due to naturally occurring phenolic compounds and other bioactive substances. While incorporating cashew apple flour offers considerable potential to reduce food waste and enhance nutrition, the current formulations pose unacceptable food safety risks under uncontrolled tropical storage conditions. For commercial viability, strict moisture control (⩽13%) and temperature regulation are essential to meet international food safety standards.

Background: Sustainable injectable drug delivery devices, such as prefilled syringes, multi-chamber syringes, and reusable systems, are gaining attention due to their potential to decrease resource use and waste. Despite these considerations, the integration of sustainability metrics into healthcare systems and pharmaceutical manufacturing is inconsistent, necessitating a systematic review of existing practices and outcomes.

Methods: To address this gap, a systematic literature review (SLR) was conducted in June 2024, utilizing the databases of PubMed/MEDLINE and Embase. The studies were examined for sustainability outcomes related to environmental impact, economic efficiency, and public health benefits of injectable drug delivery systems. Cost adjustments were standardized to their respective 2024 currency along with U.S. dollars using price indices for the United States, United Kingdom, Netherlands, and Italy.

Results: The literature search returned 2384 unique articles, with 24 studies meeting the inclusion criteria. The reviewed studies highlighted some of the potential benefits of sustainable injectable drug delivery devices. Environmental assessments reported reductions in waste and CO₂ emissions, with examples from hospital implementations of prefilled syringes cutting waste by 26% to 86%, and modular insulin pumps showing a 44% increase in recycling efficiency compared to conventional systems. Economic evaluations revealed potential cost reductions of up to 26% of total drug expenditures, attributed to inefficient drug preparation processes and unused medications. Public health outcomes ranged from identified challenges in disposal practices to safer sustainable strategies, including a 57% reduction in hazardous waste that enhanced safety in a resource-limited setting. While the included studies varied in methodological rigor, most were rated as fair quality, with 2 studies rated as poor - indicating a need for more robust evidence to strengthen future evaluations.

Conclusion: This review suggests that sustainable injectable drug delivery devices can reduce environmental impact, improve economic efficiency, and contribute to public health. By limiting waste, reducing carbon emissions, and supporting safety, these devices can offer measurable contributions for advancing sustainability in healthcare. However, the lack of clear sustainability standards and guidance from health systems and governments remains a key barrier to broader adoption.

Antimicrobial resistance (AMR) is a major global health concern, with resistant bacteria and genes spreading between humans, animals, and the environment. However, waterborne AMR in Enterobacteriaceae remains underexplored in developing countries such as Ethiopia. This study assessed the AMR profiles of Enterobacteriaceae isolated from 66 surface water samples collected from waste-receiving streams and the Gulf of Lake Tana. Bacteria were identified using standard microbiological methods, and antimicrobial susceptibility was tested by the Kirby-Bauer disk diffusion method. The most frequent isolates were Providencia alcalifaciens, Citrobacter spp., and Enterobacter spp. Resistance to first-generation cephalosporins ranged from 10.9% to 45.8% in stream isolates compared with 1.7% to 25.6% in lake isolates, while ceftriaxone resistance was detected in 13.5% and 4.5% of isolates, respectively. Among species, 30% of Escherichia coli, 22% of Enterobacter cloacae, and 12% of P. alcalifaciens were resistant to ceftriaxone, whereas resistance to cefazolin reached 40%, 67%, and 44%, respectively. Stream isolates also showed higher resistance to ampicillin (63%) and amoxicillin-clavulanic acid (29%) compared with lake isolates (50% and 12%). Overall, 44.8% of Enterobacteriaceae were multidrug-resistant. Significant differences in resistance were observed between stream and lake isolates for ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole, piperacillin-tazobactam, and cefazolin. The high prevalence of resistance to commonly used antibiotics, including third-generation cephalosporins, highlights the environmental dimension of AMR and underscores the urgent need for antimicrobial stewardship and surveillance in Ethiopia and similar settings.

This study aims to examine solid waste generation, composition, and characteristics, thereby evaluating household resource recovery practices and the factors influencing these practices. A community-based cross-sectional study was conducted, combining quantitative and qualitative methods, including a household survey and detailed proximate and ultimate analyses of waste. Relevant data were collected from 820 systematically selected households through a structured survey, complemented by measurements of solid waste generation and composition using an adapted standard checklist for solid waste composition analysis. The data were analyzed using descriptive statistics and ordinal logistic regression. The results indicate a solid waste generation rate of 0.653 kg per person per day in Jimma. The organic components accounted for 55.5%, recyclable products accounted for 23.97%, and reusable materials accounted for 11.02% of the total municipal solid waste, suggesting a 90.5% resource recovery potential. Despite huge resource potential, households' engagement in waste recovery practices is very low due to limited knowledge and tenure status, underscoring the need for targeted education and resource-oriented waste management strategies. Therefore, this study recommends targeted awareness campaigns, formalization of informal solid resource recovery sectors, household composting, and equitable infrastructure investments to align local waste management with sustainable urban development.

Background: Cholera is a significant public health issue in low- and middle-income countries. Understanding the specific factors contributing to outbreaks is crucial for designing effective control strategies, especially in prolonged outbreak situations. Therefore, this study aimed to identify determinants of cholera outbreaks in the southeastern part of Oromia, Ethiopia.

Methods: A community-based, unmatched case-control study was conducted involving 10 districts across 4 zones of the Oromia region, Ethiopia. Cases were individuals with laboratory-confirmed Vibrio cholerae infection or those linked to a confirmed case, while controls were asymptomatic individuals without symptoms. The association between risk factors and cholera was studied using a logistic regression model. Variables with P-values less than .25 were included in the multivariable logistic regression model. The Hosmer-Lemeshow test assessed the goodness-of-fit of the final model. Adjusted odds ratios were calculated to determine independent determinants of cholera outbreaks.

Results: The study involved 1218 individuals, 424 (34.8%) being cases and 794 (65.2%) controls. The study found that household heads with no formal education [AOR: 3.65; 95% CI: 1.92-6.95] and primary education [AOR: 1.99; 95% CI: 1.05-3.78], households that were farmer/housewives [AOR: 2.49, 95% CI: 1.26-4.93], pastoralists [AOR: 4.20; 95% CI: 1.73-10.20], eating raw or uncooked food [AOR: 1.57; 95% CI: 1.18-2.10], storing water every day [AOR: 2.51; 95% CI: 1.21-5.22], and a low information index [AOR: 1.79; 95% CI: 1.25-2.56] increase the odds of being a case compared to their counterparts. Married respondents [AOR = 0.46; 95% CI: 0.34-0.62], good latrine utilization [AOR: 0.59; 95% CI: 0.40-0.85], and very good latrine utilization [AOR: 0.40; 95% CI: 0.26-0.61] are associated with lower odds of cholera infection. Therefore, targeted interventions, such as improving education, sanitation, and household-level food hygiene practice, would have a significant impact on the control and prevention of cholera in the setting.

Health inequalities remain a central challenge in public health and are often shaped by social and economic conditions. However, in many cases, geographic determinants are overlooked despite having a significant impact on population health. Some geographic determinants include altitude, climate, terrain, and environmental conditions. The altitude of residence can impact health in various ways; areas located at high altitudes face challenges such as living in zones with low oxygen levels and the effects of hypoxia. Climate has a direct effect on health; heatwaves can affect agricultural production, causing food shortages and nutritional problems. Similarly, geographic isolation, limited access to water, air pollution, and biodiversity loss contribute to region-specific health risks. This paper highlights the importance of incorporating geographic determinants into public health frameworks to inform the development of context-sensitive and equitable interventions. Recognizing the influence of geography is essential to reducing health disparities and improving outcomes for populations living in environmentally vulnerable areas.