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Full Text, Thesis (PhD Doctorate), Doctor of Philosophy (PhD), Griffith School of Environment, Science, Environment, Engineering and Technology, Climate change is the biggest global health threat of the twenty-first century, responsible directly or indirectly for approximately 12.6 million of all deaths globally and projected to cause an additional 250,000 deaths each year. A key area of concern is how climate change will influence the incidence, and spread of infectious diseases such as malaria. Approximately 3.3 billion, or half of the world’s population, are at risk from malaria and under climate change projections; this number is estimated to rise by 1.6 million by the year 2030 and by 1.8 million by the year 2050. Thus, understanding climate change and malaria risk is of significant public health concern, and this is particularly important for East Africa where current research shows that the disease is already spreading into areas where communities were previously unexposed to the disease. Studies on the impact of climate change on malaria transmission show that even the smallest variation in temperature can have an exponential change in the transmission of the disease. Temperature changes facilitate faster development of the parasite within the mosquito, faster reproduction of the mosquitoes, and more biting by the mosquitoes. Rainfall is also a driver of malaria transmission and can influence the development of the mosquito by creating suitable habitats for larvae and increasing mosquito abundance. Malaria is a disease with a complex transmission cycle which is also influenced at the local level, mainly by land cover, land use and land use change. These changes can introduce the mosquito into new locations, thus extending their range, creating suitable micro-habitat conditions for mosquitoes to breed, and also increasing mosquito abundance. While climate change does influence the global distribution of malaria, the spatial extent within regions will be determined by local land use factors and by other non-climatic factors. The latter include biological, social, demographic and cultural factors, along

Full Text, Thesis (PhD Doctorate), Doctor of Philosophy (PhD), Griffith School of Environment, Science, Environment, Engineering and Technology, An effective sanitation system is vital for public health and the environment, as poor sanitation is a key contributor to a high burden of diarrhoea and hygiene related diseases and environmental pollution. Yet 2.4 billion people in developing countries are without access to sanitation facilities. Despite 15 years of international effort to halve the proportion of people without access to sanitation specified by the Millennium Development Goals (MDG) (2000-2015), little progress was made to enable the poor in rural areas and urban slums in the developing world to access effective sanitation. Moreover, the issues of sustainability relating to the usage and functioning of entire sanitation systems require more consideration to ensure safe management of human excreta. These concerns are reflected in the new sanitation target (Goal 6) of the Sustainable Development Goals urging countries to “ensure availability and sustainable management of water and sanitation for all” by 2030 (SDG) (UN, 2016). This new target poses many challenges to developing countries such as Indonesia. The challenges lie in the complex nature of sanitation issues from uptake to sustainability, which requires a multi-disciplinary solution. Evidence from many studies reveals the importance of considering multiple factors ranging from individual and behavioural, to cultural, socio-economic, institutional and technical aspects of sanitation systems. However, current approaches to address sanitation issues tend to be dominated by a single discipline perspective or are addressed from an individual level which only partially addresses the problem. There are a few studies in the sanitation sector suggesting comprehensive models, but they tend to be overly complicated and difficult for local professionals to apply to their practical situations. Comprehensively addressing sanitation issues is particularly important for rural areas in developing countries, which cannot afford costly infrastructure solutions.

Full Text, Thesis (PhD Doctorate), Doctor of Philosophy (PhD), Griffith School of Environment, Science, Environment, Engineering and Technology, Many large-scaled pandemics and disease outbreaks have been recorded in human history, causing enormous negative impacts on health, economies, and even affecting international security in the world. Recent years have seen many rapidly spreading outbreaks such as the Hantavirus pulmonary syndrome, SARS, H5N1 influenza, H1N1 influenza, Middle East respiratory syndrome (MERS), Ebola and the Zika virus. Not all of these diseases are new, but population movements have increased in both scale and speed, so there are greater risks that infectious diseases will spread rapidly to multiple countries. Pandemic crises have had serious consequences on health, tourism, travel, trade and have even caused significant political and social disruptions. Thus, effective public health emergency management to prevent and control pandemics is very important. For effective emergency management of pandemics, which are inherently unpredictable and widespread, preparedness, timely decision-making and comprehensive response involving relevant sectors are critical. But adequate preparedness and appropriate response rely on effective communication and coordination among stakeholders as well as the amount of information available at any given time, and these require a multi-sectoral approach with information sharing and communication as key tools for the prevention and management of infectious diseases outbreaks. However, multi-sectoral collaboration, coordination, information sharing and communication are often the key challenges and problems encountered in dealing with public health emergencies.

Sadika Akhter,1,2 Shannon Rutherford,1 Feroza Akhter Kumkum,2 David Bromwich,1 Iqbal Anwar,2 Aminur Rahman,2 Cordia Chu1 1Centre for Environment and Population Health, Griffith University, Brisbane, QLD, Australia; 2International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh Background: Traditionally, women in Bangladesh stayed at home in their role as daughter, wife, or mother. In the 1980s, economic reforms created a job market for poor, uneducated rural women in the ready-made garment industry, mostly located in urban areas. This increased participation in paid work has changed the gender roles of these women. Women’s earnings support their family, but they are also separated from their children, with impacts on their mental health and well-being. This study explores the lived experience of women in Bangladesh working in the ready-made garment industry as they strive to be mothers and family providers, often in high-stress conditions.Methods: The study was conducted in two industrial areas of Dhaka over 8 months. Data collection included a literature review, 20 in-depth interviews with married female garment workers, and 14 key-informant interviews with officials from the Ministry of Labour and Employment, health-service providers within the garment factories, factory managers, and representatives of the Bangladesh Garment Manufacturers and Exporters Association. The data collected were analyzed thematically.Results: Poverty was a key motivating factor for female migrant workers to move from rural areas. Their children stay in their village with their grandparents, because of their mothers’ work conditions and the lack of childcare. The women reported stress, anxiety, restlessness, and thoughts of suicide, due to the double burden of work and separation from their children and family support. Further, they cannot easily access government hospital services due to their long work hours, and the limited medical services pro

Full Text, Thesis (PhD Doctorate), Doctor of Philosophy (PhD), Griffith School of Environment, Science, Environment, Engineering and Technology, Climate change related extreme events such as floods have been and will continue to present a great challenge to disaster risk management. With the projected increase in frequency and scale of future climate extremes, there is a pressing need to develop effective strategies to reduce risk and vulnerabilities to floods, particularly in the context of urban settings in developing countries faced with rapid urbanization and a range of social and environmental threats. To deal with climate change and urban flood risks, a large body of research urges urban community resilience building. To this end, literature also highlights the importance of integrating the efforts of disaster risk reduction (DRR) and climate change adaptation (CCA). DRR and CCA represent two different fields with complimentary sets of expertise and policy goals. The former deals with ongoing operational issues of disasters and the latter with making changes to deal with emerging issues associated with climate change. Many authors have argued that collaboration or partnership between DRR and CCA will improve the robustness of strategy particularly to deal with uncertainties into the future. Despite this, in practice, partnership building between the two is difficult and in most cases the two are working in silos.

Full Text, Thesis (PhD Doctorate), Doctor of Philosophy (PhD), Griffith School of Environment, Science, Environment, Engineering and Technology, Cervical cancer, which is caused by sexually-acquired persistent infection with high risk human papillomavirus (HPV), continues to be a public health problem in the world, it being the second most common type of cancer among women. Nearly 87% of cervical cancer deaths occur in women living in developing countries, and China, because of its large population, carries a heavy burden of cervical cancer. Since the 1990s, there has been an increasing incidence of and mortality from cervical cancer in China, which currently accounts for 12% of new cases of cervical cancer in the world. Vaccinating girls before sexual debut and screening women for precancerous lesions can prevent cervical cancer. However, owing to the current high cost of HPV vaccinations, this is not an affordable or available option for many developing and low-income countries, including China. Moreover, the HPV vaccination is only effective for girls and young women before exposure to infection and only protects against HPV types responsible for about 70% of cervical cancer. Therefore, screening women for precancerous lesions to prevent cervical cancer remains the most important and effective strategy in less developed regions.

Full Text, Thesis (PhD Doctorate), Doctor of Philosophy (PhD), Griffith School of Environment, Science, Environment, Engineering and Technology, Climate change and sea level rise will continue to exacerbate existing freshwater salinization and affect large populations in many low-lying countries of the world including in Bangladesh. While ample evidence, mainly based on food consumption, indicates high salt intake causes significant health problems (e.g. elevated blood pressure (BP), hypertension and cardiovascular diseases), the evidence for health effects of consuming highly saline water is limited. In coastal Bangladesh, with over 35 million inhabitants, projected climate change points toward further intensification of the exposure to high salinity in water and presents significant threats to population’s health. Furthermore, in order to better understand potential health risks and assist in developing future response options, data about the water supply situation and consumption is imperative. Such data are scarce. This research aimed firstly to examine the salt (sodium) exposure, and the association between high drinking water salinity and blood pressure (BP) in young adults in coastal Bangladesh. There is currently limited data available about BP on healthy young adults in Bangladesh, particularly from salinity affected coastal areas. Second, this research investigated existing water supply and water consumption in order to explore appropriate adaptation opportunities for actions and strategies.

Full Text, Thesis (PhD Doctorate), Doctor of Philosophy by Publication (PhD), Griffith School of Environment, Science, Environment, Engineering and Technology, Many studies have demonstrated significant impacts of weather variation on population health in developed countries. In the last decade, there are some similar studies from China focusing on a single city or a small number of cities. However, those studies could not depict a holistic picture of temperature variation on health in China because they only included too small samples and regions. This study aims to comprehensively assess the association between temperature variation and mortality in China, and further explore the modification factors of the association. At national level, mortality data and meteorological data during 2006-2011 were collected from 66 communities across China. In Guangdong Province, we collected relevant data from 4 cities. We used a Distributed Lag Non-linear Model(DLNM) to estimate community-specific effects of temperature on non-accidental mortality. A meta-analysis was then applied to pool the estimates of community-specific effects. The key findings from this study are: (1) A U-shaped relationship was observed between ambient temperature and mortality in China. The overall threshold was at about the 75th percentile of the pooled temperature distribution in China. Cold effect was delayed and persisted, whereas hot effect was acute. (2) Mortality effect of ambient temperature varies geographically. Compared with north China, south China had a higher minimum mortality temperature (MMT), and there was a larger cold effect in the more southern parts of China and a more pronounced hot effect in more northern parts. (3) Except for absolute temperature, temperature fluctuations such as temperature change within a day and temperature change between neighboring days are also independent risk factors of daily mortality. (4) Extreme weather events such as heat wave and cold spell significantly increase mortality risk in China. The main effects of heat wave due to high temperature were greater than the added effects on the current day due to prolo

Full Text, Thesis (PhD Doctorate), Doctor of Philosophy (PhD), Griffith School of Environment, Science, Environment, Engineering and Technology, Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) has emerged as a major global health threat in the last three decades (UNAIDS and WHO, 2013). Mother-To-Child Transmission (MTCT) of HIV increases the risk of HIV being transmitted from high risk populations to the general population, taking a heavy toll on children’s health (UNICEF, 2013). Prevention of MTCT (PMTCT) measures have effectively reduced the risk of MTCT in many developed countries; however difficulties in service delivery and various access issues impede implementation of PMTCT in resource limited countries (UNICEF and WHO, 2013), including China. Hence, it is imperative that we investigate better ways to implement PMTCT to reduce the risk of MTCT of HIV. A priority strategy to reduce MTCT of HIV promoted by WHO is the integration of HIV prevention and treatment services with maternal and child health services (WHO, 2011b). This requires a shift in the management model from providing stand-alone prevention of HIV services to integrative PMTCT services. However, the effectiveness of integrated PMTCT services delivery is uneven across different health service systems around the world (Youngleson et al., 2010). In particular, delivery of integrated services is very difficult in complex health systems such as that in China.

In China, the health impact of cold weather has received little attention, which limits our understanding of the health impacts of climate change. We collected daily mortality and meteorological data in 66 communities across China from 2006 to 2011. Within each community, we estimated the effect of cold spell exposure on mortality using a Distributed Lag Nonlinear Model (DLNM). We also examined the modification effect of cold spell characteristics (intensity, duration, and timing) and individual-specific factors (causes of death, age, gender and education). Meta-analysis method was finally used to estimate the overall effects. The overall cumulative excess risk (CER) of non-accidental mortality during cold spell days was 28.2% (95% CI: 21.4%, 35.3%) compared with non-cold spell days. There was a significant increase in mortality when the cold spell duration and intensity increased or occurred earlier in the season. Cold spell effects and effect modification by cold spell characteristics were more pronounced in south China. The elderly, people with low education level and those with respiratory diseases were generally more vulnerable to cold spells. Cold spells statistically significantly increase mortality risk in China, with greater effects in southern China. This effect is modified by cold spell characteristics and individual-level factors.

The association between temperatures and risk of cardiovascular mortality has been recognized but the association drawn from previous meta-analysis was weak due to the lack of sufficient studies. This paper presented a review with updated reports in the literature about the risk of cardiovascular hospitalization in relation to different temperature exposures and examined the dose–response relationship of temperature-cardiovascular hospitalization by change in units of temperature, latitudes, and lag days. The pooled effect sizes were calculated for cold, heat, heatwave, and diurnal variation using random-effects meta-analysis, and the dose–response relationship of temperature-cardiovascular admission was modelled using random-effect meta-regression. The Cochrane Q-test and index of heterogeneity (I2) were used to evaluate heterogeneity, and Egger's test was used to evaluate publication bias. Sixty-four studies were included in meta-analysis. The pooled results suggest that for a change in temperature condition, the risk of cardiovascular hospitalization increased 2.8% (RR, 1.028; 95% CI, 1.021–1.035) for cold exposure, 2.2% (RR, 1.022; 95% CI, 1.006–1.039) for heatwave exposure, and 0.7% (RR, 1.007; 95% CI, 1.002–1.012) for an increase in diurnal temperature. However no association was observed for heat exposure. The significant dose–response relationship of temperature — cardiovascular admission was found with cold exposure and diurnal temperature. Increase in one-day lag caused a marginal reduction in risk of cardiovascular hospitalizations for cold exposure and diurnal variation, and increase in latitude was associated with a decrease in risk of cardiovascular hospitalizations for diurnal temperature only. There is a significant short-term effect of cold exposure, heatwave and diurnal variation on cardiovascular hospitalizations. Further research is needed to understand the temperature-cardiovascular relationship for different climate areas.

This study examined the short-term effects of temperature on cardiovascular hospital admissions (CHA) in the largest tropical city in Southern Vietnam. We applied Poisson time-series regression models with Distributed Lag Non-Linear Model (DLNM) to examine the temperature-CHA association while adjusting for seasonal and long-term trends, day of the week, holidays, and humidity. The threshold temperature and added effects of heat waves were also evaluated. The exposure-response curve of temperature-CHA reveals a J-shape relationship with a threshold temperature of 29.6 °C. The delayed effects temperature-CHA lasted for a week (0–5 days). The overall risk of CHA increased 12.9% (RR, 1.129; 95%CI, 0.972–1.311) during heatwave events, which were defined as temperature ≥ the 99th percentile for ≥2 consecutive days. The modification roles of gender and age were inconsistent and non-significant in this study. An additional prevention program that reduces the risk of cardiovascular disease in relation to high temperatures should be developed.