RESUMO
Climate change and degradation of ecosystem services functioning may threaten the ability of current agricultural systems to keep up with demand for adequate and inexpensive food and for clean water, waste disposal and other broader ecosystem services. Human health is likely to be affected by changes occurring across multiple geographic and time scales. Impacts range from increasing transmissibility and the range of vectorborne diseases, such as malaria and yellow fever, to undermining nutrition through deleterious impacts on food production and concomitant increases in food prices. This paper uses case studies to describe methods that make use of satellite remote sensing and Demographic and Health Survey data to better understand individual-level human health and nutrition outcomes. By bringing these diverse datasets together, the connection between environmental change and human health outcomes can be described through new research and analysis.
RESUMO
Healthy forests provide human communities with a host of important ecosystem services, including the provision of food, clean water, fuel, and natural medicines. Yet globally, about 13 million hectares of forests are lost every year, with the biggest losses in Africa and South America. As biodiversity loss and ecosystem degradation due to deforestation continue at unprecedented rates, with concomitant loss of ecosystem services, impacts on human health remain poorly understood. Here, we use data from the 2010 Malawi Demographic and Health Survey, linked with satellite remote sensing data on forest cover, to explore and better understand this relationship. Our analysis finds that forest cover is associated with improved health and nutrition outcomes among children in Malawi. Children living in areas with net forest cover loss between 2000 and 2010 were 19% less likely to have a diverse diet and 29% less likely to consume vitamin A-rich foods than children living in areas with no net change in forest cover. Conversely, children living in communities with higher percentages of forest cover were more likely to consume vitamin A-rich foods and less likely to experience diarrhea. Net gain in forest cover over the 10-year period was associated with a 34% decrease in the odds of children experiencing diarrhea (Pâ=â.002). Given that our analysis relied on observational data and that there were potential unknown factors for which we could not account, these preliminary findings demonstrate only associations, not causal relationships, between forest cover and child health and nutrition outcomes. However, the findings raise concerns about the potential short- and long-term impacts of ongoing deforestation and ecosystem degradation on community health in Malawi, and they suggest that preventing forest loss and maintaining the ecosystem services of forests are important factors in improving human health and nutrition outcomes.
RESUMO
OBJECTIVES: HIV-positive women have particular needs for contraception to avoid unwanted pregnancy, to protect their own health and to eliminate the risk of transmitting HIV to an infant. In 2004, the United Nations described a four-element strategy to preventing mother-to-child transmission of HIV; the second element is preventing unintended pregnancies among HIV-positive women. However, fertility preferences among HIV-positive women who know their status remain poorly understood. This study seeks to demonstrate the degree to which knowledge of one's own serostatus is associated with fertility preferences and contraceptive demand and use. METHODS: This study uses Demographic and Health Surveys data and bivariate and multivariate methods to assess the contribution of a proxy variable for knowledge of own HIV serostatus to women's fertility desires, demand for contraception and contraceptive method choice for Zambia, Swaziland, Zimbabwe and Lesotho. RESULTS: Knowledge of one's own HIV-positive serostatus is significantly associated with a desire to limit childbearing with contraceptive use, but not necessarily with unmet need for contraception. HIV-positive women who know their status are more likely than other women to use condoms. CONCLUSION: HIV-positive women who know their serostatus exhibit fertility desires and contraceptive behaviors that are different from those of other women. These findings support the argument that efforts to scale up the second element of the strategy to prevent mother-to-child transmission of HIV should be accelerated: it is a cost-effective, rights-based approach to preventing incidence of mother-to-child transmission of HIV. Scaling up requires full commitment by both reproductive health/family planning and HIV constituencies to concerted integration at all levels of program planning, coordination and implementation.
