Household air pollution profiles associated with persistent childhood cough in urban Uganda

Multi-pollutant exposure profiles associated with breast cancer risk: A Bayesian profile regression analysis in the French E3N cohort

BACKGROUND

Human exposure to air pollution involves complex mixtures of multiple correlated air pollutants. To date, very few studies have assessed the combined effects of exposure to multiple air pollutants on breast cancer (BC) risk.

OBJECTIVES

We aimed to assess the association between combined exposures to multiple air pollutants and breast cancer risk.

METHODS

The study was based on a case-control study nested within the French E3N cohort (5222 incident BC cases/5222 matched controls). For each woman, the average of the mean annual exposure to eight pollutants (benzo(a)oyrene, cadmium, dioxins, polychlorinated biphenyls (PCB153), nitrogen dioxide (NO2), ozone, particulate matter and fine particles (PMs)) was estimated from cohort inclusion in 1990 to the index date. We used the Bayesian Profile Regression (BPR) model, which groups individuals according to their exposure and risk levels, and assigns a risk to each cluster identified. The model was adjusted on a combination of matching variables and confounders to better consider the design of the nested case-control study. Odds ratios (OR) and their 95 % credible intervals (CrI) were estimated.

RESULTS

Among the 21 clusters identified, the cluster characterised by low exposures to all pollutants, except ozone, was taken as reference. A consistent increase in BC risk compared to the reference cluster was observed for 3 clusters: cluster 9 (OR=1.61; CrI=1.13,2.26), cluster 16 (OR=1.59; CrI=1.10,2.30) and cluster 15 (OR=1.38; CrI=1.00,1.88) characterised by high levels of NO2, PMs and PCB153. The other clusters showed no consistent association with BC.

DISCUSSION

This is the first study assessing the effect of exposure to a mixture of eight air pollutants on BC risk, using the BPR approach. Overall, results showed evidence of a positive joint effect of exposure to high levels to most pollutants, particularly high for NO2, PMs and PCB153, on the risk of BC.

The FRESHAIR4Life study: Global implementation research on non-communicable disease prevention targeting adolescents' exposure to tobacco and air pollution in disadvantaged populations

The FRESHAIR4Life study aims to reduce the non-communicable disease (NCD) burden by implementing preventive interventions targeting adolescents' exposure to tobacco use and air pollution (AP) worldwide. This paper presents the FRESHAIR4Life methodology and initial rapid review results. The rapid review, using various databases and PubMed, aimed to guide decision-making on risk factor focus, target areas, and populations. It showed variable NCD mortality rates related to tobacco use and AP across the participating countries, with tobacco as the main risk factor in the Kyrgyz Republic, Greece, and Romania, and AP prevailing in Pakistan and Uganda. Adolescent exposure levels, sources, and correlates varied. The study will continue with an in-depth situational analysis to guide the selection, adaptation, and integration of evidence-based interventions into the FRESHAIR4Life prevention package. This package will be implemented, evaluated, assessed for cost-effectiveness, and iteratively refined. The research places a strong emphasis on co-creation, capacity building, and comprehensive communication and dissemination.

Assessment of the association between health problems and cooking fuel type, and barriers towards clean cooking among rural household people in Bangladesh

BACKGROUND

In low- and middle-income countries, households mainly use solid fuels like wood, charcoal, dung, agricultural residues, and coal for cooking. This poses significant public health concerns due to the emission of harmful particles and gases. To address these issues and support Sustainable Development Goals (SDGs), adopting cleaner cooking fuels like electricity and gas are acknowledged as a viable solution. However, access to these cleaner fuels is limited, especially in rural areas.

METHODS

This study conducted a face-to-face survey with 1240 individuals in rural Bangladesh to explore the link between health issues and cooking fuel type, as well as barriers to transitioning to clean cooking. Using a convenient sampling technique across four divisions/regions, the survey gathered socio-demographic and health data, along with information on clean cooking barriers through a semi-structured questionnaire. Binary and multivariable logistic regression analyses were then employed to identify significant associations between cooking fuel type and health problems.

RESULTS

The study revealed that a majority of participants (73.3%) relied on solid fuel for cooking. The use of solid fuel was significantly correlated with factors such as lower education levels, reduced family income, location of residence, and the experience of health issues such as cough, chest pressure while breathing, eye discomfort, diabetes, asthma, and allergies. Economic challenges emerged as the foremost obstacle to the adoption of clean cooking, accompanied by other contributing factors.

CONCLUSION

The use of solid fuel in rural Bangladeshi households poses substantial health risks, correlating with respiratory, eye, cardiovascular, and metabolic issues. Lower education and income levels, along with specific residential locations, were associated with higher solid fuel usage. Economic challenges emerged as the primary obstacle to adopting clean cooking practices. These findings emphasize the need for implementing strategies to promote clean cooking, address barriers, and contribute to achieving Sustainable Development Goal targets for health and sustainable energy access in Bangladesh.

Indoor air pollution prevention practices and associated factors among household mothers in Olenchiti town, Oromia, Ethiopia

INTRODUCTION

Most households in low- and middle-income countries still cook using solid fuels in poorly ventilated dwellings. Indoor air pollution causes various health problems, like pneumonia, lung cancer, stillbirth, low birth weight, impaired cognitive development, and cataracts. Nevertheless, a few evidences are available in Africa, including Ethiopia. Therefore, this study aimed to assess the level of indoor air pollution prevention practices and associated factors among household mothers in Olenchiti town, Oromia, Ethiopia.

METHODS

A community-based cross-sectional study was conducted. Four hundred twenty mothers were randomly selected by systematic random sampling. Data was collected through an interview and observation checklist. The collected data entered into Epi-Info version 7.2.5 was cleaned, edited, and then exported to SPSS version 23 for analysis. Descriptive statistics were used to describe the findings. Binary logistic regression was computed to analyze the effect of each variable on the outcome variable. Model adequacy fitness was checked with the Hosmer-Lemeshow test. The multicollinearity of independent variables was checked with the variance inflation factor. Adjusted odds ratio with 95% confidence interval and P -value <0.05 was used as cutoff points to declare significance in the final model.

RESULTS

The overall good practices of mothers towards the prevention of indoor air pollution was 188 (45.0%). Mothers who had under-five children (AOR = 0.49, 95%CI (0.31-0.76), mothers in grade 9-12 (AOR = 0.51, 95%CI (0.28-0.92)) were significantly associated with indoor air pollution prevention practices.

CONCLUSION

The overall good practices of mothers towards indoor air pollution were low compared to different findings. Under-five children and educational status were significantly associated with indoor air pollution prevention practices in the final model. Therefore, the high school curriculums should include indoor air pollution topics.

Medicinal plants of the upper Aswa River catchment of northern Uganda - a cultural crossroads

BACKGROUND

This paper presents a comparative inventory of medicinal plant taxa and their uses by smallholder farming communities of four cultures in the Aswa River catchment of northern Uganda, situated in the eastern Sudanian savanna parkland ecotype of sub-Saharan Africa. The purpose of the study was to document the ethnobotanical use of medicinal plants by the Lango, Acholi, Teso (Atesot) and Ethur (jo Abwor), in an historical moment before civil conflict and mass displacement of the respondent communities disrupted the inter-generational transmission of traditional technical knowledge within the study area.

METHODS

Following community consultations in four districts of northern Uganda during 1999-2000, interviews were conducted with holders of specialist knowledge on plants used as medicine on basis of a plant specimen allocated a voucher number and identified by the national herbarium. Use reports reflecting specific medicinal applications were compiled in aggregate to obtain a Relative Importance Index ranking. The commonality of medicinal taxa cited between each cultural interface was assessed by the Jaccard Index of Similarity, and the similarity of specific medicinal usage by taxon using Rahman's Similarity Index.

RESULTS

The data collected from 112 respondents comprise 280 medicinal use reports describing 263 applications for 62 medical conditions, citing 108 taxa from 44 botanical families of which Fabaceae comprised 20% of all use reports. No earlier mention could be found to corroborate 72 use reports (27% of the total), representing medicinal indications as yet undocumented, and potentially worthy of investigation. The RI values ranged between 15 and 94%, with 13 taxa having RI values above 50%. The JI ratios indicate the highest degree of similarity in the plant taxa used as medicine (21%) between the Lango and Teso cultures who share a common origin; however, Rahman's Similarity Index indicates the highest similarity of specific medicinal usage by taxon between the Lango and Acholi, who share a common language group through cultural assimilation over time.

CONCLUSIONS

As a comparative study, the results imply that cultural exchange and assimilation may be a greater driver of inter-cultural similarity of ethnopharmacological use of a given taxon, as compared to shared historical origins.

Assessing the combined effect of household cooking fuel and urbanicity on acute respiratory symptoms among under-five years in sub-Saharan Africa

Background

This study sought to investigate the association between urbanicity (rural-urban residency), the use of solid biomass cooking fuels and the risk of Acute Respiratory Infections (ARIs) among children under the age of 5 in sub-Saharan Africa (SSA).

Methods

Cross-sectional data from the most recent surveys of the Demographic and Health Survey Program conducted in 31 sub-Saharan African countries were pooled for the analysis. The outcome variables, cough and rapid short breath were derived from questions that asked mothers if their children under the age of 5 suffered from cough and short rapid breath in the past two weeks preceding the survey. To examine the associations, multivariable negative log-log regression models were fitted for each outcome variable.

Results

Higher odds ratios of cough occurred among children in urban households that use unclean cooking fuel (aOR = 1.05 95% CI = 1.01, 1.08). However, lower odds ratios were observed for rural children in homes that use clean cooking fuel (aOR = 0.93 95% CI = 0.87, 0.99) relative to children in urban homes using clean cooking fuel. We also found higher odds ratios of short rapid breaths among children in rural households that use unclean cooking fuel compared with urban residents using clean cooking fuel (aOR = 1.12 95% CI = 1.08, 1.17).

Conclusion

Urbanicity and the use of solid biomass fuel for cooking were associated with an increased risk of symptoms of ARIs among children under five years in SSA. Thus, policymakers and stakeholders need to design and implement strategies that minimize children's exposure to pollutants from solid biomass cooking fuel. Such interventions could reduce the burden of respiratory illnesses in SSA and contribute to the realization of Sustainable Development Goal 3.9, which aims at reducing the number of diseases and deaths attributable to hazardous chemicals and pollution of air, water and soil.

Impact of Stove Renovation on PM2.5 Exposure, Risk Perception, Self-Protective Willingness of Rural Residents

To improve household air quality, the Chinese government has launched a number of pilot stove renovation projects, but few studies have explored the impact of the project on people's perception of and willingness to participate in these renovations; moreover, factors affecting willingness to pay for the project in rural China are not yet clear. We conducted a field measurement and a corresponding door-to-door questionnaire survey using the renovated group and the unrenovated group. The results showed that (1) the stove renovation project could not only reduce PM_2.5 exposure and the excess mortality risk of rural residents, but also (2) improve residents' risk perception and self-protective willingness. (3) Specifically, the project had a deeper impact on female and low-income residents. (4) Meanwhile, the higher the income and the larger family size, the higher the risk perception and self-protective willingness. (5) Furthermore, willingness to pay for the project was related with residents' support for the project, benefit from renovation, income, and family size. Our results recommended that stove renovation policies should pay more attention to families with lower income and smaller size.

Impact of biomass fuel smoke on respiratory health of children under 15 years old in Madagascar

BACKGROUND

Children exposed to biomass used in households are at risk to develop diseases or respiratory symptoms. In Madagascar more than 95% of households use it daily. The main objective is to study the impact of chronic exposure to biomass on respiratory health of children under 15 years old in Madagascar.

METHODS

Descriptive cross-sectional study conducted with questionnaires among urban and rural population of Antananarivo and Mahajanga provinces between 2016 and 2017. Variables were collected: number of hours spent in kitchen per day, respiratory symptoms and spirometric data. Categorized symptoms score and exposure index expressing chronic exposure to biomass were analyzed with multinomial logistic regression models.

RESULTS

Of the 661 children included in the analysis, 27.7% had 1 respiratory symptom and 29.3% had 2 or more respiratory symptoms. Moderate exposure index (aOR=1.57; CI95%=[1.30-1.89]; p<0.001) and high exposure index (aOR=1.76; CI95%=[1.39-2.24]; p<0.001) were significantly associated with 1 respiratory symptom, adjusted with provinces, household members and visitors smoking, perceived discomfort related to air pollution and birthweight. Exposure index was not significantly associated with an increased risk of having 2 or more respiratory symptoms (p = 0.754).

CONCLUSION

Respiratory symptoms were associated with exposure to biomass, living in coastal areas, birthweight, tobacco and perceived discomfort related to air pollution. Recommendations and actions must be implemented in order to improve respiratory health related to biomass among children.

Associations between air pollutants and risk of respiratory infection: patient-based bacterial culture in sputum

Air pollution is a crucial risk factor for respiratory infection. However, the relationships between air pollution and respiratory infection based on pathogen detection are scarcely explored in the available literature. We detected respiratory infections through patient-based bacterial culture in sputum, obtained hourly data of all six pollutants (PM_2.5, PM₁₀, SO₂, NO, CO, and O₃) from four air quality monitoring stations, and assessed the relationships of air pollutants and respiratory bacterial infection and multi-drug-resistant bacteria. Air pollution remains a challenge for Mianyang, China, especially PM_2.5 and PM₁₀, and there are seasonal differences; pollution is the heaviest in winter and the lowest in summer. A total of 4237 pathogenic bacteria were detected, and the positive rate of multi-drug-resistant bacteria was 0.38%. Similar seasonal differences were found with respect to respiratory infection. In a single-pollutant model, all pollutants were significantly associated with respiratory bacterial infection, but only O₃ was significantly associated with multi-drug-resistant bacteria. In multi-pollutant models (adjusted for one pollutant), the relationships of air pollutants with respiratory bacterial infection remained significant, while PM_2.5, PM₁₀, and O₃ were significantly associated with the risk of infection with multi-drug-resistant bacteria. When adjusted for other five pollutants, only O₃ was significantly associated with respiratory bacterial infection and the risk of infection with multi-drug-resistant bacteria, showing that O₃ is an independent risk factor for respiratory bacterial infection and infection with multi-drug-resistant bacteria. In summary, this study highlights the adverse effects of air pollution on respiratory infection and the risk of infection with multi-drug-resistant bacteria, which may provide a basis for the formulation of environmental policy to prevent respiratory infections.

Use of biomass fuels predicts indoor particulate matter and carbon monoxide concentrations; evidence from an informal urban settlement in Fort Portal city, Uganda

Background

Poor indoor air quality (IAQ) is a leading cause of respiratory and cardiopulmonary illnesses. Particulate matter (PM2.5) and carbon monoxide (CO) are critical indicators of IAQ, yet there is limited evidence of their concentrations in informal urban settlements in low-income countries.

Objective

This study assessed household characteristics that predict the concentrations of PM2.5 and CO within households in an informal settlement in Fort Portal City, Uganda.

Methodology

A cross-sectional study was conducted in 374 households. Concentrations of PM2.5 and CO were measured using a multi-purpose laser particle detector and a carbon monoxide IAQ meter, respectively. Data on household characteristics were collected using a structured questionnaire and an observational checklist. Data were analysed using STATA version 14.0. Linear regression was used to establish the relationship between PM2.5, CO concentrations and household cooking characteristics.

Results

The majority (89%, 332/374) of the households used charcoal for cooking. More than half (52%, 194/374) cooked outdoors. Cooking areas had significantly higher PM2.5 and CO concentrations (t = 18.14, p ≤ 0.05) and (t = 5.77 p ≤ 0.05), respectively. Cooking outdoors was associated with a 0.112 increase in the PM2.5 concentrations in the cooking area (0.112 [95% CI: -0.069, 1.614; p = 0.033]). Cooking with moderately polluting fuel was associated with a 0.718 increase in CO concentrations (0.718 [95% CI: 0.084, 1.352; p = 0.027]) in the living area.

Conclusions

The cooking and the living areas had high concentrations of PM2.5 and CO during the cooking time. Cooking with charcoal resulted in higher CO in the living area. Furthermore, cooking outdoors did not have a protective effect against PM2.5, and ambient PM2.5 exceeded the WHO Air quality limits. Interventions to improve the indoor air quality in informal settlements should promote a switch to cleaner cooking energy and improvement in the ambient air quality.

Harmonization of Epidemiologic Research Methods to Address the Environmental and Social Determinants of Urban Slum Health Challenges in Sub-Saharan Africa

Sub-Saharan Africa (SSA) has a significant proportion of populations living in urban slum conditions, where exposure to multiple environmental stressors and social inequalities is ubiquitous. This commentary synthesizes commonalities in recent environmental health studies from urban cities in East and West Africa, presented during a symposium sponsored by the Africa Chapter of the International Society of Environmental Epidemiology (ISEE) in August 2020. A key takeaway from this symposium is the need for harmonization of epidemiologic and exposure data collection in three domains tailored to the SSA context: (1) improvements in socioeconomic status (SES) measurement through harmonization in the conceptualization and operationalization of SES indicators; (2) improvements in air pollution exposure assessment in resource-constrained contexts by better integration, validation, and harmonization of exposure data of air pollution and mitigating factors; and (3) harmonization in the assessment of health outcomes and biomonitoring of contaminants. Focusing on these three domains would galvanize environmental epidemiologists in SSA around shared data collection instruments and shared data platforms and facilitate the pooling of data across the continent. Fostering this collaborative research will enable researchers and decision-makers to glean new insights and develop robust environmental health interventions and policies for SSA urban slums and for improved population health.

A Critical Review on the Development and Utilization of Energy Systems in Uganda

We live in a world that is completely dependent on energy; thus, humankind can no longer live without power. With electricity being the main form of energy today, this has increased the complexity of our life today. In Uganda, electricity generation is mainly through hydropower, which puts the country in the bottleneck of overdependence on one source of energy. There are many energy systems out there that the country can use to diversify its electricity generation. Therefore, the need to understand the level of development and utilization of various energy systems has been the underlying question for this present study. A comprehensive literature survey was conducted using electronic databases, including ScienceDirect, Wiley, Sage, Scopus, Taylor & Francis, and Google Scholar. The publications in the form of reports, conference papers, working papers, discussion papers, journal articles, book sections, and textbooks were considered in this study. In total, 11 energy systems, including human and animal energy, solid biomass (firewood), hydropower, wind, geothermal, solar, nuclear, peat, coal, petroleum, and nonsolid biomass (methanol, hydrogen, ethanol, biodiesel, and biogas), are described. The current and future development and utilization of these energy systems have been described. The challenges for developing and utilizing these systems were elaborated on, and the solutions for their challenges were presented. Hydropower from the Nile River, being the main river for large hydropower plant construction, is the dominant energy system in Uganda. Nuclear energy will be the salvation for the country's electric energy supply in the near future. Therefore, Uganda needs to bet big on nuclear energy.

A Social Vulnerability Index for Air Pollution and Its Spatially Varying Relationship to PM2.5 in Uganda

Fine particulate matter (PM2.5) is a ubiquitous air pollutant that is harmful to human health. Social vulnerability indices (SVIs) are calculated to determine where vulnerable populations are located. We developed an SVI for Uganda to identify areas with high vulnerability and exposure to air pollution. The 2014 national census was used to create the SVI. Mean PM2.5 at the subcounty level was estimated using global PM2.5 estimates. The mean PM2.5 for Kampala at the parish level was estimated using low-cost PM2.5 sensors and spatial interpolation. A local indicator of spatial association (LISA) was performed to determine significant spatial clusters of social vulnerability, and a bivariate analysis was performed to identify where significant associations were between SVI and annual PM2.5 mean concentrations. The LISA results showed significant clustering of high SVI in the northern and western regions of the country. The spatial bivariate analysis showed positive linear associations between SVI and PM2.5 concentration in subcounties in the northern, western, and central regions of Uganda, as well as in certain northern parishes in Kampala. Our approach identified areas facing both high social vulnerability and air pollution levels. These areas can be prioritized for health interventions and policy to reduce the impact of ambient PM2.5.

Association between Wood and Other Biomass Fuels and Risk of Low Birthweight in Uganda: A Cross-Sectional Analysis of 2016 Uganda Demographic and Health Survey Data

In utero exposure to household air pollution (HAP) from polluting cooking fuels has been linked to adverse pregnancy outcomes including low birthweight (LBW). No previous study in Uganda has attempted to investigate the association between the different types of biomass cooking fuels and LBW. This study was conducted to investigate the association between wood and other biomass cooking fuel use with increased risk of LBW, using the 2016 Uganda Demographic and Health Survey for 15,270 live births within five years prior to interview. LBW, defined as birthweight of <2500 g, was estimated from maternal recall and health cards. Association between household exposure to the different solid biomass cooking fuels and LBW was determined using multivariable logistic regression. Biomass cooking fuels were used in 99.6% of the households, with few (0.3%) using cleaner fuels and 0.1% with no cooking, while the prevalence of LBW was 9.6% of all live-births. Although the crude analysis suggested an association between wood fuel use and LBW compared to other biomass and kerosene fuel use (AOR: 0.82; 95% CI: 0.67−1.00), after adjusting for socio-demographic and obstetric factors, no association was observed (AOR: 0.94; 95% CI: 0.72−1.22). LBW was significantly more likely among female neonates (AOR: 1.32 (95% CI: 1.13−1.55) and neonates born to mothers living in larger households (AOR: 1.03; 95% CI: 1.00−1.07). LBW was significantly less likely among neonates delivered at term (AOR: 0.39; 95% CI: 0.31−0.49), born to women with secondary or tertiary level of education (AOR: 0.80; 95% CI: 0.64−1.00), living in households with a higher wealth index (AOR: 0.69; 95% CI: 0.50−0.96), Eastern (AOR: 0.76; 95% CI:0.59−0.98) and Northern (AOR: 0.75; 95% CI: 0.57−0.99) regions. The study findings suggest inconclusive evidence regarding the association between the use of wood compared to other biomass and kerosene cooking fuels and risk of LBW. Given the close observed association between socioeconomic status and LBW, the Ugandan government should prioritize public health actions which support female education and broader sustainable development to improve household living standards in this setting.

Risk factors of chronic cough in China: a systematic review and meta-analysis

OBJECTIVES

Risk factors of chronic cough in China have not been systematically analyzed and we hypothesized that risk factors of chronic cough might have distinct characteristics in China. Hence, we performed this meta-analysis focusing on the potential risk factors of chronic cough in China.

METHODS

We searched 7 databases for studies published before May 8, 2021. This systematic review was performed in accordance with the PRISMA checklist.

RESULTS

A total of 33 eligible articles were identified and included in this systematic review, and 28 studies were included in the meta-analysis. Our results showed that allergy (OR: 3.72; 95% CI: 1.85-7.47), nasal/sinusitis diseases (OR: 3.56; 95% CI: 2.02-6.29), family history of allergy (OR = 1.74; 95% CI: 1.59-1.90), family history of chronic respiratory diseases (OR = 1.67; 95% CI: 1.47-1.91), exposure to pollutants (OR = 1.60; 95% CI: 1.26-2.04), passive smoking (OR = 1.44; 95% CI: 1.32-1.57), and exposure to pets (OR = 1.37; 95% CI: 1.18-1.58) were risk factors for chronic cough in China.

CONCLUSIONS

Our study indicated some potential risk factors of chronic cough in China, which provides useful epidemiological information for managing chronic cough in China and is worthy as a reference for future global investigations.

Improving Post-discharge Practice of Kangaroo Mother Care: Perspectives From Communities in East-Central Uganda

INTRODUCTION

Kangaroo mother care (KMC) is among the most cost-effective and easily accessible solutions for improving the survival and wellbeing of small newborns. In this study, we examined the barriers and facilitators to continuity of KMC at home following hospital discharge in rural Uganda.

METHODS

We conducted this study in five districts in east-central Uganda, within six hospitals and at the community level. We used a qualitative approach, with two phases of data collection. Phase 1 comprised in-depth interviews with mothers who practiced KMC with their babies and caretakers who supported them and key informant interviews with health workers, district health office staff, community health workers, and traditional birth attendants. We then conducted group discussions with mothers of small newborns and their caretakers. We held 65 interviews and five group discussions with 133 respondents in total and used a thematic approach to data analysis.

RESULTS

In hospital, mothers were sensitized and taught KMC. They were expected to continue practicing it at home with regular returns to the hospital post-discharge. However, mothers practiced KMC for a shorter time at home than in the hospital. Reasons included being overburdened with competing domestic chores that did not allow time for KMC and a lack of community follow-up support by health workers. There were increased psycho-social challenges for mothers, alongside some dangerous practices like placing plastic cans of hot water near the baby to provide warmth. Respondents suggested various ways to improve the KMC experience at home, including the development of a peer-to-peer intervention led by mothers who had successfully done KMC and community follow-up of mothers by qualified health workers and community health workers.

CONCLUSION

Despite wide acceptance of KMC by health workers, challenges to effective implementation persist. Amid the global and national push to scale up KMC, potential difficulties to its adherence post-discharge in a rural, resource-limited setting remain. This study provides insights on KMC implementation and sustainability from the perspectives of key stakeholders, highlighting the need for a holistic approach to KMC that incorporates its adaptability to community settings and contexts.

Fuzzy Based Prediction Model for Air Quality Monitoring for Kampala City in East Africa

The quality of air affects lives and the environment at large. Poor air quality has claimed many lives and distorted the environment across the globe, and much more severely in African countries where air quality monitoring systems are scarce or even do not exist. Here in Africa, dirty air is brought about by the growth in industrialization, urbanization, flights, and road traffic. Air pollution remains such a silent killer, especially in Africa, and if not dealt with, it will continue to lead to health issues, such as heart conditions, stroke, and chronic respiratory organ unwellness, which later result in death. In this paper, the Kampala Air Quality Index prediction model based on the fuzzy logic inference system was designed to determine the air quality for Kampala city, according to the air pollutant concentrations (nitrogen dioxide, sulphur dioxide and fine particulate matter 2.5). It is observed that fuzzy logic algorithms are capable of determining the air quality index and therefore, can be used to predict and estimate the air quality index in real time, based on the given air pollutant concentrations. Hence, this can reduce the effects of air pollution on both humans and the environment.

Broilers' head behavior as an early warning index of production and lung health under ammonia exposure

This study investigated the effects of ammonia exposure (0, 15, 25, and 35 ppm) on head behavior, production performance and lung tissue morphology of broilers, and the relationship between head behavior, production performance, and lung tissue injury. In this experiment, a total of 264 AA commercial male broilers (21 d old) were assigned to 4 treatment groups with 6 replicates of 11 chickens for a 21-day trial period, the frequency of head-scratching and head-shaking behavior at the initial stage (2, 24, and 72 h) of ammonia exposure were recorded, and the production performance indices and the lung pathological changes after 21 d of ammonia exposure were observed. The correlation analysis was established between head behavior and production performance indices. Results showed that head-scratching behavior increased under 15 ppm ammonia for 72 h, head-shaking behavior increased when exposure to 15 ppm ammonia for 2, 24, and 72 h, and lung tissue was injured when exposure to 15 ppm ammonia for 21 d. However, exposure to 15 ppm ammonia did not influence growth performance. Compared with the control group, exposure to 25 ppm decreased the ADG and exposure to 35 ppm decreased the ADG, ADFI, and F/G. Furthermore, the increase in head-shaking frequency after 2 h and 24 h ammonia exposure was significantly associated with production performance and lung tissue injury after 21 d ammonia exposure. In conclusion, the head-shaking behavior at the initial stage of ammonia exposure can reflect the degree of harm of the later production performance and lung tissue health.

Adverse health impacts of cooking with kerosene: A multi-country analysis within the Prospective Urban and Rural Epidemiology Study

BACKGROUND

Kerosene, which was until recently considered a relatively clean household fuel, is still widely used in low- and middle-income countries for cooking and lighting. However, there is little data on its health effects. We examined cardiorespiratory effects and mortality in households using kerosene as their primary cooking fuel within the Prospective Urban Rural Epidemiology (PURE) study.

METHODS

We analyzed baseline and follow-up data on 31,490 individuals from 154 communities in China, India, South Africa, and Tanzania where there was at least 10% kerosene use for cooking at baseline. Baseline comorbidities and health outcomes during follow-up (median 9.4 years) were compared between households with kerosene versus clean (gas or electricity) or solid fuel (biomass and coal) use for cooking. Multi-level marginal regression models adjusted for individual, household, and community level covariates.

RESULTS

Higher rates of prevalent respiratory symptoms (e.g. 34% [95% CI:15-57%] more dyspnea with usual activity, 44% [95% CI: 21-72%] more chronic cough or sputum) and lower lung function (differences in FEV1: -46.3 ml (95% CI: -80.5; -12.1) and FVC: -54.7 ml (95% CI: -93.6; -15.8)) were observed at baseline for kerosene compared to clean fuel users. The odds of hypertension was slightly elevated but no associations were observed for blood pressure. Prospectively, kerosene was associated with elevated risks of all-cause (HR: 1.32 (95% CI: 1.14-1.53)) and cardiovascular (HR: 1.34 (95% CI: 1.00-1.80)) mortality, as well as major fatal and incident non-fatal cardiovascular (HR: 1.34 (95% CI: 1.08-1.66)) and respiratory (HR: 1.55 (95% CI: 0.98-2.43)) diseases, compared to clean fuel use. Further, compared to solid fuel users, those using kerosene had 20-47% higher risks for the above outcomes.

CONCLUSIONS

Kerosene use for cooking was associated with higher rates of baseline respiratory morbidity and increased risk of mortality and cardiorespiratory outcomes during follow-up when compared to either clean or solid fuels. Replacing kerosene with cleaner-burning fuels for cooking is recommended.