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{"title"=>"Malaria Infection, Poor Nutrition and Indoor Air Pollution Mediate Socioeconomic Differences in Adverse Pregnancy Outcomes in Cape Coast, Ghana", "type"=>"journal", "authors"=>[{"first_name"=>"Adeladza K.", "last_name"=>"Amegah", "scopus_author_id"=>"55542401600"}, {"first_name"=>"Obed K.", "last_name"=>"Damptey", "scopus_author_id"=>"56052839800"}, {"first_name"=>"Gideon A.", "last_name"=>"Sarpong", "scopus_author_id"=>"56053162300"}, {"first_name"=>"Emmanuel", "last_name"=>"Duah", "scopus_author_id"=>"55802863600"}, {"first_name"=>"David J.", "last_name"=>"Vervoorn", "scopus_author_id"=>"56052723700"}, {"first_name"=>"Jouni J.K.", "last_name"=>"Jaakkola", "scopus_author_id"=>"16472432100"}], "year"=>2013, "source"=>"PLoS ONE", "identifiers"=>{"scopus"=>"2-s2.0-84880655228", "doi"=>"10.1371/journal.pone.0069181", "sgr"=>"84880655228", "isbn"=>"1932-6203 (Electronic)\\r1932-6203 (Linking)", "pmid"=>"23894428", "issn"=>"19326203", "pui"=>"369412101"}, "id"=>"51b5b715-f06c-3101-8737-68b304cca0e9", "abstract"=>"BACKGROUND: The epidemiological evidence linking socioeconomic deprivation with adverse pregnancy outcomes has been conflicting mainly due to poor measurement of socioeconomic status (SES). Studies have also failed to evaluate the plausible pathways through which socioeconomic disadvantage impacts on pregnancy outcomes. We investigated the importance of maternal SES as determinant of birth weight and gestational duration in an urban area and evaluated main causal pathways for the influence of SES.\\n\\nMETHODS: A population-based cross-sectional study was conducted among 559 mothers accessing postnatal services at the four main health facilities in Cape Coast, Ghana in 2011. Information on socioeconomic characteristics of the mothers was collected in a structured questionnaire.\\n\\nRESULTS: In multivariate linear regression adjusting for maternal age, parity and gender of newborn, low SES resulted in 292 g (95% CI: 440-145) reduction in birth weight. Important SES-related determinants were neighborhood poverty (221 g; 95% CI: 355-87), low education (187 g; 95% CI: 355-20), studentship during pregnancy (291 g; 95% CI: 506-76) and low income (147 g; 95% CI: 277-17). In causal pathway analysis, malaria infection (6-20%), poor nutrition (2-51%) and indoor air pollution (10-62%) mediated substantial proportions of the observed effects of socioeconomic deprivation on birth weight. Generalized linear models adjusting for confounders indicated a 218% (RR: 3.18; 95% CI: 1.41-7.21) risk increase of LBW and 83% (RR: 1.83; 95% CI: 1.31-2.56) of PTB among low income mothers. Low and middle SES was associated with 357% (RR: 4.57; 95% CI: 1.67-12.49) and 278% (RR: 3.78; 95% CI: 1.39-10.27) increased risk of LBW respectively. Malaria infection, poor nutrition and indoor air pollution respectively mediated 10-21%, 16-44% and 31-52% of the observed effects of socioeconomic disadvantage on LBW risk.\\n\\nCONCLUSION: We provide evidence of the effects of socioeconomic deprivation, substantially mediated by malaria infection, poor nutrition and indoor air pollution, on pregnancy outcomes in a developing country setting.", "link"=>"http://www.mendeley.com/research/malaria-infection-poor-nutrition-indoor-air-pollution-mediate-socioeconomic-differences-adverse-preg-1", "reader_count"=>59, "reader_count_by_academic_status"=>{"Unspecified"=>1, "Professor > Associate Professor"=>1, "Librarian"=>2, "Researcher"=>11, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>11, "Student > Postgraduate"=>2, "Student > Master"=>17, "Other"=>3, "Student > Bachelor"=>4, "Lecturer"=>4, "Lecturer > Senior Lecturer"=>1, "Professor"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>1, "Professor > Associate Professor"=>1, "Librarian"=>2, "Researcher"=>11, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>11, "Student > Postgraduate"=>2, "Student > Master"=>17, "Other"=>3, "Student > Bachelor"=>4, "Lecturer"=>4, "Lecturer > Senior Lecturer"=>1, "Professor"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>4, "Agricultural and Biological Sciences"=>10, "Arts and Humanities"=>1, "Computer Science"=>1, "Engineering"=>1, "Environmental Science"=>5, "Nursing and Health Professions"=>3, "Biochemistry, Genetics and Molecular Biology"=>2, "Mathematics"=>1, "Medicine and Dentistry"=>16, "Psychology"=>2, "Social Sciences"=>10, "Immunology and Microbiology"=>3}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>16}, "Social Sciences"=>{"Social Sciences"=>10}, "Psychology"=>{"Psychology"=>2}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>4}, "Environmental Science"=>{"Environmental Science"=>5}, "Arts and Humanities"=>{"Arts and Humanities"=>1}, "Engineering"=>{"Engineering"=>1}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>3}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>10}, "Computer Science"=>{"Computer Science"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>3}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>2}}, "reader_count_by_country"=>{"United Kingdom"=>1, "Portugal"=>1, "Germany"=>1}, "group_count"=>5}

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• http://doi.org/10.1038/s41372-019-0510-y
• http://doi.org/10.1007/s40572-020-00273-6
• http://doi.org/10.1016/j.ijid.2019.11.026
• http://doi.org/10.1016/j.scitotenv.2020.142501
• http://doi.org/10.1186/s12936-015-0598-2
• http://doi.org/10.1186/s13002-015-0044-0
• http://doi.org/10.1155/2015/620598
• http://doi.org/10.1371/journal.pone.0144374
• http://doi.org/10.1371/journal.pone.0239310
• http://doi.org/10.1186/s12978-019-0736-3
• http://doi.org/10.1371/journal.pone.0179010
• http://doi.org/10.1016/j.nut.2017.11.003

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• {"files"=>["https://ndownloader.figshare.com/files/1555243"], "description"=>"<p>CI indicates confidence interval. GH¢ indicates Ghana cedis. RR indicates risk ratio. SES indicates socioeconomic status.</p><p>Mediation fractions (%).</p><p>Low SES: Malaria (20.7), Pre-pregnancy BMI (26.1), Cooking fuel (41.5), Joint (63.9).</p><p>Middle SES: Malaria (18.0), Pre-pregnancy BMI (27.3), Cooking fuel (31.3), Joint (60.8).</p>", "links"=>[], "tags"=>["epidemiology", "Environmental epidemiology", "Epidemiological methods", "Pediatric epidemiology", "Social epidemiology", "Global health", "Public health", "Child health", "Environmental health", "preventive medicine", "Socioeconomic aspects of health", "Women’s health", "adjusted", "attributable", "maternal", "socioeconomic"], "article_id"=>1074933, "categories"=>["Medicine"], "users"=>["Adeladza K. Amegah", "Obed K. Damptey", "Gideon A. Sarpong", "Emmanuel Duah", "David J. Vervoorn", "Jouni J. K. Jaakkola"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0069181.t005", "stats"=>{"downloads"=>0, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Unadjusted_and_adjusted_risk_of_low_birth_weight_LBW_attributable_to_maternal_socioeconomic_status_SES_/1074933", "title"=>"Unadjusted and adjusted risk of low birth weight (LBW) attributable to maternal socioeconomic status (SES).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-07-22 10:28:53"}
• {"files"=>["https://ndownloader.figshare.com/files/1555242"], "description"=>"<p>CI indicates confidence interval. GH¢ indicates Ghana cedis. RR indicates risk ratio. SES indicates socioeconomic status.</p>", "links"=>[], "tags"=>["epidemiology", "Environmental epidemiology", "Epidemiological methods", "Pediatric epidemiology", "Social epidemiology", "Global health", "Public health", "Child health", "Environmental health", "preventive medicine", "Socioeconomic aspects of health", "Women’s health", "adjusted", "preterm", "attributable", "maternal", "socioeconomic"], "article_id"=>1074932, "categories"=>["Medicine"], "users"=>["Adeladza K. Amegah", "Obed K. Damptey", "Gideon A. Sarpong", "Emmanuel Duah", "David J. Vervoorn", "Jouni J. K. Jaakkola"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0069181.t006", "stats"=>{"downloads"=>6, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Unadjusted_and_adjusted_risk_of_preterm_birth_PTB_attributable_to_maternal_socioeconomic_status_SES_/1074932", "title"=>"Unadjusted and adjusted risk of preterm birth (PTB) attributable to maternal socioeconomic status (SES).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-07-22 10:28:53"}
• {"files"=>["https://ndownloader.figshare.com/files/1555250", "https://ndownloader.figshare.com/files/1555251", "https://ndownloader.figshare.com/files/1555252"], "description"=>"<div><p>Background</p><p>The epidemiological evidence linking socioeconomic deprivation with adverse pregnancy outcomes has been conflicting mainly due to poor measurement of socioeconomic status (SES). Studies have also failed to evaluate the plausible pathways through which socioeconomic disadvantage impacts on pregnancy outcomes. We investigated the importance of maternal SES as determinant of birth weight and gestational duration in an urban area and evaluated main causal pathways for the influence of SES.</p><p>Methods</p><p>A population-based cross-sectional study was conducted among 559 mothers accessing postnatal services at the four main health facilities in Cape Coast, Ghana in 2011. Information on socioeconomic characteristics of the mothers was collected in a structured questionnaire.</p><p>Results</p><p>In multivariate linear regression adjusting for maternal age, parity and gender of newborn, low SES resulted in 292 g (95% CI: 440–145) reduction in birth weight. Important SES-related determinants were neighborhood poverty (221 g; 95% CI: 355–87), low education (187 g; 95% CI: 355–20), studentship during pregnancy (291 g; 95% CI: 506–76) and low income (147 g; 95% CI: 277–17). In causal pathway analysis, malaria infection (6–20%), poor nutrition (2–51%) and indoor air pollution (10–62%) mediated substantial proportions of the observed effects of socioeconomic deprivation on birth weight. Generalized linear models adjusting for confounders indicated a 218% (RR: 3.18; 95% CI: 1.41–7.21) risk increase of LBW and 83% (RR: 1.83; 95% CI: 1.31–2.56) of PTB among low income mothers. Low and middle SES was associated with 357% (RR: 4.57; 95% CI: 1.67–12.49) and 278% (RR: 3.78; 95% CI: 1.39–10.27) increased risk of LBW respectively. Malaria infection, poor nutrition and indoor air pollution respectively mediated 10–21%, 16–44% and 31–52% of the observed effects of socioeconomic disadvantage on LBW risk.</p><p>Conclusion</p><p>We provide evidence of the effects of socioeconomic deprivation, substantially mediated by malaria infection, poor nutrition and indoor air pollution, on pregnancy outcomes in a developing country setting.</p></div>", "links"=>[], "tags"=>["epidemiology", "Environmental epidemiology", "Epidemiological methods", "Pediatric epidemiology", "Social epidemiology", "Global health", "Public health", "Child health", "Environmental health", "preventive medicine", "Socioeconomic aspects of health", "Women’s health", "nutrition", "indoor", "mediate", "socioeconomic", "differences", "adverse", "outcomes", "cape"], "article_id"=>1074940, "categories"=>["Medicine"], "users"=>["Adeladza K. Amegah", "Obed K. Damptey", "Gideon A. Sarpong", "Emmanuel Duah", "David J. Vervoorn", "Jouni J. K. Jaakkola"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0069181.s001", "https://dx.doi.org/10.1371/journal.pone.0069181.s002", "https://dx.doi.org/10.1371/journal.pone.0069181.s003"], "stats"=>{"downloads"=>10, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Malaria_Infection_Poor_Nutrition_and_Indoor_Air_Pollution_Mediate_Socioeconomic_Differences_in_Adverse_Pregnancy_Outcomes_in_Cape_Coast_Ghana_/1074940", "title"=>"Malaria Infection, Poor Nutrition and Indoor Air Pollution Mediate Socioeconomic Differences in Adverse Pregnancy Outcomes in Cape Coast, Ghana", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2013-07-22 10:28:53"}
• {"files"=>["https://ndownloader.figshare.com/files/1555247"], "description"=>"<p>Column percentages are reported.</p><p>Covariates: ^aMothers reporting no episode of malaria during pregnancy served as reference category; ^b mothers with normal pre-pregnancy BMI served as reference category; ^cmothers using LPG as cooking fuel served as reference category.</p>", "links"=>[], "tags"=>["epidemiology", "Environmental epidemiology", "Epidemiological methods", "Pediatric epidemiology", "Social epidemiology", "Global health", "Public health", "Child health", "Environmental health", "preventive medicine", "Socioeconomic aspects of health", "Women’s health", "nutritional", "choices", "years", "served", "mothers"], "article_id"=>1074937, "categories"=>["Medicine"], "users"=>["Adeladza K. Amegah", "Obed K. Damptey", "Gideon A. Sarpong", "Emmanuel Duah", "David J. Vervoorn", "Jouni J. K. Jaakkola"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0069181.t002", "stats"=>{"downloads"=>0, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Health_nutritional_and_lifestyle_characteristics_and_cooking_fuel_choices_of_the_study_population_Covariates_a_Age_group_20_8211_29_years_served_as_reference_category_b_multiparous_mothers_served_as_reference_category_/1074937", "title"=>"Health, nutritional and lifestyle characteristics, and cooking fuel choices of the study population.Covariates: ^aAge group 20–29 years served as reference category; ^bmultiparous mothers served as reference category.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-07-22 10:28:53"}
• {"files"=>["https://ndownloader.figshare.com/files/1555245"], "description"=>"<p>SD indicates standard deviation.</p><p>Column percentages are reported.</p>a<p>Covariates: Males served as reference category.</p>", "links"=>[], "tags"=>["epidemiology", "Environmental epidemiology", "Epidemiological methods", "Pediatric epidemiology", "Social epidemiology", "Global health", "Public health", "Child health", "Environmental health", "preventive medicine", "Socioeconomic aspects of health", "Women’s health", "outcomes"], "article_id"=>1074935, "categories"=>["Medicine"], "users"=>["Adeladza K. Amegah", "Obed K. Damptey", "Gideon A. Sarpong", "Emmanuel Duah", "David J. Vervoorn", "Jouni J. K. Jaakkola"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0069181.t003", "stats"=>{"downloads"=>4, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Characteristics_of_newborns_and_pregnancy_outcomes_of_the_mothers_/1074935", "title"=>"Characteristics of newborns, and pregnancy outcomes of the mothers.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-07-22 10:28:53"}
• {"files"=>["https://ndownloader.figshare.com/files/1555244"], "description"=>"<p>CI indicates confidence interval. GH¢ indicates Ghana cedis. SES indicates socioeconomic status.</p><p>Effect estimate (β) is in grams.</p><p>Mediation fractions (%).</p><p>Low SES: Malaria (11.6), Pre-pregnancy BMI (15.1), Cooking fuel (31.8), Joint (47.3).</p><p>Middle SES: Malaria (15.5), Pre-pregnancy BMI (7.3), Cooking fuel (26.0), Joint (41.6).</p>", "links"=>[], "tags"=>["epidemiology", "Environmental epidemiology", "Epidemiological methods", "Pediatric epidemiology", "Social epidemiology", "Global health", "Public health", "Child health", "Environmental health", "preventive medicine", "Socioeconomic aspects of health", "Women’s health", "adjusted", "maternal", "socioeconomic"], "article_id"=>1074934, "categories"=>["Medicine"], "users"=>["Adeladza K. Amegah", "Obed K. Damptey", "Gideon A. Sarpong", "Emmanuel Duah", "David J. Vervoorn", "Jouni J. K. Jaakkola"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0069181.t004", "stats"=>{"downloads"=>0, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Unadjusted_and_adjusted_effect_of_maternal_socioeconomic_status_SES_on_birth_weight_/1074934", "title"=>"Unadjusted and adjusted effect of maternal socioeconomic status (SES) on birth weight.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-07-22 10:28:53"}

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Relative Metric

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F1000Prime