Publications by authors named "Mirko Winkler"

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  • The Gaza Strip has faced long-term water supply issues, impacting the accessibility and quality of drinking water for Gazans, with 25-30% lacking regular access as of 2018.
  • A survey was conducted in early 2023 to assess household drinking water quality and its association with health outcomes, focusing on participants aged 40 and older as well as younger adults.
  • The study involved interviews with 2,291 individuals across 905 households, measuring water quality for contaminants and health indicators, with a notable majority of female participants.
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  • A study was conducted among 299 farmworkers in Costa Rica to investigate the impact of pesticide exposure on respiratory and allergic health outcomes.
  • Researchers used questionnaires and urine samples to measure pesticide biomarkers and assess symptoms over the past year, employing complex statistical models.
  • Results indicated that specific pesticide metabolites, particularly those from organophosphates and fungicides, were linked to higher risks of asthma and rhinitis, with some herbicides showing negative associations, suggesting a complex relationship between pesticide exposure and health.
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Objectives: In 2008, an analysis investigating health impact assessment (HIA) practice found that only 6% of HIA-related peer-reviewed publications had a focus on low- and medium-developed countries, whereas 94% were conducted in countries with a high or very high development state. We aimed to update and deepen these observations.

Methods: We conducted a systematic review, searching PubMed and Web of Science for HIA-related papers published in the scientific literature from June 2007 to January 2023.

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Background: Hand hygiene is crucial in health care centers and schools to avoid disease transmission. Currently, little is known about hand hygiene in such facilities in protracted conflict settings.

Objective: This protocol aims to assess the effectiveness of a multicomponent hand hygiene intervention on handwashing behavior, underlying behavioral factors, and the well-being of health care workers and students.

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There is a recognised need for innovative methods to elicit the perspective of adolescents on public health issues, particularly when addressing sensitive topics such as the impact of mining projects on their health. Participatory approaches such as "photovoice" allow for deep engagement of vulnerable and marginalised populations, including adolescents. However, few existing studies have used the photovoice method to reflect on issues related to the environment and its impact on public health.

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Sub-Saharan Africa is rich in natural resources but also faces widespread poverty. The United Nations' Sustainable Development Goals brought increased attention to resource extraction projects, emphasizing their development potential in extraction regions. While mining companies are required to conduct environmental impact assessments, their effect on the project-affected communities' health mostly lacks systematic management, and their consideration of community perspectives is insufficient.

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High quality health data as collected by health management information systems (HMIS) is an important building block of national health systems. District Health Information System 2 (DHIS2) software is an innovation in data management and monitoring for strengthening HMIS that has been widely implemented in low and middle-income countries in the last decade. However, analysts and decision-makers still face significant challenges in fully utilizing the capabilities of DHIS2 data to pursue national and international health agendas.

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Calls for supporting sustainability through more and better research rest on an incomplete understanding of scientific evidence use. We argue that a variety of barriers to a transformative impact of evidence arises from diverse actor motivations within different stages of evidence use. We abductively specify this variety in policy and practice arenas for three actor motivations (truth-seeking, sense-making, and utility-maximizing) and five stages (evidence production, uptake, influence on decisions, effects on sustainability outcomes, and feedback from outcome evaluations).

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Background: Previous epidemiological studies have reported associations of pesticide exposure with poor cognitive function and behavioral problems. However, these findings have relied primarily on neuropsychological assessments. Questions remain about the neurobiological effects of pesticide exposure, specifically where in the brain pesticides exert their effects and whether compensatory mechanisms in the brain may have masked pesticide-related associations in studies that relied purely on neuropsychological measures.

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Over the past three decades, the Vietnamese Mekong Delta has experienced a significant increase in agricultural productivity, partly achieved through increased agrochemical use. To abate negative effects on human and environmental health, several national programs were launched to enhance safer pesticide use. This study aimed to assess the patterns and relationships of official sustainable agriculture educational programs, pesticide safety knowledge, and practices of smallholder farmers in the Mekong Delta.

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Objectives: The aim of this study was to assess the impact of natural resource extraction projects on HIV transmission risks in local communities in sub-Saharan Africa.

Design: Difference-in-differences design using repeated cross-sectional data from around newly opened mines.

Methods: We combined data on mine openings with HIV data from the Demographic and Health Surveys (DHS).

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  • The study investigates the genetic variability and structure of Schistosoma haematobium populations in Côte d'Ivoire, a topic with limited previous research.
  • A total of 2692 miracidia were collected and analyzed, revealing significant genetic differences between regions and a high genotypic diversity in the populations.
  • The most common genetic hybrid observed was S. bovis × S. haematobium, making up 42% of samples, highlighting the need for further research on hybrid schistosomes in local animal populations.
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Noma (cancrum oris) is a severely debilitating orofacial disease. The global annual incidence and prevalence figures of noma are outdated and were not based on epidemiological studies. Therefore, we systematically reviewed the scientific literature about the prevalence, incidence, and reported global distribution of noma.

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Background: The African continent hosts many industrial mining projects, and many more are planned due to recent prospecting discoveries and increasing demand for various minerals to promote a low-carbon future. The extraction of natural resources in sub-Saharan Africa (SSA) represents an opportunity for economic development but also poses a threat to population health through rapid urbanisation and environmental degradation. Children could benefit from improved economic growth through various channels such as access to high-quality food, better sanitation, and clean water.

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Background: Health equity features prominently in the 2030 Agenda for Sustainable Development, yet there are wide disparities in health between and within countries. In settings of natural resource extraction (e.g.

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  • A mortality surveillance system was established around two gold mines in Tanzania from February 2019 to February 2020 to assess the impact of gold mining on death rates.
  • Mining communities showed higher risks for road-traffic injuries and non-HIV infectious diseases, but lower HIV-related mortality compared to other regions.
  • Mining workers faced more than double the overall mortality risk compared to non-miners in the same areas, particularly due to injuries, highlighting the need for targeted programs to improve safety.
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Studies suggest that acute pesticide poisonings (APP) may be linked with long-term neurological effects. To examine long-term neurological and psychological distress symptoms associated with having experienced an APP, we conducted a cross-sectional study of 300 conventional and organic smallholder farmers from Zarcero County, Costa Rica, May-August 2016. We collected self-reported data on sociodemographic characteristics, occupational history, pesticide exposure, APPs, neurological and psychological distress symptoms (using the Brief Symptom Inventory (BSI)).

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Background: Pesticides can have negative effects on human and environmental health, especially when not handled as intended. In many countries, agro-input dealers sell pesticides to smallholder farmers and are supposed to provide recommendations on application and handling. This study investigates the role of agro-input dealers in transmitting safety information from chemical manufacturers to smallholder farmers, assesses the safety of their shops, what products they sell, and how agro-input dealers abide by laws and recommendations on best practices for preventing pesticide risk situations.

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In rural settings of Côte d'Ivoire, access to water, sanitation, and hygiene (WASH) at schools is often lacking. The purpose of this study was to assess the availability, quality, and use of WASH infrastructure in schools in the south-central part of Côte d'Ivoire, and to determine the hygiene practices of schoolchildren. A cross-sectional study was conducted in 20 primary schools with (n = 10) or without (n = 10) direct access to drinking water.

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Background: Watershed development (WSD) projects, aimed primarily at enhancing soil and water conservation and supporting livelihoods in semi-arid areas, have the potential to impact health by modifying the occupational and household environments in agrarian communities. To identify and address potential health concerns arising from a planned WSD project in Kolar district, India, a health impact assessment (HIA) was conducted. This necessitated understanding the health status and concerns in the project villages.

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Studies from India and several eastern African countries found that the impact of dairy animal ownership on household nutrition varied greatly, depending on the socio-geographic context. The purpose of this study was to examine the association between livestock ownership and household dietary quality in rural Kolar district, India. We collected data from a household survey in four study villages ( = all 195 households of the four villages) of Kolar district, applying a cross-sectional design.

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Natural resource extraction projects are often accompanied by complex environmental and social-ecological changes. In this paper, we evaluated the association between commodity extraction and the incidence of diseases. We retrieved council (district)-level outpatient data from all public and private health facilities from the District Health Information System (DHIS2).

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Background: Access to improved water and sanitation infrastructures are key determinants of health. The sub-Saharan African region in particular is lagging behind the ambitious goal of the 2030 Agenda for Sustainable Development to ensure universal access to improved and reliable water and sanitation for all (Sustainable Development Goal (SDG) 6). Large mining projects can promote economic growth and hence investments in water and sanitation infrastructures, but at the same time lead to rapid population growth and environmental degradation.

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Industrial mining projects can play an important role in global sustainable development if associated health risks are minimised and opportunities maximised. While a broad body of evidence from quantitative studies exists that establishes the interlinkages between mining operations and effects on public health, little research has been conducted investigating health impacts from the perspective of affected communities. This is particularly true in sub-Saharan Africa, where about a third of the remaining global mineral resources are endowed and health-related indicators for sustainable development are lagging behind.

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