Do Maternal Factors Modify the Associations Between Iron Supplementation and Low Birth Weight in Sub-Saharan Africa?Food science & nutrition • November 05, 2024
Yibeltal Bekele, Don Vicendese, Melissa Buultjens, Mehak Batra, Bircan Erbas
Iron supplementation is recommended to reduce low birth weight (LBW) but its impact in Africa is underexplored. This study examines factors that may modify the effects of maternal iron supplementation on LBW in sub-Saharan Africa. Health Survey data from 26 sub-Saharan countries, including 149,346 woman-infant pairs, were analyzed. LBW (< 2500 g) was the outcome, and iron supplementation (yes/no) and its duration (none, < 90 days, or ≥ 90 days) were exposures. A regression modeling framework was used to assess associations, adjusting for potential confounders and stratification by country income level. Family income, mother's education, maternal age, and partner's education were assessed as potential effect modifiers. The prevalence of LBW was 10.36%. Maternal iron supplementation adherence was 37.34%, but lower among poor and young women (31.43%). Not taking iron supplements during pregnancy increased the odds of LBW (aOR 1.19; 95%CI: 1.09, 1.30). Longer duration (more than 90 days) reduced the odds of LBW (aOR 0.84; 95%CI: 0.76, 0.93). These impacts were greater among poor women (aOR 0.74; 95%CI: 0.64, 0.84), women/partner with no education (aOR 0.79; 95%CI: 0.67, 0.92), and younger age (aOR 0.72; 95%CI: 0.54, 0.97). Taking iron supplements longer during pregnancy contributes to lowering LBW in sub-Saharan countries. Younger mothers from poor areas with no education, along with those whose partners lack education, appear more vulnerable and may benefit from access to supplements. Enhancing adherence and addressing these disparities are key to addressing LBW in these settings.
Extreme Weather, Vulnerable Populations, and Mental Health: The Timely Role of AI Interventions.International Journal Of Environmental Research And Public Health • February 26, 2025
Mehak Batra, Bircan Erbas
Environmental disasters are becoming increasingly frequent and severe, disproportionately impacting vulnerable populations who face compounded risks due to intersectional factors such as gender, socioeconomic status, rural residence, and cultural identity. These events exacerbate mental health challenges, including post-traumatic stress disorder (PTSD), anxiety, and depression, particularly in low- and middle-income countries (LMICs) and underserved areas of high-income countries (HICs). Addressing these disparities necessitates inclusive, culturally competent, intersectional, and cost-effective strategies. Artificial intelligence (AI) presents transformative potential for delivering scalable and culturally tailored mental health interventions that account for these vulnerabilities. This perspective highlights the importance of co-designing AI tools with at-risk populations, integrating these solutions into disaster management frameworks, and ensuring their sustainability through research, training, and policy support. By embedding mental health resilience into climate adaptation strategies, stakeholders can foster equitable recovery and reduce the long-term mental health burden of environmental disasters.
Is Iron Supplementation Associated with Infant Mortality in Sub-Saharan Africa and Does Birth Weight Modify These Associations?Nutrients • April 07, 2025
Yibeltal Bekele, Bircan Erbas, Mehak Batra
Background: Iron supplementation during pregnancy is associated with several health benefits, including a reduced risk of maternal anaemia and improved neonatal outcomes such as lower rates of low birth weight, infection, and anaemia in infancy. However, its impact on neonatal and post-neonatal mortality remains unclear in resource-limited settings, where adherence to maternal iron supplementation is low. This study examined the association between maternal iron supplementation and neonatal and post-neonatal mortality and explored whether low birth weight (LBW) modifies those associations.
Methods: This cross-sectional study utilised Demographic and Health Survey data collected between 2015 and 2023 from 26 sub-Saharan countries, including 287,642 neonates and 279,819 post-neonates. The primary outcomes were neonatal deaths (within 28 days) and post-neonatal deaths (between 29 days and 12 months). These outcomes and the exposure variables of iron supplementation and its duration were based on maternal recall. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were estimated using generalised linear mixed models, with stratification by LBW.
Results: There was no significant association between maternal iron supplementation and neonatal mortality (aOR = 1.07; 95% CI: 0.86, 1.34). However, the interaction between LBW and iron supplementation was statistically significant (p = 0.04). Among the LBW infants, the absence of iron supplementation increased the odds of neonatal mortality by 68% (aOR = 1.68; 95% CI: 1.14, 2.47), while supplementation for ≥90 days reduced the odds by 45% (aOR = 0.55; 95% CI: 0.35, 0.84). For post-neonatal mortality, lack of iron supplementation increased the odds by 25% (aOR = 1.25; 95% CI: 1.01, 1.56), whereas supplementation for ≥90 days reduced the odds by 27% (aOR = 0.73; 95% CI: 0.57, 0.93).
Conclusions: Maternal iron supplementation was associated with lower post-neonatal mortality and improved neonatal survival among LBW infants. These findings suggest that iron intake may support infant survival, particularly in vulnerable populations.
Ten-year exposure to household air pollution is associated with obstructive sleep apnoea.Environmental Research • April 05, 2025
Yaoyao Qian, Garun Hamilton, Chamara Senaratna, Caroline Lodge, Michael Abramson, Xin Dai, Dinh Bui, Anurika De Silva, Paul Thomas, Bircan Erbas, Eugene Walters, Jennifer Perret, Shyamali Dharmage
Objective: The impact of household air pollution (HAP) on obstructive sleep apnoea (OSA) was unclear from the literature. We aimed to investigate the associations between HAP exposure over 10 years and OSA in middle-aged adults.
Methods: Using the Tasmanian Longitudinal Health Study (TAHS), seven longitudinal HAP profiles were previously identified using information on household heating, cooking, mould, active and passive smoking exposure collected at two ages spanning 10 years (at mean ages 43 and 53 years). Probable OSA was only measured at 53 years using validated STOP-Bang, Berlin and OSA-50 questionnaires. Medically diagnosed OSA was self-reported. Multivariable logistic regression was used to assess the associations between HAP profiles and each definition of OSA, adjusting for age, sex, socioeconomic status and ambient air pollution.
Results: Compared with the "Least exposed" profile, characterised by reverse-cycle air conditioning, electric cooking and no smoking exposure, the "Wood and gas heating/gas cooking/smoking" profile was associated with both probable OSA defined using OSA-50 (aOR=2.39, 95%CI 1.61-3.53) and medically diagnosed OSA (aOR=2.31, 1.06-5.05). The "All gas" and "Wood heating/smoking" profiles were associated with OSA-50-defined probable OSA (aOR=1.35, 1.01-1.79; aOR=1.47, 1.10-1.96 respectively). Additionally, the "All gas" profile was associated with incident medically diagnosed OSA (aOR=2.15, 1.06-4.38).
Conclusions: Sustained exposure to wood and gas heating and gas cooking especially when combined with tobacco smoke increased the risk of OSA over 10 years in middle age. Our study strengthens the rationale for including the potential adverse effects of HAP on mid-life OSA within public educational programs and guidelines.
Footwear Toe-Box Shape and Medial Forefoot Pressures in Women With Hallux Valgus.Journal Of Foot And Ankle Research • October 17, 2024
Katrina Bajraszewski, Polly Q Lim, Andrew Buldt, Sheree Hurn, Karen Mickle, Edward Roddy, Anita Wluka, Bircan Erbas, Shannon Munteanu, Hylton Menz
Background: Narrow fitting footwear is a modifiable risk factor for the development of hallux valgus (HV). Despite this, the pressure that footwear exerts at the medial forefoot has not been fully evaluated in people with HV. Therefore, the objective of this study was to determine whether the toe box of footwear habitually worn by women with HV is associated with pressure exerted on the medial forefoot.
Methods: In-shoe peak pressure and maximum force at the medial forefoot (distal and proximal sites) were recorded from 28 women (mean age 60.7 years, SD 10.7) with moderate or severe HV using the pedar pad pressure system (Novel GmbH, Germany). The shape (width and area) of the participants' most symptomatic foot and toe-box of their usual footwear was determined using an INFOOT 3D laser scanner (I-Ware Laboratory, Japan) and hand tracing, respectively. The difference between the foot and corresponding footwear measurements as well as differences in the magnitude and timing of peak pressure and maximum force between the proximal and distal forefoot were determined using independent t-tests. Correlations between forefoot pressures with toe-box differential were determined using Spearman's ρ analyses.
Results: Peak pressure and maximum force were significantly greater (mean difference [MD] = 33.0 ± 15.4 kPa; p < 0.001 and 12.8 ± 7.3 N; p = 0.001) and occurred slightly later in the stance phase at the distal forefoot compared to the proximal forefoot (MD = 6.0 ± 6.9%; p = 0.083 and 6.9 ± 6.8%; p = 0.045, respectively). There were no significant correlations between toe-box differential and medial forefoot pressures, with all correlations less than 0.35 (p > 0.05).
Conclusions: Toe-box shape and fit of footwear typically worn by older women with painful HV was not associated with increased medial forefoot pressures in this study sample. Therefore, changing the toe-box width and area of the usual footwear worn by older women with painful, moderate or severe HV may not necessarily reduce medial forefoot pressures where footwear does not appear to play a role.
