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Wanyana MW, Migisha R, King P, Muhesi AK, Kwesiga B, Kadobera D, Bulage L, Ario AR. Factors associated with severe pneumonia among children <5 years, Kasese District, Uganda: a case-control study, January-April 2023. Pneumonia (Nathan) 2024; 16:13. [PMID: 39049136 PMCID: PMC11270805 DOI: 10.1186/s41479-024-00134-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/27/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Pneumonia is one of the leading causes of infant mortality globally, particularly in sub-Saharan Africa. In Uganda, pneumonia was the fourth leading cause of death in children <5 years in 2018. Analysis of 2013-2022 data for children <5 years from the District Health Information System indicated a high incidence of severe pneumonia in Kasese District, Uganda. We investigated to identify factors associated with severe pneumonia among children <5 years in Kasese District to inform prevention and control strategies. METHODS We conducted a 1:1 hospital-based case-control study among children aged 2-59 months presenting with pneumonia at five high-volume facilities in Kasese District from January to April 2023. A case was defined as pneumonia with ≥1 of the following danger signs: low oxygen saturation, central cyanosis, severe respiratory distress, feeding difficulties, altered consciousness, and convulsions. Controls were outpatient children aged 2-59 months with a diagnosis of non-severe pneumonia. We reviewed medical records at facilities and used an interviewer-administered questionnaire with caregivers to obtain information on socio-demographic and clinical characteristics. Logistic regression was used to identify factors associated with severe pneumonia. RESULTS We enrolled 199 cases and 174 controls. The odds of severe pneumonia were higher among children with diarrhoea only (adjusted odds ratio [aOR] = 2.9, 95%CI: 1.7-4.9), or malaria and diarrhoea (aOR = 3.4, 95%CI: 2.0-5.9), than those without a co-existing illness at the time of pneumonia diagnosis. Not being exclusively breastfed for ≥ 6 months (aOR = 2.0, 95%CI: 1.1-3.3) and exposure to indoor air pollution from cooking combustion sources (aOR = 2.9, 95%CI: 1.8-4.7) increased odds of severe pneumonia. CONCLUSION The findings highlight the significance of comorbidities, lack of exclusive breastfeeding, and exposure to indoor air pollution in the development of severe pneumonia. Promoting exclusive breastfeeding for ≥ 6 months and advocating for the use of clean energy sources, could mitigate morbidity attributable to severe pneumonia in the region.
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Affiliation(s)
- Mercy Wendy Wanyana
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda.
| | - Richard Migisha
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Patrick King
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
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Xu T, Ye X, Lu X, Lan G, Xie M, Huang Z, Wang T, Wu J, Zhan Z, Xie X. Association between solid cooking fuel and cognitive decline: Three nationwide cohort studies in middle-aged and older population. ENVIRONMENT INTERNATIONAL 2023; 173:107803. [PMID: 36805161 DOI: 10.1016/j.envint.2023.107803] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/07/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Household solid-fuel burning contributes to indoor air pollution and is linked to poor cognitive function, but how solid cooking fuel use leads to cognitive decline over time is not well elaborated. OBJECTIVE We examine the associations of solid cooking fuel with cognitive function among three nationally representative cohorts. METHODS This study uses data from the 2010-2018 China Family Panel Studies (CFPS), the 2011-2018 China Health and Retirement Longitudinal Study (CHARLS) and the 2003-2015 Mexican Health and Aging Study (MHAS) in adults over the age of 50. Time varying Cox model was conducted to measure the association between cooking fuel types and cognitive decline. Mediation analysis was used to estimate the potential mediation effects on the associations of cooking fuel types with cognitive decline risk. RESULTS Respondents in CFPS, CHARLS, and MHAS relied on solid cooking fuel at baseline approximately 56 %, 51 %, and 12 %, respectively. Using solid fuel was consistently associated with higher risk of cognitive decline in three cohorts (CFPS: HR = 1.300 [95 % CI: 1.201, 1.407], CHARLS: HR = 1.179 [95 % CI: 1.059, 1.312], MHAS: HR = 1.237 [95 % CI: 1.123, 1.362]). Compared to those with persistent solid fuel, persistent clean fuel and change from solid fuel to clean fuel were associated with a lower risk of cognitive decline. Hypertension, diabetes, physical activity, dyslipidemia and high-density lipoprotein cholesterol (HDL-C) may partially mediate the cognitive decline caused by solid fuel use. Of the cognitive decline burden, 18.23 % (95 % CI: 12.21 %, 24.73 %) in CFPS, 8.90 % (95 % CI: 2.93 %, 15.52 %) in CHARLS and 2.92 % (95 % CI: 1.52 %, 4.46 %) in MHAS of cognitive decline cases attributable to solid cooking fuel use. CONCLUSION The use of solid cooking fuel is associated with a higher risk of cognitive decline. It is essential to promote the expanded use of clean fuel to protect cognitive health.
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Affiliation(s)
- Tingting Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xiaoying Ye
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xiaoli Lu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Guohui Lan
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Mengying Xie
- The Second Clinical Medical School, Nanchang University, Nanchang, China
| | - Zelin Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Tinggui Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Jieyu Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Zhiying Zhan
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xiaoxu Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China; Clinical Research Unit, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China.
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Dharel S, Shrestha B, Basel P. Factors associated with childhood pneumonia and care seeking practices in Nepal: further analysis of 2019 Nepal Multiple Indicator Cluster Survey. BMC Public Health 2023; 23:264. [PMID: 36750815 PMCID: PMC9903409 DOI: 10.1186/s12889-022-14839-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/08/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Acute Respiratory Infection (ARI) is still a major public health problem in Nepal. The prevalence of ARI among under five children was 2.1% in 2019 and many children from marginalized families suffer disproportionately and many of them die without proper care and treatment. The objective of this study was to identify factors associated with childhood pneumonia and care-seeking practices in Nepal. METHODS This was a secondary analysis of the Nepal Multiple Indicator Cluster Survey (MICS) 2019, which uses multi-stage Probability Proportional to Size sampling. Data from 6658 children were analyzed using SPSS 22. Chi-square test and logistic regression analysis were conducted with odds ratio and its corresponding 95% confidence interval after adjusting for confounders. RESULTS Children aged 0 to 23 months had1.5 times higher odds of pneumonia compared to the age group 24 to 59 months (AOR = 1.5, CI 1.0-2.3) and children from rural area had 1.9 times the odds of having pneumonia than urban children (AOR = 1.9, CI 1.2-3.2). Underweight children had 2.3 times greater odds of having pneumonia than normal weight children (AOR = 2.3, CI 1.4-3.9). The odds of having pneumonia were 2.5 higher among children of current smoking mothers compared those with non-smoking mothers (AOR = 2.5, CI 1.1-5.7). Similarly, children from disadvantaged families had 0.6 times protective odds of pneumonia than children from non-disadvantaged families (AOR = 0.6, CI 0.4-1.0). Only one quarter of children received treatment from public facilities. Of those who received treatment, nearly half of the children received inappropriate treatment for pneumonia. One in ten children with pneumonia did not receive any kind of treatment at all. CONCLUSIONS Pneumonia is still a public health problem in low-income countries. Public health program and treatment services should be targeted to younger children, careful attention should be given to underweight children, and awareness and nutrition related activities should be focused on rural areas. Addressing inequity in access to and utilization of treatment of childhood illnesses should be prioritized.
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Affiliation(s)
- Sunita Dharel
- grid.80817.360000 0001 2114 6728Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Binjwala Shrestha
- grid.80817.360000 0001 2114 6728Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Prem Basel
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
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Shrestha S, Gurung M, Amatya P, Bijukchhe S, Bose AS, Carter MJ, Gautam MC, Gurung S, Hinds J, Kandasamy R, Kelly S, Khadka B, Maskey P, Mujadidi YF, O’Reilly PJ, Pokhrel B, Pradhan R, Shah GP, Shrestha S, Wahl B, O’Brien KL, Knoll MD, Murdoch DR, Kelly DF, Thorson S, Voysey M, Pollard AJ, Acharya K, Acharya B, Ansari I, Basi R, Bista S, Bista S, Budha AK, Budhathoki S, Deshar R, Dhungel S, Felle S, Gautam K, Gorham K, Gurung TY, Gurung P, Jha R, K.C M, Karnikar SR, Kattel A, Lama L, Magar TKP, Maharjan M, Mallik A, Michel A, Nepal D, Nepal J, Park KM, Prajapati KG, Pudasaini R, Shrestha S, Smedley M, Weeks R, Yadav JK, Yadav SK. Effect of the of 10-valent pneumococcal conjugate vaccine in Nepal 4 years after introduction: an observational cohort study. Lancet Glob Health 2022; 10:e1494-e1504. [DOI: 10.1016/s2214-109x(22)00281-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 10/14/2022]
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B.K. RK, Shrestha S, Adhikari S, Maharjan S. Pneumonia among Children Admitted to the Department of Medicine in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:785-788. [PMID: 36705121 PMCID: PMC9794941 DOI: 10.31729/jnma.7859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Pneumonia is one of the most common infectious causes of death in children around the world, accounting for 14% of all deaths of children under five years of age. The study aimed to find out the prevalence of pneumonia among children admitted to the Department of Medicine of a tertiary care hospital. METHODS A descriptive cross-sectional study was conducted in the Department of Medicine of paediatrics tertiary care centre from 1 July 2021 to 30 June 2022 among children aged 2-59 months. Ethical approval was obtained from the Institutional Review Committee (Reference number: 94). Convenience sampling method was used. Data were collected from hospital records during the study period. Point estimate and 95% Confidence Interval were calculated. RESULTS Among 385 children, pneumonia was seen in 76 (19.74%) (15.76-23.72, 95% Confidence Interval) children. A total of 30 (39.47%) patients were in the age group of 2-11 months, 52 (68.42%) were males, 38 (50%) required O2 supplementation, 26 (34.21%) required transfer to the Intensive Care Unit, and 53 (69.74%) patients stayed for <7 days in the hospital. CONCLUSIONS The prevalence of pneumonia in children admitted to the Department of Medicine was found to be higher than similar studies conducted in similar settings, with higher prevalence in young infants and the male sex than other age groups and genders, respectively.
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Affiliation(s)
- Raj Kumar B.K.
- Kanti Children Hospital, Maharajgunj, Kathmandu, Nepal,Correspondence: Dr Raj Kumar B.K., Kanti Children Hospital, Maharajgunj, Kathmandu, Nepal. , Phone: +977-9858047111
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Raqib R, Akhtar E, Sultana T, Ahmed S, Chowdhury MAH, Shahriar MH, Kader SB, Eunus M, Haq MA, Sarwar G, Islam T, Alam DS, Parvez F, Begum BA, Ahsan H, Yunus M. Association of household air pollution with cellular and humoral immune responses among women in rural Bangladesh. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 299:118892. [PMID: 35077836 PMCID: PMC9850293 DOI: 10.1016/j.envpol.2022.118892] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/29/2021] [Accepted: 01/20/2022] [Indexed: 05/29/2023]
Abstract
Household air pollution (HAP) arising from combustion of biomass fuel (BMF) is a leading cause of morbidity and mortality in low-income countries. Air pollution may stimulate pro-inflammatory responses by activating diverse immune cells and cyto/chemokine expression, thereby contributing to diseases. We aimed to study cellular immune responses among women chronically exposed to HAP through use of BMF for domestic cooking. Among 200 healthy, non-smoking women in rural Bangladesh, we assessed exposure to HAP by measuring particulate matter 2.5 (PM2.5), black carbon (BC) and carbon monoxide (CO), through use of personal monitors RTI MicroPEM™ and Lascar CO logger respectively, for 48 h. Blood samples were collected following HAP exposure assessment and were analyzed for immunoprofiling by flow cytometry, plasma IgE by immunoassay analyzer and cyto/chemokine response from monocyte-derived-macrophages (MDM) and -dendritic cells (MDDC) by multiplex immunoassay. In multivariate linear regression model, a doubling of PM2.5 was associated with small increments in immature/early B cells (CD19+CD38+) and plasmablasts (CD19+CD38+CD27+). In contrast, a doubling of CO was associated with 1.20% reduction in CD19+ B lymphocytes (95% confidence interval (CI) = -2.36, -0.01). A doubling of PM2.5 and BC each was associated with 3.12% (95%CI = -5.85, -0.38) and 4.07% (95%CI = -7.96, -0.17) decrements in memory B cells (CD19+CD27+), respectively. Exposure to CO was associated with increased plasma IgE levels (beta(β) = 240.4, 95%CI = 3.06, 477.8). PM2.5 and CO exposure was associated with increased MDM production of CXCL10 (β = 12287, 95%CI = 1038, 23536) and CCL5 (β = 835.7, 95%CI = 95.5, 1576), respectively. Conversely, BC exposure was associated with reduction in MDDC-produced CCL5 (β = -3583, 95%CI = -6358, -807.8) and TNF-α (β = -15521, 95%CI = -28968, -2074). Our findings suggest that chronic HAP exposure through BMF use adversely affects proportions of B lymphocytes, particularly memory B cells, plasma IgE levels and functions of antigen presenting cells in rural women.
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Affiliation(s)
| | - Evana Akhtar
- Infectious Diseases Division, icddr,b, Bangladesh
| | | | - Shyfuddin Ahmed
- Health Systems and Population Studies Division, icddr,b, Dhaka, 1212, Bangladesh
| | | | | | - Shirmin Bintay Kader
- Health Systems and Population Studies Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Mahbbul Eunus
- U-Chicago Research Bangladesh, Mohakhali, Dhaka, Bangladesh
| | | | - Golam Sarwar
- U-Chicago Research Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Tariqul Islam
- U-Chicago Research Bangladesh, Mohakhali, Dhaka, Bangladesh
| | | | - Faruque Parvez
- Mailman School of Public Health, Columbia University, New York, USA
| | | | - Habibul Ahsan
- Department of Public Health Sciences, University of Chicago, Chicago, USA
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Chen T, Zou C, Yuan Y, Pan J, Zhang B, Qiao L, Li Y, Qian JY, Guo Q, Yuan Y, Ding C. Indoor air pollution from solid fuel on children pneumonia in low- and middle-income countries: a systematic review and meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:24574-24588. [PMID: 35066845 DOI: 10.1007/s11356-021-18293-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/19/2021] [Indexed: 06/14/2023]
Abstract
An updated systematic review was conducted to assessing on the association between indoor air pollution caused by household energy consumption and childhood pneumonia in low- and middle-income countries. We performed a meta-analysis from the electronic databases of PubMed, Cochrane library, Web of Science, EMBASE. Studies were selected when they reported childhood pneumonia or ALRI in relation to indoor air pollution resulted from solid fuel. Studies must provide results on exposure prevalence of children aged below 5 years from Asia or Africa. We devoted ourselves to identifying randomized controlled experiments and observational epidemiological researches, which revealed the relation between household usage of solid fuel and childhood pneumonia. Among 1954 articles, 276 were reviewed thoroughly and 16 conduced to such a meta-analysis. It was found that there is a significant relationship between the solid fuel combustion and increasing risk of childhood pneumonia (OR = 1.66, 95%CI 1.36-2.02). The summary odds ratios from biomass use and mixed fuel use were, respectively, 1.86 (95%CI 1.15-3.02) and 1.58 (95%CI 1.38-1.81), with substantial between study heterogeneity (I2 = 87.2% and 29.2%, respectively). According to the subgroup analysis along with the meta-regression analysis, the risk of using solid fuel in Asian regions is higher than that in African regions. Studies based on non-hospital participates (I2 = 49.5%) may also a source of heterogeneity. We found that indoor air pollution generated by the usage of solid fuel might be a significant risk factor for pneumonia in children and suggested improving the indoor air quality by promoting cleaner fuel will be important in undeveloped countries.
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Affiliation(s)
- Tianming Chen
- School of Environmental Science and Engineering, Yancheng Institute of Technology, P.O.Box NO.211 Jianjun Road, Yancheng, 224051, Jiangsu Province, China
- Jiangsu Province Engineering Research Center of Intelligent Environmental Protection Equipment, Yancheng, 224051, Jiangsu Province, China
| | - Chao Zou
- School of Environmental Science and Engineering, Yancheng Institute of Technology, P.O.Box NO.211 Jianjun Road, Yancheng, 224051, Jiangsu Province, China
- Jiangsu Province Engineering Research Center of Intelligent Environmental Protection Equipment, Yancheng, 224051, Jiangsu Province, China
| | - Yang Yuan
- Yancheng Hospital of Traditional Chinese Medicine, Yancheng, 224001, Jiangsu, China
| | - Jingjing Pan
- School of Environmental Science and Engineering, Yancheng Institute of Technology, P.O.Box NO.211 Jianjun Road, Yancheng, 224051, Jiangsu Province, China
- Jiangsu Province Engineering Research Center of Intelligent Environmental Protection Equipment, Yancheng, 224051, Jiangsu Province, China
| | - Baoping Zhang
- School of Environmental Science and Engineering, Yancheng Institute of Technology, P.O.Box NO.211 Jianjun Road, Yancheng, 224051, Jiangsu Province, China
| | - Liang Qiao
- School of Environmental Science and Engineering, Yancheng Institute of Technology, P.O.Box NO.211 Jianjun Road, Yancheng, 224051, Jiangsu Province, China
- Jiangsu Province Engineering Research Center of Intelligent Environmental Protection Equipment, Yancheng, 224051, Jiangsu Province, China
| | - Yanping Li
- Department of Pharmacy, Jiangsu Vocational College of Medicine, Jiangsu, 224005, China
| | - Jia-Yan Qian
- Nantong Production Quality Supervising & Inspection Institute, Jiangsu, 226005, China
| | - Qingyuan Guo
- School of Environmental Science and Engineering, Yancheng Institute of Technology, P.O.Box NO.211 Jianjun Road, Yancheng, 224051, Jiangsu Province, China
- Jiangsu Province Engineering Research Center of Intelligent Environmental Protection Equipment, Yancheng, 224051, Jiangsu Province, China
| | - Ye Yuan
- School of Environmental Science and Engineering, Yancheng Institute of Technology, P.O.Box NO.211 Jianjun Road, Yancheng, 224051, Jiangsu Province, China.
- Jiangsu Province Engineering Research Center of Intelligent Environmental Protection Equipment, Yancheng, 224051, Jiangsu Province, China.
| | - Cheng Ding
- School of Environmental Science and Engineering, Yancheng Institute of Technology, P.O.Box NO.211 Jianjun Road, Yancheng, 224051, Jiangsu Province, China.
- Jiangsu Province Engineering Research Center of Intelligent Environmental Protection Equipment, Yancheng, 224051, Jiangsu Province, China.
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Odo DB, Yang IA, Knibbs LD. A Systematic Review and Appraisal of Epidemiological Studies on Household Fuel Use and Its Health Effects Using Demographic and Health Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1411. [PMID: 33546363 PMCID: PMC7913474 DOI: 10.3390/ijerph18041411] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/12/2022]
Abstract
The domestic combustion of polluting fuels is associated with an estimated 3 million premature deaths each year and contributes to climate change. In many low- and middle-income countries (LMICs), valid and representative estimates of people exposed to household air pollution (HAP) are scarce. The Demographic and Health Survey (DHS) is an important and consistent source of data on household fuel use for cooking and has facilitated studies of health effects. However, the body of research based on DHS data has not been systematically identified, nor its strengths and limitations critically assessed as a whole. We aimed to systematically review epidemiological studies using DHS data that considered cooking fuel type as the main exposure, including the assessment of the extent and key drivers of bias. Following PRISMA guidelines, we searched PubMed, Web of Science, Scopus and the DHS publication portal. We assessed the quality and risk of bias (RoB) of studies using a novel tool. Of 2748 records remaining after removing duplicates, 63 were read in full. A total of 45 out of 63 studies were included in our review, spanning 11 different health outcomes and representing 50 unique analyses. In total, 41 of 45 (91%) studies analysed health outcomes in children <5 years of age, including respiratory infections (n = 17), death (all-cause) (n = 14), low birthweight (n = 5), stunting and anaemia (n = 5). Inconsistencies were observed between studies in how cooking fuels were classified into relatively high- and low-polluting. Overall, 36/50 (80%) studies reported statistically significant adverse associations between polluting fuels and health outcomes. In total, 18/50 (36%) of the analyses were scored as having moderate RoB, while 16/50 (32%) analyses were scored as having serious or critical RoB. Although HAP exposure assessment is not the main focus of the DHS, it is the main, often only, source of information in many LMICs. An appreciable proportion of studies using it to analyse the association between cooking fuel use and health have potential for high RoB, mostly related to confounder control, exposure assessment and misclassification, and outcome ascertainment. Based on our findings, we provide some suggestions for ways in which revising the information collected by the DHS could make it even more amenable to studies of household fuel use and health, and reduce the RoB, without being onerous to collect and analyse.
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Affiliation(s)
- Daniel B. Odo
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia;
- College of Health Sciences, Arsi University, Oromia, Asella P.O. Box 193, Ethiopia
| | - Ian A. Yang
- Thoracic Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Chermside, QLD 4032, Australia;
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane QLD 4032, Australia
| | - Luke D. Knibbs
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia;
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Mathiarasan S, Hüls A. Impact of Environmental Injustice on Children's Health-Interaction between Air Pollution and Socioeconomic Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020795. [PMID: 33477762 PMCID: PMC7832299 DOI: 10.3390/ijerph18020795] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 02/07/2023]
Abstract
Air pollution disproportionately affects marginalized populations of lower socioeconomic status. There is little literature on how socioeconomic status affects the risk of exposure to air pollution and associated health outcomes, particularly for children’s health. The objective of this article was to review the existing literature on air pollution and children’s health and discern how socioeconomic status affects this association. The concept of environmental injustice recognizes how underserved communities often suffer from higher air pollution concentrations in addition to other underlying risk factors for impaired health. This exposure then exerts larger effects on their health than it does in the average population, affecting the whole body, including the lungs and the brain. Children, whose organs and mind are still developing and who do not have the means of protecting themselves or creating change, are the most vulnerable to the detrimental effects of air pollution and environmental injustice. The adverse health effects of air pollution and environmental injustice can harm children well into adulthood and may even have transgenerational effects. There is an urgent need for action in order to ensure the health and safety of future generations, as social disparities are continuously increasing, due to social discrimination and climate change.
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Affiliation(s)
- Sahana Mathiarasan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Anke Hüls
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
- Correspondence:
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Lawn JE, Ashish KC. Learning from Nepal's Progress to Inform the Path to the Sustainable Development Goals for Health, Leaving No-One Behind. Matern Child Health J 2020; 24:1-4. [PMID: 32086635 PMCID: PMC7048866 DOI: 10.1007/s10995-020-02899-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Joy E Lawn
- MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK.
| | - K C Ashish
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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