The implementation of primary health care (PHC) over the last two decades has prevented more than 300,000 child deaths in four Latin American countries, and could prevent more than 140,000 by 2030 in a scenario of economic crisis. This is the main conclusion of a study coordinated by the Barcelona Institute for Global Health (ISGlobal), a centre supported by “la Caixa” Foundation.

The 2018 Astana Declaration highlighted the critical role of PHC in ensuring that everyone enjoys the highest possible standard of health, and in achieving universal health coverage. The Declaration also stressed the urgent need to assess the effectiveness of PHC strategies in low and middle-income countries (LMICs), in order to make them more effective and sustainable.

A multi-country assessment

“Ours is the first comprehensive attempt to assess the impact of PHC as a macro-strategy in four countries representing the majority of the population (62%) in Latin America,” says ISGlobal researcher Davide Rasella, who leads the Health Impact Assessment group. He and his team conducted a retrospective impact evaluation in Brazil, Colombia, Ecuador, and Mexico from 2000 to 2019, using data on PHC coverage and mortality between birth and five years of age. They also used forecasting models up to 2030 under different economic scenarios.

The analysis shows that high PHC coverage was associated with significant reductions in mortality among newborns (of almost 30%), and children under five. The PHC effects were particularly strong for poverty-related conditions (such as anemia and malnutrition) and vaccine-preventable diseases. The models predict that in a scenario of moderate economic crisis, 142,285 child deaths could be avoided by 2030 in the four countries by increasing PHC coverage.

Latin American countries are among those that have suffered the most from the socioeconomic consequences of the COVID-19 pandemic and may be forced to implement fiscal austerity measures. “However, our findings show that expanding PHC to protect the growing number of vulnerable populations is an effective strategy to mitigate the health impact of the current economic crisis and to achieve the Sustainable Development Goals related to child health,” says Ana Moncayo, first author of the study and researcher at the Center for Research on Health In Latin America (CISeAL).

The authors also stress the importance of having sufficient and high-quality administrative data, (demographic, socioeconomic, and health-related information) to enable robust studies that can guide decision-making.

Reference

Moncayo AL, Cavalcanti D, Ordoñez JA et al. Can Primary Health Care mitigate the effects of economic crises on child health? An integrated multi-country evaluation and forecasting analysis in Latin America. Lancet Global Health. 2024.  

Climate change is here, in Europe, and it kills. This is the warning of 69 contributors of the 2024 Europe report of the Lancet Countdown , published today in the Lancet Public Health. Tracking the links between climate change and health across the region, the new report explores 42 indicators which monitor the health impacts of climate change, as well as the inadequate, delayed or missed opportunities of climate action in Europe.

This second indicator report from the Lancet Countdown in Europe has been led by the Barcelona Supercomputing Center-Centro Nacional de Supercomputación (BSC-CNS), in collaboration with the Barcelona Institute for Global Health (ISGlobal), a centre supported by the ”la Caixa Foundation”, and 40 other institutions across Europe.

Climate change is not a far-in-the-future scenario

Indicator findings show that the negative health impacts of climate change have been increasing compared with baseline levels - with most impacts exceeding previously reported levels.

• Heat-related deaths are estimated to have risen across most of Europe, with a mean increase of 17 deaths per 100,000 inhabitants between 2003–2012 and 2013–2022.
• Risky hours for physical activity due to heat stress risk increased between 1990–2022 for both medium (eg, cycling or football) and strenuous (eg, rugby or mountain biking) activities, possibly resulting in reduced physical activity and therefore increasing the risk of non-communicable diseases.
• Climatic suitability for various climate-sensitive pathogens, vectors and diseases has increased in Europe (eg, Vibrio, West Nile virus, dengue, chikungunya, Zika, malaria, leishmaniasis, and ticks, which spread Lyme disease and other tick-borne diseases).
• Both the start and end of the pollen season have shifted for alder, birch, and olive, while the season duration remained nearly the same length across most of Europe.

“Climate change is already wreaking havoc on the lives and health of people across Europe,” says Rachel Lowe , Director of the Lancet Countdown in Europe and ICREA research professor and leader of the Global Health Resilience group at the Barcelona Supercomputing Center, Spain. “Our report provides evidence on the alarming increases in climate-related health impacts across Europe, including heat-related mortality, emerging infectious diseases and food and water insecurity. The time has come for unprecedented action to limit these negative impacts on health in Europe and across the globe.”

Deepening health inequalities in a warming world

The negative climate-related health impacts and the responsibility of climate change are not equal within Europe or across the globe, often reflecting socio-economic inequalities and marginalisation. The authors reflect on aspects of inequality by highlighting at-risk groups in Europe and Europe’s responsibility for the climate crisis.

• Heat-related mortality was twice as high in women compared with men; low-income households had a substantially higher probability of experiencing food insecurity ; deaths attributable to an imbalanced diet were higher among women; and exposure to wildfire smoke was higher in highly deprived areas.
• Southern Europe tends to be more affected by heat-related illnesses, wildfires, food insecurity, drought, mosquito-borne diseases and leishmaniasis. In contrast, northern Europe is equally or more impacted by Vibrio and ticks, which can spread diseases like Lyme disease and tick-borne encephalitis.
• Despite climate change exacerbating existing health inequalities, the report shows little engagement with aspects of equality, equity or justice in climate and health research, policy and media, with only 10 (0.1%) references to the intersection of health and climate change recorded in the European Parliament in 2022.

“Climate change is inherently a social and environmental justice problem.” says Kim van Daalen , Lancet Countdown in Europe Research Fellow, lead author of the report, and post-doctoral researcher at the Barcelona Supercomputing Center, Spain. “Looking within European countries we are seeing the most disadvantaged communities being particularly affected by the climate-related health impacts. At the same time, European countries also offshore the health impacts of our consumption elsewhere, with other parts of the world experiencing local air pollution and greenhouse gas emissions as a result of the goods and services consumed by Europe.”

• In 2021, emissions from fossil fuel combustion were 5.4 tonnes of CO ₂ per person in Europe —six times that of Africa and almost three times that of Central and South America per person emissions.
• Many European countries still outsource environmental pressures elsewhere, with consumption-based CO ₂ and PM _2.5 emissions exceeding production-based emissions.

A fair and healthy environmental transition

This first update of the comprehensive assessment on climate change and health in Europe emphasises that climate change is already negatively affecting people’s health across Europe, yet the signs of political action to protect citizens are slim .

• The current trajectory estimates that carbon neutrality will be reached as late as 2100 , showing the road to net-zero energy systems remains woefully inadequate.
• Coal use increased to 13% of Europe’s total energy supply in 2021 compared to 12% in 2020; and 29 of the 53 WHO European region countries are still providing net subsidies for fossil fuels.
• During 2005–20, air pollution (PM_2.5) attributable deaths from fossil fuel combustion decreased by 59% in Europe, with much being due to air pollution control technologies.

“Exposure to air pollution is harming people’s health in Europe and beyond,” says Cathryn Tonne , co-Director of the Lancet Countdown in Europe and Research Professor at ISGlobal. “Whilst our report shows a decrease in air pollution (PM_2.5) over the past 15 years in Europe, this decrease was predominantly due to improved air pollution control technologies that decreased air pollution, but not greenhouse gas emissions. We still need appropriate policy measures that tackle air pollution and greenhouse gas emissions in parallel.”

Failure to take decisive action may exacerbate the existing climate change impacts and lead to missed opportunities for considerable health co-benefits in the short term. The authors argue that considering the impacts of climate change within and beyond Europe and Europe’s role in creating the climate crisis, Europe should commit to a fair and healthy environmental transition , which includes taking global responsibility and supporting the most affected communities.

“We are feeling the cost of delayed action already - but we also know the rewards we could reap from phasing out fossil fuels and pathways to get there,” says Prof. Rachel Lowe. “Limiting global warming to less than 1.5C degrees through a just and healthy transition would deliver life-saving benefits for people across Europe and beyond. Instead of facing ill health and threats to our livelihoods, European countries could feel the health benefits of clean air, better diets, reduced inequality and more liveable cities through urgently implementing climate policies which focus on health and wellbeing.”

About the Lancet Countdown in Europe

Established in 2021, the Lancet Countdown in Europe tracks the connections between climate change and public health across Europe, drawing on the transdisciplinary expertise of 69 contributors spanning over 40 academic and UN institutions. With the wealth of data and academic expertise available in Europe, the collaboration develops region-specific indicators to address the main challenges and opportunities of Europe’s response to climate change for health. The indicators produced by the collaboration provide information to health and climate decision-making and contribute to the European Climate and Health Observatory . In 2022, the collaboration published its first indicator report in the Lancet Public Health.

This is the second indicator report tracking progress on health and climate change in Europe, reporting on 42 indicators across five domains highlighting the negative impacts of climate change on human health, the delayed climate action of European countries, and the missed opportunities to protect or improve health through health-responsive climate action. The report was published on 13 May in the Lancet Public Health – ahead of the 77 ^th World Health Assembly, 60 ^th sessions of the UNFCCC Subsidiary Bodies, and the European Parliament elections.

The burden of heat-related mortality during the summer of 2022 in Europe may have exceeded 70,000 deaths according to a study led by the Barcelona Institute for Global Health (ISGlobal), a research centre supported by the “la Caixa” Foundation, in collaboration with the Barcelona Supercomputing Center (BSC). The authors of the study, published in The Lancet Regional Health – Europe, revised upwards initial estimates of the mortality associated with record temperatures in 2022 on the European continent.

In an earlier study, published in Nature Medicine, the same team used epidemiological models applied to weekly temperature and mortality data in 823 regions in 35 European countries and estimated the number of heat-related premature deaths in 2022 to be 62,862. In that study, the authors acknowledged that the use of weekly data would be expected to underestimate heat-related mortality, and pointed out that daily time-series data are required to accurately estimate the impact of high temperatures on mortality.

The objective of the new study was to develop a theoretical framework capable of quantifying the errors arising from the use of aggregated data, such as weekly and monthly temperature and mortality time-series. Models based on temporally aggregated data are useful because aggregated data are available in real-time from institutions such as Eurostat, facilitating quantification of the health hazard within a few days of its emergence. To develop a theoretical framework, the research team aggregated daily temperatures and mortality records from 147 regions in 16 European countries. They then analysed and compared the estimates of heat- and cold-related mortality by different levels of aggregation: daily, weekly, 2-weekly and monthly. 

Analysis revealed differences in epidemiological estimates according to the time scale of aggregation. In particular, it was found that weekly, 2-weekly and monthly models underestimated the effects of heat and cold as compared to the daily model, and that the degree of underestimation increased with the length of the aggregation period. Specifically, for the period 1998-2004, the daily model estimated an annual cold and heat-related mortality of 290,104 and 39,434 premature deaths, respectively, while the weekly model underestimated these numbers by 8.56% and 21.56%, respectively.

“It is important to note that the differences were very small during periods of extreme cold and heat, such as the summer of 2003, when the underestimation by the weekly data model was only 4.62%,” explains Joan Ballester Claramunt, the ISGlobal researcher who leads the European Research Council’s EARLY-ADAPT project.

The team used this theoretical framework to revise the mortality burden attributed to the record temperatures experienced in 2022 in their earlier study. According to the calculations made using the new methodological approach, that study underestimated the heat-related mortality by 10.28%, which would mean that the actual heat-related mortality burden in 2022, estimated using the daily data model, was 70,066 deaths, and not 62,862 deaths as originally estimated.

Using weekly data to analyse the effects of temperatures in the short term

“In general, we do not find models based on monthly aggregated data useful for estimating the short-term effects of ambient temperatures,” explains Ballester. “However, models based on weekly data do offer sufficient precision in mortality estimates to be useful in real-time practice in epidemiological surveillance and to inform public policies such as, for example, the activation of emergency plans for reducing the impact of heat waves and cold spells.”

It is an advantage in this area of research to be able to use weekly data since investigators often encounter bureaucratic obstacles that make it difficult or impossible to design large-scale epidemiological studies based on daily data. According to Ballester, when daily data is not available, the use of weekly data, which are easily accessible for Europe in real time, is a solution that can offer “a good approximation of the estimates obtained using the daily data model”.

"Aggregation of mortality data at the weekly level has important implications for designing sustainable climate-driven health early warning systems using publicly available data." says Prof Rachel Lowe, ICREA Research Professor, BSC Global Health Resilience Group Leader and Director of the Lancet Countdown in Europe.

Reference

Ballester J, van Daalen KR, Chen Z, Achebak H, Antó JM, Basagaña X, Robine JM, Herrmann FR, Tonne C, Semenza JC, Lowe R. The effect of temporal data aggregation to assess the impact of changing temperatures in Europe: an epidemiological modelling study. The Lancet Regional Health – Europe. Nov 2023. doi: 10.1016/j.lanepe.2023.100779

Primary health care, conditional cash transfers and social pensions have prevented 1.4 million deaths of all ages in Brazil over the past two decades, according to a study coordinated by the Barcelona Institute for Global Health (ISGlobal), a centre supported by “la Caixa” Foundation. If expanded, these programmes could avert an additional 1.3 million deaths and 6.6 million hospitalisations by 2030.

The COVID-19 pandemic has exacerbated poverty and social inequalities worldwide, particularly in low- and middle-income countries (LMICs). In addition, the economic consequences of the ongoing war in Ukraine and soaring inflation are expected to push even more people into poverty in the coming years. This is what we call a polycrisis: multiple crises interacting in such a way that their combined impact is greater than the sum of the parts.

In terms of public health, worsening socioeconomic conditions mean higher rates of disease and death, especially among the most vulnerable people in LMICs. But social programmes can mitigate the health consequences of economic crises. Brazil has led one of the largest welfare state expansions over the past two decades, implementing a public universal healthcare system along with conditional cash transfer programmes (Programa Bolsa Familia) for the poorest families and social pensions (Beneficio de Prestacao Continuada) for the elderly and disabled.

Reductions in hospitalisations and deaths

In this study, ISGlobal researcher Davide Rasella and his team evaluated the combined effect of these three programmes (conditional cash transfers, social pensions and primary health care) on hospitalisations and deaths over almost two decades (from 2004 to 2019). “This is the first study to conduct a nationwide combined evaluation of cash transfers, social pensions, and primary health care for a such long period in a LMIC,” says Rasella, who coordinated the study. 

Using data from 2,548 Brazilian municipalities, they show that high coverage of the three programmes led to reductions in overall hospitalisation and mortality rates, particularly among children under five years of age and adults over 70. A total of 1.46 million deaths were averted between 2004 and 2019. The research team then used forecasting methods to show that extending the programmes to the newly poor and vulnerable could avert up to 1.3 million additional deaths by 2030.

“We clearly show that expanding these three programmes is a viable strategy to mitigate the health impact of the current global polycrisis,” says Daniella Cavalcanti, co-first author of the study. “On the contrary, fiscal austerity measures would only result in a large number of preventable deaths.”

Reference

Aransiola TJ, Ordoñez JA, Cavalcanti D et al. Current and Projected Mortality and Hospitalization Rates Associated with Conditional Cash Transfer, Social Pension, and Primary Health Care Programs in Brazil, 2000-2030. JAMA Network Open. 2024; 7(4):e247519. doi: 10.1001/jamanetworkopen.2024.7519

A study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, and the Barcelona Supercomputing Center - Centro Nacional de Supercomputación (BSC-CNS), has consistently estimated daily ambient concentrations of PM_2.5, PM₁₀, NO₂ and O₃ across a large ensemble of European regions between 2003 and 2019 based on machine learning techniques. The aim was to assess the occurrence of days exceeding the 2021 guidelines of the World Health Organization (WHO) for one or multiple pollutants, referred to as “unclean air days”.

The research team analysed pollution levels in more than 1,400 regions in 35 European countries, representing 543 million people. The results, published in Nature Communications, show that overall suspended particulate matter (PM_2.5 and PM₁₀) and nitrogen dioxide (NO₂) levels have decreased in most parts of Europe. In particular, PM₁₀ levels decreased the most over the study period, followed by NO₂ and PM_2.5, with annual decreases of 2.72%, 2.45% and 1.72% respectively. In contrast, O₃ levels increased annually by 0.58% in southern Europe, leading to a nearly fourfold rise in unclean air days.

The study also looked at the number of days on which the limits for two or more pollutants were exceeded simultaneously, a confluence known as a “compound unclean air day”. Despite the overall improvements, 86.3% of the European population still experienced at least one compound unclean day per year during the study period, with PM_2.5-NO₂ and PM_2.5-O₃ emerging as the most common compound combinations.

The results highlight the significant improvements in air quality in Europe followed by the decline of PM₁₀ and NO₂, while PM_2.5 and O₃ levels have not followed a similar positive trend, resulting in a higher number of people exposed to unclean air levels. "Targeted efforts are needed to address PM_2.5 and O₃ levels and associated compound unclean days, especially in the context of rapidly increasing threats from climate change in Europe," says Zhao-Yue Chen, ISGlobal researcher and lead author of the study.

"Our consistent estimation of population exposure to compound air pollution events provides a solid basis for future research and policy development to address air quality management and public health concerns across Europe," points out Carlos Pérez García-Pando, ICREA and AXA Research Professor at the BSC-CNS.

Heterogeneous geographical distribution

The research team has developed machine learning models to estimate high-resolution daily concentrations of major air pollutants like PM_2.5, PM₁₀, NO₂ and O₃. This data-driven approach creates a comprehensive daily air quality picture for the European continent, going beyond sparsely distributed monitoring stations. The models gather data from multiple sources, including satellite-based aerosol estimates, existing atmospheric and climate data, and land use information. By analysing these air pollution estimates, the team calculated the annual average number of days in which the WHO daily limit for one or more air pollutants is exceeded.

Despite air quality improvements, 98.10%, 80.15% and 86.34% of the European population lives in areas exceeding the WHO recommended annual levels for PM_2.5, PM₁₀ and NO₂, respectively. These results closely match the European Environment Agency (EEA)'s estimates for 27 EU countries using data from urban stations only. Additionally, no country met the ozone (O₃) annual standard during the peak season from 2003 to 2019. Looking at short-term exposure, over 90.16% and 82.55% of the European population lived in areas with at least 4 days exceeding WHO daily guidelines for PM_2.5 and O₃ in 2019, while the numbers for NO₂ and PM₁₀ were 55.05% and 26.25%.

During the study period, PM_2.5 and PM₁₀ levels were highest in northern Italy and eastern Europe, with high PM₁₀ additionally in southern Europe. High NO₂ levels were mainly observed in northern Italy and in some areas of western Europe, such as in the south of the United Kingdom, Belgium and the Netherlands. Similarly, O₃ increased by 0.58% in southern Europe, while it decreased or showed a non-significant trend in the rest of the continent. On the other hand, the most significant reductions in PM_2.5 and PM₁₀ were observed in central Europe, while for NO₂ they were found in mostly urban areas of western Europe.

The complex management of ozone

The average exposure time and population exposed to unclean air concentrations of PM_2.5 and O₃ is much higher than for the other two pollutants. According to the research team, this highlights the urgency of greater control for these pollutants and the importance of addressing the increasing trend and impact of O₃ exposure.

Ground-level or tropospheric O₃ is found in the lower layers of the atmosphere and is considered a secondary pollutant because it is not emitted directly into the atmosphere, but is formed from certain precursors - such as volatile organic compounds (VOCs), carbon monoxide (CO) and nitrogen oxides (NOx) - that are produced in combustion processes, mainly in transport and industry. In high concentrations, ozone can damage human health, vegetation and ecosystems.

"Ozone management presents a complex challenge due to its secondary formation pathway. Conventional air pollution control strategies, which focus on reducing primary pollutant emissions, may not be sufficient to effectively mitigate O₃ exceedances and associated compound unclean days," says Joan Ballester Claramunt, ISGlobal researcher and senior author of the study. However, addressing climate change, which influences ozone formation through increased sunlight and rising temperatures, is crucial for long-term ozone management and protection of public health," he adds.

The challenge of compound episodes

Despite improvements in air pollution, the research team reported that over 86% of Europeans experienced at least one day with compound air pollution events each year between 2012 and 2019, where multiple pollutants exceeded WHO limits simultaneously. Among those compound days, the contribution of PM_2.5-O₃ compound days increased from 4.43% in 2004 to 35.23% in 2019, becoming the second most common type in Europe, indicating a worrying trend. They mainly occur in lower latitudes during warm seasons and are likely linked to climate change and the complex interplay between PM_2.5 and O₃.

Warmer temperatures and stronger sunlight in summer boost O₃ formation through chemical reactions. Subsequently, higher levels of O₃ will accelerate the oxidation of organic compounds in the air. This oxidation process leads to the condensation of certain oxidized compounds, forming new PM_2.5 particles. Additionally, climate change increases the likelihood of wildfires, which further elevate both O₃ and PM_2.5 levels. “This complex interplay creates a harmful loop, highlighting the urgent need to address climate change and air pollution simultaneously,” explains Ballester Claramunt.

Reference

Main study: Chen, Z.Y., Petetin, H., Turrubiates, R.F.M., Achebak, H., García-Pando, C.P. and Ballester, J., 2024. Population exposure to multiple air pollutants and its compound episodes in Europe, Nature Communications. Doi: 10.1038/s41467-024-46103-3

Related study: Chen, Z.Y., Turrubiates, R.F.M., Petetin, H., Lacima, A., García-Pando, C.P. and Ballester, J., 2024. Estimation of pan-European, daily total, fine-mode and coarse-mode Aerosol Optical Depth at 0.1° resolution to facilitate air quality assessments. Science of The Total Environment, p.170593. Doi: 10.1016/j.scitotenv.2024.170593

A growing body of research shows that exposure to air pollution, especially during pregnancy and childhood, may have a negative impact on brain development. Now a study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, has found that exposure to nitrogen dioxide (NO2) during the first two years of life is associated with poorer attention capacity in children aged 4 to 8, especially in boys. NO₂ is a pollutant that comes mainly from traffic emissions.

The study, published in Environment International, shows that higher exposure to NO2 was associated with poorer attentional function in 4- to 6-year-olds, with increased susceptibility to this pollutant observed in the second year of life. This association persisted at an age of 6 to 8 years of age only in boys, with a slightly greater susceptibility period from birth to 2 years of age.

The researchers used data from 1,703 women and their children from the INMA Project birth cohorts in four Spanish regions. Using the home address, the researchers estimated daily residential exposure to NO2 during pregnancy and the first 6 years of childhood. In parallel, they assessed the attentional function (the ability to choose what to pay attention to and what to ignore) at 4-6 years and 6-8 years, and working memory (the ability to temporarily hold information) at 6-8 years, using validated computerised tests.

Periods of higher susceptibility to air pollution

A previous INMA study reported that exposure to NO2 during pregnancy and childhood was associated with impaired attentional function in children at 4-5 years of age. The present study found that:

• Higher exposure to NO2 between 1.3 and 1.6 years of age was associated with higher hit reaction time standard error, an indicator of speed consistency, in the attentional function test at 4–6 years of age.
• Higher exposure to NO2 between 1.5 and 2.2 years of age was associated with more omission errors.
• Higher exposure to NO2 between 0.3 and 2.2 years was associated with higher hit reaction time standard error at 6–8 years only in boys.
• No associations were found between higher exposure to NO2 and working memory in children aged 6 to 8 years.

“These findings underline the potential impact of increased traffic-related air pollution on delayed development of attentional capacity and highlight the importance of further research into the long-term effects of air pollution in older age groups”, explains Anne-Claire Binter, last author of the study and postdoctoral researcher at ISGlobal.

As the brain matures

Attentional function is crucial for the development of the brain’s executive functions, which manage and control actions, thoughts and emotions to achieve a goal or purpose. “The prefrontal cortex, a part of the brain responsible for executive functions, develops slowly and it is still maturing during pregnancy and childhood,” adds Binter. This makes it vulnerable to exposure to air pollution, which has been linked in animal studies to inflammation, oxidative stress, and impaired energy metabolism in the brain.

“In boys, the association between exposure to N0₂ and attentional function may last longer because their brains mature more slowly, which could make them more vulnerable”, she points out. To understand this better, future studies should follow people over time to see how age and gender affect the relationship between air pollution and attention span, especially in older age groups.

In conclusion, “this study suggests that early childhood, up to the age of 2, seems to be a relevant period for implementing preventive measures,” says Binter. “Even a small effect at the individual level from relatively low levels of exposure, as in this study, can have large consequences at the population level. Exposure to traffic-related air pollution is therefore a determinant of the health of future generations.”

Reference

Crooijmans, K.L.H.A., Iñiguez, C., Withworth, K.W., Estarlich, M., Lertxundi, A., Fernández-Somoano, A., Tardón, A., Ibarluzea, J., Sunyer, J., Guxens M., Binter, A.C. 2024, Nitrogen dioxide exposure, attentional function, and working memory in children from 4 to 8 years: Periods of susceptibility from pregnancy to childhood, Environment International. Volume 186, 2024, 108604, ISSN 0160-4120, https://doi.org/10.1016/j.envint.2024.108604

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Sulfadoxine-pyrimethamine (SP) retains parasitological activity and remains effective for preventing P. falciparum infection in pregnant women and low birth weight in babies, even in areas with a high prevalence of mutations associated with SP resistance. This is the main conclusion of a study conducted in southern Mozambique and led by the Manhiça Health Research Institute (CISM) and the Barcelona Institute for Global Health (ISGlobal), a centre supported by "la Caixa" Foundation.

Providing preventive antimalarial treatment to pregnant women and children under five, regardless of whether they are infected, is an effective strategy for reducing the burden of malaria in these two highly vulnerable populations. In pregnant women, monthly doses of sulfadoxine-pyrimethamine (SP) after the first trimester have been shown to be safe and effective in reducing the severe consequences of malaria in mothers and their babies, including low birth weight. However, there is concern about the growing prevalence of malaria parasites that carry a series of mutations that decrease the efficacy of SP. Specifically, five mutations in two genes (quintuple mutants) are associated with SP resistance.

“Curiously, even in areas where the prevalence of quintuple mutants is high, chemoprevention with SP still seems to provide a benefit to pregnant women,” says ISGlobal researcher Alfredo Mayor. “Whether this sustained benefit is due to other non-malaria effects of sulfadoxine (which also acts as an antibiotic), or whether there is still a direct effect on malaria infections, is not clear,” he adds.

To answer this question, a team led by Mayor and CISM researcher Glòria Matambisso investigated malaria infections, antibodies, clinical outcomes and parasite resistance markers over three years in a total of 4,016 pregnant women in Southern Mozambique.

SP retains anti-parasite activity

Despite the fact that 94% of infected women at the first antenatal visit carried quintuple mutants, preventive treatment with SP (IPTp-SP) remained effective in those who took three or more doses of SP during pregnancy (84% of the participants). Specifically, they showed increased clearance of P. falciparum infections (the prevalence of infected women fell from 7.7% at the first visit to 1.9% at delivery); had a lower prevalence of antibodies resulting from parasite colonisation of the placenta; and their babies had a higher birth weight, compared to women who took less than three doses of SP.

“Our results suggest that SP retains activity against parasites carrying these five mutations, and that the observed benefit is not only due to sulfadoxine’s antibiotic properties,” says Glória Matambisso, first author of the study. In other words, the sustained parasitological effect of SP in clearing malaria infections, combined with the antibiotic properties of sulfadoxine, may explain why IPTp-SP remains beneficial even in areas where the quintuple mutation is dominant. The authors conclude that, until more effective alternatives are found, SP should continue to be used for malaria chemoprevention in pregnant women, despite the high prevalence of molecular markers of drug resistance.

“This is good news,” says Mayor. But the fact that many of the participants went to their first antenatal visit at week 21 (instead of during the first trimester, as recommended) and that 16% of them failed to receive three or more SP doses, means that there are still major barriers to the successful implementation of IPTp. “We need to strengthen our operational capacities to provide timely chemoprevention to pregnant women,” he adds.

Reference

Matambisso G, Brokhattingen N, Maculuve S et al. Parasitological and clinical effects of malaria chemoprevention with sulfadoxine-pyrimethamine in pregnant women from southern Mozambique. J Infection. 2024. Doi: 10.1016/j.jinf.2024.106144

A substantial proportion of the world’s population remains willing to get vaccinated against diseases including COVID-19, according to a new survey across 23 countries that represent more than 60% of the world’s population. The study, published in Nature Medicine, was co-led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by “la Caixa” Foundation, and the Graduate School of Public Health and Health Policy of the City University of New York (CUNY SPH). 

The severe human impact of the COVID-19 pandemic led to the rapid research and development of safe and effective vaccines based on existing models, and resulted in the largest vaccination campaign in history. Just one year after COVID-19 was declared a pandemic, more than 250 million people worldwide had been vaccinated against SARS-CoV-2, the virus that causes it. 

Although no longer considered a significant public health threat, the virus continues to circulate and mutate. This means that variant-adapted boosters are still needed, especially for the many people at higher risk of severe disease and death.

“Today, vaccine hesitancy, pandemic fatigue and vaccine fatigue are major challenges to ensuring that people stay up to date with their vaccinations, including COVID-19 boosters” says Jeffrey V. Lazarus, head of the Health Systems Research Group at ISGlobal, Professor of Global Health at CUNY SPH, and coordinator of the study. 

Vaccine confidence remains high

Through a series of annual surveys across 23 countries over the course of the pandemic, Lazarus and his colleagues have been assessing global trust in information sources and vaccines. In this fourth survey of 23,000 adults, conducted in October 2023, the research team found that the intent to get a COVID-19 booster was slightly lower (71.6% of respondents) compared to 2022 (87.9%). However, the global population’s overall trust in vaccination did not diminish. More than 3 in 5 participants (60.8%) said they were more willing to get vaccinated for diseases other than COVID-19 as a result of their experience during the pandemic, while only 23.1% were less willing. 

“This finding suggests there is a general openness to vaccination that can be used to boost confidence in new generations of COVID-19 vaccines and boosters,” says Ayman El-Mohandes, study co-author and Dean of the City University of New York School for Public Health & Health Policy. “We must design targeted messages for trusted communicators to encourage vaccine uptake.” 

The new survey also evaluated public trust in information sources used during the pandemic. Overall, the most trusted sources were healthcare providers (with a score of 6.9 out of 10) and the World Health Organization (6.5 out of 10), highlighting the importance of continuing to rely on these sources in future communication campaigns. There was, however, some variability between countries. For example, religious leaders ranked 3.16 in Sweden but 6.72 in India. 

Public trust in the ability of authorities, scientists, and health organisations to manage future pandemics presented a mixed picture. “The great variability of trust observed across countries makes it clear that improving vaccine confidence globally will require more culturally appropriate local communication strategies,” says Lazarus. “There is an urgent need to catch up on routine immunisations and prepare for potential new pandemic threats, so we must continue to monitor vaccine confidence,” he adds. 

The survey data are highly representative for different geographic regions in the world and different demographic groups (age, gender, education level) within each country.

Reference

Lazarus, J.V., White, T.M., Wyka, K. et al. Influence of COVID-19 on trust in routine immunization, health information sources and pandemic preparedness in 23 countries in 2023. Nat Med (2024). https://doi.org/10.1038/s41591-024-02939-2

Young men working in agricultural or livestock settings are the most affected by snakebites, according to research in Paraguay based on data from the last six years. The study, led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, highlights the importance of collecting more and better data to estimate the true burden of this neglected disease.

Every year, between 80,000 and 140,000 people die from the bite of a venomous snake. In 2017, the WHO added poisoning by snakebite to the list of neglected tropical diseases, to give greater visibility to a public health problem for which there is not only a problem of access to anti-venom treatments, but also a lack of reliable data at global and national levels.

In the Americas, the vast majority of snakebite cases occur in eastern Paraguay and southeastern Brazil. In Paraguay, nearly 300,000 people live in areas where at least one species of venomous snake is present and more than three hours away from a medical centre.

"The problem is that there is a great lack of updated information on the burden of snakebites in the country," says Sofia Ardiles, ISGlobal researcher and first author of the study.

The research team analysed bite cases reported in Paraguay between 2015 and 2021, as well as socio-demographic, clinical and treatment information for each case. A total of 1651 bites were reported between 2015 and 2021 (an average of 235 cases per year). These figures are similar to those reported between 2004 and 2015, indicating that the incidence has remained stable. The regions with the highest number of cases are those that form part of the Gran Chaco, a geographical region that includes territories in Argentina, Bolivia, Brazil and Paraguay, where ISGlobal is working with local partners to improve care for neglected diseases.

Men of productive age: most affected

Men of productive age (around 25 years old) account for almost 70% of cases, many of whom work in the agricultural or livestock sector. "This reinforces the notion that snakebite is an occupational disease," says Irene Losada, ISGlobal researcher and co-author of the study. Many of the bites occurred during the day, on farms or in homes, and during the rainy season. "Having a better idea of the context in which most bites occur can help us implement protective measures in the workplace," she adds.

In more than half of the cases, the snake responsible was not identified or documented, which can complicate choosing the most appropriate anti-venom. Fifteen percent of patients were treated more than six hours after the bite.

"We found that there is a lack of information on mortality, sequelae, adverse effects of treatment and patient management," says Ardiles. This underlines the importance of improving data collection to estimate the true human and social burden of this neglected disease.

The study was a joint effort with Paraguay’s Zoonosis and Rabies Control Centre, headed by Edgar Sanabria.

Reference

Ardiles-Ruesjas S, Sanabria E, Segovia Portillo VH, Jara Oroa L, de Egea V, Sequera G, Alonso-Padilla J, Losada I and Pinazo, MJ. Epidemiological and sociodemographic description of snakebite envenoming cases in Paraguay reported between 2015 and 2021. BMJ Public Health. 2024;2:e000359. doi:10.1136/bmjph-2023-000359

Date

07/05/2024

Hour

18.30 - 20.00 h

Place

CaixaForum Macaya
(Paseo de Sant Joan, 108) Barcelona

Speakers

Nerea Morán (UPM), Pilar Sampietro y Raül Torán (ISGlobal).

¿Desde las ciudades podemos ser autosuficientes desde un punto de vista energético? ¿De qué manera podemos cultivar nuestros propios alimentos en las ciudades? ¿Es un sistema viable? ¿Tendría consecuencias en la economía de mercado y el sector de la alimentación?

El 7 de mayo trataremos de responder a estas y muchas otras preguntas relacionadas con la sostenibilidad y la autosuficiencia de nuestras urbes en un contexto social en que nuestra alimentación está muy vinculada al consumo, la inmediatez y los gustos gastronómicos nuevos y elaborados.

El evento tiene una duración aproximada de 90 minutos y es gratuito. Aún así, el aforo es limitado, por lo que recomendamos que llegar puntual y reservar las entradas con antelación.

Con la participación de:

• Nerea Morán, doctora arquitecta por la Universidad Politécnica de Madrid.
• Pilar Sampietro, periodista radiofónica especializada en ecología y cultura, y coautora del libro 'La ciudad comestible' (Morsa, 2018).
• Raül Torán, divulgador científico de ISGlobal. Moderador.

Date

21/05/2024

Hour

18.30 - 20.00 h

Place

CaixaForum Macaya
(Paseo de Sant Joan, 108) Barcelona

Speakers

Carolyn Daher, Mònica Ubalde y Raül Torán, de ISGlobal.

¿Qué consecuencias comporta tanto a nivel social como para nuestra salud el hecho de crecer en una ciudad donde predomina el tráfico y el ruido? ¿Cómo afectan estos determinantes a la población más joven?

Este debate abierto, de 90 minutos de duración, abordará cómo hacer compatible el crecimiento de la ciudad con el fomento de una buena salud de la ciudadanía, y cómo repensar las urbes para disponer de más espacios públicos donde los más pequeños puedan jugar y las personas mayores recrearse.

La entrada es gratuita aunque el aforo limitado por lo que se recomienda llegar puntuales y reservar la entrada.

Con la participación de:

• Carolyn Daher, coordinadora de la Iniciativa de Planificación Urbana, Medio Ambiente y Salud de ISGlobal.
• Mònica Ubalde, investigadora postdoctoral de ISGlobal.
• Raül Torán, divulgador científico de ISGlobal. Moderador.

Campus Clínic Solidari (Solidarity Campus Clínic) aims to optimise the synergies and commitment to international and local collaboration of all the entities that make up Campus Clínic: the Hospital Clínic Barcelona, the Faculty of Medicine and Health Sciences, CAPSBE, IDIBAPS, ISGlobal and the Món Clínic Barcelona Private Foundation.
Their experience, knowledge, people, resources and partnerships are all focused on contributing to the global challenges of global health.

The aim is for all Campus professionals and students to know and learn about the global needs and challenges of health cooperation; to participate in local and international health cooperation projects; to care for people in vulnerable situations; to encourage and promote teaching, training and research in health cooperation; and to establish Campus Clínic's cooperation and commitment as a value recognised by society.

In recent conflicts and emergencies, Campus Clínic Solidari has collaborated by sending medical equipment and materials from the Hospital Clinic that had been withdrawn for renewal, but which could have a second useful life by being used to create a field hospital in Ukraine, and also to help those affected by the earthquake in Morocco.

What does Campus Clínic Solidari do?

Campus Clínic Solidari works in different strategic lines:

• Twinning with health centres in Mozambique and other regions that have the potential to host healthcare, teaching and/or research projects
• Intervention in health emergencies by providing medical material for remote support, as in the case of the Field Hospital in Ukraine or the intervention in the Moroccan earthquake.
• Call for grants to fund projects proposed by Campus Clínic professionals to develop their own or third-party initiatives. To date, over 150 international projects have been funded.
• Collaboration with NGOs and the Third Sector through stable agreements and one-off actions to ensure help gets to where it is needed; such as for example Open Arms, Bombers Solidaris, Fundació Exit, Fundació Vicente Ferrer or the Fundació Convent de Santa Clara, promoted by Sister Lucia Caram.
• Training through courses and conferences to share knowledge with the twinned centres and others where cooperation projects can be developed.

Healthcare and non-healthcare professionals, teachers and students and research personnel from all the institutions in the Campus can all participate in Campus Clínic Solidari.

A new study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, sheds light on the growth of lung function in children. The results show that increased levels of physical activity and a higher body mass index (BMI) play a key role in the recovery of early deficits. These findings, published in the journal Thorax, have important implications for clinical practice, research and public health policy, providing new insights into how to improve respiratory health from childhood to adulthood.

The study analysed data from the Spanish birth cohort of the INMA - Environment and Childhood project, which included a total of 1,151 children and adolescents aged 4-18 years. The researchers measured lung function using spirometry, a technique that assesses lung function through the amount of exhaled air. More specifically, the researchers measured forced expiratory volume in one second (FEV1), which is the volume of air exhaled in the first second during forced exhalation after a deep inhalation, and forced vital capacity (FVC), which is the maximum amount of air a person can exhale after a deep inhalation without a time limit. While FEV1 is an indicator of how open the airways are, FVC gives an indication of the size of the lungs.

Four trajectories of lung function growth were identified from the spirometries: a low trajectory (19% of the sample for both FEV1 and FVC), a normal trajectory (62% and 63%), a high trajectory (16% and 13%) and a final trajectory called "catch-up" (2% and 5% of the sample). The “catch-up” group started with lung function values below the low trajectory and showed accelerated growth between 4 and 10 years of age, reaching normal lung function values in adolescence.

"The key finding of our study is that low lung function in early childhood does not automatically translate into poor lung function in early adulthood, but that accelerated growth can recover early-life lung function deficits and result in normal values in adolescence," says Sarah Koch, ISGlobal researcher and first author of the study.

High levels of physical activity and body mass improve lung function

Using clinical records, questionnaires and results from face-to-face visits with participants and their families, the team gathered information on possible predictors of lung function growth. These were grouped into four categories: demographic and birth characteristics, allergic diseases, smoking and other environmental exposures, and physical activity and body mass.

The study results show that accelerated lung function growth is mainly associated with higher levels of physical activity in early childhood (between the ages of 4 and 7) and higher body mass index at the age of 4.

"Our study confirms and goes beyond previous research on known predictors of lung function. Children with less allergic disease were more likely to have normal or high FEV1 trajectories. This supports previous evidence on how children's allergic conditions affect lung function growth," says Judith Garcia-Aymerich, ISGlobal researcher and senior author of the study.

Clinical and public health implications

A clear risk factor for chronic respiratory disease is the early onset or accelerated lung function decline beyond that expected with normal ageing. . Therefore, understanding the determinants that predict lung function growth during childhood and adolescence is as important for preventing these diseases as understanding the determinants of lung function decline in later adulthood.

The results of this study have important implications for clinical practice and public health policy. "Both clinical management and public health policies should support and promote a healthy diet and high levels of physical activity in children with low baseline lung function, suboptimal environmental conditions or early-life allergies. This can help overcome growth limitations in lung function and improve respiratory health in childhood and adulthood," says Sarah Koch.

Reference
Koch, S., Prado Peralta, G., Carsin, AE., Abellan, A., Roda, C., Torrent, M., Iñiguez, C., Ballester, F., Ferrero, A., Zabaleta, C., Lertxundi, A., Guxens, M., Vrijheid, M., Sunyer, J., Casas, M., Garcia-Aymerich, J. Physical activity and body mass related to catch-up lung function growth in childhood: a population-based accelerated cohort study. Thorax, 2024. Doi: 10.1136/thorax-2022-219666

Genetic diversity of the malaria parasite in pregnant women and children declined in an area targeted for malaria elimination in Mozambique, according to a study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by “la Caixa” Foundation and the Manhiça Health Research Centre (CISM). The findings, published in Nature Communications, highlight the added value of routine sampling of pregnant women as a cost-effective strategy to enhance genomic surveillance of the parasite and detect changes in transmission within the community.

Genomic surveillance of the malaria parasite P. falciparum is essential to monitor the emergence and spread of drug-resistant parasites. But it can provide much more information. “We believe that the genomic diversity of the parasite population can also help us evaluate the effectiveness of interventions aimed at eliminating the disease: we expect lower genetic diversity of the parasite in areas with less transmission,” says ISGlobal researcher Alfredo Mayor. 

Regular collection of samples for genomic surveillance is challenging and costly, particularly in low-resource settings; but Mayor and his team have a solution: pregnant women attending their first antenatal care visit as an easy-to-reach sentinel population. The team previously showed that the malaria burden in pregnant women mirrors that of the community. In this study, they evaluated whether the genetic diversity of the parasite in pregnant women is also representative, and whether it can inform about changes in transmission levels.

Genomic surveillance of malaria in antenatal care

The research team sequenced P. falciparum sampled from 289 women attending their first antenatal visit and 93 children from the community, aged 2-10 years old. The samples were collected between 2015 and 2018 in three areas of southern Mozambique: one with high-transmission of the disease (Ilha Josina) and two with low-transmission (Magude, where elimination interventions were implemented, and Manhiça).

The analysis confirmed that genetic diversity and the prevalence of drug resistance markers were consistent between women attending antenatal care and children from the community. The parasite population in Ilha Josina had the highest genetic diversity, while Magude had the lowest. Furthermore, in Magude there was a clear decline in the diversity of parasites infecting a single individual (intra-host diversity), indicating a reduction in the size of the parasite population following the elimination interventions. No decrease in intra-host diversity was observed in Manhiça.

 “Our findings reveal the impact of interventions on the structure of the parasite population, which is not as apparent when looking only at the number of cases during the same time period”, says Nanna Brokhattingen, first co-author of the study. “Parasite surveillance in pregnant women can complement clinical and epidemiological data when evaluating the impact of malaria control and elimination interventions,” adds Mayor. The authors conclude that routine genomic surveillance at antenatal care clinics represents a cost-effective and convenient approach to inform about changes in disease transmission.

Reference

Nanna Brokhattingen, Glória Matambisso, Clemente da Silva et al. Genomic malaria surveillance of antenatal care users detects reduced transmission following elimination interventions in Mozambique. Nat Commun. https://doi.org/10.1038/s41467-024-46535-x.