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Chen K, Wang W, Qiu J, Guo W, Du J, Gao B, Hu Z, Qiao H. Housing conditions, cooking fuels, and health-related quality of life among rural middle-aged and elderly in northwest China: A ten-year balanced panel study. Prev Med Rep 2024; 37:102563. [PMID: 38205167 PMCID: PMC10776773 DOI: 10.1016/j.pmedr.2023.102563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/09/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
To investigate the impacts of improving housing conditions and transitioning to clean cooking fuels on health-related quality of life (HRQOL) among middle-aged and elderly populations in rural China. METHODS Using a 10-year longitudinal follow-up study, we examined changes in housing conditions, cooking fuel use, and HRQOL among 690 Chinese adults aged 45 above in rural areas. HRQOL was assessed using the European Quality of Life-5 Dimensions 3 Levels (EQ-5D-3L) questionnaire. Generalized estimating equations were utilized to analyze correlations between variables. RESULTS Using four-period balanced panel data of 10 years, there were significant differences in the self-reporting of mobility, self-care, usual activities, pain / discomfort and anxiety / depression in rural middle-aged and elderly people (p < 0.05). In terms of the EQ-5D index score and EQ-VAS score, showed a decreasing trend (p < 0.05). The housing area, housing material type, utilization of sanitary toilets, separation of housing and kitchen were separated and non-solid fuels used as cooking fuel were significantly associated with high HRQOL (p < 0.05). CONCLUSIONS This study found that good housing conditions and the use of non-solid cooking fuel had positive effects on health-related quality of life of middle-aged and elderly people in rural areas of northwest China.
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Affiliation(s)
- Kexin Chen
- School of Public Health, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, China
| | - Wenlong Wang
- School of Public Health, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, China
| | - Jiangwei Qiu
- School of Public Health, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, China
| | - Wenqin Guo
- School of Public Health, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, China
| | - Jiancai Du
- School of Public Health, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, China
| | - Baokai Gao
- School of Public Health, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, China
| | - Zhaoyan Hu
- School of Public Health, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, China
| | - Hui Qiao
- School of Public Health, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, China
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Akteruzzaman M, Rahman MA, Rabbi FM, Asharof S, Rofi MM, Hasan MK, Muktadir Islam MA, Khan MAR, Rahman MM, Rahaman MH. The impacts of cooking and indoor air quality assessment in the southwestern region of Bangladesh. Heliyon 2023; 9:e12852. [PMID: 36711262 PMCID: PMC9880388 DOI: 10.1016/j.heliyon.2023.e12852] [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: 07/30/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
The main objective of this study is to assess the impacts of cooking and indoor air quality (IAQ) in the southwestern region of Bangladesh. Here we report and compare the IAQ in considering a total of eight kitchens and living rooms of four selected households (HHs) in Jashore city and suburb area, the southwest district of Bangladesh. Air quality parameters, such as particulate matter (PM2.5) and volatile organic compounds (VOC), were assessed continuously for 24 h. In addition, Carbon dioxide (CO2) was evaluated in different phases during the study period. PM2.5, VOC, and CO2 levels were ranged from 18.52 to 207 μg/m3, 7.95-35.66 ppm, and 1061-2459 mg/m3, respectively, in the indoor cooking HHs. Conversely, while the average concentration was found between 20.63 and 23.72 μg/m3 PM2.5, 11.18-12.36 ppm VOC, and 1097-1747 mg/m3 CO2 in the outdoor cooking HHs. A significant increase in CO2 due to kitchen activities (cooking, frying, boiling) was observed that ranged between 5 and 77% compared to the background level. The calculated range of toxicity potential (TP) values was between 0.8 and 8.3 for PM2.5 in the HHs. In most of the observations, PM2.5, VOC, and CO2 exceed the standard values. The study reports that well ventilation systems and clean fuel use significantly reduce the indoor air contaminants level. Our study offers new insights about the IAQ of the southwest region of Bangladesh, particularly for suburbs and urban setups, and provides a background for further study, and decision-making. It will serve as a reference for the formulation and implementation of policies to improve air quality.
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Affiliation(s)
- Md. Akteruzzaman
- Department of Environmental Science and Technology, Jashore University of Science and Technology, Jashore 7408, Bangladesh
| | - Md. Alinur Rahman
- Department of Environmental Science and Technology, Jashore University of Science and Technology, Jashore 7408, Bangladesh
| | - Fahim Muntasir Rabbi
- Department of Environmental Science and Technology, Jashore University of Science and Technology, Jashore 7408, Bangladesh
| | - Sohely Asharof
- Department of Environmental Science and Technology, Jashore University of Science and Technology, Jashore 7408, Bangladesh
| | - Mahi Muzammel Rofi
- Department of Environmental Science and Technology, Jashore University of Science and Technology, Jashore 7408, Bangladesh
| | - Md. Kamrul Hasan
- Department of Environmental Science and Technology, Jashore University of Science and Technology, Jashore 7408, Bangladesh
| | - Md. Abdul Muktadir Islam
- Department of Chemistry, Jashore University of Science and Technology (JUST), Jashore 7408, Bangladesh
| | - M. Azizur R. Khan
- Department of Chemistry, Jashore University of Science and Technology (JUST), Jashore 7408, Bangladesh
| | - Mohammad Mahfuzur Rahman
- Department of Environmental Science and Technology, Jashore University of Science and Technology, Jashore 7408, Bangladesh
| | - Md. Hasibur Rahaman
- Department of Environmental Science and Technology, Jashore University of Science and Technology, Jashore 7408, Bangladesh,Corresponding author.
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Dhital S, Rupakheti D, Rupakheti M, Yin X, Liu Y, Mafiana JJ, Alareqi MM, Mohamednour H, Zhang B. A scientometric analysis of indoor air pollution research during 1990-2019. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2022; 320:115736. [PMID: 35932736 DOI: 10.1016/j.jenvman.2022.115736] [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: 02/07/2021] [Revised: 01/26/2022] [Accepted: 07/09/2022] [Indexed: 06/15/2023]
Abstract
Indoor air pollution (IAP) is one of the leading risk factors for various adverse health outcomes including premature deaths globally. Even though research related to IAP has been carried out, bibliometric studies with particular emphasis on this topic have been lacking. Here, we investigated IAP research from 1990 to 2019 retrieved from the Web of Science database through a comprehensive and systematic scientometric analysis using the CiteSpace 5.7.R2, a powerful tool for visualizing structural, temporal patterns and trends of a scientific field. There was an exponential increase in publications, however, with a stark difference between developed and developing countries. The journals publishing IAP related research had multiple disciplines; 'Indoor Air' journal that focuses solely on IAP issues ranked fifth among top-cited journals. The terms like 'global burden', 'comparative risk assessment,' 'household air pollution (HAP)', 'ventilation', 'respiratory health', 'emission factor', 'impact,' 'energy', 'household', 'India' were the current topical subject where author Kirk R. Smith was identified with a significant contribution. Research related to rural, fossil-fuel toxicity, IAP, and exposure-assessment had the highest citation burst signifying the particular attention of scientific communities to these subjects. Overall, this study examined the evolution of IAP research, identified the gaps and provided future research directions.
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Affiliation(s)
- Sushma Dhital
- School of Public Health, Lanzhou University, Lanzhou 730000, China.
| | - Dipesh Rupakheti
- Jiangsu Key Laboratory of Atmospheric Environment Monitoring and Pollution Control, Collaborative Innovation Center of Atmospheric Environment and Equipment Technology, School of Environmental Science and Engineering, Nanjing University of Information Science & Technology, Nanjing 210044, China
| | | | - Xiufeng Yin
- State Key Laboratory of Cryospheric Science, Northwest Institute of Eco-Environment and Resources, Chinese Academy of Sciences, Lanzhou 730000, China
| | - Yanli Liu
- School of Public Health, Lanzhou University, Lanzhou 730000, China
| | | | | | | | - Benzhong Zhang
- School of Public Health, Lanzhou University, Lanzhou 730000, China.
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Huang Y, Wang J, Chen Y, Chen L, Chen Y, Du W, Liu M. Household PM 2.5 pollution in rural Chinese homes: Levels, dynamic characteristics and seasonal variations. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 817:153085. [PMID: 35038528 DOI: 10.1016/j.scitotenv.2022.153085] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 01/08/2022] [Accepted: 01/09/2022] [Indexed: 06/14/2023]
Abstract
Humans generally spend most of their time indoors, and fine particulate matter (PM2.5) in indoor air can have seriously adverse effects on human health due to the long exposure time. This study conducted field measurements to explore seasonal variations of PM2.5 concentrations in household air by revisiting the same rural homes in southern China and factors influencing indoor PM2.5 concentrations were explored mainly by one-way ANOVA. The PM2.5 concentrations of outdoor, kitchen and living room air were 38.9 ± 12.2, 47.1 ± 20.3 and 50.8 ± 24.1 μg/m3 in summer, respectively, which were 2.3 to 2.9 times lower than those in winter (p < 0.05). The lower indoor PM2.5 pollution in summer was attributed to the transition to clean household energy and better ventilation. Fuel type can significantly affect PM2.5 concentrations in the kitchen, with greater PM2.5 pollution associated with wood combustion than electricity. Our study firstly found mosquito coil emission was an important contributor to PM2.5 in the living room of rural households, which should be investigated further. Dynamic variations of PM2.5 suggested that cooking, heating and mosquito coil emission can rapidly increase indoor PM2.5 concentrations (up to one order of magnitude higher than baseline values), as well as the indoor/outdoor PM2.5 ratios. This study had the first insight of seasonal differences of household PM2.5 in the same rural homes using real-time monitors, confirming the different patterns and characteristics of household PM2.5 pollution in different seasons.
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Affiliation(s)
- Ye Huang
- Key Laboratory of Geographic Information Science of the Ministry of Education, School of Geographic Sciences, East China Normal University, Shanghai 200241, China
| | - Jinze Wang
- Key Laboratory of Geographic Information Science of the Ministry of Education, School of Geographic Sciences, East China Normal University, Shanghai 200241, China
| | - Yan Chen
- Key Laboratory of Geographic Information Science of the Ministry of Education, School of Geographic Sciences, East China Normal University, Shanghai 200241, China
| | - Long Chen
- Key Laboratory of Geographic Information Science of the Ministry of Education, School of Geographic Sciences, East China Normal University, Shanghai 200241, China
| | - Yuanchen Chen
- College of Environment, Research Centre of Environmental Science, Zhejiang University of Technology, Hangzhou 310032, China
| | - Wei Du
- Key Laboratory of Geographic Information Science of the Ministry of Education, School of Geographic Sciences, East China Normal University, Shanghai 200241, China.
| | - Min Liu
- Key Laboratory of Geographic Information Science of the Ministry of Education, School of Geographic Sciences, East China Normal University, Shanghai 200241, China
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5
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Li Y, Wang Y, Wang J, Chen L, Wang Z, Feng S, Lin N, Du W. Quantify individual variation of real-time PM 2.5 exposure in urban Chinese homes based on a novel method. INDOOR AIR 2022; 32:e12962. [PMID: 34841578 DOI: 10.1111/ina.12962] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/19/2021] [Accepted: 11/06/2021] [Indexed: 06/13/2023]
Abstract
Fine particulate matter (PM2.5 ) concentrations show high variations in different microenvironments indoors, which has considerable impact on risk management. However, the real-time variations of PM2.5 exposure associated with per activity/microenvironment and intra-variation among family members remain undefined. In this study, real-time monitors were used to collect real-time PM2.5 data in different microenvironments in 32 households in urban community of China. Peak concentrations of PM2.5 were found in kitchen. The parallel levels of PM2.5 household indoor and outdoor indicated the benefit of clean energies use. To validly assess the health risk of individuals, we proposed a novel method to estimate the real-time exposure of all residents and firstly investigate the intra-variation of PM2.5 exposure among family members. The member who is responsible for cooking in the family had the maximum PM2.5 exposure. The ratios among intraindividual variations demonstrated children usually had lower exposure compared to the adults as they stayed more time in lower polluted microenvironments such as living room and bedroom. The exposure intensity in living room was above 1.0 for most residents, indicating it is warranted to alleviate the air pollution in living room. This study firstly focused on the intra differences of PM2.5 exposure among family members and provided a new insight for indoor air pollution management. The results suggested when adopting measures to reduce exposure, the microenvironments pattern of each member should be taken into consideration. Future work is welcomed to move another big step on this issue to protect the human health.
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Affiliation(s)
- Yungui Li
- Department of Environmental Engineering, Southwest University of Science and Technology, Mianyang, China
| | - Yuqiong Wang
- Department of Environmental Engineering, Southwest University of Science and Technology, Mianyang, China
| | - Jinze Wang
- Key Laboratory of Geographic Information Science of the Ministry of Education, School of Geographic Sciences, East China Normal University, Shanghai, China
| | - Long Chen
- Key Laboratory of Geographic Information Science of the Ministry of Education, School of Geographic Sciences, East China Normal University, Shanghai, China
| | - Zhenglu Wang
- College of Oceanography, Hohai University, Nanjing, Jiangsu, China
| | - Sheng Feng
- Department of Environmental Engineering, Southwest University of Science and Technology, Mianyang, China
| | - Nan Lin
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Du
- Key Laboratory of Geographic Information Science of the Ministry of Education, School of Geographic Sciences, East China Normal University, Shanghai, China
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Trends of Stunting Prevalence and Its Associated Factors among Nigerian Children Aged 0-59 Months Residing in the Northern Nigeria, 2008-2018. Nutrients 2021; 13:nu13124312. [PMID: 34959864 PMCID: PMC8708583 DOI: 10.3390/nu13124312] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/26/2021] [Indexed: 01/31/2023] Open
Abstract
Every year in Nigeria, malnutrition contributes to more than 33% of the deaths of children below 5 years, and these deaths mostly occur in the northern geopolitical zones (NGZs), where nearly 50% of all children below 5 years are stunted. This study examined the trends in the prevalence of stunting and its associated factors among children aged 0-23 months, 24-59 months and 0-59 months in the NGZs. The data of 33,682 recent live births in the NGZs, extracted from the Nigeria Demographic and Health Surveys from 2008 to 2018, were used to investigate the factors associated with stunting using multilevel logistic regression. Children aged 24-59 months reported the highest prevalence of stunting, with 53.3% (95% confidence interval: 52.0-54.6%). Multivariable analyses revealed four common factors that increased the odds of a child's stunting across all age subgroups: poor households, geopolitical zone (northwest or northeast), being a male and maternal height (<145 cm). Interventional strategies focused on poverty mitigation through cash transfer and educating low socioeconomic mothers on the benefits of gender-neutral supplementary feeding and the timely monitoring of the offspring of short mothers would substantially reduce stunting across all age subgroups in the NGZs.
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7
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Pratiti R. Household air pollution related to biomass cook stove emissions and its interaction with improved cookstoves. AIMS Public Health 2021; 8:309-321. [PMID: 34017894 PMCID: PMC8116181 DOI: 10.3934/publichealth.2021024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/23/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Household air pollution (HAP) is associated with significant global morbidity and mortality. Newer initiatives including improved cookstove (IC) and cleaner fuels are being implemented to improve HAP effects. Methods A literature review was conducted for household air pollution related to biomass cookstoves in resource limited countries. In January 2018, we electronically searched the PubMed database for the term cookstoves with no date restrictions. We included cohort, case-control, cross-sectional studies, conference abstracts, editorials, and reviews; studies that assessed the emissions related to cookstove and factors affecting HAP emissions. Results Twenty-three articles met the objectives of the review. Fine particulate matter with aerodynamic diameter <2.5 µm (PM2.5), carbon monoxide (CO) and polycyclic aromatic hydrocarbons (PAH) are the major HAP emissions. Emission factors are based on the stove and fuel used while the activity is based on cooking practices. Changes in composition and sources of PM2.5 causes modification to its resulting toxicity. Many PAHs and their metabolites released by HAP have carcinogenic, teratogenic and mutagenic potential. Improving ventilation decreases concentrations of PM2.5 and CO in the household air. Few standard tools are available to measure ventilation and continued IC efficacy in long term. Conclusion Unavailability of tools to measure ventilation and continued IC efficacy in long term affect uniformity and comparability of IC study results. Community education about the health effects of HAP and importance of ventilation in decreasing HAP is an important aspect of public health policy to prevent HAP effects.
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Rani R, Arokiasamy P, Meitei WB, Sikarwar A. Association between indoor air pollution and cognitive function of older adults in India: a cross-sectional multilevel analysis. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01521-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Bhargava B, Malhotra S, Chandel A, Rakwal A, Kashwap RR, Kumar S. Mitigation of indoor air pollutants using Areca palm potted plants in real-life settings. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:8898-8906. [PMID: 33074430 DOI: 10.1007/s11356-020-11177-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/06/2020] [Indexed: 06/11/2023]
Abstract
Deterioration of indoor air quality (IAQ) has become a serious concern as people spend lots of time indoors and prolonged pollution exposure can result in adverse health outcomes. Indoor plants can phytoremediate a wide variety of indoor contaminants. Nonetheless, few experiments have demonstrated their efficacy in real-time environments. Therefore, the present study aims to experimentally assess the efficiency of Areca palm potted plants in phytoremediation of primary indoor air pollutant viz. total volatile organic compounds (TVOCs), carbon dioxide (CO2), and carbon monoxide (CO) levels from real-world indoor spaces, for the first time. Four discrete naturally ventilated experimental sites (I-IV) situated at the Council of Scientific and Industrial Research- Institute of Himalayan Bioresource Technology (CSIR-IHBT) were used. For over a period of 4 months, the sites were monitored using zero plants as a control (1-4 week), three plants (5-8 week), six plants (9-12 week), and nine plants (13-16 week), respectively. Present results indicate that Areca palm potted plants can effectively reduce the TVOCs, CO2, and CO levels by 88.16% in site IV, 52.33% and 95.70% in site III, respectively. The current study concluded that Areca palm potted plants offer an efficient, cost-effective, self-regulating, sustainable solution for improving indoor air quality and thereby human well-being and productivity in closed and confined spaces.
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Affiliation(s)
- Bhavya Bhargava
- Floriculture Laboratory, Agrotechnology of Medicinal, Aromatic and Commercially Important Plants Division, Council of Scientific and Industrial Research-Institute of Himalayan Bioresource Technology, P.O. Box 6, Palampur, (H.P.), 176061, India.
| | - Sandeep Malhotra
- Floriculture Laboratory, Agrotechnology of Medicinal, Aromatic and Commercially Important Plants Division, Council of Scientific and Industrial Research-Institute of Himalayan Bioresource Technology, P.O. Box 6, Palampur, (H.P.), 176061, India
| | - Anjali Chandel
- Floriculture Laboratory, Agrotechnology of Medicinal, Aromatic and Commercially Important Plants Division, Council of Scientific and Industrial Research-Institute of Himalayan Bioresource Technology, P.O. Box 6, Palampur, (H.P.), 176061, India
| | - Anjali Rakwal
- Floriculture Laboratory, Agrotechnology of Medicinal, Aromatic and Commercially Important Plants Division, Council of Scientific and Industrial Research-Institute of Himalayan Bioresource Technology, P.O. Box 6, Palampur, (H.P.), 176061, India
| | - Rachit Raghav Kashwap
- High Altitude Biology Division, Council of Scientific and Industrial Research-Institute of Himalayan BioresourceTechnology, P.O. Box 6, Palampur, (H.P.), 176061, India
| | - Sanjay Kumar
- Biotechnology Division, Council of Scientific and Industrial Research-Institute of Himalayan BioresourceTechnology, P.O. Box 6, Palampur, (H.P.), 176061, India
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10
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Dai X, Bui DS, Perret JL, Lowe AJ, Frith PA, Bowatte G, Thomas PS, Giles GG, Hamilton GS, Tsimiklis H, Hui J, Burgess J, Win AK, Abramson MJ, Walters EH, Dharmage SC, Lodge CJ. Exposure to household air pollution over 10 years is related to asthma and lung function decline. Eur Respir J 2021; 57:13993003.00602-2020. [PMID: 32943407 DOI: 10.1183/13993003.00602-2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/07/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION We investigated if long-term household air pollution (HAP) is associated with asthma and lung function decline in middle-aged adults, and whether these associations were modified by glutathione S-transferase (GST) gene variants, ventilation and atopy. MATERIALS AND METHODS Prospective data on HAP (heating, cooking, mould and smoking) and asthma were collected in the Tasmanian Longitudinal Health Study (TAHS) at mean ages 43 and 53 years (n=3314). Subsamples had data on lung function (n=897) and GST gene polymorphisms (n=928). Latent class analysis was used to characterise longitudinal patterns of exposure. Regression models assessed associations and interactions. RESULTS We identified seven longitudinal HAP profiles. Of these, three were associated with persistent asthma, greater lung function decline and % reversibility by age 53 years compared with the "Least exposed" reference profile for those who used reverse-cycle air conditioning, electric cooking and no smoking. The "All gas" (OR 2.64, 95% CI 1.22-5.70), "Wood heating/smoking" (OR 2.71, 95% CI 1.21-6.05) and "Wood heating/gas cooking" (OR 2.60, 95% CI 1.11-6.11) profiles were associated with persistent asthma, as well as greater lung function decline and % reversibility. Participants with the GSTP1 Ile/Ile genotype were at a higher risk of asthma or greater lung function decline when exposed compared with other genotypes. Exhaust fan use and opening windows frequently may reduce the adverse effects of HAP produced by combustion heating and cooking on current asthma, presumably through increasing ventilation. CONCLUSIONS Exposures to wood heating, gas cooking and heating, and tobacco smoke over 10 years increased the risks of persistent asthma, lung function decline and % reversibility, with evidence of interaction by GST genes and ventilation.
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Affiliation(s)
- Xin Dai
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Dinh S Bui
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Peter A Frith
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia.,National Institute of Fundamental Studies, Kandy, Sri Lanka.,Dept of Basic Sciences, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Paul S Thomas
- Inflammation and Infection Research, Faculty of Medicine, University of New South Wales, Randwick, Australia
| | - Graham G Giles
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Garun S Hamilton
- Dept of Lung and Sleep Medicine, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Helen Tsimiklis
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Jennie Hui
- The PathWest Laboratory Medicine of West Australia, Perth, Australia
| | - John Burgess
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Aung K Win
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia.,University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, Australia.,Genetic Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - E Haydn Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia.,School of Medicine, University of Tasmania, Hobart, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia .,Equal senior authors
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia.,Equal senior authors
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11
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Gizaw Z, Teka Z. Correlates of Indoor Concentration of Carbon Monoxide in Residential Buildings in Gondar Town, Northwest Ethiopia. ENVIRONMENTAL HEALTH INSIGHTS 2020; 14:1178630220978234. [PMID: 33335399 PMCID: PMC7724403 DOI: 10.1177/1178630220978234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/11/2020] [Indexed: 06/12/2023]
Abstract
This community-based cross-sectional study was conducted to investigate the indoor concentration of carbon monoxide (CO) and associated factors in residential buildings of Gondar town, northwest Ethiopia. Data were collected from 384 occupied buildings and occupants using CO meter, interviewers administered questionnaire, and observation checklists. Multivariable binary logistic regression analysis was used for controlling the possible effect of confounders and to identify factors associated with indoor concentration of CO on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and P < .05. The current study revealed that 224(58.3%) occupied buildings had the concentration of CO above the permissible value for 15 minute exposure for living rooms (100 mg/m3). Indoor concentration of CO was significantly associated with access to health information [AOR = 0.081, 95%CI = (0.008, 0.803)], number of rooms [AOR = 0.016, 95% CI = (0.001, 0.279)], area of occupied room [AOR = 0.019, 95% CI = (0.001, 0.237)], buildings located away from main roads/garages [AOR = 0.045, 95% CI = (0.005, 0.415)], clean energy sources [AOR = 0.010, 95% CI = (0.001, 0.123)], presence of separate kitchen [AOR = 0.030, 95% CI = (0.004, 0.221)], no incensing in the room [AOR = 0.055, 95% CI = (0.006,0.499)] and measurements in the afternoon [AOR = 0.114, 95% CI = (0.013, 0.965)]. Residents, therefore, need to use clean energy sources, construct a kitchen with a properly constructed chimneys away from the main building, and avoid incensing inside the indoor environment.
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Affiliation(s)
- Zemichael Gizaw
- Department of Environmental and
Occupational Health and Safety, Institute of Public Health, College of Medicine and
Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zinabu Teka
- Department of Statistics, College of
Natural and Computational Sciences, University of Gondar, Gondar, Ethiopia
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Jelili MO, Gbadegesin AS, Alabi AT. Comparative Analysis of Indoor and Outdoor Particulate Matter Concentrations and Air Quality in Ogbomoso, Nigeria. J Health Pollut 2020; 10:201205. [PMID: 33324502 PMCID: PMC7731495 DOI: 10.5696/2156-9614-10.28.201205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/23/2020] [Indexed: 05/30/2023]
Abstract
BACKGROUND Airborne particulates are an issue in many urban regions around the world and their detrimental impact on human health has increasingly become a public health concern. OBJECTIVES The aim of the present study was to examine particle pollution in an urban settlement in Nigeria. This study examines the extent, spatial variation, and sources of indoor and outdoor particulate matter (PM) concentrations in Ogbomoso, Nigeria. METHODS The survey research method was adopted. Sampling included 385 buildings across selected precincts and different residential zones in the town of Ogbomoso. Particulate matter analytes (PM1, PM2.5 and PM10) within/around each building were measured with a particle counter and details on domestic utilities/practices were obtained with a questionnaire. Analysis of variance was used to determine inter-zonal variations in PM levels and simple linear regression was used to analyze the relationship between indoor and outdoor air quality. RESULTS Indoor and outdoor respirable particle (PM2.5) concentrations were lower than the World Health Organization (WHO) Interim Target limit of 75 μg/m3, while concentrations of inhalable particles (PM10) were higher than the set limit of 150 μg/m3 for daily averages. Coarse particles dominated, with an accumulative PM2.5/PM10 ratio of 0.24. The inter-zonal analysis of PM concentrations revealed that indoor and outdoor PM levels varied significantly by residential zone (p = 0.0005; p = 0.01, respectively). Regression analysis showed a significant but weak relationship between indoor and outdoor PM levels (r = +0.221), while the coefficient of determination (R2 = 0.049) showed that only about 5% of the variation in indoor air quality was associated with outdoor air quality. Particle pollution inducers were identified in the residents' waste disposal methods and adopted fuels/energy sources, with firewood and charcoal linked with increased concentrations of particulate matter. CONCLUSIONS Air quality was relatively poor in the study area given observed particulate matter concentrations. Cleaner fuels, effective waste management systems and improved roads are needed to foster better air quality in the study area. COMPETING INTERESTS The authors declare no competing financial interests.
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Affiliation(s)
- Musibau O. Jelili
- Department of Urban and Regional Planning, Faculty of Environmental Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Adeniyi S. Gbadegesin
- Department of Urban and Regional Planning, Faculty of Environmental Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Abimbola T. Alabi
- Department of Urban and Regional Planning, Faculty of Environmental Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
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Tiwari I, Herr RM, Loerbroks A, Yamamoto SS. Household Air Pollution and Angina Pectoris in Low- and Middle-Income Countries: Cross-Sectional Evidence from the World Health Survey 2002-2003. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165802. [PMID: 32796570 PMCID: PMC7460098 DOI: 10.3390/ijerph17165802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 12/03/2022]
Abstract
The evidence regarding the effects of household air pollution on angina pectoris is limited in low-and middle-income countries (LMICs). We sought to examine the association between household air pollution and angina pectoris across several countries. We analyzed data of individuals from 46 selected countries participating in the cross-sectional World Health Survey (WHS) 2002–2003. Pooled and stratified (sex, continent) logistic regression with sampling weights was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to quantify associations between the use of different household fuels with angina pectoris. In the pooled sample, we observed lower odds of angina pectoris with electricity use (OR: 0.68, 95% CI: 0.56–0.83) compared to those households reporting the use of gas as a household fuel. Increased odds of angina pectoris were observed with the use of agriculture/dung/shrub/other (OR: 1.65, 95% CI: 1.30–2.09), mixed (solid and non-solid fuels) (OR: 1.31, 95% CI: 1.09–1.56), and mixed solid fuel use (OR: 1.59, 95% CI: 1.12–2.25). Higher odds of angina pectoris were observed mainly with solid fuel use. The results highlight the importance of addressing these issues, especially in regions with a high proportion of solid fuel users and increasing levels of cardiovascular disease.
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Affiliation(s)
- Ishwar Tiwari
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada;
- Correspondence:
| | - Raphael M. Herr
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany;
| | - Adrian Loerbroks
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, 40225 Düsseldorf, Germany;
| | - Shelby S. Yamamoto
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada;
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Yamamoto SS, Yacyshyn E, Jhangri GS, Chopra A, Parmar D, Jones CA. Household air pollution and arthritis in low-and middle-income countries: Cross-sectional evidence from the World Health Organization's study on Global Ageing and Adult Health. PLoS One 2019; 14:e0226738. [PMID: 31881058 PMCID: PMC6934325 DOI: 10.1371/journal.pone.0226738] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/06/2019] [Indexed: 02/07/2023] Open
Abstract
Background Evidence points to a clear link between air pollution exposure and several chronic diseases though investigations regarding arthritis are still lacking. Emerging evidence suggests an association between ambient air pollution and rheumatoid arthritis. Household air pollution exposure, conversely, is largely unstudied but may be an important consideration for arthritis, particularly in low- and middle-income countries (LMICs), where cooking and heating activities can generate high indoor air pollutant levels. Methods We investigated the association of household air pollution (electricity vs. gas; kerosene/paraffin; coal/charcoal; wood; or agriculture/crop/animal dung/shrubs/grass as the main fuel used for cooking) and arthritis in six LMICs (China, Ghana, India, Mexico, the Russian Federation, South Africa) using data from Wave I of the World Health Organization Study on Global AGEing and Adult Health (SAGE) (2007–2010). Multivariable analyses were adjusted for sociodemographic, household and lifestyle characteristics and several comorbidities. Results The use of gas (aOR = 1.76, 95%CI: 1.40–2.21); coal (aOR = 1.74, 95%CI: 1.22–2.47); wood (aOR = 1.69, 95%CI: 1.30–2.19); or agriculture/crop/animal dung/shrubs/grass: aOR = 1.95 (1.46–2.61) fuels for cooking were strongly associated with an increased odds of arthritis, compared to electricity in cluster and stratified adjusted analyses. Gender (female), age (≥50 years), overweight (25.0 ≤BMI<30.0 kg/m2), obesity (BMI ≥30.0 kg/m2), former and current alcohol consumption, and the comorbidities angina pectoris, diabetes, chronic lung disease, depression and hypertension were also associated with a higher odds of arthritis. Underweight (BMI<18.5 kg/m2) and higher education levels (college/university completed/post-graduate studies) were associated with a lower odds of arthritis. Conclusions These findings suggest that exposure to household air pollution from cook fuels is associated with an increased odds of arthritis in these regions, which warrants further investigation.
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Affiliation(s)
- Shelby S. Yamamoto
- School of Public Health, University of Alberta, Edmonton, Canada
- * E-mail:
| | - Elaine Yacyshyn
- Division of Rheumatology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Gian S. Jhangri
- School of Public Health, University of Alberta, Edmonton, Canada
| | | | - Divya Parmar
- School of Health Sciences, City, University of London, London, England, United Kingdom
| | - C. Allyson Jones
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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Weaver AM, Gurley ES, Crabtree-Ide C, Salje H, Yoo EH, Mu L, Akter N, Ram PK. Air pollution dispersion from biomass stoves to neighboring homes in Mirpur, Dhaka, Bangladesh. BMC Public Health 2019; 19:425. [PMID: 31014315 PMCID: PMC6480710 DOI: 10.1186/s12889-019-6751-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 04/05/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Indoor air pollution, including fine particulate matter (PM2.5) and carbon monoxide (CO), is a major risk factor for pneumonia and other respiratory diseases. Biomass-burning cookstoves are major contributors to PM2.5 and CO concentrations. However, high concentrations of PM2.5 (> 1000 μg/m3) have been observed in homes in Dhaka, Bangladesh that do not burn biomass. We described dispersion of PM2.5 and CO from biomass burning into nearby homes in a low-income urban area of Dhaka, Bangladesh. METHODS We recruited 10 clusters of homes, each with one biomass-burning (index) home, and 3-4 neighboring homes that used cleaner fuels with no other major sources of PM2.5 or CO. We administered a questionnaire and recorded physical features of all homes. Over 24 h, we recorded PM2.5 and CO concentrations inside each home, near each stove, and outside one neighbor home per cluster. During 8 of these 24 h, we conducted observations for pollutant-generating activities such as cooking. For each monitor, we calculated geometric mean PM2.5 concentrations at 5-6 am (baseline), during biomass burning times, during non-cooking times, and over 24 h. We used linear regressions to describe associations between monitor location and PM2.5 and CO concentrations. RESULTS We recruited a total of 44 homes across the 10 clusters. Geometric mean PM2.5 and CO concentrations for all monitors were lowest at baseline and highest during biomass burning. During biomass burning, linear regression showed a decreasing trend of geometric mean PM2.5 and CO concentrations from the biomass stove (326.3 μg/m3, 12.3 ppm), to index home (322.7 μg/m3, 11.2 ppm), neighbor homes sharing a wall with the index home (278.4 μg/m3, 3.6 ppm), outdoors (154.2 μg/m3, 0.7 ppm), then neighbor homes that do not share a wall with the index home (83.1 μg/m3,0.2 ppm) (p = 0.03 for PM2.5, p = 0.006 for CO). CONCLUSION Biomass burning in one home can be a source of indoor air pollution for several homes. The impact of biomass burning on PM2.5 or CO is greatest in homes that share a wall with the biomass-burning home. Eliminating biomass burning in one home may improve air quality for several households in a community.
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Affiliation(s)
- Anne M. Weaver
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY USA
| | - Emily S. Gurley
- Programme for Emerging Infections, icddr,b, Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Christina Crabtree-Ide
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY USA
| | - Henrik Salje
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | - Eun-Hye Yoo
- Department of Geography, University at Buffalo, Buffalo, NY USA
| | - Lina Mu
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY USA
| | - Nasrin Akter
- Programme for Emerging Infections, icddr,b, Dhaka, Bangladesh
| | - Pavani K. Ram
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY USA
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Patel SK, Patel S, Kumar A. Effects of cooking fuel sources on the respiratory health of children: evidence from the Annual Health Survey, Uttar Pradesh, India. Public Health 2019; 169:59-68. [DOI: 10.1016/j.puhe.2019.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/05/2018] [Accepted: 01/07/2019] [Indexed: 12/28/2022]
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Naz S, Page A, Agho KE. Potential Impacts of Modifiable Behavioral and Environmental Exposures on Reducing Burden of Under-five Mortality Associated with Household Air Pollution in Nepal. Matern Child Health J 2018; 22:59-70. [PMID: 28755047 DOI: 10.1007/s10995-017-2355-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives Household air pollution (HAP) is one of the leading causes of respiratory illness and deaths among young children in low and lower-middle income countries. This study examines for the first time trends in the association between HAP from cooking fuel and under-five mortality and measures the potential impact of interventions to reduce HAP using Nepal Demographic and Health Survey datasets (2001-2011). Methods A total of 17,780 living children across four age-groups (neonatal 0-28 days, post-neonatal 1-11 months, child 12-59 months and under-five 0-59 months) were included and multi-level logistic regression models were used for analyses. Population attributable fractions of key risk factors and potential impact fractions assessing the impact of previous interventions to reduce exposure prevalence were also calculated. Results Use of cooking fuel was associated with total under-five mortality (OR 2.19, 95% CI 1.37-3.51, P = 0.001) in Nepal, with stronger associations evident for sub-group analyses of neonatal mortality (OR 2.67, 95% CI 1.47-4.82, P = 0.001). Higher association was found in rural areas and for households without a separate kitchen using polluting fuel for cooking, and in women who had never breastfed for all age-groups of children. PIF estimates, assuming a 63% of reduction of HAP based on previously published interventions in Nepal, suggested that a burden of 40% of neonatal and 33% of under-five mortality cases associated with an indoor kitchen using polluting fuel could be avoidable. Conclusion Improved infrastructure and behavioral interventions could help reduce the pollution from cooking fuel in the household resulting in further reduction in under-five mortality in Nepal.
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Affiliation(s)
- Sabrina Naz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Building 3, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia.
| | - Andrew Page
- Translational Health Research Institute, School of Medicine, Western Sydney University, Building 3, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
| | - Kingsley Emwinyore Agho
- School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
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Shupler M, Godwin W, Frostad J, Gustafson P, Arku RE, Brauer M. Global estimation of exposure to fine particulate matter (PM 2.5) from household air pollution. ENVIRONMENT INTERNATIONAL 2018; 120:354-363. [PMID: 30119008 DOI: 10.1016/j.envint.2018.08.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 05/22/2023]
Abstract
BACKGROUND Exposure to household air pollution (HAP) from cooking with dirty fuels is a leading health risk factor within Asia, Africa and Central/South America. The concentration of particulate matter of diameter ≤ 2.5 μm (PM2.5) is an important metric to evaluate HAP risk, however epidemiological studies have demonstrated significant variation in HAP-PM2.5 concentrations at household, community and country levels. To quantify the global risk due to HAP exposure, novel estimation methods are needed, as financial and resource constraints render it difficult to monitor exposures in all relevant areas. METHODS A Bayesian, hierarchical HAP-PM2.5 global exposure model was developed using kitchen and female HAP-PM2.5 exposure data available in peer-reviewed studies from an updated World Health Organization Global HAP database. Cooking environment characteristics were selected using leave-one-out cross validation to predict quantitative HAP-PM2.5 measurements from 44 studies. Twenty-four hour HAP-PM2.5 kitchen concentrations and male, female and child exposures were estimated for 106 countries in Asia, Africa and Latin America. RESULTS A model incorporating fuel/stove type (traditional wood, improved biomass, coal, dung and gas/electric), urban/rural location, wet/dry season and socio-demographic index resulted in a Bayesian R2 of 0.57. Relative to rural kitchens using gas or electricity, the mean global 24-hour HAP-PM2.5 concentrations were 290 μg/m3 higher (range of regional averages: 110, 880) for traditional stoves, 150 μg/m3 higher (range of regional averages: 50, 290) for improved biomass stoves, 850 μg/m3 higher (range of regional averages: 310, 2600) for animal dung stoves, and 220 μg/m3 higher (range of regional averages: 80, 650) for coal stoves. The modeled global average female/kitchen exposure ratio was 0.40. Average modeled female exposures from cooking with traditional wood stoves were 160 μg/m3 in rural households and 170 μg/m3 in urban households. Average male and child rural area exposures from traditional wood stoves were 120 μg/m3 and 140 μg/m3, respectively; average urban area exposures were identical to average rural exposures among both sub-groups. CONCLUSIONS A Bayesian modeling approach was used to generate unique HAP-PM2.5 kitchen concentrations and personal exposure estimates for all countries, including those with little to no available quantitative HAP-PM2.5 exposure data. The global exposure model incorporating type of fuel-stove combinations can add specificity and reduce exposure misclassification to enable an improved global HAP risk assessment.
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Affiliation(s)
- Matthew Shupler
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
| | - William Godwin
- Institute for Health Metrics & Evaluation, University of Washington, Seattle, WA, United States of America
| | - Joseph Frostad
- Institute for Health Metrics & Evaluation, University of Washington, Seattle, WA, United States of America
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raphael E Arku
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Institute for Health Metrics & Evaluation, University of Washington, Seattle, WA, United States of America
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Lamichhane P, Sharma A, Mahal A. Impact of cleaner fuel use and improved stoves on acute respiratory infections: evidence from India. Int Health 2018; 9:349-366. [PMID: 29206926 DOI: 10.1093/inthealth/ihx041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 10/18/2017] [Indexed: 11/13/2022] Open
Abstract
Background The use of cleaner fuel and improved stoves has been promoted as a means to lower harmful emissions from solid fuels. However, little is known about how exclusive use of cleaner fuels, mixed fuel use and improved stoves influences children's health. Methods We compared the impact of using liquefied petroleum gas (LPG) exclusively with mixed fuel use (LPG plus polluting fuels) and with exclusive use of polluting fuels on acute respiratory infections (ARI) among 16 157 children 0-4 years of age from households in the 2012 Indian Human Development Survey. Inverse probability weighting (IPW) procedures for multiple treatments were used for this evaluation. Results Children from households using LPG had a 5.0% lower probability of reporting ARI relative to exclusive users of polluting fuels, with larger effects (10.7%) in rural households. The probability of ARI in households using improved stoves and mixed fuel use was also lower in rural households, by 2.9% and 2.8%, respectively. The magnitude of effect varied across population subgroups, with the highest effects for children living in households living in kachha (low quality material) houses households identified as poor. Conclusion Use of LPG and improved stoves lowered the probability of ARI among children younger than 5 years.
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Affiliation(s)
- Prabhat Lamichhane
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, Victoria 3004, Australia.,School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Anurag Sharma
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - Ajay Mahal
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, Victoria 3004, Australia.,Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Nisha MK, Alam A, Raynes-Greenow C. Variations in perinatal mortality associated with different polluting fuel types and kitchen location in Bangladesh. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2018; 24:47-54. [PMID: 30156135 DOI: 10.1080/10773525.2018.1507868] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study examines the association between household air pollution from use of polluting cooking fuels and perinatal mortality in Bangladesh. We analysed the data from the Bangladesh Demographic and Health Surveys (BDHS) 2004, 2007, 2011, and 2014. The two outcome variables were stillbirth and early neonatal mortality. The exposure variable was type of primary cooking fuel used in the household (clean vs. polluting). Bivariate and multivariable analyses were conducted to obtain the crude and adjusted odds ratio (aOR), respectively. In the adjusted model, the exposure to polluting fuels was associated with early neonatal mortality (aOR: 1.46, 95% confidence interval [CI]: 1.01-2.10), but not with stillbirth (aOR: 1.25, 95% CI: 0.85-1.84). The effect of cooking with agricultural crop waste was greater for stillbirth (aOR: 1.76, 95% CI: 1.10-2.80) and for early neonatal mortality (aOR: 1.78, 95% CI: 1.13-2.80) which was also associated with wood as the main fuel (aOR: 1.52, 95% CI: 1.04-2.21). Using polluting fuels in an indoor kitchen was associated with an increased odds of stillbirth (aOR: 4.12, 95% CI: 1.49-11.41). Cooking with polluting fuels is associated with perinatal mortality. The combined association of polluting cooking fuels and indoor kitchen location was greater for stillbirth. This effect and the effect of different fuel types need further investigation. Although this is a large sample, there are some limitations with the BDHS data in both recording the exposure and the outcomes. A large prospective trial is needed to determine the precise effect size.
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Affiliation(s)
- Monjura Khatun Nisha
- a Sydney School of Public Health, The University of Sydney , Sydney , NSW , Australia
| | - Ashraful Alam
- a Sydney School of Public Health, The University of Sydney , Sydney , NSW , Australia
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Abstract
Nearly 3 billion people are exposed to household air pollution emitted from inefficient cooking and heating stoves, and almost the entire global population is exposed to detectable levels of outdoor air pollution from traffic, industry, and other sources. Over 3 million people die annually of ischemic heart disease or stroke attributed to air pollution, more than from traditional cardiac risk factors such as obesity, diabetes mellitus, or smoking. Clinicians have a role to play in reducing the burden of pollution-attributable cardiovascular disease. However, there currently exists no clear clinical approach to this problem. Here, we provide a blueprint for an evidence-based clinical approach to assessing and mitigating cardiovascular risk from exposure to air pollution. We begin with a discussion of the global burden of pollution-attributable cardiovascular disease, including a review of the mechanisms by which particulate matter air pollution leads to cardiovascular outcomes. Next, we offer a simple patient-screening tool using known risk factors for pollution exposure. We then discuss approaches to quantifying air pollution exposures and cardiovascular risk, including the development of risk maps for clinical catchment areas. We review a collection of interventions for household and outdoor air pollution, which clinicians can tailor to patients and populations at risk. Finally, we identify future research needed to quantify pollution exposures and validate clinical interventions. Overall, we demonstrate that clinicians can be empowered to mitigate the global burden of cardiovascular disease attributable to air pollution.
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Affiliation(s)
- Michael B Hadley
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (M.B.H.)
| | - Jill Baumgartner
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Quebec, Montreal, Canada (J.B.)
| | - Rajesh Vedanthan
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Quebec, Montreal, Canada (J.B.)
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Naz S, Page A, Agho KE. Attributable risk and potential impact of interventions to reduce household air pollution associated with under-five mortality in South Asia. Glob Health Res Policy 2018; 3:4. [PMID: 29376138 PMCID: PMC5772697 DOI: 10.1186/s41256-018-0059-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/03/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Solid fuel use is the major source of household air pollution (HAP) and accounts for a substantial burden of morbidity and mortality in low and middle income countries. To evaluate and compare childhood mortality attributable to HAP in four South Asian countries. METHODS A series of Demographic and Health Survey (DHS) datasets for Bangladesh, India, Nepal and Pakistan were used for analysis. Estimates of relative risk and exposure prevalence relating to use of cooking fuel and under-five mortality were used to calculate population attributable fractions (PAFs) for each country. Potential impact fractions (PIFs) were also calculated assessing theoretical scenarios based on published interventions aiming to reduce exposure prevalence. RESULTS There are an increased risk of under-five mortality in those exposed to cooking fuel compared to those not exposed in the four South Asian countries (OR = 1.30, 95% CI = 1.07-1.57, P = 0.007). Combined PAF estimates for South Asia found that 66% (95% CI: 43.1-81.5%) of the 13,290 estimated cases of under-five mortality was attributable to HAP. Joint PIF estimates (assuming achievable reductions in HAP reported in intervention studies conducted in South Asia) indicates 47% of neonatal and 43% of under-five mortality cases associated with HAP could be avoidable in the four South Asian countries studied. CONCLUSIONS Elimination of exposure to use of cooking fuel in the household targeting valuable intervention strategies (such as cooking in separate kitchen, improved cook stoves) could reduce substantially under-five mortality in South Asian countries.
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Affiliation(s)
- Sabrina Naz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Building 3, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Andrew Page
- Translational Health Research Institute, School of Medicine, Western Sydney University, Building 3, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Kingsley Emwinyore Agho
- School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
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Leavey A, Patel S, Martinez R, Mitroo D, Fortenberry C, Walker M, Williams B, Biswas P. Organic and inorganic speciation of particulate matter formed during different combustion phases in an improved cookstove. ENVIRONMENTAL RESEARCH 2017; 158:33-42. [PMID: 28599193 DOI: 10.1016/j.envres.2017.05.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/20/2017] [Accepted: 05/22/2017] [Indexed: 06/07/2023]
Abstract
Residential solid fuel combustion in cookstoves has established health impacts including bladder and lung cancers, cataracts, low birth weight, and pneumonia. The chemical composition of particulate matter (PM) from 4 commonly-used solid fuels (coal, dung, ambient/dry applewood, and oakwood pellets), emitted from a gasifier cookstove, as well as propane, were examined. Temporal changes between the different cookstove burn-phases were also explored. Normalized concentrations of non-refractory PM1, total organics, chloride, ammonium, nitrate, sulfate, and 41 particle-phase polycyclic aromatic hydrocarbons (PAHs) were measured using a High-Resolution Time-of-Flight Aerosol Mass Spectrometer (HR-ToF-AMS) and a Thermal desorption Aerosol Gas chromatograph (TAG), respectively. Coal demonstrated the highest fraction of organic matter in its particulate emission composition (98%), followed by dung (94%). Coal and dung also demonstrated the highest numbers and concentrations of PAHs. While dry applewood emitted ten times lower organic matter compared to ambient applewood, a higher fraction of these organics was composed of PAHs, especially the more toxic ones such as benzo(a)pyrene (9.63ng/L versus 0.04ng/L), and benzo(b)fluoranthene (31.32ng/L versus 0.19ng/L). Data from the AMS demonstrated no clear trends for any of the combustion fuels over the different combustion phases unlike the previously reported trends observed for the physical characteristics. Of the solid fuels, pellets demonstrated the lowest emissions. Emissions from propane were below the quantification limit of the instruments. This work highlights the benefits of incorporating additional metrics into the cookstove evaluation process, thus enriching the existing PM data inventory.
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Affiliation(s)
- Anna Leavey
- Center for Aerosol Science and Engineering (CASE), Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Sameer Patel
- Center for Aerosol Science and Engineering (CASE), Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Raul Martinez
- Center for Aerosol Science and Engineering (CASE), Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Dhruv Mitroo
- Center for Aerosol Science and Engineering (CASE), Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Claire Fortenberry
- Center for Aerosol Science and Engineering (CASE), Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Michael Walker
- Center for Aerosol Science and Engineering (CASE), Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Brent Williams
- Center for Aerosol Science and Engineering (CASE), Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Pratim Biswas
- Center for Aerosol Science and Engineering (CASE), Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA.
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Weaver AM, Parveen S, Goswami D, Crabtree-Ide C, Rudra C, Yu J, Mu L, Fry AM, Sharmin I, Luby SP, Ram PK. Pilot Intervention Study of Household Ventilation and Fine Particulate Matter Concentrations in a Low-Income Urban Area, Dhaka, Bangladesh. Am J Trop Med Hyg 2017; 97:615-623. [PMID: 28722632 DOI: 10.4269/ajtmh.16-0326] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Fine particulate matter (PM2.5) is a risk factor for pneumonia; ventilation may be protective. We tested behavioral and structural ventilation interventions on indoor PM2.5 in Dhaka, Bangladesh. We recruited 59 good ventilation (window or door in ≥ 3 walls) and 29 poor ventilation (no window, one door) homes. We monitored baseline indoor and outdoor PM2.5 for 48 hours. We asked all participants to increase ventilation behavior, including opening windows and doors, and operating fans. Where permitted, we installed windows in nine poor ventilation homes, then repeated PM2.5 monitoring. We estimated effects using linear mixed-effects models and conducted qualitative interviews regarding motivators and barriers to ventilation. Compared with poor ventilation homes, good ventilation homes were larger, their residents wealthier and less likely to use biomass fuel. In multivariable linear mixed-effects models, ventilation structures and opening a door or window were inversely associated with the number of hours PM2.5 concentrations exceeded 100 and 250 μg/m3. Outdoor air pollution was positively associated with the number of hours PM2.5 concentrations exceeded 100 and 250 μg/m3. Few homes accepted window installation, due to landlord refusal and fear of theft. Motivators for ventilation behavior included cooling of the home and sunlight; barriers included rain, outdoor odors or noise, theft risk, mosquito entry, and, for fan use, perceptions of wasting electricity or unavailability of electricity. We concluded that ventilation may reduce indoor PM2.5 concentrations but, there are barriers to increasing ventilation and, in areas with high ambient PM2.5 concentrations, indoor concentrations may remain above recommended levels.
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Affiliation(s)
- Anne M Weaver
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana.,Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
| | - Shahana Parveen
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Doli Goswami
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Christina Crabtree-Ide
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
| | - Carole Rudra
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
| | - Jihnhee Yu
- Department of Biostatistics, University at Buffalo, Buffalo, New York
| | - Lina Mu
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Alicia M Fry
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Iffat Sharmin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Stephen P Luby
- Stanford University, Stanford, California.,International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Pavani K Ram
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
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Naz S, Page A, Agho KE. Household air pollution from use of cooking fuel and under-five mortality: The role of breastfeeding status and kitchen location in Pakistan. PLoS One 2017; 12:e0173256. [PMID: 28278260 PMCID: PMC5344381 DOI: 10.1371/journal.pone.0173256] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/17/2017] [Indexed: 11/19/2022] Open
Abstract
Household air pollution (HAP) mainly from cooking fuel is one of the major causes of respiratory illness and deaths among young children in low and middle-income countries like Pakistan. This study investigates for the first time the association between HAP from cooking fuel and under-five mortality using the 2013 Pakistan Demographic and Health Survey (PDHS) data. Multi-level logistic regression models were used to examine the association between HAP and under-five mortality in a total of 11,507 living children across four age-groups (neonatal aged 0-28 days, post-neonatal aged 1-11 months, child aged 12-59 months and under-five aged 0-59 months). Use of cooking fuel was weakly associated with total under-five mortality (OR = 1.22, 95%CI = 0.92-1.64, P = 0.170), with stronger associations evident for sub-group analyses of children aged 12-59 months (OR = 1.98, 95%CI = 0.75-5.25, P = 0.169). Strong associations between use of cooking fuel and mortality were evident (ORs >5) in those aged 12-59 months for households without a separate kitchen using polluting fuels, and in children whose mother never breastfed. The results of this study suggest that HAP from cooking fuel is associated with a modest increase in the risk of death among children under five years of age in Pakistan, but particularly in those aged 12-59 months, and those living in poorer socioeconomic conditions. To reduce exposure to cooking fuel which is a preventable determinant of under-five mortality in Pakistan, the challenge remains to promote behavioural interventions such as breastfeeding in infancy period, keeping young children away from the cooking area, and improvements in housing and kitchen design.
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Affiliation(s)
- Sabrina Naz
- Centre of Health Research, School of Medicine, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
| | - Andrew Page
- Centre of Health Research, School of Medicine, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
| | - Kingsley Emwinyore Agho
- School of Science and Health, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
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Indoor Air Quality and ventilation assessment of rural mountainous households of Nepal. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.ijsbe.2016.08.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Khayath N, Qi S, de Blay F. Bronchopneumopathie chronique obstructive (BPCO) et environnement intérieur. Rev Mal Respir 2016; 33:666-674. [DOI: 10.1016/j.rmr.2016.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
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Naz S, Page A, Agho KE. Household air pollution and under-five mortality in India (1992-2006). Environ Health 2016; 15:54. [PMID: 27113939 PMCID: PMC4845508 DOI: 10.1186/s12940-016-0138-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/19/2016] [Indexed: 05/16/2023]
Abstract
BACKGROUND Household air pollution (HAP) - predominantly from cooking fuel is a major public health hazard and one of the leading causes of respiratory illness and deaths among children under-five years in India. This study investigates the association between HAP from cooking fuel and under-five mortality using India's National Family and Health Survey (NFHS) datasets over the period 1992-2006 (total of 166,382 children), and the extent to which the association differed by environmental and behavioral factors affecting level of exposure. METHODS The association between HAP and under-five mortality of three age-groups (neonatal age between 0-28 days, post-neonatal age between 1-11 months and children aged between 12-59 months) was examined using multi-level logistic regression models. RESULTS HAP was associated with mortality among children aged under-five (OR = 1.30, 95%CI = 1.18-1.43, P < 0.001) and was more strongly associated in sub-group analyses of post-neonatal mortality (OR = 1.42, 95%CI = 1.19-1.71, P < 0.001) and child mortality (OR = 1.42, 95%CI = 1.05-1.91, P = 0.021) than neonatal mortality (OR = 1.23, 95%CI = 1.09-1.39, P = 0.001). The association was stronger for households in rural areas and for households without a separate kitchen using polluting fuel, and in women who had never breastfed for all age-groups. CONCLUSION Use of cooking fuel in the household is associated with increased risk of mortality in children aged under-five years. Factors relating to access to clean fuels, improvements in infrastructure and household design and behavioral factors are discussed, and can result in further declines in under-five mortality in India.
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Affiliation(s)
- Sabrina Naz
- />Centre of Health Research, School of Medicine, Western Sydney University, Building 3, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Andrew Page
- />Centre of Health Research, School of Medicine, Western Sydney University, Building 3, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Kingsley Emwinyore Agho
- />School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
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Household Air Pollution and Under-Five Mortality in Bangladesh (2004-2011). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:12847-62. [PMID: 26501296 PMCID: PMC4627003 DOI: 10.3390/ijerph121012847] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 08/30/2015] [Accepted: 10/09/2015] [Indexed: 11/17/2022]
Abstract
Household air pollution (HAP) is one of the leading causes of respiratory illness and deaths among children under five years in Bangladesh. This study investigates the association between HAP from cooking fuel and under-five mortality using Bangladesh Demographic and Health Survey (BDHS) datasets over the period 2004–2011 (n = 18,308 children), and the extent to which this association differed by environmental and behavioral factors affecting level of exposure. The association between HAP and neonatal (age between 0–28 days), infant (age between 0 and 11 months) and under–five (age between 0 and 59 months) mortality was examined using multilevel logistic regression models. HAP was not strongly associated with overall neonatal (OR = 1.49, 95% CI = 1.01–2.22, p = 0.043), infant (OR = 1.27, 95% CI = 0.91–1.77, p = 0.157) or under-five mortality (OR = 1.14, 95% CI = 0.83–1.55, p = 0.422) in the context of overall decreasing trends in under-five mortality. The association was stronger for households with an indoor kitchen using polluting fuels, and in women who had never breastfed. Reductions in exposure to pollution from cooking fuel, given it is a ubiquitous and modifiable risk factor, can result in further declines in under-five mortality with household design and behavioural interventions.
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Joseph T, Dubey B, McBean EA. A critical review of arsenic exposures for Bangladeshi adults. THE SCIENCE OF THE TOTAL ENVIRONMENT 2015; 527-528:540-551. [PMID: 26004539 DOI: 10.1016/j.scitotenv.2015.05.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/09/2015] [Accepted: 05/09/2015] [Indexed: 06/04/2023]
Abstract
Groundwater, the most important source of water for drinking, cooking, and irrigation in Bangladesh, is a significant contributor to the daily human intake of arsenic. Other arsenic intake pathways, established as relevant for Bangladeshi adults through this review, include consumption of contaminated edible plant parts and animal-origin food, inhalation of contaminated air, soil ingestion, betel quid chewing, and tobacco smoking. This review qualifies and quantifies these arsenic intake pathways through analysis of the range of arsenic levels observed in different food types, water, soil, and air in Bangladesh, and highlights the contributions of dietary intake variation and cooking method in influencing arsenic exposures. This study also highlights the potential of desirable dietary patterns and intakes in increasing arsenic exposure which is relevant to Bangladesh where nutritional deficiencies and lower-than-desirable dietary intakes continue to be a major concern.
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Affiliation(s)
- Tijo Joseph
- School of Engineering, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G2W1, Canada
| | - Brajesh Dubey
- School of Engineering, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G2W1, Canada; Environmental Engineering Division, Department of Civil Engineering, Indian Institute of Technology, Kharagpur, West Bengal 721302, India.
| | - Edward A McBean
- School of Engineering, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G2W1, Canada
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Leavey A, Londeree J, Priyadarshini P, Puppala J, Schechtman KB, Yadama G, Biswas P. Real-time particulate and CO concentrations from cookstoves in rural households in Udaipur, India. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2015; 49:7423-31. [PMID: 25985217 DOI: 10.1021/acs.est.5b02139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Almost 3 billion people around the globe use traditional three-stone cookstoves and open fires to warm and feed themselves. The World Health Organization estimates annual mortality rates from domestic solid fuel combustion to be around 4 million. One of the most affected countries is India. Quantifying pollutant concentrations from these cookstoves during different phases of operation and understanding the factors influencing their variability may help to identify where improvements should be targeted, enhancing indoor air quality for millions of the world's most vulnerable people. Gas and particulate measurements were collected between June and August, 2012, for 51 households using traditional cookstoves, in the villages of Udaipur district, Rajasthan, India. Mean pollutant concentrations during steady-state mode were 4989 μm(2) cm(-3), 9835 μg m(-3), and 18.5 ppm for lung-deposited surface area, PM2.5, and CO, respectively. Simple and multivariate regression analysis was conducted. Fuel amount, fuel diameter, duration of the cookstove run, roof-type, and the room dimension explained between 7% and 21% of the variability for the pollutant metrics. CO demonstrated weaker correlations with explanatory variables. Some of these variables may be indicative of socio-economic status and could be used as proxies of exposure in lieu of pollutant measurements, hence these variables may help identify which households to prioritize for intervention. Such associations should be further explored.
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Affiliation(s)
- Anna Leavey
- †Aerosol and Air Quality Research Laboratory, Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, Campus Box 1180, St. Louis, Missouri 63130, United States
| | - Jessica Londeree
- ‡George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, St. Louis, Missouri 63130, United States
| | - Pratiti Priyadarshini
- §Foundation for Ecological Security, Udaipur Team, Opp Jyoti School, Fatehpura, Udaipur 313 001, Rajasthan, India
| | - Jagdeesh Puppala
- §Foundation for Ecological Security, Udaipur Team, Opp Jyoti School, Fatehpura, Udaipur 313 001, Rajasthan, India
| | - Kenneth B Schechtman
- ∥Division of Biostatistics, Washington University School of Medicine, Campus Box 8067, St. Louis, Missouri 63110, United States
| | - Gautam Yadama
- ‡George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, St. Louis, Missouri 63130, United States
| | - Pratim Biswas
- †Aerosol and Air Quality Research Laboratory, Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, Campus Box 1180, St. Louis, Missouri 63130, United States
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Nasanen-Gilmore SPK, Saha S, Rasul I, Rousham EK. Household environment and behavioral determinants of respiratory tract infection in infants and young children in northern Bangladesh. Am J Hum Biol 2015; 27:851-8. [PMID: 25994352 DOI: 10.1002/ajhb.22736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/06/2015] [Accepted: 04/21/2015] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Respiratory tract infections (RTI) are one of the leading causes of under-five mortality in Bangladesh. Solid biomass fuels are the main source of domestic fuel used for cooking across Bangladesh, leading to smoke and pollution exposure in the home. This article aims to identify risk factors for RTI among children aged under five years in Bangladesh with a particular focus on the household environment, fuel use, and cooking practices. METHODS A cross-sectional household-health survey was carried out in 321 households in northern Bangladesh. The survey included care-giver interviews on cooking practices, child health, and household behaviors during cooking. Health status of the youngest child (under five years) from each household was recorded through maternal interviews, medical diagnosis, and assessment of biomarkers (C-reactive protein (CRP), hemoglobin) from finger-prick blood samples. Anthropometric status (weight, height) was recorded. RESULTS Children who spent ≥30 minutes/day within 5 feet of the stove during cooking had a significantly increased risk of moderate/severe RTI compared with children spending <30 minutes/day close to the stove (OR = 2.15, 95%CI: 1.20-3.86, P = 0.01), independent of socio-economic status (SES), biomass fuel type (wood, dung, plant-derived, compressed rice husks), child age, anthropometric status, CRP and hemoglobin. CONCLUSIONS In environments with a heavy reliance on solid biomass fuels, the amount of time a child spends near the stove during cooking may be an important risk for RTI. These novel findings from Bangladesh warrant further investigation of mother-infant behaviors during cooking in relation to child health, to ascertain whether the association is likely to be causal.
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Affiliation(s)
| | - Subir Saha
- Office of School Wellness Programs, New York City Department of Education, New York
| | - Izaz Rasul
- Concern Worldwide, Bangladesh, Gulshan 1, Dhaka, Bangladesh
| | - Emily K Rousham
- Centre for Global Health and Human Development, School of Sports, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
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Upadhyay AK, Singh A, Kumar K, Singh A. Impact of indoor air pollution from the use of solid fuels on the incidence of life threatening respiratory illnesses in children in India. BMC Public Health 2015; 15:300. [PMID: 25884539 PMCID: PMC4397688 DOI: 10.1186/s12889-015-1631-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 03/12/2015] [Indexed: 11/13/2022] Open
Abstract
Background India contributes 24% of the global annual child deaths due to acute respiratory infections (ARIs). According to WHO, nearly 50% of the deaths among children due to ARIs is because of indoor air pollution (IAP). There is insufficient evidence on the relationship between IAP from the use of solid fuels and incidence of life threatening respiratory illnesses (LTRI) in children in India. Methods Panel data of children born during 2001–02, from the Young Lives Study (YLS) conducted in India during 2002 and 2006–07 was used to estimate the impact of household use of solid fuels for cooking on LTRI in children. Multivariable two-stage random effects logistic regression model was used to estimate the odds of suffering from LTRI among children from households using solid fuels relative to children from households using other fuels (Gas/Electricity/Kerosene). Results Bivariate results indicate that the probability of an episode of LTRI was considerably higher among children from households using solid fuels for cooking (18%) than among children from households using other fuels (10%). Moreover, children from households using solid fuels in both the rounds of YLS were more likely to suffer from one or more than one episode of LTRI compared to children from households using solid fuels in only one round. Two-stage random effects logistic regression result shows that children from households using solid fuels were 1.78 (95% CI: 1.05-2.99) times as likely to suffer from LTRI as those from households using other fuels. Conclusion The findings of this paper provide conclusive evidence on the harmful effects of the use of solid fuels for cooking on LTRI in India. The Government of India must make people aware about the health risks associated with the use of solid fuels for cooking and strive to promote the use of cleaner fuels.
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Affiliation(s)
- Ashish Kumar Upadhyay
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400 088, India.
| | - Abhishek Singh
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400 088, India.
| | - Kaushalendra Kumar
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400 088, India.
| | - Ashish Singh
- Indian Institute of Technology Bombay, Mumbai, India.
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Doshi S, Silk BJ, Dutt D, Ahmed M, Cohen AL, Taylor TH, Brooks WA, Goswami D, Luby SP, Fry AM, Ram PK. Household-level risk factors for influenza among young children in Dhaka, Bangladesh: a case-control study. Trop Med Int Health 2015; 20:719-29. [PMID: 25682788 DOI: 10.1111/tmi.12475] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify household-level factors associated with influenza among young children in a crowded community in Dhaka, Bangladesh. METHODS We conducted a case-control study using existing active surveillance for respiratory illness. Cases were children aged 12-59 months with laboratory-confirmed influenza. Controls were children frequency-matched by age group with no respiratory illness in the prior 6 months. We interviewed caregivers and observed household handwashing behaviour. Soap consumption was estimated by summing weight differences of three bars of soap sequentially left in each household. We measured concentrations of airborne particulate matter <2.5 μg in diameter (PM2.5) in a subset of households. We used logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI). RESULTS We enrolled 145 cases and 341 controls between March 2009 and April 2010. Case and control household members were observed to wash hands with similar frequency during a 5-h period (mean, 0.64 events vs. 0.63, P = 0.87), and similar daily soap consumption per capita (mean 2.92 grams vs. 2.93, P = 0.92). Case households were more likely than controls to have crowded (≥4 persons) sleeping areas (aOR = 1.67, CI: 1.06-2.63) and cross-ventilated cooking spaces (aOR = 1.75, CI: 1.16-2.63). Case and control households had similar median 24-h geometric mean PM2.5 concentrations in the cooking (69.2 vs. 69.6 μg/m(3), P = 0.45) and sleeping (65.4 vs. 67.4 μg/m(3), P = 0.19) spaces. CONCLUSIONS Handwashing with soap was practiced infrequently and was not associated with paediatric influenza in this community. Interventions aimed at crowded households may reduce influenza incidence in young children.
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Affiliation(s)
- Saumil Doshi
- Centers for Disease Control and Prevention, Atlanta, GA, USA; Howard University, Washington, DC, USA
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Alam DS, Chowdhury MAH, Siddiquee AT, Ahmed S, Hossain MD, Pervin S, Streatfield K, Cravioto A, Niessen LW. Adult cardiopulmonary mortality and indoor air pollution: a 10-year retrospective cohort study in a low-income rural setting. Glob Heart 2015; 7:215-21. [PMID: 25691484 DOI: 10.1016/j.gheart.2012.06.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 06/21/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Indoor air pollution (IAP) due to solid fuel use is a major risk factor of respiratory and cardiovascular mortality and morbidity. Rural Matlab in Bangladesh has been partly supplied with natural gas since the early 1990s, which offered a natural experiment to investigate the long-term impact of IAP on cardiopulmonary mortality. OBJECTIVE This study sought to compare adult cardiopulmonary mortality in relation to household fuel type as a surrogate for exposure to indoor air pollution. STUDY DESIGN This was a retrospective cohort study. We identified all households in 11 villages in Matlab, Bangladesh, and categorized them as either supplied with natural gas or using solid fuel for cooking or heating since January 1, 2001. Cause-specific mortality data including cardiopulmonary deaths were obtained through verbal autopsy as part of a permanent surveillance. Person-years (PYs) of exposure were computed from baseline until the event. Subjects with missing information on cause of death, outward migration, or on fuel type were excluded. Event rates for each fuel category were calculated as well as the relative risk of dying with 95% confidence intervals (CI). SETTING Rural Matlab, Bangladesh. PATIENTS Adults 18 years of age or older. OUTCOME MEASURE Death from cardiopulmonary diseases over a 10-year period. FINDINGS In total, 946 cardiopulmonary deaths occurred with 884 in the solid-fuel and 62 in the gas-supplied households (n=7,565 and n=508, respectively) over the 10-year period. Cardiopulmonary death rate was 6.2 per 1,000 PYs in the solid-fuel group and 5.3 per 1,000 PYs in people living in households using gas. Mortality due to cardiovascular event was 5.1 and 4.8 per 1,000 PY in people from the solid-fuel and gas-supplied households, respectively, and the incident rate ratio was 1.07 (95% CI: 0.82 to 1.41). Mortality due to respiratory disease was 1.2 and 0.5 per 1,000 PYs in the solid-fuel and gas-supplied groups, respectively, and the incident rate ratio was 2.26 (95% CI: 1.02 to 4.99). INTERPRETATION Household solid-fuel use is associated with increased respiratory mortality and nonsignificantly increased risk of cardiovascular mortality. Reduction of exposure to pollution due to in-household solid-fuel use is likely to improve survival in Bangladeshi and similar populations.
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Affiliation(s)
- Dewan S Alam
- Centre for Control of Chronic Diseases (CCCD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh.
| | - Muhammad Ashique H Chowdhury
- Centre for Control of Chronic Diseases (CCCD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
| | - Ali Tanweer Siddiquee
- Centre for Control of Chronic Diseases (CCCD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
| | - Shyfuddin Ahmed
- Centre for Control of Chronic Diseases (CCCD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
| | - Mohammad Didar Hossain
- Centre for Control of Chronic Diseases (CCCD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
| | - Sonia Pervin
- Centre for Control of Chronic Diseases (CCCD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
| | - Kim Streatfield
- Centre for Population Urbanization and Climate Change (CPUC), icddr,b, Mohakhali, Dhaka 1212, Bangladesh
| | - Alejandro Cravioto
- Centre for Control of Chronic Diseases (CCCD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
| | - Louis W Niessen
- Centre for Control of Chronic Diseases (CCCD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ranabhat CL, Kim CB, Kim CS, Jha N, Deepak KC, Connel FA. Consequence of indoor air pollution in rural area of Nepal: a simplified measurement approach. Front Public Health 2015; 3:5. [PMID: 25674557 PMCID: PMC4306325 DOI: 10.3389/fpubh.2015.00005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 01/06/2015] [Indexed: 12/04/2022] Open
Abstract
People of developing countries especially from rural area are commonly exposed to high levels of household pollution for 3–7 h daily using biomass in their kitchen. Such biomass produces harmful smoke and makes indoor air pollution (IAP). Community-based cross-sectional study was performed to identify effects of IAP by simplified measurement approach in Sunsari District of Nepal. Representative samples of 157 housewives from household, involving more than 5 years in kitchen were included by cluster sampling. Data were analyzed by SPSS and logistic regression was applied for the statistical test. Most (87.3%) housewives used biomass as a cooking fuel. Tearing of eyes, difficulty in breathing, and productive cough were the main reported health problems and traditional mud stoves and use of unrefined biomass were statistically significant (p < 0.05) and more risk (AOR > 2) with health problems related to IAP. The treatment cost and episodes of acute respiratory infection was >2 folders higher in severe IAP than mild IAP. Simplified measurement approach could be helpful to measure IAP in rural area. Some effective intervention is suggested to reduce the severe level of IAP considering women and children.
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Affiliation(s)
- Chhabi Lal Ranabhat
- Department of Preventive Medicine, Wonju College of Medicine Yonsei University , Wonju, Gangwon , South Korea ; Institute for Poverty Alleviation and International Development, Yonsei University , Wonju, Gangwon , South Korea
| | - Chun-Bae Kim
- Department of Preventive Medicine, Wonju College of Medicine Yonsei University , Wonju, Gangwon , South Korea ; Institute for Poverty Alleviation and International Development, Yonsei University , Wonju, Gangwon , South Korea
| | - Chang-Soo Kim
- Institute for Poverty Alleviation and International Development, Yonsei University , Wonju, Gangwon , South Korea
| | - Nilambar Jha
- BP Koirala Institute of Health Science, School of Public Health and Community Medicine , Dharan , Nepal
| | - K C Deepak
- BP Koirala Institute of Health Science, School of Public Health and Community Medicine , Dharan , Nepal
| | - Fredric A Connel
- Department of Health Services, School of Public Health, University of Washington , Seattle, WA , USA
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Ezeh OK, Agho KE, Dibley MJ, Hall JJ, Page AN. The effect of solid fuel use on childhood mortality in Nigeria: evidence from the 2013 cross-sectional household survey. Environ Health 2014; 13:113. [PMID: 25514998 PMCID: PMC4290397 DOI: 10.1186/1476-069x-13-113] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 11/28/2014] [Indexed: 05/17/2023]
Abstract
BACKGROUND In Nigeria, approximately 69% of households use solid fuels as their primary source of domestic energy for cooking. These fuels produce high levels of indoor air pollution. This study aimed to determine whether Nigerian children residing in households using solid fuels at <5 years of age were at higher risk of death. METHODS The 2013 Nigeria Demographic and Health Survey data were analysed in Cox regression analyses to examine the effects of solid fuel use on deaths of children aged 0-28 days (neonatal), 1-11 months (post-neonatal), and 12-59 months (child). RESULTS The results indicated that approximately 0.8% of neonatal deaths, 42.9% of post-neonatal deaths, and 36.3% of child deaths could be attributed to use of solid fuels. The multivariable analyses found that use of solid fuel was associated with post-neonatal mortality (hazard ratio [HR] =1.92, 95% confidence interval [CI]: 1.42-2.58) and child mortality (HR = 1.63, CI: 1.09-2.42), but was not associated with neonatal mortality (HR = 1.01, CI: 0.73-1.26). Living in rural areas and poor households were associated with an increased risk of death during the three mortality periods. CONCLUSION Living in a rural area and poor households were strongly associated with an increased risk of a child > 1 to < 60 months dying due to use of solid fuels. The health effects of household use of solid fuels are a major public health threat that requires increased research and policy development efforts. Research should focus on populations in rural areas and low socioeconomic households so that child survival in Nigeria can be improved.
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Affiliation(s)
- Osita Kingsley Ezeh
- />School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Kingsley Emwinyore Agho
- />School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Michael John Dibley
- />Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney, NSW 2006 Australia
| | - John Joseph Hall
- />School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Andrew Nicolas Page
- />School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2571 Australia
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Chakraborty D, Mondal NK, Datta JK. Indoor pollution from solid biomass fuel and rural health damage: A micro-environmental study in rural area of Burdwan, West Bengal. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.ijsbe.2014.11.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Barnes BR. Behavioural change, indoor air pollution and child respiratory health in developing countries: a review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:4607-18. [PMID: 24776723 PMCID: PMC4053881 DOI: 10.3390/ijerph110504607] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 03/31/2014] [Accepted: 04/01/2014] [Indexed: 11/16/2022]
Abstract
Indoor air pollution caused by the indoor burning of solid biomass fuels has been associated with Acute Respiratory Infections such as pneumonia amongst children of less than five years of age. Behavioural change interventions have been identified as a potential strategy to reduce child indoor air pollution exposure, yet very little is known about the impact of behavioural change interventions to reduce indoor air pollution. Even less is known about how behaviour change theory has been incorporated into indoor air pollution behaviour change interventions. A review of published studies spanning 1983-2013 suggests that behavioural change strategies have the potential to reduce indoor air pollution exposure by 20%-98% in laboratory settings and 31%-94% in field settings. However, the evidence is: (1) based on studies that are methodologically weak; and (2) have little or no underlying theory. The paper concludes with a call for more rigorous studies to evaluate the role of behavioural change strategies (with or without improved technologies) to reduce indoor air pollution exposure in developing countries as well as interventions that draw more strongly on existing behavioural change theory and practice.
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Affiliation(s)
- Brendon R Barnes
- Psychology Department, University of Johannesburg, Auckland Park, 2006, South Africa.
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Gurley ES, Salje H, Homaira N, Ram PK, Haque R, Petri WA, Bresee J, Moss WJ, Luby SP, Breysse P, Azziz-Baumgartner E. Indoor exposure to particulate matter and age at first acute lower respiratory infection in a low-income urban community in Bangladesh. Am J Epidemiol 2014; 179:967-73. [PMID: 24607596 DOI: 10.1093/aje/kwu002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The timing of a child's first acute lower respiratory infection (ALRI) is important, because the younger a child is when he or she experiences ALRI, the greater the risk of death. Indoor exposure to particulate matter less than or equal to 2.5 µm in diameter (PM2.5) has been associated with increased frequency of ALRI, but little is known about how it may affect the timing of a child's first ALRI. In this study, we aimed to estimate the association between a child's age at first ALRI and indoor exposure to PM2.5 in a low-income community in Dhaka, Bangladesh. We followed 257 children from birth through age 2 years to record their age at first ALRI. Between May 2009 and April 2010, we also measured indoor concentrations of PM2.5 in children's homes. We used generalized gamma distribution models to estimate the relative age at first ALRI associated with the mean number of hours in which PM2.5 concentrations exceeded 100 µg/m(3). Each hour in which PM2.5 levels exceeded 100 µg/m(3) was independently associated with a 12% decrease (95% confidence interval: 2, 21; P = 0.021) in age at first ALRI. Interventions to reduce indoor exposure to PM2.5 could increase the ages at which children experience their first ALRI in this urban community.
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Salje H, Gurley ES, Homaira N, Ram PK, Haque R, Petri W, Moss WJ, Luby SP, Breysse P, Azziz-Baumgartner E. Impact of neighborhood biomass cooking patterns on episodic high indoor particulate matter concentrations in clean fuel homes in Dhaka, Bangladesh. INDOOR AIR 2014; 24:213-20. [PMID: 24033488 PMCID: PMC3932152 DOI: 10.1111/ina.12065] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 08/17/2013] [Indexed: 05/05/2023]
Abstract
Exposure to particulate matter (PM2.5 ) from the burning of biomass is associated with increased risk of respiratory disease. In Dhaka, Bangladesh, households that do not burn biomass often still experience high concentrations of PM2.5 , but the sources remain unexplained. We characterized the diurnal variation in the concentrations of PM2.5 in 257 households and compared the risk of experiencing high PM2.5 concentrations in biomass and non-biomass users. Indoor PM2.5 concentrations were estimated every minute over 24 h once a month from April 2009 through April 2010. We found that households that used gas or electricity experienced PM2.5 concentrations exceeding 1000 μg/m(3) for a mean of 35 min within a 24-h period compared with 66 min in biomass-burning households. In both households that used biomass and those that had no obvious source of particulate matter, the probability of PM2.5 exceeding 1000 μg/m(3) were highest during distinct morning, afternoon, and evening periods. In such densely populated settings, indoor pollution in clean fuel households may be determined by biomass used by neighbors, with the highest risk of exposure occurring during cooking periods. Community interventions to reduce biomass use may reduce exposure to high concentrations of PM2.5 in both biomass and non-biomass using households.
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Affiliation(s)
- Henrik Salje
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emily S. Gurley
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nusrat Homaira
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Pavani K. Ram
- University at Buffalo School of Public Health and Health Professions, Buffalo, New York, USA
| | - Rashidul Haque
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - William Petri
- University of Virginia, Charlottesville, Virginia, USA
| | - William J. Moss
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stephen P. Luby
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Global Disease Detection Program, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Patrick Breysse
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eduardo Azziz-Baumgartner
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Global Disease Detection Program, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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Ram PK, Dutt D, Silk BJ, Doshi S, Rudra CB, Abedin J, Goswami D, Fry AM, Brooks WA, Luby SP, Cohen AL. Household air quality risk factors associated with childhood pneumonia in urban Dhaka, Bangladesh. Am J Trop Med Hyg 2014; 90:968-75. [PMID: 24664785 DOI: 10.4269/ajtmh.13-0532] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
To inform interventions to reduce the high burden of pneumonia in urban settings such as Kamalapur, Bangladesh, we evaluated household air quality risk factors for radiographically confirmed pneumonia in children. In 2009-2010, we recruited children < 5 years of age with pneumonia and controls from a population-based surveillance for respiratory and febrile illnesses. Piped natural gas was used by 85% of 331 case and 91% of 663 control households. Crowding, a tin roof in the living space, low socioeconomic status, and male sex of the child were risk factors for pneumonia. The living space in case households was 28% less likely than in control households to be cross-ventilated. Particulate matter concentrations were not significantly associated with pneumonia. With increasing urbanization and supply of improved cooking fuels to urban areas, the high burden of respiratory illnesses in urban populations such as Kamalapur may be reduced by decreasing crowding and improving ventilation in living spaces.
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Affiliation(s)
- Pavani K Ram
- University at Buffalo, Buffalo, New York; International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh; Centers for Disease Control and Prevention, Atlanta, Georgia
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Yamamoto SS, Louis VR, Sié A, Sauerborn R. Biomass smoke in Burkina Faso: what is the relationship between particulate matter, carbon monoxide, and kitchen characteristics? ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2014; 21:2581-91. [PMID: 24197962 DOI: 10.1007/s11356-013-2062-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 08/07/2013] [Indexed: 05/21/2023]
Abstract
In Burkina Faso where cooking with biomass is very common, little information exists regarding kitchen characteristics and their impact on air pollutant levels. The measurement of air pollutants such as respirable particulate matter (PM10), an important component of biomass smoke that has been linked to adverse health outcomes, can also pose challenges in terms of cost and the type of equipment needed. Carbon monoxide could potentially be a more economical and simpler measure of air pollution. The focus of this study was to first assess the association of kitchen characteristics with measured PM10 and CO levels and second, the relationship of PM10 with CO concentrations, across these different kitchen characteristics in households in Nouna, Burkina Faso. Twenty-four-hour concentrations of PM10 (area) were measured with portable monitors and CO (area and personal) estimated using color dosimeter tubes. Data on kitchen characteristics were collected through surveys. Most households used both wood and charcoal burned in three-stone and charcoal stoves. Mean outdoor kitchen PM10 levels were relatively high (774 μg/m(3), 95 % CI 329-1,218 μg/m(3)), but lower than indoor concentrations (Satterthwaite t value, -6.14; p < 0.0001). In multivariable analyses, outdoor kitchens were negatively associated with PM10 (OR = 0.06, 95 % CI 0.02-0.16, p value <0.0001) and CO (OR = 0.03, 95 % CI 0.01-0.11, p value <0.0001) concentrations. Strong area PM10 and area CO correlations were found with indoor kitchens (Spearman's r = 0.82, p < 0.0001), indoor stove use (Spearman's r = 0.82, p < 0.0001), and the presence of a smoker in the household (Spearman's r = 0.83, p < 0.0001). Weak correlations between area PM10 and personal CO levels were observed with three-stone (Spearman's r = 0.23, p = 0.008) and improved stoves (Spearman's r = 0.34, p = 0.003). This indicates that the extensive use of biomass fuels and multiple stove types for cooking still produce relatively high levels of exposure, even outdoors, suggesting that both fuel subsidies and stove improvement programs are likely necessary to address this problem. These findings also indicate that area CO color dosimeter tubes could be a useful measure of area PM10 concentrations when levels are influenced by strong emission sources or when used in indoors. The weaker correlation observed between area PM10 and personal CO levels suggests that area exposures are not as useful as proxies for personal exposures, which can vary widely from those recorded by stationary monitors.
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Affiliation(s)
- S S Yamamoto
- Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany,
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Zhou Z, Dionisio KL, Verissimo TG, Kerr AS, Coull B, Howie S, Arku RE, Koutrakis P, Spengler JD, Fornace K, Hughes AF, Vallarino J, Agyei-Mensah S, Ezzati M. Chemical characterization and source apportionment of household fine particulate matter in rural, peri-urban, and urban West Africa. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2014; 48:1343-51. [PMID: 24351083 DOI: 10.1021/es404185m] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Household air pollution in sub-Saharan Africa and other developing regions is an important cause of disease burden. Little is known about the chemical composition and sources of household air pollution in sub-Saharan Africa, and how they differ between rural and urban homes. We analyzed the chemical composition and sources of fine particles (PM2.5) in household cooking areas of multiple neighborhoods in Accra, Ghana, and in peri-urban (Banjul) and rural (Basse) areas in The Gambia. In Accra, biomass burning accounted for 39-62% of total PM2.5 mass in the cooking area in different neighborhoods; the absolute contributions were 10-45 μg/m(3). Road dust and vehicle emissions comprised 12-33% of PM2.5 mass. Solid waste burning was also a significant contributor to household PM2.5 in a low-income neighborhood but not for those living in better-off areas. In Banjul and Basse, biomass burning was the single dominant source of cooking-area PM2.5, accounting for 74-87% of its total mass; the relative and absolute contributions of biomass smoke to PM2.5 mass were larger in households that used firewood than in those using charcoal, reaching as high as 463 μg/m(3) in Basse homes that used firewood for cooking. Our findings demonstrate the need for policies that enhance access to cleaner fuels in both rural and urban areas, and for controlling traffic emissions in cities in sub-Saharan Africa.
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Affiliation(s)
- Zheng Zhou
- Department of Global Health and Population, Harvard School of Public Health , Boston, Massachusetts, United States
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Perception and Barriers to Indoor Air Quality and Perceived Impact on Respiratory Health: An Assessment in Rural Honduras. ADVANCES IN PUBLIC HEALTH 2014. [DOI: 10.1155/2014/105260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective. The aim of this study was to identify household-specific factors associated with respiratory symptoms and to study the perceived impact of indoor air pollution (IAP) as a health issue.Methods. An IRB-approved, voluntary, anonymous 23-item survey was conducted in Spanish at a medical outreach clinic in June 2012 and at the homes of survey respondentsN=79. Comparative analyses were performed to investigate relationships between specific house characteristics and respiratory complaints.Results. Seventy-nine surveys were completed. Respiratory symptoms were frequently reported by survey respondents: 42% stated that smoke in their household caused them to have watery eyes, 42% reported household members with coughs within the past two weeks, and 25% stated that there were currently household members experiencing difficulty in breathing. Stove location and kitchen roof construction material were significantly associated with frequency of respiratory symptoms. The vast majority used firewood as their major fuel type. Most respondents indicated that neither indoor air quality was a problem nor did it affect their daily life.Conclusions. Respiratory complaints are common in Yoro, Honduras. Stove location and kitchen roof construction material were significantly associated with frequency of respiratory symptoms; this may have implications for efforts to improve respiratory health in the region.
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Balakrishnan K, Sankar S, Ghosh S, Thangavel G, Mukhopadhyay K, Ramaswamy P, Johnson P, Thanasekaraan V. Household Air Pollution Related to Solid Cookfuel Use: The Exposure and Health Situation in Developing Countries. THE HANDBOOK OF ENVIRONMENTAL CHEMISTRY 2014. [DOI: 10.1007/698_2014_260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Van Vliet EDS, Asante K, Jack DW, Kinney PL, Whyatt RM, Chillrud SN, Abokyi L, Zandoh C, Owusu-Agyei S. Personal exposures to fine particulate matter and black carbon in households cooking with biomass fuels in rural Ghana. ENVIRONMENTAL RESEARCH 2013; 127:40-8. [PMID: 24176411 PMCID: PMC4042308 DOI: 10.1016/j.envres.2013.08.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 08/19/2013] [Accepted: 08/22/2013] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To examine cooking practices and 24-h personal and kitchen area exposures to fine particulate matter (PM2.5) and black carbon in cooks using biomass in Ghana. METHODS Researchers administered a detailed survey to 421 households. In a sub-sample of 36 households, researchers collected 24-h integrated PM2.5 samples (personal and kitchen area); in addition, the primary cook was monitored for real-time PM2.5. All filters were also analyzed for black carbon using a multi-wavelength reflectance method. Predictors of PM2.5 exposure were analyzed, including cooking behaviors, fuel, stove and kitchen type, weather, demographic factors and other smoke sources. RESULTS The majority of households cooked outdoors (55%; 231/417), used biomass (wood or charcoal) as their primary fuel (99%; 412/413), and cooked on traditional fires (77%, 323/421). In the sub-sample of 29 households with complete, valid exposure monitoring data, the 24-h integrated concentrations of PM2.5 were substantially higher in the kitchen sample (mean 446.8 µg/m3) than in the personal air sample (mean 128.5 µg/m3). Black carbon concentrations followed the same pattern such that concentrations were higher in the kitchen sample (14.5 µg/m3) than in the personal air sample (8.8 µg/m3). Spikes in real-time personal concentrations of PM2.5 accounted for the majority of exposure; the most polluted 5%, or 72 min, of the 24-h monitoring period accounted for 75% of all exposure. Two variables that had some predictive power for personal PM2.5 exposures were primary fuel type and ethnicity, while reported kerosene lantern use was associated with increased personal and kitchen area concentrations of black carbon. CONCLUSION Personal concentrations of PM2.5 exhibited considerable inter-subject variability across kitchen types (enclosed, semi-enclosed, outdoor), and can be elevated even in outdoor cooking settings. Furthermore, personal concentrations of PM2.5 were not associated with kitchen type and were not predicted by kitchen area samples; rather they were driven by spikes in PM2.5 concentrations during cooking. Personal exposures were more enriched with black carbon when compared to kitchen area samples, underscoring the need to explore other sources of incomplete combustion such as roadway emissions, charcoal production and kerosene use.
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Affiliation(s)
- Eleanne D S Van Vliet
- Mailman School of Public Health, Columbia University, 722 West 168th Street, 11th Floor, Room 1104E, New York, NY, USA.
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Gurley ES, Homaira N, Salje H, Ram PK, Haque R, Petri W, Bresee J, Moss WJ, Breysse P, Luby SP, Azziz-Baumgartner E. Indoor exposure to particulate matter and the incidence of acute lower respiratory infections among children: a birth cohort study in urban Bangladesh. INDOOR AIR 2013; 23:379-86. [PMID: 23906055 PMCID: PMC3773273 DOI: 10.1111/ina.12038] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 02/16/2013] [Indexed: 05/05/2023]
Abstract
Approximately half of all children under two years of age in Bangladesh suffer from an acute lower respiratory infection (ALRI) each year. Exposure to indoor biomass smoke has been consistently associated with an increased risk of ALRI in young children. Our aim was to estimate the effect of indoor exposure to particulate matter (PM2.5 ) on the incidence of ALRI among children in a low-income, urban community in Bangladesh. We followed 257 children through two years of age to determine their frequency of ALRI and measured the PM2.5 concentrations in their sleeping space. Poisson regression was used to estimate the association between ALRI and the number of hours per day that PM2.5 concentrations exceeded 100 μg/m(3) , adjusting for known confounders. Each hour that PM2.5 concentrations exceeded 100 μg/m(3) was associated with a 7% increase in incidence of ALRI among children aged 0-11 months (adjusted incidence rate ratio (IRR) 1.07, 95% CI 1.01-1.14), but not in children 12-23 months old (adjusted IRR 1.00, 95% CI 0.92-1.09). Results from this study suggest that reducing indoor PM2.5 exposure could decrease the frequency of ALRI among infants, the children at highest risk of death from these infections.
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Affiliation(s)
- Emily S. Gurley
- icddr,b (formerly known as International Centre for Diarrheal Diseases Research, Bangladesh), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh, ESG
- Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N. Wolfe Street, Baltimore, Maryland 21205, USA
| | - Nusrat Homaira
- icddr,b (formerly known as International Centre for Diarrheal Diseases Research, Bangladesh), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh, ESG
| | - Henrik Salje
- Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N. Wolfe Street, Baltimore, Maryland 21205, USA
| | - Pavani K. Ram
- University at Buffalo School of Public Health and Health Professions, 3435 Main Street, Buffalo, New York 14214, USA
| | - Rashidul Haque
- icddr,b (formerly known as International Centre for Diarrheal Diseases Research, Bangladesh), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh, ESG
| | - William Petri
- University of Virginia, 1215 Lee Street, Charlottesville, Virginia 22908, USA
| | - Joseph Bresee
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, Georgia 30333, USA
| | - William J. Moss
- Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N. Wolfe Street, Baltimore, Maryland 21205, USA
| | - Patrick Breysse
- Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N. Wolfe Street, Baltimore, Maryland 21205, USA
| | - Stephen P. Luby
- icddr,b (formerly known as International Centre for Diarrheal Diseases Research, Bangladesh), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh, ESG
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, Georgia 30333, USA
| | - Eduardo Azziz-Baumgartner
- icddr,b (formerly known as International Centre for Diarrheal Diseases Research, Bangladesh), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh, ESG
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, Georgia 30333, USA
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Clark ML, Peel JL, Balakrishnan K, Breysse PN, Chillrud SN, Naeher LP, Rodes CE, Vette AF, Balbus JM. Health and household air pollution from solid fuel use: the need for improved exposure assessment. ENVIRONMENTAL HEALTH PERSPECTIVES 2013; 121:1120-8. [PMID: 23872398 PMCID: PMC3801460 DOI: 10.1289/ehp.1206429] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 07/15/2013] [Indexed: 05/18/2023]
Abstract
BACKGROUND Nearly 3 billion people worldwide rely on solid fuel combustion to meet basic household energy needs. The resulting exposure to air pollution causes an estimated 4.5% of the global burden of disease. Large variability and a lack of resources for research and development have resulted in highly uncertain exposure estimates. OBJECTIVE We sought to identify research priorities for exposure assessment that will more accurately and precisely define exposure-response relationships of household air pollution necessary to inform future cleaner-burning cookstove dissemination programs. DATA SOURCES As part of an international workshop in May 2011, an expert group characterized the state of the science and developed recommendations for exposure assessment of household air pollution. SYNTHESIS The following priority research areas were identified to explain variability and reduce uncertainty of household air pollution exposure measurements: improved characterization of spatial and temporal variability for studies examining both short- and long-term health effects; development and validation of measurement technology and approaches to conduct complex exposure assessments in resource-limited settings with a large range of pollutant concentrations; and development and validation of biomarkers for estimating dose. Addressing these priority research areas, which will inherently require an increased allocation of resources for cookstove research, will lead to better characterization of exposure-response relationships. CONCLUSIONS Although the type and extent of exposure assessment will necessarily depend on the goal and design of the cookstove study, without improved understanding of exposure-response relationships, the level of air pollution reduction necessary to meet the health targets of cookstove interventions will remain uncertain.
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Affiliation(s)
- Maggie L Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
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