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Chandyo RK, Schwinger C, Kvestad I, Ulak M, Ranjitkar S, Shrestha M, Nguyen LV, Corona-Perez D, DeVivo I, Shrestha L, Strand TA. The association between household biomass fuel use and leukocyte telomere length among toddlers in Bhaktapur, Nepal. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023; 33:448-454. [PMID: 36138138 PMCID: PMC10234806 DOI: 10.1038/s41370-022-00474-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 06/03/2023]
Abstract
BACKGROUND Biomass fuels are still in use for cooking by many households in resource poor countries such as Nepal and is a major source of household air pollution (HAP). Chronic exposure to HAP has been shown to be associated with shorter telomere length in adults. OBJECTIVES To measure the association between exposure related to household biomass fuel in infancy and leukocyte telomere length (LTL) at 18-23 months of age among 497 children from Bhaktapur, Nepal. METHODS In a prospective cohort study design, we have collected information on household cooking fuel use and several clinical, anthropometric, demographic, and socioeconomic variables. We estimated the association between biomass fuel use and the relative LTL in multiple linear regression models. RESULTS Most of the families (78%) reported liquified petroleum gas (LPG) as the primary cooking fuel, and 18.7% used biomass. The mean relative (SD) LTL was 1.03 (0.19). Children living in households using biomass fuel had on average 0.09 (95% CI: 0.05 to 0.13) units shorter LTL than children in households with no biomass fuel use. The observed association was unaltered after adjusting for relevant confounders. The association between LTL and biomass use was strongest among children from households with ≤2 rooms and without separate kitchen. SIGNIFICANCE Exposure to biomass fuel use in early life might have consequences for longevity, and risk of chronic illnesses reflected in shortening of the telomeres. Our findings support the ongoing effort to reduce exposure to biomass fuel in low-resource settings. IMPACT STATEMENTS Biomass for cooking is a leading source of household air pollution in low and middle-income countries, contributing to many chronic diseases and premature deaths. Chronic exposure to biomass fuel through oxidative stress and inflammation has been associated with a shortening of the telomeres, a "biological marker" of longevity. This prospective cohort study describes the association between household biomass fuel use and leukocyte telomere length among 497 toddlers. Leukocyte telomere length was significantly shorter among children living in households with biomass fuel than in children from homes where mainly LPG was used for cooking. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov: NCT02272842, registered October 21, 2014, Universal Trial Number: U1111-1161-5187 (September 8, 2014).
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Affiliation(s)
- Ram K Chandyo
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Catherine Schwinger
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ingrid Kvestad
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
| | - Manjeswori Ulak
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Suman Ranjitkar
- Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Merina Shrestha
- Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Linda Vy Nguyen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Diana Corona-Perez
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Immaculata DeVivo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Laxman Shrestha
- Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Tor A Strand
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
- Department of Research, Innlandet Hospital Trust, Lillehammer, Norway.
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Adhikari TB, Paudel K, Paudel R, Bhusal S, Rijal A, Högman M, Neupane D, Sigsgaard T, Kallestrup P. Burden and risk factors of chronic respiratory diseases in Nepal, 1990-2019: An analysis of the global burden of diseases study. Health Sci Rep 2023; 6:e1091. [PMID: 36741854 PMCID: PMC9887632 DOI: 10.1002/hsr2.1091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 01/13/2023] [Accepted: 01/20/2023] [Indexed: 02/01/2023] Open
Abstract
Background and Aims Chronic respiratory diseases (CRDs) substantially contribute to morbidity and mortality globally and in Nepal. However, there is a paucity of evidence on the trend and the burden of CRDs in Nepal. This study reports the trend of the burden and contribution of major risk factors to CRDs in Nepal from 1990 to 2019. Methods This study is an observational study using publicly available data from Global Burden of Disease 2019 estimations for Nepal. The age-standardized and age-specific prevalence, incidence, mortality, disability-adjusted life years (DALYs), and risk factors for CRDs in Nepal were extracted to measure the burden and its trend. The data are presented as percentages or as rates per 100,000 population. Results The age-standardized incidence rate of CRDs in Nepal in 2019 was 913.6 per 100,000 (95% uncertainty interval [UI]: 828.7-1000.1), which was an increase of 7.7% from 848.6 per 100,000 (95% UI: 780.2-918.2) in 1990. However, the age-standardized prevalence rate [4453/100,000 (4234.2-4671.8) in 1990; 4457.1/100,000 (4255.2-4666.8) in 2019] was almost stagnant. Most CRDs attributed to deaths and DALYs were due to chronic obstructive pulmonary disease. Conclusions Air pollution and smoking are the main risk factors for DALYs due to CRDs in Nepal. This surging burden of the incidence rate of CRDs in Nepal calls for more effective actions to curb the risk factors and diseases.
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Affiliation(s)
- Tara Ballav Adhikari
- Nepal Health FrontiersTokha‐5KathmanduNepal,COBIN ProjectNepal Development SocietyChitwanNepal,Department of Public Health, Section for Environment, Occupation & HealthAarhus UniversityAarhusDenmark
| | | | | | | | - Anupa Rijal
- Nepal Health FrontiersTokha‐5KathmanduNepal,COBIN ProjectNepal Development SocietyChitwanNepal,Department of Regional Health Research, The Faculty of Health SciencesUniversity of Southern DenmarkOdenseDenmark
| | - Marieann Högman
- Department of Medical Sciences, Respiratory, Allergy and Sleep ResearchUppsala UniversityUppsalaSweden
| | - Dinesh Neupane
- COBIN ProjectNepal Development SocietyChitwanNepal,Department of International Health, Johns Hopkins Bloomberg School of Public HealthJohns Hopkins UniversityMDBaltimoreUSA
| | - Torben Sigsgaard
- Department of Public Health, Section for Environment, Occupation & HealthAarhus UniversityAarhusDenmark
| | - Per Kallestrup
- Department of Public Health, Section for Global HealthAarhus UniversityAarhusDenmark
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Balasubramani K, Prasad KA, Kodali NK, Abdul Rasheed NK, Chellappan S, Sarma DK, Kumar M, Dixit R, James MM, Behera SK, Shekhar S, Balabaskaran Nina P. Spatial epidemiology of acute respiratory infections in children under 5 years and associated risk factors in India: District-level analysis of health, household, and environmental datasets. Front Public Health 2022; 10:906248. [PMID: 36582369 PMCID: PMC9792853 DOI: 10.3389/fpubh.2022.906248] [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: 03/28/2022] [Accepted: 11/07/2022] [Indexed: 12/15/2022] Open
Abstract
Background In India, acute respiratory infections (ARIs) are a leading cause of mortality in children under 5 years. Mapping the hotspots of ARIs and the associated risk factors can help understand their association at the district level across India. Methods Data on ARIs in children under 5 years and household variables (unclean fuel, improved sanitation, mean maternal BMI, mean household size, mean number of children, median months of breastfeeding the children, percentage of poor households, diarrhea in children, low birth weight, tobacco use, and immunization status of children) were obtained from the National Family Health Survey-4. Surface and ground-monitored PM2.5 and PM10 datasets were collected from the Global Estimates and National Ambient Air Quality Monitoring Programme. Population density and illiteracy data were extracted from the Census of India. The geographic information system was used for mapping, and ARI hotspots were identified using the Getis-Ord Gi* spatial statistic. The quasi-Poisson regression model was used to estimate the association between ARI and household, children, maternal, environmental, and demographic factors. Results Acute respiratory infections hotspots were predominantly seen in the north Indian states/UTs of Uttar Pradesh, Bihar, Delhi, Haryana, Punjab, and Chandigarh, and also in the border districts of Uttarakhand, Himachal Pradesh, and Jammu and Kashmir. There is a substantial overlap among PM2.5, PM10, population density, tobacco smoking, and unclean fuel use with hotspots of ARI. The quasi-Poisson regression analysis showed that PM2.5, illiteracy levels, diarrhea in children, and maternal body mass index were associated with ARI. Conclusion To decrease ARI in children, urgent interventions are required to reduce the levels of PM2.5 and PM10 (major environmental pollutants) in the hotspot districts. Furthermore, improving sanitation, literacy levels, using clean cooking fuel, and curbing indoor smoking may minimize the risk of ARI in children.
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Affiliation(s)
| | - Kumar Arun Prasad
- Department of Geography, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
| | - Naveen Kumar Kodali
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
| | | | - Savitha Chellappan
- Department of Public Health and Community Medicine, ICMR—National Institute of Traditional Medicine, Belgaum, Karnataka, India
| | - Devojit Kumar Sarma
- Department of Molecular Biology, ICMR—National Institute for Research in Environmental Health, Bhopal, Madhya Pradesh, India
| | - Manoj Kumar
- Department of Microbiology, ICMR—National Institute for Research in Environmental Health, Bhopal, Madhya Pradesh, India
| | - Rashi Dixit
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
| | - Meenu Mariya James
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
| | - Sujit Kumar Behera
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
| | - Sulochana Shekhar
- Department of Geography, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
| | - Praveen Balabaskaran Nina
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India,Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India,*Correspondence: Praveen Balabaskaran Nina
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Kvestad I, Chandyo RK, Schwinger C, Ranjitkar S, Hysing M, Ulak M, Shrestha M, Shrestha L, Strand TA. Biomass fuel use for cooking in Nepalese families and child cognitive abilities, results from a community-based study. ENVIRONMENTAL RESEARCH 2022; 212:113265. [PMID: 35500855 DOI: 10.1016/j.envres.2022.113265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Biomass fuel use for cooking is widespread in low to middle income countries. Studies on the association between biomass fuel use and cognitive abilities in children are limited. OBJECTIVE To examine the association between biomass fuel use for cooking and cognitive abilities in Nepalese children at 4 years of age. METHODS In a cohort design we have information on biomass fuel use in the households of 533 children in infancy and cognitive abilities when they were 4 years old from a community-based sample. Cognitive abilities were measured by the Wechsler Preschool and Primary Scale of Intelligence, 4th edition (WPPSI-IV) and the NEPSY-II. We examined the associations between biomass fuel use and scores on the WPPSI-IV Full-Scale IQ (FSIQ) (primary outcome), and WPPSI index and NEPSY-II subtest scores in multiple linear regression models. The associations were also examined in predefined subgroups. RESULTS Ninety-nine (18.6%) of the families used biomass fuel for cooking. Children in these families had lower mean FSIQ than children in families with no biomass use (83.3 (95%CI 81.7, 85.0) vs. 85.3 (95%CI 84.5, 86.0)), with a mean difference of -2.2 (95%CI -3.9, -0.5) adjusting for demographics and socio-economic status. The association between biomass fuel use and cognitive abilities was strongest in subgroups of children from households with more than three rooms, with separate kitchen and bedroom, and with higher wealth-score. These interactions were significant for number of rooms in the home (p = 0.04), if the household had separate bedroom and kitchen (p = 0.05), and for the wealth-score (p = 0.03). CONCLUSION Biomass fuel use for cooking in Nepalese families was associated with lower overall cognitive abilities at 4 years. Uncertainties include exposure misclassification and unmeasured confounding. The associations between biomass fuel use and neurodevelopment in children needs further investigation with more precise measurements of the exposure.
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Affiliation(s)
- Ingrid Kvestad
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway; Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
| | - Ram K Chandyo
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Catherine Schwinger
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Suman Ranjitkar
- Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Manjeswori Ulak
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Merina Shrestha
- Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Laxman Shrestha
- Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Tor A Strand
- Department of Research, Innlandet Hospital Trust, Lillehammer, Norway; Centre for Intervention Science in Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
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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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Schwinger C, Kvestad I, Chandyo RK, Ulak M, Shrestha M, Ranjitkar S, Strand TA. The association between biomass fuel use for cooking and linear growth in young children in Bhaktapur, Nepal. ENVIRONMENT INTERNATIONAL 2022; 161:107089. [PMID: 35063791 DOI: 10.1016/j.envint.2022.107089] [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: 08/19/2021] [Revised: 01/06/2022] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND There are still many people in the world who prepare their meals on open fires or stoves using solid fuels from biomass, especially in low-and middle-income countries. Although biomass cooking fuels have been associated with adverse health impacts and diseases, the association with child linear growth remains unclear. OBJECTIVES In a cohort design, we aimed to describe the association between the use of biomass cooking fuels and linear growth in children aged 18-23 months living in the urban and peri-urban community of Bhaktapur, situated in the Kathmandu valley in Nepal. METHODS Caretakers of 600 marginally stunted children aged 6-11 months were interviewed about their source of cooking fuel and other socio-demographic characteristics at enrolment into a randomized controlled trial. Children's body length was measured when children were 18-23 months old. In linear regression models, we estimated the association between the use of biomass fuel and length-for-age Z-scores (LAZ), adjusted for relevant confounders. We repeated these analyses in pre-defined sub-groups and different percentiles of LAZ using quantile regression models. RESULTS Among study participants, 101 (18%) used biomass as cooking fuel. The association between biomass fuel and LAZ was not statistically significant in the full sample (adjusted regression coefficient: -0.14, 95% CI: -0.28, 0.00). The association was stronger in some of the sub-groups and in the lower tail of the LAZ distribution (those who are stunted), but neither reached statistical significance. DISCUSSION Children from households in poor, urban neighborhoods in Nepal which used biomass fuel for cooking were on average slightly shorter than other children, although the association only approached statistical significance. As this was an observational study, residual confounding cannot be excluded. Further studies are needed to confirm these associations, in particular those seen in certain sub-groups.
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Affiliation(s)
- Catherine Schwinger
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Ingrid Kvestad
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway; Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
| | - Ram K Chandyo
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Manjeswori Ulak
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Merina Shrestha
- Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Suman Ranjitkar
- Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Tor A Strand
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Research, Innlandet Hospital Trust, Lillehammer, Norway.
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Estimating long-term average household air pollution concentrations from repeated short-term measurements in the presence of seasonal trends and crossover. Environ Epidemiol 2022; 6:e188. [PMID: 35169666 PMCID: PMC8835562 DOI: 10.1097/ee9.0000000000000188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/26/2021] [Indexed: 11/26/2022] Open
Abstract
Estimating long-term exposure to household air pollution is essential for quantifying health effects of chronic exposure and the benefits of intervention strategies. However, typically only a small number of short-term measurements are made. We compare different statistical models for combining these short-term measurements into predictions of a long-term average, with emphasis on the impact of temporal trends in concentrations and crossover in study design. We demonstrate that a linear mixed model that includes time adjustment provides the best predictions of long-term average, which have lower error than using household averages or mixed models without time, for a variety of different study designs and underlying temporal trends. In a case study of a cookstove intervention study in Honduras, we further demonstrate how, in the presence of strong seasonal variation, long-term average predictions from the mixed model approach based on only two or three measurements can have less error than predictions based on an average of up to six measurements. These results have important implications for the efficiency of designs and analyses in studies assessing the chronic health impacts of long-term exposure to household air pollution.
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Sahoo MM. Significance between air pollutants, meteorological factors, and COVID-19 infections: probable evidences in India. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:40474-40495. [PMID: 33638789 PMCID: PMC7912974 DOI: 10.1007/s11356-021-12709-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/25/2021] [Indexed: 04/15/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease represents the causative agent with a potentially fatal risk which is having great global human health concern. Earlier studies suggested that air pollutants and meteorological factors were considered as the risk factors for acute respiratory infection, which carries harmful pathogens and affects the immunity. The study intended to explore the correlation between air pollutants, meteorological factors, and the daily reported infected cases caused by novel coronavirus in India. The daily positive infected cases, concentrations of air pollutants, and meteorological factors in 288 districts were collected from January 30, 2020, to April 23, 2020, in India. Spearman's correlation and generalized additive model (GAM) were applied to investigate the correlations of four air pollutants (PM2.5, PM10, NO2, and SO2) and eight meteorological factors (Temp, DTR, RH, AH, AP, RF, WS, and WD) with COVID-19-infected cases. The study indicated that a 10 μg/m3 increase during (Lag0-14) in PM2.5, PM10, and NO2 resulted in 2.21% (95%CI: 1.13 to 3.29), 2.67% (95% CI: 0.33 to 5.01), and 4.56 (95% CI: 2.22 to 6.90) increase in daily counts of Coronavirus Disease 2019 (COVID 19)-infected cases respectively. However, only 1 unit increase in meteorological factor levels in case of daily mean temperature and DTR during (Lag0-14) associated with 3.78% (95%CI: 1.81 to 5.75) and 1.82% (95% CI: -1.74 to 5.38) rise of COVID-19-infected cases respectively. In addition, SO2 and relative humidity were negatively associated with COVID-19-infected cases at Lag0-14 with decrease of 7.23% (95% CI: -10.99 to -3.47) and 1.11% (95% CI: -3.45 to 1.23) for SO2 and for relative humidity respectively. The study recommended that there are significant correlations between air pollutants and meteorological factors with COVID-19-infected cases, which substantially explain the effect of national lockdown and suggested positive implications for control and prevention of the spread of SARS-CoV-2 disease.
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Affiliation(s)
- Mrunmayee Manjari Sahoo
- Domain of Environmental and Water Resources Engg, SCE, Lovely Professional University, Phagwara, 144411, India.
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Xu H, Ta W, Yang L, Feng R, He K, Shen Z, Meng Z, Zhang N, Li Y, Zhang Y, Lu J, Li X, Qu L, Ho SSH, Cao J. Characterizations of PM 2.5-bound organic compounds and associated potential cancer risks on cooking emissions from dominated types of commercial restaurants in northwestern China. CHEMOSPHERE 2020; 261:127758. [PMID: 32736246 DOI: 10.1016/j.chemosphere.2020.127758] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/28/2020] [Accepted: 07/17/2020] [Indexed: 06/11/2023]
Abstract
Cooking emissions are both indoor and outdoor sources for fine particulate matter (PM2.5) but their contributions are often ignored. The PM2.5-bound organic compounds, including alkanols, alkanes, monocarboxylic acids, dicarboxylic acids, and polycyclic aromatic hydrocarbons (PAHs) were determined in the emissions from the most popular types of restaurants in the capital city of northwestern China. The mean concentration of total quantified organic compounds (ΣPM_O) ranged from 1112 to 32,016 ng m-3, with the maximum for the Chinese barbecue restaurants. The ΣPM_O accounted for an average of 11% of PM2.5 mass, demonstrating their significances in the cooking emissions. Hexadecanoic acid (C16) and 1-hexadecanol (C16) were considered as the tracers for stir-frying, steaming, and boiling which are usually applied in the traditional Chinese cuisines; 1-undecanol (C11), 9-fluorenone, and indeno[1,2,3-cd]pyrene were found to be potential markers for grilling and deep-frying which are widely applied in the Western style cooking method. The PAH diagnostic ratios also illustrated their representatives to distinguish the emissions from traditional Chinese cuisines and the Western-style restaurants. The estimated carcinogenic risks for the restaurants that consumed a large amount of oils and employed high temperature cooking methods (e.g., barbecuing and deep-frying) were 2.6-4.2 times exceeded the international safety limit. The organic profiles obtained in this study could be contributed to refine PM2.5 source apportionment in urban areas in northwestern China. The estimations of potential cancer risks urge the establishment of more stringent legislations to protect the health of the catering staffs.
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Affiliation(s)
- Hongmei Xu
- MOE Key Laboratory of Thermo-Fluid Science and Engineering, Department of Environmental Science and Engineering, Xi'an Jiaotong University, Xi'an, 710049, China; SKLLQG, Key Lab of Aerosol Chemistry & Physics, Institute of Earth Environment, Chinese Academy of Sciences, Xi'an, 710061, China.
| | - Weiyuan Ta
- Shaanxi Environmental Survey and Assessment Center, Xi'an, 710054, China
| | - Lin Yang
- Shaanxi Environmental Survey and Assessment Center, Xi'an, 710054, China
| | - Rong Feng
- MOE Key Laboratory of Thermo-Fluid Science and Engineering, Department of Environmental Science and Engineering, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Kailai He
- MOE Key Laboratory of Thermo-Fluid Science and Engineering, Department of Environmental Science and Engineering, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Zhenxing Shen
- MOE Key Laboratory of Thermo-Fluid Science and Engineering, Department of Environmental Science and Engineering, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Zhaojun Meng
- Shaanxi Environmental Survey and Assessment Center, Xi'an, 710054, China
| | - Ningning Zhang
- SKLLQG, Key Lab of Aerosol Chemistry & Physics, Institute of Earth Environment, Chinese Academy of Sciences, Xi'an, 710061, China
| | - Yaqi Li
- MOE Key Laboratory of Thermo-Fluid Science and Engineering, Department of Environmental Science and Engineering, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Yue Zhang
- MOE Key Laboratory of Thermo-Fluid Science and Engineering, Department of Environmental Science and Engineering, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Jiaqi Lu
- MOE Key Laboratory of Thermo-Fluid Science and Engineering, Department of Environmental Science and Engineering, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Xuan Li
- Xi'an Environmental Monitoring Centre, Xi'an, 710121, China
| | - Linli Qu
- Hong Kong Premium Services and Research Laboratory, Kowloon, Hong Kong, China
| | - Steven Sai Hang Ho
- Hong Kong Premium Services and Research Laboratory, Kowloon, Hong Kong, China; Division of Atmospheric Sciences, Desert Research Institute, Reno, NV89512, United States.
| | - Junji Cao
- SKLLQG, Key Lab of Aerosol Chemistry & Physics, Institute of Earth Environment, Chinese Academy of Sciences, Xi'an, 710061, China
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10
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A hierarchical model for estimating the exposure-response curve by combining multiple studies of acute lower respiratory infections in children and household fine particulate matter air pollution. ACTA ACUST UNITED AC 2020; 4:e119. [PMID: 33778354 PMCID: PMC7941787 DOI: 10.1097/ee9.0000000000000119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/15/2020] [Indexed: 11/25/2022]
Abstract
Adverse health effects of household air pollution, including acute lower respiratory infections (ALRIs), pose a major health burden around the world, particularly in settings where indoor combustion stoves are used for cooking. Individual studies have limited exposure ranges and sample sizes, while pooling studies together can improve statistical power. Methods We present hierarchical models for estimating long-term exposure concentrations and estimating a common exposure-response curve. The exposure concentration model combines temporally sparse, clustered longitudinal observations to estimate household-specific long-term average concentrations. The exposure-response model provides a flexible, semiparametric estimate of the exposure-response relationship while accommodating heterogeneous clustered data from multiple studies. We apply these models to three studies of fine particulate matter (PM2.5) and ALRIs in children in Nepal: a case-control study in Bhaktapur, a stepped-wedge trial in Sarlahi, and a parallel trial in Sarlahi. For each study, we estimate household-level long-term PM2.5 concentrations. We apply the exposure-response model separately to each study and jointly to the pooled data. Results The estimated long-term PM2.5 concentrations were lower for households using electric and gas fuel sources compared with households using biomass fuel. The exposure-response curve shows an estimated ALRI odds ratio of 3.39 (95% credible interval = 1.89, 6.10) comparing PM2.5 concentrations of 50 and 150 μg/m3 and a flattening of the curve for higher concentrations. Conclusions These flexible models can accommodate additional studies and be applied to other exposures and outcomes. The studies from Nepal provides evidence of a nonlinear exposure-response curve that flattens at higher concentrations.
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11
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Arku RE, Brauer M, Duong M, Wei L, Hu B, Ah Tse L, Mony PK, Lakshmi PVM, Pillai RK, Mohan V, Yeates K, Kruger L, Rangarajan S, Koon T, Yusuf S, Hystad P. Adverse health impacts of cooking with kerosene: A multi-country analysis within the Prospective Urban and Rural Epidemiology Study. ENVIRONMENTAL RESEARCH 2020; 188:109851. [PMID: 32798956 PMCID: PMC7748391 DOI: 10.1016/j.envres.2020.109851] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/09/2020] [Accepted: 06/17/2020] [Indexed: 06/06/2023]
Abstract
BACKGROUND Kerosene, which was until recently considered a relatively clean household fuel, is still widely used in low- and middle-income countries for cooking and lighting. However, there is little data on its health effects. We examined cardiorespiratory effects and mortality in households using kerosene as their primary cooking fuel within the Prospective Urban Rural Epidemiology (PURE) study. METHODS We analyzed baseline and follow-up data on 31,490 individuals from 154 communities in China, India, South Africa, and Tanzania where there was at least 10% kerosene use for cooking at baseline. Baseline comorbidities and health outcomes during follow-up (median 9.4 years) were compared between households with kerosene versus clean (gas or electricity) or solid fuel (biomass and coal) use for cooking. Multi-level marginal regression models adjusted for individual, household, and community level covariates. RESULTS Higher rates of prevalent respiratory symptoms (e.g. 34% [95% CI:15-57%] more dyspnea with usual activity, 44% [95% CI: 21-72%] more chronic cough or sputum) and lower lung function (differences in FEV1: -46.3 ml (95% CI: -80.5; -12.1) and FVC: -54.7 ml (95% CI: -93.6; -15.8)) were observed at baseline for kerosene compared to clean fuel users. The odds of hypertension was slightly elevated but no associations were observed for blood pressure. Prospectively, kerosene was associated with elevated risks of all-cause (HR: 1.32 (95% CI: 1.14-1.53)) and cardiovascular (HR: 1.34 (95% CI: 1.00-1.80)) mortality, as well as major fatal and incident non-fatal cardiovascular (HR: 1.34 (95% CI: 1.08-1.66)) and respiratory (HR: 1.55 (95% CI: 0.98-2.43)) diseases, compared to clean fuel use. Further, compared to solid fuel users, those using kerosene had 20-47% higher risks for the above outcomes. CONCLUSIONS Kerosene use for cooking was associated with higher rates of baseline respiratory morbidity and increased risk of mortality and cardiorespiratory outcomes during follow-up when compared to either clean or solid fuels. Replacing kerosene with cleaner-burning fuels for cooking is recommended.
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Affiliation(s)
- Raphael E Arku
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA; School of Population and Public Health, The University of British Columbia, Vancouver, Canada.
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - MyLinh Duong
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Li Wei
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, China
| | - Bo Hu
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, China
| | - Lap Ah Tse
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Prem K Mony
- Division of Epidemiology & Population Health, St John's Medical College & Research Institute, Bangalore, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Rajamohanan K Pillai
- School of Health Policy, Kerala University of Health Sciences, Trivandrum, India
| | | | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Lanthe Kruger
- North-West University, Africa Unit for Transdisciplinary Health Research (AUTHeR), South Africa
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Teo Koon
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, USA
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12
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Kim KN, Kim S, Lim YH, Song IG, Hong YC. Effects of short-term fine particulate matter exposure on acute respiratory infection in children. Int J Hyg Environ Health 2020; 229:113571. [PMID: 32554254 DOI: 10.1016/j.ijheh.2020.113571] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/14/2020] [Accepted: 05/25/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Previous studies on the association between fine particulate matter (PM2.5) exposure and acute respiratory infection in children are scarce and present inconsistent results. We estimated the association between short-term PM2.5 exposure and acute respiratory infection among children aged 0-4 years using a difference-in-differences approach. METHODS We used data on the daily PM2.5 concentrations, hospital admissions for acute respiratory infection, and meteorological factors of the 15 regions in the Republic of Korea (2013-2015). To estimate the cumulative effects, we used a difference-in-differences approach generalized to multiple spatial units (regions) and time periods (day) with distributed lag non-linear models. RESULTS With PM2.5 levels of 20.0 μg/m3 as a reference, PM2.5 levels of 30.0 μg/m3 were positively associated with the risk of acute upper respiratory infection (relative risk (RR) = 1.048, 95% confidence interval (CI): 1.028, 1.069) and bronchitis or bronchiolitis (RR = 1.060, 95% CI: 1.038, 1.082) but not with the risk of acute lower respiratory infection and pneumonia. PM2.5 levels of 40.0 μg/m3 were also positively associated with the risk of acute upper respiratory infection (RR = 1.083, 95% CI: 1.046, 1.122) and bronchitis or bronchiolitis (RR = 1.094, 95% CI: 1.054, 1.136). CONCLUSIONS We found the associations of short-term PM2.5 exposure with acute upper respiratory infection and bronchitis or bronchiolitis among children aged 0-4 years. As causal inference methods can provide more convincing evidence of the effects of PM2.5 levels on respiratory infections, public health policies and guidelines regarding PM2.5 need to be strengthened accordingly.
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Affiliation(s)
- Kyoung-Nam Kim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Public Health and Preventive Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soontae Kim
- Department of Environmental and Safety Engineering, Ajou University, Suwon, Republic of Korea
| | - Youn-Hee Lim
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - In Gyu Song
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yun-Chul Hong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Public Health and Preventive Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
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13
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Deng M, Li P, Shan M, Yang X. Optimizing supply airflow and its distribution between primary and secondary air in a forced-draft biomass pellet stove. ENVIRONMENTAL RESEARCH 2020; 184:109301. [PMID: 32120124 DOI: 10.1016/j.envres.2020.109301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/01/2019] [Accepted: 02/24/2020] [Indexed: 06/10/2023]
Abstract
Forced-draft biomass stoves improve the pollutant emission performance of biomass combustion. The parameters of supply airflow and its distribution between primary air (PA) and secondary air (SA) have a significant effect on the performance of this stove type. In this study, we designed an air supply control system to accurately quantify the airflow rates, and monitored the dynamic emissions of focused pollutant species including carbon monoxide (CO), nitrogen oxides (NOx), particulate matter (PM2.5), and the fuel burning rate. The tested stove had a combustion structure typical of many popular stoves, and wood pellets were the burning fuel. Three total airflow rates (92 L/min, 184 L/min, and 276 L/min) were selected, and six distributions between PA and SA (PA:SA) for each airflow rate were tested, which included 10:0 (full PA), 8:2, 6:4, 5:5, 4:6, and 2:8. The results showed that the test duration, burning rate, and pollutant (CO, NOx, and PM2.5) emission performances of different airflows or distributions varied. Overall, when the PA and SA distribution mode was determined, the total airflow rate of 184 L/min was the optimal supply airflow rate. Under the same total airflow rate, the burning and emission performances were better when the primary and secondary airflows were similar, namely from 4:6 to 6:4. This study provided core information about stove air supply and distribution, which is essential to quantitatively determine the stove air supply mode to significantly improve stove performances.
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Affiliation(s)
- Mengsi Deng
- Department of Building Science, Tsinghua University, Beijing, 100084, China
| | - Pengchao Li
- Department of Building Science, Tsinghua University, Beijing, 100084, China
| | - Ming Shan
- Department of Building Science, Tsinghua University, Beijing, 100084, China.
| | - Xudong Yang
- Department of Building Science, Tsinghua University, Beijing, 100084, China
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14
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Arlington L, Patel AB, Simmons E, Kurhe K, Prakash A, Rao SR, Hibberd PL. Duration of solid fuel cookstove use is associated with increased risk of acute lower respiratory infection among children under six months in rural central India. PLoS One 2019; 14:e0224374. [PMID: 31648283 PMCID: PMC6812868 DOI: 10.1371/journal.pone.0224374] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 10/12/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction India has a higher number of deaths due to acute lower respiratory infections (ALRIs) in children <5 years than any other country. The underlying cause of half of ALRI deaths is household air pollution from burning of solid fuels, according to the World Health Organization. If there is a direct association between duration of exposure and increased ALRI risk, a potential strategy might be to limit the child’s exposure to burning solid fuel. Methods and materials Children born to pregnant women participating in the Global Network for Women and Children's Health Maternal and Newborn Health Registry near Nagpur, India were followed every two weeks from birth to six months to diagnose ALRI. The number of hours per day that the child’s mother spent in front of a burning solid fuel cookstove was recorded. Children of mothers using only clean cookstoves were classified as having zero hours of exposure. Odds Ratios with 95% confidence intervals were obtained from Generalized Estimating Equations logistic models that assessed the relationship of exposure to solid fuels with risk of ≥1 ALRI, adjusted for sex of the child, household smoking, wealth, maternal age, birth weight and parity. Results Between August 2013 and March 2014, 302 of 1,586 children (19%) had ≥1 episode of ALRI. Results from the multivariable analysis indicate that the odds of ALRI significantly increased from 1.2 (95% CI: 0.7–2.2) for <1 hour of exposure to 2.1 (95% CI: 1.4–3.3) for >3 hours of exposure to solid fuel cookstoves compared with no exposure (p<0.01). Additionally, decreasing wealth [middle: 1.2 (0.9, 1.6); poor: 1.4 (1.2–1.7); p<0.001] was associated with ALRIs. Conclusions Our study findings indicate that increasing the time mothers spend cooking near solid fuel cookstoves while children are in the house may be associated with development of ≥1 ALRI in children <6 months.
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Affiliation(s)
- Lauren Arlington
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Archana B. Patel
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
- Department of Pediatrics, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| | - Elizabeth Simmons
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Kunal Kurhe
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | - Amber Prakash
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | - Sowmya R. Rao
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Patricia L. Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
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15
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Yao Y, Wang D, Ma H, Li C, Chang X, Low P, Hammond SK, Turyk ME, Wang J, Liu S. The impact on T-regulatory cell related immune responses in rural women exposed to polycyclic aromatic hydrocarbons (PAHs) in household air pollution in Gansu, China: A pilot investigation. ENVIRONMENTAL RESEARCH 2019; 173:306-317. [PMID: 30951957 DOI: 10.1016/j.envres.2019.03.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/16/2019] [Accepted: 03/21/2019] [Indexed: 06/09/2023]
Abstract
Previous studies found associations between impairments of immune functions and exposure to polycyclic aromatic hydrocarbons (PAHs) in ambient air pollution in the U. S. and China. However, the results remain inconclusive due to the limitations of these studies. In this study, we aimed to examine the direction and magnitude of immune changes related to PAH exposure from household air pollution among rural women living in Gansu, China. Healthy village women (n = 34) were recruited and enrolled in the study. Questionnaires were administered. Blood and urine samples were collected and analyzed during non-heating (September 2017, "summer") and heating (January 2018, "winter") seasons. Urinary 1-hydroxypyrene (1-OHP) was quantified as the biomarker of PAH exposure. To evaluate Treg cell related immune functions, we examined immunoglobulin E (IgE), percent of T-regulatory (Treg) cells, and gene expression of following: forkhead box transcription factor 3 (Foxp3), transforming growth factor-β (TGF-β), interleukin 10 (IL-10), and interleukin 35 (IL-35), composed of interleukin-12 alpha (IL-12α) and Epstein-Barr-virus-induced gene 3 (EBi3). Urinary 8-hydroxy-2-deoxyguanosine (8-OHdG) was measured to evaluate oxidative DNA damage. The results showed that the concentration of 1-OHP increased from 0.90 to 17.4 μmol mol-Cr -1 from summer to winter (p < 0.001). Meanwhile, average percent of Treg cells decreased from 5.01% to 1.15% (p < 0.001); IgE and mRNA expressions of Foxp3, TGF-β, IL-10, IL-12α and EBi3 all significantly decreased (p < 0.001); Urinary 8-OHdG increased from 12.7 to 30.3 ng mg-Cr -1 (p < 0.001). The changes in 8-OHdG, Foxp3 and TGF-β were significantly associated with the increase of 1-OHP. The results suggested that we observed a substantial increase of PAH exposure in winter, which was significantly associated with the repression on Treg cell function and oxidative DNA damage. Exposure to PAHs in household air pollution possibly induced immune impairments among rural women in northwest China.
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Affiliation(s)
- Yueli Yao
- Department of Toxicology, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Dong Wang
- Department of Toxicology, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Haitao Ma
- Department of Toxicology, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Chengyun Li
- Department of Toxicology, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Xiaoru Chang
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Patrick Low
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - S Katharine Hammond
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Mary Ellen Turyk
- School of Public Health, University of Illinois, Chicago, IL, USA
| | - Junling Wang
- Department of Toxicology, School of Public Health, Lanzhou University, Lanzhou, Gansu, China.
| | - Sa Liu
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA; School of Health Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA.
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16
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Arinola GO, Dutta A, Oluwole O, Olopade CO. Household Air Pollution, Levels of Micronutrients and Heavy Metals in Cord and Maternal Blood, and Pregnancy Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122891. [PMID: 30562990 PMCID: PMC6313792 DOI: 10.3390/ijerph15122891] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 12/02/2022]
Abstract
Cooking with kerosene emits toxic pollutants that may impact pregnancy outcomes. Sixty-eight women in their first trimester of pregnancy, kerosene users (n = 42) and liquefied natural gas (LNG) users (n = 26), were followed until birth. Maternal and cord blood were collected immediately after birth. Levels of micronutrients and heavy metals were quantified. Pregnancy outcomes (gestation age (GA), birth weight (BW), and chest and head circumference) were also measured. Mean (± standard deviation (SD)) age of mothers in kerosene and LNG groups were similar (p = 0.734). Mean (±SD) BW of newborns of LNG users was significantly higher compared to newborns of kerosene users (3.43 ± 0.32 vs. 3.02 ± 0.43, p < 0.001). Mean GA (in weeks) was similar between the two groups (p = 0.532). Women in the kerosene group had significantly higher cord blood levels of zinc, lead, mercury, iodine and vitamin B6 and lower levels of folic acid compared to LNG users (p < 0.05). Newborns of kerosene users had reduced levels of zinc, lead, mercury, iodine, vitamins B6 and B12, folic acid, and homocysteine compared with LNG users (p < 0.05). Also, cooking with kerosene was significantly associated with reduced birth weight after adjusting for potential confounders (β ± standard error (SE) = −0.326 ± 0.155; p = 0.040). Smoke from kerosene stove was associated with reduced birth weight and micronutrients imbalance in mothers and newborns.
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Affiliation(s)
| | - Anindita Dutta
- Department of Medicine and Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, MC 2021 Chicago, IL 60637, USA.
| | - Oluwafemi Oluwole
- Department of Pediatrics and the Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada.
| | - Christopher O Olopade
- Department of Medicine and Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, MC 2021 Chicago, IL 60637, USA.
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Ozoh OB, Okwor TJ, Adetona O, Akinkugbe AO, Amadi CE, Esezobor C, Adeyeye OO, Ojo O, Nwude VN, Mortimer K. Cooking Fuels in Lagos, Nigeria: Factors Associated with Household Choice of Kerosene or Liquefied Petroleum Gas (LPG). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040641. [PMID: 29614713 PMCID: PMC5923683 DOI: 10.3390/ijerph15040641] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 03/26/2018] [Accepted: 03/28/2018] [Indexed: 11/16/2022]
Abstract
Cooking with dirty-burning fuels is associated with health risk from household air pollution. We assessed the prevalence of and factors associated with the use of cooking fuels, and attitudes and barriers towards use of liquefied petroleum gas (LPG). This was a cross-sectional, population-based survey conducted in 519 households in Lagos, Nigeria. We used a structured questionnaire to obtain information regarding choice of household cooking fuel and the attitudes towards the use of LPG. Kerosene was the most frequently used cooking fuel (n = 475, 91.5%; primary use n = 364, 70.1%) followed by charcoal (n = 159, 30.6%; primary use n = 88, 17%) and LPG (n = 86, 16.6%; primary use n = 63, 12.1%). Higher level of education, higher income and younger age were associated with LPG vs. kerosene use. Fuel expenditure on LPG was significantly lower than for kerosene ( N (Naira) 2169.0 ± 1507.0 vs. N 2581.6 ± 1407.5). Over 90% of non-LPG users were willing to switch to LPG but cited safety issues and high cost as potential barriers to switching. Our findings suggest that misinformation and beliefs regarding benefits, safety and cost of LPG are important barriers to LPG use. An educational intervention program could be a cost-effective approach to improve LPG adoption and should be formally addressed through a well-designed community-based intervention study.
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Affiliation(s)
- Obianuju B Ozoh
- College of Medicine, University of Lagos, Idi-Araba, Lagos 100254, Nigeria.
- Lagos University Teaching Hospital, Idi-Araba, Lagos 100254, Nigeria.
| | - Tochi J Okwor
- University of Nigeria Teaching Hospital Ituku Ozalla, Enugu 400114, Nigeria.
| | - Olorunfemi Adetona
- College of Public Health, Ohio State University, Columbus, OH 43210, USA.
| | - Ayesha O Akinkugbe
- College of Medicine, University of Lagos, Idi-Araba, Lagos 100254, Nigeria.
- Lagos University Teaching Hospital, Idi-Araba, Lagos 100254, Nigeria.
| | - Casmir E Amadi
- College of Medicine, University of Lagos, Idi-Araba, Lagos 100254, Nigeria.
- Lagos University Teaching Hospital, Idi-Araba, Lagos 100254, Nigeria.
| | - Christopher Esezobor
- College of Medicine, University of Lagos, Idi-Araba, Lagos 100254, Nigeria.
- Lagos University Teaching Hospital, Idi-Araba, Lagos 100254, Nigeria.
| | - Olufunke O Adeyeye
- College of Medicine, Lagos State University, Ikeja, Lagos 100271, Nigeria.
| | - Oluwafemi Ojo
- Lagos University Teaching Hospital, Idi-Araba, Lagos 100254, Nigeria.
| | - Vivian N Nwude
- Lagos University Teaching Hospital, Idi-Araba, Lagos 100254, Nigeria.
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
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Women's Ideas about the Health Effects of Household Air Pollution, Developed through Focus Group Discussions and Artwork in Southern Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020248. [PMID: 29389909 PMCID: PMC5858317 DOI: 10.3390/ijerph15020248] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/22/2018] [Accepted: 01/29/2018] [Indexed: 11/17/2022]
Abstract
Household air pollution is a major cause of ill health, but few solutions have been effective to date. While many quantitative studies have been conducted, few have explored the lived experiences and perceptions of women who do the cooking, and as a result are those most exposed to household air pollution. In this study, we worked with groups of home cooks, and sought to use art as a means of engaging them in discussions of how household air pollution from cooking affects their lives. In the Terai district of southern Nepal, we held four focus groups that included 26 local women from urban and peri-urban areas, as well as six local artists. The women then met approximately weekly over four months, and produced images related to air pollution. Transcripts from the focus groups were reviewed independently by two authors, who initially categorised data deductively to pre-defined nodes, and subsequently inductively reviewed emergent themes. Women identified a number of health effects from air pollution. The main physical effects related to the eye and the respiratory system, and women and young children were seen as most vulnerable. The psychosocial effects of air pollution included reduced food intake by women and lethargy. Suggested solutions included modifications to the cooking process, changing the location of stoves, and increasing ventilation. The main barriers were financial. The lived experiences of women in southern Nepal around the problem of air pollution offers a more nuanced and context-specific understanding of the perceptions and challenges of addressing air pollution, which can be used to inform future interventions.
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