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Owusu M, Adu E, Kalu LE, Martey E, Acheampong G, Enimil A, Appiah JA, Badu-Peprah A, Sylverken J, Sylverken AA, Nguah SB, Westeel E, Pouzol S, Drosten C, Adu-Sarkodie Y. Aetiological agents of pneumonia among HIV and non-HIV infected children in Ghana: A case-control study. PLoS One 2024; 19:e0299222. [PMID: 38517865 PMCID: PMC10959341 DOI: 10.1371/journal.pone.0299222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 02/05/2024] [Indexed: 03/24/2024] Open
Abstract
Pneumonia is the leading cause of death in children, however, the microbial aetiology of pneumonia is not well elucidated in low- and middle-income countries. Our study was aimed at determining the microbial aetiologies of childhood pneumonia and associated risk factors in HIV and non-HIV infected children. We conducted a case-control study that enrolled children with pneumonia as cases and non-pneumonia as controls from July 2017 to May 2020. Induced sputum and blood samples were investigated for microbial organisms using standard microbiological techniques. DNA/RNA was extracted from sputum samples and tested for viral and bacterial agents. Four hundred and four (404) subjects consisting of 231 (57.2%) cases and 173 (42.8%) controls were enrolled. We identified a significant (p = 0.011) proportion of viruses in cases (125; 54.1%, 95%CI: 47.4-60.7) than controls (71; 33.6%, 95%CI: 33.6-48.8) and these were mostly contributed to by Respiratory Syncytial Virus. Staphylococcus aureus (16; 4.0%), Klebsiella spp. (15, 3.7%) and Streptococcus pneumoniae (8, 2.0%) were the main bacterial agents identified in sputum or induced sputum samples. HIV infected children with viral-bacterial co-detection were found to have very severe pneumonia compared to those with only viral or bacterial infection. Indoor cooking (OR = 2.36; 95%CI:1.41-3.96) was found to be associated with pneumonia risk in patients. This study demonstrates the importance of various microbial pathogens, particularly RSV, in contributing to pneumonia in HIV and non-HIV paediatric populations. There is a need to accelerate clinical trials of RSV vaccines in African populations to support improvement of patient care.
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Affiliation(s)
- Michael Owusu
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
- Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eric Adu
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Lotenna Elsie Kalu
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eugene Martey
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Anthony Enimil
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - John Adabie Appiah
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Justice Sylverken
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Augustina Angelina Sylverken
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Samuel Blay Nguah
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | | | - Yaw Adu-Sarkodie
- Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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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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Dida GO, Lutta PO, Abuom PO, Mestrovic T, Anyona DN. Factors predisposing women and children to indoor air pollution in rural villages, Western Kenya. Arch Public Health 2022; 80:46. [PMID: 35093174 PMCID: PMC8801101 DOI: 10.1186/s13690-022-00791-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 01/07/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Indoor air pollution (IAP) remains a major global public health hazard more so in developing countries where use of fossil fuels is still very common. However, despite the popularity of kerosene and fuelwood as energy sources among many households in the Sub-Saharan Africa, little is known about their health effects and the predisposing factors particularly on those with direct exposure. This study sought to relate indoor air pollution exposure to self-reported prevalence of respiratory outcomes including (sputum production, congestion, breathing difficulties, eye problems, fatigue, and headaches and wheezing) among women and children of Trans Nzoia County, in the rural villages of western Kenya. METHODS In this cross-sectional survey, simple random technique was used to select 251 households from 14 villages. Households were the sampling units, while the woman of the household with/or in custody of a child aged less than 5 years old were the unit of analysis. A total of 251 women with/or in custody of a child aged less than 5 years old took part in the study. A structured questionnaire was used to collect information on cause and effects of IAP among women and children. Data was analyzed descriptively and inferentially. We used Poisson generalized linear models with IAP symptoms and indoor cooking as dependent variables and household profiles and other socio-demographics as independent variables to identify the factors that affect health outcome. RESULTS Mean age of respondents was 36.49 years, (95% CI [35.5, 37.5]). Most (64.5%) houses were semi-permanent, with 58.6% having an average kitchen size (5.6 m2). Wood and kerosene were the most preferred fuel types for cooking (96.8%) and lighting (97.4%), respectively. Smoke from the wood was identified as the dominant (96.8%) source of IAP. Most women (92.0%) and children (95.4%) had coughs of varying intensities during the year, while 31.5% of the women reported wheezing. About 98% of them experienced fatigued and headaches. Use of wood fuel was associated with increased coughing (p = 0.03), phlegm (p = 0.02), wheezing (p = 0.04), eye problems (p = 0.03) and headaches (p = 0.01) among women and children in the previous 24 h. Education level, ventilation, main fuel source used in 24 h, indoor cooking and house type were significantly associated with IAP health effects (p ≤ 0.05). CONCLUSIONS Supporting the impoverished households and increasing their level of awareness on health-effects of IAP occasioned by use of biomass fuel while cooking indoors may be the first step in implementing a programme aimed at reducing exposure among rural households in Trans Nzoia County, in rural parts of Western Kenya.
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Affiliation(s)
- Gabriel O Dida
- Department of Health Systems Management and Public Health, Technical University of Kenya, Nairobi, Kenya.
- School of Public Health and Community Development, Maseno University, Kisumu, Kenya.
| | - Patrick O Lutta
- School of Public Health and Community Development, Maseno University, Kisumu, Kenya
| | - Paul O Abuom
- Deparment of Environmental Science, Maseno University, Kisumu, Kenya
| | - Tomislav Mestrovic
- University Centre Varazdin, University North, Varazdin, Croatia
- Institute for Health Metrics and Evaluation and the Department of Health Metrics Sciences, University of Washington, Seattle, USA
| | - Douglas N Anyona
- Deparment of Environmental Science, Maseno University, Kisumu, Kenya
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Al-Janabi Z, Woolley KE, Thomas GN, Bartington SE. A Cross-Sectional Analysis of the Association between Domestic Cooking Energy Source Type and Respiratory Infections among Children Aged under Five Years: Evidence from Demographic and Household Surveys in 37 Low-Middle Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8516. [PMID: 34444264 PMCID: PMC8394069 DOI: 10.3390/ijerph18168516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In low- and middle-income countries (LMICs), household air pollution as a result of using solid biomass for cooking, lighting and heating (HAP) is associated with respiratory infections, accounting for approximately 4 million early deaths each year worldwide. The majority of deaths are among children under five years. This population-based cross-sectional study investigates the association between solid biomass usage and risk of acute respiratory infections (ARI) and acute lower respiratory infections (ALRI) in 37 LMICs within Africa, Americas, Southeast Asia, European, Eastern Mediterranean and Western Pacific regions. MATERIALS AND METHODS Using population-based data obtained from Demographic and Health surveys (2010-2018), domestic cooking energy sources were classified solid biomass (wood, charcoal/dung, agricultural crop) and cleaner energy sources (e.g., Liquid Petroleum Gas (LPG), electricity, biogas and natural gas). Composite measures of ARI (shortness of breath, cough) and ALRI (shortness of breath, cough and fever) were composed using maternally reported respiratory symptoms over the two-week period prior to the interview. Multivariable logistic regression was used to identify the association between biomass fuel usage with ARI and ALRI, accounting for relevant individual, household and situational confounders, including stratification by context (urban/rural). RESULTS After adjustment, in the pooled analysis, children residing in solid biomass cooking households had an observed increased adjusted odds ratio of ARI (AOR: 1.17; 95% CI: 1.09-1.25) and ALRI (AOR: 1.16; 95% CI 1.07-1.25) compared to cleaner energy sources. In stratified analyses, a comparable association was observed in urban areas (ARI: 1.16 [1.06-1.28]; ALRI: 1.14 [1.02-1.27]), but only significant for ARI among those living in rural areas (ARI: 1.14 [1.03-1.26]). CONCLUSION Switching domestic cooking energy sources from solid biomass to cleaner alternatives would achieve a respiratory health benefit in children under five years worldwide. High quality mixed-methods research is required to improve acceptability and sustained uptake of clean cooking energy source interventions in LMIC settings.
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Affiliation(s)
| | | | - G. Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (Z.A.-J.); (K.E.W.); (S.E.B.)
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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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