Effect of household air pollution due to solid fuel combustion on childhood respiratory diseases in a semi urban population in Sri Lanka

Exposure to indoor air pollution using biomass among rural households in Southern Ethiopia

Most rural households in Ethiopia depend on traditional cooking fuels. The inefficient combustion of those fuels significantly raises health concerns by exposing them to indoor air pollution. This study aimed to assess the factors contributing to indoor air pollution exposure in rural households. The study was based on data from 573 households selected randomly using a multi-stage sampling approach. Descriptive statistics and a Generalized Ordered Logit model, which explores the relationship between various independent variables and levels of exposure to indoor air pollution, were used. The study employed indicators such as traditional solid fuel use, inadequate ventilation during cooking, and lack of improved cookstoves as proxies to assess households' exposure to indoor air pollution. More than 79% of households were found to be severely polluted. Women were the most exposed to indoor air pollution. The number of rooms, having a bank or microfinance savings account, education, income, access to electricity, floor building material, number of dependent family members, and cooking time were the main contributing factors. The use of clean fuels, improved cookstoves, and adequate ventilation must be strongly advocated.

Association of residential greenness with incident allergic rhinitis among adults: A prospective analysis of UK Biobank

BACKGROUND

Limited studies have assessed the impact of residential greenness exposure on allergic rhinitis in adults, and its relationship with ambient air pollutants remains unknown.

OBJECTIVE

To investigate the association of residential greenness with allergic rhinitis incidence and explore the mediation effects of ambient air pollutants in adults using data from a prospective cohort study in UK Biobank.

METHODS

Greenness was defined as the area-weighted mean of greenness coverage based on the land used data from the Generalized Land Use Database for England (GLUD) 2005 in the UK Biobank. Multiple Cox proportional hazard models and a generalized additive model incorporating restricted cubic splines were used to model the potential nonlinear effect of residential greenness on allergic rhinitis incidence and the potential mediation effect of ambient air pollutants.

RESULTS

Among the 281,699 subjects included in the analysis, 3260 allergic rhinitis incident cases occurred after a median follow-up of 14 years. With per 10% increase in residential greenness at a 300-m buffer, a 2.5% (95% CI: 1.0%, 4.0%) decreased risk of allergic rhinitis was observed. An L-shaped, non-linear dose-response relationship was indicated with a threshold of 54.9% greenness above which no excess allergic rhinitis risk was seen. PM10 partially mediated the relationship between greenness and allergic rhinitis incidence with a mediation effect of 26.9% (95% CI: 12.6%, 41.2%). A similar pattern of association was found at 1000-m buffer size.

CONCLUSION

This study demonstrates a significant beneficial effect of residential greenness on reducing allergic rhinitis incidence. Greenness may erase air pollutants and mitigate the rhinitis risk from air pollution.

Risk factors for the development of severe or very severe respiratory syncytial virus-related lower respiratory tract infection in Indian infants: A cohort study in Melghat, India

OBJECTIVES

Respiratory syncytial virus (RSV) is undoubtedly the single most important cause of severe lower respiratory tract infection (LRTI) globally. While new prevention measures in young infants have become available, their use in developing countries is likely many years away. While risk factors for severe or very severe RSV LRTI in impoverished rural areas likely differ to urban areas, there are very few studies, especially those conducted in India, the major country contributing to the global burden of disease.

METHODS

Active surveillance for acute LRTI in enrolled infants and children <2 years of age, was conducted through weekly home visits in 93 villages of Melghat, India, from August 2016 to December 2020. Local hospitals and primary health centres were surveyed for admissions of enrolled subjects. Nasopharyngeal swabs were collected from children with severe, or very severe LRTIs and all who died, with RSV testing using nucleic acid tests at ICMR, National Institute of Virology Pune. Risk factors for both RSV associated and non-RSV associated, severe and very severe LRTI were identified through univariate and multivariate logistic regression.

RESULTS

There were 483 severe or very severe RSV LRTI cases and 2807 non-RSV severe or very severe LRTI infections in a cohort of 13,318 children. Weight for age z-score ≤-2, the use of kerosene or wood for cooking, obtaining drinking water from a public tap and low gestational age significantly increased the risk of RSV LRTI. A higher wealth score index and water purification were protective. Comparison with non-RSV LRTI showed male sex as an additional risk factor. The analysis highlighted the risk of kerosene use [OR = 17.8 (3.0-104.4) (p ≤ 0.001)] and [OR = 3.4 (0.8-14.4) (p ≤ 0.05)] for RSV and non-RSV LRTIs, respectively.

CONCLUSIONS

Nutritional status and environmental air quality are predisposing factors for developing an RSV LRI in young children, factors which are amenable to environmental and behavioural interventions.

Prevalence and determinants of diarrhoea and acute respiratory infections among children aged under five years in West Africa: evidence from demographic and health surveys

BACKGROUND

Diarrhoea and pneumonia are the leading causes of morbidity and mortality in children aged <5 y (under five) globally. This study sought to investigate the prevalence and determinants of diarrhoea and acute respiratory infections (ARIs) among children under five in West Africa.

METHODS

The most recent demographic and health survey (DHS) standard for 13 West African countries was used in the study. We calculated the prevalence of diarrhoea and ARIs (2 wk prior to the survey) and performed multivariable complex logistic regression analysis to identify possible predictors of diarrhoea and ARIs.

RESULTS

The weighted prevalence of diarrhoea and ARI was 13.7% and 15.9%, respectively. The prevalence of comorbid diarrhoea and ARI was 4.4%. Children aged <2 y (p<0.001), mothers aged <30 y (p<0.003), mothers without formal education (p<0.001), poor households (p<0.001) and poor nutritional status, wasting (p=0.005) and underweight (p<0.001), were the independent predictors of diarrhoea. The independent predictors of ARIs were children with no childhood vaccinations (p=0.002), use of solid fuel in the household (p=0.007), being underweight (p=0.05) and diarrhoea (p<0.001).

CONCLUSIONS

The findings imply the need for holistic public health interventions such as increased vaccination coverage, population-based nutritional programmes and campaigns on the use of cleaner cooking fuel targeted at high-risk subgroups in the population to reduce the burden and adverse effects of diarrhoea and ARIs in the West African region.

Exploring the links between indoor air pollutants and health outcomes in South Asian countries: a systematic review

Indoor air pollution (IAP) has adverse effects on the health of people, globally. The objective of this systematic review was to present the range of health problems studied in association with indoor air pollutants in South Asian countries. We searched five databases, including PubMed, Web of Science, Scopus, Google Scholar, and CAB Direct for articles published between the years 2000 and 2020. We retrieved 5,810 articles, out of which we included 90 articles in our review. Among South Asian countries, only five countries have published results related to relationship between indoor air pollutants and adverse health conditions. All studies have shown adversity of indoor air pollutants on human's health. We found indoor solid fuel burning as a key source of indoor air pollution in the included studies, while women and children were most affected by their exposure to solid fuel burning. More than half of the studies accounted particulate matter responsible for indoor air pollution bearing negative health effects. In the included studies, eyes and lungs were the most commonly affected body organs, exhibiting common symptoms like cough, breathing difficulty and wheezing. This might have developed into common conditions like respiratory tract infection, chronic obstructive pulmonary diseases and eye cataract. In addition to promote research in South Asian countries, future research should focus on novel digital ways of capturing effects of indoor air pollutants among vulnerable segments of the population. As a result of this new knowledge, public health agencies should develop and test interventions to reduce people's exposure levels and prevent them to develop adverse health outcomes.

Kitchen fine particulate matter (PM2.5) concentrations from biomass fuel use in rural households of Northwest Ethiopia

Background

Combustion of solid biomass fuels using traditional stoves which is the daily routine for 3 billion people emits various air pollutants including fine particulate matter which is one of the widely recognized risk factors for various cardiorespiratory and other health problems. But, there is only limited evidences of kitchen PM2.5 concentrations in rural Ethiopia.

Objective

This study is aimed to estimate the 24-h average kitchen area concentrations of PM2.5 and to identify associated factors in rural households of northwest Ethiopia.

Method

The average kitchen area PM2.5 concentrations were measured using a low-cost light-scattering Particle and Temperature Sensor Plus (PATS+) for a 24-h sampling period. Data from the PATS+ was downloaded in electronic form for further analysis. Other characteristics were collected using face-to-face interviews. Independent sample t-test and one-way analysis of variance were used to test differences in PM2.5 concentrations between and among various characteristics, respectively.

Result

Mixed fuels were the most common cooking biomass fuel. The 24-h average kitchen PM2.5 concentrations was estimated to be 405 μg/m3, ranging from 52 to 965 μg/m3. The average concentrations were 639 vs. 336 μg/m3 (p < 0.001) in the thatched and corrugated iron sheet roof kitchens, respectively. The average concentration was also higher among mixed fuel users at 493 vs. 347 μg/m3 (p = 0.042) compared with firewood users and 493 vs. 233 μg/m3 (p = 0.007) as compared with crop residue fuel users. Statistically significant differences were also observed across starter fuel types 613 vs. 343 μg/m3 (p = 0.016) for kerosene vs. dried leaves and Injera baking events 523 vs. 343 μg/m3 (p < 0.001) for baked vs. not baked events.

Conclusion

The average kitchen PM2.5 concentrations in the study area exceeded the world health organization indoor air quality guideline value of 15 μg/m3 which can put pregnant women at greater risk and contribute to poor pregnancy outcomes. Thatched roof kitchen, mixed cooking fuel, kerosene fire starter, and Injera baking events were positively associated with high-level average kitchen PM2.5. concentration. Simple cost-effective interventions like the use of chimney-fitted improved stoves and sensitizing women about factors that aggravate kitchen PM2.5 concentrations could reduce kitchen PM 2.5 levels in the future.

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

Background

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

Methods

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

Results

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

Conclusion

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

Household use of biomass fuel, especially traditional stove is associated with childhood wheeze and eczema: a cross sectional study of rural communities in Kandy, Sri Lanka

BACKGROUND

Most households in low- and middle-income countries (LMICs) rely on biomass fuel for daily cooking. Studies investigating the association between early life exposure to household air pollution and health outcomes in children in LMICs are limited.

OBJECTIVE

To investigate the effects of biomass fuel for cooking and different types of stoves on wheeze and allergies in children of rural Sri Lankan communities.

METHODS

A cross-sectional study was conducted on 452 children aged 5 years and younger in Kandy, Sri Lanka. Mothers completed a questionnaire on the use of biomass fuel and respiratory and allergic outcomes in children. The associations between biomass fuel and outcomes were analyzed using logistic regression models, adjusting for potential confounders.

RESULTS

Use of biomass fuel for cooking was associated with increased risk of childhood wheeze (aOR 2.29; 95% CI 1.04-5.08) and eczema (aOR 4.57; 95% CI 1.24-16.89) compared with households that used clean fuel (liquid petroleum gas (LPG), electricity and/or biogas). Among households that used biomass fuel, use of traditional biomass stoves was associated with a higher risk of childhood wheeze (aOR 2.95; 95% CI 1.19-7.33), allergic rhinitis (aOR 3.01; 95% CI 1.42-6.39), and eczema (aOR 7.39; 95% CI 1.70-32.06) compared with households that used clean stoves.

CONCLUSION

Children living in households that use biomass fuel, especially traditional biomass cookstoves, have a higher risk of wheeze and allergic diseases. Access to affordable clean energy sources that reduce air pollution may help improve the health of children in rural LMICs.

Supplemental data for this article is available online at at www.tandfonline.com/ijas .

Impact of solid fuel usage on respiratory symptoms among reproductive aged women: a cross-sectional study in Sri Lanka

BACKGROUND

Worldwide, around 3 billion people rely on solid fuel for their daily energy needs. Household air pollution secondary to solid fuel burning is a major risk factor for respiratory mobility among vulnerable populations. This study aimed to investigate the respiratory symptoms associated with solid fuel usage, the level of kitchen fuel smoke exposure and its association with respiratory symptoms among reproductive-aged women in Sri Lanka, where most households exclusively use firewood as the primary cooking fuel.

METHODS

A descriptive cross-sectional study was conducted among 403 reproductive-aged women (15 to 49 years) in the Central Province, Sri Lanka. A structured interviewer-administered questionnaire was used to collect data, and an exposure assessment was done using a breath carbon monoxide monitor.

RESULTS

After adjusting for potential confounding factors by the logistic regression models, the odds ratios (OR) of the liquid petroleum gas-only users for at least one respiratory symptom relevant to cough (OR: 0.39; 95% confidence interval [CI]: 0.20-0.78), wheezing (OR: 0.47; 95% [CI]: 0.26-0.87), and dyspnea (OR: 0.44; 95% CI: 0.24-0.84) were significantly lower compared to firewood-only users. The mean of expired air carbon monoxide and estimated carboxyhemoglobin levels of liquid petroleum gas-only users (2.84 ± 2.85 ppm; 1.08 ± 0.46%) were significantly lower than those of firewood-only users (5.27 ± 4.64 ppm; 1.47 ± 0.74%).

CONCLUSIONS

The use of firewood increased the risk of respiratory symptoms among reproductive-aged women in Sri Lanka. Health education focused on positive behavioral changes and effective and efficient clean energy policies are recommended to mitigate the risk associated with solid fuel smoke exposure.

Cleaning the Flue in Wood-Burning Stoves Is a Key Factor in Reducing Household Air Pollution

In experimental settings, replacing old wood stoves with new wood stoves results in reduced personal exposure to household air pollution. We tested this assumption by measuring PM2.5 and levoglucosan concentrations inside homes and correlated them with wood stove age. Methods: Thirty homes in the Albuquerque, NM area were monitored over a seven-day period using in-home particulate monitors placed in a common living area during the winter months. Real-time aerosol monitoring was performed, and filter samples were analyzed gravimetrically to calculate PM2.5 concentrations and chemically to determine concentrations of levoglucosan. A linear regression model with backward stepwise elimination was performed to determine the factors that would predict household air pollution measures. Results: In this sample, 73.3% of the households used wood as their primary source of heating, and 60% burned daily or almost daily. The mean burn time over the test week was 50 ± 38 h, and only one household burned wood 24/day (168 h). The average PM2.5 concentration (standard deviation) for the 30 homes during the seven-day period was 34.6 µg/m3 (41.3 µg/m3), and median (min, max) values were 15.5 µg/m3 (7.3 µg/m3, 193 µg/m3). Average PM2.5 concentrations in 30 homes ranged from 0−15 μg/m3 to >100 μg/m3. Maximum PM2.5 concentrations ranged from 100−200 μg/m3 to >3000 μg/m3. The levoglucosan levels showed a linear correlation with the total PM2.5 collected by the filters (R2 = 0.92). However, neither mean nor peak PM2.5 nor levoglucosan levels were correlated with the age (10.85 ± 8.54 years) of the wood stove (R2 ≤ 0.07, p > 0.23). The final adjusted linear regression model showed that average PM2.5 was associated with reports of cleaning the flue with a beta estimate of 35.56 (3.47−67.65) and R2 = 0.16 (p = 0.04). Discussion: Cleaning the flue and not the wood stove age was associated with household air pollution indices. Education on wood stove maintenance and safe burning practices may be more important in reducing household air pollution than the purchase of new stoves.

Temporal Variation and Factors Associated with Allergic Rhinitis in a Cohort of Rural Preschool Children from Sri Lanka

BACKGROUND

Allergic rhinitis is a common chronic childhood disease with a low diagnosis rate, causing poor quality of life, absenteeism, decreased school performance and significant healthcare cost. However, data on the prevalence of allergic rhinitis is sparse in preschoolers of rural geography, especially in developing countries.

AIM

To describe the epidemiology of allergic rhinitis in preschoolers from a rural geography of a developing country.

METHODS

A population-based cross-sectional study was conducted in Anuradhapura district, Sri Lanka using the WHO-30 cluster methodology with probability proportionate to size sampling. The International Study of Asthma and Allergy in Childhood questionnaire was used to assess symptomatology.

RESULTS

The response rate was 91.8%, with 548 (51.7%) male and 512 (48.3%) female participants. The mean age was 4.4 (± 0.7) years. Allergic rhinitis was reported in 123 (11.6%; 95% CI 9.7-13.5), and eye symptoms were reported in 41 (3.9%; 95% CI 2.8-5.2) children. Activities of daily living were disturbed due to nasal symptoms in 113 (10.7%; 95% CI 8.8-12.5). Allergic rhinitis was independently associated with severe asthma (OR 6.26; 95% CI 3.54-11.06), sleeping on the floor (OR 4.79; 95% CI 1.33-17.25) and having cats in the households (OR 1.86; 95% CI 1.18-2.91). Nasal symptoms were more common in January and August to October months. The standardized local highest monthly temperature, lowest monthly temperature, highest monthly humidity and dew point strongly predicted allergic rhinitis symptom exacerbation (F=4.8, p=0.036, adjusted R square=57.8%, VIF≤2.259, DW=2.1).

CONCLUSIONS

Allergic rhinitis affects 1 in 10 preschool children of rural Sri Lanka. The factors associated and environmental factor model developed to predict symptom exacerbation could be used to prevent allergic rhinitis exacerbations.

Association of Acute Respiratory Infections with Indoor Air Pollution from Biomass Fuel Exposure among Under-Five Children in Jimma Town, Southwestern Ethiopia

Background

Most of the households in developing countries burn biomass fuel in traditional stoves with incomplete combustion that leads to high indoor air pollution and acute respiratory infections. Acute respiratory infection is the most common cause of under-five morbidity and mortality accounting for 2 million deaths worldwide and responsible for 18% of deaths among under-five children in Ethiopia. Although studies were done on acute respiratory infections, the majority of studies neither clinically diagnose respiratory infections nor use instant measurement of particulate matter.

Methods

The community-based cross-sectional study design was employed among under-five children in Jimma town from May 21 to June 7, 2020. A total of 265 children through systematic random sampling were included in the study. The data were collected using a pretested semistructured questionnaire and laser pm 2.5 meter for indoor particulate matter concentration. Associations among factors were assessed through correlation analysis, and binary logistic regression was done to predict childhood acute respiratory infections. Variables with p-value less than 0.25 in bivariate regression were the candidate for the final multivariate logistic regression. Two independent sample t-tests were done to compare significant mean difference between concentrations of particulate matter.

Results

Among 265 under-five children who were involved in the study, 179 (67.5%) were living in households that predominantly use biomass fuel. Prevalence of acute respiratory infections in the study area was 16%. Children living in households that use biomass fuel were four times more likely to develop acute respiratory infections than their counterparts (AOR: 4.348; 95% CI: 1.632, 11.580). The size of household was significantly associated with the prevalence of acute respiratory infections. Under-five children living in households that have a family size of six and greater had odds of 1.7 increased risk of developing acute respiratory infections than their counterparts (AOR: 1.7; 95% CI: 1.299, 2.212). The other factor associated with acute respiratory infection was separate kitchen; children living in households in which there were no separate kitchen were four times at increased risk of developing acute respiratory infection than children living in households which have separate kitchen (AOR: 4.591; 95% CI: 1.849, 11.402). The concentration of indoor particulate matter was higher in households using biomass fuel than clean fuel. There was statistically higher particulate matter concentration in the kitchen than living rooms (t = 4.509, p ≤ 0.001). Particulate matter 2.5 concentrations (μg/m³) of the households that had parental smoking were significantly higher than their counterparts (AOR: 20.224; 95% CI: 1.72, 12.58).

Conclusion

There is an association between acute respiratory infections and biomass fuel usage among under-five children. Focusing on improved energy sources is essential to reduce the burden and assure the safety of children.

Health impacts of indoor air pollution from household solid fuel on children and women

The inefficient and incomplete combustion of solid fuel (SF) is associated with high levels of indoor air pollutants leading to 3.55 million deaths annually. The risk is higher in women and children, due to their higher exposure duration and unique physical properties. The current article aims to provide a critical overview regarding the use of solid fuel, its associated pollutants, their toxicity mechanisms and, most importantly the associated health impacts, especially in women and children. Pollutants associated with SF mostly include polycyclic aromatic hydrocarbons, particulate matter, nitrous oxide, carbon monoxide and sulfur dioxide, and their concentrations are two- to threefold higher in indoor environments. These pollutants can lead to a variety of health risks by inducing different toxicity mechanisms, such as oxidative stress, DNA methylation, and gene activation. Exposed children have an increased prevalence of low birth weight, acute lower respiratory tract infections, anemia and premature mortality. On the other hand, lung cancer, chronic obstructive pulmonary disease and cardiovascular diseases are the major causes of disability and premature death in women. Indoor air pollution resulting from SF combustion is a major public health threat globally. To reduce the risks, it is important to identify future research gaps and implement effective interventions and policies.

How far climatic parameters associated with air quality induced risk state (AQiRS) during COVID-19 persuaded lockdown in India

Global temperature rises in response to accumulating greenhouse gases is a well-debated issue in the present time. Historical records show that greenhouse gases positively influence temperature. Lockdown incident has brought an opportunity to justify the relation between greenhouse gas centric air pollutants and climatic variables considering a concise period. The present work has intended to explore the trend of air quality parameters, and air quality induced risk state since pre to during the lockdown period in reference to India and justifies the influence of pollutant parameters on climatic variables. Results showed that after implementation of lockdown, about 70% area experienced air quality improvement during the lockdown. The hazardous area was reduced from 7.52% to 5.17%. The spatial association between air quality components and climatic variables were not found very strong in all the cases. Still, statistically, a significant relation was observed in the case of surface pressure and moisture. From this, it can be stated that pollutant components can control the climatic components. This study recommends that pollution source management could be a partially good step for bringing climatic resilience of a region.

Effects of indoor air pollution due to solid fuel combustion on physical growth of children under 5 in Sri Lanka: A descriptive cross sectional study

Solid fuel combustion is an important risk factor of morbidity. This study was conducted to determine the effect of indoor air pollution (IAP) due to solid fuel combustion on physical growth in 262 Sri Lankan children under five. Exposure was defined by the type of fuel used for cooking. Pollutant levels were measured in a subsample of households. “High” exposure group (households using biomass fuel/kerosene oil for cooking) comprised 60% of the study population; the prevalence of wasting was 19.7% and underweight was 20.4% in the entire population where 68% were from the high exposure group. Children from the “high” exposure group had significantly lower mean z-scores for weight-for-height (p = 0.047), height-for-age (p = 0.004) and weight-for-age (p = 0.001) as compared to the “low” exposure group (children of households using liquefied petroleum gas and/or electricity) after adjusting for confounders. Z-scores of weight-for-age, height-for-age and weight-for-height were negatively correlated with CO (p = 0.001, 0.018, 0.020, respectively) and PM_2.5 concentrations (p<0.001,p = 0.024 p = 0.008, respectively). IAP due to combustion of biomass fuel leads to poor physical growth.

Housing Risk Factors Associated with Respiratory Disease: A Systematic Review

Cold, damp and mouldy housing arises from the degradation of the housing stock over time due to weathering and a lack of maintenance. Living in such houses is associated with many adverse impacts on human health, especially for those with existing health issues. This paper presents a systematic review, using the PRISMA protocol, consisting of an exploratory analysis of housing-related risk factors associated with respiratory disease. The review consisted of 360 studies investigating 19 risk factors associated with respiratory conditions. Each fall into one of four categories, namely, (1) outdoor environment-related factors; (2) indoor air pollution-related factors; (3) housing non-structure-related factors; or (4) housing structure-related factors. The results show that effects of poor housing conditions on occupants’ respiratory health is a growing research field, where poor indoor air quality, mainly due to a lack of adequate ventilation, was found to be the most influential risk factor. Usage of solid fuel and living in an urban area without a pollutant-free air filtration system are the main risk factors related to inadequate ventilation. Therefore, an adequate and reliable ventilation system with air-infiltration was considered to be the main mitigation solution to improve indoor air quality. It is suggested that government organisations and health practitioners could use the identified risk factors to measure the healthiness of existing dwellings and take measures to improve existing conditions and develop regulations for new housing construction to promote the healthy home concept. Further research is needed for risk mitigation strategies to reduce the respiratory health burden attributed to housing.

Household Air Pollution from Biomass Fuel for Cooking and Adverse Fetal Growth Outcomes in Rural Sri Lanka

The aim of this study was to investigate the impact of biomass fuel for cooking on adverse fetal growth outcomes in Sri Lanka. A cross-sectional study of mothers recruited at maternity clinics in rural communities in Sri Lanka’s Central Province was undertaken. Data pertaining to household air pollution and fetal growth parameters were collected using an interviewer-administered questionnaire. Logistic regression models, adjusted for potential confounders, were used to evaluate the impact of biomass fuel for cooking on low birth weight (LBW) and small for gestational age (SGA) parameters. Findings showed that exposure to biomass cooking fuels during pregnancy was associated with an increased risk of LBW adjusted odds ratio (aOR) 2.74 (95% CI 1.08–6.96) and SGA (aOR: 1.87, 95% CI 1.03–3.41) compared with the use of clean energy. The risk of LBW was highest for traditional biomass stoves compared to improved biomass stoves (aOR: 3.23, 95% 1.17–8.89) and biomass use in kitchens without a chimney compared to kitchens with a chimney (aOR: 4.63, 95% 1.54–13.93). Similar trends were observed for SGA.

Adverse Environmental Exposure and Respiratory Health in Children

The burden imposed by pollution falls more on those living in low-income and middle-income countries, affecting children more than adults. Most air pollution results from incomplete combustion and contains a mixture of particulate matter and gases. Air pollution exposure has negative impacts on respiratory health. This article concentrates on air pollution in 2 settings, the child's home and the ambient environment. There is an inextricable 2-way link between air pollution and climate change, and the effects of climate change on childhood respiratory health also are discussed.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Prevalence of pneumonia and its associated factors among under-five children in East Africa: a systematic review and meta-analysis

Background

Pneumonia is defined as an acute inflammation of the Lungs’ parenchymal structure. It is a major public health problem and the leading cause of morbidity and mortality in under-five children especially in developing countries. In 2015, it was estimated that about 102 million cases of pneumonia occurred in under-five children, of which 0.7 million were end up with death. Different primary studies in Eastern Africa showed the burden of pneumonia. However, inconsistency among those studies was seen and no review has been conducted to report the amalgamated magnitude and associated factors. Therefore, this review aimed to estimate the national prevalence and associated factors of pneumonia in Eastern Africa

Methods

Using PRISMA guideline, we systematically reviewed and meta-analyzed studies that examined the prevalence and associated factors of pneumonia from PubMed, Cochrane library, and Google Scholar. Heterogeneity across the studies was evaluated using the Q and the I² test. A weighted inverse variance random-effects model was applied to estimate the national prevalence and the effect size of associated factors. The subgroup analysis was conducted by country, study design, and year of publication. A funnel plot and Egger’s regression test were used to see publication bias. Sensitivity analysis was also done to identify the impact of studies.

Result

A total of 34 studies with 87, 984 participants were used for analysis. The pooled prevalence of pneumonia in East Africa was 34% (95% CI; 23.80–44.21). Use of wood as fuel source (AOR = 1.53; 95% CI:1.30–1.77; I² = 0.0%;P = 0.465), cook food in living room (AOR = 1.47;95% CI:1.16–1.79; I² = 0.0%;P = 0.58), caring of a child on mother during cooking (AOR = 3.26; 95% CI:1.80–4.72; I² = 22.5%;P = 0.26), Being unvaccinated (AOR = 2.41; 95% CI:2.00–2.81; I² = 51.4%;P = 0.055), Child history of Acute Respiratory Tract Infection (ARTI) (AOR = 2.62; 95% CI:1.68–3.56; I² = 11.7%;P = 0.337) were identified factors of pneumonia.

Conclusion

The prevalence of pneumonia in Eastern Africa remains high. This review will help policy-makers and program officers to design pneumonia preventive interventions.

Maternal exposure to PM2.5 may increase the risk of congenital hypothyroidism in the offspring: a national database based study in China

Background

Maternal exposure to air pollution is related to fetal dysplasia. However, the association between maternal exposure to air pollution and the risk of congenital hypothyroidism (CH) in the offspring is largely unknown.

Methods

We conducted a national database based study in China to explore the association between these two parameters. The incidence of CH was collected from October 1, 2014 to October 1, 2015 from the Chinese Maternal and Child Health Surveillance Network. Considering that total period of pregnancy and consequently the total period of particle exposure is approximately 10 months, average exposure levels of PM_2.5, PM₁₀ and Air Quality Index (AQI) were collected from January 1, 2014 to January 1, 2015. Generalized additive model was used to evaluate the association between air pollution and the incidence of CH, and constructing receiver operating characteristic (ROC) curve was used to calculate the cut-off value.

Results

The overall incidence of CH was 4.31 per 10,000 screened newborns in China from October 1, 2014 to October 1, 2015. For every increase of 1 μg/m³ in the PM_2.5 exposure during gestation could increase the risk of CH (adjusted OR = 1.016 per 1 μg/m³ change, 95% CI, 1.001–1.031). But no significant associations were found with regard to PM₁₀ (adjusted OR = 1.009, 95% CI, 0.996–1.018) or AQI (adjusted OR = 1.012, 95% CI,0.998–1.026) and the risk of CH in the offspring. The cut-off value of prenatal PM_2.5 exposure for predicting the risk of CH in the offspring was 61.165 μg/m³.

Conclusions

The present study suggested that maternal exposure to PM_2.5 may exhibit a positive association with increased risk of CH in the offspring. We also proposed a cut-off value of PM_2.5 exposure that might determine reduction in the risk of CH in the offspring in highly polluted areas.