Neighborhood characteristics and HIV treatment outcomes: A scoping review.

Recognizing challenges faced by people living with HIV is vital for improving their HIV treatment outcomes. While individual-level interventions play a crucial role, community factors can shape the impact of individual interventions on treatment outcomes. Understanding neighborhood characteristics' association with HIV treatment outcomes is crucial for optimizing effectiveness. This review aims to summarize the research scope on the association between neighborhood characteristics and HIV treatment outcomes. The databases PubMed, CINAHL (EBSCOhost), Embase (Elsevier), and PsychINFO (EBSCOhost) were searched from the start of each database to Nov 21, 2022. Screening was performed by three independent reviewers. Full-text publications of all study design meeting inclusion criteria were included in the review. There were no language or geographical limitations. Conference proceedings, abstract only, and opinion reports were excluded from the review. The search yielded 7,822 publications, 35 of which met the criteria for inclusion in the review. Studies assessed the relationship between neighborhood-level disadvantage (n = 24), composition and interaction (n = 17), social-economic status (n = 18), deprivation (n = 16), disorder (n = 8), and rural-urban status (n = 7) and HIV treatment outcomes. The relationship between all neighborhood characteristics and HIV treatment outcomes was not consistent across studies. Only 7 studies found deprivation had a negative association with HIV treatment outcomes; 6 found that areas with specific racial/ethnic densities were associated with poor HIV treatment outcomes, and 5 showed that disorder was associated with poor HIV treatment outcomes. Three studies showed that rural residence was associated with improved HIV treatment outcomes. There were inconsistent findings regarding the association between neighborhood characteristics and HIV treatment outcomes. While the impact of neighborhood characteristics on disease outcomes is highly recognized, there is a paucity of standardized definitions and metrics for community characteristics to support a robust assessment of this hypothesis. Comparative studies that define and assess how specific neighborhood indicators independently or jointly affect HIV treatment outcomes are highly needed.

Preferences and Demand for Mosquito Control among Dengue-Endemic Communities in Peñuelas, Puerto Rico: An Application of the Best-Worst Choice Model.

Aedes aegypti is the primary vector of dengue virus and threatens 3.9 billion people living in many tropical and subtropical countries. Prevention and reduction of dengue and other Aedes-borne viruses, including Zika and chikungunya, requires control of mosquito populations. Community mobilization and input are essential components of vector control efforts. Many vector control campaigns do not engage communities prior to implementation, leading to program failure. Those that do often conduct basic knowledge, attitude, and practice surveys that are not designed to explicitly elicit preferences. Here, we applied a novel stated preference elicitation tool, best-worst choice, to understand preferences, willingness to participate, and willingness to pay for mosquito control in dengue-endemic communities of Peñuelas, Puerto Rico. Findings revealed that the community preferred mosquito control programs that are 1) applied at the neighborhood level, 2) implemented by the local government, and 3) focused specifically on reducing disease transmission (e.g., dengue) instead of mosquito nuisance. Programs targeting the reduction of disease transmission and higher educational level of participants increased willingness to participate. Participants were willing to pay an average of $72 annually to have a program targeting the reduction of diseases such as dengue. This study serves as a model to engage communities in the design of mosquito control programs and improve stakeholders' decision-making.

Resilience Informatics for Public Health.

Resilience research is attracting increasing attention as stressors such as pandemics and climate change impact normal life worldwide. Informatics tools can play an important role in enhancing resilience of people, communities, and organizations. We present Resilience Informatics as a sub-discipline of resilience research and propose a conceptual framework for Resilience Informatics to aid in the development and effective deployment of informatics systems for resilience.

Defining the roles of local precipitation and anthropogenic water sources in driving the abundance of Aedes aegypti, an emerging disease vector in urban, arid landscapes.

Understanding drivers of disease vectors' population dynamics is a pressing challenge. For short-lived organisms like mosquitoes, landscape-scale models must account for their highly local and rapid life cycles. Aedes aegypti, a vector of multiple emerging diseases, has become abundant in desert population centers where water from precipitation could be a limiting factor. To explain this apparent paradox, we examined Ae. aegypti abundances at > 660 trapping locations per year for 3 years in the urbanized Maricopa County (metropolitan Phoenix), Arizona, USA. We created daily precipitation layers from weather station data using a kriging algorithm, and connected localized daily precipitation to numbers of mosquitoes trapped at each location on subsequent days. Precipitation events occurring in either of two critical developmental periods for mosquitoes were correlated to suppressed subsequent adult female presence and abundance. LASSO models supported these analyses for female presence but not abundance. Precipitation may explain 72% of Ae. aegypti presence and 90% of abundance, with anthropogenic water sources supporting mosquitoes during long, precipitation-free periods. The method of using kriging and weather station data may be generally applicable to the study of various ecological processes and patterns, and lead to insights into microclimates associated with a variety of organisms' life cycles.

The Effectiveness of Social Norm Appeals on Promoting COVID-19 Prevention Behaviors: A Multistudy Examination.

Recent research shows social norm perceptions predict people's adherence to COVID-19 preventative health practices. Nonetheless, additional empirical studies are necessary to evaluate the effectiveness of different types of social norm messages on behavioral outcomes with experimental designs. Guided by the social norm literature and frameworks, the current research addresses this need by examining the effects of descriptive and injunctive norm appeals promoting the practice of social distancing and mask-wearing with both a controlled experiment and social media campaigns. Results from this multistudy investigation showed the effectiveness of descriptive and injunctive norm messages (v. no message exposure) in promoting focal behaviors and highlighted the superiority of injunctive norm appeals in promoting behavioral intentions and increasing social media engagement. Theoretical implications and recommendations for practice are discussed.

Aedes aegypti abundance in urban neighborhoods of Maricopa County, Arizona, is linked to increasing socioeconomic status and tree cover.

BACKGROUND: Understanding coupled human-environment factors which promote Aedes aegypti abundance is critical to preventing the spread of Zika, chikungunya, yellow fever and dengue viruses. High temperatures and aridity theoretically make arid lands inhospitable for Ae. aegypti mosquitoes, yet their populations are well established in many desert cities. METHODS: We investigated associations between socioeconomic and built environment factors and Ae. aegypti abundance in Maricopa County, Arizona, home to Phoenix metropolitan area. Maricopa County Environmental Services conducts weekly mosquito surveillance with CO2-baited Encephalitis Vector Survey or BG-Sentinel traps at > 850 locations throughout the county. Counts of adult female Ae. aegypti from 2014 to 2017 were joined with US Census data, precipitation and temperature data, and 2015 land cover from high-resolution (1 m) aerial images from the National Agricultural Imagery Program. RESULTS: From 139,729 trap-nights, 107,116 Ae. aegypti females were captured. Counts were significantly positively associated with higher socioeconomic status. This association was partially explained by higher densities of non-native landscaping in wealthier neighborhoods; a 1% increase in the density of tree cover around the trap was associated with a ~ 7% higher count of Ae. aegypti (95% CI: 6-9%). CONCLUSIONS: Many models predict that climate change will drive aridification in some heavily populated regions, including those where Ae. aegypti are widespread. City climate change adaptation plans often include green spaces and vegetation cover to increase resilience to extreme heat, but these may unintentionally create hospitable microclimates for Ae. aegypti. This possible outcome should be addressed to reduce the potential for outbreaks of Aedes-borne diseases in desert cities.

Understanding low COVID-19 booster uptake among US adults.

BACKGROUND: Vaccinations against SARS-CoV-2 have consistently been shown to reduce the risk of severe COVID-19 disease. However, uptake of boosters has stalled in the United States at less than 20% of the eligible population. The objective of this study was to assess the reasons for not having obtained a bivalent booster within an existing COVID-19 cohort. METHODS: A total of 2196 adult participants from the Arizona CoVHORT, a population-based cohort in the United States established in May 2020, who had received at least one dose of the COVID-19 vaccine, responded to surveys administered between February 13 and March 29, 2023 querying receipt of a bivalent booster and if not, the reasons for not receiving it. Descriptive statistics were employed, including frequencies of responses by participant characteristics, and multivariable logistic regression was used to assess the association between participant characteristics and selected themes for not having received the bivalent booster. RESULTS: The most commonly reported reason for not having been boosted was a prior SARS-CoV-2 infection (39.5%), followed by concern about vaccine side effects (31.5%), believing that the booster would not provide additional protection over the vaccines already received (28.6%), and concern about booster safety (23.4%) or that it would not protect from SARS-CoV-2 infection (23.1%). For themes related to reasons for not having been boosted, those 60 years of age or older were less likely to select items related to knowledge (OR: 0.24; 95% CI: 0.11-0.55) or logistical concerns (OR: 0.09; 95% CI: 0.03-0.30) about the vaccine; while those reporting Hispanic ethnicity were more likely to convey concerns about logistics than those reporting non-Hispanic ethnicity (OR: 2.15; 95% CI: 1.08-4.30). Finally, compared to college graduates, those with some college or technical school were significantly more likely to select items related to the risks and benefits of the bivalent vaccine not being clear as reasons for not having been boosted (OR: 2.41; 95% CI: 1.69-3.43). CONCLUSIONS: Improvement in booster uptake is necessary for optimal public health in the United States. The development of vaccines against SARS-CoV-2 occurred at an unprecedented speed, but vaccine uptake remains among the greatest current public health challenges as updated boosters continue to be developed and made available to the public. Interventions to improve vaccination rates require a variety of approaches.

Motivations for pre-exposure prophylaxis uptake and decline in an HIV-hyperendemic setting: findings from a qualitative implementation study in Lesotho.

BACKGROUND: Pre-Exposure Prophylaxis (PrEP) has demonstrated clinical efficacy in preventing HIV infection, yet its uptake remains low. This study, conducted in five PrEP implementing districts in Lesotho, examined factors motivating persons at risk of HIV infection to adopt or reject PrEP when offered freely. METHODS: In-depth interviews were undertaken with stakeholders directly engaged with PrEP policy (n = 5), program implementation (n = 4), and use (current PrEP users = 55, former PrEP users = 36, and PrEP decliners (n = 6)). Focus group discussions (n = 11, 105 total participants) were conducted with health staff directly providing HIV and PrEP services. RESULTS: Demand for PrEP was reported highest among those at greatest risk for HIV acquisition: those in serodiscordant relationships and/or engaged in sex work. Culturally sensitive PrEP counseling was described as an opportunity to transfer knowledge, build trust, and address user concerns. Conversely, top-down counseling resulted in PrEP distrust and confusion about HIV status. Key motivations for PrEP uptake revolved around sustaining core social relationships, desire for safer conception, and caring for ailing relatives. The decline of PrEP initiation was driven by a combination of individual-level factors (risk perception, perceived side effects, disbelief of the drug's efficacy and PrEP's daily pill regimen), societal factors (lack of social support and HIV-related stigma), and structural factors related to PrEP access. CONCLUSIONS: Our findings suggest strategies for effective national PrEP rollout and implementation include: (1) demand creation campaigns which highlight positive aspects of PrEP, while simultaneously addressing apprehensions for uptake; (2) strengthening health provider counseling capacity; and (3) addressing societal and structural HIV-related stigma.

Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection.

Importance: SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals. Objective: To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections. Design, Setting, and Participants: Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling. Exposure: SARS-CoV-2 infection. Main Outcomes and Measures: PASC and 44 participant-reported symptoms (with severity thresholds). Results: A total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months. Conclusions and Relevance: A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.

A scoping review of maternal health among resettled refugee women in the United States.

Background: Globally, refugee women continue to face higher maternity-related risks from preventable complications during pregnancy and childbirth, partly due to high health care costs, unfamiliarity with the healthcare system, language barriers, and discrimination. Nevertheless, there is still a paucity of literature that evaluates the available evidence in the US. This scoping review delineated the body of literature on maternal health among refugee women resettled in the US in order to identify knowledge gaps in the literature and highlight future research priorities and directions for maternal health promotion. Methods: Electronic databases were searched in PubMed, CINAHL, PsycINFO, and EMBASE from inception through July 2021. We included all peer-reviewed study designs; qualitative, quantitative, and mixed method if they reported on refugee women's perinatal health experiences and outcomes in the US. Results: A total of 2,288 records were identified, with 29 articles meeting the inclusion criteria. Refugee women tend to initiate prenatal care late and have fewer prenatal care visits compared to women born in the US. Some of them were reluctant to get obstetric interventions such as labor induction and cesarean delivery. Despite numerous risk factors, refugee women had generally better maternal health outcomes. Studies have also highlighted the importance of health care providers' cultural competency and sensitivity, as well as the potential role of community health workers as a bridge between refugee women and health care providers. Conclusions: The scoping review emphasizes the need for early prenatal care initiation and more frequent prenatal care visits among refugee women. Furthermore, more needs to be done to mitigate resistance to obstetric interventions and mistrust. The mechanism by which healthy migrant effects occur could be better understood, allowing protective factors to be maintained throughout the resettlement and acculturation process. The scoping review identifies critical gaps in the literature, such as the underrepresentation of different ethnic groups of refugee women in refugee maternal studies in the US. Since this invisibility may indicate unspoken and unaddressed needs, more attention should be paid to underrepresented and understudied groups of refugee women in order to achieve health equity for all.

Assessing climate and health curriculum in graduate public health education in the United States.

Climate change has been identified as both a challenge and an opportunity for public health. The onus to prepare the next generation of public health practitioners lies heavily on schools and programs of public health. This article (i) assesses the status of climate change and health curricula in accredited schools of public health in the United States and (ii) proposes strategies to better train professionals so they are more informed and prepared to mitigate, manage, and respond to the health impacts of climate change. Course offerings and syllabi listed in online course catalogs from 90 nationally accredited schools of public health were evaluated with the purpose of identifying the extent of climate change education in graduate programs. Only 44 public health institutions were found to offer a climate change related course at the graduate level of education. Of the 103 courses identified, approximately 50% (n = 46) are focused on this climate change and health. These courses cover a wide array of topics with an emphasis on conveying fundamental concepts. In-depth assessment revealed a need for integrating learning opportunities that build practical skills useful in a hands-on public health practice environment. This assessment indicates the limited availability of climate-health course offerings available to graduate students in accredited schools. The findings are used to propose an educational framework to integrate climate change into public health curricula. The proposed framework, while rooted in existing directives, adopts a tiered approach that can be readily applied by institutions training the next generation of public health leaders.

Differences in Longevity and Temperature-Driven Extrinsic Incubation Period Correlate with Varying Dengue Risk in the Arizona-Sonora Desert Region.

Dengue transmission is determined by a complex set of interactions between the environment, Aedes aegypti mosquitoes, dengue viruses, and humans. Emergence in new geographic areas can be unpredictable, with some regions having established mosquito populations for decades without locally acquired transmission. Key factors such as mosquito longevity, temperature-driven extrinsic incubation period (EIP), and vector-human contact can strongly influence the potential for disease transmission. To assess how these factors interact at the edge of the geographical range of dengue virus transmission, we conducted mosquito sampling in multiple urban areas located throughout the Arizona-Sonora desert region during the summer rainy seasons from 2013 to 2015. Mosquito population age structure, reflecting mosquito survivorship, was measured using a combination of parity analysis and relative gene expression of an age-related gene, SCP-1. Bloodmeal analysis was conducted on field collected blood-fed mosquitoes. Site-specific temperature was used to estimate the EIP, and this predicted EIP combined with mosquito age were combined to estimate the abundance of "potential" vectors (i.e., mosquitoes old enough to survive the EIP). Comparisons were made across cities by month and year. The dengue endemic cities Hermosillo and Ciudad Obregon, both in the state of Sonora, Mexico, had higher abundance of potential vectors than non-endemic Nogales, Sonora, Mexico. Interestingly, Tucson, Arizona consistently had a higher estimated abundance of potential vectors than dengue endemic regions of Sonora, Mexico. There were no observed city-level differences in species composition of blood meals. Combined, these data offer insights into the critical factors required for dengue transmission at the ecological edge of the mosquito's range. However, further research is needed to integrate an understanding of how social and additional environmental factors constrain and enhance dengue transmission in emerging regions.

Pre-existing conditions associated with post-acute sequelae of COVID-19.

Post-acute sequelae of COVID-19 (PASC) are conditions that occur or remain at least 28 days after SARS-CoV-2 infection. While some risk factors for PASC have been identified, little is known about pre-existing conditions that render one susceptible to developing PASC. Data from participants (n = 1224) in a longitudinal COVID-19 cohort study in Arizona were used to investigate comorbid conditions associated with PASC. After adjustment of the models for age, BMI, gender, race, and smoking, the following pre-existing conditions were statistically significantly associated with the development of PASC: asthma (OR = 1.54; 95% CI = 1.10-2.15); chronic constipation (OR = 4.29; 95% CI = 1.15-16.00); reflux (OR = 1.54; 95% CI = 1.01-2.34); rheumatoid arthritis (OR = 3.69; 95%CI = 1.15-11.82); seasonal allergies (OR = 1.56; 95% CI = 1.22-1.98); and depression/anxiety (OR = 1.72; 95% CI = 1.17-2.52). When grouping conditions together, statistically significant associations with PASC were observed for respiratory (OR = 1.47; 95% CI = 1.06-2.14); gastrointestinal (OR = 1.62; 95% CI = 1.16-2.26), and autoimmune conditions (OR = 4.38; 95% CI = 1.59-12.06). After adjustment for severity of acute SARS-CoV-2 infection and depression/anxiety, seasonal allergies (OR = 1.48; 95% CI 1.15-1.91) and autoimmune disease (OR = 3.78; 95% CI - 1.31-10.91) remained significantly associated with risk for PASC. These findings indicate that numerous pre-existing conditions may be associated with an increased risk for the development of PASC. Patients with these conditions should consider taking extra steps to avoid infection.

Healthcare System Distrust and Non-Prescription Antibiotic Use: A Cross-Sectional Survey of Adult Antibiotic Users.

Antibiotic resistance is a major public health concern driven by antibiotic overuse. Antibiotic stewardship programs are often limited to clinical settings and do little to address non-prescription antibiotic use in community settings. This study investigates the association between non-prescription antibiotic use and healthcare system distrust in the United States and Mexico. An online survey was deployed in the United States and Mexico with enhanced sampling through in-person recruiting in the border region. Non-prescription antibiotic use was defined as having bought or borrowed non-prescription oral or injectable antibiotics within the last 3 years. The survey included a previously validated 10-item scale to measure healthcare system distrust. Logistic regression was used to model the use of non-prescription antibiotics by the level of healthcare system distrust, adjusted for demographic characteristics and antibiotic knowledge. In total, 568 survey participants were included in the analysis, 48.6% of whom had used non-prescription oral or injectable antibiotics in the last 3 years. In the fully adjusted regression model, the odds of using non-prescription antibiotics were 3.2 (95% CI: 1.8, 6.1) times higher for those in the highest distrust quartile versus the lowest. These findings underscore the importance of community-based antibiotic stewardship and suggest that these programs are particularly critical for communities with high levels of healthcare system distrust.

COVID-19 vaccination and changes in the menstrual cycle among vaccinated persons.

OBJECTIVE: To describe the characteristics of people who experience changes to their menstrual cycle after COVID-19 vaccination. DESIGN: Longitudinal study. PATIENT(S): We recruited a volunteer sample with and without a history of SARS-CoV-2 infection who enrolled in the Arizona COVID-19 Cohort (CoVHORT) study and participated in a reproductive sub-cohort who were pre-menopausal, not pregnant, and had received a COVID-19 vaccine in 2021 (n = 545). EXPOSURE(S): Demographic and reproductive characteristics were collected via self-reports. MAIN OUTCOME MEASURE(S): Information on self-reported changes in the menstrual cycle after COVID-19 vaccination was collected from May 2021 to December 2021. We looked at demographic and reproductive characteristics as predictors of menstrual cycle change. RESULT(S): The majority of our vaccinated sample received the Pfizer-BioNTech vaccine (58%), and were 26-35 years old (51%), non-Hispanic (84%), and White (88%). Approximately 25% of vaccinated participants reported a change in their menstrual cycle after vaccination; the majority reported changes after their second dose (56%) as compared with their first (18%) and third (14%) doses. The most commonly reported changes were irregular menstruation (43%), increased premenstrual symptoms (34%), increased menstrual pain or cramps (30%), and abnormally heavy or prolonged bleeding (31%). High self-reported perceived stress levels compared with low perceived stress (OR, 2.22; 95% CI 1.12-4.37) and greater body mass index (OR, 1.04; 95% CI 1.00-1.07) were associated with greater odds of experiencing the menstrual cycle changes after the vaccination. Participants having a history of SARS-CoV-2 infection were less likely to report changes in their menstrual cycle after vaccination compared with the participants with no history of SARS-CoV-2 infection (OR, 0.58; 95% CI 0.32-1.04). CONCLUSION(S): Among vaccinated participants, approximately 25% of them reported predominantly temporary changes in the menstrual cycle, however, we are unable to determine whether these changes are due to normal cycle variability. The COVID-19 vaccines are safe and effective for everyone, including pregnant people and people trying to conceive; hence, these findings should not discourage vaccination.

Self-Reported Symptoms at Last Febrile Illness as a Predictor of Treatment-Seeking in Western Kenya: A Cross-Sectional Study.

Timely treatment-seeking behavior can reduce morbidity and mortality due to infectious diseases. Patterns of treatment-seeking behavior can differ by access to health care, and perceptions of disease severity and symptoms. We evaluated the association between self-reported symptoms at last illness and the level of treatment-seeking behaviors. We analyzed cross-sectional data from 1,037 participants from the lowlands and highlands of Western Kenya from 2015 using logistic regression models. There was considerable heterogeneity in the symptoms and treatment-seeking behaviors reported among individuals who were febrile at their last illness. A greater number of self-reported categories of symptoms tended to be associated with a higher likelihood of treatment-seeking in both sites. Participants were significantly more likely to seek treatment if they reported fever, aches, and digestive symptoms at last illness than just fever and aches or fever alone, but the frequency of treatment-seeking for fever in combination with aches and respiratory symptoms did not follow a consistent pattern. Among those who sought treatment, most used a formal source, but the patterns were inconsistent across sites and by the number of symptoms categories. Understanding the drivers of treatment-seeking behavior after febrile illness is important to control and treat infectious diseases in Kenya.

Design and implementation of a health messaging protocol employed for use within a COVID-19 health dissemination platform.

Introduction: AZCOVIDTXT, a bilingual, two-way information sharing platform was created in April of 2020 in response to rising COVID-19 cases in Arizona. The aim of this paper is to delineate the protocol and processes used to develop and disseminate health messaging to serve as guidance for other groups, universities, or public health programs in the implementation or enhancement of health communication services. Methods: Health messaging formats included website articles, published on the system's website (azcovidtxt.org), infographics posted on social media, and SMS. Social media and SMS infographics were intended to highlight and augment the topics covered in the weekly website articles, to create a seamless multimodal source of reliable COVID-19 information for AZCOVIDTXT enrollees and the broader public. All health messaging information, text message and social media content was planned and reviewed collaboratively by the AZCOVIDTXT team topic experts for accuracy, efficacy, and content consistency. Results: As of July 2021, AZCOVIDTXT provided weekly COVID-19-related health communication to 3,747 participating households located across 225 Arizona zip codes. AZCOVIDTXT has developed and sent 446 unique, bilingual SMS for a total of 271,977 contact points. The team has produced and published 179 website articles, which averaged a combined 7,000-page views per month, and 173 social media posts were made available to 268 followers across three platforms. Discussion: Several programmatic aspects were deemed essential to the success of AZCOVIDTXT. These included (1) addressing community specific needs, (2) creating timely and relevant content, (3) developing an adaptable system, and (4) prioritizing system automation where possible, (5) having an interdisciplinary team approach to identifying and crafting key messages.

Risk factors associated with under-five stunting, wasting, and underweight in four provinces of the Democratic Republic of Congo: analysis of the ASSP project baseline data.

BACKGROUND: Determining the magnitude and risk factors of undernutrition in a country that has one of the highest prevalence of undernutrition in the world is paramount for developing contextual interventions. METHODS: This study used baseline data from the ASSP project to estimate prevalence of stunting, wasting, and underweight in four provinces of DRC. It involved 3911 children aged 0-59 months old and mother pairs. Height-for-age Z scores, Weight-for-height Z scores, and Weight-for-age Z scores were calculated and used to classify child stunting, wasting and underweight respectively, based on the 2006 World Health Organization (WHO) growth reference. Hierarchical logistic regressions were used to identify risk factors associated with stunting, wasting and underweight. All analyses were conducted using STATA 15.1, and statistical significance was set at p < 0.05. RESULTS: The prevalence of stunting, underweight and wasting was 42.7%, 21.9% and 8.2% respectively. Increasing child's age was a risk factor associated with stunting and underweight, while sex was not associated with the 3 indicators of undernutrition. Low levels of mother's education, mothers working in the last 12 months prior to the survey, children living in the province of Kasai occidental, children born at a health facility, children perceived by their mothers to be born very small were associated with higher risks of stunting. Factors associated with underweight were children from the province of Kasai occidental, mothers who worked in the last 12 months prior to the survey, and children perceived to be born very small or small by their mothers. Children born to mothers aged 35-49 years and children breastfed in combination with drinking water were at higher risk of wasting. CONCLUSION: Prevalence of undernutrition in DRC is high. This study has identified certain modifiable risk factors associated with stunting, wasting and underweight. To reduce the burden of undernutrition in DRC, authorities should target factors at individual and community levels by improving women's education, child feeding practices and promoting agriculture.

COVID-19 lockdowns: Employment and business disruptions, water access and hygiene practices in Nairobi's informal settlements.

Host to one billion people around the world, informal settlements are especially vulnerable to COVID-19 lockdown measures as they already lack basic services such as water, toilets, and secure housing. Additionally, many residents work in informal labor markets that have been affected by the lockdowns, resulting in further reductions in access to resources, including clean water. This study uses a cross-sectional design (n = 532) to examine the vulnerabilities of households to employment and business disruptions, water access and hygiene practices during the COVID-19 lockdowns between April and June 2020 in three informal settlements in Nairobi, Kenya. We used survey questions from the Household Water Insecurity Experience Scale (HWISE) to investigate the relationship between employment and business disruptions, water access, and hygiene practices (i.e., hand washing, body washing, clothes washing, and being able to use or drink clean water). Of the sampled households, 96% were forced to reduce work hours during the lockdowns, and these households had 92% lower odds of being able to afford water than households who did not experience a work hour reduction (OR = 0.08, p < .001). Household challenges in affording water were likely due to a combination of reduced household income, increased water prices, and pre-existing poverty, and were ultimately associated with lower hygiene scores (Beta = 1.9, p < .001). Our results highlight a compounding tragedy of reduced water access in informal settlements that were already facing water insecurities at a time when water is a fundamental requirement for following hygiene guidelines to reduce disease burden during an ongoing pandemic. These outcomes emphasize the need for targeted investments in permanent water supply infrastructures and improved hygiene behaviors as a public health priority among households in informal settlements.

Outdoor Activity Associated with Higher Self-Reported Emotional Well-Being During COVID-19.

Shifts in activity patterns during the COVID-19 pandemic might have impacted the benefits of outdoor activities for mental health. By leveraging an existing mobile application, we collected self-reported data on daily outdoor activities, emotional well-being, and the influence of COVID-19 on participant's outdoor activity levels during April-July 2020. Individuals reporting outdoor activities, in greenspaces or in their residence, had higher well-being scores and this effect increased with age. Self-reported impacts of COVID-19 on emotional well-being were associated with lower well-being scores. This work suggests that outdoor activities may have improved mental health during the COVID-19 pandemic.