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Etchie AT, Etchie TO, Elemile OO, Boladale O, Oni T, Akanno I, Bankole DT, Ibitoye OO, Pillarisetti A, Sivanesan S, Afolabi TY, Krishnamurthi K, Swaminathan N. Burn to kill: Wood ash a silent killer in Africa. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 748:141316. [PMID: 32814289 DOI: 10.1016/j.scitotenv.2020.141316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 06/11/2023]
Abstract
Aside the emissions, burning of wood in traditional cookstoves (TCs) also generates substantial amount of ash containing hazardous pollutants such as polycyclic aromatic hydrocarbons (PAHs) and toxic metals. But, their concentrations in the ash, particularly in Africa where over 70% of the population utilize TCs, remain unknown. Here, we determined concentrations of sixteen PAHs and eleven heavy metals in ashes from twelve different African TCs, comprising six three-stone fires (TSFs) and six built-in-place cookstoves (BIPCs), burning common African wood species under real world situation. For each TC, ash samples were collected for six consecutive days (Monday-Saturday), and a total of seventy-two daily samples were collected from January-June 2019. Ash yields were measured gravimetrically, and concentrations of the pollutants were determined following standard analytical protocols. The results were used alongside secondary data (annual fuelwood consumption, African fuelwood densities, population proportion using fuelwood and surface human population density) to estimate annual tonnage, exposure potential and risk to health in Africa, using Monte Carlo simulation technique. The ash yields from all TCs studied exceeded 1% on dry weight basis, indicating that ash is a major waste by-product of wood combustion in TCs. TSFs produced more ash (5.7 ± 0.7%) than BIPCs (3.4 ± 1.0%). Concentrations of As, Cd, Hg and Pb in ashes were significantly higher (α = 0.05) for TSFs than BIPCs. In contrast, concentrations of PAHs were higher in ashes from BIPCs than TSFs. Assuming ash consumption rates range from 250 to 500 mg/day for young children weighing 10 to 30 kg, the upper dose (μg/kg-day) of Pb (0.2-3.9) or Σ16PAHs (0.02-0.34), for instance, surpasses the 0.3 μg/kg-day of Pb or PAH recognized as causing adverse effects in children, indicating a concern. The top five countries with the highest annual tonnage or exposure potential to toxic pollutants are Nigeria>Ethiopia>DR-Congo>Tanzania>Uganda, or Rwanda>Burundi>Uganda>Nigeria>Guinea-Bissau, respectively.
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Affiliation(s)
| | | | | | - Oluwatobi Boladale
- Department of Physical Sciences, Landmark University, Omu-Aran, Nigeria.
| | - Timileyin Oni
- Department of Civil Engineering, Landmark University, Omu-Aran, Nigeria.
| | - Ifeanyi Akanno
- Department of Civil Engineering, Landmark University, Omu-Aran, Nigeria.
| | | | | | - Ajay Pillarisetti
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, USA.
| | - Saravanadevi Sivanesan
- National Environmental Engineering Research Institute, Council of Scientific and Industrial Research (CSIR-NEERI), Nagpur, India.
| | | | - Kannan Krishnamurthi
- National Environmental Engineering Research Institute, Council of Scientific and Industrial Research (CSIR-NEERI), Nagpur, India.
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102
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Cohen A, Pillarisetti A, Luo Q, Zhang Q, Li H, Zhong G, Zhu G, Colford JM, Smith KR, Ray I, Tao Y. Boiled or Bottled: Regional and Seasonal Exposures to Drinking Water Contamination and Household Air Pollution in Rural China. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:127002. [PMID: 33275452 PMCID: PMC7717838 DOI: 10.1289/ehp7124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND Inadequate access to safe drinking water remains a global health problem, particularly in rural areas. Boiling is the most commonly used form of point-of-use household water treatment (HWT) globally, although the use of bottled water in low- and middle-income countries (LMICs) is increasing rapidly. OBJECTIVES We assessed the regional and seasonal prevalence of HWT practices (including bottled water use) in low-income rural areas in two Chinese provinces, evaluated the microbiological safety of drinking water and associated health outcomes, and estimated the air pollution burden associated with the use of solid fuels for boiling. METHODS We conducted cross-sectional surveys and collected drinking water samples from 1,033 rural households in Guangxi and Henan provinces. Temperature sensors affixed to pots and electric kettles were used to corroborate self-reported boiling frequencies and durations, which were used to model household air pollution (HAP) in terms of estimated particulate matter ≤ 2.5 μ m in aerodynamic diameter (PM 2.5 ) concentrations. RESULTS Based on summer data collection in both provinces, after controlling for covariates, boiling with electric kettles was associated with the largest log reduction in thermotolerant coliforms (TTCs) (- 0.66 log 10 TTC most probable number/ 100 mL ), followed by boiling with pots (- 0.58 ), and bottled water use (- 0.39 ); all were statistically significant (p < 0.001 ). Boiling with electric kettles was associated with a reduced risk of TTC contamination [risk ratio ( RR ) = 0.25 , p < 0.001 ] and reported diarrhea (RR = 0.80 , p = 0.672 ). TTCs were detected in 51% (n = 136 ) of bottled water samples. For households boiling with biomass, modeled PM 2.5 concentrations averaged 79 μ g / m 3 (standard deviation = 21 ). DISCUSSION Our findings suggest that where boiling is already common and electricity access is widespread, the promotion of electricity-based boiling may represent a pragmatic stop-gap means of expanding safe water access until centralized, or decentralized, treated drinking water is available; displacing biomass use for water boiling could also reduce HAP concentrations and exposures. Our results also highlight the risks of increasing bottled water use in rural areas, and its potential to displace other sources of safe drinking water, which could in turn hamper efforts in China and other LMICs toward universal and affordable safe water access. https://doi.org/10.1289/EHP7124.
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Affiliation(s)
- Alasdair Cohen
- Public Health Program, Department of Population Health Sciences, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, Virginia, USA
| | - Ajay Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Qing Luo
- National Center for Rural Water Supply Technical Guidance, Chinese Center for Disease Control and Prevention (CDC), Beijing, China
| | - Qi Zhang
- National Center for Rural Water Supply Technical Guidance, Chinese Center for Disease Control and Prevention (CDC), Beijing, China
| | - Hongxing Li
- National Center for Rural Water Supply Technical Guidance, Chinese Center for Disease Control and Prevention (CDC), Beijing, China
| | - Gemei Zhong
- Guangxi CDC, Nanning, Guangxi Autonomous Region, China
| | - Gang Zhu
- Henan CDC, Zhengzhou, Henan Province, China
| | - John M. Colford
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Kirk R. Smith
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Isha Ray
- Energy and Resources Group, University of California, Berkeley, Berkeley, California, USA
- Berkeley Water Center, University of California, Berkeley, Berkeley, California, USA
| | - Yong Tao
- National Center for Rural Water Supply Technical Guidance, Chinese Center for Disease Control and Prevention (CDC), Beijing, China
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103
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Pozzer A, Dominici F, Haines A, Witt C, Münzel T, Lelieveld J. Regional and global contributions of air pollution to risk of death from COVID-19. Cardiovasc Res 2020; 116:2247-2253. [PMID: 33236040 PMCID: PMC7797754 DOI: 10.1093/cvr/cvaa288] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/03/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022] Open
Abstract
AIMS The risk of mortality from the coronavirus disease that emerged in 2019 (COVID-19) is increased by comorbidity from cardiovascular and pulmonary diseases. Air pollution also causes excess mortality from these conditions. Analysis of the first severe acute respiratory syndrome coronavirus (SARS-CoV-1) outcomes in 2003, and preliminary investigations of those for SARS-CoV-2 since 2019, provide evidence that the incidence and severity are related to ambient air pollution. We estimated the fraction of COVID-19 mortality that is attributable to the long-term exposure to ambient fine particulate air pollution. METHODS AND RESULTS We characterized global exposure to fine particulates based on satellite data, and calculated the anthropogenic fraction with an atmospheric chemistry model. The degree to which air pollution influences COVID-19 mortality was derived from epidemiological data in the USA and China. We estimate that particulate air pollution contributed ∼15% (95% confidence interval 7-33%) to COVID-19 mortality worldwide, 27% (13 - 46%) in East Asia, 19% (8-41%) in Europe, and 17% (6-39%) in North America. Globally, ∼50-60% of the attributable, anthropogenic fraction is related to fossil fuel use, up to 70-80% in Europe, West Asia, and North America. CONCLUSION Our results suggest that air pollution is an important cofactor increasing the risk of mortality from COVID-19. This provides extra motivation for combining ambitious policies to reduce air pollution with measures to control the transmission of COVID-19.
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Affiliation(s)
- Andrea Pozzer
- International Center for Theoretical Physics, Trieste, Italy
- Max Planck Institute for Chemistry, Atmospheric Chemistry
Department, Mainz, Germany
| | - Francesca Dominici
- Harvard T.H. Chan School of Public Health, Department of
Biostatistics, Boston, MA, USA
| | - Andy Haines
- Centre for Climate Change and Planetary Health, London School of Hygiene and
Tropical Medicine, London, UK
| | - Christian Witt
- Charité University Medicine, Pneumological Oncology and
Transplantology, Berlin, Germany
| | - Thomas Münzel
- University Medical Center of the Johannes Gutenberg University,
Mainz, Germany
- German Center for Cardiovascular Research, Mainz, Germany
| | - Jos Lelieveld
- Max Planck Institute for Chemistry, Atmospheric Chemistry
Department, Mainz, Germany
- The Cyprus Institute, Climate and Atmosphere Research Center,
Nicosia, Cyprus
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104
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Fandiño-Del-Rio M, Kephart JL, Williams KN, Moulton LH, Steenland K, Checkley W, Koehler K. Household air pollution exposure and associations with household characteristics among biomass cookstove users in Puno, Peru. ENVIRONMENTAL RESEARCH 2020; 191:110028. [PMID: 32846169 PMCID: PMC7658004 DOI: 10.1016/j.envres.2020.110028] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/26/2020] [Accepted: 07/29/2020] [Indexed: 05/24/2023]
Abstract
BACKGROUND Household air pollution (HAP) from combustion of biomass fuel, such as wood and animal dung, is among the leading environmental risk factors for preventable disease. Close to half of the world's population relies on biomass cookstoves for their daily cooking needs. Understanding factors that affect HAP can inform measures to maximize the effectiveness of cookstove interventions in a cost-effective manner. However, the impact of kitchen and household characteristics, as well as the presence of secondary stoves, on HAP concentrations is poorly understood in Puno, Peru. OBJECTIVE To explore how household characteristics explain variability of kitchen area concentrations and personal exposures to CO, PM2.5 and BC from biomass cookstoves among women in rural Peru. METHODS Household characteristics (including kitchen materials and layout, wealth, and cooking behaviors) and HAP measurements were collected from 180 households in Puno, Peru, from baseline measurements of a randomized trial. Kitchen area concentrations and personal exposures to carbon monoxide (CO), fine particulate matter (PM2.5) and black carbon (BC) were sampled for 48 h. We implemented simple and multivariable linear regression models to determine the associations between household characteristics and both kitchen area concentration and personal exposure to each pollutant. RESULTS Mean daily kitchen area concentrations and personal exposures to HAP were, on average, 48 times above World Health Organization indoor guidelines for PM2.5. We found that roof type explained the most variability in HAP and was strongly associated with both kitchen area concentrations and personal exposures for all pollutants after adjusting for other household variables. Personal exposures were 27%-36% lower for PM2.5, CO and BC, in households with corrugated metal roofs, compared to roofs made of natural materials (straw, totora or reed) after adjusting for other factors. Higher kitchen area concentrations were also associated with less wealth, owning more animals, or sampling during the dry season in multivariable models. Having a liquefied petroleum gas (LPG) stove and having a chimney were associated with lower personal exposures, but were not associated with kitchen area concentrations. Personal exposures were lower by 21% for PM2.5 and 28% for CO and BC concentrations among participants who had both LPG and biomass stoves compared to those with only biomass cookstoves adjusting for other household factors. CONCLUSIONS Characterizing HAP within different settings can help identify effective and culturally-relevant solutions to reduce HAP exposures. We found that housing roof type is strongly related to kitchen area concentrations and personal exposures to HAP, perhaps because of greater ventilation in kitchens with metal roofs compared to those with thatch roofs. Although HAP concentrations remained above guidelines for all households, promoting use of metal roof materials and LPG stoves may be actionable interventions that can help reduce exposures to HAP in high-altitude rural Peru and similar settings.
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Affiliation(s)
- Magdalena Fandiño-Del-Rio
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, 21205, USA.
| | - Josiah L Kephart
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, 21205, USA.
| | - Kendra N Williams
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, 21205, USA; Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA.
| | - Lawrence H Moulton
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.
| | - Kyle Steenland
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
| | - William Checkley
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, 21205, USA; Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA; Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.
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105
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Sambandam S, Mukhopadhyay K, Sendhil S, Ye W, Pillarisetti A, Thangavel G, Natesan D, Ramasamy R, Natarajan A, Aravindalochanan V, Vinayagamoorthi A, Sivavadivel S, Uma Maheswari R, Balakrishnan L, Gayatri S, Nargunanathan S, Madhavan S, Puttaswamy N, Garg SS, Quinn A, Rosenthal J, Johnson M, Liao J, Steenland K, Piedhrahita R, Peel J, Checkley W, Clasen T, Balakrishnan K. Exposure contrasts associated with a liquefied petroleum gas (LPG) intervention at potential field sites for the multi-country household air pollution intervention network (HAPIN) trial in India: results from pilot phase activities in rural Tamil Nadu. BMC Public Health 2020; 20:1799. [PMID: 33243198 PMCID: PMC7690197 DOI: 10.1186/s12889-020-09865-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/09/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The Household Air Pollution Intervention Network (HAPIN) trial aims to assess health benefits of a liquefied petroleum gas (LPG) cookfuel and stove intervention among women and children across four low- and middle-income countries (LMICs). We measured exposure contrasts for women, achievable under alternative conditions of biomass or LPG cookfuel use, at potential HAPIN field sites in India, to aid in site selection for the main trial. METHODS We recruited participants from potential field sites within Villupuram and Nagapattinam districts in Tamil Nadu, India, that were identified during a feasibility assessment. We performed. (i) cross-sectional measurements on women (N = 79) using either biomass or LPG as their primary cookfuel and (ii) before-and-after measurements on pregnant women (N = 41), once at baseline while using biomass fuel and twice - at 1 and 2 months - after installation of an LPG stove and free fuel intervention. We involved participants to co-design clothing and instrument stands for personal and area sampling. We measured 24 or 48-h personal exposures and kitchen and ambient concentrations of fine particulate matter (PM2.5) using gravimetric samplers. RESULTS In the cross-sectional analysis, median (interquartile range, IQR) kitchen PM2.5 concentrations in biomass and LPG using homes were 134 μg/m3 [IQR:71-258] and 27 μg/m3 [IQR:20-47], while corresponding personal exposures were 75 μg/m3 [IQR:55-104] and 36 μg/m3 [IQR:26-46], respectively. In before-and-after analysis, median 48-h personal exposures for pregnant women were 72 μg/m3 [IQR:49-127] at baseline and 25 μg/m3 [IQR:18-35] after the LPG intervention, with a sustained reduction of 93% in mean kitchen PM2.5 concentrations and 78% in mean personal PM2.5 exposures over the 2 month intervention period. Median ambient concentrations were 23 μg/m3 [IQR:19-27). Participant feedback was critical in designing clothing and instrument stands that ensured high compliance. CONCLUSIONS An LPG stove and fuel intervention in the candidate HAPIN trial field sites in India was deemed suitable for achieving health-relevant exposure reductions. Ambient concentrations indicated limited contributions from other sources. Study results provide critical inputs for the HAPIN trial site selection in India, while also contributing new information on HAP exposures in relation to LPG interventions and among pregnant women in LMICs. TRIAL REGISTRATION ClinicalTrials.Gov. NCT02944682 ; Prospectively registered on October 17, 2016.
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Affiliation(s)
- Sankar Sambandam
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Porur, Chennai, 600116, India
| | - Krishnendu Mukhopadhyay
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Porur, Chennai, 600116, India
| | - Saritha Sendhil
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Porur, Chennai, 600116, India
| | - Wenlu Ye
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ajay Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Gurusamy Thangavel
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Porur, Chennai, 600116, India
| | - Durairaj Natesan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Porur, Chennai, 600116, India
| | - Rengaraj Ramasamy
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Porur, Chennai, 600116, India
| | - Amudha Natarajan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Porur, Chennai, 600116, India
| | - Vigneswari Aravindalochanan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Porur, Chennai, 600116, India
| | - A Vinayagamoorthi
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Porur, Chennai, 600116, India
| | - S Sivavadivel
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Porur, Chennai, 600116, India
| | - R Uma Maheswari
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Porur, Chennai, 600116, India
| | - Lingeswari Balakrishnan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Porur, Chennai, 600116, India
| | - S Gayatri
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Porur, Chennai, 600116, India
| | - Srinivasan Nargunanathan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Porur, Chennai, 600116, India
| | - Sathish Madhavan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Porur, Chennai, 600116, India
| | - Naveen Puttaswamy
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Porur, Chennai, 600116, India
| | - Sarada S Garg
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Porur, Chennai, 600116, India
| | - Ashlinn Quinn
- Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Josh Rosenthal
- Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | | | - Jiawen Liao
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Jennifer Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Porur, Chennai, 600116, India.
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Xie M, Zhao Z, Holder AL, Hays MD, Chen X, Shen G, Jetter JJ, Champion WM, Wang Q. Chemical composition, structures, and light absorption of N-containing aromatic compounds emitted from burning wood and charcoal in household cookstoves. ATMOSPHERIC CHEMISTRY AND PHYSICS 2020; 20:14077-14090. [PMID: 33552150 PMCID: PMC7863623 DOI: 10.5194/acp-20-14077-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
N-containing aromatic compounds (NACs) are an important group of light-absorbing molecules in the atmosphere. They are often observed in combustion emissions, but their chemical formulas and structural characteristics remain uncertain. In this study, red oak wood and charcoal fuels were burned in cookstoves using the standard water boiling test (WBT) procedure. Submicron aerosol particles in the cookstove emissions were collected using quartz (Q f ) and polytetrafluoroethylene (PTFE) filter membranes positioned in parallel. A back-up quartz filter (Q b ) was also installed downstream of the PTFE filter to evaluate the effect of sampling artifact on NACs measurements. Liquid chromatography-mass spectroscopy (LC-MS) techniques identified seventeen NAC chemical formulas in the cookstove emissions. The average concentrations of total NACs in Q b samples (0.37 ± 0.31 - 1.79 ± 0.77 μg m-3) were greater than 50% of those observed in the Q f samples (0.51 ± 0.43 - 3.91 ± 2.06 μg m-3), and the Q b to Q f mass ratios of individual NACs had a range of 0.02 - 2.71, indicating that the identified NACs might have substantial fractions remaining in the gas-phase. In comparison to other sources, cookstove emissions from red oak or charcoal fuels did not exhibit unique NAC structural features, but had distinct NACs composition. However, before identifying NACs sources by combining their structural and compositional information, the gas-particle partitioning behaviors of NACs should be further investigated. The average contributions of total NACs to the light absorption of organic matter at λ = 365 nm (1.10 - 2.57%) in Q f and Q b samples (10.7 - 21.0%) are up to 10 times larger than their mass contributions (Q f 0.31 - 1.01%, Q b 1.08 - 3.31%), so the identified NACs are mostly strong light absorbers. To explain more sample extracts absorption, future research is needed to understand the chemical and optical properties of high molecular weight (e.g., MW > 500 Da) entities in particulate matter.
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Affiliation(s)
- Mingjie Xie
- Collaborative Innovation Center of Atmospheric Environment and Equipment Technology, Jiangsu Key Laboratory of Atmospheric Environment Monitoring and Pollution Control, School of Environmental Science and Engineering, Nanjing University of Information Science & Technology, 219 Ningliu Road, Nanjing 210044, China
| | - Zhenzhen Zhao
- Collaborative Innovation Center of Atmospheric Environment and Equipment Technology, Jiangsu Key Laboratory of Atmospheric Environment Monitoring and Pollution Control, School of Environmental Science and Engineering, Nanjing University of Information Science & Technology, 219 Ningliu Road, Nanjing 210044, China
| | - Amara L. Holder
- Office of Research and Development, U.S. Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC 27711, USA
| | - Michael D. Hays
- Office of Research and Development, U.S. Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC 27711, USA
| | - Xi Chen
- Office of Research and Development, U.S. Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC 27711, USA
| | - Guofeng Shen
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing 100871, China
| | - James J. Jetter
- Office of Research and Development, U.S. Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC 27711, USA
| | - Wyatt M. Champion
- Oak Ridge Institute for Science and Education (ORISE) Postdoctoral Fellow at U.S. Environmental Protection Agency, Office of Research and Development, Air Methods and Characterization Division, 109 T.W. Alexander Drive, Research Triangle Park, NC 27711, USA
| | - Qin’geng Wang
- State Key Laboratory of Pollution Control and Resource Reuse, Nanjing University, Nanjing 210023, China
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107
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Associations of household solid fuel for heating and cooking with hypertension in Chinese adults. J Hypertens 2020; 39:667-676. [PMID: 33186328 DOI: 10.1097/hjh.0000000000002689] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The association between indoor air pollution resulting from household solid fuel use for heating and cooking with hypertension or blood pressure (BP) remains less clear. This study aims to rectify these knowledge gaps in a large Chinese population. METHODS During 2005-2009, 44 007 individuals aged 35-70 years with complete information on household solid fuel use for cooking and heating were recruited from 279 urban and rural communities of 12 centers. Solid fuel referred to charcoal, coal, wood, agriculture crop, animal dung or shrub. Annual concentration of ambient atmospheric particulate matter that have a diameter of less than 2.5 μm for all communities was collected. Generalized linear mixed models using community as the random effect were performed to estimate the association with hypertension prevalence or BP after considering ambient atmospheric particulate matter that have a diameter of less than 2.5 μm and a comprehensive set of potential confounding factors at the individual and household level. RESULTS A total of 47.6 and 61.2% of participants used household solid fuel for heating and cooking, respectively. Solid fuel use for heating was not associated with an increase in hypertension prevalence (adjusted odds ratio = 1.08, 95% confident interval: 0.98, 1.20) or elevated SBP (0.62 mmHg, 95% confident interval: -0.24, 1.48). No association was found between solid fuel for cooking and hypertension or BP, and no additional risk was observed among participants who had both exposures to solid fuel for heating and cooking compared with those used for heating only. CONCLUSION The current large Chinese study revealed a statistically insignificant increase in the association between solid fuel use for heating and hypertension prevalence or BP. As this cross-sectional study has its inherent limitation on causality, findings from this study would have to be confirmed by prospective cohort studies.
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108
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Burney P, Patel J, Minelli C, Gnatiuc L, Amaral AFS, Kocabaş A, Cherkaski HH, Gulsvik A, Nielsen R, Bateman E, Jithoo A, Mortimer K, Sooronbaev TM, Lawin H, Nejjari C, Elbiaze M, El Rhazi K, Zheng JP, Ran P, Welte T, Obaseki D, Erhabor G, Elsony A, Osman NB, Ahmed R, Nizankowska-Mogilnicka E, Mejza F, Mannino DM, Bárbara C, Wouters EFM, Idolor LF, Loh LC, Rashid A, Juvekar S, Gislason T, Al Ghobain M, Studnicka M, Harrabi I, Denguezli M, Koul PA, Jenkins C, Marks G, Jõgi R, Hafizi H, Janson C, Tan WC, Aquart-Stewart A, Mbatchou B, Nafees A, Gunasekera K, Seemungal T, Padukudru Anand M, Enright P, Vollmer WM, Blangiardo M, Elfadaly FG, Buist AS. Prevalence and Population Attributable Risk for Chronic Airflow Obstruction in a Large Multinational Study. Am J Respir Crit Care Med 2020; 203:1353-1365. [PMID: 33171069 DOI: 10.1164/rccm.202005-1990oc] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: The Global Burden of Disease programme identified smoking, and ambient and household air pollution as the main drivers of death and disability from Chronic Obstructive Pulmonary Disease (COPD). Objective: To estimate the attributable risk of chronic airflow obstruction (CAO), a quantifiable characteristic of COPD, due to several risk factors. Methods: The Burden of Obstructive Lung Disease study is a cross-sectional study of adults, aged≥40, in a globally distributed sample of 41 urban and rural sites. Based on data from 28,459 participants, we estimated the prevalence of CAO, defined as a post-bronchodilator one-second forced expiratory volume to forced vital capacity ratio < lower limit of normal, and the relative risks associated with different risk factors. Local RR were estimated using a Bayesian hierarchical model borrowing information from across sites. From these RR and the prevalence of risk factors, we estimated local Population Attributable Risks (PAR). Measurements and Main Results: Mean prevalence of CAO was 11.2% in men and 8.6% in women. Mean PAR for smoking was 5.1% in men and 2.2% in women. The next most influential risk factors were poor education levels, working in a dusty job for ≥10 years, low body mass index (BMI), and a history of tuberculosis. The risk of CAO attributable to the different risk factors varied across sites. Conclusions: While smoking remains the most important risk factor for CAO, in some areas poor education, low BMI and passive smoking are of greater importance. Dusty occupations and tuberculosis are important risk factors at some sites.
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Affiliation(s)
- Peter Burney
- Imperial College, Respiratory Epidemiology and Public Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Jaymini Patel
- Imperial College London, NHLI - Respiratory Epidemiology, London, United Kingdom of Great Britain and Northern Ireland
| | - Cosetta Minelli
- Imperial College, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Louisa Gnatiuc
- University of Oxford, 6396, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - André F S Amaral
- Imperial College London, 4615, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland;
| | - Ali Kocabaş
- Cukurova Universitesi Tip Fakultesi, 63988, Pulmonary Disease, Adana, Turkey
| | | | - Amund Gulsvik
- University of Bergen, 1658, Department of Thoracic Medicine, Institute of Medicine, Bergen, Norway
| | | | | | - Anamika Jithoo
- University of Cape Town Lung Institute, 108145, Cape Town, South Africa
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine and Aintree University Hospital NHS Foundation Trust, Respiratory Medicine, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | | | - Hervé Lawin
- University of Abomey-Calavi, 107790, Unit of Teaching and Research in Occupational and Environmental Health, Faculty of Health Sciences, Cotonou, Benin
| | - Chakib Nejjari
- Laboratoire d'épidémiologie, Recherche Clinique et Santé Communautaire, Fes, Morocco
| | - Mohammed Elbiaze
- Universite Sidi Mohamed Ben Abdellah Faculte de Medecine et de Pharmacie de Fes Bibliotheque, 548123, Fes, Morocco
| | - Karima El Rhazi
- Universite Sidi Mohamed Ben Abdellah Faculte de Medecine et de Pharmacie de Fes Bibliotheque, 548123, Fes, Morocco
| | - Jin-Ping Zheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Pixin Ran
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China, Guangzhou, China
| | - Tobias Welte
- Medizinische Hochschule Hannover, Direktor der Abteilung Pneumologie, Hannover, Germany
| | | | | | | | | | | | | | - Filip Mejza
- Jagiellonian University Medical College, 49573, Krakow, Poland
| | - David M Mannino
- Medical Expert at GlaxoSmithKline, Lexington, Kentucky, United States.,University of Ketucky, Epidemiology , Lexington, Kentucky, United States
| | - Cristina Bárbara
- Hospital Pulido Valente, 70896, Unidade de Técnicas Invasivas Pneumológicas, Pneumologia II, Lisboa, Portugal.,Universidade de Lisboa Faculdade de Medicina, 37811, Instituto de Saúde Ambiental, Lisboa, Portugal
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Li-Cher Loh
- Penang Medical College, 26696, Georgetown, Malaysia
| | - Abdul Rashid
- Royal College of Surgeons of Ireland and University College Dublin, Malaysia Campus, Penang, Malaysia
| | | | | | | | | | - Imed Harrabi
- Faculty of Medicine, Sousse, Tunisia, Sousse, Tunisia
| | - Meriam Denguezli
- Universite de Sousse Faculte de Medecine de Sousse, 280226, Sousse, Tunisia
| | - Parvaiz A Koul
- Sher-i-Kashmir Institute of Medical Sciences, 29078, Internal Medicine, Srinagar, India
| | | | - Guy Marks
- Institute of Respiratory Medicine, Campertown, New South Wales, Australia
| | - Rain Jõgi
- Foundation Tartu University Clinics, Lung Clinic, Tartu, Estonia
| | | | - Christer Janson
- Uppsala Uiversity, Dep of Respiratory Medicine, Uppsala, Sweden
| | - Wan C Tan
- Univ British Columbia, icapture center, vancouver, British Columbia, Canada
| | | | | | | | | | - Terry Seemungal
- University of the West Indies, Clinical Medical Sciences, Champs Fleurs, Trinidad and Tobago
| | - Mahesh Padukudru Anand
- JSS Academy of Higher Education and Research, Department of Pulmonary Medicine, JSS Medical College, , Mysore, India
| | - Paul Enright
- University of Arizona, Medicine, Tucson, Arizona, United States
| | | | - Marta Blangiardo
- Imperial College London School of Public Health, 156430, Department of Epidemiology and Biostatistics, London, United Kingdom of Great Britain and Northern Ireland
| | - Fadlalla G Elfadaly
- The Open University, 5488, Milton Keynes, United Kingdom of Great Britain and Northern Ireland
| | - A Sonia Buist
- Oregon Health Sciences University, Medicine / Pulmonary & Critical Care, Portland, Oregon, United States
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109
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Lee KK, Bing R, Kiang J, Bashir S, Spath N, Stelzle D, Mortimer K, Bularga A, Doudesis D, Joshi SS, Strachan F, Gumy S, Adair-Rohani H, Attia EF, Chung MH, Miller MR, Newby DE, Mills NL, McAllister DA, Shah ASV. Adverse health effects associated with household air pollution: a systematic review, meta-analysis, and burden estimation study. Lancet Glob Health 2020; 8:e1427-e1434. [PMID: 33069303 PMCID: PMC7564377 DOI: 10.1016/s2214-109x(20)30343-0] [Citation(s) in RCA: 169] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/17/2020] [Accepted: 07/13/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND 3 billion people worldwide rely on polluting fuels and technologies for domestic cooking and heating. We estimate the global, regional, and national health burden associated with exposure to household air pollution. METHODS For the systematic review and meta-analysis, we systematically searched four databases for studies published from database inception to April 2, 2020, that evaluated the risk of adverse cardiorespiratory, paediatric, and maternal outcomes from exposure to household air pollution, compared with no exposure. We used a random-effects model to calculate disease-specific relative risk (RR) meta-estimates. Household air pollution exposure was defined as use of polluting fuels (coal, wood, charcoal, agricultural wastes, animal dung, or kerosene) for household cooking or heating. Temporal trends in mortality and disease burden associated with household air pollution, as measured by disability-adjusted life-years (DALYs), were estimated from 2000 to 2017 using exposure prevalence data from 183 of 193 UN member states. 95% CIs were estimated by propagating uncertainty from the RR meta-estimates, prevalence of household air pollution exposure, and disease-specific mortality and burden estimates using a simulation-based approach. This study is registered with PROSPERO, CRD42019125060. FINDINGS 476 studies (15·5 million participants) from 123 nations (99 [80%] of which were classified as low-income and middle-income) met the inclusion criteria. Household air pollution was positively associated with asthma (RR 1·23, 95% CI 1·11-1·36), acute respiratory infection in both adults (1·53, 1·22-1·93) and children (1·39, 1·29-1·49), chronic obstructive pulmonary disease (1·70, 1·47-1·97), lung cancer (1·69, 1·44-1·98), and tuberculosis (1·26, 1·08-1·48); cerebrovascular disease (1·09, 1·04-1·14) and ischaemic heart disease (1·10, 1·09-1·11); and low birthweight (1·36, 1·19-1·55) and stillbirth (1·22, 1·06-1·41); as well as with under-5 (1·25, 1·18-1·33), respiratory (1·19, 1·18-1·20), and cardiovascular (1·07, 1·04-1·11) mortality. Household air pollution was associated with 1·8 million (95% CI 1·1-2·7) deaths and 60·9 million (34·6-93·3) DALYs in 2017, with the burden overwhelmingly experienced in low-income and middle-income countries (LMICs; 60·8 million [34·6-92·9] DALYs) compared with high-income countries (0·09 million [0·01-0·40] DALYs). From 2000, mortality associated with household air pollution had reduced by 36% (95% CI 29-43) and disease burden by 30% (25-36), with the greatest reductions observed in higher-income nations. INTERPRETATION The burden of cardiorespiratory, paediatric, and maternal diseases associated with household air pollution has declined worldwide but remains high in the world's poorest regions. Urgent integrated health and energy strategies are needed to reduce the adverse health impact of household air pollution, especially in LMICs. FUNDING British Heart Foundation, Wellcome Trust.
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Affiliation(s)
- Kuan Ken Lee
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Rong Bing
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Joanne Kiang
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Sophia Bashir
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Nicholas Spath
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Dominik Stelzle
- Center for Global Health, Department of Neurology and Department of Sport and Health Sciences, Technical University, Munich, Germany
| | | | - Anda Bularga
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Dimitrios Doudesis
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Shruti S Joshi
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Fiona Strachan
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Sophie Gumy
- Department of Public Health and Environment, WHO, Geneva, Switzerland
| | | | - Engi F Attia
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Mark R Miller
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Anoop S V Shah
- Department of Non-communicable Disease, London School of Hygiene & Tropical Medicine, London, UK.
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110
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Pillarisetti A, Roy S, Diamond-Smith N, Ghorpade M, Dhongade A, Balakrishnan K, Sambandam S, Patil R, Levine DI, Juvekar S, Smith KR. Marriage-based pilot clean household fuel intervention in India for improved pregnancy outcomes. BMJ Open 2020; 10:e044127. [PMID: 33020110 PMCID: PMC7537452 DOI: 10.1136/bmjopen-2020-044127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Health interventions often target pregnant women and their unborn children. Interventions in rural India targeting pregnant women, however, often do not cover the critical early windows of susceptibility during the first trimester and parts of the second trimester. This pilot seeks to determine if targeting newlyweds could protect entire pregnancies with a clean stove and fuel intervention. METHODS We recruited 50 newlywed couples who use biomass as a cooking fuel into a clean cooking intervention that included a liquefied petroleum gas (LPG) stove, two gas cylinders, a table to place the stove on and health education. We first evaluated whether community health workers in this region could identify and recruit couples at marriage. We quantified how many additional days of pregnancy could be covered by an intervention if we recruited at marriage versus recruiting after detection of pregnancy. RESULTS On average, we identified and visited newlywed couples within 40 (SD 21) days of marriage. Of the 50 couples recruited, 25 pregnancies and 18 deliveries were identified during this 1-year study. Due to challenges securing fuel from the LPG supply system, not all couples received their intervention prior to pregnancy. Regardless, couples recruited in the marriage arm had substantially more days with the intervention than couples recruited into a similar arm recruited at pregnancy (211 SD 46 vs 120 SD 45). At scale, a stove intervention targeting new marriages would cover about twice as many weeks of first pregnancies as an intervention recruiting after detection of pregnancy. CONCLUSIONS We were able to recruit in early marriage using existing community health workers. Households recruited early in marriage had more days with clean fuel coverage than those recruited at pregnancy. Our findings indicate that recruitment at marriage is feasible and warrants further exploration for stove and other interventions targeting pregnancy-related outcomes.
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Affiliation(s)
- Ajay Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Sudipto Roy
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | | | - Makarand Ghorpade
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Arun Dhongade
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Kalpana Balakrishnan
- ICMR Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sankar Sambandam
- ICMR Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Rutuja Patil
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - David I Levine
- Haas School of Business, University of California, Berkeley, California, USA
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
- Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Kirk R Smith
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA
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111
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Bukhman G, Mocumbi AO, Atun R, Becker AE, Bhutta Z, Binagwaho A, Clinton C, Coates MM, Dain K, Ezzati M, Gottlieb G, Gupta I, Gupta N, Hyder AA, Jain Y, Kruk ME, Makani J, Marx A, Miranda JJ, Norheim OF, Nugent R, Roy N, Stefan C, Wallis L, Mayosi B. The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion. Lancet 2020; 396:991-1044. [PMID: 32941823 PMCID: PMC7489932 DOI: 10.1016/s0140-6736(20)31907-3] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/29/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Gene Bukhman
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA; Partners In Health, Boston, MA, USA; Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Ana O Mocumbi
- Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Maputo, Mozambique
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Anne E Becker
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
| | - Zulfiqar Bhutta
- Center for Global Child Health, Hospital for Sick Kids, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; Institute for Global Health & Development, Aga Khan University, South-Central Asia, East Africa, and UK
| | | | - Chelsea Clinton
- Clinton Foundation, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Matthew M Coates
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA; Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Majid Ezzati
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Gary Gottlieb
- Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Indrani Gupta
- Health Policy Research Unit, Institute of Economic Growth, Delhi, India
| | - Neil Gupta
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA; Partners In Health, Boston, MA, USA; Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Adnan A Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yogesh Jain
- Jan Swasthya Sahyog, Bilaspur, Chhattisgarh, India
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrew Marx
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ole F Norheim
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rachel Nugent
- Research Triangle Institute International, Seattle, WA, USA
| | - Nobhojit Roy
- WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, Department of Surgery, BARC Hospital, HBNI University, Government of India, Mumbai, India; Field Health Systems Laboratory, Bihar Technical Support Programme, CARE India, Madhubani, Bihar, India
| | - Cristina Stefan
- SingHealth Duke-NUS Global Health Institute (SDGHI), Duke-NUS Medical School, Singapore; African Medical Research and Innovation Institute, Cape Town, South Africa
| | - Lee Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Bongani Mayosi
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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112
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Williams KN, Kephart JL, Fandiño-Del-Rio M, O'Brien CJ, Moulton LH, Koehler K, Harvey SA, Checkley W. Use of liquefied petroleum gas in Puno, Peru: Fuel needs under conditions of free fuel and near-exclusive use. ENERGY FOR SUSTAINABLE DEVELOPMENT : THE JOURNAL OF THE INTERNATIONAL ENERGY INITIATIVE 2020; 58:150-157. [PMID: 33442225 PMCID: PMC7799435 DOI: 10.1016/j.esd.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Reducing the burden of household air pollution could be achieved with exclusive adoption of cleaner fuels such as liquefied petroleum gas (LPG). However, we lack understanding of how much LPG is required to support exclusive use and how household characteristics affect this quantity. This paper used data from 90 participants in the Cardiopulmonary outcomes and Household Air Pollution (CHAP) trial in Puno, Peru who received free LPG deliveries for one year. Households with a mean of four members that cooked nearly exclusively (>98%) with LPG used an average of 19.1 kg (95% CI 18.5 to 19.6) of LPG per month for tasks similar to those done with the traditional biomass stove. LPG use per month was 0.5 kg higher for each additional pig or dog owned (p=0.003), 0.7 kg higher for each additional household member (p<0.001), 0.3 kg higher for households in the second-lowest compared to the lowest wealth quintile (p=0.01), and 1.1 kg higher if the household had previously received subsidized LPG (p=0.05). LPG use per month was 1.1 kg lower during the rainy season (p<0.001) and 1.7 kg lower during the planting season (p<0.001) compared to the cold and harvest seasons, despite the fact that LPG was not typically used for space heating. LPG use decreased by 0.05 kg per month over the course of one year after receiving the LPG stove (p=0.02). These results suggest that achieving exclusive LPG use in Puno, Peru requires that rural residents have affordable access to an average of two 10 kg LPG tanks per month. Conducting similar investigations in other countries could help policymakers set and target LPG subsidies to ensure that households have access to enough LPG to achieve exclusive LPG use and the potential health benefits.
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Affiliation(s)
- Kendra N Williams
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Josiah L Kephart
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Magdalena Fandiño-Del-Rio
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Carolyn J O'Brien
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lawrence H Moulton
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Steven A Harvey
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - William Checkley
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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113
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Shupler M, Hystad P, Birch A, Miller-Lionberg D, Jeronimo M, Arku RE, Chu YL, Mushtaha M, Heenan L, Rangarajan S, Seron P, Lanas F, Cazor F, Lopez-Jaramillo P, Camacho PA, Perez M, Yeates K, West N, Ncube T, Ncube B, Chifamba J, Yusuf R, Khan A, Hu B, Liu X, Wei L, Tse LA, Mohan D, Kumar P, Gupta R, Mohan I, Jayachitra KG, Mony PK, Rammohan K, Nair S, Lakshmi PVM, Sagar V, Khawaja R, Iqbal R, Kazmi K, Yusuf S, Brauer M. Household and personal air pollution exposure measurements from 120 communities in eight countries: results from the PURE-AIR study. Lancet Planet Health 2020; 4:e451-e462. [PMID: 33038319 PMCID: PMC7591267 DOI: 10.1016/s2542-5196(20)30197-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 05/03/2023]
Abstract
BACKGROUND Approximately 2·8 billion people are exposed to household air pollution from cooking with polluting fuels. Few monitoring studies have systematically measured health-damaging air pollutant (ie, fine particulate matter [PM2·5] and black carbon) concentrations from a wide range of cooking fuels across diverse populations. This multinational study aimed to assess the magnitude of kitchen concentrations and personal exposures to PM2·5 and black carbon in rural communities with a wide range of cooking environments. METHODS As part of the Prospective Urban and Rural Epidemiological (PURE) cohort, the PURE-AIR study was done in 120 rural communities in eight countries (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Data were collected from 2541 households and from 998 individuals (442 men and 556 women). Gravimetric (or filter-based) 48 h kitchen and personal PM2·5 measurements were collected. Light absorbance (10-5m-1) of the PM2·5 filters, a proxy for black carbon concentrations, was calculated via an image-based reflectance method. Surveys of household characteristics and cooking patterns were collected before and after the 48 h monitoring period. FINDINGS Monitoring of household air pollution for the PURE-AIR study was done from June, 2017, to September, 2019. A mean PM2·5 kitchen concentration gradient emerged across primary cooking fuels: gas (45 μg/m3 [95% CI 43-48]), electricity (53 μg/m3 [47-60]), coal (68 μg/m3 [61-77]), charcoal (92 μg/m3 [58-146]), agricultural or crop waste (106 μg/m3 [91-125]), wood (109 μg/m3 [102-118]), animal dung (224 μg/m3 [197-254]), and shrubs or grass (276 μg/m3 [223-342]). Among households cooking primarily with wood, average PM2·5 concentrations varied ten-fold (range: 40-380 μg/m3). Fuel stacking was prevalent (981 [39%] of 2541 households); using wood as a primary cooking fuel with clean secondary cooking fuels (eg, gas) was associated with 50% lower PM2·5 and black carbon concentrations than using only wood as a primary cooking fuel. Similar average PM2·5 personal exposures between women (67 μg/m3 [95% CI 62-72]) and men (62 [58-67]) were observed. Nearly equivalent average personal exposure to kitchen exposure ratios were observed for PM2·5 (0·79 [95% 0·71-0·88] for men and 0·82 [0·74-0·91] for women) and black carbon (0·64 [0·45-0·92] for men and 0·68 [0·46-1·02] for women). INTERPRETATION Using clean primary fuels substantially lowers kitchen PM2·5 concentrations. Importantly, average kitchen and personal PM2·5 measurements for all primary fuel types exceeded WHO's Interim Target-1 (35 μg/m3 annual average), highlighting the need for comprehensive pollution mitigation strategies. FUNDING Canadian Institutes for Health Research, National Institutes of Health.
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Affiliation(s)
- Matthew Shupler
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Aaron Birch
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Matthew Jeronimo
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Raphael E Arku
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Yen Li Chu
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Maha Mushtaha
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Laura Heenan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | | | - Karen Yeates
- Pamoja Tunaweza Research Centre, Moshi, Tanzania; Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Nicola West
- Pamoja Tunaweza Research Centre, Moshi, Tanzania
| | - Tatenda Ncube
- Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
| | - Brian Ncube
- Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
| | - Jephat Chifamba
- Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Afreen Khan
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Bo Hu
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoyun Liu
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Li Wei
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lap Ah Tse
- Jockey Club School of Public health and Primary Care, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | | | - Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Jaipur, India
| | - Indu Mohan
- Mahatma Gandhi Medical College, Jaipur, India
| | - K G Jayachitra
- St John's Medical College & Research Institute, Bangalore, India
| | - Prem K Mony
- St John's Medical College & Research Institute, Bangalore, India
| | - Kamala Rammohan
- Health Action By People, Thiruvananthapuram and Medical College, Trivandrum, India
| | - Sanjeev Nair
- Health Action By People, Thiruvananthapuram and Medical College, Trivandrum, India
| | - P V M Lakshmi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Sagar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rehman Khawaja
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Romaina Iqbal
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Khawar Kazmi
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Chen Y, Fei J, Sun Z, Shen G, Du W, Zang L, Yang L, Wang Y, Wu R, Chen A, Zhao M. Household air pollution from cooking and heating and its impacts on blood pressure in residents living in rural cave dwellings in Loess Plateau of China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:36677-36687. [PMID: 32562231 DOI: 10.1007/s11356-020-09677-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/09/2020] [Indexed: 05/03/2023]
Abstract
Cave dwelling is an ancient and unique type of residence in the Loess Plateau of Northern China, where the economics are less-developed. The majority of the local dwellers rely on traditional solid fuels for cooking and heating, which can emit large amounts of particles into both indoor and outdoor environments. In this study, we measured the real-time household concentrations of PM2.5 and explored the association between personal daily PM2.5 exposure and blood pressure (BP). Cooking and heating activities with different energies made a great variation in the household PM2.5 air pollution, and residents using biomass had the highest personal PM2.5 exposure. Temperature and relative humidity are both significantly linear correlated with household PM2.5 air pollution. Besides, systolic blood pressure (SBP) was demonstrated to be positively associated with personal PM2.5 exposure: with each 10-μg/m3 incremental PM2.5 concentration when controlling all the other factors, SBP will increase by 0.36 mmHg (95% confident interval (CI) 0.05-0.0.77 mmHg). If solid fuels could be replaced with clean energies, personal PM2.5 exposure and SBP would reduce by more than 21% and 3.7%, respectively, calling for efficient intervention programs to mitigate household air pollution of cave dwellings and protect health of those residents.
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Affiliation(s)
- Yuanchen Chen
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Province, College of Environment, Zhejiang University of Technology, Hangzhou, 310014, Zhejiang, China
| | - Jie Fei
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Province, College of Environment, Zhejiang University of Technology, Hangzhou, 310014, Zhejiang, China
| | - Zhe Sun
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Guofeng Shen
- Ministry of Education Laboratory of Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, 100871, China
| | - Wei Du
- Ministry of Education Laboratory of Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, 100871, China
| | - Lu Zang
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Province, College of Environment, Zhejiang University of Technology, Hangzhou, 310014, Zhejiang, China
- Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China
| | - Liyang Yang
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Province, College of Environment, Zhejiang University of Technology, Hangzhou, 310014, Zhejiang, China
| | - Yonghui Wang
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Province, College of Environment, Zhejiang University of Technology, Hangzhou, 310014, Zhejiang, China
| | - Ruxin Wu
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Province, College of Environment, Zhejiang University of Technology, Hangzhou, 310014, Zhejiang, China
| | - An Chen
- College of Information Engineering, China Jiliang University, Hangzhou, 310018, Zhejiang, China
| | - Meirong Zhao
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Province, College of Environment, Zhejiang University of Technology, Hangzhou, 310014, Zhejiang, China.
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115
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Arku RE, Brauer M, Duong M, Wei L, Hu B, Ah Tse L, Mony PK, Lakshmi PVM, Pillai RK, Mohan V, Yeates K, Kruger L, Rangarajan S, Koon T, Yusuf S, Hystad P. Adverse health impacts of cooking with kerosene: A multi-country analysis within the Prospective Urban and Rural Epidemiology Study. ENVIRONMENTAL RESEARCH 2020; 188:109851. [PMID: 32798956 PMCID: PMC7748391 DOI: 10.1016/j.envres.2020.109851] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/09/2020] [Accepted: 06/17/2020] [Indexed: 06/06/2023]
Abstract
BACKGROUND Kerosene, which was until recently considered a relatively clean household fuel, is still widely used in low- and middle-income countries for cooking and lighting. However, there is little data on its health effects. We examined cardiorespiratory effects and mortality in households using kerosene as their primary cooking fuel within the Prospective Urban Rural Epidemiology (PURE) study. METHODS We analyzed baseline and follow-up data on 31,490 individuals from 154 communities in China, India, South Africa, and Tanzania where there was at least 10% kerosene use for cooking at baseline. Baseline comorbidities and health outcomes during follow-up (median 9.4 years) were compared between households with kerosene versus clean (gas or electricity) or solid fuel (biomass and coal) use for cooking. Multi-level marginal regression models adjusted for individual, household, and community level covariates. RESULTS Higher rates of prevalent respiratory symptoms (e.g. 34% [95% CI:15-57%] more dyspnea with usual activity, 44% [95% CI: 21-72%] more chronic cough or sputum) and lower lung function (differences in FEV1: -46.3 ml (95% CI: -80.5; -12.1) and FVC: -54.7 ml (95% CI: -93.6; -15.8)) were observed at baseline for kerosene compared to clean fuel users. The odds of hypertension was slightly elevated but no associations were observed for blood pressure. Prospectively, kerosene was associated with elevated risks of all-cause (HR: 1.32 (95% CI: 1.14-1.53)) and cardiovascular (HR: 1.34 (95% CI: 1.00-1.80)) mortality, as well as major fatal and incident non-fatal cardiovascular (HR: 1.34 (95% CI: 1.08-1.66)) and respiratory (HR: 1.55 (95% CI: 0.98-2.43)) diseases, compared to clean fuel use. Further, compared to solid fuel users, those using kerosene had 20-47% higher risks for the above outcomes. CONCLUSIONS Kerosene use for cooking was associated with higher rates of baseline respiratory morbidity and increased risk of mortality and cardiorespiratory outcomes during follow-up when compared to either clean or solid fuels. Replacing kerosene with cleaner-burning fuels for cooking is recommended.
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Affiliation(s)
- Raphael E Arku
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA; School of Population and Public Health, The University of British Columbia, Vancouver, Canada.
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - MyLinh Duong
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Li Wei
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, China
| | - Bo Hu
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, China
| | - Lap Ah Tse
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Prem K Mony
- Division of Epidemiology & Population Health, St John's Medical College & Research Institute, Bangalore, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Rajamohanan K Pillai
- School of Health Policy, Kerala University of Health Sciences, Trivandrum, India
| | | | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Lanthe Kruger
- North-West University, Africa Unit for Transdisciplinary Health Research (AUTHeR), South Africa
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Teo Koon
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, USA
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116
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Yin P, Brauer M, Cohen AJ, Wang H, Li J, Burnett RT, Stanaway JD, Causey K, Larson S, Godwin W, Frostad J, Marks A, Wang L, Zhou M, Murray CJL. The effect of air pollution on deaths, disease burden, and life expectancy across China and its provinces, 1990-2017: an analysis for the Global Burden of Disease Study 2017. Lancet Planet Health 2020; 4:e386-e398. [PMID: 32818429 PMCID: PMC7487771 DOI: 10.1016/s2542-5196(20)30161-3] [Citation(s) in RCA: 245] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 05/15/2023]
Abstract
BACKGROUND Air pollution is an important public health concern in China, with high levels of exposure to both ambient and household air pollution. To inform action at provincial levels in China, we estimated the exposure to air pollution and its effect on deaths, disease burden, and loss of life expectancy across all provinces in China from 1990 to 2017. METHODS In all 33 provinces, autonomous regions, municipalities, and special administrative regions in China, we estimated exposure to air pollution, including ambient particulate matter pollution (defined as the annual gridded concentration of PM2·5), household air pollution (defined as the percentage of households using solid cooking fuels and the corresponding exposure to PM2·5), and ozone pollution (defined as average gridded ozone concentrations). We used the methods of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 to estimate deaths and disability-adjusted life-years (DALYs) attributable to air pollution, and what the life expectancy would have been if air pollution levels had been less than the minimum level causing health loss. FINDINGS The average annual population-weighted PM2·5 exposure in China was 52·7 μg/m3 (95% uncertainty interval [UI] 41·0-62·8) in 2017, which is 9% lower than in 1990 (57·8 μg/m3, 45·0-67·0). We estimated that 1·24 million (95% UI 1·08-1·40) deaths in China were attributable to air pollution in 2017, including 851 660 (712 002-990 271) from ambient PM2·5 pollution, 271 089 (209 882-346 561) from household air pollution from solid fuels, and 178 187 (67 650-286 229) from ambient ozone pollution. The age-standardised DALY rate attributable to air pollution was 1513·1 per 100 000 in China in 2017, and was higher in males (1839·8 per 100 000) than in females (1198·3 per 100 000). The age-standardised death rate attributable to air pollution decreased by 60·6% (55·7-63·7) for China overall between 1990 and 2017, driven by an 85·4% (83·2-87·3) decline in household air pollution and a 12·0% (1·4-22·1) decline in ambient PM2·5 pollution. 40·0% of DALYs for COPD were attributable to air pollution, as were 35·6% of DALYs for lower respiratory infections, 26·1% for diabetes, 25·8% for lung cancer, 19·5% for ischaemic heart disease, and 12·8% for stroke. We estimated that if the air pollution level in China was below the minimum causing health loss, the average life expectancy would have been 1·25 years greater. The DALY rate per 100 000 attributable to air pollution varied across provinces, ranging from 482·3 (371·1-604·1) in Hong Kong to 1725·6 (720·4-2653·1) in Xinjiang for ambient pollution, and from 18·7 (9·1-34·0) in Shanghai to 1804·5 (1339·5-2270·1) in Tibet for household pollution. Although the overall mortality attributable to air pollution decreased in China between 1990 and 2017, 12 provinces showed an increasing trend during the past 27 years. INTERPRETATION Pollution from ambient PM2·5 and household burning of solid fuels decreased markedly in recent years in China, after extensive efforts to control emissions. However, PM2·5 concentrations still exceed the WHO Air Quality Guideline for the entire population of China, with 81% living in regions exceeding the WHO Interim Target 1, and air pollution remains an important risk factor. Sustainable development policies should be implemented and enforced to reduce the impact of air pollution on long-term economic development and population health. FUNDING Bill & Melinda Gates Foundation; and China National Key Research and Development Program.
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Affiliation(s)
- Peng Yin
- National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aaron J Cohen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Health Effects Institute, Boston, MA, USA
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jie Li
- National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | | | - Jeffrey D Stanaway
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kate Causey
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Samantha Larson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - William Godwin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Joseph Frostad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ashley Marks
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Lijun Wang
- National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maigeng Zhou
- National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Tiotiu AI, Novakova P, Nedeva D, Chong-Neto HJ, Novakova S, Steiropoulos P, Kowal K. Impact of Air Pollution on Asthma Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176212. [PMID: 32867076 PMCID: PMC7503605 DOI: 10.3390/ijerph17176212] [Citation(s) in RCA: 181] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/20/2020] [Accepted: 08/25/2020] [Indexed: 12/15/2022]
Abstract
Asthma is a chronic respiratory disease characterized by variable airflow obstruction, bronchial hyperresponsiveness, and airway inflammation. Evidence suggests that air pollution has a negative impact on asthma outcomes in both adult and pediatric populations. The aim of this review is to summarize the current knowledge on the effect of various outdoor and indoor pollutants on asthma outcomes, their burden on its management, as well as to highlight the measures that could result in improved asthma outcomes. Traffic-related air pollution, nitrogen dioxide and second-hand smoking (SHS) exposures represent significant risk factors for asthma development in children. Nevertheless, a causal relation between air pollution and development of adult asthma is not clearly established. Exposure to outdoor pollutants can induce asthma symptoms, exacerbations and decreases in lung function. Active tobacco smoking is associated with poorer asthma control, while exposure to SHS increases the risk of asthma exacerbations, respiratory symptoms and healthcare utilization. Other indoor pollutants such as heating sources and molds can also negatively impact the course of asthma. Global measures, that aim to reduce exposure to air pollutants, are highly needed in order to improve the outcomes and management of adult and pediatric asthma in addition to the existing guidelines.
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Affiliation(s)
- Angelica I. Tiotiu
- Department of Pulmonology, University Hospital of Nancy, 54395 Nancy, France
- Development of Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control (EA 3450 DevAH), University of Lorraine, 54395 Nancy, France
- Correspondence: ; Tel.: +33-383-154-299
| | - Plamena Novakova
- Clinic of Clinical Allergy, Medical University, 1000 Sofia, Bulgaria;
| | | | - Herberto Jose Chong-Neto
- Division of Allergy and Immunology, Department of Pediatrics, Federal University of Paraná, Curitiba 80000-000, Brazil;
| | - Silviya Novakova
- Allergy Unit, Internal Consulting Department, University Hospital “St. George”, 4000 Plovdiv, Bulgaria;
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital Dragana, 68100 Alexandroupolis, Greece;
| | - Krzysztof Kowal
- Department of Allergology and Internal Medicine, Medical University of Bialystok, 15-037 Bialystok, Poland;
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Affiliation(s)
- Heather Adair-Rohani
- Department of Environment, Climate Change and Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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119
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Heitzinger K, Hawes SE, Rocha CA, Alvarez C, Evans CA. Assessment of the Feasibility and Acceptability of Using Water Pasteurization Indicators to Increase Access to Safe Drinking Water in the Peruvian Amazon. Am J Trop Med Hyg 2020; 103:455-464. [PMID: 32372750 PMCID: PMC7356428 DOI: 10.4269/ajtmh.18-0963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Approximately two billion people lack access to microbiologically safe drinking water globally. Boiling is the most popular household water treatment method and significantly reduces diarrheal disease, but is often practiced inconsistently or ineffectively. The use of low-cost technologies to improve boiling is one approach with potential for increasing access to safe drinking water. We conducted household trials to evaluate the feasibility and acceptability of water pasteurization indicators (WAPIs) in the Peruvian Amazon in 2015. A total of 28 randomly selected households were enrolled from a rural and a peri-urban community. All households trialed two WAPI designs, each for a 2-week period. Ninety-six percent of participants demonstrated the correct use of the WAPIs at the end of each trial, and 88% expressed satisfaction with both WAPI models. Ease of use, short treatment time, knowledge of the association between WAPI use and improved health, and the taste of treated water were among the key factors that influenced acceptability. Ease of use was the key factor that influenced design preference. Participants in both communities preferred a WAPI with a plastic box that floated on the water's surface compared with a WAPI with a wire that was dipped into the pot of drinking water while it was heating (77% versus 15%, P < 0.001); we selected the box design for a subsequent randomized trial of this intervention. The high feasibility and acceptability of the WAPIs in this study suggest that these interventions have potential to increase access to safe water in resource-limited settings.
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Affiliation(s)
- Kristen Heitzinger
- Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
- IFHAD: Innovation for Health and Development, Department of Infectious Disease, Imperial College London, London, United Kingdom
- Address correspondence to Kristen Heitzinger, Asociación Benéfica Prisma, 251 Carlos Gonzales, Lima 15073 Peru. E-mail:
| | - Stephen E. Hawes
- Department of Epidemiology, University of Washington, Seattle, Washington
| | | | - Carlos Alvarez
- Regional Center for Disease Prevention and Control, Loreto Regional Ministry of Health, Iquitos, Peru
| | - Carlton A. Evans
- Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
- IFHAD: Innovation for Health and Development, Department of Infectious Disease, Imperial College London, London, United Kingdom
- IFHAD: Innovation for Health and Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
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Arku RE, Brauer M, Ahmed SH, AlHabib KF, Avezum Á, Bo J, Choudhury T, Dans AM, Gupta R, Iqbal R, Ismail N, Kelishadi R, Khatib R, Koon T, Kumar R, Lanas F, Lear SA, Wei L, Lopez-Jaramillo P, Mohan V, Poirier P, Puoane T, Rangarajan S, Rosengren A, Soman B, Caklili OT, Yang S, Yeates K, Yin L, Yusoff K, Zatoński T, Yusuf S, Hystad P. Long-term exposure to outdoor and household air pollution and blood pressure in the Prospective Urban and Rural Epidemiological (PURE) study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 262:114197. [PMID: 32146361 PMCID: PMC7767575 DOI: 10.1016/j.envpol.2020.114197] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 01/27/2020] [Accepted: 02/14/2020] [Indexed: 05/25/2023]
Abstract
Exposure to air pollution has been linked to elevated blood pressure (BP) and hypertension, but most research has focused on short-term (hours, days, or months) exposures at relatively low concentrations. We examined the associations between long-term (3-year average) concentrations of outdoor PM2.5 and household air pollution (HAP) from cooking with solid fuels with BP and hypertension in the Prospective Urban and Rural Epidemiology (PURE) study. Outdoor PM2.5 exposures were estimated at year of enrollment for 137,809 adults aged 35-70 years from 640 urban and rural communities in 21 countries using satellite and ground-based methods. Primary use of solid fuel for cooking was used as an indicator of HAP exposure, with analyses restricted to rural participants (n = 43,313) in 27 study centers in 10 countries. BP was measured following a standardized procedure and associations with air pollution examined with mixed-effect regression models, after adjustment for a comprehensive set of potential confounding factors. Baseline outdoor PM2.5 exposure ranged from 3 to 97 μg/m3 across study communities and was associated with an increased odds ratio (OR) of 1.04 (95% CI: 1.01, 1.07) for hypertension, per 10 μg/m3 increase in concentration. This association demonstrated non-linearity and was strongest for the fourth (PM2.5 > 62 μg/m3) compared to the first (PM2.5 < 14 μg/m3) quartiles (OR = 1.36, 95% CI: 1.10, 1.69). Similar non-linear patterns were observed for systolic BP (β = 2.15 mmHg, 95% CI: -0.59, 4.89) and diastolic BP (β = 1.35, 95% CI: -0.20, 2.89), while there was no overall increase in ORs across the full exposure distribution. Individuals who used solid fuels for cooking had lower BP measures compared to clean fuel users (e.g. 34% of solid fuels users compared to 42% of clean fuel users had hypertension), and even in fully adjusted models had slightly decreased odds of hypertension (OR = 0.93; 95% CI: 0.88, 0.99) and reductions in systolic (-0.51 mmHg; 95% CI: -0.99, -0.03) and diastolic (-0.46 mmHg; 95% CI: -0.75, -0.18) BP. In this large international multi-center study, chronic exposures to outdoor PM2.5 was associated with increased BP and hypertension while there were small inverse associations with HAP.
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Affiliation(s)
- Raphael E Arku
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA; School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada.
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | | | | | - Álvaro Avezum
- Dante Pazzanese Institute of Cardiology and University of Santo Amaro, São Paulo, Brazil
| | - Jian Bo
- Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | | | | | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Romaina Iqbal
- Departments of Community Health Sciences and Medicine, The Aga Khan University, Karachi, Pakistan
| | | | - Roya Kelishadi
- Cardiovascular Research Institute, Isfahan University of Medical Sciences, Iran
| | - Rasha Khatib
- Advocate Research Institute, Advocate Health Care, Downers Grove, IL, USA
| | - Teo Koon
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Rajesh Kumar
- School of Public Health, PGIMER, Chandigarh, India
| | | | | | - Li Wei
- Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | | | | | - Paul Poirier
- Université Laval and Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Annika Rosengren
- University of Gothenburg and Sahlgrenska University Hospital Gothenburg, Sweden
| | - Biju Soman
- Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | - Ozge Telci Caklili
- Istanbul University, Faculty of Medicine, Department of Endocrinology and Metabolism, Turkey
| | - Shunyun Yang
- Center for Disease Control and Prevention, Yunnan, China
| | | | - Lu Yin
- Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Khalid Yusoff
- UCSI University, Kuala Lumpur, Malaysia & Universiti Teknologi MARA, Selayang, Malaysia
| | - Tomasz Zatoński
- Department of Otolaryngology Head and Neck Surgery, Medical University, Wrocław, Poland
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Perry Hystad
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
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121
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Amegah AK, Boachie J, Näyhä S, Jaakkola JJK. Association of biomass fuel use with reduced body weight of adult Ghanaian women. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2020; 30:670-679. [PMID: 30804452 DOI: 10.1038/s41370-019-0129-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/21/2019] [Accepted: 02/05/2019] [Indexed: 06/09/2023]
Abstract
The association of biomass fuel use with body weight has never been investigated. We therefore examined the effect of biomass fuel use on body weight of adult Ghanaian women. Data from the 2014 Ghana Demographic and Health Survey, a nationally representative population-based survey was analysed for this study. A total of 4751 women who had anthropometric (height and weight) data qualified for inclusion in this study. In linear regression modelling, charcoal use resulted in 3.08 kg (95% CI: 2.04, 4.12) and 0.81 kg/m2 (95%CI: 0.29, 1.33) reduction in weight and body mass index (BMI), respectively, compared to clean fuel (electricity, liquefied petroleum gas and natural gas) use. Use of wood resulted in much higher reduction in weight and BMI. In modified Poisson regression, charcoal users had 19% (Adjusted Prevalence Ratio [aPR] = 0.81; 95%CI: 0.71, 0.92) and 29% (aPR = 0.71; 95%CI: 0.61, 0.83) decreased risk of overweight and obesity, respectively, compared to clean fuel users. Wood users had much higher decreased risk of overweight and obesity. In conclusion, biomass fuel use was associated with reduced body weight and BMI of Ghanaian women and is the first report on the relationship. However, it is important that our findings are confirmed and the biological mechanisms elucidated through rigorous study designs.
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Affiliation(s)
- A Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Johnmark Boachie
- Public Health Research Group, Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Simo Näyhä
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
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122
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Gould CF, Schlesinger SB, Molina E, Lorena Bejarano M, Valarezo A, Jack DW. Long-standing LPG subsidies, cooking fuel stacking, and personal exposure to air pollution in rural and peri-urban Ecuador. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2020; 30:707-720. [PMID: 32415299 PMCID: PMC7316622 DOI: 10.1038/s41370-020-0231-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/06/2020] [Accepted: 04/23/2020] [Indexed: 05/05/2023]
Abstract
Ecuador presents a unique case study for evaluating personal air pollution exposure in a middle-income country where a clean cooking fuel has been available at low cost for several decades. We measured personal PM2.5 exposure, stove use, and participant location during a 48-h monitoring period for 157 rural and peri-urban households in coastal and Andean Ecuador. While nearly all households owned a liquefied petroleum gas (LPG) stove and used it as their primary cooking fuel, one-quarter of households utilized firewood as a secondary fuel and 10% used induction stoves secondary to LPG. Stove use monitoring demonstrated clear within- and across-meal fuel stacking patterns. Firewood-owning participants had higher distributions of 48-h and 10-min PM2.5 exposure as compared with primary LPG and induction stove users, and this effect became more pronounced with firewood use during monitoring.Accounting for within-subject clustering, contemporaneous firewood stove use was associated with 101 μg/m3 higher 10-min PM2.5 exposure (95% CI: 94-108 μg/m3). LPG and induction cooking events were largely not associated with contemporaneous PM2.5 exposure. Our results suggest that firewood use is associated with average and short-term personal air pollution exposure above the WHO interim-I guideline, even when LPG is the primary cooking fuel.
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Affiliation(s)
- Carlos F Gould
- Department of Environmental Health Science, Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - Emilio Molina
- Department of Mechanical Engineering, Universidad San Francisco de Quito, Quito, Ecuador
| | - M Lorena Bejarano
- Department of Mechanical Engineering, Universidad San Francisco de Quito, Quito, Ecuador
| | - Alfredo Valarezo
- Department of Mechanical Engineering, Universidad San Francisco de Quito, Quito, Ecuador
| | - Darby W Jack
- Department of Environmental Health Science, Columbia University Mailman School of Public Health, New York, NY, USA.
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123
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What Motivates Behavior Change? Analyzing User Intentions to Adopt Clean Technologies in Low-Resource Settings Using the Theory of Planned Behavior. ENERGIES 2020. [DOI: 10.3390/en13113021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Understanding and integrating the user’s decision-making process into product design and distribution strategies is likely to lead to higher adoption rates and ultimately increased impacts, particularly for those products that require a change in habit or behavior such as clean energy technologies. This study applies the Theory of Planned Behavior (TPB) in design for global development, where understanding the tendency to adopt beneficial technologies based on parsimonious approaches is critical to programmatic impact. To investigate robustness and applicability of behavioral models in a data scarce setting, this study applies TPB to the adoption of biomass cookstoves in a sample size of two remote communities in Honduras and Uganda before and after a trial period. Using multiple ordinal logistic regressions, the intention to adopt the technology was modeled. Results quantify the influence of these factors on households’ intentions to cook their main meals with improved cookstoves. For example, the intention of participants with slightly stronger beliefs regarding the importance of reducing smoke emissions was 3.3 times higher than average to cook more main meals with clean cookstoves. The quantitative method of this study enables technology designers to design and develop clean technologies that better suit user behavior, needs, and priorities. In addition, the data driven approach of this study provides insights for policy makers to design policies such as subsidies, information campaigns, and supply chains that reflect behavioral attributes for culturally tailored clean technology adoption initiatives. Furthermore, this work discusses potential sources of bias and statistical challenges in data-scarce regions, and outlines methods to address them.
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124
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Sharma A, Kumar P. Quantification of air pollution exposure to in-pram babies and mitigation strategies. ENVIRONMENT INTERNATIONAL 2020; 139:105671. [PMID: 32278197 DOI: 10.1016/j.envint.2020.105671] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/09/2020] [Accepted: 03/16/2020] [Indexed: 05/02/2023]
Abstract
Young children are particularly vulnerable to air pollution exposure during their early childhood development, yet research on exposure to in-pram babies in different types of single/double prams is limited. This work aims to mimick their exposure to multiple air pollutants - particulate matter ≤10 µm in aerodynamic diameter (PM10), ≤2.5 µm (PM2.5; fine particles), ≤1 µm (PM1), ≤0.10 µm (measured as particle number concentration, PNC) - in three different types of prams (single pram facing the road; single pram facing parents; double pram facing the road). We also assessed the differences in exposure concentrations between typical adult and in-pram baby breathing height via simultaneous measurements besides assessing their physico-chemical properties (morphology and elemental composition). In addition, we analysed the impact of pram covers in mitigating in-pram exposure concentrations of selected pollutants. We carried out a total of 89 single runs, repeating on a 2.1 km long pre-defined route between an origin-destination pair (the University of Surrey to a local school) during the morning (08:00-10:00 h; local time) and afternoon (15:00-17:00 h) hours. These run simulated morning drop-off and afternoon pick-off times of school children. Overall, the experimental runs took about 66 h and covered the total length of 145 km. Substantial variability is observed in measured concentrations of different pollutants within each run (e.g., up to 290-times for PNC) and between different runs performed during different times of the day (e.g., ~62% variability in average PNC; ~7% for PM1 and 8% for PM2.5 during morning versus afternoon). The average in-pram concentration of fine particles was always higher by up to 44% compared with adult breathing height during both morning and afternoon runs. The comparison of exposure concentrations at two different sitting heights of double pram showed that PNC concentrations were higher by about 72% at the bottom seat compared to the top seat. Scanning electron microscope (SEM) analysis of PM2.5-10 revealed traces of brake wear, tyre wear and re-suspended dust minerals with the predominance of brake and tyre wear emissions at baby height compared with a relatively larger share of earth crust elements at adult height. For mitigation measures, pram covers reduced concentrations of small-sized particles by as much as 39% (fine particles) and 43% (coarse particles). Our results reinforce the need for mitigating exposures to in-pram babies, especially at urban pollution hotspots such as busy congested roads, bus stops, and traffic intersections.
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Affiliation(s)
- Ashish Sharma
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, United Kingdom
| | - Prashant Kumar
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, United Kingdom.
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125
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Maas A, Kothe H, Centeno IP, Gutiérrez Leiva MJ, Dalhoff K. Prevalence of Chronic Bronchitis and Respiratory Health Profile of a Population Exposed to Wood Smoke in Nicaragua. J Health Pollut 2020; 10:200607. [PMID: 32509408 PMCID: PMC7269325 DOI: 10.5696/2156-9614-10.26.200607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Household air pollution (HAP) is one of the most important environmental risk factors worldwide associated with chronic respiratory diseases. OBJECTIVES The present study focused on respiratory health in a population with high wood smoke exposure in Nicaragua. METHODS We employed a cross-sectional study with 213 participants. Data on the prevalence of chronic bronchitis (chronic bronchitis), chronic obstructive pulmonary disease (COPD) and asthma, including respiratory scores and pulmonary function tests, were documented. The role of risk factors for chronic bronchitis was analyzed. RESULTS We found a high prevalence of chronic airway diseases in the population exposed to wood smoke. A higher prevalence of chronic bronchitis was found in persons serving as primary cooks in households. Further confounding factors for chronic bronchitis included age, a prior diagnosis of asthma, inhalational allergies and lower socioeconomic status. Respiratory scores were elevated in individuals with chronic bronchitis. CONCLUSIONS This is one of the first studies in a wood smoke-exposed population in Nicaragua showing a high prevalence of chronic bronchitis and COPD with an emphasis on the analysis of personal and environmental risk factors. Further studies are needed to address which combination of interventions is most efficient for ameliorating respiratory health hazards. PARTICIPANT CONSENT Obtained. ETHICS APPROVAL The study protocol was approved by the Ethics Committee of the University of Luebeck, Germany (reference number 12-214), and by the Ethics Committee of the Department of Medical Sciences at National Autonomous University of Nicaragua, Managua, Nicaragua. COMPETING INTERESTS The authors declare no competing financial interests.
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Affiliation(s)
| | | | - Ivette Pilarte Centeno
- Faculty of Medical Sciences, National Autonomous University of Nicaragua (UNAN), Managua, Nicaragua
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Effects of the Use of Air Purifier on Indoor Environment and Respiratory System among Healthy Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103687. [PMID: 32456250 PMCID: PMC7277583 DOI: 10.3390/ijerph17103687] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022]
Abstract
Air purifiers have become popular among ordinary families. However, it remains controversial whether indoor air purification improves the respiratory health of healthy adults. A randomized crossover intervention study was conducted with 32 healthy individuals. The subjects were categorized into two groups. One group continuously used true air purifiers, and the other followed with sham air purifiers for 4 weeks. Following this first intervention, all the subjects underwent a 4-week washout period and continued with the second 4-week intervention with the alternate air purifiers. We collected fine particulate matter (PM) ≤ 2.5 µm in aerodynamic diameter (PM2.5), coarse particulate matter between 2.5 and 10 µm in aerodynamic diameter (PM10–2.5) and ozone (O3). The subjects’ pulmonary function and fractional exhaled nitric oxide (FeNO) were measured during the study period. The indoor PM2.5 concentrations decreased by 11% with the true air purifiers compared to those with sham air purifiers. However, this decrease was not significant (p = 0.08). The air purification did not significantly improve the pulmonary function of the study subjects. In contrast, an increase in the indoor PM10–2.5 and O3 concentration led to a significant decrease in the forced expiratory volume in one second (FEV1.0)/forced vital capacity (FVC) and maximal mid-expiratory flow (MMEF), respectively. In conclusion, air purification slightly improved the indoor PM2.5 concentrations in ordinary homes but had no demonstrable impact on improving health.
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127
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Adane MM, Alene GD, Mereta ST, Wanyonyi KL. Facilitators and barriers to improved cookstove adoption: a community-based cross-sectional study in Northwest Ethiopia. Environ Health Prev Med 2020; 25:14. [PMID: 32414323 PMCID: PMC7229589 DOI: 10.1186/s12199-020-00851-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/23/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Among the environmental risk factors, household air pollution exposure from traditional cooking practices is one of the biggest killers globally, which mainly impacts developing countries where many families rely on traditional cooking practices. Although improved cookstove adoption is central to tackle this public health issue, the efforts to disseminate cookstove technologies have faced challenges, and the adoption rates are reported to be very low in many developing countries including Ethiopia. Therefore, this study aimed to determine the magnitude and identify potential factors that may act as facilitators or barriers to adoption from users' point of view. METHODS As part of the wider stove trial project, a cross-sectional study was conducted among a total of 5830 households under randomly selected clusters. The required data were collected through face-to-face interviews, and a backward stepwise logistic regression analysis technique was applied to evaluate the effect of potential predictor variables on adoption using adjusted odds ratio (AOR) as measures of effect. RESULTS The prevalence of adoption was found to be 12.3% (95% CI 11.5-13.2), and households headed by females (AOR 1.96; 95% CI 1.24-3.10), private house ownership (AOR 4.58; 95% CI 3.89-6.19), separate cooking location (AOR 1.84; 95% CI 1.49-2.78), fuel purchasing (AOR 2.13; 95% CI 1.64-2.76), health benefit (AOR 1.76; 95% CI 1.15-2.70), optimistic social interaction (AOR 1.81; 95% CI 1.46-2.26), traditional suitability (AOR 1.58; 95% CI 1.28-1.95), stove use demonstration experience (AOR 2.47; 95% CI 1.98-3.07), cheap price (AOR 2.48; 95% CI 1.91-3.21), availability (AOR 1.81; 95% CI 1.5-1, 2.17), fuel-saving benefit (AOR 1.63; 95% CI 1.18-2.24), and more durable stove (AOR 1.71; 95% CI 1.30-2.26) of cookstove played a significant role as facilitators to adoption. In addition, lower educational level of head (AOR 0.31; 95% CI 0.23-0.42) and fuel processing requirement (AOR 0.55; 95% CI 0.44-0.70) of cookstove were found to be barriers for adoption. CONCLUSIONS Extremely lower improved cookstove adoption was observed due to household- and setting-related, cookstove technology-related, user knowledge- and perception-related, and financial- and market development-related factors. Therefore, to gain successful adoption, implementers and policymakers should consider those important factors in the implementation of clean cooking solutions to the community.
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Affiliation(s)
- Mesafint Molla Adane
- Department of Environmental Health, School of Public Health, College of Medicine & Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Getu Degu Alene
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine & Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Seid Tiku Mereta
- Departments of Environmental Health Science and Technology, Jimma University, Jimma, Ethiopia
| | - Kristina Lutomya Wanyonyi
- Queen Mary University of London, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, London, UK
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128
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Goyal N, Karra M, Canning D. Early-life exposure to ambient fine particulate air pollution and infant mortality: pooled evidence from 43 low- and middle-income countries. Int J Epidemiol 2020; 48:1125-1141. [PMID: 31074784 DOI: 10.1093/ije/dyz090] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Many low- and middle-income countries are experiencing high and increasing exposure to ambient fine particulate air pollution (PM2.5). The effect of PM2.5 on infant and child mortality is usually modelled using concentration response curves extrapolated from studies conducted in settings with low ambient air pollution, which may not capture its full effect. METHODS We pool data on more than half a million births from 69 nationally representative Demographic and Health Surveys that were conducted in 43 low- and middle-income countries between 1998 and 2014, and we calculate early-life exposure (exposure in utero and post partum) to ambient PM2.5 using high-resolution calibrated satellite data matched to the child's place of residence. We estimate the association between the log of early-life PM2.5 exposure, both overall and separated by type, and the odds of neonatal and infant mortality, adjusting for child-level, parent-level and household-level characteristics. RESULTS We find little evidence that early-life exposure to overall PM2.5 is associated with higher odds of mortality relative to low exposure to PM2.5. However, about half of PM2.5 is naturally occurring dust and sea-salt whereas half is from other sources, comprising mainly carbon-based compounds, which are mostly due to human activity. We find a very strong association between exposure to carbonaceous PM2.5 and infant mortality, particularly neonatal mortality, i.e. mortality in the first 28 days after birth. We estimate that, at the mean level of exposure in the sample to carbonaceous PM2.5-10.9 µg/m3-the odds of neonatal mortality are over 50% higher than in the absence of pollution. CONCLUSION Our results suggest that the current World Health Organization guideline of limiting the overall ambient PM2.5 level to less than 10 µg/m³ should be augmented with a lower limit for harmful carbonaceous PM2.5.
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Affiliation(s)
- Nihit Goyal
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore.,The Whitney and Betty MacMillan Center for International and Area Studies, Yale University, New Haven, CT, USA
| | - Mahesh Karra
- Frederick S Pardee School of Global Studies, Boston University, Boston, MA, USA.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - David Canning
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
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129
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Hartinger SM, Nuño N, Hattendorf J, Verastegui H, Karlen W, Ortiz M, Mäusezahl D. A factorial cluster-randomised controlled trial combining home-environmental and early child development interventions to improve child health and development: rationale, trial design and baseline findings. BMC Med Res Methodol 2020; 20:73. [PMID: 32241260 PMCID: PMC7115072 DOI: 10.1186/s12874-020-00950-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/06/2020] [Indexed: 12/16/2022] Open
Abstract
Background Exposure to unhealthy environments and inadequate child stimulation are main risk factors that affect children’s health and wellbeing in low- and middle-income countries. Interventions that simultaneously address several risk factors at the household level have great potential to reduce these negative effects. We present the design and baseline findings of a cluster-randomised controlled trial to evaluate the impact of an integrated home-environmental intervention package and an early child development programme to improve diarrhoea, acute respiratory infections and childhood developmental outcomes in children under 36 months of age living in resource-limited rural Andean Peru. Methods We collected baseline data on children’s developmental performance, health status and demography as well as microbial contamination in drinking water. In a sub-sample of households, we measured indoor kitchen 24-h air concentration levels of carbon monoxide (CO) and fine particulate matter (PM2.5) and CO for personal exposure. Results We recruited and randomised 317 children from 40 community-clusters to four study arms. At baseline, all arms had similar health and demographic characteristics, and the developmental status of children was comparable between arms. The analysis revealed that more than 25% of mothers completed primary education, a large proportion of children were stunted and diarrhoea prevalence was above 18%. Fifty-two percent of drinking water samples tested positive for thermo-tolerant coliforms and the occurrence of E.coli was evenly distributed between arms. The mean levels of kitchen PM2.5 and CO concentrations were 213 μg/m3 and 4.8 ppm, respectively. Conclusions The trial arms are balanced with respect to most baseline characteristics, such as household air and water pollution, and child development. These results ensure the possible estimation of the trial effectiveness. This trial will yield valuable information for assessing synergic, rational and cost-effective benefits of the combination of home-based interventions. Trial Registry ISRCTN-26548981.
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Affiliation(s)
- Stella M Hartinger
- Department of Epidemiology & Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Nestor Nuño
- Department of Epidemiology & Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jan Hattendorf
- Department of Epidemiology & Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Hector Verastegui
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Walter Karlen
- Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | | | - Daniel Mäusezahl
- Department of Epidemiology & Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Kypridemos C, Puzzolo E, Aamaas B, Hyseni L, Shupler M, Aunan K, Pope D. Health and Climate Impacts of Scaling Adoption of Liquefied Petroleum Gas (LPG) for Clean Household Cooking in Cameroon: A Modeling Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:47001. [PMID: 32233878 PMCID: PMC7228103 DOI: 10.1289/ehp4899] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND The Cameroon government has set a target that, by 2030, 58% of the population will be using Liquefied Petroleum Gas (LPG) as a cooking fuel, in comparison with less than 20% in 2014. The National LPG Master Plan (Master Plan) was developed for scaling up the LPG sector to achieve this target. OBJECTIVES This study aimed to estimate the potential impacts of this planned LPG expansion (the Master Plan) on population health and climate change mitigation, assuming primary, sustained use of LPG for daily cooking. METHODS We applied existing and developed new mathematical models to calculate the health and climate impacts of expanding LPG primary adoption for household cooking in Cameroon over two periods: a) short-term (2017-2030): Comparing the Master Plan 58% target with a counterfactual LPG adoption of 32% in 2030, in line with current trends; and b) long-term (2031-2100, climate modeling only), assuming Cameroon will become a mature and saturated LPG market by 2100 (73% adoption, based on Latin American countries). We compared this with a counterfactual adoption of 41% by 2100, in line with current trends. RESULTS By 2030, successful implementation of the Master Plan was estimated to avert about 28,000 (minimum = 22,000 , maximum = 35,000 ) deaths and 770,000 (minimum = 580,000 maximum = 1 million ) disability-adjusted life years. For the same period, we estimated reductions in pollutant emissions of more than a third in comparison with the counterfactual, leading to a global cooling of - 0.1 milli ° C in 2030. For 2100, a cooling impact from the Master Plan leading to market saturation (73%) was estimated to be - 0.70 milli ° C in comparison with to the counterfactual, with a range of - 0.64 to - 0.93 milli ° C based on different fractions of nonrenewable biomass. DISCUSSION Successful implementation of the Master Plan could have significant positive impacts on population health in Cameroon with no adverse impacts on climate. https://doi.org/10.1289/EHP4899.
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Affiliation(s)
- Chris Kypridemos
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Elisa Puzzolo
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
- Global LPG Partnership (GLPGP), New York, USA
| | - Borgar Aamaas
- CICERO Center for International Climate Research, Oslo, Norway
| | - Lirije Hyseni
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Matthew Shupler
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Kristin Aunan
- CICERO Center for International Climate Research, Oslo, Norway
| | - Daniel Pope
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
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Clasen T, Checkley W, Peel JL, Balakrishnan K, McCracken JP, Rosa G, Thompson LM, Barr DB, Clark ML, Johnson MA, Waller LA, Jaacks LM, Steenland K, Miranda JJ, Chang HH, Kim DY, McCollum ED, Davila-Roman VG, Papageorghiou A, Rosenthal JP. Design and Rationale of the HAPIN Study: A Multicountry Randomized Controlled Trial to Assess the Effect of Liquefied Petroleum Gas Stove and Continuous Fuel Distribution. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:47008. [PMID: 32347766 PMCID: PMC7228119 DOI: 10.1289/ehp6407] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND Globally, nearly 3 billion people rely on solid fuels for cooking and heating, the vast majority residing in low- and middle-income countries (LMICs). The resulting household air pollution (HAP) is a leading environmental risk factor, accounting for an estimated 1.6 million premature deaths annually. Previous interventions of cleaner stoves have often failed to reduce exposure to levels that produce meaningful health improvements. There have been no multicountry field trials with liquefied petroleum gas (LPG) stoves, likely the cleanest scalable intervention. OBJECTIVE This paper describes the design and methods of an ongoing randomized controlled trial (RCT) of LPG stove and fuel distribution in 3,200 households in 4 LMICs (India, Guatemala, Peru, and Rwanda). METHODS We are enrolling 800 pregnant women at each of the 4 international research centers from households using biomass fuels. We are randomly assigning households to receive LPG stoves, an 18-month supply of free LPG, and behavioral reinforcements to the control arm. The mother is being followed along with her child until the child is 1 year old. Older adult women (40 to < 80 years of age) living in the same households are also enrolled and followed during the same period. Primary health outcomes are low birth weight, severe pneumonia incidence, stunting in the child, and high blood pressure (BP) in the older adult woman. Secondary health outcomes are also being assessed. We are assessing stove and fuel use, conducting repeated personal and kitchen exposure assessments of fine particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ), carbon monoxide (CO), and black carbon (BC), and collecting dried blood spots (DBS) and urinary samples for biomarker analysis. Enrollment and data collection began in May 2018 and will continue through August 2021. The trial is registered with ClinicalTrials.gov (NCT02944682). CONCLUSIONS This study will provide evidence to inform national and global policies on scaling up LPG stove use among vulnerable populations. https://doi.org/10.1289/EHP6407.
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Affiliation(s)
- Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, Tamil Nadu, India
| | - John P. McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Ghislaine Rosa
- Department of Disease Control, Faculty of Infections and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Lisa M. Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Dana Boyd Barr
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Maggie L. Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | | | - Lance A. Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lindsay M. Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kyle Steenland
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Howard H. Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Dong-Yun Kim
- Office of Biostatistics Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Eric D. McCollum
- Eudowood Division of Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Victor G. Davila-Roman
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Aris Papageorghiou
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | - Joshua P. Rosenthal
- Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - HAPIN Investigators
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, Tamil Nadu, India
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
- Department of Disease Control, Faculty of Infections and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
- Berkeley Air Monitoring Group, Berkeley, California, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Office of Biostatistics Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Eudowood Division of Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
- Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
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Walker ES, Clark ML, Young BN, Rajkumar S, Benka-Coker ML, Bachand AM, Brook RD, Nelson TL, Volckens J, Reynolds SJ, L’Orange C, Africano S, Pinel ABO, Good N, Koehler K, Peel JL. Exposure to household air pollution from biomass cookstoves and self-reported symptoms among women in rural Honduras. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2020; 30:160-173. [PMID: 30760020 PMCID: PMC6692243 DOI: 10.1080/09603123.2019.1579304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/31/2018] [Indexed: 06/09/2023]
Abstract
Household air pollution from combustion of solid fuels is an important risk factor for morbidity and mortality, causing an estimated 2.6 million premature deaths globally in 2016. Self-reported health symptoms are a meaningful measure of quality of life, however, few studies have evaluated symptoms and quantitative measures of exposure to household air pollution. We assessed the cross-sectional association of self-reported symptoms and exposures to household air pollution among women in rural Honduras using stove type (traditional [n = 76]; cleaner-burning Justa [n = 74]) and 24-hour average personal and kitchen fine particulate matter (PM2.5) concentrations. The odds of prevalent symptoms were higher among women using traditional stoves vs Justa stoves (e.g. headache: odds ratio = 2.23; 95% confidence interval = 1.13-4.39). Associations between symptoms and measured PM2.5 were generally consistent with the null. These results add to the evidence suggesting reduced exposures and better health-related quality of life among women using cleaner-burning biomass stoves.
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Affiliation(s)
- Ethan S. Walker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Maggie L. Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Bonnie N. Young
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Sarah Rajkumar
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Megan L. Benka-Coker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Annette M. Bachand
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Robert D. Brook
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Tracy L. Nelson
- Department of Health and Exercise Science and Colorado School of Public Health, Colorado State University, Fort Collins, CO, USA
| | - John Volckens
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Stephen J. Reynolds
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
- Mountain and Plains ERC, Denver, CO, USA
| | - Christian L’Orange
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | | | | | - Nicholas Good
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Kirsten Koehler
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
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Exposure to Wood Smoke and Associated Health Effects in Sub-Saharan Africa: A Systematic Review. Ann Glob Health 2020; 86:32. [PMID: 32211302 PMCID: PMC7082829 DOI: 10.5334/aogh.2725] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Observational studies suggest that exposure to wood smoke is associated with a variety of adverse health effects in humans. Objective We aimed to summarise evidence from sub-Saharan Africa on levels of exposure to pollutants in wood smoke and the association between such exposures and adverse health outcomes. Methods PubMed and Google scholar databases were searched for original articles reporting personal exposure levels to pollutants or health outcomes associated with wood smoke exposure in Sub-Saharan African population. Results Mean personal PM2.5 and carbon monoxide levels in the studies ranged from 26.3 ± 1.48 μg/m3 to 1574 ± 287μg/m3 and from 0.64 ± 2.12 ppm to 22 ± 2.4 ppm, respectively. All the reported personal PM2.5 exposure levels were higher than the World Health Organization's Air Quality Guideline (AQG) for 24-hour mean exposure. Use of wood fuels in domestic cooking is the major source of wood smoke exposure in this population. Occupational exposure to wood smoke included the use of wood fuels in bakery, fish drying, cassava processing and charcoal production. Females were exposed to higher levels of these pollutants than males of the same age range. Major determinants for higher exposure to wood smoke in SSA included use of unprocessed firewood, female gender and occupational exposure. We recorded strong and consistent associations between exposure to wood smoke and respiratory diseases including acute respiratory illness and impaired lung function. Positive associations were reported for increased blood pressure, low birth weight, oesophageal cancer, sick building syndrome, non-syndromic cleft lip and/or cleft palate and under-five mortality. Conclusion There is high level of exposure to wood smoke in SSA and this exposure is associated with a number of adverse health effects. There is urgent need for aggressive programs to reduce wood smoke exposure in this population.
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Adane MM, Alene GD, Mereta ST, Wanyonyi KL. Prevalence and risk factors of acute lower respiratory infection among children living in biomass fuel using households: a community-based cross-sectional study in Northwest Ethiopia. BMC Public Health 2020; 20:363. [PMID: 32192454 PMCID: PMC7083007 DOI: 10.1186/s12889-020-08515-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/12/2020] [Indexed: 11/20/2022] Open
Abstract
Background Childhood acute lower respiratory infection in the form of pneumonia is recognized as the single largest cause of childhood death globally accounting for 16% of the overall deaths. Some studies also reported a higher prevalence of childhood acute respiratory infection in Ethiopia, which ranges from 16% up to 33.5%. Concerning the risk factors, there are limited community-based studies in Ethiopia in general, and in the current study region in particular. Therefore, the present study was conducted to investigate the prevalence of childhood acute respiratory infection and associated factors in Northwest Ethiopia. Methods As part of the wider stove trial project, a cross-sectional study was conducted in May 2018 among a total of 5830 children aged less than 4 years old in randomly selected clusters. Binary logistic regression was applied to identify factors linked with childhood acute lower respiratory infection and adjusted odds ratios were used as measures of effect with a 95% confidence interval. Results A total of 5830 children were included in the study within 100 clusters. Out of which 51.7% were male and 48.3% female. The prevalence of childhood lower acute respiratory infection was 19.2% (95% CI: 18.2–20.2) and found to decrease among children living in homes with chimney, eaves space and improved cookstove than children living in households with no chimney, eaves space and improved cookstove with estimated AOR of 0.60 (95% CI: 0.51–0.70), 0.70 (95% CI: 0.60–0.84) and 0.43 (95% CI: 0.28–0.67) respectively. It was also associated with other cooking-related factors such as cow dung fuel use [AOR = 1.54 (95% CI: 1.02–2.33)], child spending time near stove during cooking [AOR = 1.41 (95% CI: 1.06–1.88), presence of extra indoor burning events [AOR = 2.19 (95% CI: 1.41–3.40)] and with frequent cooking of meals [AOR = 1.55 (95% CI: 1.13–2.13)]. Conclusion High prevalence of childhood acute lower respiratory infection was demonstrated by this study and it was found to be associated with household ventilation, cooking technology, and behavioral factors. Therefore, we recommend a transition in household ventilation, cooking technologies as well as in child handling and in the peculiar local extra indoor burning practices.
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Affiliation(s)
- Mesafint Molla Adane
- Department of Environmental Health, School of Public Health, College of Medicine & Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Getu Degu Alene
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine & Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Seid Tiku Mereta
- Departments of Environmental Health Science and Technology, Jimma University, Jimma, Ethiopia
| | - Kristina L Wanyonyi
- Department of Dental Academy, Faculty of Science, University of Portsmouth, Portsmouth, England
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Mocumbi AO, Stewart S, Patel S, Al-Delaimy WK. Cardiovascular Effects of Indoor Air Pollution from Solid Fuel: Relevance to Sub-Saharan Africa. Curr Environ Health Rep 2020; 6:116-126. [PMID: 31102183 DOI: 10.1007/s40572-019-00234-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW This research aims to summarize evidence on the cardiovascular effects of indoor air pollution (IAP) from solid fuel and identify areas for research and policy for low- and middle-income countries. RECENT FINDINGS IAP affects people from low socioeconomic status in Latin America, Asia, and Africa, who depend upon biomass as a fuel for cooking, heating, and lighting. In these settings, IAP disproportionately affects women, children, the elderly, and people with cardiopulmonary disease. The health effects of IAP include acute respiratory infections, chronic obstructive pulmonary disease, pneumoconiosis, cataract and blindness, pulmonary tuberculosis, adverse effects to pregnancy, cancer, and cardiovascular and cerebrovascular disease. New methods for assessing individual IAP exposure, exposing pathways of IAP-related cardiovascular disease, and performing qualitative research focusing on population preferences regarding strategies to reduce IAP exposure have been the most important developments in tackling the burden of IAP. Unfortunately, major disparities exist regarding research into the cardiovascular effects of IAP, with only few studies coming from sub-Saharan Africa, despite this region having the highest proportion of households using solid fuels. Premature cardiovascular deaths and disability can be averted in low-middle income countries by addressing biomass fuel usage by the most disadvantaged settings. While research is needed to uncover the mechanisms involved in cardiovascular outcomes linked to IAP, immediate action is needed to educate the most affected populations on IAP health hazards and to reduce their exposure to this environmental risk through promoting improved housing and better ventilation, as well as increasing access to affordable clean cooking energy.
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Affiliation(s)
- Ana Olga Mocumbi
- Universidade Eduardo Mondlane, Maputo, Mozambique.
- Instituto Nacional de Saúde, Maputo, Mozambique.
| | - Simon Stewart
- Universidade Eduardo Mondlane, Maputo, Mozambique
- Hatter Institute for Cardiovascular Research in Africa, Cape Town, South Africa
| | - Sam Patel
- Universidade Eduardo Mondlane, Maputo, Mozambique
- Hospital Central de Maputo, Maputo, Mozambique
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Benka-Coker ML, Peel JL, Volckens J, Good N, Bilsback KR, L'Orange C, Quinn C, Young BN, Rajkumar S, Wilson A, Tryner J, Africano S, Osorto AB, Clark ML. Kitchen concentrations of fine particulate matter and particle number concentration in households using biomass cookstoves in rural Honduras. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 258:113697. [PMID: 31875572 PMCID: PMC7068841 DOI: 10.1016/j.envpol.2019.113697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/21/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
Cooking and heating with solid fuels results in high levels of household air pollutants, including particulate matter (PM); however, limited data exist for size fractions smaller than PM2.5 (diameter less than 2.5 μm). We collected 24-h time-resolved measurements of PM2.5 (n = 27) and particle number concentrations (PNC, average diameter 10-700 nm) (n = 44; 24 with paired PM2.5 and PNC) in homes with wood-burning traditional and Justa (i.e., with an engineered combustion chamber and chimney) cookstoves in rural Honduras. The median 24-h PM2.5 concentration (n = 27) was 79 μg/m3 (interquartile range [IQR]: 44-174 μg/m3); traditional (n = 15): 130 μg/m3 (IQR: 48-250 μg/m3); Justa (n = 12): 66 μg/m3 (IQR: 44-97 μg/m3). The median 24-h PNC (n = 44) was 8.5 × 104 particles (pt)/cm3 (IQR: 3.8 × 104-1.8 × 105 pt/cm3); traditional (n = 27): 1.3 × 105 pt/cm3 (IQR: 3.3 × 104-2.0 × 105 pt/cm3); Justa (n = 17): 6.3 × 104 pt/cm3 (IQR: 4.0 × 104-1.2 × 105 pt/cm3). The 24-h average PM2.5 and particle number concentrations were correlated for the full sample of cookstoves (n = 24, Spearman ρ: 0.83); correlations between PM2.5 and PNC were higher in traditional stove kitchens (n = 12, ρ: 0.93) than in Justa stove kitchens (n = 12, ρ: 0.67). The 24-h average concentrations of PM2.5 and PNC were also correlated with the maximum average concentrations during shorter-term averaging windows of one-, five-, 15-, and 60-min, respectively (Spearman ρ: PM2.5 [0.65, 0.85, 0.82, 0.71], PNC [0.74, 0.86, 0.88, 0.86]). Given the moderate correlations observed between 24-h PM2.5 and PNC and between 24-h and the shorter-term averaging windows within size fractions, investigators may need to consider cost-effectiveness and information gained by measuring both size fractions for the study objective. Further evaluations of other stove and fuel combinations are needed.
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Affiliation(s)
- Megan L Benka-Coker
- Department of Health Sciences, Gettysburg College, 300 North Washington Street, Campus Box 432, Gettysburg, PA, 17325, USA; Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - John Volckens
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, 80523, USA
| | - Nicholas Good
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, 80523, USA
| | - Kelsey R Bilsback
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, 80523, USA
| | - Christian L'Orange
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, 80523, USA
| | - Casey Quinn
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, 80523, USA
| | - Bonnie N Young
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - Sarah Rajkumar
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - Ander Wilson
- Department of Statistics, Colorado State University, Fort Collins, CO, 80523, USA
| | - Jessica Tryner
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, 80523, USA
| | - Sebastian Africano
- Trees, Water & People, 633 Remington Street, Fort Collins, CO, 80524, USA
| | - Anibal B Osorto
- Asociación Hondureña para el Desarrollo, Tegucigalpa, Honduras
| | - Maggie L Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, 80523, USA.
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Liang W, Wang B, Shen G, Cao S, Mcswain B, Qin N, Zhao L, Yu D, Gong J, Zhao S, Zhang Y, Duan X. Association of solid fuel use with risk of stunting in children living in China. INDOOR AIR 2020; 30:264-274. [PMID: 31755597 PMCID: PMC7047593 DOI: 10.1111/ina.12627] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/16/2019] [Accepted: 11/19/2019] [Indexed: 05/02/2023]
Abstract
Stunting adversely affects physical and mental outcomes of children. It has not been examined whether household air pollution from solid fuel combustion is a risk factor for stunting in children. In a total of 41,439 children aged 6-17 across China, height was measured using a unified protocol. Multivariable linear regression models and logistic regression models were used to assess the associations of solid fuel use for cooking/heating with stunting in children. Adjusted for covariates, cooking/heating with solid fuel was significantly associated with a lower z-score for height for age and sex (β = -0.21 [-0.32 to -0.09] and -0.17 [-0.31 to -0.03], respectively) and an increased risk of stunting with an estimated ORs of 1.34 [1.07~1.68] and 1.37 [1.02~1.83], respectively. The risk of stunting associated with solid fuel use was statistically significant in high-age children. And the effect was greater on girls than on boys, though the difference was not statistically significant. Our study suggested that Chinese children living in households using solid fuel had a significantly higher risk of stunting than those living in households using cleaner fuel.
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Affiliation(s)
- Weigang Liang
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Beibei Wang
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Guofeng Shen
- College of Urban and Environmental Sciences, Peking university, Beijing 100871, China
| | - Suzhen Cao
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Bertrand Mcswain
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Ning Qin
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Liyun Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Dongmei Yu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jicheng Gong
- BIC-ESAT and SKL-ESPC, College of Environmental Science and Engineering, Peking university, Beijing 100871, China
| | - Shanshan Zhao
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, NC 27709, USA
| | - Yawei Zhang
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT 06520, USA
| | - Xiaoli Duan
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing 100083, China
- Corresponding authors: Dr. Xiaoli Duan, School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing 100083, China, Tel: +86 010 62334308, Fax: +86 010 8493 4276,
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Yu K, Lv J, Qiu G, Yu C, Guo Y, Bian Z, Yang L, Chen Y, Wang C, Pan A, Liang L, Hu FB, Chen Z, Li L, Wu T. Cooking fuels and risk of all-cause and cardiopulmonary mortality in urban China: a prospective cohort study. Lancet Glob Health 2020; 8:e430-e439. [PMID: 31972151 PMCID: PMC7031698 DOI: 10.1016/s2214-109x(19)30525-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/08/2019] [Accepted: 11/26/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cooking practice has transitioned from use of solid fuels to use of clean fuels, with addition of better ventilation facilities. However, the change in mortality risk associated with such a transition remains unclear. METHODS The China Kadoorie Biobank (CKB) Study enrolled participants (aged 30-79 years) from ten areas across China; we chose to study participants from five urban areas where transition from use of solid fuels to clean fuels for cooking was prevalent. Participants who reported regular cooking (weekly or more frequently) at baseline were categorised as persistent clean fuel users, previous solid fuel users, or persistent solid fuel users, according to self-reported fuel use histories. All-cause and cardiopulmonary mortality were identified through linkage to China's Disease Surveillance Point system and local mortality records. FINDINGS Between June 24, 2004, and July 15, 2008, 226 186 participants living in five urban areas of China were enrolled in the CKB Study. Among 171 677 participants who reported cooking regularly (weekly or more frequently), 75 785 (44%) were persistent clean fuel users, 80 511 (47%) were previous solid fuel users, and 15 381 (9%) were persistent solid fuel users. During a mean of 9·8 (SD 1·7) years of follow-up, 10 831 deaths were documented, including 3819 cardiovascular deaths and 761 respiratory deaths. Compared with persistent clean fuel users, persistent solid fuel users had significantly higher risks of all-cause mortality (hazard ratio [HR] 1·19, 95% CI 1·10-1·28), cardiovascular mortality (1·24, 1·10-1·39), and respiratory mortality (1·43, 1·10-1·85). The excess risk of all-cause and cardiopulmonary mortality fell by more than 60% in 5 years after cessation of solid fuel use and continued to decrease afterwards. Use of ventilation was associated with lower all-cause mortality risk, even among persistent clean fuel users (HR 0·78, 0·69-0·89). INTERPRETATION Solid fuel use for cooking is associated with a higher risk of mortality, and cessation of solid fuel use cuts excess mortality risks swiftly and substantially within 5 years. Ventilation use also lowers the risk of mortality, even among people who persistently use clean fuels. It is of prime importance for both policy makers and the public to accelerate the transition from solid fuels to clean fuels and promote efficient ventilation to minimise further adverse health effects. FUNDING National Natural Science Foundation of China, Wellcome Trust, and Kadoorie Charitable Foundation.
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Affiliation(s)
- Kuai Yu
- Department of Occupational and Environmental Health and Department of Epidemiology and Biostatistics, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Gaokun Qiu
- Department of Occupational and Environmental Health and Department of Epidemiology and Biostatistics, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Chaolong Wang
- Department of Occupational and Environmental Health and Department of Epidemiology and Biostatistics, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - An Pan
- Department of Occupational and Environmental Health and Department of Epidemiology and Biostatistics, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liming Liang
- Department of Epidemiology and Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Frank B Hu
- Department of Nutrition and Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.
| | - Tangchun Wu
- Department of Occupational and Environmental Health and Department of Epidemiology and Biostatistics, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Estévez-García JA, Schilmann A, Riojas-Rodríguez H, Berrueta V, Blanco S, Villaseñor-Lozano CG, Flores-Ramírez R, Cortez-Lugo M, Pérez-Padilla R. Women exposure to household air pollution after an improved cookstove program in rural San Luis Potosi, Mexico. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 702:134456. [PMID: 31734613 DOI: 10.1016/j.scitotenv.2019.134456] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 09/01/2019] [Accepted: 09/13/2019] [Indexed: 05/18/2023]
Abstract
The state government of San Luis Potosí (SLP), Mexico implemented an improved cookstove (ICS) program in rural areas. As part of the comprehensive program evaluation, we compared fine particulate material (PM2.5) concentrations in kitchens and patios in treated (TH), and non-treated households (NTH), and analyzed pollutant levels according to patterns of fuels and devices use reported by the women. A panel study was conducted in 728 households (357 TH and 371 NTH) in three regions of SLP including two sampling rounds in 2015-16. Data on exposure determinants, ICS conditions and cooking practices were collected. Daily PM2.5 in kitchen and patio was measured in a subsample. The average treatment effect was estimated using the double difference method. We constructed a mixed linear model to estimate PM2.5 levels for the entire study sample and obtained personal exposure according to time-activity logs. NTH had lower socioeconomic status compared to TH. The average daily PM2.5 concentrations in NTH compared to TH were 155.2 and 92.6 μg/m3 for kitchen and 35.4 and 39.8 μg/m3 for patio, respectively. PM2.5 levels showed significant regional differences but no significant treatment effect. In many cases, the ICS was added to previous open fire and LPG use (stacking). The household size, kitchen ventilation, relative humidity, temperature and the ratio of indoor/outdoor PM2.5 concentration were significant predictors of kitchen PM2.5 levels. The daily PM2.5 personal exposure was significantly reduced using ICS in good conditions or LPG (57 μg/m3) compared to the traditional open fire (86 μg/m3). This study strengthens the evidence on the potential daily PM2.5 exposure reduction for women using an ICS in good conditions or LPG, displacing the polluting open fire. Comprehensive strategies tailored to the sociocultural context of the communities are needed to implement clean energy programs that achieve adoption and sustained use of ICS or LPG.
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Affiliation(s)
- Jesús Alejandro Estévez-García
- Environmental Health Department, National Institute of Public Health, Av. Universidad 655, Colonia Santa María, Ahuacatitlan, 62100 Cuernavaca, Morelos, Mexico.
| | - Astrid Schilmann
- Environmental Health Department, National Institute of Public Health, Av. Universidad 655, Colonia Santa María, Ahuacatitlan, 62100 Cuernavaca, Morelos, Mexico.
| | - Horacio Riojas-Rodríguez
- Environmental Health Department, National Institute of Public Health, Av. Universidad 655, Colonia Santa María, Ahuacatitlan, 62100 Cuernavaca, Morelos, Mexico.
| | - Víctor Berrueta
- Interdisciplinary Group for Appropriate Rural Technology (GIRA), C.P.61609 Patzcuaro, Michoacan, Mexico
| | - Salvador Blanco
- General Coordination of Pollution and Environmental Health, National Institute of Ecology and Climate Change (INECC), Periférico Sur 5000, 4530, Mexico City, Mexico.
| | - César Gerardo Villaseñor-Lozano
- Coordination for Innovation and Application of Science and Technology (CIACYT), Autonomous University of San Luis Potosi, Avenida Sierra Leona 550, 78210 San Luis Potosí, Mexico
| | - Rogelio Flores-Ramírez
- CONACyT Research Fellow, Coordination for Innovation and Application of Science and Technology (CIACYT), Autonomous University of San Luis Potosi. Avenida Sierra Leona 550, 78210 San Luis Potosí, Mexico
| | - Marlene Cortez-Lugo
- Environmental Health Department, National Institute of Public Health, Av. Universidad 655, Colonia Santa María, Ahuacatitlan, 62100 Cuernavaca, Morelos, Mexico
| | - Rogelio Pérez-Padilla
- Tobacco and COPD Department, National Institute of Respiratory Diseases (INER), Tlalpan 4502, 14080 Mexico City, Mexico
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Lee AG, Kaali S, Quinn A, Delimini R, Burkart K, Opoku-Mensah J, Wylie BJ, Yawson AK, Kinney PL, Ae-Ngibise KA, Chillrud S, Jack D, Asante KP. Prenatal Household Air Pollution Is Associated with Impaired Infant Lung Function with Sex-Specific Effects. Evidence from GRAPHS, a Cluster Randomized Cookstove Intervention Trial. Am J Respir Crit Care Med 2020; 199:738-746. [PMID: 30256656 DOI: 10.1164/rccm.201804-0694oc] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
RATIONALE Approximately 2.8 billion people are exposed daily to household air pollution from polluting cookstoves. The effects of prenatal household air pollution on lung development are unknown. OBJECTIVES To prospectively examine associations between prenatal household air pollution and infant lung function and pneumonia in rural Ghana. METHODS Prenatal household air pollution exposure was indexed by serial maternal carbon monoxide personal exposure measurements. Using linear regression, we examined associations between average prenatal carbon monoxide and infant lung function at age 30 days, first in the entire cohort (n = 384) and then stratified by sex. Quasi-Poisson generalized additive models explored associations between infant lung function and pneumonia. MEASUREMENTS AND MAIN RESULTS Multivariable linear regression models showed that average prenatal carbon monoxide exposure was associated with reduced time to peak tidal expiratory flow to expiratory time (β = -0.004; P = 0.01), increased respiratory rate (β = 0.28; P = 0.01), and increased minute ventilation (β = 7.21; P = 0.05), considered separately, per 1 ppm increase in average prenatal carbon monoxide. Sex-stratified analyses suggested that girls were particularly vulnerable (time to peak tidal expiratory flow to expiratory time: β = -0.003, P = 0.05; respiratory rate: β = 0.36, P = 0.01; minute ventilation: β = 11.25, P = 0.01; passive respiratory compliance normalized for body weight: β = 0.005, P = 0.01). Increased respiratory rate at age 30 days was associated with increased risk for physician-assessed pneumonia (relative risk, 1.02; 95% confidence interval, 1.00-1.04) and severe pneumonia (relative risk, 1.04; 95% confidence interval, 1.00-1.08) in the first year of life. CONCLUSIONS Increased prenatal household air pollution exposure is associated with impaired infant lung function. Altered infant lung function may increase risk for pneumonia in the first year of life. These findings have implications for future respiratory health. Clinical trial registered with www.clinicaltrials.gov (NCT 01335490).
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Affiliation(s)
- Alison G Lee
- 1 Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Seyram Kaali
- 2 Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Ashlinn Quinn
- 3 Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - Rupert Delimini
- 4 Department of Biomedical Sciences, University of Health and Allied Services, Volta Region, Ghana
| | - Katrin Burkart
- 5 Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Jones Opoku-Mensah
- 2 Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Blair J Wylie
- 6 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massacusetts
| | - Abena Konadu Yawson
- 2 Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Patrick L Kinney
- 7 Department of Health, Boston University School of Public Health, Boston, Massachusetts; and
| | - Kenneth A Ae-Ngibise
- 2 Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Steven Chillrud
- 8 Lamont-Doherty Earth Observatory at Columbia University, Palisades, New York
| | - Darby Jack
- 5 Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Kwaku Poku Asante
- 2 Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
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Semlali BEB, El Amrani C, Ortiz G. Hadoop Paradigm for Satellite Environmental Big Data Processing. INTERNATIONAL JOURNAL OF AGRICULTURAL AND ENVIRONMENTAL INFORMATION SYSTEMS 2020. [DOI: 10.4018/ijaeis.2020010102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The important growth of industrial, transport, and agriculture activities, has not led only to the air quality and climate changes issues, but also to the increase of the potential natural disasters. The emission of harmful gases, particularly: the Vertical Column Density (VCD) of CO, SO2 and NOx, is one of the major factors causing the aforementioned environmental problems. Our research aims to contribute finding solution to this hazardous phenomenon, by using remote sensing (RS) techniques to monitor air quality which may help decision makers. However, RS data is not easy to manage, because of their huge amount, high complexity, variety, and velocity, Thus, our manuscript explains the different aspects of the used satellite data. Furthermore, this article has proven that RS data could be regarded as big data. Accordingly, we have adopted the Hadoop big data architecture and explained how to process efficiently RS environmental data.
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Affiliation(s)
| | - Chaker El Amrani
- LIST Lab, Faculty of Sciences and Techniques of Tangier, Abdelmalek Essaâdi University, Morocco
| | - Guadalupe Ortiz
- UCASE Research Group, Escuela Superior de Ingeniería, University of Cadiz, Spain
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142
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Yamamoto SS, Yacyshyn E, Jhangri GS, Chopra A, Parmar D, Jones CA. Household air pollution and arthritis in low-and middle-income countries: Cross-sectional evidence from the World Health Organization's study on Global Ageing and Adult Health. PLoS One 2019; 14:e0226738. [PMID: 31881058 PMCID: PMC6934325 DOI: 10.1371/journal.pone.0226738] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/06/2019] [Indexed: 02/07/2023] Open
Abstract
Background Evidence points to a clear link between air pollution exposure and several chronic diseases though investigations regarding arthritis are still lacking. Emerging evidence suggests an association between ambient air pollution and rheumatoid arthritis. Household air pollution exposure, conversely, is largely unstudied but may be an important consideration for arthritis, particularly in low- and middle-income countries (LMICs), where cooking and heating activities can generate high indoor air pollutant levels. Methods We investigated the association of household air pollution (electricity vs. gas; kerosene/paraffin; coal/charcoal; wood; or agriculture/crop/animal dung/shrubs/grass as the main fuel used for cooking) and arthritis in six LMICs (China, Ghana, India, Mexico, the Russian Federation, South Africa) using data from Wave I of the World Health Organization Study on Global AGEing and Adult Health (SAGE) (2007–2010). Multivariable analyses were adjusted for sociodemographic, household and lifestyle characteristics and several comorbidities. Results The use of gas (aOR = 1.76, 95%CI: 1.40–2.21); coal (aOR = 1.74, 95%CI: 1.22–2.47); wood (aOR = 1.69, 95%CI: 1.30–2.19); or agriculture/crop/animal dung/shrubs/grass: aOR = 1.95 (1.46–2.61) fuels for cooking were strongly associated with an increased odds of arthritis, compared to electricity in cluster and stratified adjusted analyses. Gender (female), age (≥50 years), overweight (25.0 ≤BMI<30.0 kg/m2), obesity (BMI ≥30.0 kg/m2), former and current alcohol consumption, and the comorbidities angina pectoris, diabetes, chronic lung disease, depression and hypertension were also associated with a higher odds of arthritis. Underweight (BMI<18.5 kg/m2) and higher education levels (college/university completed/post-graduate studies) were associated with a lower odds of arthritis. Conclusions These findings suggest that exposure to household air pollution from cook fuels is associated with an increased odds of arthritis in these regions, which warrants further investigation.
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Affiliation(s)
- Shelby S. Yamamoto
- School of Public Health, University of Alberta, Edmonton, Canada
- * E-mail:
| | - Elaine Yacyshyn
- Division of Rheumatology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Gian S. Jhangri
- School of Public Health, University of Alberta, Edmonton, Canada
| | | | - Divya Parmar
- School of Health Sciences, City, University of London, London, England, United Kingdom
| | - C. Allyson Jones
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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143
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Burney P, Amaral AFS. Air pollution and chronic airway disease: is the evidence always clear? Lancet 2019; 394:2198-2200. [PMID: 31761449 DOI: 10.1016/s0140-6736(19)32537-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/14/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Peter Burney
- National Heart and Lung Institute, Imperial College, London, UK.
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144
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Goodman D, Crocker ME, Pervaiz F, McCollum ED, Steenland K, Simkovich SM, Miele CH, Hammitt LL, Herrera P, Zar HJ, Campbell H, Lanata CF, McCracken JP, Thompson LM, Rosa G, Kirby MA, Garg S, Thangavel G, Thanasekaraan V, Balakrishnan K, King C, Clasen T, Checkley W. Challenges in the diagnosis of paediatric pneumonia in intervention field trials: recommendations from a pneumonia field trial working group. THE LANCET. RESPIRATORY MEDICINE 2019; 7:1068-1083. [PMID: 31591066 PMCID: PMC7164819 DOI: 10.1016/s2213-2600(19)30249-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/27/2019] [Accepted: 07/03/2019] [Indexed: 12/14/2022]
Abstract
Pneumonia is a leading killer of children younger than 5 years despite high vaccination coverage, improved nutrition, and widespread implementation of the Integrated Management of Childhood Illnesses algorithm. Assessing the effect of interventions on childhood pneumonia is challenging because the choice of case definition and surveillance approach can affect the identification of pneumonia substantially. In anticipation of an intervention trial aimed to reduce childhood pneumonia by lowering household air pollution, we created a working group to provide recommendations regarding study design and implementation. We suggest to, first, select a standard case definition that combines acute (≤14 days) respiratory symptoms and signs and general danger signs with ancillary tests (such as chest imaging and pulse oximetry) to improve pneumonia identification; second, to prioritise active hospital-based pneumonia surveillance over passive case finding or home-based surveillance to reduce the risk of non-differential misclassification of pneumonia and, as a result, a reduced effect size in a randomised trial; and, lastly, to consider longitudinal follow-up of children younger than 1 year, as this age group has the highest incidence of severe pneumonia.
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Affiliation(s)
- Dina Goodman
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Mary E Crocker
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA; Division of Pediatric Pulmonology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Farhan Pervaiz
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA; School of Medicine, and Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kyle Steenland
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Suzanne M Simkovich
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Catherine H Miele
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Laura L Hammitt
- School of Medicine, and Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Phabiola Herrera
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Heather J Zar
- Department of Pediatrics and Child Health, SA-MRC Unit on Child & Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Harry Campbell
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Claudio F Lanata
- Instituto de Investigación Nutricional, Lima, Peru; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - John P McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Lisa M Thompson
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Ghislaine Rosa
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Miles A Kirby
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sarada Garg
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Medical College & Research Institute (Deemed University), Chennai, India
| | - Gurusamy Thangavel
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Medical College & Research Institute (Deemed University), Chennai, India
| | - Vijayalakshmi Thanasekaraan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Medical College & Research Institute (Deemed University), Chennai, India
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Medical College & Research Institute (Deemed University), Chennai, India
| | - Carina King
- Institute for Global Health, University College London, London, UK
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA; School of Medicine, and Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
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Nicole W. Smoke Alarm? Solid Fuel Use May Be a Risk Factor for Mortality and Disease. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:124001. [PMID: 31825673 PMCID: PMC6957276 DOI: 10.1289/ehp6257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
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146
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Carrión D, Kaali S, Kinney PL, Owusu-Agyei S, Chillrud S, Yawson AK, Quinn A, Wylie B, Ae-Ngibise K, Lee AG, Tokarz R, Iddrisu L, Jack DW, Asante KP. Examining the relationship between household air pollution and infant microbial nasal carriage in a Ghanaian cohort. ENVIRONMENT INTERNATIONAL 2019; 133:105150. [PMID: 31518936 PMCID: PMC6868532 DOI: 10.1016/j.envint.2019.105150] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/19/2019] [Accepted: 09/02/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND Pneumonia, a leading cause of childhood mortality, is associated with household air pollution (HAP) exposure. Mechanisms between HAP and pneumonia are poorly understood, but studies suggest that HAP may increase the likelihood of bacterial, instead of viral, pneumonia. We assessed the relationship between HAP and infant microbial nasal carriage among 260 infants participating in the Ghana Randomized Air Pollution and Health Study (GRAPHS). METHODS Data are from GRAPHS, a cluster-randomized controlled trial of cookstove interventions (improved biomass or LPG) versus the 3-stone (baseline) cookstove. Infants were surveyed for pneumonia during the first year of life and had routine personal exposure assessments. Nasopharyngeal swabs collected from pneumonia cases (n = 130) and healthy controls (n = 130) were analyzed for presence of 22 common respiratory microbes by MassTag polymerase chain reaction. Data analyses included intention-to-treat (ITT) comparisons of microbial species presence by study arm, and exposure-response relationships. RESULTS In ITT analyses, 3-stone arm participants had a higher mean number of microbial species than the LPG (LPG: 2.71, 3-stone: 3.34, p < 0.0001, n = 260). This difference was driven by increased bacterial (p < 0.0001) rather than viral species presence (non-significant). Results were pronounced in pneumonia cases and attenuated in healthy controls. Higher prevalence bacterial species were Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. Exposure-response relationships did not yield significant associations between measured CO and nasal microbial carriage. CONCLUSIONS Our intention-to-treat findings are consistent with a link between HAP and bacterial nasal carriage. No relationships were found for viral carriage. Given the null results in exposure-response analysis, it is likely that a pollutant besides CO is driving these differences.
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Affiliation(s)
| | - Seyram Kaali
- Kintampo Health Research Centre, Kintampo, Ghana
| | - Patrick L Kinney
- Department of Environmental Health, Boston University, Boston, USA
| | | | - Steven Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, New York, USA
| | | | - Ashlinn Quinn
- Fogarty International Center, National Institutes of Health, Bethesda, USA
| | - Blair Wylie
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, USA
| | | | - Alison G Lee
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Rafal Tokarz
- Center for Infection and Immunity, Columbia University, New York, USA
| | | | - Darby W Jack
- Department of Environmental Health Sciences, Columbia University, New York, USA.
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Stanistreet D, Hyseni L, Puzzolo E, Higgerson J, Ronzi S, Anderson de Cuevas R, Adekoje O, Bruce N, Mbatchou Ngahane B, Pope D. Barriers and Facilitators to the Adoption and Sustained Use of Cleaner Fuels in Southwest Cameroon: Situating 'Lay' Knowledge within Evidence-Based Policy and Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4702. [PMID: 31779156 PMCID: PMC6926764 DOI: 10.3390/ijerph16234702] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/16/2022]
Abstract
Approximately four million people die each year in low- and middle-income countries from household air pollution (HAP) due to inefficient cooking with solid fuels. Liquid Petroleum Gas (LPG) offers a clean energy option in the transition towards renewable energy. This qualitative study explored lay knowledge of barriers and facilitators to scaling up clean fuels in Cameroon, informed by Quinn et al.'s Logic Model. The model has five domains and we focused on the user and community needs domain, reporting the findings of 28 semi-structured interviews (SSIs) and four focus group discussions (FGDs) that explored the reasons behind fuel use choices. The findings suggest that affordability, safety, convenience, and awareness of health issues are all important influences on decision making to the adoption and sustained use of LPG, with affordability being the most critical issue. We also found the ability of clean fuels to meet cooking needs to be central to decision-making, rather than an aspect of convenience, as the logic model suggests. Local communities provide important insights into the barriers and facilitators to using clean fuels. We adapt Quinn et al.'s logic model accordingly, giving more weight to lay knowledge so that it is better positioned to inform policy development.
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Affiliation(s)
- Debbi Stanistreet
- Department of Epidemiology and Public Health, Royal College Surgeons Ireland, Dublin D02 YN77, Ireland;
| | - Lirije Hyseni
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3BX, UK; (L.H.); (E.P.); (S.R.); (N.B.); (D.P.)
| | - Elisa Puzzolo
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3BX, UK; (L.H.); (E.P.); (S.R.); (N.B.); (D.P.)
| | - James Higgerson
- Department of Nursing, Midwifery and Social Work, University of Manchester, Manchester M13 9PL, UK;
| | - Sara Ronzi
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3BX, UK; (L.H.); (E.P.); (S.R.); (N.B.); (D.P.)
| | - Rachel Anderson de Cuevas
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3BX, UK; (L.H.); (E.P.); (S.R.); (N.B.); (D.P.)
| | - Oluwakorede Adekoje
- Department of Epidemiology and Public Health, Royal College Surgeons Ireland, Dublin D02 YN77, Ireland;
| | - Nigel Bruce
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3BX, UK; (L.H.); (E.P.); (S.R.); (N.B.); (D.P.)
| | | | - Daniel Pope
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3BX, UK; (L.H.); (E.P.); (S.R.); (N.B.); (D.P.)
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148
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International Approach to Environmental and Lung Health. A Perspective from the Fogarty International Center. Ann Am Thorac Soc 2019; 15:S109-S113. [PMID: 29676630 DOI: 10.1513/annalsats.201708-685mg] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The global burden of lung disease is substantial, accounting for an estimated 7.5 million deaths per year, approximately 14% of annual deaths worldwide. The prime illnesses include, in descending order, chronic obstructive pulmonary disease, lung cancer, tuberculosis, acute respiratory infections, asthma, and interstitial lung fibrosis. Key risk factors include smoking, both indoor and outdoor air pollution, and occupational exposures. Although the distribution of both the diseases and the risk factors varies greatly by age, geography, and setting, the greatest burden falls on populations living in low- and middle-income countries. Improvements in these metrics will require major public health interventions to curb smoking; improving air quality both in the community and the household; addressing the ever-present burden of infections, including tuberculosis, flu, and the many agents that cause acute respiratory disease; and identifying and protecting workers from the hazards of exposure to toxic substances. Although research over the years has identified many ways to reduce or prevent the enormous burden of disease, a huge gap exists between what we know and what we can do. This "implementation gap" is the greatest challenge we face in this field today. Research on how best to address and implement the changes needed will require not only biomedical advances to improve treatment but also social, economic, and policy research. We still need to elaborate more effective evidence-based policies and interventions to control tobacco use, address ambient and household air pollution, and improve the prevention and treatment of tuberculosis and acute respiratory infections with vaccines and drugs and reduce exposures to environmental and occupational hazards. Until these efforts receive greater prioritization, the burden of disease is unlikely to diminish a great deal more.
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149
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Zheng H, Zhao B, Wang S, Wang T, Ding D, Chang X, Liu K, Xing J, Dong Z, Aunan K, Liu T, Wu X, Zhang S, Wu Y. Transition in source contributions of PM 2.5 exposure and associated premature mortality in China during 2005-2015. ENVIRONMENT INTERNATIONAL 2019; 132:105111. [PMID: 31476640 DOI: 10.1016/j.envint.2019.105111] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 05/09/2023]
Abstract
The serious fine particle (PM2.5) pollution in China causes millions of premature deaths. Driven by swift economic growth and stringent control policies, air pollutant emissions in China have changed significantly in the last decade, but the change in the source contribution of PM2.5-related health impacts remains unclear. In this study, we develop a multi-pollutant emission inventory in China for 2005-2015, and combine chemical transport modeling, ambient/household exposure evaluation and health impact assessment to quantify the contribution of eight emission sectors to PM2.5 exposure and associated health risk. From 2005 to 2015, the mortality due to PM2.5 from ambient air pollution (AAP) decreases from 1.04 (95% confidence interval, 0.84-1.25) million to 0.87 (0.70-1.04) million. The agricultural sector contributes 25% and 32% to ambient PM2.5-attributed mortality in 2005 and 2015, respectively, representing the largest contributor during this period. The contribution of power plants drops monotonously from 13% to 6%. The percentage contribution of industrial process drops significantly while the contribution of industrial combustion stays the same level. The overall contribution of industry is still as large as 26% in 2015 in spite of strict control measures. For transportation, despite strict emission standards, its contribution increases remarkably due to the rapid growth of vehicle population. When both ambient and household PM2.5 exposures are taken into account, the mortality due to integrated population-weighted exposure to PM2.5 (IPWE) drops from 1.78 (1.46-2.09) million in 2005 to 1.28 (1.05-1.52) million in 2015. Most of the IPWE reduction comes from domestic combustion as a result of urbanization and improved income, whereas this sector remains the largest contributor (58%) to IPWE-related health risk in 2015. Our results suggest that the government should dynamically adjust the air pollution control strategy according to the change in source contributions. Domestic combustion and agriculture should be prioritized considering their predominant contributions to mortality and the lack of effective control policies. More stringent control measures for industry and transportation are necessary since the existing policies have not adequately reduced their health impacts. Electricity production is no longer the top priority of air pollution control policies given its lower health impact compared with that of other sources.
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Affiliation(s)
- Haotian Zheng
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing 100084, China; State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, Beijing 100084, China
| | - Bin Zhao
- Joint Institute for Regional Earth System Science and Engineering and Department of Atmospheric and Oceanic Sciences, University of California, Los Angeles, CA 90095, USA; Pacific Northwest National Laboratory, Richland, WA 99352, USA.
| | - Shuxiao Wang
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing 100084, China; State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, Beijing 100084, China.
| | - Tong Wang
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing 100084, China; State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, Beijing 100084, China
| | - Dian Ding
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing 100084, China; State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, Beijing 100084, China
| | - Xing Chang
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing 100084, China; State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, Beijing 100084, China
| | - Kaiyun Liu
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing 100084, China; State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, Beijing 100084, China
| | - Jia Xing
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing 100084, China; State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, Beijing 100084, China
| | - Zhaoxin Dong
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing 100084, China; State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, Beijing 100084, China
| | - Kristin Aunan
- CICERO Center for International Climate Research, N-0318 Oslo, Norway
| | - Tonghao Liu
- China National Environmental Monitoring Centre, Beijing 100012, China
| | - Xiaomeng Wu
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing 100084, China; State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, Beijing 100084, China
| | - Shaojun Zhang
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing 100084, China; State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, Beijing 100084, China
| | - Ye Wu
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing 100084, China; State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, Beijing 100084, China
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150
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Schilmann A, Riojas-Rodríguez H, Catalán-Vázquez M, Estevez-García JA, Masera O, Berrueta-Soriano V, Armendariz-Arnez C, Pérez-Padilla R, Cortez-Lugo M, Rodríguez-Dozal S, Romieu I. A follow-up study after an improved cookstove intervention in rural Mexico: Estimation of household energy use and chronic PM 2.5 exposure. ENVIRONMENT INTERNATIONAL 2019; 131:105013. [PMID: 31352264 DOI: 10.1016/j.envint.2019.105013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 07/09/2019] [Accepted: 07/11/2019] [Indexed: 05/24/2023]
Abstract
The benefits of improved biomass cookstoves (ICS) depends on their adoption and sustained use. Few studies have documented if and how they are used more than five years after being introduced. We conducted a 9-year prospective cohort study among young rural women in the highlands of Michoacan, Mexico. Participants had received a Patsari ICS during a community trial either in 2005 or 2006. With retrospective information collected in 2012-13, we studied the households' energy use, ICS survival, and cooking practices during the follow-up period. Using an exposure model constructed with personal PM2.5 measurements in a subsample of homes at the time of the initial trial in 2005, we estimated the exposure associated with different energy use patterns during the follow-up period. The ICS had a mean lifespan of 4 years, after which more than half of the stoves were not in use; therefore, the use of open fire increased, particularly among the indigenous communities. ICS use peak was achieved two years after the initial trial, either exclusively or combined with open fire. Yearly household energy use and other variables were used to estimate chronic air pollution exposure. Mean PM2.5 exposure during the follow-up period ranged from 51 to 319 μg/m3; the median was 102 and 146 μg/m3 for mainly ICS and mainly open fire use, respectively. The ICS has a useful period after which it needs maintenance, repair, or replacement. Unfortunately, many programs have not afforded a follow-up component. Exposure to biomass smoke air pollutants can be reduced by using an ICS instead of the traditional open fire. Household energy strategies should ensure equitable access to clean energy options adapted to local needs and preferences with culturally appropriate technology implemented on a sustainable perspective.
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Affiliation(s)
- Astrid Schilmann
- Environmental Health Department, Centre for Population Health Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Horacio Riojas-Rodríguez
- Environmental Health Department, Centre for Population Health Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico.
| | - Minerva Catalán-Vázquez
- Clinical Epidemiology Department, National Institute of Respiratory Diseases (INER), Mexico City, Mexico
| | - Jesús Alejandro Estevez-García
- Environmental Health Department, Centre for Population Health Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Omar Masera
- Institute for Ecosystem and Sustainability Research, National Autonomous University of Mexico (UNAM), Morelia, Michoacan, Mexico
| | - Víctor Berrueta-Soriano
- Interdisciplinary Group on Appropriate Rural Technology (GIRA), Patzcuaro, Michoacan, Mexico
| | - Cynthia Armendariz-Arnez
- Escuela Nacional de Estudios Superiores Unidad Morelia, National Autonomous University of Mexico (UNAM), Morelia, Michoacan, Mexico
| | - Rogelio Pérez-Padilla
- Tobacco and COPD Department, National Institute of Respiratory Diseases (INER), Mexico City, Mexico
| | - Marlene Cortez-Lugo
- Environmental Health Department, Centre for Population Health Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Sandra Rodríguez-Dozal
- Environmental Health Department, Centre for Population Health Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Isabelle Romieu
- Environmental Health Department, Centre for Population Health Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico; Hubert Department of Global Health, Emory University, Atlanta, GA, USA
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