Global Environmental Health

Syed Moshfiqur Rahman, Associate Professor

Environmental health deals with assessment and control of physical, chemical, biological, social, and psychological factors external to a person that have the potential to impact human health. Globally, millions of death and lost disability-adjusted life-years are attributable to environmental exposures and related illnesses. Most of the environmental exposures stem from unsafe water and sanitation, air pollution, indoor smoke from solid fuels, toxic hazards, vector-borne diseases, and global climate change. Environment-related diseases represent an enormous global health concern, particularly in low- and middle-income countries. It is especially an issue in impoverished communities, where there is often a lack of awareness and knowledge about the effects of toxic metals and other environmental hazards on women’s and children’s health. The developmental origins of health and disease (DOHaD) hypothesis and emerging evidence indicate that early-life exposure to environmental toxicants and pollutants via air, water, and food impart long-term effects on physical and mental health as well as on cognitive development and social behavior and result in the development of metabolic syndromes later in life.

The primary objective of the scientific program is to understand the role of environment as a determinant of health. The aim is also to study the effect of many different essential and toxic elements on child and adolescent’s growth and development, and specifically about how this research can be used to implement community-based approaches to improving maternal, child, and adolescent’s health and also to educate advanced-level students about the environmental determinants of health and climate change with a global health perspective.

Subgroup lead:

Syed Moshfiqur Rahman, Associate Professor

Syed Moshfiqurs profile page

Ongoing research projects

To evaluate adverse health effects of early-life exposure to polycyclic aromatic hydrocarbons (PAH) and toxic metals, such as arsenic, cadmium, lead etcetera, on growth, development and cardio-metabolic risk indicators among children and adolescents.

To assess blood level of different hormones related to growth and reproduction during adolescence and their environmental correlates.

Collaborators
Karolinska Institutet, Lund University, and International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b)

Funding
FORMAS and Swedish Research Council

Responsible researcher/contact person
Syed Moshfiqur Rahman, syed.moshfiqur@kbh.uu.se

With every 30 neonates dying per 1,000 live births, Bangladesh is dismally contributing to the global neonatal death rate as one of the top countries. In Bangladesh, neonatal deaths account for 67% of all under-5 deaths.1 Preterm birth and low-birth-weight (LBW) are the second major cause, accounting for 19% of those neonatal deaths. Moreover, preterm birth and LBW are the main reasons contributing to lifelong morbidity with impaired neurodevelopment and learning disabilities, and long-term complications including asthma, and pneumonia common among those who survive. One of the major causes of death due to prematurity is hypothermia. The body core temperature of a premature neonate may rapidly drop below the normal range of 36.5-37.5°C / 97.7-99.5°F. Therefore, prevention of hypothermia is fundamental to promoting the survival of babies born preterm. The World Health Organization recommends Kangaroo Mother Care (KMC) for managing babies born preterm and with LBW in which a mother or a caregiver has to provide skin-to-skin care for 16-20 hours to maintain thermal regulation body temperature. Although KMC has been proven to be a safe, efficacious, and cost-effective intervention in different health facility settings, gaps remain in maintaining continuous skin-to-skin care practices, particularly in Bangladesh. Many barriers exist which hinder the effectiveness of skin-to-skin care practices including a lack of support from family members for the mothers’ personal and resting time during the hospital stay, pain/fatigue of mother (e.g. immediately after caesarean section, other illness).

This study has proposed to promote optimum thermal regulation by developing and introducing a thermal jacket to support to existing KMC practice. The thermal jacket uses a chemical warming pad (CWP) that releases energy fitted in a “heat-tight” jacket which can be worn by premature or LBW neonates during periods when it is not feasible for the mothers to provide KMC care. The overall aim of this research is to develop and test a thermal jacket for maintaining euthermia of preterm and LBW neonates in the context of Bangladesh.

PhD student: Anisuddin Ahmed

Supervisors: Syed Moshfiqur Rahman, Mats Målqvist, Ahmed Ehsanur Rahman, Shams El Arifeen

Funding: Islamic Development Bank (KSA), Ministry of Health (GoB), Global Affairs Canada

Collaborator: International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b).

Lead (Pb) is a potent neurotoxin, and children are particularly vulnerable due to their developing physiology and high-risk behaviours. Soil remediation interventions have been shown to effectively reduce lead exposure. The study aims to measure the effectiveness of soil remediation at abandoned used lead acid battery (ULAB) recycling sites, along with household cleaning and community awareness in reducing blood lead levels (BLLs) in children. Additionally, it explores the associations between Pb exposure with hematological, cardiovascular, renal, immunological, and endocrinological parameters in children aged 0–12 years. This study follows a quasi-experimental design, with abandoned ULAB sites as intervention sites and two control sites in Bangladesh. The intervention consists of soil remediation and community education with data collected before and 12 months after the interventions. Data collection will include a comprehensive Pb exposure survey and collect environmental, turmeric samples, and blood from the child. Pb concentrations in environmental samples and turmeric samples will be determined using XRF analyzer. Child BLL will be measured using Graphite Furnace Atomic Absorption Spectrometry (GF-AAS). Proposed biochemical parameters will be analyzed using routine laboratory methods. This study could provide valuable insights for designing targeted interventions in similar settings and mitigating exposure to Pb.

Ref. Rahman, Mahbubur, et al. "Effectiveness of soil remediation intervention in abandoned used lead acid battery (ULAB) recycling sites to reduce lead exposure among the children." MethodsX (2024): 102772.

PhD student: Md Mahbubur Rahman

Supervisors: Syed Moshfiqur Rahman, Maria Kippler, Rubhana Raqib and Steve Luby

Funding: Pure Earth

Collaborator: International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b) and Stanford University, USA.

Preterm birth is a global health concern due to its immediate and long-term effects on health and socioeconomic status. Preterm infants are more likely to experience neurological, cognitive, and physical challenges leading to increased difficulties in adulthood. Parental maturity at birth may also influence offspring development, suggesting an intergenerational effect. Most evidence on the long-term health of preterm adults comes from high-income countries, with limited studies in low- and middle-income countries.

The aim of this doctoral research is to investigate the impact of preterm birth on mortality and health outcomes (e.g., cardio-metabolic disorders, depression) in adulthood (ages 18 and older) and to analyze the intergenerational effects of preterm birth on the development of offspring in a rural area of Bangladesh, a lower middle-income country in the Global South.

The study will utilize data from the Matlab Health and Demographic Surveillance System (HDSS), which has been collecting gestational age data based on the Last Menstrual Period (LMP) from a rural population of 250,000 since 1978, along with detailed records of births, deaths, and migration events. The HDSS’s individual-level unique identification system and intergenerational linkage ensure data reliability. Additionally, the research will gather biometric, anthropometric, and mental health data. This study will help fill in the knowledge gap regarding the long-term health and social impacts of preterm birth in the Global South.

PhD student: Md. Moinuddin Haider

Supervisors: Syed Moshfiqur Rahman, Mohammad Redwanul Islam, Sarah Salway

Funding source: Core fund of icddr,b and ALF, Uppsala University

Collaborator: International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b)

Completed projects

PhD student: Sheikh Jamal Hossain

Supervisors: Syed Moshfiqur Rahman, Jena Hamadani, Anisur Rahman

Ensuring psychosocial stimulation for urban children is a big challenge since the urban system in low- and middle-income countries is complex. Little is known about what happen if psychosocial stimulation and nutrition education is provided using urban lactating allowance program on children’s growth and development. This PhD project is based on data available from a cluster randomized controlled trial in an urban area of Bangladesh. The aim is to deliver a package of psychosocial stimulation and nutrition education using unconditional cash transfer platform and to measure the effect on disadvantaged children’s growth and development in urban Bangladesh. The stimulation and nutrition education was provided domiciliary fortnightly for one year for the children aged 6-16 months. Children’s cognitive, motor and language development was measured using Bayley-III, Mother’s quality of life will also be measured using World Health Organization Quality of Life (WHOQoL) questionnaire. Intention to treat analysis will be done to see the intervention effect.

Collaborators
International

PhD student: Chalobol Chalermsri

Supervisors: Syed Moshfiqur Rahman, Shirin Ziaei, Eva-Charlotte Ekström, Weerasak Muangpaisan

The qualitative and quantitative research aim to explore the dietary diversity and its health effects among the elderly population in Thailand. Thai elderly and informal caregivers in Samut Sakhon Province, Thailand were interviewed to explore the experiences and determinants influencing the food choices and eating practices from their own perspectives. For examining the associated factors and the health consequences of dietary diversity, the data from Thai National Health Examination Survey (NHES) 2009-2014 were analysed. After that, the nutritional educational intervention via mobile application will be developed and implemented to improve the nutritional knowledge and the dietary diversity in Thai elderly.

Collaborators
Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b)

Teaching activities

Writing Mixed Methods Studies and Getting Them Published (FMF0056: 2 credits):

We have been conducting this doctoral course every autumn since 2019.This course takes a step-by-step approach to guiding participants through the process of writing research articles based on mixed-methods research principles and article publication in quality journals. The course provides an editor’s perspective on how students can improve their research writing to enhance the chances of publication and citation. The course takes a practicality-oriented, skills-based approach to dealing with the challenges new authors are faced with, starting with the basics of identifying the parts of research which are best suited to be published in article form, to finding good quality journals for publication as well as the ability to write with clarity for maximum impact.

  1. Environment, Health, and Climate Change (3PE050: 5 Credits):

We are conducting this course every year in autumn in collaboration with the Department of Earth Sciences at Uppsala University, two ENLIGHT universities (the University of Tartu in Estonia and the University of Groningen in the Netherlands), and Uppsala Municipality. ENLIGHT is a European University alliance of ten comprehensive, research-intensive universities from ten European countries (Belgium, Estonia, France, Germany, Ireland, Netherlands, Slovakia, Spain, Sweden, Switzerland). Students from different ENLIGHT universities are participating in this course.

  1. Challenges and Strategies for strengthening health systems in vulnerable contexts (3PE210: 7.5 credits)

The course intends to build an understanding of issues pertaining to navigating through the building blocks of health systems in low-resource, vulnerable, and fragile settings. While organization and functionality of health systems are explained through frameworks and standards, the value addition of the course is its focus on practitioners’ challenges with options and strategies to navigate through those. The participants should have a bachelor's or a professional degree equivalent to a Swedish Kandidatexamen, from an internationally recognised university.

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