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Odo DB, Yang IA, Dey S, Hammer MS, van Donkelaar A, Martin RV, Dong GH, Yang BY, Hystad P, Knibbs LD. A cross-sectional analysis of ambient fine particulate matter (PM 2.5) exposure and haemoglobin levels in children aged under 5 years living in 36 countries. ENVIRONMENTAL RESEARCH 2023; 227:115734. [PMID: 36963710 DOI: 10.1016/j.envres.2023.115734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/23/2023] [Accepted: 03/20/2023] [Indexed: 05/08/2023]
Abstract
Low haemoglobin (Hb) concentrations and anaemia in children have adverse effects on development and functioning, some of which may have consequences in later life. Exposure to ambient air pollution is reported to be associated with anaemia, but there is little evidence specific to low- and middle-income countries (LMICs), where childhood anaemia prevalence is greatest. We aimed to determine if long-term ambient fine particulate matter (≤2.5 μm in aerodynamic diameter [PM2.5]) exposure was associated with Hb levels and the prevalence of anaemia in children aged <5 years living in 36 LMICs. We used Demographic and Health Survey data, collected between 2010 and 2019, which included blood Hb measurements. Satellite-derived estimates of annual average PM2.5 was the main exposure variable, which was linked to children's area of residence. Anaemia was defined according to standard World Health Organization guidelines (Hb < 11 g/dL). The association of PM2.5 with Hb levels and anaemia prevalence was examined using multivariable linear and logistic regression models, respectively. We examined whether the effects of ambient PM2.5 were modified by a child's sex and age, household wealth index, and urban/rural place of residence. Models were adjusted for relevant covariates, including other outdoor pollutants and household cooking fuel. The study included 154,443 children, of which 89,904 (58.2%) were anaemic. The country-level prevalence of anaemia ranged from 15.8% to 87.9%. Mean PM2.5 exposure was 33.0 (±21.6) μg/m3. The adjusted model showed that a 10 μg/m3 increase in annual PM2.5 concentration was associated with greater odds of anaemia (OR = 1.098 95% CI: 1.087, 1.109). The same increase in PM2.5 was associated with a decrease in average Hb levels of 0.075 g/dL (95% CI: 0.081, 0.068). There was evidence of effect modification by household wealth index and place of residence, with greater adverse effects in children from lower wealth quintiles and children in rural areas. Exposure to annual PM2.5 was cross-sectionally associated with decreased blood Hb levels, and greater risk of anaemia, in children aged <5 years living in 36 LMICs.
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Affiliation(s)
- Daniel B Odo
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia; College of Health Sciences, Arsi University, Asela, Ethiopia.
| | - Ian A Yang
- Thoracic Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia; UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sagnik Dey
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi, India; Arun Duggal Centre of Excellence for Research in Climate Change and Air Pollution, Indian Institute of Technology Delhi, New Delhi, India
| | - Melanie S Hammer
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Aaron van Donkelaar
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Randall V Martin
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, USA
| | - Luke D Knibbs
- School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia; Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Camperdown, NSW, 2050, Australia
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Atalell KA, Tamir TT, Alemu TG, Techane MA. Spatial distributions and determinants of anaemia among adolescent girls in Ethiopia: a secondary analysis of EDHS 2016 - a cross-sectional study. BMJ Open 2022; 12:e059405. [PMID: 35618330 PMCID: PMC9137342 DOI: 10.1136/bmjopen-2021-059405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the spatial distributions and determinants of anaemia among adolescent girls in Ethiopia. Exploring the spatial epidemiology of anaemia and identifying the risk factors would inform policymakers to come up with evidence-based prevention strategies for anaemia, especially in adolescent girls, who are the most affected segment of the population. METHODS Secondary analysis of the Ethiopian Demographic and Health Survey 2016 was conducted. A total of 3172 adolescents were included in the analysis. The Bernoulli model was fitted using SaTScan V.9.6 to identify hotspot areas and the geospatial pattern and prediction of anaemia were mapped using ArcGIS V.10.8. A multilevel logistic regression model was fitted to identify factors associated with anaemia among adolescent girls. Adjusted OR with 95% CI was calculated and variables having a p value less than 0.05 were statistically significant factors of anaemia. RESULT The overall prevalence of anaemia among adolescent girls in Ethiopia was 23.8 (22.4 to 25.3), with significant spatial variations across the country. The SaTScan analysis identified a primary cluster in the eastern, northeastern and southeastern parts of Ethiopia (loglikelihood ratio=39, p<0.001). High anaemia prevalence was observed in eastern parts of the country. In the multivariable multilevel logistic regression analysis, no formal education (adjusted OR (AOR)=1.49, 95% CI 1.05 to 2.12), Afar (AOR=3.36, 95% CI 1.87 to 6.05), Somali (AOR=4.63, 95% CI 2.61 to 8.23), Harari (AOR=1.90, 95% CI 1.32 to 4.10), Dire Dawa (AOR=2.32, 95% CI 1.32 to 4.10) and high cluster altitude (AOR=1.37, 95% CI 1.03 to 1.82) were significantly associated with anaemia. CONCLUSION The national distributions of anaemia varied substantially across Ethiopia. Educational status, region and cluster altitude were significantly associated with anaemia in the multivariable logistic regression model. Thus, targeted public health interventions for adolescent girls should be implemented in the hotspot areas.
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Affiliation(s)
- Kendalem Asmare Atalell
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Masresha Asmare Techane
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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