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Heinzerling AP, Guarnieri MJ, Mann JK, Diaz JV, Thompson LM, Diaz A, Bruce NG, Smith KR, Balmes JR. Lung function in woodsmoke-exposed Guatemalan children following a chimney stove intervention. Thorax 2016; 71:421-8. [PMID: 26966237 PMCID: PMC10666195 DOI: 10.1136/thoraxjnl-2015-207783] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/15/2015] [Indexed: 11/04/2022]
Abstract
RATIONALE Household air pollution (HAP) from solid fuel combustion is a major contributor to the global burden of disease, with considerable impact from respiratory infections in children. The impact of HAP on lung function is unknown. OBJECTIVES The Childhood Exposure to Respirable Particulate Matter (CRECER) prospective cohort study followed Guatemalan children who participated in the Randomised Exposure Study of Pollution Indoors and Respiratory Effects (RESPIRE) trial of a chimney stove intervention to determine the effect of early childhood HAP exposure on growth of lung function. METHODS RESPIRE households with pregnant women or infant children were randomised to receive a chimney stove at the beginning or at the end of the 18-month trial. During CRECER, a subset of these children, as well as children from households with newly installed stoves, were followed with spirometry beginning at age 5. Biomass smoke exposure was measured using personal carbon monoxide tubes. Two-stage regression models were employed to analyse associations with lung function growth. MEASUREMENTS AND MAIN RESULTS Longitudinal peak expiratory flow (PEF) and FEV1 data were available for 443 and 437 children, respectively, aged 5-8 (mean follow-up 1.3 years). Decreases in PEF growth of 173 mL/min/year (95% CI -341 to -7) and FEV1 of 44 mL/year (95% CI -91 to 4) were observed with stove installation at 18 months compared with stove installation at birth in analyses adjusted for multiple covariates. No statistically significant associations were observed between personal HAP exposure and lung function. CONCLUSIONS A significant decrease in PEF growth and a large non-significant decrease in FEV1 growth were observed with later stove installation. Additional studies including longer follow-up and cleaner stoves or fuels are needed.
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Affiliation(s)
- Amy P Heinzerling
- Department of Medicine, University of California San Francisco, California, USA
| | - Michael J Guarnieri
- Department of Medicine, University of California San Francisco, California, USA
| | - Jennifer K Mann
- Department of Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA
| | - Janet V Diaz
- Department of Medicine, University of California San Francisco, California, USA
| | - Lisa M Thompson
- School of Nursing, University of California, San Francisco, California, USA
| | - Anaite Diaz
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala
| | - Nigel G Bruce
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Kirk R Smith
- Department of Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA
| | - John R Balmes
- Department of Medicine, University of California San Francisco, California, USA
- Department of Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA
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202
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Raspanti GA, Hashibe M, Siwakoti B, Wei M, Thakur BK, Pun CB, Al-Temimi M, Lee YCA, Sapkota A. Household air pollution and lung cancer risk among never-smokers in Nepal. ENVIRONMENTAL RESEARCH 2016; 147:141-145. [PMID: 26874046 DOI: 10.1016/j.envres.2016.02.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/05/2016] [Accepted: 02/04/2016] [Indexed: 06/05/2023]
Abstract
More than half of the global population relies on biomass fuels (wood, charcoal, crop residue, dung) for cooking and/or heating purposes. Household air pollution (HAP) resulting from the use of these solid fuels is of particular concern, given the overall prevalence as well as the intensity of exposure and the range of potential adverse health outcomes. Long term exposure to HAP is a major public health concern, particularly among women and children in low and middle income countries. In this study, we investigated the association between exposure to HAP resulting from combustion of biomass and lung cancer risk among Nepalese population. Using a hospital-based case-control study (2009-2012), we recruited 606 lung cancer cases and 606 healthy controls matched on age (±5 years), gender, and geographical residence. We used unconditional logistic regression to compute odds ratios (ORs) and 95% Confidence Intervals (95% CI) for lung cancer risk associated with HAP exposures, adjusting for potential confounders (tobacco use, TB status, SES, age, gender, ethnicity, and exposure to second hand smoke. In our overall analysis, we observed increased risk of lung cancer among those who were exposed to HAPs (OR: 1.77, 95% CI: 1.00-3.14). A more detailed analysis stratified by smoking status showed considerably higher risk of lung cancer associated with increasing duration of exposure to HAP from biomass combustion, with evidence of a borderline exposure-response relationship (Ptrend=0.05) that was more pronounced among never-smokers (Ptrend=0.01). Our results suggest that chronic exposure to HAP resulting from biomass combustion is associated with increased lung cancer risk, particularly among never-smokers in Nepal.
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Affiliation(s)
- Greg A Raspanti
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, United States
| | - Mia Hashibe
- Division of Public Health, Department of Family & Preventive Medicine, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Bhola Siwakoti
- B.P. Koirala Memorial Cancer Hospital, Bharatpur, Chitwan, Nepal
| | - Mei Wei
- Division of Public Health, Department of Family & Preventive Medicine, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, United States
| | | | - Chin Bahadur Pun
- B.P. Koirala Memorial Cancer Hospital, Bharatpur, Chitwan, Nepal
| | - Mohammed Al-Temimi
- Division of Public Health, Department of Family & Preventive Medicine, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Yuan-Chin Amy Lee
- Division of Public Health, Department of Family & Preventive Medicine, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Amir Sapkota
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, United States.
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203
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Asante KP, Kinney P, Zandoh C, Vliet EV, Nettey E, Abokyi L, Owusu-Agyei S, Jack D. CHILDHOOD RESPIRATORY MORBIDITY AND COOKING PRACTICES AMONG HOUSEHOLDS IN A PREDOMINANTLY RURAL AREA OF GHANA. Afr J Infect Dis 2016; 10:102-110. [PMID: 28480444 PMCID: PMC5411984 DOI: 10.21010/ajid.v10i2.5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Household air pollution is a leading risk factor for respiratory morbidity and mortality in developing countries where biomass fuel is mainly used for cooking. Materials and Method: A household cross-sectional survey was conducted in a predominantly rural area of Ghana in 2007 to determine the prevalence of respiratory symptoms and their associated risk factors. Household cooking practices were also assessed as part of the survey. Results: Household heads of twelve thousand, three hundred and thirty-three households were interviewed. Fifty-seven percent (7006/12333) of these households had at least one child less than five years of age. The prevalence of symptoms of acute lower respiratory infections (ALRI) was 13.7% (n= 957, 95% CI 12.8 – 15.5%). A majority (77.8%, 95% CI, 77.7 - 78.5%) of households used wood as their primary fuel. Majority of respondents who used wood as their primary fuel obtained them by gathering wood from their neighborhood (95.6%, 9177/9595) and used a 3-stone local stove for cooking (94.9%, 9101/9595). In a randomly selected subset of respondents, females were the persons who mostly gathered firewood from the fields (90.8%, 296/326) and did the cooking (94.8%, 384/406) for the household. Conclusion: Symptoms of ALRI reported by caregivers is high in the Kintampo area of Ghana where biomass fuel use is also high. There is the need to initiate interventions that use improved cook stoves and to test the health benefits of such interventions.
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Affiliation(s)
- Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Research Centre, P. O. Box 200, Kintampo, Ghana
| | - Patrick Kinney
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, 722 West 168th Street, Room 1104ENew York, NY 10032
| | - Charles Zandoh
- Kintampo Health Research Centre, Ghana Health Research Centre, P. O. Box 200, Kintampo, Ghana
| | - Eleanne Van Vliet
- Kintampo Health Research Centre, Ghana Health Research Centre, P. O. Box 200, Kintampo, Ghana
| | - Ernest Nettey
- Kintampo Health Research Centre, Ghana Health Research Centre, P. O. Box 200, Kintampo, Ghana
| | - Livesy Abokyi
- Kintampo Health Research Centre, Ghana Health Research Centre, P. O. Box 200, Kintampo, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Research Centre, P. O. Box 200, Kintampo, Ghana
| | - Darby Jack
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, 722 West 168th Street, Room 1104ENew York, NY 10032
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204
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Kuhn R, Rothman DS, Turner S, Solórzano J, Hughes B. Beyond Attributable Burden: Estimating the Avoidable Burden of Disease Associated with Household Air Pollution. PLoS One 2016; 11:e0149669. [PMID: 26982804 PMCID: PMC4794200 DOI: 10.1371/journal.pone.0149669] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 01/18/2016] [Indexed: 12/20/2022] Open
Abstract
Background The Global Burden of Disease (GBD) studies have transformed global understanding of health risks by producing comprehensive estimates of attributable disease burden, or the current disease that would be eliminated if a risk factor did not exist. Yet many have noted the greater policy significance of avoidable burden, or the future disease that could actually be eliminated if a risk factor were eliminated today. Avoidable risk may be considerably lower than attributable risk if baseline levels of exposure or disease are declining, or if a risk factor carries lagged effects on disease. As global efforts to deliver clean cookstoves accelerate, a temporal estimation of avoidable risk due to household air pollution (HAP) becomes increasingly important, particularly in light of the rapid uptake of modern stoves and ongoing epidemiologic transitions in regions like South and Southeast Asia. Methods and Findings We estimate the avoidable burden associated with HAP using International Futures (IFs), an integrated forecasting system that has been used to model future global disease burdens and risk factors. Building on GBD and other estimates, we integrated a detailed HAP exposure estimation and exposure-response model into IFs. We then conducted a counterfactual experiment in which HAP exposure is reduced to theoretical minimum levels in 2015. We evaluated avoidable mortality and DALY reductions for the years 2015 to 2024 relative to a Base Case scenario in which only endogenous changes occurred. We present results by cause and region, looking at impacts on acute lower respiratory infection (ALRI) and four noncommunicable diseases (NCDs). We found that just 2.6% of global DALYs would be averted between 2015 and 2024, compared to 4.5% of global DALYs attributed to HAP in the 2010 GBD study, due in large part to the endogenous tendency towards declining traditional stove usage in the IFs base case forecast. The extent of diminished impact was comparable for ALRI and affected NCDs, though for different reasons. ALRI impacts diminish due to the declining burden of ALRI in the base case forecast, particularly apparent in South Asia and Southeast Asia. Although NCD burdens are rising in regions affected by HAP, the avoidable risk of NCD nonetheless diminishes due to lagged effects. Because the stove transition and the decline of ALRI are proceeding more slowly in Sub-Saharan Africa, avoidable impacts would also be more persistent (3.9% of total DALY due to HAP) compared to South Asia (3.6%) or Southeast Asia (2.5%). Conclusions Our results illustrate how a temporal dynamic calculation of avoidable risk may yield different estimates, compared to a static attributable risk estimate, of the global and regional burden of disease. Our results suggest a window of rising and falling opportunity for HAP interventions that may have already closed in Southeast Asia and may be closing quickly in South Asia, but may remain open longer in Sub-Saharan Africa. A proper accounting of global health priorities should apply an avoidable risk framework that considers the role of ongoing social, economic and health transitions in constantly altering the disease and risk factor landscape.
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Affiliation(s)
- Randall Kuhn
- Global Health Affairs Program, Josef Korbel School of International Studies, University of Denver, Denver, Colorado, United States of America
- * E-mail:
| | - Dale S. Rothman
- Frederick S. Pardee Center for International Futures, Josef Korbel School of International Studies, University of Denver, Denver, Colorado, United States of America
| | - Sara Turner
- Frederick S. Pardee Center for International Futures, Josef Korbel School of International Studies, University of Denver, Denver, Colorado, United States of America
| | - José Solórzano
- Frederick S. Pardee Center for International Futures, Josef Korbel School of International Studies, University of Denver, Denver, Colorado, United States of America
| | - Barry Hughes
- Frederick S. Pardee Center for International Futures, Josef Korbel School of International Studies, University of Denver, Denver, Colorado, United States of America
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206
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Guarnieri M, Diaz E, Pope D, Eisen EA, Mann J, Smith KR, Smith-Sivertsen T, Bruce NG, Balmes JR. Lung Function in Rural Guatemalan Women Before and After a Chimney Stove Intervention to Reduce Wood Smoke Exposure: Results From the Randomized Exposure Study of Pollution Indoors and Respiratory Effects and Chronic Respiratory Effects of Early Childhood Exposure to Respirable Particulate Matter Study. Chest 2016; 148:1184-1192. [PMID: 26065915 DOI: 10.1378/chest.15-0261] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND COPD is the third most frequent cause of death globally, with much of this burden attributable to household biomass smoke exposure in developing countries. As biomass smoke exposure is also associated with cardiovascular disease, lower respiratory infection, lung cancer, and cataracts, it presents an important target for public health intervention. METHODS Lung function in Guatemalan women exposed to wood smoke from open fires was measured throughout the Randomized Exposure Study of Pollution Indoors and Respiratory Effects (RESPIRE) stove intervention trial and continued during the Chronic Respiratory Effects of Early Childhood Exposure to Respirable Particulate Matter (CRECER) cohort study. In RESPIRE, early stove households received a chimney woodstove at the beginning of the 18-month trial, and delayed stove households received a stove at trial completion. Personal exposure to wood smoke was assessed with exhaled breath carbon monoxide (CO) and personal CO tubes. Change in lung function between intervention groups and as a function of wood smoke exposure was assessed using random effects models. RESULTS Of 306 women participating in both studies, acceptable spirometry was collected in 129 early stove and 136 delayed stove households (n = 265), with a mean follow-up of 5.6 years. Despite reduced wood smoke exposures in early stove households, there were no significant differences in any of the measured spirometric variables during the study period (FEV1, FVC, FEV1/FVC ratio, and annual change) after adjustment for confounding. CONCLUSIONS In these young Guatemalan women, there was no association between lung function and early randomization to a chimney stove or personal wood smoke exposure. Future stove intervention trials should incorporate cleaner stoves, longer follow-up, or potentially susceptible groups to identify meaningful differences in lung function.
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Affiliation(s)
- Michael Guarnieri
- Department of Pulmonary and Critical Care, University of California, San Francisco, San Francisco, CA
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Daniel Pope
- Department of Public Health and Policy, University of Liverpool, Liverpool, England
| | - Ellen A Eisen
- School of Public Health, Environmental Sciences, University of California, Berkeley, Berkeley, CA, Norway
| | - Jennifer Mann
- School of Public Health, Environmental Sciences, University of California, Berkeley, Berkeley, CA, Norway
| | - Kirk R Smith
- School of Public Health, Environmental Sciences, University of California, Berkeley, Berkeley, CA, Norway
| | | | - Nigel G Bruce
- Department of Public Health and Policy, University of Liverpool, Liverpool, England
| | - John R Balmes
- Department of Medicine, University of California, San Francisco, San Francisco, CA; School of Public Health, Environmental Sciences, University of California, Berkeley, Berkeley, CA, Norway.
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207
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Conklin LM, Bigogo G, Jagero G, Hampton L, Junghae M, da Gloria Carvalho M, Pimenta F, Beall B, Taylor T, Plikaytis B, Laserson KF, Vulule J, Van Beneden C, Whitney CG, Breiman RF, Feikin DR. High Streptococcus pneumoniae colonization prevalence among HIV-infected Kenyan parents in the year before pneumococcal conjugate vaccine introduction. BMC Infect Dis 2016; 16:18. [PMID: 26774803 PMCID: PMC4715316 DOI: 10.1186/s12879-015-1312-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 12/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae is a leading cause of pneumonia, meningitis and sepsis in developing countries, particularly among children and HIV-infected persons. Pneumococcal oropharyngeal (OP) or nasopharyngeal (NP) colonization is a precursor to development of invasive disease. New conjugate vaccines hold promise for reducing colonization and disease. METHODS Prior to introduction of 10-valent pneumococcal conjugate vaccine (PCV10), we conducted a cross-sectional survey among HIV-infected parents of children <5 years old in rural Kenya. Other parents living with an HIV-infected adult were also enrolled. After broth enrichment, NP and OP swabs were cultured for pneumococcus. Serotypes were identified by Quellung. Antimicrobial susceptibility was performed using broth microdilution. RESULTS We enrolled 973 parents; 549 (56.4%) were HIV-infected, 153 (15.7%) were HIV-uninfected and 271 (27.9%) had unknown HIV status. Among HIV-infected parents, the median age was 32 years (range 15-74) and 374/549 (68%) were mothers. Pneumococci were isolated from 237/549 (43.2%) HIV-infected parents and 41/153 (26.8%) HIV-non-infected parents (p = 0.0003). Colonization with PCV10 serotypes was not significantly more frequent in HIV-infected (12.9%) than HIV-uninfected parents (11.8%; p = 0.70). Among HIV-infected parents, cooking site separate from sleeping area and CD4 count >250 were protective (OR = 0.6; 95% CI 0.4, 0.9 and OR = 0.5; 95% CI 0.2, 0.9, respectively); other associations were not identified. Among 309 isolates tested from all parents, 255 (80.4%) were penicillin non-susceptible (MIC ≥0.12 μg/ml). CONCLUSIONS Prevalence of pneumococcal colonization is high among HIV-infected parents in rural Kenya. If young children are the pneumococcal reservoir for this population, PCV10 introduction may reduce vaccine-type colonization and disease among HIV-infected parents through indirect protection.
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Affiliation(s)
- Laura M Conklin
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. .,Respiratory Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS C-25, Atlanta, GA, 30333, USA.
| | - Godfrey Bigogo
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya. .,KEMRI/CDC Research Collaboration, P. O. Box 1578, Kisumu, 40100, Kenya.
| | - Geofrey Jagero
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya.
| | - Lee Hampton
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Muthoni Junghae
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya.
| | | | - Fabiana Pimenta
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Bernard Beall
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Thomas Taylor
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Brian Plikaytis
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Kayla F Laserson
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya.
| | - John Vulule
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Chris Van Beneden
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Cynthia G Whitney
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Robert F Breiman
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya.
| | - Daniel R Feikin
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya.
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Patel AB, Bang A, Singh M, Dhande L, Chelliah LR, Malik A, Khadse S. A randomized controlled trial of hospital versus home based therapy with oral amoxicillin for severe pneumonia in children aged 3 - 59 months: The IndiaCLEN Severe Pneumonia Oral Therapy (ISPOT) Study. BMC Pediatr 2015; 15:186. [PMID: 26577943 PMCID: PMC4650851 DOI: 10.1186/s12887-015-0510-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 11/14/2015] [Indexed: 11/04/2022] Open
Abstract
Background Pneumonia is the leading cause of child mortality under five years of age worldwide. For pneumonia with chest indrawing in children aged 3–59 months, injectable penicillin and hospitalization was the recommended treatment. This increased the health care cost and exposure to nosocomial infections. We compared the clinical and cost outcomes of a seven day treatment with oral amoxicillin with the first 48 h of treatment given in the hospital (hospital group) or at home (home group). Methods We conducted an open-label, multi-center, two-arm randomized clinical trial at six tertiary hospitals in India. Children aged 3 to 59 months with chest indrawing pneumonia were randomized to home or hospital group. Clinical outcomes, treatment adherence, and patient safety were monitored through home visits on day 3, 5, 8, and 14 with an additional visit for the home group at 24 h. Clinical outcomes included treatment failure rates up to 7 days (primary outcome) and between 8–14 days (secondary outcome) using the intention to treat and per protocol analyses. Cost outcomes included direct medical, direct non-medical and indirect costs for a random 17 % subsample using the micro-costing technique. Results 1118 children were enrolled and randomized to home (n = 554) or hospital group (n = 564). Both groups had similar baseline characteristics. Overall treatment failure rate was 11.5 % (per protocol analysis). The hospital group was significantly more likely to fail treatment than the home group in the intention to treat analysis. Predictors with increased risk of treatment failure at any time were age 3–11 months, receiving antibiotics within 48 h prior to enrolment and use of high polluting fuel. Death rates at 7 or 14 days did not differ significantly. (Difference −0.0 %; 95 % CI −0.5 to 0.5). The median total treatment cost was Rs. 399 for the home group versus Rs. 602 for the hospital group (p < 0.001), for the same effect of 5 % failure rate at the end of 7 days of treatment in the random subsample. Conclusions Home based oral amoxicillin treatment was equivalent to hospital treatment for first 48 h in selected children of chest indrawing pneumonia and was cheaper. Consistent with the recent WHO simplified guidelines, management with home based oral amoxicillin for select children with only fast breathing and chest-indrawing can be a cost effective intervention. Trial Registration ClinicalTrials.gov NCT01386840, registered 25th June 2011 and the Indian Council of Medical Research REFCTRI/2010/000629. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0510-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Archana B Patel
- Lata Medical Research Foundation and Indira Gandhi Government Medical College, Nagpur, India.
| | - Akash Bang
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India.
| | - Meenu Singh
- Post Graduate Institute of Medical Sciences, Chandigarh, India.
| | - Leena Dhande
- Lata Medical Research Foundation and Indira Gandhi Government Medical College, Nagpur, India.
| | | | - Ashraf Malik
- Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India.
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Quinn AK, Ae-Ngibise KA, Jack DW, Boamah EA, Enuameh Y, Mujtaba MN, Chillrud SN, Wylie BJ, Owusu-Agyei S, Kinney PL, Asante KP. Association of Carbon Monoxide exposure with blood pressure among pregnant women in rural Ghana: Evidence from GRAPHS. Int J Hyg Environ Health 2015; 219:176-83. [PMID: 26614250 DOI: 10.1016/j.ijheh.2015.10.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/15/2015] [Accepted: 10/30/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE The Ghana Randomized Air Pollution and Health Study (GRAPHS) is a community-level randomized-controlled trial of cookstove interventions for pregnant women and their newborns in rural Ghana. Given that household air pollution from biomass burning may be implicated in adverse cardiovascular outcomes, we sought to determine whether exposure to carbon monoxide (CO) from woodsmoke was associated with blood pressure (BP) among 817 adult women. METHODS Multivariate linear regression models were used to evaluate the association between CO exposure, determined with 72 hour personal monitoring at study enrollment, and BP, also measured at study enrollment. At the time of these assessments, women were in the first or second trimester of pregnancy. RESULTS A significant positive association was found between CO exposure and diastolic blood pressure (DBP): on average, each 1 ppm increase in exposure to CO was associated with 0.43 mmHg higher DBP [0.01, 0.86]. A non-significant positive trend was also observed for systolic blood pressure (SBP). CONCLUSION This study is one of very few to have examined the relationship between household air pollution and blood pressure among pregnant women, who are at particular risk for hypertensive complications. The results of this cross-sectional study suggest that household air pollution from wood-burning fires is associated with higher blood pressure, particularly DBP, in pregnant women at early to mid-gestation. The clinical implications of the observed association toward the eventual development of chronic hypertension and/or hypertensive complications of pregnancy remain uncertain, as few of the women were overtly hypertensive at this point in their pregnancies.
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Affiliation(s)
- Ashlinn K Quinn
- Mailman School of Public Health, Columbia University, New York, NY, USA.
| | | | - Darby W Jack
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ellen Abrafi Boamah
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Yeetey Enuameh
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Mohammed Nuhu Mujtaba
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory of Columbia University, Palisades, NY, USA
| | - Blair J Wylie
- Division of Maternal-Fetal Medicine, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Patrick L Kinney
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
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Foote EM, Singleton RJ, Holman RC, Seeman SM, Steiner CA, Bartholomew M, Hennessy TW. Lower respiratory tract infection hospitalizations among American Indian/Alaska Native children and the general United States child population. Int J Circumpolar Health 2015; 74:29256. [PMID: 26547082 PMCID: PMC4636865 DOI: 10.3402/ijch.v74.29256] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/05/2015] [Accepted: 10/05/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The lower respiratory tract infection (LRTI)-associated hospitalization rate in American Indian and Alaska Native (AI/AN) children aged <5 years declined during 1998-2008, yet remained 1.6 times higher than the general US child population in 2006-2008. PURPOSE Describe the change in LRTI-associated hospitalization rates for AI/AN children and for the general US child population aged <5 years. METHODS A retrospective analysis of hospitalizations with discharge ICD-9-CM codes for LRTI for AI/AN children and for the general US child population <5 years during 2009-2011 was conducted using Indian Health Service direct and contract care inpatient data and the Nationwide Inpatient Sample, respectively. We calculated hospitalization rates and made comparisons to previously published 1998-1999 rates prior to pneumococcal conjugate vaccine introduction. RESULTS The average annual LRTI-associated hospitalization rate declined from 1998-1999 to 2009-2011 in AI/AN (35%, p<0.01) and the general US child population (19%, SE: 4.5%, p<0.01). The 2009-2011 AI/AN child average annual LRTI-associated hospitalization rate was 20.7 per 1,000, 1.5 times higher than the US child rate (13.7 95% CI: 12.6-14.8). The Alaska (38.9) and Southwest regions (27.3) had the highest rates. The disparity was greatest for infant (<1 year) pneumonia-associated and 2009-2010 H1N1 influenza-associated hospitalizations. CONCLUSIONS Although the LRTI-associated hospitalization rate declined, the 2009-2011 AI/AN child rate remained higher than the US child rate, especially in the Alaska and Southwest regions. The residual disparity is likely multi-factorial and partly related to household crowding, indoor smoke exposure, lack of piped water and poverty. Implementation of interventions proven to reduce LRTI is needed among AI/AN children.
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Affiliation(s)
- Eric M Foote
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Rosalyn J Singleton
- Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
- Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Anchorage, AK, USA;
| | - Robert C Holman
- Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Anchorage, AK, USA
| | - Sara M Seeman
- Division of High-Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, GA, USA
| | - Claudia A Steiner
- Healthcare Cost and Utilization Project, Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Michael Bartholomew
- Division of Epidemiology and Disease Prevention, Indian Health Service, Rockville, MD, USA
| | - Thomas W Hennessy
- Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Anchorage, AK, USA
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Thompson LM, Peñaloza RA, Stormfields K, Kooistra R, Valencia-Moscoso G, Muslima H, Khan NZ. Validation and adaptation of rapid neurodevelopmental assessment instrument for infants in Guatemala. Child Care Health Dev 2015; 41:1131-9. [PMID: 26250756 PMCID: PMC4715612 DOI: 10.1111/cch.12279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 06/08/2015] [Accepted: 06/28/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Timely detection of neurodevelopmental impairments in children can prompt referral for critical services that may prevent permanent disability. However, screening of impairments is a significant challenge in low-resource countries. We adapted and validated the rapid neurodevelopmental assessment (RNDA) instrument developed in Bangladesh to assess impairment in nine domains: primitive reflexes, gross and fine motor development, vision, hearing, speech, cognition, behaviour and seizures. METHODS We conducted a cross-sectional study of 77 infants (0-12 months) in rural Guatemala in July 2012 and July 2013. We assessed inter-rater reliability and predictive validity between the 27-item RNDA and the 325-item Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) and concurrent validity based on chronic malnutrition, a condition associated with neurodevelopmental impairments. For both RNDA and BSID-III, standardized scores below 80 were defined as borderline impairment. RESULTS Children came from rural households (92%), were born to indigenous women of Mayan descent (73%) and had moderate or severe growth stunting (43%). Inter-rater reliability for eight RNDA domains was of moderate to high reliability (weighted κ coefficients, 0.49-0.99). Children screened positive for impairment in fine motor (17%) and gross motor (14%) domains using the RNDA. The RNDA had good concurrent ability; infants who were growth stunted had higher mean levels of impairment in gross motor, speech and cognition domains (all p < 0.001). The RNDA took 20-30 min to complete compared with 45-60 min for BSID-III. CONCLUSIONS Wide-scale implementation of a simple, valid and reliable screening tool like the RNDA by community health workers would facilitate early screening and referral of infants at-risk for neurodevelopmental impairment.
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Affiliation(s)
- Lisa M. Thompson
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco
| | - Reneé Asteria Peñaloza
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco
| | - Kate Stormfields
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco
| | - Rebecca Kooistra
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco
| | | | - Humaira Muslima
- Department of Pediatric Neuroscience, Dhaka Shishu (Children’s) Hospital, Dhaka, Bangladesh
| | - Naila Zaman Khan
- Department of Pediatric Neuroscience, Dhaka Shishu (Children’s) Hospital, Dhaka, Bangladesh
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Muala A, Rankin G, Sehlstedt M, Unosson J, Bosson JA, Behndig A, Pourazar J, Nyström R, Pettersson E, Bergvall C, Westerholm R, Jalava PI, Happo MS, Uski O, Hirvonen MR, Kelly FJ, Mudway IS, Blomberg A, Boman C, Sandström T. Acute exposure to wood smoke from incomplete combustion--indications of cytotoxicity. Part Fibre Toxicol 2015; 12:33. [PMID: 26511835 PMCID: PMC4625445 DOI: 10.1186/s12989-015-0111-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/21/2015] [Indexed: 12/16/2022] Open
Abstract
Background Smoke from combustion of biomass fuels is a major risk factor for respiratory disease, but the underlying mechanisms are poorly understood. The aim of this study was to determine whether exposure to wood smoke from incomplete combustion would elicit airway inflammation in humans. Methods Fourteen healthy subjects underwent controlled exposures on two separate occasions to filtered air and wood smoke from incomplete combustion with PM1 concentration at 314 μg/m3 for 3 h in a chamber. Bronchoscopy with bronchial wash (BW), bronchoalveolar lavage (BAL) and endobronchial mucosal biopsies was performed after 24 h. Differential cell counts and soluble components were analyzed, with biopsies stained for inflammatory markers using immunohistochemistry. In parallel experiments, the toxicity of the particulate matter (PM) generated during the chamber exposures was investigated in vitro using the RAW264.7 macrophage cell line. Results Significant reductions in macrophage, neutrophil and lymphocyte numbers were observed in BW (p < 0.01, <0.05, <0.05, respectively) following the wood smoke exposure, with a reduction in lymphocytes numbers in BAL fluid (<0.01. This unexpected cellular response was accompanied by decreased levels of sICAM-1, MPO and MMP-9 (p < 0.05, <0.05 and <0.01). In contrast, significant increases in submucosal and epithelial CD3+ cells, epithelial CD8+ cells and submucosal mast cells (p < 0.01, <0.05, <0.05 and <0.05, respectively), were observed after wood smoke exposure. The in vitro data demonstrated that wood smoke particles generated under these incomplete combustion conditions induced cell death and DNA damage, with only minor inflammatory responses. Conclusions Short-term exposure to sooty PAH rich wood smoke did not induce an acute neutrophilic inflammation, a classic hallmark of air pollution exposure in humans. While minor proinflammatory lymphocytic and mast cells effects were observed in the bronchial biopsies, significant reductions in BW and BAL cells and soluble components were noted. This unexpected observation, combined with the in vitro data, suggests that wood smoke particles from incomplete combustion could be potentially cytotoxic. Additional research is required to establish the mechanism of this dramatic reduction in airway leukocytes and to clarify how this acute response contributes to the adverse health effects attributed to wood smoke exposure. Trial registration NCT01488500 Electronic supplementary material The online version of this article (doi:10.1186/s12989-015-0111-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ala Muala
- Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine, Umeå University, Umeå, Sweden
| | - Gregory Rankin
- Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine, Umeå University, Umeå, Sweden
| | - Maria Sehlstedt
- Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine, Umeå University, Umeå, Sweden
| | - Jon Unosson
- Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine, Umeå University, Umeå, Sweden
| | - Jenny A Bosson
- Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine, Umeå University, Umeå, Sweden
| | - Annelie Behndig
- Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine, Umeå University, Umeå, Sweden
| | - Jamshid Pourazar
- Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine, Umeå University, Umeå, Sweden
| | - Robin Nyström
- Department of Applied Physics and Electronics, Thermochemical Energy Conversion Laboratory, Umeå University, Umeå, Sweden
| | - Esbjörn Pettersson
- Department of Applied Physics and Electronics, Thermochemical Energy Conversion Laboratory, Umeå University, Umeå, Sweden
| | - Christoffer Bergvall
- Department of Environmental Science and Analytical Chemistry, Arrhenius Laboratory, Stockholm University, Stockholm, Sweden
| | - Roger Westerholm
- Department of Environmental Science and Analytical Chemistry, Arrhenius Laboratory, Stockholm University, Stockholm, Sweden
| | - Pasi I Jalava
- Department of Environmental Science, University of Eastern Finland, Kuopio, Finland
| | - Mikko S Happo
- Department of Environmental Science, University of Eastern Finland, Kuopio, Finland
| | - Oskari Uski
- Department of Environmental Science, University of Eastern Finland, Kuopio, Finland
| | | | - Frank J Kelly
- Environmental Research Group, MRC-PHE Centre for Environment and Health, King's College London, London, UK
| | - Ian S Mudway
- Environmental Research Group, MRC-PHE Centre for Environment and Health, King's College London, London, UK
| | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine, Umeå University, Umeå, Sweden
| | - Christoffer Boman
- Department of Applied Physics and Electronics, Thermochemical Energy Conversion Laboratory, Umeå University, Umeå, Sweden
| | - Thomas Sandström
- Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine, Umeå University, Umeå, Sweden.
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Berlan D. Pneumonia's second wind? A case study of the global health network for childhood pneumonia. Health Policy Plan 2015; 31 Suppl 1:i33-47. [PMID: 26438780 DOI: 10.1093/heapol/czv070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 02/03/2023] Open
Abstract
Advocacy, policy, research and intervention efforts against childhood pneumonia have lagged behind other health issues, including malaria, measles and tuberculosis. Accelerating progress on the issue began in 2008, following decades of efforts by individuals and organizations to address the leading cause of childhood mortality and establish a global health network. This article traces the history of this network's formation and evolution to identify lessons for other global health issues. Through document review and interviews with current, former and potential network members, this case study identifies five distinct eras of activity against childhood pneumonia: a period of isolation (post WWII to 1984), the duration of WHO's Acute Respiratory Infections (ARI) Programme (1984-1995), Integrated Management of Childhood illness's (IMCI) early years (1995-2003), a brief period of network re-emergence (2003-2008) and recent accelerating progress (2008 on). Analysis of these eras reveals the critical importance of building a shared identity in order to form an effective network and take advantage of emerging opportunities. During the ARI era, an initial network formed around a relatively narrow shared identity focused on community-level care. The shift to IMCI led to the partial dissolution of this network, stalled progress on addressing pneumonia in communities and missed opportunities. Frustrated with lack of progress on the issue, actors began forming a network and shared identity that included a broad spectrum of those whose interests overlap with pneumonia. As the network coalesced and expanded, its members coordinated and collaborated on conducting and sharing research on severity and tractability, crafting comprehensive strategies and conducting advocacy. These network activities exerted indirect influence leading to increased attention, funding, policies and some implementation.
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Affiliation(s)
- David Berlan
- Florida State University, 650 Bellamy Building, Tallahassee, FL 32306-2250, USA
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Klasen EM, Wills B, Naithani N, Gilman RH, Tielsch JM, Chiang M, Khatry S, Breysse PN, Menya D, Apaka C, Carter EJ, Sherman CB, Miranda JJ, Checkley W. Low correlation between household carbon monoxide and particulate matter concentrations from biomass-related pollution in three resource-poor settings. ENVIRONMENTAL RESEARCH 2015; 142:424-31. [PMID: 26245367 PMCID: PMC4932836 DOI: 10.1016/j.envres.2015.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 07/16/2015] [Accepted: 07/17/2015] [Indexed: 05/17/2023]
Abstract
Household air pollution from the burning of biomass fuels is recognized as the third greatest contributor to the global burden of disease. Incomplete combustion of biomass fuels releases a complex mixture of carbon monoxide (CO), particulate matter (PM) and other toxins into the household environment. Some investigators have used indoor CO concentrations as a reliable surrogate of indoor PM concentrations; however, the assumption that indoor CO concentration is a reasonable proxy of indoor PM concentration has been a subject of controversy. We sought to describe the relationship between indoor PM2.5 and CO concentrations in 128 households across three resource-poor settings in Peru, Nepal, and Kenya. We simultaneously collected minute-to-minute PM2.5 and CO concentrations within a meter of the open-fire stove for approximately 24h using the EasyLog-USB-CO data logger (Lascar Electronics, Erie, PA) and the personal DataRAM-1000AN (Thermo Fisher Scientific Inc., Waltham, MA), respectively. We also collected information regarding household construction characteristics, and cooking practices of the primary cook. Average 24h indoor PM2.5 and CO concentrations ranged between 615 and 1440 μg/m(3), and between 9.1 and 35.1 ppm, respectively. Minute-to-minute indoor PM2.5 concentrations were in a safe range (<25 μg/m(3)) between 17% and 65% of the time, and exceeded 1000 μg/m(3) between 8% and 21% of the time, whereas indoor CO concentrations were in a safe range (<7 ppm) between 46% and 79% of the time and exceeded 50 ppm between 4%, and 20% of the time. Overall correlations between indoor PM2.5 and CO concentrations were low to moderate (Spearman ρ between 0.59 and 0.83). There was also poor agreement and evidence of proportional bias between observed indoor PM2.5 concentrations vs. those estimated based on indoor CO concentrations, with greater discordance at lower concentrations. Our analysis does not support the notion that indoor CO concentration is a surrogate marker for indoor PM2.5 concentration across all settings. Both are important markers of household air pollution with different health and environmental implications and should therefore be independently measured.
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Affiliation(s)
- Elizabeth M Klasen
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Beatriz Wills
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Neha Naithani
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Nepal Nutrition Intervention Project Sarlahi, Kathmandu, Nepal
| | - Robert H Gilman
- Program in Global Disease Epidemiology and Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - James M Tielsch
- Department of Global Health, School of Public Health and Health Services, George Washington University, Washington DC, USA
| | | | - Subarna Khatry
- Nepal Nutrition Intervention Project Sarlahi, Kathmandu, Nepal
| | - Patrick N Breysse
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Diana Menya
- School of Public Health, Moi University, Eldoret, Kenya; AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
| | - Cosmas Apaka
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
| | - E Jane Carter
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya; Division of Pulmonary Medicine, The Warren Alpert School of Medicine, Brown University, Providence, USA
| | - Charles B Sherman
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya; Division of Pulmonary Medicine, The Warren Alpert School of Medicine, Brown University, Providence, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Program in Global Disease Epidemiology and Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA; CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
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215
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Are Randomized Trials Necessary to Advance Epidemiologic Research on Household Air Pollution? CURR EPIDEMIOL REP 2015. [DOI: 10.1007/s40471-015-0054-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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216
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Jack DW, Asante KP, Wylie BJ, Chillrud SN, Whyatt RM, Ae-Ngibise KA, Quinn AK, Yawson AK, Boamah EA, Agyei O, Mujtaba M, Kaali S, Kinney P, Owusu-Agyei S. Ghana randomized air pollution and health study (GRAPHS): study protocol for a randomized controlled trial. Trials 2015; 16:420. [PMID: 26395578 PMCID: PMC4579662 DOI: 10.1186/s13063-015-0930-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Household air pollution exposure is a major health risk, but validated interventions remain elusive. METHODS/DESIGN The Ghana Randomized Air Pollution and Health Study (GRAPHS) is a cluster-randomized trial that evaluates the efficacy of clean fuels (liquefied petroleum gas, or LPG) and efficient biomass cookstoves in the Brong-Ahafo region of central Ghana. We recruit pregnant women into LPG, efficient cookstove, and control arms and track birth weight and physician-assessed severe pneumonia incidence in the first year of life. A woman is eligible to participate if she is in the first or second trimester of pregnancy and carrying a live singleton fetus, if she is the primary cook, and if she does not smoke. We hypothesize that babies born to intervention mothers will weigh more and will have fewer cases of physician-assessed severe pneumonia in the first year of life. Additionally, an extensive personal air pollution exposure monitoring effort opens the way for exposure-response analyses, which we will present alongside intention-to-treat analyses. Major funding was provided by the National Institute of Environmental Health Sciences, The Thrasher Research Fund, and the Global Alliance for Clean Cookstoves. DISCUSSION Household air pollution exposure is a major health risk that requires well-tested interventions. GRAPHS will provide important new evidence on the efficacy of both efficient biomass cookstoves and LPG, and will thus help inform health and energy policies in developing countries. TRIAL REGISTRATION The trial was registered with clinicaltrials.gov on 13 April 2011 with the identifier NCT01335490 .
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Affiliation(s)
- Darby W Jack
- Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
| | - Blair J Wylie
- Division of Maternal-Fetal Medicine, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Steve N Chillrud
- Lamont-Doherty Earth Observatory of Columbia University, New York, NY, USA.
| | - Robin M Whyatt
- Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Kenneth A Ae-Ngibise
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
| | - Ashlinn K Quinn
- Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Abena Konadu Yawson
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
| | - Ellen Abrafi Boamah
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
| | - Oscar Agyei
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
| | - Mohammed Mujtaba
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
| | - Seyram Kaali
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
| | - Patrick Kinney
- Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
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Hatisuka MFDB, Arruda GOD, Fernandes CAM, Marcon SS. Análise da tendência das taxas de internações por pneumonia bacteriana em crianças e adolescentes. ACTA PAUL ENFERM 2015. [DOI: 10.1590/1982-0194201500051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objetivo Analisar a distribuição e a tendência das taxas de internações por pneumonia bacteriana em crianças e adolescentes. Métodos Estudo ecológico de séries temporais com dados secundários obtidos no Sistema de Informações Hospitalares do Sistema Único de Saúde. Foram calculados coeficientes de internação para 10.000 habitantes, por triênio. Para análise de tendência utilizaram-se modelos de regressão polinomial. Resultados As maiores taxas de internação ocorreram na Macrorregião de Saúde Oeste, entre o segundo e o quarto triênio. As taxas foram maiores na faixa etária de um a quatro anos e no sexo masculino, durante todo o período. Observou-se tendência crescente das internações em crianças menores de um ano. Conclusão As taxas de internação por pneumonia diferem por macrorregional de saúde, idade e sexo, sendo maior na região oeste, em crianças do sexo masculino e com idade entre um e quatro anos, com tendência crescente entre os menores de um ano.
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Sunderland ME, Nayak RU. Reengineering Biomedical Translational Research with Engineering Ethics. SCIENCE AND ENGINEERING ETHICS 2015; 21:1019-1031. [PMID: 24928281 DOI: 10.1007/s11948-014-9567-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 05/27/2014] [Indexed: 06/03/2023]
Abstract
It is widely accepted that translational research practitioners need to acquire special skills and knowledge that will enable them to anticipate, analyze, and manage a range of ethical issues. While there is a small but growing literature that addresses the ethics of translational research, there is a dearth of scholarship regarding how this might apply to engineers. In this paper we examine engineers as key translators and argue that they are well positioned to ask transformative ethical questions. Asking engineers to both broaden and deepen their consideration of ethics in their work, however, requires a shift in the way ethics is often portrayed and perceived in science and engineering communities. Rather than interpreting ethics as a roadblock to the success of translational research, we suggest that engineers should be encouraged to ask questions about the socio-ethical dimensions of their work. This requires expanding the conceptual framework of engineering beyond its traditional focus on "how" and "what" questions to also include "why" and "who" questions to facilitate the gathering of normative, socially-situated information. Empowering engineers to ask "why" and "who" questions should spur the development of technologies and practices that contribute to improving health outcomes.
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Affiliation(s)
- Mary E Sunderland
- Department of Nuclear Engineering, 4155 Etcheverry Hall, MC 1730, University of California, Berkeley, Berkeley, CA, 94720-1730, USA,
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Johnson MA, Chiang RA. Quantitative Guidance for Stove Usage and Performance to Achieve Health and Environmental Targets. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:820-6. [PMID: 25816219 PMCID: PMC4529010 DOI: 10.1289/ehp.1408681] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 03/25/2015] [Indexed: 05/20/2023]
Abstract
BACKGROUND Displacing the use of polluting and inefficient cookstoves in developing countries is necessary to achieve the potential health and environmental benefits sought through clean cooking solutions. Yet little quantitative context has been provided on how much displacement of traditional technologies is needed to achieve targets for household air pollutant concentrations or fuel savings. OBJECTIVES This paper provides instructive guidance on the usage of cooking technologies required to achieve health and environmental improvements. METHODS We evaluated different scenarios of displacement of traditional stoves with use of higher performing technologies. The air quality and fuel consumption impacts were estimated for these scenarios using a single-zone box model of indoor air quality and ratios of thermal efficiency. RESULTS Stove performance and usage should be considered together, as lower performing stoves can result in similar or greater benefits than a higher performing stove if the lower performing stove has considerably higher displacement of the baseline stove. Based on the indoor air quality model, there are multiple performance-usage scenarios for achieving modest indoor air quality improvements. To meet World Health Organization guidance levels, however, three-stone fire and basic charcoal stove usage must be nearly eliminated to achieve the particulate matter target (< 1-3 hr/week), and substantially limited to meet the carbon monoxide guideline (< 7-9 hr/week). CONCLUSIONS Moderate health gains may be achieved with various performance-usage scenarios. The greatest benefits are estimated to be achieved by near-complete displacement of traditional stoves with clean technologies, emphasizing the need to shift in the long term to near exclusive use of clean fuels and stoves. The performance-usage scenarios are also provided as a tool to guide technology selection and prioritize behavior change opportunities to maximize impact.
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220
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Improved stove interventions to reduce household air pollution in low and middle income countries: a descriptive systematic review. BMC Public Health 2015; 15:650. [PMID: 26169364 PMCID: PMC4499941 DOI: 10.1186/s12889-015-2024-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/06/2015] [Indexed: 11/10/2022] Open
Abstract
Background Household air pollution (HAP) resulting from the use of solid fuels presents a major public health hazard. Improved stoves have been offered as a potential tool to reduce exposure to HAP and improve health outcomes. Systematic information on stove interventions is limited. Methods We conducted a systematic review of the current evidence of improved stove interventions aimed at reducing HAP in real life settings. An extensive search of ten databases commenced in April 2014. In addition, we searched clinical trial registers and websites for unpublished studies and grey literature. Studies were included if they reported on an improved stove intervention aimed at reducing HAP resulting from solid fuel use in a low or middle-income country. Results The review identified 5,243 records. Of these, 258 abstracts and 57 full texts were reviewed and 36 studies identified which met the inclusion criteria. When well-designed, implemented and monitored, stove interventions can have positive effects. However, the impacts are unlikely to reduce pollutant levels to World Health Organization recommended levels. Additionally, many participants in the included studies continued to use traditional stoves either instead of, or in additional to, new improved options. Conclusions Current evidence suggests improved stove interventions can reduce exposure to HAP resulting from solid fuel smoke. Studies with longer follow-up periods are required to assess if pollutant reductions reported in the current literature are sustained over time. Adoption of new technologies is challenging and interventions must be tailored to the needs and preferences of the households of interest. Future studies require greater process evaluation to improve knowledge of implementation barriers and facilitators. Review registration The review was registered on Prospero (registration number CRD42014009796 ). Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2024-7) contains supplementary material, which is available to authorized users.
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Farmer SA, Nelin TD, Falvo MJ, Wold LE. Ambient and household air pollution: complex triggers of disease. Am J Physiol Heart Circ Physiol 2015; 307:H467-76. [PMID: 24929855 DOI: 10.1152/ajpheart.00235.2014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Concentrations of outdoor air pollution are on the rise, particularly due to rapid urbanization worldwide. Alternatively, poor ventilation, cigarette smoke, and other toxic chemicals contribute to rising concentrations of indoor air pollution. The World Health Organization recently reported that deaths attributable to indoor and outdoor air pollutant exposure are more than double what was originally documented. Epidemiological, clinical, and animal data have demonstrated a clear connection between rising concentrations of air pollution (both indoor and outdoor) and a host of adverse health effects. During the past five years, animal, clinical, and epidemiological studies have explored the adverse health effects associated with exposure to both indoor and outdoor air pollutants throughout the various stages of life. This review provides a summary of the detrimental effects of air pollution through examination of current animal, clinical, and epidemiological studies and exposure during three different periods: maternal (in utero), early life, and adulthood. Additionally, we recommend future lines of research while suggesting conceivable strategies to curb exposure to indoor and outdoor air pollutants.
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Indoor Particulate Matter Concentration, Water Boiling Time, and Fuel Use of Selected Alternative Cookstoves in a Home-Like Setting in Rural Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015. [PMID: 26198238 PMCID: PMC4515674 DOI: 10.3390/ijerph120707558] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Alternative cookstoves are designed to improve biomass fuel combustion efficiency to reduce the amount of fuel used and lower emission of air pollutants. The Nepal Cookstove Trial (NCT) studies effects of alternative cookstoves on family health. Our study measured indoor particulate matter concentration (PM2.5), boiling time, and fuel use of cookstoves during a water-boiling test in a house-like setting in rural Nepal. Study I was designed to select a stove to be used in the NCT; Study II evaluated stoves used in the NCT. In Study I, mean indoor PM2.5 using wood fuel was 4584 μg/m3, 1657 μg/m3, and 2414 μg/m3 for the traditional, alternative mud brick stove (AMBS-I) and Envirofit G-series, respectively. The AMBS-I reduced PM2.5 concentration but increased boiling time compared to the traditional stove (p-values < 0.001). Unlike AMBS-I, Envirofit G-series did not significantly increase overall fuel consumption. In Phase II, the manufacturer altered Envirofit stove (MAES) and Nepal Nutrition Intervention Project Sarlahi (NNIPS) altered Envirofit stove (NAES), produced lower mean PM2.5, 1573 μg/m3 and 1341 μg/m3, respectively, relative to AMBS-II 3488 μg/m3 for wood tests. The liquid propane gas stove had the lowest mean PM2.5 concentrations, with measurements indistinguishable from background levels. Results from Study I and II showed significant reduction in PM2.5 for all alternative stoves in a controlled setting. In study I, the AMBS-I stove required more fuel than the traditional stove. In contrast, in study II, the MAES and NAES stoves required statistically less fuel than the AMBS-II. Reductions and increases in fuel use should be interpreted with caution because the composition of fuels was not standardized--an issue which may have implications for generalizability of other findings as well. Boiling times for alternative stoves in Study I were significantly longer than the traditional stove--a trade-off that may have implications for acceptability of the stoves among end users. These extended cooking times may increase cumulative exposure during cooking events where emission rates are lower; these differences must be carefully considered in the evaluation of alternative stove designs.
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Rylance J, Fullerton DG, Scriven J, Aljurayyan AN, Mzinza D, Barrett S, Wright AKA, Wootton DG, Glennie SJ, Baple K, Knott A, Mortimer K, Russell DG, Heyderman RS, Gordon SB. Household air pollution causes dose-dependent inflammation and altered phagocytosis in human macrophages. Am J Respir Cell Mol Biol 2015; 52:584-93. [PMID: 25254931 DOI: 10.1165/rcmb.2014-0188oc] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Three billion people are exposed to household air pollution from biomass fuel use. Exposure is associated with higher incidence of pneumonia, and possibly tuberculosis. Understanding mechanisms underlying these defects would improve preventive strategies. We used human alveolar macrophages obtained from healthy Malawian adults exposed naturally to household air pollution and compared them with human monocyte-derived macrophages exposed in vitro to respirable-sized particulates. Cellular inflammatory response was assessed by IL-6 and IL-8 production in response to particulate challenge; phagosomal function was tested by uptake and oxidation of fluorescence-labeled beads; ingestion and killing of Streptococcus pneumoniae and Mycobacterium tuberculosis were measured by microscopy and quantitative culture. Particulate ingestion was quantified by digital image analysis. We were able to reproduce the carbon loading of naturally exposed alveolar macrophages by in vitro exposure of monocyte-derived macrophages. Fine carbon black induced IL-8 release from monocyte-derived and alveolar macrophages (P < 0.05) with similar magnitude responses (log10 increases of 0.93 [SEM = 0.2] versus 0.74 [SEM = 0.19], respectively). Phagocytosis of pneumococci and mycobacteria was impaired with higher particulate loading. High particulate loading corresponded with a lower oxidative burst capacity (P = 0.0015). There was no overall effect on killing of M. tuberculosis. Alveolar macrophage function is altered by particulate loading. Our macrophage model is comparable morphologically to the in vivo uptake of particulates. Wood smoke-exposed cells demonstrate reduced phagocytosis, but unaffected mycobacterial killing, suggesting defects related to chronic wood smoke inhalation limited to specific innate immune functions.
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Affiliation(s)
- Jamie Rylance
- 1 Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
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Pinkerton KE, Harbaugh M, Han MK, Jourdan Le Saux C, Van Winkle LS, Martin WJ, Kosgei RJ, Carter EJ, Sitkin N, Smiley-Jewell SM, George M. Women and Lung Disease. Sex Differences and Global Health Disparities. Am J Respir Crit Care Med 2015; 192:11-6. [PMID: 25945507 PMCID: PMC4511423 DOI: 10.1164/rccm.201409-1740pp] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 05/05/2015] [Indexed: 12/29/2022] Open
Abstract
There is growing evidence that a number of pulmonary diseases affect women differently and with a greater degree of severity than men. The causes for such sex disparity is the focus of this Blue Conference Perspective review, which explores basic cellular and molecular mechanisms, life stages, and clinical outcomes based on environmental, sociocultural, occupational, and infectious scenarios, as well as medical health beliefs. Owing to the breadth of issues related to women and lung disease, we present examples of both basic and clinical concepts that may be the cause for pulmonary disease disparity in women. These examples include those diseases that predominantly affect women, as well as the rising incidence among women for diseases traditionally occurring in men, such as chronic obstructive pulmonary disease. Sociocultural implications of pulmonary disease attributable to biomass burning and infectious diseases among women in low- to middle-income countries are reviewed, as are disparities in respiratory health among sexual minority women in high-income countries. The implications of the use of complementary and alternative medicine by women to influence respiratory disease are examined, and future directions for research on women and respiratory health are provided.
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Affiliation(s)
| | - Mary Harbaugh
- Public Advisory Roundtable of the American Thoracic Society, New York, New York
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Bensch G, Peters J. The intensive margin of technology adoption--Experimental evidence on improved cooking stoves in rural Senegal. JOURNAL OF HEALTH ECONOMICS 2015; 42:44-63. [PMID: 25841214 DOI: 10.1016/j.jhealeco.2015.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 03/12/2015] [Accepted: 03/12/2015] [Indexed: 05/22/2023]
Abstract
Today, almost 3 billion people in developing countries rely on biomass as primary cooking fuel, with profound negative implications for their well-being. Improved biomass cooking stoves are alleged to counteract these adverse effects. This paper evaluates take-up and impacts of low-cost improved stoves through a randomized controlled trial. The randomized stove is primarily designed to curb firewood consumption, but not smoke emissions. Nonetheless, we find considerable effects not only on firewood consumption, but also on smoke exposure and, consequently, smoke-related disease symptoms. The reduced smoke exposure results from behavioural changes in terms of increased outside cooking and a reduction in cooking time. We conclude that in order to assess the effectiveness of a technology-oriented intervention, it is critical to not only account for the incidence of technology adoption - the extensive margin - but also for the way the new technology is used - the intensive margin.
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Affiliation(s)
- Gunther Bensch
- Rheinisch-Westfälisches Institut für Wirtschaftsforschung (RWI), Essen, Germany
| | - Jörg Peters
- Rheinisch-Westfälisches Institut für Wirtschaftsforschung (RWI), Essen, Germany; AMERU, University of the Witwatersrand, Johannesburg, South Africa.
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Wu A, Budge PJ, Williams J, Griffin MR, Edwards KM, Johnson M, Zhu Y, Hartinger S, Verastegui H, Gil AI, Lanata CF, Grijalva CG. Incidence and Risk Factors for Respiratory Syncytial Virus and Human Metapneumovirus Infections among Children in the Remote Highlands of Peru. PLoS One 2015; 10:e0130233. [PMID: 26107630 PMCID: PMC4479592 DOI: 10.1371/journal.pone.0130233] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 05/17/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The disease burden and risk factors for respiratory syncytial virus (RSV) and human metapneumovirus (MPV) infections among children living in remote, rural areas remain unclear. MATERIALS AND METHODS We conducted a prospective, household-based cohort study of children aged <3 years living in remote rural highland communities in San Marcos, Cajamarca, Peru. Acute respiratory illnesses (ARI), including lower respiratory tract infection (LRTI), were monitored through weekly household visits from March 2009 through September 2011. Nasal swabs collected during ARI/LRTI were tested for RSV, MPV, and other respiratory viruses using real-time RT-PCR. Incidence rates and rate ratios were calculated using mixed effects Poisson regression. RESULTS Among 892 enrolled children, incidence rates of RSV and MPV ARI were 30 and 17 episodes per 100 child-years, respectively. The proportions of RSV and MPV ARI that presented as LRTI were 12.5% and 8.9%, respectively. Clinic visits for ARI and hospitalizations were significantly more frequent (all p values <0.05) among children with RSV (clinic 41% and hospital 5.3%) and MPV ARI (38% and 3.5%) when compared with other viral infections (23% and 0.7%) and infections without virus detected (24% and 0.6%). In multivariable analysis, risk factors for RSV detection included younger age (RR 1.02, 95% CI: 1.00-1.03), the presence of a smoker in the house (RR 1.63, 95% CI: 1.12-2.38), residing at higher altitudes (RR 1.93, 95% CI: 1.25-3.00 for 2nd compared to 1st quartile residents; RR 1.98, 95% CI: 1.26-3.13 for 3rd compared to 1st quartile residents). Having an unemployed household head was significantly associated with MPV risk (RR 2.11, 95% CI: 1.12-4.01). CONCLUSION In rural high altitude communities in Peru, childhood ARI due to RSV or MPV were common and associated with higher morbidity than ARI due to other viruses or with no viral detections. The risk factors identified in this study may be considered for interventional studies to control infections by these viruses among young children from developing countries.
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Affiliation(s)
- Andrew Wu
- School of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Philip J. Budge
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - John Williams
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Marie R. Griffin
- Department of Health Policy, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Kathryn M. Edwards
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, United States of America
- Vanderbilt Vaccine Research Program, Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Monika Johnson
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Stella Hartinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Instituto de Investigación Nutricional, Lima, Peru
| | | | - Ana I. Gil
- Instituto de Investigación Nutricional, Lima, Peru
| | | | - Carlos G. Grijalva
- Department of Health Policy, Vanderbilt University, Nashville, Tennessee, United States of America
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Cohen AL, McMorrow M, Walaza S, Cohen C, Tempia S, Alexander-Scott M, Widdowson MA. Potential Impact of Co-Infections and Co-Morbidities Prevalent in Africa on Influenza Severity and Frequency: A Systematic Review. PLoS One 2015; 10:e0128580. [PMID: 26068416 PMCID: PMC4466242 DOI: 10.1371/journal.pone.0128580] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/28/2015] [Indexed: 12/14/2022] Open
Abstract
Infectious diseases and underlying medical conditions common to Africa may affect influenza frequency and severity. We conducted a systematic review of published studies on influenza and the following co-infections or co-morbidities that are prevalent in Africa: dengue, malaria, measles, meningococcus, Pneumocystis jirovecii pneumonia (PCP), hemoglobinopathies, and malnutrition. Articles were identified except for influenza and PCP. Very few studies were from Africa. Sickle cell disease, dengue, and measles co-infection were found to increase the severity of influenza disease, though this is based on few studies of dengue and measles and the measles study was of low quality. The frequency of influenza was increased among patients with sickle cell disease. Influenza infection increased the frequency of meningococcal disease. Studies on malaria and malnutrition found mixed results. Age-adjusted morbidity and mortality from influenza may be more common in Africa because infections and diseases common in the region lead to more severe outcomes and increase the influenza burden. However, gaps exist in our knowledge about these interactions.
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Affiliation(s)
- Adam L. Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Influenza Program, Centers for Disease Control and Prevention—South Africa, Pretoria, South Africa
- United States Public Health Service, Rockville, Maryland, United States of America
- * E-mail:
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- United States Public Health Service, Rockville, Maryland, United States of America
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Sandringham, South Africa
- School of Public Health and Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Sandringham, South Africa
- School of Public Health and Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Influenza Program, Centers for Disease Control and Prevention—South Africa, Pretoria, South Africa
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Sandringham, South Africa
| | - Marissa Alexander-Scott
- Division of Applied Research and Technology (DART), National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, Cincinnati, Ohio, United States of America
- University of Illinois, Springfield, Illinois, United States of America
| | - Marc-Alain Widdowson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Balakrishnan K, Sambandam S, Ramaswamy P, Ghosh S, Venkatesan V, Thangavel G, Mukhopadhyay K, Johnson P, Paul S, Puttaswamy N, Dhaliwal RS, Shukla DK. Establishing integrated rural-urban cohorts to assess air pollution-related health effects in pregnant women, children and adults in Southern India: an overview of objectives, design and methods in the Tamil Nadu Air Pollution and Health Effects (TAPHE) study. BMJ Open 2015; 5:e008090. [PMID: 26063570 PMCID: PMC4466609 DOI: 10.1136/bmjopen-2015-008090] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/28/2015] [Accepted: 05/07/2015] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION In rapidly developing countries such as India, the ubiquity of air pollution sources in urban and rural communities often results in ambient and household exposures significantly in excess of health-based air quality guidelines. Few efforts, however, have been directed at establishing quantitative exposure-response relationships in such settings. We describe study protocols for The Tamil Nadu Air Pollution and Health Effects (TAPHE) study, which aims to examine the association between fine particulate matter (PM2.5) exposures and select maternal, child and adult health outcomes in integrated rural-urban cohorts. METHODS AND ANALYSES The TAPHE study is organised into five component studies with participants drawn from a pregnant mother-child cohort and an adult cohort (n=1200 participants in each cohort). Exposures are assessed through serial measurements of 24-48 h PM2.5 area concentrations in household microenvironments together with ambient measurements and time-activity recalls, allowing exposure reconstructions. Generalised additive models will be developed to examine the association between PM2.5 exposures, maternal (birth weight), child (acute respiratory infections) and adult (chronic respiratory symptoms and lung function) health outcomes while adjusting for multiple covariates. In addition, exposure models are being developed to predict PM2.5 exposures in relation to household and community level variables as well as to explore inter-relationships between household concentrations of PM2.5 and air toxics. Finally, a bio-repository of peripheral and cord blood samples is being created to explore the role of gene-environment interactions in follow-up studies. ETHICS AND DISSEMINATION The study protocols have been approved by the Institutional Ethics Committee of Sri Ramachandra University, the host institution for the investigators in this study. Study results will be widely disseminated through peer-reviewed publications and scientific presentations. In addition, policy-relevant recommendations are also being planned to inform ongoing national air quality action plans concerning ambient and household air pollution.
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Affiliation(s)
- Kalpana Balakrishnan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Environmental Health: Air Pollution, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - Sankar Sambandam
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Environmental Health: Air Pollution, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - Padmavathi Ramaswamy
- Department of Physiology, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - Santu Ghosh
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Environmental Health: Air Pollution, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | | | - Gurusamy Thangavel
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Environmental Health: Air Pollution, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - Krishnendu Mukhopadhyay
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Environmental Health: Air Pollution, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - Priscilla Johnson
- Department of Physiology, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - Solomon Paul
- Department of Human Genetics, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - Naveen Puttaswamy
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Environmental Health: Air Pollution, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - Rupinder S Dhaliwal
- Division of Non-Communicable Diseases, Indian Council for Medical Research, New Delhi, Delhi, India
| | - D K Shukla
- Division of Non-Communicable Diseases, Indian Council for Medical Research, New Delhi, Delhi, India
| | - SRU-CAR Team
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Environmental Health: Air Pollution, Sri Ramachandra University, Chennai, Tamil Nadu, India
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Cooking and season as risk factors for acute lower respiratory infections in African children: a cross-sectional multi-country analysis. PLoS One 2015; 10:e0128933. [PMID: 26042802 PMCID: PMC4456387 DOI: 10.1371/journal.pone.0128933] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 05/02/2015] [Indexed: 01/30/2023] Open
Abstract
Background Acute lower respiratory infections (ALRI) are a leading cause of death among African children under five. A significant proportion of these are attributable to household air pollution from solid fuel use. Methods We assessed the relationship between cooking practices and ALRI in pooled datasets of Demographic and Health Surveys conducted between 2000 and 2011 in countries of sub-Saharan Africa. The impacts of main cooking fuel, cooking location and stove ventilation were examined in 18 (n = 56,437), 9 (n = 23,139) and 6 countries (n = 14,561) respectively. We used a causal diagram and multivariable logistic mixed models to assess the influence of covariates at individual, regional and national levels. Results Main cooking fuel had a statistically significant impact on ALRI risk (p<0.0001), with season acting as an effect modifier (p = 0.034). During the rainy season, relative to clean fuels, the odds of suffering from ALRI were raised for kerosene (OR 1.64; CI: 0.99, 2.71), coal and charcoal (OR 1.54; CI: 1.21, 1.97), wood (OR 1.20; CI: 0.95, 1.51) and lower-grade biomass fuels (OR 1.49; CI: 0.93, 2.35). In contrast, during the dry season the corresponding odds were reduced for kerosene (OR 1.23; CI: 0.77, 1.95), coal and charcoal (OR 1.35; CI: 1.06, 1.72) and lower-grade biomass fuels (OR 1.07; CI: 0.69, 1.66) but increased for wood (OR 1.32; CI: 1.04, 1.66). Cooking location also emerged as a season-dependent statistically significant (p = 0.0070) determinant of ALRI, in particular cooking indoors without a separate kitchen during the rainy season (OR 1.80; CI: 1.30, 2.50). Due to infrequent use in Africa we could, however, not demonstrate an effect of stove ventilation. Conclusions We found differential and season-dependent risks for different types of solid fuels and kerosene as well as cooking location on child ALRI. Future household air pollution studies should consider potential effect modification of cooking fuel by season.
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Williams KN, Northcross AL, Graham JP. Health impacts of household energy use: indicators of exposure to air pollution and other risks. Bull World Health Organ 2015; 93:507-8. [PMID: 26170510 PMCID: PMC4490808 DOI: 10.2471/blt.14.144923] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 01/17/2015] [Accepted: 02/12/2015] [Indexed: 12/02/2022] Open
Affiliation(s)
- Kendra N Williams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America (USA)
| | - Amanda L Northcross
- Department of Environmental and Occupational Health and Department of Global Health, George Washington University School of Public Health and Health Services, Washington, DC, USA
| | - Jay P Graham
- Department of Environmental and Occupational Health and Department of Global Health, George Washington University School of Public Health and Health Services, Washington, DC, USA
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Sun L, Lin Z, Liao K, Xi Z, Wang D. Adverse effects of coal combustion related fine particulate matter (PM2.5) on nematode Caenorhabditis elegans. THE SCIENCE OF THE TOTAL ENVIRONMENT 2015; 512-513:251-260. [PMID: 25625637 DOI: 10.1016/j.scitotenv.2015.01.058] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 01/15/2015] [Accepted: 01/19/2015] [Indexed: 06/04/2023]
Abstract
The toxic effects of coal combustion related fine particulate matter (PM2.5), collected from Datong, Shanxi province, China, on nematode Caenorhabditis elegans were investigated. Exposure to PM2.5 resulted in deficits in development, reproduction, locomotion behavior, and lifespan, and induction of intestinal autofluorescence or reactive oxygen species (ROS) production. Prolonged exposure to PM2.5 led to more severe toxicity on nematodes than acute exposure. In addition, exposure to PM2.5 induced altered expression patterns of genes required for the control of oxidative stress. Reduction in mean defecation cycle length and developmental deficits in AVL and DVB neurons, which are involved in the control of defecation behavior, were also triggered by PM2.5 exposure. Thus, oxidative stress and abnormal defecation behavior may contribute greatly to the toxicity of coal combustion related PM2.5 in nematodes. The results also imply that the long-term adverse effects of coal combustion related PM2.5 on environmental organisms should be carefully considered.
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Affiliation(s)
- Lingmei Sun
- Key Laboratory of Environmental Medicine Engineering in Ministry of Education, Medical School of Southeast University, Nanjing 210009, China
| | - Zhiqing Lin
- Institute of Health and Environmental Medicine, Key Laboratory of Risk Assessment and Control Technology for Environmental & Food Safety, Tianjin 300050, China
| | - Kai Liao
- Key Laboratory of Environmental Medicine Engineering in Ministry of Education, Medical School of Southeast University, Nanjing 210009, China
| | - Zhuge Xi
- Institute of Health and Environmental Medicine, Key Laboratory of Risk Assessment and Control Technology for Environmental & Food Safety, Tianjin 300050, China.
| | - Dayong Wang
- Key Laboratory of Environmental Medicine Engineering in Ministry of Education, Medical School of Southeast University, Nanjing 210009, China.
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The rise of multiple imputation: a review of the reporting and implementation of the method in medical research. BMC Med Res Methodol 2015; 15:30. [PMID: 25880850 PMCID: PMC4396150 DOI: 10.1186/s12874-015-0022-1] [Citation(s) in RCA: 214] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/18/2015] [Indexed: 12/16/2022] Open
Abstract
Background Missing data are common in medical research, which can lead to a loss in statistical power and potentially biased results if not handled appropriately. Multiple imputation (MI) is a statistical method, widely adopted in practice, for dealing with missing data. Many academic journals now emphasise the importance of reporting information regarding missing data and proposed guidelines for documenting the application of MI have been published. This review evaluated the reporting of missing data, the application of MI including the details provided regarding the imputation model, and the frequency of sensitivity analyses within the MI framework in medical research articles. Methods A systematic review of articles published in the Lancet and New England Journal of Medicine between January 2008 and December 2013 in which MI was implemented was carried out. Results We identified 103 papers that used MI, with the number of papers increasing from 11 in 2008 to 26 in 2013. Nearly half of the papers specified the proportion of complete cases or the proportion with missing data by each variable. In the majority of the articles (86%) the imputed variables were specified. Of the 38 papers (37%) that stated the method of imputation, 20 used chained equations, 8 used multivariate normal imputation, and 10 used alternative methods. Very few articles (9%) detailed how they handled non-normally distributed variables during imputation. Thirty-nine papers (38%) stated the variables included in the imputation model. Less than half of the papers (46%) reported the number of imputations, and only two papers compared the distribution of imputed and observed data. Sixty-six papers presented the results from MI as a secondary analysis. Only three articles carried out a sensitivity analysis following MI to assess departures from the missing at random assumption, with details of the sensitivity analyses only provided by one article. Conclusions This review outlined deficiencies in the documenting of missing data and the details provided about imputation. Furthermore, only a few articles performed sensitivity analyses following MI even though this is strongly recommended in guidelines. Authors are encouraged to follow the available guidelines and provide information on missing data and the imputation process. Electronic supplementary material The online version of this article (doi:10.1186/s12874-015-0022-1) contains supplementary material, which is available to authorized users.
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Kleimola LB, Patel AB, Borkar JA, Hibberd PL. Consequences of household air pollution on child survival: evidence from demographic and health surveys in 47 countries. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2015; 21:294-302. [PMID: 25843087 DOI: 10.1179/2049396715y.0000000007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Over one-third of the world's population is exposed to household air pollution (HAP) but the separate effects of cooking with solid fuel and kerosene on childhood mortality are unclear. OBJECTIVES To evaluate the effects of both solid fuels and kerosene on neonatal (0-28 days) and child (29 days-59 months) mortality. METHODS We used Demographic and Health Surveys from 47 countries and calculated adjusted relative risks (aRR) using Poisson regression models. RESULTS The aRR of neonatal and child mortality in households exposed to solid fuels were 1.24 (95% CI: 1.14, 1.34) and 1.21 (95% CI: 1.12, 1.30), respectively, and the aRR for neonatal and child mortality in households exposed to kerosene were 1.34 (95% CI: 1.18, 1.52) and 1.12 (95% CI: 0.99, 1.27), controlling for individual, household, and country-level predictors of mortality. CONCLUSIONS Kerosene should not be classified as a clean fuel. Neonates are at risk for mortality from exposure to solid fuels and kerosene.
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Affiliation(s)
- Lauren B Kleimola
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital , Boston, MA, USA
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Pope D, Diaz E, Smith-Sivertsen T, Lie RT, Bakke P, Balmes JR, Smith KR, Bruce NG. Exposure to household air pollution from wood combustion and association with respiratory symptoms and lung function in nonsmoking women: results from the RESPIRE trial, Guatemala. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:285-92. [PMID: 25398189 PMCID: PMC4384202 DOI: 10.1289/ehp.1408200] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 11/12/2014] [Indexed: 05/21/2023]
Abstract
BACKGROUND With 40% of the world's population relying on solid fuel, household air pollution (HAP) represents a major preventable risk factor for COPD (chronic obstructive pulmonary disease). Meta-analyses have confirmed this relationship; however, constituent studies are observational, with virtually none measuring exposure directly. OBJECTIVES We estimated associations between HAP exposure and respiratory symptoms and lung function in young, nonsmoking women in rural Guatemala, using measured carbon monoxide (CO) concentrations in exhaled breath and personal air to assess exposure. METHODS The Randomized Exposure Study of Pollution Indoors and Respiratory Effects (RESPIRE) Guatemala study was a trial comparing respiratory outcomes among 504 women using improved chimney stoves versus traditional cookstoves. The present analysis included 456 women with data from postintervention surveys including interviews at 6, 12, and 18 months (respiratory symptoms) and spirometry and CO (ppm) in exhaled breath measurements. Personal CO was measured using passive diffusion tubes at variable times during the study. Associations between CO concentrations and respiratory health were estimated using random intercept regression models. RESULTS Respiratory symptoms (cough, phlegm, wheeze, or chest tightness) during the previous 6 months were positively associated with breath CO measured at the same time of symptom reporting and with average personal CO concentrations during the follow-up period. CO in exhaled breath at the same time as spirometry was associated with lower lung function [average reduction in FEV1 (forced expiratory volume in 1 sec) for a 10% increase in CO was 3.33 mL (95% CI: -0.86, -5.81)]. Lung function measures were not significantly associated with average postintervention personal CO concentrations. CONCLUSIONS Our results provide further support for the effects of HAP exposures on airway inflammation. Further longitudinal research modeling continuous exposure to particulate matter against lung function will help us understand more fully the impact of HAP on COPD.
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Affiliation(s)
- Daniel Pope
- Division of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
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Quansah R, Ochieng CA, Semple S, Juvekar S, Emina J, Armah FA, Luginaah I. Effectiveness of interventions to reduce indoor air pollution and/or improve health in homes using solid fuel in lower and middle income countries: protocol for a systematic review. Syst Rev 2015; 4:22. [PMID: 25875770 PMCID: PMC4378274 DOI: 10.1186/s13643-015-0012-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 02/09/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Indoor air pollution (IAP) interventions are widely promoted as a means of reducing indoor air pollution/health from solid fuel use; and research addressing impact of these interventions has increased substantially in the past two decades. It is timely and important to understand more about effectiveness of these interventions. We describe the protocol of a systematic review to (i) evaluate effectiveness of IAP interventions to improve indoor air quality and/or health in homes using solid fuel for cooking and/or heating in lower- and middle-income countries, (ii) identify the most effective intervention to improve indoor air quality and/or health, and (iii) identify future research needs. METHODS This review will be conducted according to the National Institute for Health and Care Excellence (NICE) guidelines and will be reported following the PRISMA statement. Ovid MEDLINE, Ovid Embase, SCOPUS, and PubMed searches were conducted in September 2013 and updated in November 2014 (and include any further search updates in February 2015). Additional references will be located through searching the references cited by identified studies and through the World Health Organization Global database of household air pollution measurements. We will also search our own archives. Data extraction and risk of bias assessment of all included papers will be conducted independently by five reviewers. DISCUSSION The study will provide insights into what interventions are most effective in reducing indoor air pollution and/or adverse health outcomes in homes using solid fuel for cooking or heating in lower- or middle-income countries. The findings from this review will be used to inform future IAP interventions and policy on poverty reduction and health improvement in poor communities who rely on biomass and solid fuels for cooking and heating. SYSTEMATIC REVIEW REGISTRATION The review has been registered with PROSPERO (registration number CRD42014009768 ).
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Affiliation(s)
- Reginald Quansah
- Biological, Environmental & Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
- Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
| | | | - Sean Semple
- Scottish Centre for Indoor Air Division of Applied Health Science, University of Aberdeen, Aberdeen, Scotland, UK.
| | - Sanjar Juvekar
- KEM Hospital Research Centre, Pune, India.
- INDEPTH, Accra, Ghana.
| | | | - Frederick Ato Armah
- Department of Geography, Western University Canada, London, Ontario, Canada.
| | - Isaac Luginaah
- Department of Geography, Western University Canada, London, Ontario, Canada.
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Schilmann A, Riojas-Rodríguez H, Ramírez-Sedeño K, Berrueta VM, Pérez-Padilla R, Romieu I. Children's Respiratory Health After an Efficient Biomass Stove (Patsari) Intervention. ECOHEALTH 2015; 12:68-76. [PMID: 25201350 DOI: 10.1007/s10393-014-0965-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 07/07/2014] [Indexed: 06/03/2023]
Abstract
Household use of fuelwood represents a socio-ecological condition with important health effects mainly in rural areas from developing countries. One approach to tackle this problem has been the introduction of efficient wood-burning chimney stoves. The aim of this study was to assess the impact of the introduction of Patsari stoves on the respiratory health of young children in highlands Michoacán, Mexico. A total of 668 households in six rural communities in a fuelwood using region were selected and randomized to receive an improved stove (Patsari) or rely entirely on the traditional wood fire until the end of the follow-up including 10 monthly visits. Adherence to the intervention was variable over the follow-up time. The actual use of the Patsari stove as reported by the mother showed a protective effect mainly on the upper and lower respiratory infection duration (IRR URI 0.79, 95% CI 0.70-0.89, and LRI 0.41, 95% CI 0.21-0.80) compared to households that used only an open fire. Fewer days of child's ill health represents saved time for the woman and avoided disease treatment costs for the family, as well as a decrease in public health costs due to a reduction in the frequency of patient visits.
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Affiliation(s)
- Astrid Schilmann
- Environmental Health Department, National Institute of Public Health (INSP), Av. Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
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Kelly MS, Wirth KE, Madrigano J, Feemster KA, Cunningham CK, Arscott-Mills T, Boiditswe S, Shah SS, Finalle R, Steenhoff AP. The effect of exposure to wood smoke on outcomes of childhood pneumonia in Botswana. Int J Tuberc Lung Dis 2015; 19:349-55. [PMID: 25686146 PMCID: PMC4352146 DOI: 10.5588/ijtld.14.0557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Tertiary hospital in Gaborone, Botswana. OBJECTIVE To examine whether exposure to wood smoke worsens outcomes of childhood pneumonia. DESIGN Prospective cohort study of children aged 1-23 months meeting clinical criteria for pneumonia. Household use of wood as a cooking fuel was assessed during a face-to-face questionnaire with care givers. We estimated crude and adjusted risk ratios (RRs) and 95% confidence intervals (CIs) for treatment failure at 48 h by household use of wood as a cooking fuel. We assessed for effect modification by age (1-5 vs. 6-23 months) and malnutrition (none vs. moderate vs. severe). RESULTS The median age of the 284 enrolled children was 5.9 months; 17% had moderate or severe malnutrition. Ninety-nine (35%) children failed treatment at 48 h and 17 (6%) died. In multivariable analyses, household use of wood as a cooking fuel increased the risk of treatment failure at 48 h (RR 1.44, 95%CI 1.09-1.92, P = 0.01). This association differed by child nutritional status (P = 0.02), with a detrimental effect observed only among children with no or moderate malnutrition. CONCLUSIONS Exposure to wood smoke worsens outcomes for childhood pneumonia. Efforts to prevent exposure to smoke from unprocessed fuels may improve pneumonia outcomes among children.
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Affiliation(s)
- Matthew S. Kelly
- Botswana-UPenn Partnership, Gaborone, Botswana
- Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Kathleen E. Wirth
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Jaime Madrigano
- Department of Environmental and Occupational Health, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Kristen A. Feemster
- Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Coleen K. Cunningham
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Tonya Arscott-Mills
- Botswana-UPenn Partnership, Gaborone, Botswana
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Samir S. Shah
- Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rodney Finalle
- Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew P. Steenhoff
- Botswana-UPenn Partnership, Gaborone, Botswana
- Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Northcross AL, Hwang N, Balakrishnan K, Mehta S. Assessing exposures to household air pollution in public health research and program evaluation. ECOHEALTH 2015; 12:57-67. [PMID: 25380652 PMCID: PMC4416115 DOI: 10.1007/s10393-014-0990-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 09/22/2014] [Accepted: 09/28/2014] [Indexed: 05/23/2023]
Abstract
Exposure to smoke from the use of solid fuels and inefficient stoves for cooking and heating is responsible for approximately 4 million premature deaths yearly. As increasing investments are made to tackle this important public health issue, there is a need for identifying and providing guidance on best practices for exposure and stove performance monitoring, particularly for public health research and evaluation studies. This paper, which builds upon the discussion at an expert consultation on exposure assessment convened by the Global Alliance for Clean Cookstoves, the Centers for Disease Control and Prevention, and PATH in late 2012, aims to provide general guidance on what to monitor, who and where to monitor, and how to monitor household air pollution exposures. In addition, we summarize information about commercially available monitoring equipment and the technical properties of these monitors most important for household air pollution exposure assessment. The target audience includes epidemiologists conducting health studies and program evaluators aiming to quantify changes in exposures to estimate the potential health benefits of cookstoves intervention projects.
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Affiliation(s)
- Amanda L Northcross
- Department of Environmental and Occupational Health, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave 7th Floor, 20057, Washington, DC, USA,
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Laborde A, Tomasina F, Bianchi F, Bruné MN, Buka I, Comba P, Corra L, Cori L, Duffert CM, Harari R, Iavarone I, McDiarmid MA, Gray KA, Sly PD, Soares A, Suk WA, Landrigan PJ. Children's health in Latin America: the influence of environmental exposures. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:201-9. [PMID: 25499717 PMCID: PMC4348745 DOI: 10.1289/ehp.1408292] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 12/02/2014] [Indexed: 05/18/2023]
Abstract
BACKGROUND Chronic diseases are increasing among children in Latin America. OBJECTIVE AND METHODS To examine environmental risk factors for chronic disease in Latin American children and to develop a strategic initiative for control of these exposures, the World Health Organization (WHO) including the Pan American Health Organization (PAHO), the Collegium Ramazzini, and Latin American scientists reviewed regional and relevant global data. RESULTS Industrial development and urbanization are proceeding rapidly in Latin America, and environmental pollution has become widespread. Environmental threats to children's health include traditional hazards such as indoor air pollution and drinking-water contamination; the newer hazards of urban air pollution; toxic chemicals such as lead, asbestos, mercury, arsenic, and pesticides; hazardous and electronic waste; and climate change. The mix of traditional and modern hazards varies greatly across and within countries reflecting industrialization, urbanization, and socioeconomic forces. CONCLUSIONS To control environmental threats to children's health in Latin America, WHO, including PAHO, will focus on the most highly prevalent and serious hazards-indoor and outdoor air pollution, water pollution, and toxic chemicals. Strategies for controlling these hazards include developing tracking data on regional trends in children's environmental health (CEH), building a network of Collaborating Centres, promoting biomedical research in CEH, building regional capacity, supporting development of evidence-based prevention policies, studying the economic costs of chronic diseases in children, and developing platforms for dialogue with relevant stakeholders.
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Affiliation(s)
- Amalia Laborde
- Faculty of Medicine, University of the Republic of Uruguay, Montevideo, Uruguay
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Rosenthal J. The real challenge for cookstoves and health: more evidence. ECOHEALTH 2015; 12:8-11. [PMID: 25691140 DOI: 10.1007/s10393-014-0997-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/23/2014] [Accepted: 10/29/2014] [Indexed: 06/04/2023]
Affiliation(s)
- Joshua Rosenthal
- Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, 20892-2220, USA,
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Breiman RF, Cosmas L, Njenga M, Williamson J, Mott JA, Katz MA, Erdman DD, Schneider E, Oberste M, Neatherlin JC, Njuguna H, Ondari DM, Odero K, Okoth GO, Olack B, Wamola N, Montgomery JM, Fields BS, Feikin DR. Severe acute respiratory infection in children in a densely populated urban slum in Kenya, 2007-2011. BMC Infect Dis 2015; 15:95. [PMID: 25879805 PMCID: PMC4351931 DOI: 10.1186/s12879-015-0827-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 02/11/2015] [Indexed: 12/17/2022] Open
Abstract
Background Reducing acute respiratory infection burden in children in Africa remains a major priority and challenge. We analyzed data from population-based infectious disease surveillance for severe acute respiratory illness (SARI) among children <5 years of age in Kibera, a densely populated urban slum in Nairobi, Kenya. Methods Surveillance was conducted among a monthly mean of 5,874 (range = 5,778-6,411) children <5 years old in two contiguous villages in Kibera. Participants had free access to the study clinic and their health events and utilization were noted during biweekly home visits. Patients meeting criteria for SARI (WHO-defined severe or very severe pneumonia, or oxygen saturation <90%) from March 1, 2007-February 28, 2011 had blood cultures processed for bacteria, and naso- and oro- pharyngeal swabs collected for quantitative real-time reverse transcription polymerase chain reaction testing for influenza viruses, parainfluenza viruses (PIV), respiratory syncytial virus (RSV), adenovirus, and human metapneumovirus (hMPV). Swabs collected during January 1, 2009 – February 28, 2010 were also tested for rhinoviruses, enterovirus, parechovirus, Mycoplasma pneumoniae, and Legionella species. Swabs were collected for simultaneous testing from a selected group of control-children visiting the clinic without recent respiratory or diarrheal illnesses. Results SARI overall incidence was 12.4 cases/100 person-years of observation (PYO) and 30.4 cases/100 PYO in infants. When comparing detection frequency in swabs from 815 SARI cases and 115 healthy controls, only RSV and influenza A virus were significantly more frequently detected in cases, although similar trends neared statistical significance for PIV, adenovirus and hMPV. The incidence for RSV was 2.8 cases/100 PYO and for influenza A was 1.0 cases/100 PYO. When considering all PIV, the rate was 1.1 case/100 PYO and the rate per 100 PYO for SARI-associated disease was 1.5 for adenovirus and 0.9 for hMPV. RSV and influenza A and B viruses were estimated to account for 16.2% and 6.7% of SARI cases, respectively; when taken together, PIV, adenovirus, and hMPV may account for >20% additional cases. Conclusions Influenza viruses and RSV (and possibly PIV, hMPV and adenoviruses) are important pathogens to consider when developing technologies and formulating strategies to treat and prevent SARI in children.
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243
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Martin WJ. On the Global Epidemic of CVD and Why Household Air Pollution Matters. Glob Heart 2015; 7:201-6. [PMID: 25691483 DOI: 10.1016/j.gheart.2012.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 06/21/2012] [Indexed: 11/26/2022] Open
Affiliation(s)
- William J Martin
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
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Muralidharan V, Sussan TE, Limaye S, Koehler K, Williams DL, Rule AM, Juvekar S, Breysse PN, Salvi S, Biswal S. Field testing of alternative cookstove performance in a rural setting of western India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:1773-87. [PMID: 25654775 PMCID: PMC4344692 DOI: 10.3390/ijerph120201773] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/27/2015] [Indexed: 11/16/2022]
Abstract
Nearly three billion people use solid fuels for cooking and heating, which leads to extremely high levels of household air pollution and is a major cause of morbidity and mortality. Many stove manufacturers have developed alternative cookstoves (ACSs) that are aimed at reducing emissions and fuel consumption. Here, we tested a traditional clay chulha cookstove (TCS) and five commercially available ACSs, including both natural draft (Greenway Smart Stove, Envirofit PCS-1) and forced draft stoves (BioLite HomeStove, Philips Woodstove HD4012, and Eco-Chulha XXL), in a test kitchen in a rural village of western India. Compared to the TCS, the ACSs produced significant reductions in particulate matter less than 2.5 µm (PM2.5) and CO concentrations (Envirofit: 22%/16%, Greenway: 24%/42%, BioLite: 40%/35%, Philips: 66%/55% and Eco-Chulha: 61%/42%), which persisted after normalization for fuel consumption or useful energy. PM2.5 and CO concentrations were lower for forced draft stoves than natural draft stoves. Furthermore, the Philips and Eco-Chulha units exhibited higher cooking efficiency than the TCS. Despite significant reductions in concentrations, all ACSs failed to achieve PM2.5 levels that are considered safe by the World Health Organization (ACSs: 277-714 μg/m³ or 11-28 fold higher than the WHO recommendation of 25 μg/m³).
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Affiliation(s)
- Veena Muralidharan
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune 411011, India.
| | - Thomas E Sussan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | | | - Kirsten Koehler
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - D'Ann L Williams
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Ana M Rule
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune 411011, India.
| | - Patrick N Breysse
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | | | - Shyam Biswal
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Wren HM, Solomons NW, Chomat AM, Scott ME, Koski KG. Cultural determinants of optimal breastfeeding practices among indigenous Mam-Mayan women in the Western Highlands of Guatemala. J Hum Lact 2015; 31:172-84. [PMID: 25583316 DOI: 10.1177/0890334414560194] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Among indigenous Mam-Mayan women, breastfeeding practices may be intertwined with cultural influences during the early postpartum period. OBJECTIVES Our study explored whether beliefs regarding transmission of emotions through breast milk, the feeding of agüitas or temascal (traditional sauna) use were associated with achievement of the World Health Organization infant feeding recommendations and if these cultural practices served as moderators of the relationship between optimal breastfeeding practices and infant anthropometry. METHODS We recruited 190 mother-infant dyads at infant age < 46 days. Data on breastfeeding and cultural practices were collected via questionnaire. Infant length, weight, and head circumference were measured and z scores were calculated. Multiple linear and logistic regression analyses were used to examine determinants of initiation of breastfeeding within 1 hour, breastfeeding frequency, breastfeeding exclusivity, and infant weight-for-age z score (WAZ). RESULTS Mothers who delivered at the traditional midwife's house (odds ratio [OR] = 2.5) and those who did not believe in the transmission of susto (fright) through breast milk (OR = 2.4) were more likely to initiate breastfeeding within 1 hour postpartum. Higher breastfeeding frequency was observed among mothers who spent more time in the temascal. Initiating early breastfeeding within 1 hour postpartum was the sole infant feeding practice positively associated with exclusive breastfeeding and WAZ. CONCLUSIONS Our investigation in the Western Highlands of Guatemala has highlighted the link between cultural practices and beliefs during lactation, breastfeeding practices and infant growth. Public health practitioners need to understand how local cultural practices influence early initiation of breastfeeding to promote adequate infant weight.
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Affiliation(s)
- Hilary M Wren
- School of Dietetics and Human Nutrition, McGill University, Montreal, Canada
| | - Noel W Solomons
- Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala
| | | | - Marilyn E Scott
- Institute of Parasitology, McGill University, Montreal, Canada
| | - Kristine G Koski
- School of Dietetics and Human Nutrition, McGill University, Montreal, Canada
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Prasodjo R, Musadad DA, Muhidin S, Pardosi J, Silalahi M. Advocate program for healthy traditional houses, Ume Kbubu, in a Timor community: preserving traditional behavior and promoting improved health outcomes. JOURNAL OF HEALTH COMMUNICATION 2015; 20 Suppl 1:10-19. [PMID: 25839199 DOI: 10.1080/10810730.2015.1013390] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Families in the Timor society of Indonesia have customarily used traditional houses, called Ume Kbubu, for confinement practices of a newborn baby and the mother during the first 40 days after birth. The practice, known as Sei (smoke) tradition, involves retaining heat, which is believed to foster healing, inside the house by continuously burning a wood burning stove. Exacerbated by inadequate ventilation in the traditional house, this practice results in poor indoor air quality and negatively affects the health of the mother and baby. Preliminary findings from a baseline study conducted in 2009 identified high levels of indoor air pollution in Ume Kbubu where mothers practiced the Sei tradition. Many respondents expressed that they suffered from respiratory health problems during the practice. On the basis of those results, a follow-up study was conducted in 2011 to develop and test a communication-focused behavior change intervention that would foster conversion of traditional houses into healthy Ume Kbubu and promote changes to traditional practices for better health outcomes. The study suggests that redesigning an Ume Kbubu house could promote better air quality inside the house and involving the community in the health intervention program led to positive changes in the Sei practice (i.e., decreasing the Sei period's length from 40 days to 4 days on average and attempting to reduce household air pollution). The study resulted in several recommendations in relation to sustained transformation to improve health behaviors.
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Affiliation(s)
- Rachmalina Prasodjo
- a National Institute of Health Research and Development , Ministry of Health , Indonesia , Jakarta , Indonesia
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Rosenbaum J, Derby E, Dutta K. Understanding consumer preference and willingness to pay for improved cookstoves in Bangladesh. JOURNAL OF HEALTH COMMUNICATION 2015; 20 Suppl 1:20-27. [PMID: 25839200 DOI: 10.1080/10810730.2014.989345] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The USAID/WASHplus project conducted a comprehensive assessment to understand consumer needs and preferences as they relate to increasing the uptake and consistent, exclusive, and correct use of improved cookstoves (ICSs) in Bangladesh. The assessment included household ICS trials, fuel and stove use monitoring, and consumers' perceived value of and willingness to pay for ICSs. Results showed that cooks appreciated and liked the ICS, but that no models met consumer needs sufficiently to replace traditional stoves. Initially, many preferred ICSs over traditional stoves, but this preference decreased over the 3-week trial period. Complaints and suggestions for improvement fell into two general categories: those that can be addressed through fairly simple modifications to the stove design, and those more appropriately addressed through point-of-purchase consumer education and follow-up from service agents or health outreach workers. Most households using the ICS realized fuel use reductions, although these were lower than expected, partly because of continued parallel traditional stove use. When given the option to purchase the stoves at market value, only one of 105 households did so; however, a separate assessment showed that 80% of participants (12 of 15 households) preferred to keep the stove rather than receive a cash buyout at market value. This indicates that users value the ICS when acquisition barriers are removed and highlights the need for better financing options.
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Affiliation(s)
- Julia Rosenbaum
- a FHI360, USAID/WASHplus Project , Washington , District of Columbia , USA
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Stanistreet D, Hyseni L, Bashin M, Sadumah I, Pope D, Sage M, Bruce N. The role of mixed methods in improved cookstove research. JOURNAL OF HEALTH COMMUNICATION 2015; 20 Suppl 1:84-93. [PMID: 25839206 DOI: 10.1080/10810730.2014.999896] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The challenge of promoting access to clean and efficient household energy for cooking and heating is a critical issue facing low- and middle-income countries today. Along with clean fuels, improved cookstoves (ICSs) continue to play an important part in efforts to reduce the 4 million annual premature deaths attributed to household air pollution. Although a range of ICSs are available, there is little empirical evidence on appropriate behavior change approaches to inform adoption and sustained used at scale. Specifically, evaluations using either quantitative or qualitative methods provide an incomplete picture of the challenges in facilitating ICS adoption. This article examines how studies that use the strengths of both these approaches can offer important insights into behavior change in relation to ICS uptake and scale-up. Epistemological approaches, study design frameworks, methods of data collection, analytical approaches, and issues of validity and reliability in the context of mixed methods ICS research are examined, and the article presents an example study design from an evaluation study in Kenya incorporating a nested approach and a convergent case oriented design. The authors discuss the benefits and methodological challenges of mixed-methods approaches in the context of researching behavior change and ICS use recognizing that such methods represent relatively uncharted territory. The authors propose that more published examples are needed to provide frameworks for other researchers seeking to apply mixed methods in this context and suggest a comprehensive research agenda is required that incorporates integrated mixed-methods approaches, to provide best evidence for future scale-up.
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Affiliation(s)
- Debbi Stanistreet
- a Department of Public Health and Policy, Institute of Psychology, Health and Society , University of Liverpool , Liverpool , United Kingdom
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Abstract
As described in a recently released report of the Forum of International Respiratory Societies, four of the leading causes of death in the world are chronic obstructive pulmonary disease, acute respiratory tract infections, lung cancer, and tuberculosis. A fifth, asthma, causes enormous global morbidity. Not enough progress has been made in introducing new therapies and reducing disease burden for these illnesses in the last few decades, despite generous investments and some notable progress in biomedical research. Four external and modifiable drivers are responsible for a substantial percentage of the disease burden represented by the major lung diseases: tobacco, outdoor air pollution, household air pollution, and occupational exposures to lung toxins. Especially in low- and middle-income countries, but in highly developed economies as well, pressures for economic development and lax regulation are contributing to the continued proliferation of these drivers. Public health approaches to the most common lung diseases could have enormous effects on reducing morbidity and mortality. There must be increased advocacy from and mobilization of civil society to bring attention to the drivers of lung diseases in the world. The World Health Organization should negotiate accords similar to the Framework Convention on Tobacco Control to address air pollution and occupational exposures. Large increases in funding by government agencies and nongovernmental organizations around the world are needed to identify technologies that will reduce health risks while allowing populations to enjoy the benefits of economic development. This paradigm, focused more on public health than on individual medical treatment, has the best chance of substantial reduction in the burden of lung disease around the world in the next several years.
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Smith KR, Bruce N, Balakrishnan K, Adair-Rohani H, Balmes J, Chafe Z, Dherani M, Hosgood HD, Mehta S, Pope D, Rehfuess E. Millions dead: how do we know and what does it mean? Methods used in the comparative risk assessment of household air pollution. Annu Rev Public Health 2014; 35:185-206. [PMID: 24641558 DOI: 10.1146/annurev-publhealth-032013-182356] [Citation(s) in RCA: 323] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In the Comparative Risk Assessment (CRA) done as part of the Global Burden of Disease project (GBD-2010), the global and regional burdens of household air pollution (HAP) due to the use of solid cookfuels, were estimated along with 60+ other risk factors. This article describes how the HAP CRA was framed; how global HAP exposures were modeled; how diseases were judged to have sufficient evidence for inclusion; and how meta-analyses and exposure-response modeling were done to estimate relative risks. We explore relationships with the other air pollution risk factors: ambient air pollution, smoking, and secondhand smoke. We conclude with sensitivity analyses to illustrate some of the major uncertainties and recommendations for future work. We estimate that in 2010 HAP was responsible for 3.9 million premature deaths and ∼4.8% of lost healthy life years (DALYs), ranking it highest among environmental risk factors examined and one of the major risk factors of any type globally.
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Affiliation(s)
- Kirk R Smith
- School of Public Health, University of California, Berkeley, California 94720-7360; ,
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