1
|
Nawsherwan, Khan SA, Mubarik S, Le Z, Akbar F, Wang Y. Epidemiological trends and age-period-cohort effects on cardiovascular diseases burden attributable to ambient air pollution across BRICS. Sci Rep 2024; 14:11464. [PMID: 38769093 PMCID: PMC11106240 DOI: 10.1038/s41598-024-62295-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024] Open
Abstract
Long-term exposure to ambient air pollution raises the risk of deaths and morbidity worldwide. From 1990 to 2019, we observed the epidemiological trends and age-period-cohort effects on the cardiovascular diseases (CVD) burden attributable to ambient air pollution across Brazil, Russia, India, China, and South Africa (BRICS). The number of CVD deaths related to ambient particulate matter (PM) pollution increased nearly fivefold in China [5.0% (95% CI 4.7, 5.2)] and India [5.7% (95% CI 5.1, 6.3)] during the study period. The age-standardized CVD deaths and disability-adjusted life years (DALYs) due to ambient PM pollution significantly increased in India and China but decreased in Brazil and Russia. Due to air pollution, the relative risk (RR) of premature CVD mortality (< 70 years) was higher in Russia [RR 12.6 (95% CI 8.7, 17.30)] and India [RR 9.2 (95% CI 7.6, 11.20)]. A higher period risk (2015-2019) for CVD deaths was found in India [RR 1.4 (95% CI 1.4, 1.4)] followed by South Africa [RR 1.3 (95% CI 1.3, 1.3)]. Across the BRICS countries, the RR of CVD mortality markedly decreased from the old birth cohort to young birth cohorts. In conclusion, China and India showed an increasing trend of CVD mortality and morbidity due to ambient PM pollution and higher risk of premature CVD deaths were observed in Russia and India.
Collapse
Affiliation(s)
- Nawsherwan
- School of Medicine, Xiamen Cardiovascular Hospital of Xiamen University, Fujian Branch of National Clinical Research Center for Cardiovascular Diseases, Xiamen, China.
| | - Shahzad Ali Khan
- Department of Public Health, School of Public Health, Health Services Academy, Islamabad, Pakistan
| | - Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, Hubei, China
| | - Zhang Le
- School of Medicine, Xiamen Cardiovascular Hospital of Xiamen University, Fujian Branch of National Clinical Research Center for Cardiovascular Diseases, Xiamen, China
| | - Fazli Akbar
- Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Nutrition and Food Hygiene, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yan Wang
- School of Medicine, Xiamen Cardiovascular Hospital of Xiamen University, Fujian Branch of National Clinical Research Center for Cardiovascular Diseases, Xiamen, China.
| |
Collapse
|
2
|
McCarrick S, Delaval MN, Dauter UM, Krais AM, Snigireva A, Abera A, Broberg K, Eriksson AC, Isaxon C, Gliga AR. Toxicity of particles derived from combustion of Ethiopian traditional biomass fuels in human bronchial and macrophage-like cells. Arch Toxicol 2024; 98:1515-1532. [PMID: 38427118 DOI: 10.1007/s00204-024-03692-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/23/2024] [Indexed: 03/02/2024]
Abstract
The combustion of traditional fuels in low-income countries, including those in sub-Saharan Africa, leads to extensive indoor particle exposure. Yet, the related health consequences in this context are understudied. This study aimed to evaluate the in vitro toxicity of combustion-derived particles relevant for Sub-Saharan household environments. Particles (< 2.5 µm) were collected using a high-volume sampler during combustion of traditional Ethiopian biomass fuels: cow dung, eucalyptus wood and eucalyptus charcoal. Diesel exhaust particles (DEP, NIST 2975) served as reference particles. The highest levels of particle-bound polycyclic aromatic hydrocarbons (PAHs) were found in wood (3219 ng/mg), followed by dung (618 ng/mg), charcoal (136 ng/mg) and DEP (118 ng/mg) (GC-MS). BEAS-2B bronchial epithelial cells and THP-1 derived macrophages were exposed to particle suspensions (1-150 µg/mL) for 24 h. All particles induced concentration-dependent genotoxicity (comet assay) but no pro-inflammatory cytokine release in epithelial cells, whereas dung and wood particles also induced concentration-dependent cytotoxicity (Alamar Blue). Only wood particles induced concentration-dependent cytotoxicity and genotoxicity in macrophage-like cells, while dung particles were unique at increasing secretion of pro-inflammatory cytokines (IL-6, IL-8, TNF-α). In summary, particles derived from combustion of less energy dense fuels like dung and wood had a higher PAH content and were more cytotoxic in epithelial cells. In addition, the least energy dense and cheapest fuel, dung, also induced pro-inflammatory effects in macrophage-like cells. These findings highlight the influence of fuel type on the toxic profile of the emitted particles and warrant further research to understand and mitigate health effects of indoor air pollution.
Collapse
Affiliation(s)
- Sarah McCarrick
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Mathilde N Delaval
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Joint Mass Spectrometry Centre (JMSC), Cooperation Group Comprehensive Molecular Analytics, Helmholtz Munich, Neuherberg, Germany
| | - Ulrike M Dauter
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Annette M Krais
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | | | - Asmamaw Abera
- Ergonomics and Aerosol Technology, Lund University, Lund, Sweden
- NanoLund, Lund University, Lund, Sweden
- Addis Ababa University, Addis Ababa, Ethiopia
| | - Karin Broberg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Axel C Eriksson
- Ergonomics and Aerosol Technology, Lund University, Lund, Sweden
- NanoLund, Lund University, Lund, Sweden
| | - Christina Isaxon
- Ergonomics and Aerosol Technology, Lund University, Lund, Sweden
- NanoLund, Lund University, Lund, Sweden
| | - Anda R Gliga
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
3
|
Han CI, Lee J. Impact of Overseas Deployment on Fatty Liver and Metabolic Diseases Among Korean Soldiers. Mil Med 2024:usae016. [PMID: 38330091 DOI: 10.1093/milmed/usae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/27/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The prevalence of metabolic diseases is increasing worldwide and is influenced by multiple environmental, psychological, and dietary factors. As overseas deployment (OD) of Korean soldiers brings about changes in these factors, this study aimed to explore the impact of OD on metabolic diseases. MATERIALS AND METHODS We collected paired health checkup data of Korean soldiers between January 2020 and December 2022, before and after their deployment. We analyzed changes in lipid profile, fasting glucose, and liver function biomarkers during OD and compared the prevalence of metabolic diseases before and after the OD. RESULTS A total of 2,953 soldiers were enrolled. During OD, body weight, body mass index, total cholesterol, low-density lipoprotein, and fasting glucose levels decreased significantly. Furthermore, the prevalence of obesity, impaired fasting glucose, and nonalcoholic fatty liver disease decreased significantly from 45.78% to 33.49%, P < .001; 38.60% to 34.41%, P < .001; and 24.89% to 18.88%, P < .001, respectively. In a subgroup analysis of participants with long-term deployment (duration >365 days), only the prevalence of obesity decreased significantly during deployment, whereas the prevalence of hypertension and dyslipidemia increased. CONCLUSIONS Metabolic biomarkers improved, and the prevalence of metabolic diseases decreased significantly during OD. However, personnel with long-term deployment did not experience significant improvements in these parameters. Further analysis is needed to identify the factors influencing these discrepancies.
Collapse
Affiliation(s)
- Chang In Han
- Department of Internal Medicine, Armed Forces Goyang Hospital, Goyang 10267, Republic of Korea
| | - Jaejun Lee
- Department of Internal Medicine, Armed Forces Goyang Hospital, Goyang 10267, Republic of Korea
- The Catholic University Liver Research Center, Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| |
Collapse
|
4
|
Wells CD, Kasoar M, Ezzati M, Voulgarakis A. Significant human health co-benefits of mitigating African emissions. ATMOSPHERIC CHEMISTRY AND PHYSICS 2024; 24:1025-1039. [PMID: 38348019 PMCID: PMC7615628 DOI: 10.5194/acp-24-1025-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Future African aerosol emissions, and therefore air pollution levels and health outcomes, are uncertain and understudied. Understanding the future health impacts of pollutant emissions from this region is crucial. Here, this research gap is addressed by studying the range in the future health impacts of aerosol emissions from Africa in the Shared Socioeconomic Pathway (SSP) scenarios, using the UK Earth System Model version 1 (UKESM1), along with human health concentration-response functions. The effects of Africa following a high-pollution aerosol pathway are studied relative to a low-pollution control, with experiments varying aerosol emissions from industry and biomass burning. Using present-day demographics, annual deaths within Africa attributable to ambient particulate matter are estimated to be lower by 150 000 (5th-95th confidence interval of 67 000-234 000) under stronger African aerosol mitigation by 2090, while those attributable to O3 are lower by 15 000 (5th-95th confidence interval of 9000-21 000). The particulate matter health benefits are realised predominantly within Africa, with the O3-driven benefits being more widespread - though still concentrated in Africa - due to the longer atmospheric lifetime of O3. These results demonstrate the important health co-benefits from future emission mitigation in Africa.
Collapse
Affiliation(s)
- Christopher D. Wells
- The Grantham Institute for Climate Change and the Environment, Imperial College London, London, UK
- School of Earth and Environment, University of Leeds, Leeds, UK
| | - Matthew Kasoar
- Leverhulme Centre for Wildfires, Environment and Society, Department of Physics, Imperial College London, London, UK
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Apostolos Voulgarakis
- Leverhulme Centre for Wildfires, Environment and Society, Department of Physics, Imperial College London, London, UK
- School of Environmental Engineering, Technical University of Crete, Chania, Greece
| |
Collapse
|
5
|
Katoto PDMC, Bihehe D, Brand A, Mushi R, Kusinza A, Alwood BW, van Zyl-Smit RN, Tamuzi JL, Sam-Agudu NA, Yotebieng M, Metcalfe J, Theron G, Godri Pollitt KJ, Lesosky M, Vanoirbeek J, Mortimer K, Nawrot T, Nemery B, Nachega JB. Household air pollution and risk of pulmonary tuberculosis in HIV-Infected adults. Environ Health 2024; 23:6. [PMID: 38233832 PMCID: PMC10792790 DOI: 10.1186/s12940-023-01044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND In low- and middle-income countries countries, millions of deaths occur annually from household air pollution (HAP), pulmonary tuberculosis (PTB), and HIV-infection. However, it is unknown whether HAP influences PTB risk among people living with HIV-infection. METHODS We conducted a case-control study among 1,277 HIV-infected adults in Bukavu, eastern Democratic Republic of Congo (February 2018 - March 2019). Cases had current or recent (<5y) PTB (positive sputum smear or Xpert MTB/RIF), controls had no PTB. Daily and lifetime HAP exposure were assessed by questionnaire and, in a random sub-sample (n=270), by 24-hour measurements of personal carbon monoxide (CO) at home. We used multivariable logistic regression to examine the associations between HAP and PTB. RESULTS We recruited 435 cases and 842 controls (median age 41 years, [IQR] 33-50; 76% female). Cases were more likely to be female than male (63% vs 37%). Participants reporting cooking for >3h/day and ≥2 times/day and ≥5 days/week were more likely to have PTB (aOR 1·36; 95%CI 1·06-1·75) than those spending less time in the kitchen. Time-weighted average 24h personal CO exposure was related dose-dependently with the likelihood of having PTB, with aOR 4·64 (95%CI 1·1-20·7) for the highest quintile [12·3-76·2 ppm] compared to the lowest quintile [0·1-1·9 ppm]. CONCLUSION Time spent cooking and personal CO exposure were independently associated with increased risk of PTB among people living with HIV. Considering the high burden of TB-HIV coinfection in the region, effective interventions are required to decrease HAP exposure caused by cooking with biomass among people living with HIV, especially women.
Collapse
Affiliation(s)
- Patrick D M C Katoto
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- Office of the President and CEO, South African Medical Research Council, Cape Town, South Africa.
- Centre for Tropical Diseases and Global Health, Catholic University of Bukavu, Bukavu, Democratic Republic of the Congo.
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Dieudonné Bihehe
- Department of Internal Medicine, Université Evangélique en Afrique, Bukavu, DR, Congo
| | - Amanda Brand
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Raymond Mushi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Aline Kusinza
- Department of Medicine, Division of Pulmonology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Brian W Alwood
- Department of Medicine, Division of Pulmonology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Richard N van Zyl-Smit
- Division of Pulmonology & UCT Lung Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jacques L Tamuzi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA
| | - John Metcalfe
- Division of Pulmonary and Critical Care Medicine, Trauma Center, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Grant Theron
- South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, NRF-DST Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa
| | - Krystal J Godri Pollitt
- Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, CT, USA
| | - Maia Lesosky
- Division of epidemiology and Biostatistics, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Jeroen Vanoirbeek
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Tim Nawrot
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Centre of Environmental Health, University of Hasselt, Hasselt, Belgium
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jean B Nachega
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA.
- Department of Medicine, Center for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- Department of Epidemiology and Center for Global Health, Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, 130 DeSoto St., Room A522 Crabtree Hall, Pittsburgh, 15260, PA, USA.
| |
Collapse
|
6
|
Navaratnam AMD, Williams H, Sharp SJ, Woodcock J, Khreis H. Systematic review and meta-analysis on the impact of COVID-19 related restrictions on air quality in low- and middle-income countries. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 908:168110. [PMID: 37884141 DOI: 10.1016/j.scitotenv.2023.168110] [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: 08/09/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Low- and middle-income countries (LMIC) are disproportionately affected by air pollution and its health burden, representing a global inequity. The COVID-19 pandemic provided a unique opportunity to investigate the impact of unprecedented lockdown measures on air pollutant concentrations globally. We aim to quantify air pollutant concentration changes across LMIC settings as a result of COVID-19 restrictions. METHODS Searches for this systematic review and meta-analysis were carried out across five databases on 30th March 2022; MEDLINE, Embase, Web of Science, Scopus and Transport Research Information Documentation. Modelling and observational studies were included, as long as the estimates reflected city or town level data and were taken exclusively in pre-lockdown and lockdown periods. Mean percentage changes per pollutant were calculated and meta-analyses were carried out to calculate mean difference in measured ground-level observed concentrations for each pollutant (PROSPERO CRD42022326924). FINDINGS Of the 2982 manuscripts from initial searches, 256 manuscripts were included providing 3818 percentage changes of all pollutants. No studies included any countries from Sub-Saharan Africa and 34 % and 39.4 % of studies were from China and India, respectively. There was a mean percentage change of -37.4 %, -21.7 %, -54.6 %, -39.1 %, -48.9 %, 16.9 %, -34.9 %, -30.6 % and - 14.7 % for black carbon (BC), carbon monoxide (CO), nitric oxide (NO), nitrogen dioxide (NO2), oxides of nitrogen (NOx), ozone (O3), particulate matter 10 (PM10) and 2.5 (PM2.5) and sulphur dioxide (SO2), respectively. Meta-analysis included 100 manuscripts, providing 908 mean concentration differences, which showed significant reduction in mean concentration in all study settings for BC (-0.46 μg/m3, PI -0.85; -0.08), CO (-0.25 mg/m3, PI -0.44; -0.03), NO2 (-19.41 μg/m3, PI -31.14; -7.68) and NOx (-22.32 μg/m3, PI -40.94; -3.70). INTERPRETATION The findings of this systematic review and meta-analysis quantify and confirm the trends reported across the globe in air pollutant concentration, including increases in O3. Despite the majority of global urban growth occurring in LMIC, there are distinct geographical gaps in air pollution data and, where it is available, differing approaches to analysis and reporting.
Collapse
Affiliation(s)
| | - Harry Williams
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - James Woodcock
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Haneen Khreis
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
| |
Collapse
|
7
|
Landrigan PJ, Britt M, Fisher S, Holmes A, Kumar M, Mu J, Rizzo I, Sather A, Yousuf A, Kumar P. Assessing the Human Health Benefits of Climate Mitigation, Pollution Prevention, and Biodiversity Preservation. Ann Glob Health 2024; 90:1. [PMID: 38186855 PMCID: PMC10768568 DOI: 10.5334/aogh.4161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
Background Since the Industrial Revolution, humanity has amassed great wealth and achieved unprecedented material prosperity. These advances have come, however, at great cost to the planet. They are guided by an economic model that focuses almost exclusively on short-term gain, while ignoring natural capital and human capital. They have relied on the combustion of vast quantities of fossil fuels, massive consumption of the earth's resources, and production and environmental release of enormous quantities of chemicals, pesticides, fertilizers, and plastics. They have caused climate change, pollution, and biodiversity loss, the "Triple Planetary Crisis". They are responsible for more than 9 million premature deaths per year and for widespread disease - impacts that fall disproportionately upon the poor and the vulnerable. Goals To map the human health impacts of climate change, pollution, and biodiversity loss. To outline a framework for assessing the health benefits of interventions against these threats. Findings Actions taken by national governments and international agencies to mitigate climate change, pollution, and biodiversity loss can improve health, prevent disease, save lives, and enhance human well-being. Yet assessment of health benefits is largely absent from evaluations of environmental remediation programs. This represents a lost opportunity to quantify the full benefits of environmental remediation and to educate policy makers and the public. Recommendations We recommend that national governments and international agencies implementing interventions against climate change, pollution, and biodiversity loss develop metrics and strategies for quantifying the health benefits of these interventions. We recommend that they deploy these tools in parallel with assessments of ecologic and economic benefits. Health metrics developed by the Global Burden of Disease (GBD) study may provide a useful starting point.Incorporation of health metrics into assessments of environmental restoration will require building transdisciplinary collaborations. Environmental scientists and engineers will need to work with health scientists to establish evaluation systems that link environmental and economic data with health data. Such systems will assist international agencies as well as national and local governments in prioritizing environmental interventions.
Collapse
Affiliation(s)
- Philip J. Landrigan
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, US
- Centre Scientifique de Monaco, MC
| | - Michael Britt
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, US
| | - Samantha Fisher
- City University of New York, Graduate School of Public Health and Health Policy, New York City, NY, US
| | | | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Kenya
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, US
| | - Jenna Mu
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, US
| | - Isabella Rizzo
- The George Washington University, Elliot School of International Affairs, Washington D.C., US
| | - Anna Sather
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, US
| | | | | |
Collapse
|
8
|
Ayejoto DA, Agbasi JC, Nwazelibe VE, Egbueri JC, Alao JO. Understanding the connections between climate change, air pollution, and human health in Africa: Insights from a literature review. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, TOXICOLOGY AND CARCINOGENESIS 2023; 41:77-120. [PMID: 37880976 DOI: 10.1080/26896583.2023.2267332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Climate change and air pollution are two interconnected global challenges that have profound impacts on human health. In Africa, a continent known for its rich biodiversity and diverse ecosystems, the adverse effects of climate change and air pollution are particularly concerning. This review study examines the implications of air pollution and climate change for human health and well-being in Africa. It explores the intersection of these two factors and their impact on various health outcomes, including cardiovascular disease, respiratory disorders, mental health, and vulnerable populations such as children and the elderly. The study highlights the disproportionate effects of air pollution on vulnerable groups and emphasizes the need for targeted interventions and policies to protect their health. Furthermore, it discusses the role of climate change in exacerbating air pollution and the potential long-term consequences for public health in Africa. The review also addresses the importance of considering temperature and precipitation changes as modifiers of the health effects of air pollution. By synthesizing existing research, this study aims to shed light on complex relationships and highlight the key findings, knowledge gaps, and potential solutions for mitigating the impacts of climate change and air pollution on human health in the region. The insights gained from this review can inform evidence-based policies and interventions to mitigate the adverse effects on human health and promote sustainable development in Africa.
Collapse
Affiliation(s)
- Daniel A Ayejoto
- Department of Environmental and Sustainability Sciences, Texas Christian University, Fort Worth, Texas, USA
| | - Johnson C Agbasi
- Department of Geology, Chukwuemeka Odumegwu Ojukwu University, Uli, Anambra State, Nigeria
| | - Vincent E Nwazelibe
- Department of Earth Sciences, Albert Ludwig University of Freiburg, Freiburg, Germany
| | - Johnbosco C Egbueri
- Department of Geology, Chukwuemeka Odumegwu Ojukwu University, Uli, Anambra State, Nigeria
| | - Joseph O Alao
- Department of Physics, Air Force Institute of Technology, Kaduna, Nigeria
| |
Collapse
|
9
|
Mokammel A, Malkawi M, Momeniha F, Safi HAM, Niazi S, Yousefian F, Azimi F, Naddafi K, Shamsipour M, Roostaei V, Faridi S, Hassanvand MS. Assessing capabilities of conducted ambient air pollution health effects studies in 22 Eastern Mediterranean countries to adopt air quality standards: a review. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2023; 21:295-304. [PMID: 37869598 PMCID: PMC10584797 DOI: 10.1007/s40201-023-00862-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/18/2023] [Indexed: 10/24/2023]
Abstract
Purpose The Eastern Mediterranean Region (EMR) countries suffer from exposure to high levels of ambient air pollutants due to dust storms and have unique climatic as well as topographic and socio-economic conditions which lead to adverse health effects on humans. The purpose of the review was to evaluate the quantity and quality of published articles on air pollution and health-based studies in 22 EMR countries to determine if they can be applied to adopting air quality standards. Methods We designed a review based on a broad search of the literature in the Scopus, PubMed, and web of science (WOS) databases published from January 1, 2000, to January 2, 2022, using combinations of the following relevant terms: air pollution, health, and EMR countries. The generic eligibility criteria for this review were based on the population, exposure, comparator, outcome, and study design (PECOS) statement. Results The search results showed that following the PRISMA approach, of 2947 identified articles, 353 studies were included in this review. The analysis of the types of studies showed that about 70% of the studies conducted in EMR countries were Health Burden Estimation studies (31%), Ecological and time trend ecological studies (23%), and cross-sectional studies (16%). Also, researchers from Iran participated in the most published relevant studies in the region 255 (~ 63%) and just 10 published documents met all the PECOS criteria. Conclusion The lack of sufficient studies which can meet the PECOS appraising criteria and the lack of professionals in this field are some of the issues that make it impossible to use as potential documents in the WHO future studies and adopt air quality standards. Supplementary Information The online version contains supplementary material available at 10.1007/s40201-023-00862-1.
Collapse
Affiliation(s)
- Adel Mokammel
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Mazen Malkawi
- Centre for Environmental Health Action (CEHA), World Health Organization (WHO), Amman, Jordan
| | - Fatemeh Momeniha
- Center for Solid Waste Research, Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Heba Adel Moh’d Safi
- Faculty of Science, School of Earth and Atmospheric Sciences, Queensland University of Technology (QUT), International Laboratory for Air Quality and Health, Brisbane, 4001 Australia
| | - Sadegh Niazi
- Faculty of Science, School of Earth and Atmospheric Sciences, Queensland University of Technology (QUT), International Laboratory for Air Quality and Health, Brisbane, 4001 Australia
| | - Fatemeh Yousefian
- Department of Environmental Health Engineering, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Faramarz Azimi
- Environmental Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Kazem Naddafi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Mansour Shamsipour
- Department of Research Methodology and Data Analysis, Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Roostaei
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Faridi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadegh Hassanvand
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Vanker A. 'Let Africa Breath': air pollution, environmental exposures and lung health - an ongoing challenge. Thorax 2023; 78:1061-1062. [PMID: 37524390 DOI: 10.1136/thorax-2023-220454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Affiliation(s)
- Aneesa Vanker
- Department of Paediatrics and Child Health and SAMRC unit on Child and Adolescent Health, University of Cape Town, Rondebosch, Western Cape, South Africa
| |
Collapse
|
11
|
Katoto PDMC, Bihehe D, Brand A, Mushi R, Kusinza A, Alwood BW, van Zyl-Smit RN, Tamuzi JL, Sam-Agudu NA, Yotebieng M, Metcalfe J, Theron G, Godri Pollitt KJ, Lesosky M, Vanoirbeek J, Mortimer K, Nawrot T, Nemery B, Nachega JB. Household Air Pollution and Risk of Pulmonary Tuberculosis in HIV-Infected Adults. RESEARCH SQUARE 2023:rs.3.rs-3410503. [PMID: 37886487 PMCID: PMC10602081 DOI: 10.21203/rs.3.rs-3410503/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background In developing countries, millions of deaths occur annually from household air pollution (HAP), pulmonary tuberculosis (PTB), and HIV-infection. However, it is unknown whether HAP influences PTB risk among people living with HIV-infection. Methods We conducted a case-control study among 1,277 HIV-infected adults in Bukavu, eastern Democratic Republic of Congo (February 2018 - March 2019). Cases had current or recent (<5y) PTB (positive sputum smear or Xpert MTB/RIF), controls had no PTB. Daily and lifetime HAP exposure were assessed by questionnaire and, in a random sub-sample (n=270), by 24-hour measurements of personal carbon monoxide (CO) at home. We used multivariable logistic regression to examine the associations between HAP and PTB. Results We recruited 435 cases and 842 controls (median age 41 years, [IQR] 33-50; 76% female). Cases were more likely to be female than male (63% vs 37%). Participants reporting cooking for >3h/day and ≥2 times/day and ≥5 days/weekwere more likely to have PTB (aOR 1·36; 95%CI 1·06-1·75) than those spending less time in the kitchen. Time-weighted average 24h personal CO exposure was related dose-dependently with the likelihood of having PTB, with aOR 4·64 (95%CI 1·1-20·7) for the highest quintile [12·3-76·2 ppm] compared to the lowest quintile [0·1-1·9 ppm]. Conclusion Time spent cooking and personal CO exposure were independently associated with increased risk of PTB among people living with HIV. Considering the high burden of TB-HIV coinfection in the region, effective interventions are required to decrease HAP exposure caused by cooking with biomass among people living with HIV, especially women.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - John Metcalfe
- Zuckerberg San Francisco General Hospital, University of California
| | - Grant Theron
- NRF-DST Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Kalisa E, Clark ML, Ntakirutimana T, Amani M, Volckens J. Exposure to indoor and outdoor air pollution in schools in Africa: Current status, knowledge gaps, and a call to action. Heliyon 2023; 9:e18450. [PMID: 37560671 PMCID: PMC10407038 DOI: 10.1016/j.heliyon.2023.e18450] [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: 05/23/2023] [Revised: 07/04/2023] [Accepted: 07/18/2023] [Indexed: 08/11/2023] Open
Abstract
Chronic exposure to indoor and outdoor air pollution is linked to adverse human health impacts worldwide, and in children, these include increased respiratory symptoms, reduced cognitive and academic performance, and absences from school. African children are exposed to high levels of air pollution from aging diesel and gasoline second-hand vehicles, dusty roads, trash burning, and solid-fuel combustion for cooking. There is a need for more empirical evidence on the impact of air pollutants on schoolchildren in most countries of Africa. Therefore, we conducted a scoping review on schoolchildren's exposure to indoor and outdoor PM2.5 (particulate matter with an aerodynamic diameter less than 2.5 μm and PM10 (particulate matter with an aerodynamic diameter less than 10 μm) in Africa. Following PRISMA guidelines, our search strategy yielded 2975 records, of which eight peer-reviewed articles met our selection criteria and were considered in the final analysis. We also analyzed satellite data on PM2.5 and PM10 levels in five African regions from 1990 to 2019 and compared schoolchildren's exposure to PM2.5 and PM10 levels in Africa with available data from the rest of the world. The findings showed that schoolchildren in Africa are frequently exposed to PM2.5 and PM10 levels exceeding the recommended World Health Organization air quality guidelines. We conclude with a list of recommendations and strategies to reduce air pollution exposure in African schools. Education can help to produce citizens who are literate in environmental science and policy. More air quality measurements in schools and intervention studies are needed to protect schoolchildren's health and reduce exposure to air pollution in classrooms across Africa.
Collapse
Affiliation(s)
- Egide Kalisa
- College of Science and Technology, Center of Excellence in Biodiversity and Natural Resource Management, University of Rwanda, Kigali, P.O BOX, 4285, Kigali, Rwanda
- Air Quality Processes Research Section, Environment and Climate Change Canada, 4905 Dufferin Street, Toronto, M3H5T4, Canada
| | - Maggie L. Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Theoneste Ntakirutimana
- University of Rwanda, School of Public Health, College of Medicine and Health Sciences, Kigali, P.O BOX, 4285, Kigali, Rwanda
| | - Mabano Amani
- Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals (BEECA), Universitat de Barcelona (UB), Av. Diagonal 643, 08028, Barcelona, Spain
| | - John Volckens
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, 80523, USA
| |
Collapse
|
13
|
Raheja G, Nimo J, Appoh EKE, Essien B, Sunu M, Nyante J, Amegah M, Quansah R, Arku RE, Penn SL, Giordano MR, Zheng Z, Jack D, Chillrud S, Amegah K, Subramanian R, Pinder R, Appah-Sampong E, Tetteh EN, Borketey MA, Hughes AF, Westervelt DM. Low-Cost Sensor Performance Intercomparison, Correction Factor Development, and 2+ Years of Ambient PM 2.5 Monitoring in Accra, Ghana. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:10708-10720. [PMID: 37437161 PMCID: PMC10373484 DOI: 10.1021/acs.est.2c09264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 07/14/2023]
Abstract
Particulate matter air pollution is a leading cause of global mortality, particularly in Asia and Africa. Addressing the high and wide-ranging air pollution levels requires ambient monitoring, but many low- and middle-income countries (LMICs) remain scarcely monitored. To address these data gaps, recent studies have utilized low-cost sensors. These sensors have varied performance, and little literature exists about sensor intercomparison in Africa. By colocating 2 QuantAQ Modulair-PM, 2 PurpleAir PA-II SD, and 16 Clarity Node-S Generation II monitors with a reference-grade Teledyne monitor in Accra, Ghana, we present the first intercomparisons of different brands of low-cost sensors in Africa, demonstrating that each type of low-cost sensor PM2.5 is strongly correlated with reference PM2.5, but biased high for ambient mixture of sources found in Accra. When compared to a reference monitor, the QuantAQ Modulair-PM has the lowest mean absolute error at 3.04 μg/m3, followed by PurpleAir PA-II (4.54 μg/m3) and Clarity Node-S (13.68 μg/m3). We also compare the usage of 4 statistical or machine learning models (Multiple Linear Regression, Random Forest, Gaussian Mixture Regression, and XGBoost) to correct low-cost sensors data, and find that XGBoost performs the best in testing (R2: 0.97, 0.94, 0.96; mean absolute error: 0.56, 0.80, and 0.68 μg/m3 for PurpleAir PA-II, Clarity Node-S, and Modulair-PM, respectively), but tree-based models do not perform well when correcting data outside the range of the colocation training. Therefore, we used Gaussian Mixture Regression to correct data from the network of 17 Clarity Node-S monitors deployed around Accra, Ghana, from 2018 to 2021. We find that the network daily average PM2.5 concentration in Accra is 23.4 μg/m3, which is 1.6 times the World Health Organization Daily PM2.5 guideline of 15 μg/m3. While this level is lower than those seen in some larger African cities (such as Kinshasa, Democratic Republic of the Congo), mitigation strategies should be developed soon to prevent further impairment to air quality as Accra, and Ghana as a whole, rapidly grow.
Collapse
Affiliation(s)
- Garima Raheja
- Department
of Earth and Environmental Sciences, Columbia
University, New York, New York 10027, United States
- Lamont-Doherty
Earth Observatory of Columbia University, Palisades, New York 10964, United States
| | - James Nimo
- Department
of Physics, University of Ghana, Legon, Ghana, Ghana
- African
Institute of Mathematical Sciences, Kigali, Rwanda
| | | | | | - Maxwell Sunu
- Ghana
Environmental Protection Agency, Accra, Ghana
| | - John Nyante
- Ghana
Environmental Protection Agency, Accra, Ghana
| | | | | | - Raphael E. Arku
- Department
of Environmental Health Sciences, School of Public Health and Health
Sciences, University of Massachusetts, Amherst, Massachusetts 01003, United States
| | - Stefani L. Penn
- Industrial
Economics, Inc, Cambridge, Massachusetts 02140, United States
| | - Michael R. Giordano
- Univ
Paris Est Creteil, CNRS UMS 3563, Ecole Nationale des Ponts et Chaussés,
Université de Paris, OSU-EFLUVE—Observatoire Sciences
de L’Univers-Envelopes Fluides de La Ville à L’Exobiologie, F-94010 Créteil, France
| | - Zhonghua Zheng
- Department
of Earth and Environmental Sciences, The
University of Manchester, Manchester M13 9PL, U.K.
| | - Darby Jack
- Department of Environmental Health Sciences, Mailman
School of Public
Health, Columbia University, New York, New York 10032, United States
| | - Steven Chillrud
- Department of Environmental Health Sciences, Mailman
School of Public
Health, Columbia University, New York, New York 10032, United States
| | | | - R. Subramanian
- Univ
Paris Est Creteil, CNRS UMS 3563, Ecole Nationale des Ponts et Chaussés,
Université de Paris, OSU-EFLUVE—Observatoire Sciences
de L’Univers-Envelopes Fluides de La Ville à L’Exobiologie, F-94010 Créteil, France
- Kigali Collaborative
Research Centre, Kigali, Rwanda
| | - Robert Pinder
- Environmental Protection Agency, Raleigh, North Carolina 27709, United States
| | | | | | | | | | - Daniel M. Westervelt
- Lamont-Doherty
Earth Observatory of Columbia University, Palisades, New York 10964, United States
- NASA Goddard Institute for Space Science, New York, New York 10025, United States
| |
Collapse
|
14
|
Abbah AP, Xu S, Johannessen A. Long-term exposure to outdoor air pollution and asthma in low-and middle-income countries: A systematic review protocol. PLoS One 2023; 18:e0288667. [PMID: 37471334 PMCID: PMC10358890 DOI: 10.1371/journal.pone.0288667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/01/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Several epidemiological studies have examined the risk of asthma and respiratory diseases in association with long-term exposure to outdoor air pollution. However, little is known regarding the adverse effects of long-term exposure to outdoor air pollution on the development of these outcomes in low- and middle-income countries (LMICs). Our study aims to investigate the association between long-term exposure to outdoor air pollution and asthma and respiratory diseases in LMICs through a systematic review with meta-analysis. METHODS This systematic review and meta-analysis will follow the PRISMA (Preferred Reporting for Systematic Reviews and Meta-Analyses) checklist and flowchart guidelines. The inclusion criteria that will be used in our study are 1) Original research articles with full text in English; 2) Studies including adult humans; 3) Studies with long-term air pollution assessment in LMICs, air pollutants including nitrogen oxide (NO2), sulfur oxide (SO2), particulate matter (PM2.5 and PM10), carbon monoxide (CO) and ozone (O3); 4) cohort and cross-sectional studies; 5) Studies reporting associations between air pollution and asthma and respiratory symptoms. A comprehensive search strategy will be used to identify studies published up till August 2022 and indexed in Embase, Medline, and Web of Science. Three reviewers will independently screen records retrieved from the database searches. Where there are enough studies with similar exposure and outcomes, we will calculate, and report pooled effect estimates using meta-analysis. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022311326. DISCUSSION Findings from the health effects of long-term exposure to outdoor air pollution may be of importance for policymakers. This review will also identify any gaps in the current literature on this topic in LMICs and provide direction for future research.
Collapse
Affiliation(s)
- Achenyo Peace Abbah
- Department of Global Public Healthand Primary Care, Center for International Health, University of Bergen, Bergen, Norway
| | - Shanshan Xu
- Department of Global Public Healthand Primary Care, Center for International Health, University of Bergen, Bergen, Norway
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| |
Collapse
|
15
|
Chakaya J, Mecha J, Beekman M. Over-prescription of short-acting β 2-agonists remains a serious health concern in Kenya: results from the SABINA III study. BMC PRIMARY CARE 2023; 24:141. [PMID: 37422638 PMCID: PMC10329295 DOI: 10.1186/s12875-023-02030-8] [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: 05/05/2022] [Accepted: 03/09/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Despite a high asthma burden in Kenya, insights into asthma management practices, including prescription of short-acting β2-agonists (SABAs), are lacking. Therefore, this study describes patient demographics, disease characteristics, and asthma treatment patterns in the Kenyan cohort of the SABA use IN Asthma (SABINA) III study. METHODS Patients with asthma (aged ≥ 12 years) with medical records containing data for ≥ 12 months prior to the study visit from 19 sites across Kenya were included in this cross-sectional study and classified by investigator-defined asthma severity (guided by the 2017 Global Initiative for Asthma [GINA] recommendations) and practice type (primary/specialist care). Data on severe exacerbation history, prescribed asthma treatments, and over-the-counter (OTC) SABA purchases in the 12 months before the study visit and asthma symptom control at the time of the study visit were collated using electronic case report forms. All analyses were descriptive in nature. RESULTS Overall, 405 patients were analyzed (mean age, 44.4 years; female, 68.9%), of whom 54.8% and 45.2% were enrolled by primary care clinicians and specialists, respectively. Most patients were classified with mild asthma (76.0%, GINA treatment steps 1-2) and were overweight or obese (57.0%). Only 19.5% of patients reported full healthcare reimbursement, with 59% receiving no healthcare reimbursement. The mean asthma duration of patients was 13.5 years. Asthma was partly controlled/uncontrolled in 78.0% of patients, with 61.5% experiencing ≥ 1 severe exacerbation in the preceding 12 months. Crucially, 71.9% of patients were prescribed ≥ 3 SABA canisters, defined as over-prescription; 34.8% were prescribed ≥ 10 SABA canisters. Additionally, 38.8% of patients purchased SABA OTC, of whom 66.2% purchased ≥ 3 SABA canisters. Among patients with both SABA purchases and prescriptions, 95.5% and 57.1% had prescriptions for ≥ 3 and ≥ 10 SABA canisters, respectively. Inhaled corticosteroids (ICS), ICS with a long-acting β2-agonist fixed-dose combination, and oral corticosteroid bursts were prescribed to 58.8%, 24.7%, and 22.7% of patients, respectively. CONCLUSIONS SABA over-prescription occurred in almost three-quarters of patients, with over one-third of patients purchasing SABA OTC. Therefore, SABA over-prescription is a major public health concern in Kenya, underscoring an urgent need to align clinical practices with latest evidence-based recommendations.
Collapse
Affiliation(s)
- Jeremiah Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya.
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | | | | |
Collapse
|
16
|
Amadu I, Seidu AA, Mohammed A, Duku E, Miyittah MK, Ameyaw EK, Hagan JE, Musah MH, Ahinkorah BO. Assessing the combined effect of household cooking fuel and urbanicity on acute respiratory symptoms among under-five years in sub-Saharan Africa. Heliyon 2023; 9:e16546. [PMID: 37346351 PMCID: PMC10279788 DOI: 10.1016/j.heliyon.2023.e16546] [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: 05/16/2022] [Revised: 05/02/2023] [Accepted: 05/18/2023] [Indexed: 06/23/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Iddrisu Amadu
- Africa Centre of Excellence in Coastal Resilience (ACECoR)-Centre for Coastal Management, University of Cape Coast, Cape Coast, Ghana
- Department of Fisheries and Aquatic Sciences, School of Biological Sciences, College of Agriculture and Natural Sciences, University of Cape Coast, Ghana
- Emperiks Research, NT0085, Tamale, Ghana
| | - Abdul-Aziz Seidu
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Box 256, Ghana
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Queensland, Australia
| | - Aliu Mohammed
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Eric Duku
- Africa Centre of Excellence in Coastal Resilience (ACECoR)-Centre for Coastal Management, University of Cape Coast, Cape Coast, Ghana
- Department of Fisheries and Aquatic Sciences, School of Biological Sciences, College of Agriculture and Natural Sciences, University of Cape Coast, Ghana
- Hen Mpoano (Our Coast), Takoradi P.O. Box AX 296, Ghana
| | - Michael K. Miyittah
- Africa Centre of Excellence in Coastal Resilience (ACECoR)-Centre for Coastal Management, University of Cape Coast, Cape Coast, Ghana
- Department of Environmental Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Hong Kong
| | - John Elvis Hagan
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Bielefeld University, Bielefeld, Germany
| | - Mohammed Hafiz Musah
- Department of Health Information Management, Tamale Teaching Hospital, Tamale, Ghana
| | | |
Collapse
|
17
|
Shiferaw AB, Kumie A, Tefera W. Fine particulate matter air pollution and the mortality of children under five: a multilevel analysis of the Ethiopian Demographic and Health Survey of 2016. Front Public Health 2023; 11:1090405. [PMID: 37325299 PMCID: PMC10267360 DOI: 10.3389/fpubh.2023.1090405] [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: 11/05/2022] [Accepted: 05/10/2023] [Indexed: 06/17/2023] Open
Abstract
Background Every year, polluted air is costing the globe 543,000 deaths of children under five. The particulate matter below 2.5 μm diameter (PM2.5) is a part of air pollution that has adverse effects on children's health. In Ethiopia, the effect of ambient PM2.5 is least explored. This study aimed to assess the association between PM2.5 and under-five mortality in Ethiopia. Methods The study used the data from the Ethiopian Demographic Health Surveys conducted in 2016, collected between January 18 and June 27. All children under five who had data on child mortality and location coordinates were included in the study. Exposure to ambient PM2.5 concentration was a satellite-based estimate by the Atmospheric Composition Analysis Group at Washington and Dalhousie University, in the United States and Canada, respectively. Annual mean pollution levels and mortality datasets were matched by children's geographical location and dates of birth, death, and interview. The relationship between ambient PM2.5 and under-five mortality was determined by a multilevel multivariable logistic regression on R software. The statistical analyses were two-sided at a 95% confidence interval. Results The study addressed 10,452 children with the proportion of under-five mortality being 5.4% (95% CI 5.0-6.8%). The estimated lifetime annual mean exposure of ambient total PM2.5 was 20.1 ± 3.3 μgm-3. A 10-unit increase in the lifetime annual mean ambient total PM2.5 was associated with 2.29 [95% CI 1.44, 3.65] times more odds of under-five mortality after adjusting for other variables. Conclusion Children under five are exposed to higher levels of ambient PM2.5 concentration, exceeding the limit set by the World Health Organization. Ambient PM2.5 is significantly associated with under-five mortality, adjusting for other variables. Strong measures need to be taken to reduce air pollution.
Collapse
Affiliation(s)
- Ashenafie Bereded Shiferaw
- Department of Social and Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abera Kumie
- Department of Environmental and Behavioral Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Worku Tefera
- Department of Environmental and Behavioral Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
18
|
Alli AS, Clark SN, Wang J, Bennett J, Hughes AF, Ezzati M, Brauer M, Nimo J, Bedford-Moses J, Baah S, Cavanaugh A, Agyei-Mensah S, Owusu G, Baumgartner J, Arku RE. High-resolution patterns and inequalities in ambient fine particle mass (PM 2.5) and black carbon (BC) in the Greater Accra Metropolis, Ghana. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 875:162582. [PMID: 36870487 PMCID: PMC10131145 DOI: 10.1016/j.scitotenv.2023.162582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/06/2023] [Accepted: 02/27/2023] [Indexed: 06/02/2023]
Abstract
Growing cities in sub-Saharan Africa (SSA) experience high levels of ambient air pollution. However, sparse long-term city-wide air pollution exposure data limits policy mitigation efforts and assessment of the health and climate effects. In the first study of its kind in West Africa, we developed high resolution spatiotemporal land use regression (LUR) models to map fine particulate matter (PM2.5) and black carbon (BC) concentrations in the Greater Accra Metropolitan Area (GAMA), one of the fastest sprawling metropolises in SSA. We conducted a one-year measurement campaign covering 146 sites and combined these data with geospatial and meteorological predictors to develop separate Harmattan and non-Harmattan season PM2.5 and BC models at 100 m resolution. The final models were selected with a forward stepwise procedure and performance was evaluated with 10-fold cross-validation. Model predictions were overlayed with the most recent census data to estimate the population distribution of exposure and socioeconomic inequalities in exposure at the census enumeration area level. The fixed effects components of the models explained 48-69 % and 63-71 % of the variance in PM2.5 and BC concentrations, respectively. Spatial variables related to road traffic and vegetation explained the most variability in the non-Harmattan models, while temporal variables were dominant in the Harmattan models. The entire GAMA population is exposed to PM2.5 levels above the World Health Organization guideline, including even the Interim Target 3 (15 μg/m3), with the highest exposures in poorer neighborhoods. The models can be used to support air pollution mitigation policies, health, and climate impact assessments. The measurement and modelling approach used in this study can be adapted to other African cities to bridge the air pollution data gap in the region.
Collapse
Affiliation(s)
- Abosede S Alli
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, USA
| | - Sierra N Clark
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Jiayuan Wang
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, USA
| | - James Bennett
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | | | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - James Nimo
- Department of Physics, University of Ghana, Accra, Ghana
| | | | - Solomon Baah
- Department of Physics, University of Ghana, Accra, Ghana
| | | | - Samuel Agyei-Mensah
- Department of Geography and Resource Development, University of Ghana, Accra, Ghana
| | - George Owusu
- Institute of Statistical, Social & Economic Research, University of Ghana, Accra, Ghana
| | - Jill Baumgartner
- Institute for Health and Social Policy, McGill University, Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Raphael E Arku
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, USA.
| |
Collapse
|
19
|
Gordon JND, Bilsback KR, Fiddler MN, Pokhrel RP, Fischer EV, Pierce JR, Bililign S. The Effects of Trash, Residential Biofuel, and Open Biomass Burning Emissions on Local and Transported PM 2.5 and Its Attributed Mortality in Africa. GEOHEALTH 2023; 7:e2022GH000673. [PMID: 36743737 PMCID: PMC9884662 DOI: 10.1029/2022gh000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/22/2022] [Accepted: 01/03/2023] [Indexed: 06/18/2023]
Abstract
Long-term exposure to ambient fine particulate matter (PM2.5) is the second leading risk factor of premature death in Sub-Saharan Africa. We use GEOS-Chem to quantify the effects of (a) trash burning, (b) residential solid-fuel burning, and (c) open biomass burning (BB) (i.e., landscape fires) on ambient PM2.5 and PM2.5-attributable mortality in Africa. Using a series of sensitivity simulations, we excluded each of the three combustion sources in each of five African regions. We estimate that in 2017 emissions from these three combustion sources within Africa increased global ambient PM2.5 by 2%, leading to 203,000 (95% confidence interval: 133,000-259,000) premature mortalities yr-1 globally and 167,000 premature mortalities yr-1 in Africa. BB contributes more ambient PM2.5-related premature mortalities per year (63%) than residential solid-fuel burning (29%) and trash burning (8%). Open BB in Central Africa leads to the largest number of PM2.5-attributed mortalities inside the region, while trash burning in North Africa and residential solid-fuel burning in West Africa contribute the most regional mortalities for each source. Overall, Africa has a unique ambient air pollution profile because natural sources, such as windblown dust and BB, contribute strongly to ambient PM2.5 levels and PM2.5-related mortality. Air pollution policies may need to focus on taking preventative measures to avoid exposure to ambient PM2.5 from these less-controllable sources.
Collapse
Affiliation(s)
- Janica N. D. Gordon
- Department of PhysicsNorth Carolina Agricultural and Technical State UniversityGreensboroNCUSA
- Applied Sciences and Technology PhD programNorth Carolina Agricultural and Technical State UniversityGreensboroNCUSA
| | - Kelsey R. Bilsback
- Department of Atmospheric ScienceColorado State UniversityFort CollinsCOUSA
- PSE Healthy EnergyOaklandCAUSA
| | - Marc N. Fiddler
- Department of ChemistryNorth Carolina Agricultural and Technical State UniversityGreensboroNCUSA
| | - Rudra P. Pokhrel
- Department of PhysicsNorth Carolina Agricultural and Technical State UniversityGreensboroNCUSA
- NOAA Chemical Sciences LaboratoryBoulderCOUSA
- Cooperative Institute for Research in Environmental SciencesUniversity of Colorado BoulderBoulderCOUSA
| | - Emily V. Fischer
- Department of Atmospheric ScienceColorado State UniversityFort CollinsCOUSA
| | - Jeffrey R. Pierce
- Department of Atmospheric ScienceColorado State UniversityFort CollinsCOUSA
| | - Solomon Bililign
- Department of PhysicsNorth Carolina Agricultural and Technical State UniversityGreensboroNCUSA
- Applied Sciences and Technology PhD programNorth Carolina Agricultural and Technical State UniversityGreensboroNCUSA
| |
Collapse
|
20
|
Okello G, Nantanda R, Awokola B, Thondoo M, Okure D, Tatah L, Bainomugisha E, Oni T. Air quality management strategies in Africa: A scoping review of the content, context, co-benefits and unintended consequences. ENVIRONMENT INTERNATIONAL 2023; 171:107709. [PMID: 36580733 DOI: 10.1016/j.envint.2022.107709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/07/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
One of the major consequences of Africa's rapid urbanisation is the worsening air pollution, especially in urban centres. However, existing societal challenges such as recovery from the COVID-19 pandemic, poverty, intensifying effects of climate change are making prioritisation of addressing air pollution harder. We undertook a scoping review of strategies developed and/or implemented in Africa to provide a repository to stakeholders as a reference that could be applied for various local contexts. The review includes strategies assessed for effectiveness in improving air quality and/or health outcomes, co-benefits of the strategies, potential collaborators, and pitfalls. An international multidisciplinary team convened to develop well-considered research themes and scope from a contextual lens relevant to the African continent. From the initial 18,684 search returns, additional 43 returns through reference chaining, contacting topic experts and policy makers, 65 studies and reports were included for final analysis. Three main strategy categories obtained from the review included technology (75%), policy (20%) and education/behavioural change (5%). Most strategies (83%) predominantly focused on household air pollution compared to outdoor air pollution (17%) yet the latter is increasing due to urbanisation. Mobility strategies were only 6% compared to household energy strategies (88%) yet motorised mobility has rapidly increased over recent decades. A cost effective way to tackle air pollution in African cities given the competing priorities could be by leveraging and adopting implemented strategies, collaborating with actors involved whilst considering local contextual factors. Lessons and best practices from early adopters/implementers can go a long way in identifying opportunities and mitigating potential barriers related to the air quality management strategies hence saving time on trying to "reinvent the wheel" and prevent pitfalls. We suggest collaboration of various stakeholders, such as policy makers, academia, businesses and communities in order to formulate strategies that are suitable and practical to various local contexts.
Collapse
Affiliation(s)
- Gabriel Okello
- Institute for Sustainability Leadership, University of Cambridge, Cambridge, United Kingdom; MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom; AirQo, Department of Computer Science, Makerere University, Kampala, Uganda.
| | | | - Babatunde Awokola
- Department of Clinical Services, Medical Research Council Gambia at London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - Meelan Thondoo
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Deo Okure
- AirQo, Department of Computer Science, Makerere University, Kampala, Uganda
| | - Lambed Tatah
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | | | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
21
|
Abe KC, Rodrigues MA, Miraglia SGEK. Health impact assessment of air pollution in Lisbon, Portugal. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2022; 72:1307-1315. [PMID: 36048722 DOI: 10.1080/10962247.2022.2118192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Lisbon has about 500,000 inhabitants and it's the capital and the main economic hub of Portugal. Studies have demonstrated that exposure to Particulate Matter with an aerodynamic diameter<2.5 μm (PM2.5) have strong association with health effects. Researchers continue to identify new harmful air pollutants effects in our health even in low levels. OBJECTIVES This study evaluates air pollution scenarios considering a Health Impact Assessment approach in Lisbon, Portugal. METHODS We have studied abatement scenarios of PM2.5 concentrations and the health effects in the period from 2015 to 2017 using the APHEKOM tool and the associated health costs were assessed by Value of Life Year. RESULTS The mean concentration of PM2.5 in Lisbon was 23 μg/m3 ± 10 μg/m3 (±Standard Deviation). If we consider that World Health Organization (WHO) standards of PM2.5 (10 μg/m3) were reached, Lisbon would avoid more than 423 premature deaths (equivalent to 9,172 life years' gain) and save more than US$45 million annually. If Lisbon city could even diminish the mean of PM2.5 by 5 μg/m3, nearly 165 deaths would be avoided, resulting in a gain of US$17 million annually. CONCLUSION According to our findings, if considered the worst pollution scenario, levels of PM2.5 could improve the life's quality and save a significant amount of economic resources.Implications: The manuscript addresses the health effects and costs of air pollution and constitutes an important target for improving public policies on air pollutants in Portugal. Although Portugal has low levels of air pollution, there are significant health and economic effects that, for the most part, are underreported. The health impact assessment approach associated with costs had not yet been addressed in Portugal, which makes this study more relevant in the analysis of policies aimed to drive stricter control on pollutants' emissions. Health costs are a fundamental element to support decision-making process and to orientate the trade-offs in investments for improving public policies so that to diminish health effects, which can impact the management of the local health services and the population's quality of life, especially after the pandemic period when resources are scarce.
Collapse
Affiliation(s)
- Karina Camasmie Abe
- Universidade Federal de São Paulo, Instituto de Ciências Ambientais, Químicas e Farmacêuticas - ICAQF, Laboratório de Economia, Saúde e Poluição Ambiental, São Paulo, Brazil
| | - Matilde Alexandra Rodrigues
- Centro de Investigação em Saúde Ambiental - CISA e Centro de Investigação em Reabilitação, Escola Superior de Saúde do Instituto Politécnico do Porto, Porto, Portugal
| | - Simone Georges El Khouri Miraglia
- Universidade Federal de São Paulo, Instituto de Ciências Ambientais, Químicas e Farmacêuticas - ICAQF, Laboratório de Economia, Saúde e Poluição Ambiental, São Paulo, Brazil
| |
Collapse
|
22
|
Okunromade O, Yin J, Ray C, Adhikari A. Air Quality and Cancer Prevalence Trends across the Sub-Saharan African Regions during 2005-2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811342. [PMID: 36141614 PMCID: PMC9517113 DOI: 10.3390/ijerph191811342] [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: 07/03/2022] [Revised: 08/23/2022] [Accepted: 09/05/2022] [Indexed: 06/01/2023]
Abstract
Poor air quality and environmental pollution remain some of the main etiological factors leading to cancers and cancer-related deaths worldwide. As a result of human activities, deleterious airborne chemicals can be dispersed not only in the environment but also released in occupational environments and industrial areas. Air pollutants and cancer links are now established through various oxidative stress-related mechanisms and related DNA damages. Generally, ambient and indoor air pollutants have been understudied in sub-Saharan Africa (SSA) compared to other regions in the world. Our study not only highlights the deleterious effects of air pollutants in these developing countries, but it has strived to examine the trends and correlations between cancers and some air pollutants-carbon dioxide, other greenhouse gases, PM2.5, and human development index-in some SSA countries, where recent cancer burdens were reported as high. Our results showed strikingly higher yearly trends of cancers and above-mentioned air pollutant levels in some sub-Saharan countries during 2005-2020. Relative risks (RR) of these air pollutants-related cancer case rates were, however, below, or slightly above 1.0, or not statistically significant possibly due to other responsible and confounding factors which were not considered in our analyses due to data unavailability. We recommend new approaches to monitoring, minimizing, and creating awareness of the trends of hazardous air pollutants in sub-Saharan Africa, which will help ameliorate cancer prevalence and support the reduction in air pollution levels within regulatory limits, thereby relieving the cumulative burdens of cancers. Utilization of the findings from the study will support large-scale public health and health policy efforts on cancer management through environmental stewardship in SSA countries having the poorest outcome and the shortest survival rates from cancers.
Collapse
Affiliation(s)
- Omolola Okunromade
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA
| | - Jingjing Yin
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA
| | - Clara Ray
- Department of Geology and Geography, College of Science and Mathematics, Georgia Southern University, Statesboro, GA 30460, USA
| | - Atin Adhikari
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA
| |
Collapse
|
23
|
Nyadanu SD, Dunne J, Tessema GA, Mullins B, Kumi-Boateng B, Lee Bell M, Duko B, Pereira G. Prenatal exposure to ambient air pollution and adverse birth outcomes: An umbrella review of 36 systematic reviews and meta-analyses. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 306:119465. [PMID: 35569625 DOI: 10.1016/j.envpol.2022.119465] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/12/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
Multiple systematic reviews and meta-analyses linked prenatal exposure to ambient air pollutants to adverse birth outcomes with mixed findings, including results indicating positive, negative, and null associations across the pregnancy periods. The objective of this study was to systematically summarise systematic reviews and meta-analyses on air pollutants and birth outcomes to assess the overall epidemiological evidence. Systematic reviews with/without meta-analyses on the association between air pollutants (NO2, CO, O3, SO2, PM2.5, and PM10) and birth outcomes (preterm birth; stillbirth; spontaneous abortion; birth weight; low birth weight, LBW; small-for-gestational-age) up to March 30, 2022 were included. We searched PubMed, CINAHL, Scopus, Medline, Embase, and the Web of Science Core Collection, systematic reviews repositories, grey literature databases, internet search engines, and references of included studies. The consistency in the directions of the effect estimates was classified as more consistent positive or negative, less consistent positive or negative, unclear, and consistently null. Next, the confidence in the direction was rated as either convincing, probable, limited-suggestive, or limited non-conclusive evidence. Final synthesis included 36 systematic reviews (21 with and 15 without meta-analyses) that contained 295 distinct primary studies. PM2.5 showed more consistent positive associations than other pollutants. The positive exposure-outcome associations based on the entire pregnancy period were more consistent than trimester-specific exposure averages. For whole pregnancy exposure, a more consistent positive association was found for PM2.5 and birth weight reductions, particulate matter and spontaneous abortion, and SO2 and LBW. Other exposure-outcome associations mostly showed less consistent positive associations and few unclear directions of associations. Almost all associations showed probable evidence. The available evidence indicates plausible causal effects of criteria air pollutants on birth outcomes. To strengthen the evidence, more high-quality studies are required, particularly from understudied settings, such as low-and-middle-income countries. However, the current evidence may warrant the adoption of the precautionary principle.
Collapse
Affiliation(s)
- Sylvester Dodzi Nyadanu
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia; Education, Culture, and Health Opportunities (ECHO) Ghana, ECHO Research Group International, P. O. Box 424, Aflao, Ghana.
| | - Jennifer Dunne
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia
| | - Gizachew Assefa Tessema
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia; School of Public Health, University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - Ben Mullins
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia
| | - Bernard Kumi-Boateng
- Department of Geomatic Engineering, University of Mines and Technology, P. O. Box 237, Tarkwa, Ghana
| | - Michelle Lee Bell
- School of the Environment, Yale University, New Haven, CT, 06511, USA
| | - Bereket Duko
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia; Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, 0473, Oslo, Norway; enAble Institute, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia
| |
Collapse
|
24
|
Ingole V, Dimitrova A, Sampedro J, Sacoor C, Acacio S, Juvekar S, Roy S, Moraga P, Basagaña X, Ballester J, Antó JM, Tonne C. Local mortality impacts due to future air pollution under climate change scenarios. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 823:153832. [PMID: 35151734 DOI: 10.1016/j.scitotenv.2022.153832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
The health impacts of global climate change mitigation will affect local populations differently. However, most co-benefits analyses have been done at a global level, with relatively few studies providing local level results. We aimed to quantify the local health impacts due to fine particles (PM2.5) under the governance arrangements embedded in the Shared Socioeconomic Pathways (SSPs1-5) under two greenhouse gas concentration scenarios (Representative Concentration Pathways (RCPs) 2.6 and 8.5) in local populations of Mozambique, India, and Spain. We simulated the SSP-RCP scenarios using the Global Change Analysis Model, which was linked to the TM5-FASST model to estimate PM2.5 levels. PM2.5 levels were calibrated with local measurements. We used comparative risk assessment methods to estimate attributable premature deaths due to PM2.5 linking local population and mortality data with PM2.5-mortality relationships from the literature, and incorporating population projections under the SSPs. PM2.5 attributable burdens in 2050 differed across SSP-RCP scenarios, and sensitivity of results across scenarios varied across populations. Future attributable mortality burden of PM2.5 was highly sensitive to assumptions about how populations will change according to SSP. SSPs reflecting high challenges for adaptation (SSPs 3 and 4) consistently resulted in the highest PM2.5 attributable burdens mid-century. Our analysis of local PM2.5 attributable premature deaths under SSP-RCP scenarios in three local populations highlights the importance of both socioeconomic development and climate policy in reducing the health burden from air pollution. Sensitivity of future PM2.5 mortality burden to SSPs was particularly evident in low- and middle- income country settings due either to high air pollution levels or dynamic populations.
Collapse
Affiliation(s)
- Vijendra Ingole
- Barcelona Institute for Global Health (ISGlobal), Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Barcelona, Parc de Salut Mar, Spain; King Abdullah University of Science and Technology (KAUST), Computer, Electrical and Mathematical Science and Engineering Division, Saudi Arabia
| | - Asya Dimitrova
- Barcelona Institute for Global Health (ISGlobal), Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Barcelona, Parc de Salut Mar, Spain
| | - Jon Sampedro
- Basque Centre for Climate Change (BC3), Sede Building 1, 1st Floor Scientific Campus of the University of the Basque Country, 48940 Leioa, Spain
| | | | | | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Sudipto Roy
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Paula Moraga
- King Abdullah University of Science and Technology (KAUST), Computer, Electrical and Mathematical Science and Engineering Division, Saudi Arabia
| | - Xavier Basagaña
- Barcelona Institute for Global Health (ISGlobal), Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Barcelona, Parc de Salut Mar, Spain
| | - Joan Ballester
- Barcelona Institute for Global Health (ISGlobal), Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Barcelona, Parc de Salut Mar, Spain
| | - Josep M Antó
- Barcelona Institute for Global Health (ISGlobal), Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Barcelona, Parc de Salut Mar, Spain
| | - Cathryn Tonne
- Barcelona Institute for Global Health (ISGlobal), Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Barcelona, Parc de Salut Mar, Spain.
| |
Collapse
|
25
|
Fuller R, Landrigan PJ, Balakrishnan K, Bathan G, Bose-O'Reilly S, Brauer M, Caravanos J, Chiles T, Cohen A, Corra L, Cropper M, Ferraro G, Hanna J, Hanrahan D, Hu H, Hunter D, Janata G, Kupka R, Lanphear B, Lichtveld M, Martin K, Mustapha A, Sanchez-Triana E, Sandilya K, Schaefli L, Shaw J, Seddon J, Suk W, Téllez-Rojo MM, Yan C. Pollution and health: a progress update. Lancet Planet Health 2022; 6:e535-e547. [PMID: 35594895 DOI: 10.1016/s2542-5196(22)00090-0] [Citation(s) in RCA: 348] [Impact Index Per Article: 174.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 05/23/2023]
Abstract
The Lancet Commission on pollution and health reported that pollution was responsible for 9 million premature deaths in 2015, making it the world's largest environmental risk factor for disease and premature death. We have now updated this estimate using data from the Global Burden of Diseases, Injuriaes, and Risk Factors Study 2019. We find that pollution remains responsible for approximately 9 million deaths per year, corresponding to one in six deaths worldwide. Reductions have occurred in the number of deaths attributable to the types of pollution associated with extreme poverty. However, these reductions in deaths from household air pollution and water pollution are offset by increased deaths attributable to ambient air pollution and toxic chemical pollution (ie, lead). Deaths from these modern pollution risk factors, which are the unintended consequence of industrialisation and urbanisation, have risen by 7% since 2015 and by over 66% since 2000. Despite ongoing efforts by UN agencies, committed groups, committed individuals, and some national governments (mostly in high-income countries), little real progress against pollution can be identified overall, particularly in the low-income and middle-income countries, where pollution is most severe. Urgent attention is needed to control pollution and prevent pollution-related disease, with an emphasis on air pollution and lead poisoning, and a stronger focus on hazardous chemical pollution. Pollution, climate change, and biodiversity loss are closely linked. Successful control of these conjoined threats requires a globally supported, formal science-policy interface to inform intervention, influence research, and guide funding. Pollution has typically been viewed as a local issue to be addressed through subnational and national regulation or, occasionally, using regional policy in higher-income countries. Now, however, it is increasingly clear that pollution is a planetary threat, and that its drivers, its dispersion, and its effects on health transcend local boundaries and demand a global response. Global action on all major modern pollutants is needed. Global efforts can synergise with other global environmental policy programmes, especially as a large-scale, rapid transition away from all fossil fuels to clean, renewable energy is an effective strategy for preventing pollution while also slowing down climate change, and thus achieves a double benefit for planetary health.
Collapse
Affiliation(s)
- Richard Fuller
- Global Alliance on Health and Pollution, Geneva, Switzerland.
| | - Philip J Landrigan
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, USA
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra University, Chennai, India
| | | | - Stephan Bose-O'Reilly
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich, Munich, Germany
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Jack Caravanos
- Environmental Public Health Sciences, School of Global Health, New York University, New York, NY, USA
| | - Tom Chiles
- Biology Department, Boston College, Chestnut Hill, MA, USA
| | | | - Lilian Corra
- Global Alliance on Health and Pollution, Geneva, Switzerland
| | - Maureen Cropper
- Department of Economics, University of Maryland, College Park, MD, USA
| | | | - Jill Hanna
- Global Alliance on Health and Pollution, Geneva, Switzerland
| | | | - Howard Hu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - David Hunter
- Translational Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Rachael Kupka
- Global Alliance on Health and Pollution, Geneva, Switzerland
| | - Bruce Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Maureen Lichtveld
- Environmental and Occupational Health Department, University of Pittsburgh, Pittsburgh, PA, USA
| | - Keith Martin
- Consortium of Universities for Global Health, Washington, DC, USA
| | | | - Ernesto Sanchez-Triana
- Global Practice on Environment and Natural Resources, The World Bank, Washington, DC, USA
| | - Karti Sandilya
- Global Alliance on Health and Pollution, Geneva, Switzerland
| | - Laura Schaefli
- Global Alliance on Health and Pollution, Geneva, Switzerland
| | - Joseph Shaw
- O'Neil School of Public and Environmental Affairs, Indiana University, Bloomington, IN, USA
| | - Jessica Seddon
- Air Quality, Ross Center, World Resources Institute, Washington, DC, USA
| | - William Suk
- Hazardous Substances Research Branch, Division of Extramural Research and Training, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Martha María Téllez-Rojo
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Avenida Universidad, Cuernavaca, Mexico
| | - Chonghuai Yan
- Ministry of Education, Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
26
|
Flanagan E, Oudin A, Walles J, Abera A, Mattisson K, Isaxon C, Malmqvist E. Ambient and indoor air pollution exposure and adverse birth outcomes in Adama, Ethiopia. ENVIRONMENT INTERNATIONAL 2022; 164:107251. [PMID: 35533531 DOI: 10.1016/j.envint.2022.107251] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 06/14/2023]
Abstract
Air pollution poses a threat to human health, with pregnant women and their developing fetuses being particularly vulnerable. A high dual burden of ambient and indoor air pollution exposure has been identified in Ethiopia, but studies investigating their effects on adverse birth outcomes are currently lacking. This study explores the association between ambient air pollution (NOX and NO2) and indoor air pollution (cooking fuel type) and fetal and neonatal death in Adama, Ethiopia. A prospective cohort of mothers and their babies was used, into which pregnant women were recruited at their first antenatal visit (n = 2085) from November 2015 to February 2018. Previously developed land-use regression models were utilized to assess ambient concentrations of NOX and NO2 at the residential address, whereas data on cooking fuel type was derived from questionnaires. Birth outcome data was obtained from self-reported questionnaire responses during the participant's postnatal visit or by phone if an in-person meeting was not possible. Binary logistic regression was employed to assess associations within the final study population (n = 1616) using both univariate and multivariate models; the latter of which adjusted for age, education, parity, and HIV status. Odds ratios (OR) and their corresponding 95% confidence intervals (CI) were reported. Within the cohort, 69 instances of fetal death (n = 16 miscarriages; n = 53 stillbirths) and 16 cases of neonatal death were identified. The findings suggest a tendency towards an association between ambient NOX and NO2 exposure during pregnancy and an increased risk of fetal death overall as well as stillbirth, specifically. However, statistical significance was not observed. Results for indoor air pollution and neonatal death were inconclusive. As limited evidence on the effects of exposure to ambient air pollution on adverse birth outcomes exists in Sub-Saharan Africa and Ethiopia, additional studies with larger study populations should be conducted.
Collapse
Affiliation(s)
- Erin Flanagan
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Anna Oudin
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | - John Walles
- Clinical Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Asmamaw Abera
- Ethiopia Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kristoffer Mattisson
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | - Christina Isaxon
- Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Faculty of Engineering, LTH, Lund University, Lund, Sweden
| | - Ebba Malmqvist
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| |
Collapse
|
27
|
Jiang W, Chen Y. Air Pollution, Foreign Direct Investment, and Mental Health: Evidence From China. Front Public Health 2022; 10:858672. [PMID: 35669748 PMCID: PMC9163302 DOI: 10.3389/fpubh.2022.858672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/07/2022] [Indexed: 11/26/2022] Open
Abstract
Recently, there has been interest in the relationship between mental health and air pollution; however, the results are inconsistent and the contribution of foreign direct investment (FDI) has received little attention. This article studies the effects of air pollution on mental health and the moderating role of FDI based on the China Health and Retirement Longitudinal Study (CHARLS) data in 2015 and 2018 applying the fixed effects panel regression approach and the threshold model. The results show that mental health is adversely affected by air pollution, especially PM2.5, PM10, sulfur dioxide (SO2), carbon monoxide (CO), and nitrogen dioxide (NO2). Second, FDI has an alleviating influence on the negative relationship. Third, the effects of air pollution and FDI are heterogeneous based on regional characteristics, including location, medical resource and investment in science and technology, and individual characteristics covering education level, age, income, and physical health. Finally, the threshold effects show that FDI has a moderating effect when it is >1,745.59 million renminbi (RMB). There are only 11.19% of cities exceeding the threshold value in China. When the value of air quality index (AQI) exceeds 92.79, air pollution is more harmful to mental health. Government should actively introduce high-quality FDI at the effective level and control air pollution to improve mental health.
Collapse
Affiliation(s)
- Wei Jiang
- School of Economics, Qingdao University, Qingdao, China
- *Correspondence: Wei Jiang
| | - Yunfei Chen
- School of Economics, Shanghai University, Shanghai, China
| |
Collapse
|
28
|
Sousa AC, Pastorinho MR, Masjedi MR, Urrutia-Pereira M, Arrais M, Nunes E, To T, Ferreira AJ, Robalo-Cordeiro C, Borrego C, Teixeira JP, Taborda-Barata L. Issue 1 - "Update on adverse respiratory effects of outdoor air pollution" Part 2): Outdoor air pollution and respiratory diseases: Perspectives from Angola, Brazil, Canada, Iran, Mozambique and Portugal. Pulmonology 2022; 28:376-395. [PMID: 35568650 DOI: 10.1016/j.pulmoe.2021.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To analyse the GARD perspective on the health effects of outdoor air pollution, and to synthesise the Portuguese epidemiological contribution to knowledge on its respiratory impact. RESULTS Ambient air pollution has deleterious respiratory effects which are more apparent in larger, densely populated and industrialised countries, such as Canada, Iran, Brazil and Portugal, but it also affects people living in low-level exposure areas. While low- and middle-income countries (LMICs), are particularly affected, evidence based on epidemiological studies from LMICs is both limited and heterogeneous. While nationally, Portugal has a relatively low level of air pollution, many major cities face with substantial air pollution problems. Time series and cross-sectional epidemiological studies have suggested increased respiratory hospital admissions, and increased risk of respiratory diseases in people who live in urban areas and are exposed to even a relatively low level of air pollution. CONCLUSIONS Adverse respiratory effects due to air pollution, even at low levels, have been confirmed by epidemiological studies. However, evidence from LMICs is heterogeneous and relatively limited. Furthermore, longitudinal cohort studies designed to study and quantify the link between exposure to air pollutants and respiratory diseases are needed. Worldwide, an integrated approach must involve multi-level stakeholders including governments (in Portugal, the Portuguese Ministry of Health, which hosts GARD-Portugal), academia, health professionals, scientific societies, patient associations and the community at large. Such an approach not only will garner a robust commitment, establish strong advocacy and clear objectives, and raise greater awareness, it will also support a strategy with adequate measures to be implemented to achieve better air quality and reduce the burden of chronic respiratory diseases (CRDs).
Collapse
Affiliation(s)
- A C Sousa
- Comprehensive Health Research Centre (CHRC) and Department of Biology, University of Évora, Pólo da Mitra, Apartado 94, Évora 7002-554, Portugal; NuESA-Health and Environment Study Unit, Faculty of Health Sciences, University of Beira Interior, Avenida Infante D. Henrique, Covilhã 6200-506, Portugal
| | - M R Pastorinho
- NuESA-Health and Environment Study Unit, Faculty of Health Sciences, University of Beira Interior, Avenida Infante D. Henrique, Covilhã 6200-506, Portugal; Comprehensive Health Research Centre (CHRC), Department of Medical and Health Sciences, University of Évora, Colégio Luís António Verney, Rua Romão Ramalho, 59, Évora 7000-671, Portugal
| | - M R Masjedi
- Department of Pulmonary Medicine, Shahid Beheshti University of Medical Sciences, 7th Floor, Bldg n 2, SBUMS, Arabi Avenue, Daneshjoo Boulevard, Velenjak, Tehran 19839-63113, Iran
| | - M Urrutia-Pereira
- Universidade Federal do Pampa, BR 472 - Km 585, Caixa Postal 118, Uruguaiana (RS) CEP 97501-970, Brazil
| | - M Arrais
- Department of Pulmonology, Military Hospital, Rua 17 de Setembro, 27/29, Cidade Alta, Luanda, Angola; Centro de Investigação em Saúde de Angola - CISA, Caxito, Bengo, Angola
| | - E Nunes
- Department of Pulmonology, Central Hospital of Maputo, Agostinho Neto, 64, Maputo 1100, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Avenida Dr. Salvador Allende, Caixa Postal 257, Maputo, Mozambique
| | - T To
- The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5G 1 × 8, Canada
| | - A J Ferreira
- Department of Pulmonology, Centro Hospitalar Universitário de Coimbra, Praceta Prof. Mota Pinto, Coimbra 3004-561, Portugal; Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, Coimbra 3000-548, Portugal
| | - C Robalo-Cordeiro
- Department of Pulmonology, Centro Hospitalar Universitário de Coimbra, Praceta Prof. Mota Pinto, Coimbra 3004-561, Portugal; Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, Coimbra 3000-548, Portugal
| | - C Borrego
- CESAM & Department of Environment and Planning, University of Aveiro, Aveiro 3810-193, Portugal; IDAD - Instituto do Ambiente e Desenvolvimento, Campus Universitário de Santiago, Aveiro 3810-193, Portugal
| | - J P Teixeira
- EPIUnit - Instituto de Saúde Pública, University of Porto, Rua das Taipas, 135, Porto 4050-091, Portugal; Department of Environmental Health, Portuguese National Institute of Health, Rua Alexandre Herculano, 321, Porto 4000-055, Portugal
| | - L Taborda-Barata
- NuESA-Health and Environment Study Unit, Faculty of Health Sciences, University of Beira Interior, Avenida Infante D. Henrique, Covilhã 6200-506, Portugal; UBIAir-Clinical & Experimental Lung Centre, UBIMedical, University of Beira Interior, EM506 Covilhã 6200-000, Portugal; CICS-Health Sciences Research Centre, University of Beira Interior, Avenida Infante D. Henrique, Covilhã 6200-506, Portugal.
| |
Collapse
|
29
|
Cichowitz C, Masoza T, Peck RN. Air pollution and preclinical atherosclerotic cardiovascular disease in adolescents living with HIV: an opportunity for prevention. AIDS 2022; 36:901-902. [PMID: 35506268 PMCID: PMC9074093 DOI: 10.1097/qad.0000000000003212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Cody Cichowitz
- Department of Medicine, Center for Global Health, Massachusetts General Hospital, Boston MA
| | - Tulla Masoza
- Department of Pediatrics, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Robert N. Peck
- Department of Pediatrics, Weill Bugando School of Medicine, Mwanza, Tanzania
- Center for Global Health, Weill Cornell Medical College, New York, NY
- Mwanza Interventions Trial Unit, Mwanza, Tanzania
| |
Collapse
|
30
|
Amegah AK, Dakuu G, Mudu P, Jaakkola JJK. Particulate matter pollution at traffic hotspots of Accra, Ghana: levels, exposure experiences of street traders, and associated respiratory and cardiovascular symptoms. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022; 32:333-342. [PMID: 34218260 DOI: 10.1038/s41370-021-00357-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND There are limited studies on the health effects of street trading in spite of common knowledge that individuals engaged in the trade are exposed to high levels of traffic-related air pollution per their mode of operation, and also the fact that the venture is a dominant occupation in cities of Sub-Saharan Africa (SSA) and other developing regions. OBJECTIVE We characterized particulate matter (PM) pollution levels at traffic hotspots of Accra, Ghana during the dry and wet seasons, and assessed exposure experiences of street traders. METHODS A cross-sectional study was conducted among 236 street traders operating along six selected traffic routes of Accra and a comparison group of 186 office workers. PurpleAir PA-II monitors were used to measure PM levels at the selected traffic routes. We estimated annual PM2.5 exposure of street traders using assigned seasonal PM2.5 levels, and information collected in a structured questionnaire on their activity patterns. Outcomes investigated were self-reported respiratory and cardiovascular symptoms. RESULTS PM levels at Accra traffic hotspots were high in both seasons. 1 ug/m3 increase in PM2.5 exposure increased respiratory, cardiovascular, and overall symptoms by a factor of 0.00027 (95% CI: 0.00012, 0.00041), 0.00022 (95% CI: 0.00007, 0.00036), and 0.00048 (95% CI: 0.00023, 0.00073), respectively. Compared to office workers, high PM2.5 exposure among street traders was associated with increased odds of coughing, catarrh (postnasal drip), sneezing, rapid heart beating, irregular heartbeat, sharp chest pains, fainting spells, headaches, and dizziness. Low and medium PM2.5 exposure was associated with increased odds of dermatitis, rapid heart beating, and irregular heartbeat, and sharp chest pains, respectively. CONCLUSIONS We found consistent evidence that PM2.5 exposure among street traders increases the occurrence of respiratory and cardiovascular symptoms. We also provide indicative measurements of PM levels at traffic hotspots of a rapidly growing SSA city with heavy vehicular traffic and yet, limited air quality monitoring capacity.
Collapse
Affiliation(s)
- A Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Gordon Dakuu
- World Health Organization Country Office for Ghana, Accra, Ghana
| | | | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland
| |
Collapse
|
31
|
Theron LC, Abreu-Villaça Y, Augusto-Oliveira M, Brennan C, Crespo-Lopez ME, de Paula Arrifano G, Glazer L, Gwata N, Lin L, Mareschal I, Mermelstein S, Sartori L, Stieger L, Trotta A, Hadfield K. A systematic review of the mental health risks and resilience among pollution-exposed adolescents. J Psychiatr Res 2022; 146:55-66. [PMID: 34953306 DOI: 10.1016/j.jpsychires.2021.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/26/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
Abstract
Pollution is harmful to human physical health and wellbeing. What is less well established is the relationship between adolescent mental health - a growing public health concern - and pollution. In response, we systematically reviewed studies documenting associations between pollution and mental health in adolescents. We searched Africa Wide, Medline, PsycArticles, PsycInfo, PubMed, CINAHL, ERIC, SciELO, Scopus, and Web of Science Core Collection for studies published up to 10 April 2020 that investigated exposure to any pollutant and symptoms of anxiety; depression; disruptive, impulse-control, and conduct disorders; neurodevelopmental disorders; psychosis; or substance abuse in 10-24-year-olds (i.e., adolescents as per expanded and more inclusive definition of adolescence). This identified 2291 records and we assessed 128 papers for inclusion. We used a narrative synthesis to coalesce the studies' findings. This review is registered on PROSPERO, CRD42020176664. Seventeen studies from Asia, Europe, the Middle East, and North America were included. Air and water pollution exposure was associated with elevated symptoms of depression, generalised anxiety, psychosis, and/or disruptive, impulse control and conduct disorder. Exposure to lead and solvents was associated with neurodevelopmental impairments. Most studies neglected factors that could have supported the mental health resilience of adolescents exposed to pollution. Notwithstanding the limited quality of most reviewed studies, results suggest that pollution exposure is a risk to adolescent mental health. High-quality research is urgently required, including the factors and processes that protect the mental health of pollution-exposed adolescents. Studies with adolescents living in low- and lower middle-income countries and the southern hemisphere must be prioritized.
Collapse
Affiliation(s)
- Linda C Theron
- Department of Educational Psychology, University of Pretoria, South Africa.
| | - Yael Abreu-Villaça
- Departamento de Ciências Fisiológicas, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Brazil.
| | - Marcus Augusto-Oliveira
- Laboratory of Molecular Pharmacology, Institute of Biological Sciences, Federal University of Pará, Brazil.
| | - Caroline Brennan
- Department of Biological and Experimental Psychology, Queen Mary University of London, United Kingdom.
| | - Maria Elena Crespo-Lopez
- Laboratory of Molecular Pharmacology, Institute of Biological Sciences, Federal University of Pará, Brazil.
| | - Gabriela de Paula Arrifano
- Laboratory of Molecular Pharmacology, Institute of Biological Sciences, Federal University of Pará, Brazil.
| | - Lilah Glazer
- Department of Biological and Experimental Psychology, Queen Mary University of London, United Kingdom.
| | - Netsai Gwata
- Department of Educational Psychology, University of Pretoria, South Africa.
| | - Liyuan Lin
- Department of Biological and Experimental Psychology, Queen Mary University of London, United Kingdom.
| | - Isabelle Mareschal
- Department of Biological and Experimental Psychology, Queen Mary University of London, United Kingdom.
| | | | - Luke Sartori
- Department of Biological and Experimental Psychology, Queen Mary University of London, United Kingdom.
| | - Liesl Stieger
- Education Library, University of Pretoria, South Africa.
| | - Andres Trotta
- Institute of Collective Health, National University of Lanús, Argentina.
| | - Kristin Hadfield
- Trinity Centre for Global Health, Trinity College Dublin, Ireland; School of Psychology, Trinity College Dublin, Ireland.
| |
Collapse
|
32
|
De Matteis S, Forastiere F, Baldacci S, Maio S, Tagliaferro S, Fasola S, Cilluffo G, La Grutta S, Viegi G. Issue 1 - “Update on adverse respiratory effects of outdoor air pollution”. Part 1): Outdoor air pollution and respiratory diseases: A general update and an Italian perspective. Pulmonology 2022; 28:284-296. [DOI: 10.1016/j.pulmoe.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022] Open
|
33
|
Kawano A, Kim Y, Meas M, Sokal-Gutierrez K. Association between satellite-detected tropospheric nitrogen dioxide and acute respiratory infections in children under age five in Senegal: spatio-temporal analysis. BMC Public Health 2022; 22:178. [PMID: 35081933 PMCID: PMC8790943 DOI: 10.1186/s12889-022-12577-3] [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: 08/16/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is growing evidence to suggest that exposure to a high concentration of nitrogen dioxide (NO2) can lead to a higher incidence of Acute Respiratory Infections (ARIs) in children; however, such an association remains understudied in Sub-Saharan Africa due to the limited availability of exposure data. This study explored this association by using the satellite-detected tropospheric NO2 concentrations measured by Sentinel-5 Precursor and ARI symptoms in children under age five collected in the Demographic and Health Survey (DHS) in Senegal. METHODS We matched the daily tropospheric NO2 exposure with the individual ARI symptoms according to the DHS survey clusters spatially and temporally and conducted a logistic regression analysis to estimate the association of exposure to NO2 with ARI symptoms in two preceding weeks. RESULTS We observed a positive association between exposure to continuous levels of NO2 and ARI symptoms after adjusting for confounders (OR 1.27 per 10 mol/m2, 95% CI: 1.06 - 1.52). When the association was further examined by quartile exposure categories, the 4th quartile category was positively associated with symptoms of ARI after adjusting for confounders (OR 1.71, 95% CI: 1.08-2.69). This suggests that exposure to certain high levels of NO2 is associated with the increased risk of children having symptoms of ARI in Senegal. CONCLUSIONS This study highlights the need for increased research on the effects of ambient NO2 exposure in Africa as well as the need for more robust, ground-based air monitoring in the region. For a country like Senegal, where more than 90% of the population lives in areas that do not meet the national air quality standards, it is urgently required to implement air pollution prevention efforts to protect children from the health hazards of air pollution.
Collapse
Affiliation(s)
- Ayako Kawano
- School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA, 94704, USA
| | - Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Michelle Meas
- School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA, 94704, USA
| | - Karen Sokal-Gutierrez
- School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA, 94704, USA.
| |
Collapse
|
34
|
Nisbet EG, Allen G, Fisher RE, France JL, Lee JD, Lowry D, Andrade MF, Bannan TJ, Barker P, Bateson P, Bauguitte SJB, Bower KN, Broderick TJ, Chibesakunda F, Cain M, Cozens AE, Daly MC, Ganesan AL, Jones AE, Lambakasa M, Lunt MF, Mehra A, Moreno I, Pasternak D, Palmer PI, Percival CJ, Pitt JR, Riddle AJ, Rigby M, Shaw JT, Stell AC, Vaughan AR, Warwick NJ, E. Wilde S. Isotopic signatures of methane emissions from tropical fires, agriculture and wetlands: the MOYA and ZWAMPS flights. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2022; 380:20210112. [PMID: 34865533 PMCID: PMC8646140 DOI: 10.1098/rsta.2021.0112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
We report methane isotopologue data from aircraft and ground measurements in Africa and South America. Aircraft campaigns sampled strong methane fluxes over tropical papyrus wetlands in the Nile, Congo and Zambezi basins, herbaceous wetlands in Bolivian southern Amazonia, and over fires in African woodland, cropland and savannah grassland. Measured methane δ13CCH4 isotopic signatures were in the range -55 to -49‰ for emissions from equatorial Nile wetlands and agricultural areas, but widely -60 ± 1‰ from Upper Congo and Zambezi wetlands. Very similar δ13CCH4 signatures were measured over the Amazonian wetlands of NE Bolivia (around -59‰) and the overall δ13CCH4 signature from outer tropical wetlands in the southern Upper Congo and Upper Amazon drainage plotted together was -59 ± 2‰. These results were more negative than expected. For African cattle, δ13CCH4 values were around -60 to -50‰. Isotopic ratios in methane emitted by tropical fires depended on the C3 : C4 ratio of the biomass fuel. In smoke from tropical C3 dry forest fires in Senegal, δ13CCH4 values were around -28‰. By contrast, African C4 tropical grass fire δ13CCH4 values were -16 to -12‰. Methane from urban landfills in Zambia and Zimbabwe, which have frequent waste fires, had δ13CCH4 around -37 to -36‰. These new isotopic values help improve isotopic constraints on global methane budget models because atmospheric δ13CCH4 values predicted by global atmospheric models are highly sensitive to the δ13CCH4 isotopic signatures applied to tropical wetland emissions. Field and aircraft campaigns also observed widespread regional smoke pollution over Africa, in both the wet and dry seasons, and large urban pollution plumes. The work highlights the need to understand tropical greenhouse gas emissions in order to meet the goals of the UNFCCC Paris Agreement, and to help reduce air pollution over wide regions of Africa. This article is part of a discussion meeting issue 'Rising methane: is warming feeding warming? (part 2)'.
Collapse
Affiliation(s)
- MOYA/ZWAMPS Team
- Department of Earth Sciences, Royal Holloway, University of London, Egham TW20 0EX, UK
| | - Euan G. Nisbet
- Department of Earth Sciences, Royal Holloway, University of London, Egham TW20 0EX, UK
| | - Grant Allen
- Centre for Atmospheric Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Rebecca E. Fisher
- Department of Earth Sciences, Royal Holloway, University of London, Egham TW20 0EX, UK
| | - James L. France
- Department of Earth Sciences, Royal Holloway, University of London, Egham TW20 0EX, UK
- British Antarctic Survey, Natural Environment Research Council, Cambridge CB3 0ET, UK
| | - James D. Lee
- National Centre for Atmospheric Sciences, Department of Chemistry, University of York, Heslington, York YO10 5DD, UK
| | - David Lowry
- Department of Earth Sciences, Royal Holloway, University of London, Egham TW20 0EX, UK
| | - Marcos F. Andrade
- Laboratory for Atmospheric Physics, Institute for Physics Research, Universidad Mayor de San Andrés-UMSA, Campus Universitario, Cota-Cota Calle No 27, La Paz, Bolivia
- Department Atmospheric and Oceanic Sciences, University of Maryland, College Park, MD 20742, USA
| | - Thomas J. Bannan
- Centre for Atmospheric Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Patrick Barker
- Centre for Atmospheric Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Prudence Bateson
- Centre for Atmospheric Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Stéphane J.-B. Bauguitte
- Facility for Airborne Atmospheric Measurement, Cranfield University, College Road, Cranfield MK43 0AL, UK
| | - Keith N. Bower
- Centre for Atmospheric Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | | | - Francis Chibesakunda
- Geological Survey of Zambia, Ministry of Mines and Mineral Development, PO Box 50135, Ridgeway, Lusaka, Zambia
| | - Michelle Cain
- Centre for Environment and Agricultural Informatics, Cranfield University, College Road, Cranfield MK43 0AL, UK
| | - Alice E. Cozens
- Department of Earth Sciences, Royal Holloway, University of London, Egham TW20 0EX, UK
| | - Michael C. Daly
- Department of Earth Sciences, University of Oxford, South Parks Road, Oxford OX1 3AN, UK
| | - Anita L. Ganesan
- School of Geographical Sciences, University of Bristol, Bristol BS8 1SS, UK
| | - Anna E. Jones
- British Antarctic Survey, Natural Environment Research Council, Cambridge CB3 0ET, UK
| | - Musa Lambakasa
- Geological Survey of Zambia, Ministry of Mines and Mineral Development, PO Box 50135, Ridgeway, Lusaka, Zambia
| | - Mark F. Lunt
- School of GeoSciences, University of Edinburgh, Edinburgh EH9 3FF, UK
| | - Archit Mehra
- Centre for Atmospheric Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK
- Now at Faculty of Science and Engineering, University of Chester, Chester, UK
| | - Isabel Moreno
- Laboratory for Atmospheric Physics, Institute for Physics Research, Universidad Mayor de San Andrés-UMSA, Campus Universitario, Cota-Cota Calle No 27, La Paz, Bolivia
| | - Dominika Pasternak
- National Centre for Atmospheric Sciences, Department of Chemistry, University of York, Heslington, York YO10 5DD, UK
- Wolfson Atmospheric Chemistry Laboratories, Department of Chemistry, University of York, York YO10 5DD, UK
| | - Paul I. Palmer
- School of GeoSciences, University of Edinburgh, Edinburgh EH9 3FF, UK
- National Centre for Earth Observation, University of Edinburgh, Edinburgh EH9 3FF, UK
| | - Carl J. Percival
- Now at Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - Joseph R. Pitt
- School of Marine and Atmospheric Sciences, Stony Brook University, Stony Brook, NY 11794, USA
| | - Amber J. Riddle
- Department of Earth Sciences, Royal Holloway, University of London, Egham TW20 0EX, UK
| | - Matthew Rigby
- School of Chemistry, University of Bristol, Bristol BS8 1TS, UK
| | - Jacob T. Shaw
- Centre for Atmospheric Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Angharad C. Stell
- School of Geographical Sciences, University of Bristol, Bristol BS8 1SS, UK
| | - Adam R. Vaughan
- Wolfson Atmospheric Chemistry Laboratories, Department of Chemistry, University of York, York YO10 5DD, UK
| | - Nicola J. Warwick
- Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge CB2 1EW, UK
| | - Shona E. Wilde
- Wolfson Atmospheric Chemistry Laboratories, Department of Chemistry, University of York, York YO10 5DD, UK
| |
Collapse
|
35
|
Gladson LA, Cromar KR, Ghazipura M, Knowland KE, Keller CA, Duncan B. Communicating respiratory health risk among children using a global air quality index. ENVIRONMENT INTERNATIONAL 2022; 159:107023. [PMID: 34920275 DOI: 10.1016/j.envint.2021.107023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
Air pollution poses a serious threat to children's respiratory health around the world. Satellite remote-sensing technology and air quality models can provide pollution data on a global scale, necessary for risk communication efforts in regions without ground-based monitoring networks. Several large centers, including NASA, produce global pollution forecasts that may be used alongside air quality indices to communicate local, daily risk information to the public. Here we present a health-based, globally applicable air quality index developed specifically to reflect the respiratory health risks among children exposed to elevated outdoor air pollution. Additive, excess-risk air quality indices were developed using 51 different coefficients derived from time-series health studies evaluating the impacts of ambient fine particulate matter, nitrogen dioxide, and ozone on children's respiratory morbidity outcomes. A total of four indices were created which varied based on whether or not the underlying studies controlled for co-pollutants and in the adjustment of excess risks of individual pollutants. Combined with historical estimates of air pollution provided globally at a 25 × 25 km2 spatial resolution from the NASA's Goddard Earth Observing System composition forecast (GEOS-CF) model, each of these indices were examined in a global sample of 664 small and 140 large cities for study year 2017. Adjusted indices presented the most normal distributions of locally-scaled index values, which has been shown to improve associations with health risks, while indices based on coefficients controlling for co-pollutants had little effect on index performance. We provide the steps and resources need to apply our final adjusted index at the local level using freely-available forecasting data from the GEOS-CF model, which can provide risk communication information for cities around the world to better inform individual behavior modification to best protect children's respiratory health.
Collapse
Affiliation(s)
- Laura A Gladson
- Marron Institute of Urban Management, New York University, New York, USA; New York University Grossman School of Medicine, New York, NY, USA
| | - Kevin R Cromar
- Marron Institute of Urban Management, New York University, New York, USA; New York University Grossman School of Medicine, New York, NY, USA.
| | - Marya Ghazipura
- Marron Institute of Urban Management, New York University, New York, USA; New York University Grossman School of Medicine, New York, NY, USA
| | - K Emma Knowland
- Universities Space Research Association, Columbia, MD, USA; NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - Christoph A Keller
- Universities Space Research Association, Columbia, MD, USA; NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - Bryan Duncan
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| |
Collapse
|
36
|
Shen WT, Yu X, Zhong SB, Ge HR. Population Health Effects of Air Pollution: Fresh Evidence From China Health and Retirement Longitudinal Survey. Front Public Health 2022; 9:779552. [PMID: 35004584 PMCID: PMC8733201 DOI: 10.3389/fpubh.2021.779552] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
The effects of air pollution on population health are currently a hot topic. However, few studies have examined the physical and mental health effects of air pollution jointly in China. Using data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018, this study explores how air pollution affects the physical and mental health of middle-aged and elderly residents. The empirical results highlight that air pollution can negatively affect both physical and mental health. In terms of physical health, those exposed to chronic shock are likely to suffer more adverse effects from air pollution than those exposed to acute shock. In terms of mental health, those exposed to depression suffer greater adverse effects than those exposed to episodic memory and mental cognition. Besides, heterogeneity analysis also shows that air pollution affects the mental and physical health of males more than females. Furthermore, the increase in air pollution is expected to result in huge hospitalization costs. Therefore, the Chinese government should formulate differentiated public health policies to reduce the effects of air pollution on the health of middle-aged and elderly residents.
Collapse
Affiliation(s)
- Wei-Teng Shen
- Business School, Zhejiang Wanli University, Ningbo, China
| | - Xuan Yu
- Business School, Ningbo University, Ningbo, China
| | - Shun-Bin Zhong
- School of Information, Central University of Finance and Economics, Beijing, China
| | - Hao-Ran Ge
- Business School, Zhejiang Wanli University, Ningbo, China
| |
Collapse
|
37
|
Personal Exposure to Fine Particles (PM 2.5) in Northwest Africa: Case of the Urban City of Bamako in Mali. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010611. [PMID: 35010869 PMCID: PMC8744751 DOI: 10.3390/ijerph19010611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/30/2021] [Accepted: 01/01/2022] [Indexed: 02/01/2023]
Abstract
Personal exposure to particulate matter (PM) from anthropogenic activities is a major concern in African countries, including Mali. However, knowledge of particulates is scant. This study was undertaken to characterize personal exposure to PM2.5 microns or less in diameter (PM2.5) in the city of Bamako in Mali. The exposure to PM2.5, through daily activities was observed from September 2020 to February 2021. Participants wore palm-sized optical PM2.5 sensors on their chest during their daily activities. The exposure levels in four different groups of residents were investigated in relation to their daily activities. The variation in PM2.5 concentration was measured during different activities in different microenvironments, and the main sources of exposure were identified. The highest average 10 min concentrations were observed at home and in bedrooms, while the participants were using specific products typically used in Africa, Asia, and South America that included insecticides (IST; 999 µg/m3) and incense (ICS; 145 µg/m3), followed by traffic (216 µg/m3) and cooking (150 µg/m3). The lowest average 10 min concentrations were also observed in the same microenvironment lacking IST or ICS (≤14 µg/m3). With no use of specific products, office workers and students were the least exposed, and drivers and cooks were the most exposed. The concentrations are up to 7.5 and 3 times higher than the World Health Organization's yearly and daily recommended exposure levels, respectively, indicating the need to promptly elaborate and apply effective mitigation strategies to improve air quality and protect public health. This study highlights the importance of indoor air pollution sources related to culture and confirms previous studies on urban outdoor air pollution sources, especially in developing countries. The findings could be applied to cities other than Bamako, as similar practices and lifestyles are common in different cultures.
Collapse
|
38
|
Abera A, Friberg J, Isaxon C, Jerrett M, Malmqvist E, Sjöström C, Taj T, Vargas AM. Air Quality in Africa: Public Health Implications. Annu Rev Public Health 2021; 42:193-210. [PMID: 33348996 DOI: 10.1146/annurev-publhealth-100119-113802] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This review highlights the importance of air quality in the African urban development process. We address connections between air pollution and (a) rapid urbanization, (b) social problems, (c) health impacts, (d) climate change, (e) policies, and (f) new innovations. We acknowledge that air pollution levels in Africa can be extremely high and a serious health threat. The toxic content of the pollution could relate to region-specific sources such as low standards for vehicles and fuels, cooking with solid fuels, and burning household waste. We implore the pursuit of interdisciplinary research to create new approaches with relevant stakeholders. Moreover, successful air pollution research must regard conflicts, tensions, and synergies inherent to development processes in African municipalities, regions, and countries. This includes global relationships regarding climate change, trade, urban planning, and transportation. Incorporating aspects of local political situations (e.g., democracy) can also enhance greater political accountability and awareness about air pollution.
Collapse
Affiliation(s)
- Asmamaw Abera
- Department of Public Health, Addis Ababa University, 9086 Addis Ababa, Ethiopia
| | - Johan Friberg
- Division of Nuclear Physics, Faculty of Engineering, Lund University, 223 63 Lund, Sweden
| | - Christina Isaxon
- Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Lund University, 223 62 Lund, Sweden;
| | - Michael Jerrett
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, California 90095, USA
| | - Ebba Malmqvist
- Division of Occupational and Environmental Medicine, Lund University, 221 00 Lund, Sweden;
| | - Cheryl Sjöström
- Centre for Environmental and Climate Science, Lund University, 221 00 Lund, Sweden
| | - Tahir Taj
- Division of Occupational and Environmental Medicine, Lund University, 221 00 Lund, Sweden
| | | |
Collapse
|
39
|
Zhang D, Du L, Wang W, Zhu Q, Bi J, Scovronick N, Naidoo M, Garland RM, Liu Y. A machine learning model to estimate ambient PM 2.5 concentrations in industrialized highveld region of South Africa. REMOTE SENSING OF ENVIRONMENT 2021; 266:112713. [PMID: 34776543 PMCID: PMC8589277 DOI: 10.1016/j.rse.2021.112713] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Exposure to fine particulate matter (PM2.5) has been linked to a substantial disease burden globally, yet little has been done to estimate the population health risks of PM2.5 in South Africa due to the lack of high-resolution PM2.5 exposure estimates. We developed a random forest model to estimate daily PM2.5 concentrations at 1 km2 resolution in and around industrialized Gauteng Province, South Africa, by combining satellite aerosol optical depth (AOD), meteorology, land use, and socioeconomic data. We then compared PM2.5 concentrations in the study domain before and after the implementation of the new national air quality standards. We aimed to test whether machine learning models are suitable for regions with sparse ground observations such as South Africa and which predictors played important roles in PM2.5 modeling. The cross-validation R2 and Root Mean Square Error of our model was 0.80 and 9.40 μg/m3, respectively. Satellite AOD, seasonal indicator, total precipitation, and population were among the most important predictors. Model-estimated PM2.5 levels successfully captured the temporal pattern recorded by ground observations. Spatially, the highest annual PM2.5 concentration appeared in central and northern Gauteng, including northern Johannesburg and the city of Tshwane. Since the 2016 changes in national PM2.5 standards, PM2.5 concentrations have decreased in most of our study region, although levels in Johannesburg and its surrounding areas have remained relatively constant. This is anadvanced PM2.5 model for South Africa with high prediction accuracy at the daily level and at a relatively high spatial resolution. Our study provided a reference for predictor selection, and our results can be used for a variety of purposes, including epidemiological research, burden of disease assessments, and policy evaluation.
Collapse
Affiliation(s)
- Danlu Zhang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Linlin Du
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Wenhao Wang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Qingyang Zhu
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Jianzhao Bi
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Noah Scovronick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Mogesh Naidoo
- Council for Scientific and Industrial Research, Pretoria 0001, South Africa
| | - Rebecca M Garland
- Council for Scientific and Industrial Research, Pretoria 0001, South Africa
- Unit for Environmental Sciences and Management, North-West University, Potchefstroom 2520, South Africa
- Department of Geography, Geo-informatics and Meteorology, University of Pretoria, Pretoria 0001, South Africa
| | - Yang Liu
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| |
Collapse
|
40
|
Bachwenkizi J, Liu C, Meng X, Zhang L, Wang W, van Donkelaar A, Martin RV, Hammer MS, Chen R, Kan H. Fine particulate matter constituents and infant mortality in Africa: A multicountry study. ENVIRONMENT INTERNATIONAL 2021; 156:106739. [PMID: 34217038 DOI: 10.1016/j.envint.2021.106739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/30/2021] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Few studies have investigated the association between exposure to fine particulate matter (PM2.5) and infant mortality in developing countries, especially for the health effects of specific PM2.5 constituents. OBJECTIVE We aimed to examine the association of long-term exposure to specific PM2.5 constituents with infant mortality in 15 African countries from 2005 to 2015. METHODS Based on the Demographic and Health Surveys (DHS) dataset, we included birth history records from 15 countries in Africa and conducted a multicountry cross-sectional study to examine the associations between specific PM2.5 constituents and infant mortality. We estimated annual residential exposure using satellite-derived PM2.5 for mass and a chemical transport model (GEOS-Chem) for its six constituents, including organic matter (OM), black carbon (BC), sulfate (SO42-), nitrate (NO3-), ammonium (NH4+), and soil dust (DUST). Multivariable logistic regression analysis was employed by fitting single-constituent models, the constituent-PM2.5 models, and the constituent-residual models. We also conducted stratified analyses by potential effect modifiers and examined the specific associations for each country. RESULTS We found positive and significant associations between PM2.5 total mass and most of its constituents with infant mortality. In the single-constituent model, for an IQR increase in pollutant concentrations, the odds ratio (OR) of infant mortality was 1.03 (95 %CI; 1.01, 1.06) for PM2.5 total mass, and was 1.04 (95 %CI: 1.02, 1.06), 1.04 (95 %CI: 1.02, 1.05), 1.02 (95 %CI: 1.00, 1.03), 1.04 (1.01, 1.06) for BC, OM, SO42-, and DUST, respectively. The associations of BC, OM, and SO42- remained significant in the other two models. We observed larger estimates in subgroups with older maternal age, living in urban areas, using unclean cooking energy, and with access to piped water. The associations varied among countries, and by different constituents. CONCLUSIONS The carbonaceous fractions and sulfate play a major important role among PM2.5 constituents on infant mortality. Our findings have certain policy implications for implementing effective measures for targeted reduction in specific sources (fossil fuel combustion and biomass burning) of PM2.5 constituents against the risk of infant mortality.
Collapse
Affiliation(s)
- Jovine Bachwenkizi
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Cong Liu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Xia Meng
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Lina Zhang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Weidong Wang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, B3H 4R2 Halifax, Nova Scotia, Canada; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, B3H 4R2 Halifax, Nova Scotia, Canada; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Melanie S Hammer
- Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China; Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3), Fudan University, Shanghai 200030, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China; Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3), Fudan University, Shanghai 200030, China.
| |
Collapse
|
41
|
Cai YS, Gibson H, Ramakrishnan R, Mamouei M, Rahimi K. Ambient Air Pollution and Respiratory Health in Sub-Saharan African Children: A Cross-Sectional Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189729. [PMID: 34574653 PMCID: PMC8467583 DOI: 10.3390/ijerph18189729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/11/2021] [Accepted: 09/13/2021] [Indexed: 02/03/2023]
Abstract
Ambient air pollution is projected to become a major environmental risk in sub-Saharan Africa (SSA). Research into its health impacts is hindered by limited data. We aimed to investigate the cross-sectional relationship between particulate matter with a diameter ≤ 2.5 μm (PM2.5) and prevalence of cough or acute lower respiratory infection (ALRI) among children under five in SSA. Data were collected from 31 Demographic and Health Surveys (DHS) in 21 SSA countries between 2005–2018. Prior-month average PM2.5 preceding the survey date was assessed based on satellite measurements and a chemical transport model. Cough and ALRI in the past two weeks were derived from questionnaires. Associations were analysed using conditional logistic regression within each survey cluster, adjusting for child’s age, sex, birth size, household wealth, maternal education, maternal age and month of the interview. Survey-specific odds ratios (ORs) were pooled using random-effect meta-analysis. Included were 368,366 and 109,664 children for the analysis of cough and ALRI, respectively. On average, 20.5% children had reported a cough, 6.4% reported ALRI, and 32% of children lived in urban areas. Prior-month average PM2.5 ranged from 8.9 to 64.6 μg/m3. Pooling all surveys, no associations were observed with either outcome in the overall populations. Among countries with medium-to-high Human Development Index, positive associations were observed with both cough (pooled OR: 1.022, 95%CI: 0.982–1.064) and ALRI (pooled OR: 1.018, 95%CI: 0.975–1.064) for 1 μg/m3 higher of PM2.5. This explorative study found no associations between short-term ambient PM2.5 and respiratory health among young SSA children, necessitating future analyses using better-defined exposure and health metrics to study this important link.
Collapse
Affiliation(s)
- Yutong Samuel Cai
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX3 9DU, UK; (H.G.); (M.M.); (K.R.)
- Deep Medicine Programme, Oxford Martin School, University of Oxford, Oxford OX1 3BD, UK
- Informal Cities Programme, Oxford Martin School, University of Oxford, Oxford OX1 3BD, UK
- Correspondence:
| | - Harry Gibson
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX3 9DU, UK; (H.G.); (M.M.); (K.R.)
- Deep Medicine Programme, Oxford Martin School, University of Oxford, Oxford OX1 3BD, UK
- Informal Cities Programme, Oxford Martin School, University of Oxford, Oxford OX1 3BD, UK
| | - Rema Ramakrishnan
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK;
| | - Mohammad Mamouei
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX3 9DU, UK; (H.G.); (M.M.); (K.R.)
- Deep Medicine Programme, Oxford Martin School, University of Oxford, Oxford OX1 3BD, UK
- Informal Cities Programme, Oxford Martin School, University of Oxford, Oxford OX1 3BD, UK
| | - Kazem Rahimi
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX3 9DU, UK; (H.G.); (M.M.); (K.R.)
- Deep Medicine Programme, Oxford Martin School, University of Oxford, Oxford OX1 3BD, UK
- Informal Cities Programme, Oxford Martin School, University of Oxford, Oxford OX1 3BD, UK
| |
Collapse
|
42
|
Turcu C, Crane M, Hutchinson E, Lloyd S, Belesova K, Wilkinson P, Davies M. A multi-scalar perspective on health and urban housing: an umbrella review. BUILDINGS & CITIES 2021; 2:734-758. [PMID: 34738085 PMCID: PMC7611930 DOI: 10.5334/bc.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
With more than half the world's population living in cities, understanding how the built environment impacts human health at different urban scales is crucial. To be able to shape cities for health, an understanding is needed of planetary health impacts, which encompass the human health impacts of human-caused disruptions on the Earth's natural ecosystems. This umbrella review maps health evidence across the spatial scales of the built environment (building; neighbourhood; and wider system, including city, regional and planetary levels), with a specific focus on urban housing. Systematic reviews published in English between January 2011 and December 2020 were searched across 20 databases, with 1176 articles identified and 124 articles screened for inclusion. Findings suggests that most evidence reports on health determinants at the neighbourhood level, such as greenspace, physical and socio-economic conditions, transport infrastructure and access to local services. Physical health outcomes are also primarily reported, with an emerging interest in mental health outcomes. There is little evidence on planetary health outcomes and significant gaps in the research literature are identified. Based on these findings, three potential directions are identified for future research.
Collapse
Affiliation(s)
- Catalina Turcu
- The Bartlett Faculty of the Built Environment, University College London, London, UK
| | - Melanie Crane
- The Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Emma Hutchinson
- Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
| | - Simon Lloyd
- Climate and Health Programme (CLIMA), Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Kristine Belesova
- Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK
| | - Paul Wilkinson
- Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK
| | - Mike Davies
- UCL Institute for Environmental Design and Engineering, Faculty of the Built Environment, University College London, London, UK
| |
Collapse
|
43
|
Alli AS, Clark SN, Hughes A, Nimo J, Bedford-Moses J, Baah S, Wang J, Vallarino J, Agyemang E, Barratt B, Beddows A, Kelly F, Owusu G, Baumgartner J, Brauer M, Ezzati M, Agyei-Mensah S, Arku RE. Spatial-temporal patterns of ambient fine particulate matter (PM 2.5) and black carbon (BC) pollution in Accra. ENVIRONMENTAL RESEARCH LETTERS : ERL [WEB SITE] 2021; 16:074013. [PMID: 34239599 PMCID: PMC8227509 DOI: 10.1088/1748-9326/ac074a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 05/06/2023]
Abstract
Sub-Saharan Africa (SSA) is rapidly urbanizing, and ambient air pollution has emerged as a major environmental health concern in growing cities. Yet, effective air quality management is hindered by limited data. We deployed robust, low-cost and low-power devices in a large-scale measurement campaign and characterized within-city variations in fine particulate matter (PM2.5) and black carbon (BC) pollution in Accra, Ghana. Between April 2019 and June 2020, we measured weekly gravimetric (filter-based) and minute-by-minute PM2.5 concentrations at 146 unique locations, comprising of 10 fixed (∼1 year) and 136 rotating (7 day) sites covering a range of land-use and source influences. Filters were weighed for mass, and light absorbance (10-5m-1) of the filters was used as proxy for BC concentration. Year-long data at four fixed sites that were monitored in a previous study (2006-2007) were compared to assess changes in PM2.5 concentrations. The mean annual PM2.5 across the fixed sites ranged from 26 μg m-3 at a peri-urban site to 43 μg m-3 at a commercial, business, and industrial (CBI) site. CBI areas had the highest PM2.5 levels (mean: 37 μg m-3), followed by high-density residential neighborhoods (mean: 36 μg m-3), while peri-urban areas recorded the lowest (mean: 26 μg m-3). Both PM2.5 and BC levels were highest during the dry dusty Harmattan period (mean PM2.5: 89 μg m-3) compared to non-Harmattan season (mean PM2.5: 23 μg m-3). PM2.5 at all sites peaked at dawn and dusk, coinciding with morning and evening heavy traffic. We found about a 50% reduction (71 vs 37 μg m-3) in mean annual PM2.5 concentrations when compared to measurements in 2006-2007 in Accra. Ambient PM2.5 concentrations in Accra may have plateaued at levels lower than those seen in large Asian megacities. However, levels are still 2- to 4-fold higher than the WHO guideline. Effective and equitable policies are needed to reduce pollution levels and protect public health.
Collapse
Affiliation(s)
- Abosede S Alli
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, United States of America
| | - Sierra N Clark
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
- MRC Center for Environment and Health, Imperial College London, London, United Kingdom
| | - Allison Hughes
- Department of Physics, University of Ghana, Legon, Ghana
| | - James Nimo
- Department of Physics, University of Ghana, Legon, Ghana
| | | | - Solomon Baah
- Department of Physics, University of Ghana, Legon, Ghana
| | - Jiayuan Wang
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, United States of America
| | - Jose Vallarino
- Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Ernest Agyemang
- Department of Geography and Resource Development, University of Ghana, Legon, Ghana
| | - Benjamin Barratt
- MRC Center for Environment and Health, Imperial College London, London, United Kingdom
- NIHR HPRU in Environmental Exposures and Health, Imperial College London, London, United Kingdom
| | - Andrew Beddows
- MRC Center for Environment and Health, Imperial College London, London, United Kingdom
- NIHR HPRU in Environmental Exposures and Health, Imperial College London, London, United Kingdom
| | - Frank Kelly
- MRC Center for Environment and Health, Imperial College London, London, United Kingdom
- NIHR HPRU in Environmental Exposures and Health, Imperial College London, London, United Kingdom
| | - George Owusu
- Department of Geography and Resource Development, University of Ghana, Legon, Ghana
| | - Jill Baumgartner
- Institute for Health and Social Policy, McGill University, Montreal, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States of America
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
- MRC Center for Environment and Health, Imperial College London, London, United Kingdom
- Regional Institute for Population Studies, University of Ghana, Legon, Ghana
| | - Samuel Agyei-Mensah
- Department of Geography and Resource Development, University of Ghana, Legon, Ghana
| | - Raphael E Arku
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, United States of America
| |
Collapse
|
44
|
Malik S, Iqbal A, Imran A, Usman M, Nadeem M, Asif S, Bokhari A. Impact of economic capabilities and population agglomeration on PM 2.5 emission: empirical evidence from sub-Saharan African countries. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:34017-34026. [PMID: 32978733 DOI: 10.1007/s11356-020-10907-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/16/2020] [Indexed: 06/11/2023]
Abstract
The utilization of economic capabilities to raise production in the economy enhances the industrial activities and use of transportation. These activities deteriorate the quality of the environment and raise the level of particulate matter (PM2.5). The objective of this study is to investigate the impact of economic capabilities and population agglomeration on PM2.5 emissions for the sample of 23 sub-Saharan African countries-a highly polluted region of the world. The study used panel regression from 2007 to 2015 and found that production capabilities are highly significant and directly effecting PM2.5 emissions. The Kuznets hypothesis does not hold in this region, and the concentration of population in urban areas is also significant. To avoid the problem of possible endogeneity in the empirical model and for robustness check, the study also utilized system GMM and found consistent results. The findings of the study are highly valuable to reduce PM2.5 and propose that the policymakers in Sub-Saharan African countries should opt for industrial specialization rather than economic complexity and ensure that the proper measures are taken to control PM2.5. Moreover, population concentrations should not be taken place in a few main urban cities.
Collapse
Affiliation(s)
- Summaira Malik
- Department of Economics, COMSATS University Islamabad (CUI), Lahore Campus, Lahore, Pakistan
| | - Asim Iqbal
- Department of Economics and Business Administration, Division of Arts and Social Sciences, University of Education, Lahore, Pakistan
| | - Asma Imran
- Department of Management Sciences, COMSATS University Islamabad (CUI), Lahore Campus, Lahore, Pakistan
| | - Muhammad Usman
- School of Business and Economics, University of Management and Technology (UMT), Lahore, Pakistan
| | - Muhammad Nadeem
- National College of Business Administration and Economics, Lahore, Pakistan
| | - Saira Asif
- Faculty of Sciences, Department of Botany, PMAS Arid Agriculture University, Murree Road, Rawalpindi, Punjab, Pakistan
| | - Awais Bokhari
- Department of Chemical Engineering, COMSATS University Islamabad (CUI), Lahore Campus, Defence Road, Off Raiwind Road, Lahore, Punjab, Pakistan.
| |
Collapse
|
45
|
Yoseph M, Paddick SM, Gray WK, Andrea D, Barber R, Colgan A, Dotchin C, Urasa S, Kisoli A, Kissima J, Haule I, Rogathi J, Safic S, Mushi D, Robinson L, Walker RW. Prevalence estimates of dementia in older adults in rural Kilimanjaro 2009-2010 and 2018-2019: is there evidence of changing prevalence? Int J Geriatr Psychiatry 2021; 36:950-959. [PMID: 33480089 DOI: 10.1002/gps.5498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/27/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Although limited, existing epidemiological data on dementia in sub-Saharan Africa indicate that prevalence may be increasing; contrasting with recent decreases observed in high-income countries. We have previously reported the age-adjusted prevalence of dementia in rural Tanzania in 2009-2010 as 6.4% (95% confidence interval [CI] 4.9-7.9) in individuals aged ≥70 years. We aimed to repeat a community-based dementia prevalence study in the same setting to assess whether prevalence has changed. METHODS This was a two-phase door-to-door community-based cross-sectional survey in Kilimanjaro, Tanzania. In Phase I, trained primary health workers screened all consenting individuals aged ≥60 years from 12 villages using previously validated, locally developed, tools (IDEA cognitive screen and IDEA-Instrumental Activities of Daily Living questionnaire). Screening was conducted using a mobile digital application (app) on a hand-held tablet. In Phase II, a stratified sample of those identified in Phase I were clinically assessed using the DSM-5 criteria and diagnoses subsequently confirmed by consensus panel. RESULTS Of 3011 people who consented, 424 screened positive for probable dementia and 227 for possible dementia. During clinical assessment in Phase II, 105 individuals met DSM-5 dementia criteria. The age-adjusted prevalence of dementia was 4.6% (95% CI 2.9-6.4) in those aged ≥60 years and 8.9% (95% CI 6.1-11.8) in those aged ≥70 years. Prevalence rates increased significantly with age. CONCLUSIONS The prevalence of dementia in this rural Tanzanian population appears to have increased since 2010, although not significantly. Dementia is likely to become a significant health burden in this population as demographic transition continues.
Collapse
Affiliation(s)
- Marcella Yoseph
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Stella-Maria Paddick
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - William K Gray
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | | | - Robyn Barber
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Aoife Colgan
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Dotchin
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Sarah Urasa
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Aloyce Kisoli
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - John Kissima
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - Irene Haule
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - Jane Rogathi
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Declare Mushi
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Louise Robinson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard W Walker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| |
Collapse
|
46
|
Trushna T, Tripathi AK, Rana S, Tiwari RR. Nutraceuticals with anti-inflammatory and anti-oxidant properties as intervention for reducing the health effects of fine particulate matter: Potential and Prospects. Comb Chem High Throughput Screen 2021; 25:1639-1660. [PMID: 33845731 DOI: 10.2174/1386207324666210412121226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/24/2021] [Accepted: 02/28/2021] [Indexed: 11/22/2022]
Abstract
Air pollution, especially particulate matter pollution adversely affects human health. A growing pool of evidence has emerged which underscores the potential of individual-level nutritional interventions in attenuating the adverse health impact of exposure to PM2.5. Although controlling emission and reducing the overall levels of air pollution remains the ultimate objective globally, the sustainable achievement of such a target and thus consequent protection of human health will require a substantial amount of time and concerted efforts worldwide. In the meantime, smaller-scale individual-level interventions that can counter the inflammatory or oxidative stress effects triggered by exposure to particulate matter may be utilized to ameliorate the health effects of PM2.5 pollution. One such intervention is incorporation of nutraceuticals in the diet. Here, we present a review of the evidence generated from various in vitro, in vivo and human studies regarding the effects of different anti-inflammatory and antioxidant nutraceuticals in ameliorating the health effects of particulate matter air pollution. The studies discussed in this review suggest that these nutraceuticals when consumed as a part of the diet, or as additional supplementation, can potentially negate the cellular level adverse effects of exposure to particulate pollution. The potential benefits of adopting a non-pharmacological diet-based approach to air pollution-induced disease management have also been discussed. We argue that before a nutraceuticals-based approach can be used for widespread public adoption, further research, especially human clinical trials, is essential to confirm the beneficial action of relevant nutraceuticals and to explore the safe limits of human supplementation and the risk of side effects. Future research should focus on systematically translating bench-based knowledge regarding nutraceuticals gained from in-vitro and in-vivo studies into clinically usable nutritional guidelines.
Collapse
Affiliation(s)
- Tanwi Trushna
- Department of Environmental Health and Epidemiology, ICMR- National Institute for Research in Environmental Health, Bhopal- 462030. India
| | - Amit K Tripathi
- Department of Molecular Biology, ICMR-National Institute for Research in Environmental Health, Bhopal- 462030. India
| | - Sindhuprava Rana
- Department of Bioinformatics, ICMR-National Institute for Research in Environmental Health, Bhopal- 462030. India
| | - Rajnarayan R Tiwari
- ICMR- National Institute for Research in Environmental Health (NIREH), Bhopal-462030, Madhya Pradesh. India
| |
Collapse
|
47
|
Katoto PDMC, Brand AS, Bakan B, Obadia PM, Kuhangana C, Kayembe-Kitenge T, Kitenge JP, Nkulu CBL, Vanoirbeek J, Nawrot TS, Hoet P, Nemery B. Acute and chronic exposure to air pollution in relation with incidence, prevalence, severity and mortality of COVID-19: a rapid systematic review. Environ Health 2021; 20:41. [PMID: 33838685 PMCID: PMC8035877 DOI: 10.1186/s12940-021-00714-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/05/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND Air pollution is one of the world's leading mortality risk factors contributing to seven million deaths annually. COVID-19 pandemic has claimed about one million deaths in less than a year. However, it is unclear whether exposure to acute and chronic air pollution influences the COVID-19 epidemiologic curve. METHODS We searched for relevant studies listed in six electronic databases between December 2019 and September 2020. We applied no language or publication status limits. Studies presented as original articles, studies that assessed risk, incidence, prevalence, or lethality of COVID-19 in relation with exposure to either short-term or long-term exposure to ambient air pollution were included. All patients regardless of age, sex and location diagnosed as having COVID-19 of any severity were taken into consideration. We synthesised results using harvest plots based on effect direction. RESULTS Included studies were cross-sectional (n = 10), retrospective cohorts (n = 9), ecological (n = 6 of which two were time-series) and hypothesis (n = 1). Of these studies, 52 and 48% assessed the effect of short-term and long-term pollutant exposure, respectively and one evaluated both. Pollutants mostly studied were PM2.5 (64%), NO2 (50%), PM10 (43%) and O3 (29%) for acute effects and PM2.5 (85%), NO2 (39%) and O3 (23%) then PM10 (15%) for chronic effects. Most assessed COVID-19 outcomes were incidence and mortality rate. Acutely, pollutants independently associated with COVID-19 incidence and mortality were first PM2.5 then PM10, NO2 and O3 (only for incident cases). Chronically, similar relationships were found for PM2.5 and NO2. High overall risk of bias judgments (86 and 39% in short-term and long-term exposure studies, respectively) was predominantly due to a failure to adjust aggregated data for important confounders, and to a lesser extent because of a lack of comparative analysis. CONCLUSION The body of evidence indicates that both acute and chronic exposure to air pollution can affect COVID-19 epidemiology. The evidence is unclear for acute exposure due to a higher level of bias in existing studies as compared to moderate evidence with chronic exposure. Public health interventions that help minimize anthropogenic pollutant source and socio-economic injustice/disparities may reduce the planetary threat posed by both COVID-19 and air pollution pandemics.
Collapse
Affiliation(s)
- Patrick D. M. C. Katoto
- Department of Medicine and Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
- Department of Internal Medicine, Division of Respiratory Medicine & Centre for Global Health and Tropical Diseases, Catholic University of Bukavu, Bukavu, Democratic Republic of the Congo
| | - Amanda S. Brand
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Buket Bakan
- Department of Molecular Biology and Genetics, Faculty of Science, Ataturk University, 25240 Erzurum, Turkey
| | - Paul Musa Obadia
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (O&N 706), B-3000 Leuven, Belgium
- Unit of Toxicology and Environment, School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Carsi Kuhangana
- Unit of Toxicology and Environment, School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
- Department of Public Health, Faculty of Medicine and Public Health, University of Kolwezi, Kolwezi, Democratic Republic of the Congo
| | - Tony Kayembe-Kitenge
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (O&N 706), B-3000 Leuven, Belgium
- Unit of Toxicology and Environment, School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Joseph Pyana Kitenge
- Occupational Medicine and Environmental Health, Department of Public Health, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Celestin Banza Lubaba Nkulu
- Unit of Toxicology and Environment, School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Jeroen Vanoirbeek
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (O&N 706), B-3000 Leuven, Belgium
| | - Tim S. Nawrot
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (O&N 706), B-3000 Leuven, Belgium
- Centre of Environmental Health, University of Hasselt, Hasselt, Belgium
| | - Peter Hoet
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (O&N 706), B-3000 Leuven, Belgium
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (O&N 706), B-3000 Leuven, Belgium
| |
Collapse
|
48
|
Ephraim-Emmanuel BC, Ordinioha B. Exposure and Public Health Effects of Polycyclic Aromatic Hydrocarbon Compounds in Sub-Saharan Africa: A Systematic Review. Int J Toxicol 2021; 40:250-269. [PMID: 33813922 DOI: 10.1177/10915818211002487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIM In order to achieve improved global health, environmental health risks that could affect this goal have to be reduced as much as possible. This review thus aimed at determining the exposure levels, health risk assessments, and public health effects of polycyclic aromatic hydrocarbons (PAHs) in sub-Saharan Africa (SSA). This review was developed using guidelines provided for Preferred Reporting Items for Systematic Review and Meta-Analysis. Search was done on Google Scholar, Scopus, and PubMed databases. A study was included if it was carried out in SSA from 2000 to 2020 and written in English language. Fifty-two studies were finally retained and used for the review. Extracted data included the concentrations of 8 selected priority PAHs (including the PAHs prioritized for their carcinogenic potentials), their sources and reported outcomes. In SSA, PAHs exposure has been linked to the use of unprocessed biomass fuels for cooking, release of poorly treated petrochemical effluents into water bodies, and so on. Related public health effects included the occurrence of respiratory, cardiovascular abnormalities, and so on. Others included destruction of natural biodiversity in soil, water, and atmospheric environmental media. Health risk assessments also buttressed the occurrence of these public health effects of PAHs. In SSA, the region is exposed to a substantial amount of PAHs pollution which is associated with deleterious environmental and epidemiological effects. The adoption of healthier forms of energy, a change of attitude to one that favors environmental sustainability, and proper enforcement of environmental regulations are, however, necessary for attaining environmental sanity in SSA.
Collapse
Affiliation(s)
- Benson Chukwunweike Ephraim-Emmanuel
- Environmental Health Department, World Bank Africa Centre of Excellence, Centre for Public Health and Toxicological Research (ACE-PUTOR), 54716University of Port-Harcourt, Rivers State, Nigeria
| | - Best Ordinioha
- Department of Environmental Health, School of Public Health, 327041University of Port Harcourt, Rivers State, Nigeria
| |
Collapse
|
49
|
Lugon L, Sartelet K, Kim Y, Vigneron J, Chrétien O. Simulation of primary and secondary particles in the streets of Paris using MUNICH. Faraday Discuss 2021; 226:432-456. [PMID: 33237094 DOI: 10.1039/d0fd00092b] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
High particle concentrations are observed in the streets. Regional-scale chemistry-transport models are not able to reproduce these high concentrations, because their spatial resolution is not fine enough. Local-scale models are usually employed to simulate the high concentrations in street networks, but they often adopt substantial simplifications to determine background concentrations and use simplified chemistry. This study presents the new version of the local-scale Model of Urban Network of Intersecting Canyons and Highways (MUNICH) that integrates background concentrations simulated by the regional-scale chemistry-transport model Polair3D, and uses the same complex chemistry module as Polair3D, SSH-aerosol, to represent secondary aerosol formation. Gas and aerosol concentrations in Paris streets are simulated with MUNICH, considering a street-network with more than 3800 street segments, between 3 May and 30 June. Comparisons with PM10 and PM2.5 measurements at several locations of Paris show that the high PM10 and PM2.5 concentrations are well represented. Furthermore, the simulated chemical composition of fine particles corresponds well to a yearly measured composition. To understand the influence of the secondary pollutant formation, several sensitivity simulations are conducted. Simulations with and without gas-phase chemistry show that the influence of gas-phase chemistry on the formation of NO2 is large (37% on average over May and across all modelled streets), but the influence on condensables is lower (less than 2% to 3% on average at noon for inorganics and organics), but may reach more than 20% depending on the street. The assumption used to compute gas/particle mass transfer by condensation/evaporation is important for inorganic and organic compounds of particles, as using the thermodynamic equilibrium assumption leads to an overestimation of the organic concentrations by 4.7% on average (up to 31% at noon depending on the streets). Ammonia emissions from traffic lead to an increase in inorganic concentrations by 3% on average, reaching 26% depending on the street segments. Not taking into account gas-phase chemistry and aerosol dynamics in the modelling leads to an underestimation of organic concentrations by about 11% on average over the streets and time, but this underestimation may reach 51% depending on the streets and the time of the day.
Collapse
Affiliation(s)
- Lya Lugon
- CEREA, Joint Laboratory École des Ponts ParisTech/EDF R&D, Université Paris-Est, Champs-sur-Marne, France.
| | | | | | | | | |
Collapse
|
50
|
Edlund KK, Killman F, Molnár P, Boman J, Stockfelt L, Wichmann J. Health Risk Assessment of PM 2.5 and PM 2.5-Bound Trace Elements in Thohoyandou, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031359. [PMID: 33540914 PMCID: PMC7908426 DOI: 10.3390/ijerph18031359] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/22/2021] [Accepted: 01/28/2021] [Indexed: 12/26/2022]
Abstract
We assessed the health risks of fine particulate matter (PM2.5) ambient air pollution and its trace elemental components in a rural South African community. Air pollution is the largest environmental cause of disease and disproportionately affects low- and middle-income countries. PM2.5 samples were previously collected, April 2017 to April 2018, and PM2.5 mass determined. The filters were analyzed for chemical composition. The United States Environmental Protection Agency’s (US EPA) health risk assessment method was applied. Reference doses were calculated from the World Health Organization (WHO) guidelines, South African National Ambient Air Quality Standards (NAAQS), and US EPA reference concentrations. Despite relatively moderate levels of PM2.5 the health risks were substantial, especially for infants and children. The average annual PM2.5 concentration was 11 µg/m3, which is above WHO guidelines, but below South African NAAQS. Adults were exposed to health risks from PM2.5 during May to October, whereas infants and children were exposed to risk throughout the year. Particle-bound nickel posed both non-cancer and cancer risks. We conclude that PM2.5 poses health risks in Thohoyandou, despite levels being compliant with yearly South African NAAQS. The results indicate that air quality standards need to be tightened and PM2.5 levels lowered in South Africa.
Collapse
Affiliation(s)
- Karl Kilbo Edlund
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-405 30 Göteborg, Sweden; (F.K.); (P.M.); (L.S.)
- Correspondence:
| | - Felicia Killman
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-405 30 Göteborg, Sweden; (F.K.); (P.M.); (L.S.)
| | - Peter Molnár
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-405 30 Göteborg, Sweden; (F.K.); (P.M.); (L.S.)
| | - Johan Boman
- Department of Chemistry and Molecular Biology, University of Gothenburg, SE-412 96 Göteborg, Sweden;
| | - Leo Stockfelt
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-405 30 Göteborg, Sweden; (F.K.); (P.M.); (L.S.)
| | - Janine Wichmann
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Gezina 0031, South Africa;
| |
Collapse
|