1
|
Medgyesi DN, Mujtaba MN, Yang Q, Abubakari SW, Lee AG, Porter J, Chillrud SN, Kaali S, Jack DW, Asante KP. Geospatial determinants of maternal and child exposure to fine particulate matter in Kintampo, Ghana: Levels within the household and community, by surrounding building density and near roadways. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2024; 34:802-813. [PMID: 37798345 PMCID: PMC10995107 DOI: 10.1038/s41370-023-00606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Personal exposure to fine particulate matter (PM2.5) from household air pollution is well-documented in sub-Saharan Africa, but spatiotemporal patterns of exposure are poorly characterized. OBJECTIVE We used paired GPS and personal PM2.5 data to evaluate changes in exposure across location-time environments (e.g., household and community, during cooking and non-cooking hours), building density and proximity to roadways. METHODS Our study included 259 sessions of geolocated, gravimetrically-calibrated one-minute personal PM2.5 measurements from participants in the GRAPHS Child Lung Function Study. The household vicinity was defined using a 50-meter buffer around participants' homes. Community boundaries were developed using a spatial clustering algorithm applied to an open-source dataset of building footprints in Africa. For each GPS location, we estimated building density (500 m buffer) and proximity to roadways (100 m buffer). We estimated changes in PM2.5 exposure by location (household, community), time of day (morning/evening cooking hours, night), building density, and proximity to roadways using linear mixed effect models. RESULTS Relative to nighttime household exposure, PM2.5 exposure during evening cooking hours was 2.84 (95%CI = 2.70-2.98) and 1.80 (95%CI = 1.54-2.10) times higher in the household and community, respectively. Exposures were elevated in areas with the highest versus lowest quartile of building density (FactorQ1vsQ4 = 1.60, 95%CI = 1.42-1.80). The effect of building density was strongest during evening cooking hours, and influenced levels in both the household and community (31% and 65% relative increase from Q1 to Q4, respectively). Being proximal to a trunk, tertiary or track roadway increased exposure by a factor of 1.16 (95%CI = 1.07-1.25), 1.68 (95%CI = 1.45-1.95) and 1.27 (95%CI = 1.06-1.53), respectively. IMPACT Household air pollution from cooking with solid fuels in sub-Saharan Africa is a major environmental concern for maternal and child health. Our study advances previous knowledge by quantifying the impact of household cooking activities on air pollution levels in the community, and identifying two geographic features, building density and roadways, that contribute to maternal and child daily exposure. Household cooking contributes to higher air pollution levels in the community especially in areas with greater building density. Findings underscore the need for equitable clean household energy transitions that reach entire communities to reduce health risks from household and outdoor air pollution.
Collapse
Affiliation(s)
- Danielle N Medgyesi
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Mohammed Nuhu Mujtaba
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, North Municipality, Ghana
| | - Qiang Yang
- Lamont-Doherty Earth Observatory, Columbia University, Palisades, NY, USA
- Elsevier Global STM Journals, New York, NY, USA
| | - Sulemana Watara Abubakari
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, North Municipality, Ghana
| | - Alison G Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeremy Porter
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Sociology, School of Humanities and Social Sciences, Brooklyn College, Brooklyn, NY, USA
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, Palisades, NY, USA
| | - Seyram Kaali
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, North Municipality, Ghana
| | - Darby W Jack
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, North Municipality, Ghana
| |
Collapse
|
2
|
Daouda M, Kaali S, Spring E, Mujtaba MN, Jack D, Dwommoh Prah RK, Colicino E, Tawiah T, Gennings C, Osei M, Janevic T, Chillrud SN, Agyei O, Gould CF, Lee AG, Asante KP. Prenatal Household Air Pollution Exposure and Childhood Blood Pressure in Rural Ghana. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:37006. [PMID: 38506828 PMCID: PMC10953816 DOI: 10.1289/ehp13225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 01/18/2024] [Accepted: 02/08/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND The association between prenatal household air pollution (HAP) exposure and childhood blood pressure (BP) is unknown. OBJECTIVE Within the Ghana Randomized Air Pollution and Health Study (GRAPHS) we examined time-varying associations between a) maternal prenatal and b) first-year-of-life HAP exposure with BP at 4 years of age and, separately, whether a stove intervention delivered prenatally and continued through the first year of life could improve BP at 4 years of age. METHODS GRAPHS was a cluster-randomized cookstove intervention trial wherein n = 1,414 pregnant women were randomized to one of two stove interventions: a) a liquefied petroleum gas (LPG) stove or improved biomass stove, or b) control (open fire cooking). Maternal HAP exposure over pregnancy and child HAP exposure over the first year of life was quantified by repeated carbon monoxide (CO) measurements; a subset of women (n = 368 ) also performed one prenatal and one postnatal personal fine particulate matter (PM 2.5 ) measurement. Systolic and diastolic BP (SBP and DBP) were measured in n = 667 4-y-old children along with their PM 2.5 exposure (n = 692 ). We examined the effect of the intervention on resting BP z -scores. We also employed reverse distributed lag models to examine time-varying associations between a) maternal prenatal and b) first-year-of-life HAP exposure and resting BP z -scores. Among those with PM 2.5 measures, we examined associations between PM 2.5 and resting BP z -scores. Sex-specific effects were considered. RESULTS Intention-to-treat analyses identified that DBP z -score at 4 years of age was lower among children born in the LPG arm (LPG β = - 0.20 ; 95% CI: - 0.36 , - 0.03 ) as compared with those in the control arm, and females were most susceptible to the intervention. Higher CO exposure in late gestation was associated with higher SBP and DBP z -score at 4 years of age, whereas higher late-first-year-of-life CO exposure was associated with higher DBP z -score. In the subset with PM 2.5 measurements, higher maternal postnatal PM 2.5 exposure was associated with higher SBP z -scores. DISCUSSION These findings suggest that prenatal and first-year-of-life HAP exposure are associated with child BP and support the need for reductions in exposure to HAP, with interventions such as cleaner cooking beginning in pregnancy. https://doi.org/10.1289/EHP13225.
Collapse
Affiliation(s)
- Misbath Daouda
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York, USA
- Department of Environmental Health Sciences, School of Public Health, University of California, Berkeley, USA
| | - Seyram Kaali
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Ghana
| | - Emma Spring
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mohammed N. Mujtaba
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Ghana
| | - Darby Jack
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York, USA
| | - Rebecca Kyerewaa Dwommoh Prah
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Ghana
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Theresa Tawiah
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Ghana
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Musah Osei
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Ghana
| | - Teresa Janevic
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Steven N. Chillrud
- Lamont-Doherty Earth Observatory of Columbia University, New York, New York, USA
| | - Oscar Agyei
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Ghana
| | - Carlos F. Gould
- Department of Earth System Science, Stanford University, Stanford, California, USA
| | - Alison G. Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Ghana
| |
Collapse
|
3
|
Hassani A, Schneider P, Vogt M, Castell N. Low-Cost Particulate Matter Sensors for Monitoring Residential Wood Burning. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:15162-15172. [PMID: 37756014 PMCID: PMC10569052 DOI: 10.1021/acs.est.3c03661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023]
Abstract
Conventional monitoring systems for air quality, such as reference stations, provide reliable pollution data in urban settings but only at relatively low spatial density. This study explores the potential of low-cost sensor systems (LCSs) deployed at homes of residents to enhance the monitoring of urban air pollution caused by residential wood burning. We established a network of 28 Airly (Airly-GSM-1, SP. Z o.o., Poland) LCSs in Kristiansand, Norway, over two winters (2021-2022). To assess performance, a gravimetric Kleinfiltergerät measured the fine particle mass concentration (PM2.5) in the garden of one participant's house for 4 weeks. Results showed a sensor-to-reference correlation equal to 0.86 for raw PM2.5 measurements at daily resolution (bias/RMSE: 9.45/11.65 μg m-3). High-resolution air quality maps at a 100 m resolution were produced by combining the output of an air quality model (uEMEP) using data assimilation techniques with the network data that were corrected and calibrated by using a proposed five-step network data processing scheme. Leave-one-out cross-validation demonstrated that data assimilation reduced the model's RMSE, MAE, and bias by 44-56, 38-48, and 41-52%, respectively.
Collapse
Affiliation(s)
- Amirhossein Hassani
- The Climate and Environmental
Research Institute NILU, P.O. Box 100, Kjeller 2027, Norway
| | - Philipp Schneider
- The Climate and Environmental
Research Institute NILU, P.O. Box 100, Kjeller 2027, Norway
| | - Matthias Vogt
- The Climate and Environmental
Research Institute NILU, P.O. Box 100, Kjeller 2027, Norway
| | - Núria Castell
- The Climate and Environmental
Research Institute NILU, P.O. Box 100, Kjeller 2027, Norway
| |
Collapse
|
4
|
Zhang Y, Chen S, Chen L, Wu Y, Wei J, Ma T, Chen M, Ma Q, Liu J, Wang X, Xing Y, Wu L, Li W, Liu X, Guo X, Ma J, Dong Y, Zhang J. Association of SO 2/CO exposure and greenness with high blood pressure in children and adolescents: A longitudinal study in China. Front Public Health 2023; 11:1097510. [PMID: 37304113 PMCID: PMC10248062 DOI: 10.3389/fpubh.2023.1097510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/06/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction We aimed to investigate the association between greenness around schools, long-term gaseous air pollution exposure (SO2 and CO), and blood pressure in children and adolescents. Methods From 2006 to 2018, a total of 219,956 Chinese children and adolescents aged 7-17 years in Beijing and Zhongshan were included in this longitudinal study. Annual average concentrations of SO2 and CO and the mean values of normalized difference vegetation index around schools were calculated. We used the generalized estimation equation model, restricted cubic spline model, and Cox model to analyze the health effects. Results Among all the subjects, 52,515 had the first onset of HBP. During the follow-up, HBP's cumulative incidence and incidence density were 23.88% and 7.72 per 100 person-year respectively. Exposures to SO2 and CO were significantly associated with SBP [β = 1.30, 95% CI: (1.26, 1.34) and 0.78 (0.75, 0.81)], DBP [β = 0.81 (0.79, 0.84) and 0.46 (0.44, 0.48)] and HBP [HR = 1.58 (1.57, 1.60) and 1.42 (1.41, 1.43)]. The risks of HBP attributed to SO2 and CO pollution would be higher in school-aged children in the low greenness group: the attributable fractions (AFs) were 26.31% and 20.04%, but only 13.90% and 17.81% in the higher greenness group. The AFs were also higher for normal-BMI children and adolescents in the low greenness group (AFs = 30.90% and 22.64%, but 14.41% and 18.65% in the high greenness group), while the AFs were not as high as expected for obese children in the low greenness group (AFs = 10.64% and 8.61%), nor was it significantly lower in the high greenness group (AFs = 9.60% and 10.72%). Discussion Greenness could alleviate the damage effects of SO2/CO exposure on the risks of HBP among children and adolescents, and the benefit is BMI sensitivity. It might offer insights for policymakers in making effective official interventions to prevent and control the prevalence of childhood HBP and the future disease burden caused by air pollution.
Collapse
Affiliation(s)
- Yi Zhang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Shuo Chen
- Beijing Physical Examination Center, Beijing, China
| | - Li Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Yu Wu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, United States
| | - Tao Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Manman Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Qi Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Jieyu Liu
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Xinxin Wang
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China
| | - Yi Xing
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Lijuan Wu
- Department of Epidemiology and Health Statistics, Capital Medical University School of Public Health, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Weiming Li
- Department of Epidemiology and Health Statistics, Capital Medical University School of Public Health, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xiangtong Liu
- Department of Epidemiology and Health Statistics, Capital Medical University School of Public Health, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xiuhua Guo
- Department of Epidemiology and Health Statistics, Capital Medical University School of Public Health, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Jingbo Zhang
- Beijing Physical Examination Center, Beijing, China
| |
Collapse
|
5
|
Afaghi S, Ramezankhani A, Azizi F, Hadaegh F. Gender-specific effect of outdoor temperature and seasonal variation on blood pressure components: a cross-sectional study on Iranian adults from 2015 to 2018. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:48220-48231. [PMID: 36752918 DOI: 10.1007/s11356-023-25732-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
Blood pressure (BP) is influenced by both individual and environmental factors such as ambient temperature. However, the gender-stratified and component-specific impact of temperature on BP is not well understood. Herein, we examined the temperature and seasonal effects on four main BP components, namely systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP), in both genders. A total of 8990 (3954 men) Tehranian adults during 2015-2018 were included. Linear regression models for analyzing data in three models including unadjusted, age-adjusted, and further adjusted for known sociodemographic and cardiovascular confounders were conducted. Among women, each 10 °C increment was associated with a significant decrease of - 0.48 mmHg (95% confidence interval (CI): - 0.86, - 0.19) and - 0.65 mmHg (- 0.76, - 0.41) in SBP and MAP, respectively. In men, the corresponding value for SBP was - 0.46 (- 0.82, - 0.16) mmHg (P = 0.058). Gender-specific analysis in each season showed that among women, PP increased in autumn and winter with each 10 °C decrease (P < 0.05). The mean increase in SBP (3.4 and 2.06 mmHg in women and men, respectively), DBP (1.66 and 1.19 mmHg), and MAP (2.71 and 1.12 mmHg) was observed during winter compared to summer (all P < 0.05). PP showed seasonality only in women (1.46 mmHg, P-value = 0.003). In both genders, SBP in age > 60 years was more susceptible to variation compared to younger ages. Furthermore, obese women had more SBP changes compared to their non-obese counterparts (all P for interaction < 0.05). In conclusion, there was a sex difference in BP response to the outdoor temperature, with higher vulnerability among women. The reverse relation between temperature and BP occurred particularly among elderly and obese individuals. Careful monitoring of BP in cold seasons, specifically in the mentioned subgroups, could potentially attenuate cardiovascular risks.
Collapse
Affiliation(s)
- Siamak Afaghi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azra Ramezankhani
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
6
|
Ye W, Pillarisetti A, de León O, Steenland K, Peel JL, Clark ML, Checkley W, Underhill LJ, Quinn A, Balakrishnan K, Garg SS, McCracken JP, Thompson LM, Díaz-Artiga A, Rosa G, Davila-Roman VG, de las Fuentes L, Papageorghiou AT, Chen Y, Wang J, Thomas FC. Baseline associations between household air pollution exposure and blood pressure among pregnant women in the Household Air Pollution Intervention Network (HAPIN) multi-country randomized controlled trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.23.23284847. [PMID: 36747716 PMCID: PMC9901046 DOI: 10.1101/2023.01.23.23284847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Cooking and heating using solid fuels can result in dangerous levels of exposure to household air pollution (HAP). HAPIN is an ongoing randomized controlled trial assessing the impact of a liquified petroleum gas stove and fuel intervention on HAP exposure and health in Guatemala, India, Peru, and Rwanda among households that rely primarily on solid cooking fuels. Given the potential impacts of HAP exposure on cardiovascular outcomes during pregnancy, we seek to characterize the relationship between personal exposures to HAP and blood pressure among pregnant women at baseline (prior to intervention) in the study. We assessed associations between PM2.5 (particulate matter with an aerodynamic diameter ≤2.5 μm), BC (black carbon), and CO (carbon monoxide) exposures and blood pressure at baseline, prior to intervention, among 3195 pregnant women between 9 and 19 weeks of gestation. We measured 24-hour personal exposure to PM2.5/BC/CO and gestational blood pressure. Multivariable linear regression models were used to evaluate associations between personal exposures to three air pollutants and blood pressure parameters. Trial-wide, we found moderate increases in systolic blood pressure (SBP) and decreases in diastolic blood pressure (DBP) as exposure to PM2.5, BC, and CO increased. None of these associations, however, were significant at the 0.05 level. HAP exposure and blood pressure associations were inconsistent in direction and magnitude within each country. We observed effect modification by body mass index (BMI) in India and Peru. Compared to women with normal weights, obese women in India and Peru (but not in Rwanda or Guatemala) had higher SBP per unit increase in log transformed PM2.5 and BC exposures. We did not find a cross-sectional association between HAP exposure and blood pressure in pregnant women; however, HAP may be associated with higher blood pressure in pregnant women who are obese, but this increase was not consistent across settings.
Collapse
Affiliation(s)
- Wenlu Ye
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA
| | - Ajay Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA
| | - Oscar de León
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Maggie L. Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lindsay J. Underhill
- Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Ashlinn Quinn
- Berkeley Air Monitoring Group, Berkeley, California, USA
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Sarada S. Garg
- Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - John P. McCracken
- Global Health Institute, Collage of Public Health, University of Georgia, Athens, Georgia, USA
| | - Lisa M. Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Anaité Díaz-Artiga
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala
| | - Ghislaine Rosa
- Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Lisa de las Fuentes
- Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Aris T. Papageorghiou
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | - Yunyun Chen
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jiantong Wang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | | |
Collapse
|
7
|
Nicolaou L, Underhill L, Hossen S, Simkovich S, Thangavel G, Rosa G, McCracken JP, Davila-Roman V, de las Fuentes L, Quinn AK, Clark M, Diaz A, Pillarisetti A, Steenland K, Waller LA, Jabbarzadeh S, Peel JL, Checkley W. Cross-sectional analysis of the association between personal exposure to household air pollution and blood pressure in adult women: Evidence from the multi-country Household Air Pollution Intervention Network (HAPIN) trial. ENVIRONMENTAL RESEARCH 2022; 214:114121. [PMID: 36029836 PMCID: PMC9492861 DOI: 10.1016/j.envres.2022.114121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/20/2022] [Accepted: 08/13/2022] [Indexed: 06/18/2023]
Abstract
Elevated blood pressure (BP) is a leading risk factor for the global burden of disease. Household air pollution (HAP), resulting from the burning of biomass fuels, may be an important cause of elevated BP in resource-poor communities. We examined the exposure-response relationship of personal exposures to HAP -fine particulate matter (PM2.5), carbon monoxide (CO), and black carbon (BC) - with BP measures in women aged 40-79 years across four resource-poor settings in Guatemala, Peru, India and Rwanda. BP was obtained within a day of 24-h personal exposure measurements at baseline, when participants were using biomass for cooking. We used generalized additive models to characterize the shape of the association between BP and HAP, accounting for the interaction of personal exposures and age and adjusting for a priori identified confounders. A total of 418 women (mean age 52.2 ± 7.9 years) were included in this analysis. The interquartile range of exposures to PM2.5 was 42.9-139.5 μg/m3, BC was 6.4-16.1 μg/m3, and CO was 0.5-2.9 ppm. Both SBP and PP were positively associated with PM2.5 exposure in older aged women, achieving statistical significance around 60 years of age. The exact threshold varied by BP measure and PM2.5 exposures being compared. For example, SBP of women aged 65 years was on average 10.8 mm Hg (95% CI 1.0-20.6) higher at 232 μg/m3 of PM2.5 exposure (90th percentile) when compared to that of women of the same age with personal exposures of 10 μg/m3. PP in women aged 65 years was higher for exposures ≥90 μg/m3, with mean differences of 6.1 mm Hg (95% CI 1.8-10.5) and 9.2 mm Hg (95% CI 3.3-15.1) at 139 (75th percentile) and 232 μg/m3 (90th percentile) respectively, when compared to that of women of the same age with PM2.5 exposures of 10 μg/m3. Our findings suggest that reducing HAP exposures may help to reduce BP, particularly among older women.
Collapse
Affiliation(s)
- Laura Nicolaou
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
| | - Lindsay Underhill
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
| | - Shakir Hossen
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
| | - Suzanne Simkovich
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA; Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville, USA; Division of Pulmonary and Critical Care Medicine, Georgetown University School of Medicine, Washington, USA
| | - Gurusamy Thangavel
- Sri Ramachandra Institute for Higher Education and Research, Chennai, India
| | - Ghislaine Rosa
- Faculty of Infectious and Tropical Diseases, London School of Tropical Medicine and Hygiene, London, UK
| | - John P McCracken
- Center for Health Studies, Universidad Del Valle de Guatemala, Guatemala City, Guatemala; Global Health Institute, Epidemiology and Biostatistics Department, University of Georgia, Athens, GA, USA
| | | | | | - Ashlinn K Quinn
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Maggie Clark
- Department of Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Anaite Diaz
- Center for Health Studies, Universidad Del Valle de Guatemala, Guatemala City, Guatemala
| | - Ajay Pillarisetti
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Kyle Steenland
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shirin Jabbarzadeh
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer L Peel
- Department of Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA; Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
| |
Collapse
|
8
|
Ye W, Steenland K, Quinn A, Liao J, Balakrishnan K, Rosa G, Ndagijimana F, Ntivuguruzwa JDD, Thompson LM, McCracken JP, Díaz-Artiga A, Rosenthal JP, Papageorghiou A, Davila-Roman VG, Pillarisetti A, Johnson M, Wang J, Nicolaou L, Checkley W, Peel JL, Clasen TF. Effects of a Liquefied Petroleum Gas Stove Intervention on Gestational Blood Pressure: Intention-to-Treat and Exposure-Response Findings From the HAPIN Trial. Hypertension 2022; 79:1887-1898. [PMID: 35708015 PMCID: PMC9278708 DOI: 10.1161/hypertensionaha.122.19362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Approximately 3 to 4 billion people worldwide are exposed to household air pollution, which has been associated with increased blood pressure (BP) in pregnant women in some studies. METHODS We recruited 3195 pregnant women in Guatemala, India, Peru, and Rwanda and randomly assigned them to intervention or control groups. The intervention group received a gas stove and fuel during pregnancy, while the controls continued cooking with solid fuels. We measured BP and personal exposure to PM2.5, black carbon and carbon monoxide 3× during gestation. We conducted an intention-to-treat and exposure-response analysis to determine if household air pollution exposure was associated with increased gestational BP. RESULTS Median 24-hour PM2.5 dropped from 84 to 24 μg/m3 after the intervention; black carbon and carbon monoxide decreased similarly. Intention-to-treat analyses showed an increase in systolic BP and diastolic BP in both arms during gestation, as expected, but the increase was greater in intervention group for both systolic BP (0.69 mm Hg [0.03-1.35]; P=0.04) and diastolic BP (0.62 mm Hg [0.05-1.19]; P=0.03). The exposure-response analyses suggested that higher exposures to household air pollution were associated with moderately higher systolic BP and diastolic BP; however, none of these associations reached conventional statistical significance. CONCLUSIONS In intention-to-treat, we found higher gestational BP in the intervention group compared with controls, contrary to expected. In exposure-response analyses, we found a slight increase in BP with higher exposure, but it was not statistically significant. Overall, an intervention with gas stoves did not markedly affect gestational BP.
Collapse
Affiliation(s)
- Wenlu Ye
- Gangarosa Department of Environmental Health, Rollins School of Public Health (W.Y., K.S., A. Pillarisetti, T.F.C.), Emory University, Atlanta, GA
- Environmental Health Sciences, School of Public Health, University of California, Berkeley (W.Y., A. Pillarisetti)
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Rollins School of Public Health (W.Y., K.S., A. Pillarisetti, T.F.C.), Emory University, Atlanta, GA
| | - Ashlinn Quinn
- Berkeley Air Monitoring Group, Berkeley, CA (A.Q., M.J.)
| | - Jiawen Liao
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles (J.L.)
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India (K.B.)
| | - Ghislaine Rosa
- Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, United Kingdom (G.R.)
| | | | | | - Lisa M. Thompson
- Nell Hodgson Woodruff School of Nursing (L.M.T.), Emory University, Atlanta, GA
| | - John P. McCracken
- Department of Environmental Health Sciences, University of Georgia, Athens (J.P.M.)
| | | | - Joshua P. Rosenthal
- Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD (J.P.R.)
| | - Aris Papageorghiou
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, United Kingdom (A. Papageorghiou)
| | | | - Ajay Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health (W.Y., K.S., A. Pillarisetti, T.F.C.), Emory University, Atlanta, GA
- Environmental Health Sciences, School of Public Health, University of California, Berkeley (W.Y., A. Pillarisetti)
| | | | - Jiantong Wang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health (J.W.), Emory University, Atlanta, GA
| | - Laura Nicolaou
- Division of Pulmonary and Critical Care, School of Medicine (L.N., W.C.), Johns Hopkins University, Baltimore, MD
- Center for Global Non-Communicable Disease Research and Training (L.N., W.C.), Johns Hopkins University, Baltimore, MD
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine (L.N., W.C.), Johns Hopkins University, Baltimore, MD
- Center for Global Non-Communicable Disease Research and Training (L.N., W.C.), Johns Hopkins University, Baltimore, MD
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Thomas F. Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health (W.Y., K.S., A. Pillarisetti, T.F.C.), Emory University, Atlanta, GA
| |
Collapse
|
9
|
Ye W, Thangavel G, Pillarisetti A, Steenland K, Peel JL, Balakrishnan K, Jabbarzadeh S, Checkley W, Clasen T. Association between personal exposure to household air pollution and gestational blood pressure among women using solid cooking fuels in rural Tamil Nadu, India. ENVIRONMENTAL RESEARCH 2022; 208:112756. [PMID: 35065931 PMCID: PMC8935388 DOI: 10.1016/j.envres.2022.112756] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/06/2022] [Accepted: 01/15/2022] [Indexed: 05/22/2023]
Abstract
BACKGROUND The Household Air Pollution Intervention Network (HAPIN) trial is an ongoing multi-center randomized controlled trial assessing the impact of a liquified petroleum gas (LPG) cookstove and fuel intervention on health. Given the potential impacts of household air pollution (HAP) exposure from burning solid fuels on cardiovascular health during pregnancy, we sought to determine whether baseline exposures to particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5), black carbon (BC) and carbon monoxide (CO) were associated with blood pressure among 799 pregnant women in Tamil Nadu, India, one of the HAPIN trial centers. METHODS Multivariable linear regression models were used to examine the association between 24-h personal exposure to PM2.5/BC/CO and systolic and diastolic blood pressure, controlling for maternal age, body mass index (BMI), mother's education, household wealth, gestational age, and season. At the time of measurement, women were between 9- and 20-weeks of gestation. RESULTS We found that systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher in pregnant women exposed to higher levels of HAP, though only the result for CO and DBP reached conventional statistical significance (p < 0.05). We observed a positive association between CO and DBP among the entire study cohort: a 1-log μg/m3 increase in CO exposure was associated with 0.36 mmHg higher DBP (95% confidence interval [CI]: 0.02 to 0.70). The effect was stronger in pregnant women with higher CO exposures (in the 3rd [≥ 0.9 and < 2.1 ppm] and 4th quartiles [≥ 2.1 and ≤ 46.9 ppm]). We also found that pregnant women with PM2.5 exposures in the highest quartile (≥ 129.9 and ≤ 2100 μg/m3) had a borderline significant association (p = 0.054) with DBP compared to those who had PM2.5 exposures in the lowest quartile (≥ 9.4 and < 47.7 μg/m3). No evidence of association was observed for BC exposure and blood pressure. CONCLUSION This study contributes to limited evidence regarding the relationship between HAP exposure and blood pressure among women during pregnancy, a critical window for both mother and child's life-course health. Results from this cross-sectional study suggest that exposures to PM2.5 and CO from solid fuel use are associated with higher blood pressure in pregnant women during their first or second trimester.
Collapse
Affiliation(s)
- Wenlu Ye
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Gurusamy Thangavel
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Ajay Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer L Peel
- Dept of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Shirin Jabbarzadeh
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
10
|
Zoller T, Mfinanga EH, Zumba TB, Asilia PJ, Mutabazi EM, Wimmersberger D, Mhimbira F, Haraka F, Reither K. Symptoms and functional limitations related to respiratory health and carbon monoxide poisoning in Tanzania: a cross sectional study. Environ Health 2022; 21:38. [PMID: 35365149 PMCID: PMC8976359 DOI: 10.1186/s12940-022-00847-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The burden of chronic respiratory symptoms and respiratory functional limitations is underestimated in Africa. Few data are available on carbon monoxide (CO) poisoning in sub-Saharan Africa and existing data is derived from CO in ambient air, but not from biomarkers in the blood. METHODS Data from the Tanzanian Lung Health study, a cross-sectional study on lung health among outpatients and visitors to an urban as well as a rural hospital in Tanzania, was analyzed to describe respiratory symptoms and functional limitations. Saturation of peripheral blood with carbon monoxide (SpCO) was measured transcutaneously and non-invasively in participants using a modified pulse oxymeter indicative of CO poisoning. Univariate and multivariate analysis was performed. RESULTS Nine hundred and ninety-seven participants were included in the analysis, the median age of participants was 46 years (49% male). 38% of participants reported some degree of chronic shortness of breath and 26% felt limited in their daily activities or at work by this symptom. The median SpCO was 7% (IQR 4-13, range 2-31%) among all participants without active smoking status (N = 808). Participants cooking with gas or electricity had the lowest SpCO (median 5%), followed by participants cooking with charcoal (median 7%). Cooking with wood, particularly using a stove, resulted in highest SpCO (median 11.5%). Participants from households where cooking takes place in a separate room had the lowest SpCO as compared to cooking outside or cooking in a shared room inside (6% vs. 9% vs.10.5%, p < 0.01). Sex or the activity of cooking itself was not associated with a difference in SpCO. Multivariate analysis confirmed cooking in a separate room (as compared to cooking outside) and living in a rural vs. urban setting as protective factors against high SpCO. CONCLUSION The findings demonstrate a high burden of chronic respiratory symptoms which also cause socioeconomic impact. High levels of SpCO indicate a relevant burden of carbon monoxide poisoning in the local population. The level of CO in the blood is more dependent on shared exposure to sources of CO with the type of housing and type of cooking fuel as most relevant factors, and less on person-individual risk factors or activities.
Collapse
Affiliation(s)
- Thomas Zoller
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4051, Basel, Switzerland
- Ifakara Health Institute, Dar es Salaam, Tanzania
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- University of Basel, Basel, Switzerland
| | | | | | | | | | - David Wimmersberger
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4051, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Frederick Haraka
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4051, Basel, Switzerland
- Ifakara Health Institute, Dar es Salaam, Tanzania
- University of Basel, Basel, Switzerland
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4051, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
| |
Collapse
|
11
|
Kundel V, Agyapong PD, Parekh A, Kaali S, Prah RKD, Taweesedt P, Tawiah T, Ayappa I, Mujtaba MN, Agyei O, Jack D, Osei M, Kwarteng AA, Lee A, Asante KP. Characterizing sleep-wake patterns in mothers and children in an agrarian community: results from the Ghana Randomized Air Pollution and Health Study. Sleep 2022; 45:6526421. [PMID: 35143676 PMCID: PMC9366631 DOI: 10.1093/sleep/zsac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/13/2022] [Indexed: 11/15/2022] Open
Abstract
STUDY OBJECTIVES Several studies have examined sleep patterns in rural/indigenous communities, however little is known about sleep characteristics in women of reproductive age, and children within these populations. We investigate sleep-wake patterns in mothers and children (ages 3-5 years) leveraging data from the Ghana Randomized Air Pollution and Health Study (GRAPHS). METHODS The GRAPHS cohort comprises of rural/agrarian communities in Ghana and collected multiday actigraphy in a subset of women and children to assess objective sleep-wake patterns. Data were scored using the Cole-Kripke and Sadeh algorithms for mothers/children. We report descriptive, baseline characteristics and objective sleep measures, compared by access to electricity/poverty status. RESULTS We analyzed data for 58 mothers (mean age 33 ± 6.6) and 64 children (mean age 4 ± 0.4). For mothers, mean bedtime was 9:40 pm ± 56 min, risetime 5:46 am ± 40 min, and total sleep time (TST) was 6.3 h ± 46 min. For children, median bedtime was 8:07 pm (interquartile range [IQR]: 7:50,8:43), risetime 6:09 am (IQR: 5:50,6:37), and mean 24-h TST 10.44 h ± 78 min. Children with access to electricity had a reduced TST compared to those without electricity (p = 0.02). Mean bedtime was later for both mothers (p = 0.05) and children (p = 0.08) classified as poor. CONCLUSIONS Mothers in our cohort demonstrated a shorter TST, and earlier bed/risetimes compared to adults in postindustrialized nations. In contrast, children had a higher TST compared to children in postindustrialized nations, also with earlier sleep-onset and offset times. Investigating objective sleep-wake patterns in rural/indigenous communities can highlight important differences in sleep health related to sex, race/ethnicity, and socioeconomic status, and help estimate the impact of industrialization on sleep in developed countries.
Collapse
Affiliation(s)
- Vaishnavi Kundel
- Corresponding author. Vaishnavi Kundel, Icahn School of Medicine at Mount Sinai, Division of Pulmonary, Critical Care and Sleep, One Gustave L Levy Place, Box 1232, New York, NY 10029, USA.
| | - Prince Darko Agyapong
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Ankit Parekh
- Icahn School of Medicine at Mount Sinai, Division of Pulmonary, Critical Care and Sleep Medicine, New York, NY, USA
| | - Seyram Kaali
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | | | - Pahnwat Taweesedt
- Division of Pulmonary Medicine, Corpus Christi Medical Center, Corpus Christi, TX, USA
| | - Theresa Tawiah
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, Division of Pulmonary, Critical Care and Sleep Medicine, New York, NY, USA
| | - Mohammed Nuhu Mujtaba
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Oscar Agyei
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Darby Jack
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Musah Osei
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | | | - Alison Lee
- Icahn School of Medicine at Mount Sinai, Division of Pulmonary, Critical Care and Sleep Medicine, New York, NY, USA
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| |
Collapse
|
12
|
Woolley KE, Dickinson-Craig E, Lawson HL, Sheikh J, Day R, Pope FD, Greenfield SM, Bartington SE, Warburton D, Manaseki-Holland S, Price MJ, Moore DJ, Thomas GN. Effectiveness of interventions to reduce household air pollution from solid biomass fuels and improve maternal and child health outcomes in low- and middle-income countries: A systematic review and meta-analysis. INDOOR AIR 2022; 32:e12958. [PMID: 34989443 DOI: 10.1111/ina.12958] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/03/2021] [Accepted: 11/06/2021] [Indexed: 06/14/2023]
Abstract
Interventions to reduce household air pollution (HAP) are key to reducing associated morbidity and mortality in low- and middle- income countries (LMICs); especially among pregnant women and young children. This systematic review aims to determine the effectiveness of interventions aimed to reduce HAP exposure associated with domestic solid biomass fuel combustion, compared to usual cooking practices, for improving health outcomes in pregnant women and children under five in LMIC settings. A systematic review and meta-analysis was undertaken with searches undertaken in MEDLINE, EMBASE, CENTRAL, GIM, ClinicalTrials.gov, and Greenfile in August 2020. Inclusion criteria were experimental, non-experimental, or quasi-experimental studies investigating the impact of interventions to reduce HAP exposure and improve associated health outcomes among pregnant women or children under 5 years. Study selection, data extraction, and quality assessment using the Effective Public Health Practice Project tool were undertaken independently by two reviewers. Seventeen out of 7293 retrieved articles (seven pregnancy, nine child health outcome; 13 studies) met the inclusion criteria. These assessed improved cookstoves (ICS; n = 10 studies), ethanol stoves (n = 1 study), and Liquefied Petroleum Gas (LPG; n = 2 studies) stoves interventions. Meta-analysis showed no significant effect of ICS interventions compared to traditional cooking for risk of preterm birth (n = 2 studies), small for gestational age (n = 2 studies), and incidence of acute respiratory infections (n = 6 studies). Although an observed increase in mean birthweight was observed, this was not statistically significant (n = 4). However, ICS interventions reduced the incidence of childhood burns (n = 3; observations = 41 723; Rate Ratio: 0.66 [95% CI: 0.45-0.96]; I2 : 46.7%) and risk of low birth weight (LBW; n = 4; observations = 3456; Odds Ratio: 0.73 [95% CI: 0.61-0.87]; I2 : 21.1%). Although few studies reported health outcomes, the data indicate that ICS interventions were associated with reduced risk of childhood burns and LBW. The data highlight the need for the development and implementation of robust, well-reported and monitored, community-driven intervention trials with longer-term participant follow-up.
Collapse
Affiliation(s)
- Katherine E Woolley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Heidi L Lawson
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jameela Sheikh
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rosie Day
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Francis D Pope
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Sheila M Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - David Warburton
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | | | - Malcolm J Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
| | - David J Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
13
|
Abdo M, Kanyomse E, Alirigia R, Coffey ER, Piedrahita R, Diaz-Sanchez D, Hagar Y, Naumenko DJ, Wiedinmyer C, Hannigan MP, Oduro AR, Dickinson KL. Health impacts of a randomized biomass cookstove intervention in northern Ghana. BMC Public Health 2021; 21:2211. [PMID: 34863138 PMCID: PMC8642932 DOI: 10.1186/s12889-021-12164-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Household air pollution (HAP) from cooking with solid fuels has adverse health effects. REACCTING (Research on Emissions, Air quality, Climate, and Cooking Technologies in Northern Ghana) was a randomized cookstove intervention study that aimed to determine the effects of two types of "improved" biomass cookstoves on health using self-reported health symptoms and biomarkers of systemic inflammation from dried blood spots for female adult cooks and children, and anthropometric growth measures for children only. METHODS Two hundred rural households were randomized into four different cookstove groups. Surveys and health measurements were conducted at four time points over a two-year period. Chi-square tests were conducted to determine differences in self-reported health outcomes. Linear mixed models were used to assess the effect of the stoves on inflammation biomarkers in adults and children, and to assess the z-score deviance for the anthropometric data for children. RESULTS We find some evidence that two biomarkers of oxidative stress and inflammation, serum amyloid A and C-reactive protein, decreased among adult primary cooks in the intervention groups relative to the control group. We do not find detectable impacts for any of the anthropometry variables or self-reported health. CONCLUSIONS Overall, we conclude that the REACCTING intervention did not substantially improve the health outcomes examined here, likely due to continued use of traditional stoves, lack of evidence of particulate matter emissions reductions from "improved" stoves, and mixed results for HAP exposure reductions. CLINICAL TRIAL REGISTRY ClinicalTrials.gov (National Institutes of Health); Trial Registration Number: NCT04633135 ; Date of Registration: 11 November 2020 - Retrospectively registered. URL: https://clinicaltrials.gov/ct2/show/NCT04633135?term=NCT04633135&draw=2&rank=1.
Collapse
Affiliation(s)
- Mona Abdo
- Colorado School of Public Health, Aurora, USA
| | | | - Rex Alirigia
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, USA
| | - Evan R. Coffey
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, USA
| | | | - David Diaz-Sanchez
- Environmental Protection Agency Human Studies Facility, Chapel Hill, USA
| | - Yolanda Hagar
- Department of Applied Mathematics, University of Colorado Boulder, Boulder, USA
| | - Daniel J. Naumenko
- Department of Anthropology, University of Colorado Boulder, Boulder, USA
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, USA
| | - Christine Wiedinmyer
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, USA
- Cooperative Institute for Research in Environmental Sciences, University of Colorado Boulder, Boulder, USA
| | - Michael P. Hannigan
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, USA
| | | | | |
Collapse
|
14
|
Wu CM, Adetona O, Song C. Acute cardiovascular responses of wildland firefighters to working at prescribed burn. Int J Hyg Environ Health 2021; 237:113827. [PMID: 34403889 DOI: 10.1016/j.ijheh.2021.113827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
Wildland firefighters at prescribed burns are exposed to elevated levels of wildland fire smoke (WFS) while performing physically demanding tasks. WFS exposure has been linked to increases in hospital and emergency admissions for cardiovascular disorders in the general population. However, knowledge about the cardiovascular effect of occupational WFS exposure among wildland firefighters is limited. To provide a better understanding of the effect of this exposure scenario on acute hemodynamic responses, resting systolic/diastolic blood pressure (SBP/DBP) and heart rate (HR) of wildland firefighters were measured before (pre-shift), after (post-shift), and the morning (next morning) immediately following prescribed burn shifts (burn days) and regular work shifts (non-burn days). A total of 38 firefighters (34 males and 4 females) participated in this study and resting BP and HR were recorded on 9 burn days and 7 non-burn days. On burn days, HR significantly increased from pre-to post-shift (13.25 bpm, 95% CI: 7.47 to 19.02 bpm) while SBP significantly decreased in the morning following the prescribed burns compared to pre-shift (-6.25 mmHg, 95% CI: -12.30 to -0.20 mmHg). However, this was due to the decrease of SBP in the firefighters who were hypertensive (-8.46 mmHg, 95% CI: -16.08 to -0.84 mmHg). Significant cross-shift reductions (post-shift/next morning vs. pre-shift) were observed in SBP on burn days compared to non-burn days (-7.01 mmHg, 95% CI: -10.94 to -3.09 mmHg and -8.64 mmHg, 95% CI: -13.81 to -3.47 mmHg, respectively). A significant reduction on burn days was also observed from pre-shift to the following morning for HR compared to non-burn days (-7.28 bpm, 95% CI: -13.50 to -1.06 bpm) while HR significantly increased in pre-to post-shift on burn days compared to non-burn days (10.61 bpm, 95% CI: 5.05 to 16.17 bpm). The decreased BP observed in wildland firefighters might be due to a high level of carbon monoxide exposure and exercise-induced hypotension. The increase in HR immediately after prescribed burns might be attributable to WFS exposure and physical exertion in prescribed burn shifts. The results suggest that wildland firefighting exposure might cause a distinct hemodynamic response, including SBP reduction and HR increment, especially for those who have pre-existing hypertension.
Collapse
Affiliation(s)
- Chieh-Ming Wu
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA.
| | - Olorunfemi Adetona
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Chi Song
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
15
|
Prenatal Household Air Pollution Exposure, Cord Blood Mononuclear Cell Telomere Length and Age Four Blood Pressure: Evidence from a Ghanaian Pregnancy Cohort. TOXICS 2021; 9:toxics9070169. [PMID: 34357912 PMCID: PMC8309911 DOI: 10.3390/toxics9070169] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/04/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022]
Abstract
Associations between prenatal household air pollution exposure (HAP), newborn telomere length and early childhood blood pressure are unknown. Methods: Pregnant women were randomized to liquefied petroleum gas (LPG) stove, improved biomass stove or control (traditional, open fire cook stove). HAP was measured by personal carbon monoxide (CO) (n = 97) and fine particulate matter (PM2.5) (n = 60). At birth, cord blood mononuclear cells (CBMCs) were collected for telomere length (TL) analyses. At child age four years, we measured resting blood pressure (BP) (n = 97). We employed multivariable linear regression to determine associations between prenatal HAP and cookstove arm and assessed CBMC relative to TL separately. We then examined associations between CBMC TL and resting BP. Results: Higher prenatal PM2.5 exposure was associated with reduced TL (β = -4.9% (95% CI -8.6, -0.4), p = 0.03, per 10 ug/m3 increase in PM2.5). Infants born to mothers randomized to the LPG cookstove had longer TL (β = 55.3% (95% CI 16.2, 109.6), p < 0.01)) compared with control. In all children, shorter TL was associated with higher systolic BP (SBP) (β = 0.35 mmHg (95% CI 0.001, 0.71), p = 0.05, per 10% decrease in TL). Increased prenatal HAP exposure is associated with shorter TL at birth. Shorter TL at birth is associated with higher age four BP, suggesting that TL at birth may be a biomarker of HAP-associated disease risk.
Collapse
|
16
|
Nsanya MK, Ayieko P, Hashim R, Mgema E, Fitzgerald D, Kapiga S, Peck RN. Sustained high blood pressure and 24-h ambulatory blood pressure monitoring in Tanzanian adolescents. Sci Rep 2021; 11:8397. [PMID: 33864003 PMCID: PMC8052360 DOI: 10.1038/s41598-021-87996-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/30/2021] [Indexed: 12/20/2022] Open
Abstract
Estimates for prevalence of high blood pressure (BP) among adolescents in Africa vary widely and few studies, if any, have documented the results of the recommended stepwise BP screening. In this cross-sectional study in Tanzania, we aimed to estimate prevalence of sustained high BP in 3 public secondary schools using the American Academy of Pediatrics BP screening strategy. On Day 1, one screening automated office BP (AOBP) measurement (Step 1) was followed by two more AOBP measurements (Step 2). Repeat AOBP measurements were obtained after about one month on adolescents with high AOBP measurements on Day 1 (Step 3). Participants with sustained high BP underwent 24-h ambulatory BP monitoring (step 4). Of all 500 enrolled participants, the prevalence of high blood pressure at each step in the process was 36.6% (183), 25.6% (128), 10.2% (51), and 2.6%(13) respectively for Steps 1-4. All except 6 students completed all 4 steps of the BP screening algorithm as indicated. We conclude that diagnosis of hypertension in African adolescents should use multiple AOBP measurements over multiple days followed by 24-h ABPM. Screening for high BP in school settings appears to be feasible and could provide a platform for cardiovascular disease education and health promotion.
Collapse
Affiliation(s)
- Mussa K Nsanya
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania.
| | - Philip Ayieko
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ramadhan Hashim
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
| | - Ezekiel Mgema
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
| | | | - Saidi Kapiga
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- London School of Hygiene and Tropical Medicine, London, UK
| | - Robert N Peck
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- Weill Cornell Medical College, New York, USA
| |
Collapse
|
17
|
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.
Collapse
|
18
|
|
19
|
Bellows AL, Spiegelman D, Du S, Jaacks LM. The Association of Cooking Fuel Use, Dietary Intake, and Blood Pressure among Rural Women in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155516. [PMID: 32751678 PMCID: PMC7432946 DOI: 10.3390/ijerph17155516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 01/04/2023]
Abstract
Household air pollution (HAP) from solid cooking fuels continues to affect 600 million people in China and has been associated with high blood pressure. The role of diet in HAP-associated high blood pressure has yet to be evaluated in China. The aim of this study was to estimate the impact of cooking fuel on change in blood pressure and evaluate whether intake of antioxidant- and omega-3 fatty acid-rich foods (fruits, vegetables, and seafood) attenuates any adverse effects of solid fuel use on blood pressure. We analyzed longitudinal data collected between 1991 and 2011 from nonpregnant women aged 18 to 80 years living in rural areas of China. We used linear mixed effects models to estimate the association between cooking fuel (coal or wood versus clean [electric or liquid petroleum gas]) and blood pressure. Possible mediation of the fuel effect by diet was assessed by the difference method. A total of 6671 women were included in this study. Women less than 40 years of age cooking with cleaner fuels over time had lower rates of change in systolic blood pressure compared to women cooking with coal (p = 0.004), and this effect was not mediated by dietary intake. Associations between fuel use and change in diastolic blood pressure were not significant. These findings lend further support for there being a direct effect of reducing HAP on improvements in blood pressure, independent of concurrent dietary intake.
Collapse
Affiliation(s)
- Alexandra L. Bellows
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Donna Spiegelman
- Center for Methods on Implementation and Prevention Science, Yale School of Public Health, New Haven, CT 06520, USA;
| | - Shufa Du
- Department of Nutrition, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Lindsay M. Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Global Academy of Agriculture and Food Security, The University of Edinburgh, Edinburgh EH25 9RG, UK
- Correspondence:
| |
Collapse
|
20
|
Cooking fuels use and carotid intima-media thickness during early pregnancy of women in Myanmar. PLoS One 2020; 15:e0236151. [PMID: 32726349 PMCID: PMC7390349 DOI: 10.1371/journal.pone.0236151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fuels burned in households for cooking cause indoor air pollution, exposing those who are cooking. Despite the mounting evidence of the effects of fuels use on health, few studies focus on the effect of cooking fuels have on carotid intima-media thickness (CIMT), a surrogate atherosclerosis biomarker in the early stages of pregnancy. This study aimed to examine the association between the use of cooking fuels and CIMT during early trimester of pregnancy among cooking women in Myanmar. METHODOLOGY In this cross-sectional study, a part of an ongoing birth cohort analysis, a total of 192 cooking pregnant women over 18 years with gestational weeks less than 18 were recruited from 15 rural health centers in Nay Pyi Taw from September to November 2019. Sociodemographic data, residential data, and fuels use data were collected with semi-structured questionnaires in face-to-face interviews. Anthropometric, hemodynamic, blood lipids, and ultrasound CIMT measurements were performed under standard protocols. Multiple linear regression was modeled to explore associations. RESULTS The study included 70 firewood fuel users, 26 charcoal fuel users, and 96 electricity fuel users. Following adjustments for potential confounding factors, firewood use was significantly associated with the increase of all CIMT analyzed. Importantly, a greater increase of mean CIMT of the right common carotid artery (RCCA; β = 0.033 mm; 95%CI: 0.006, 0.058; P<0.05) had significant association with charcoal use compared to firewood use (β = 0.029 mm; 95%CI: 0.010, 0.049; P<0.05). CONCLUSIONS Our findings demonstrate that the indoor use of cooking fuels that cause indoor air pollution, such as firewood and charcoal, is a considerable risk factor for human health and is associated with increased CIMT, wherein charcoal use contributes to more increase of mean CIMT of the RCCA. Measures to prevent health risks related to the use of such fuels should be instituted early on during pregnancy.
Collapse
|
21
|
Zhang L, An J, Tian X, Liu M, Tao L, Liu X, Wang X, Zheng D, Guo X, Luo Y. Acute effects of ambient particulate matter on blood pressure in office workers. ENVIRONMENTAL RESEARCH 2020; 186:109497. [PMID: 32304927 DOI: 10.1016/j.envres.2020.109497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/10/2020] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
Exposure to ambient particulate matter with a diameter of <2.5 μm (PM2.5) has been linked to increases in blood pressure. The aim of this study was to assess the effects of short-term exposure to PM2.5 on blood pressure in office workers in Beijing, China. A total of 4801 individuals aged 18-60 years underwent an annual medical examination between 2013 and 2017. Levels of air pollutants were obtained from 35 fixed monitoring stations and correlated with the employment location of each participant to predict personal exposure via kriging interpolation. Linear mixed-effects models were used to estimate the changes in blood pressure associated with PM2.5 exposure at various lag times. After adjusting for personal characteristics and other potential confounders, each interquartile range increase in PM2.5 was associated with a 0.413-mmHg (95% confidence interval [CI]: 0.252-0.573), 0.171-mmHg (95% CI: 0.053-0.288), 0.278-mmHg (95% CI: 0.152-0.404), and 0.241-mmHg (95% CI: 0.120-0.362) increase in systolic blood pressure, diastolic blood pressure, pulse pressure, and mean arterial pressure, respectively (p < 0.05). Men, individuals previously diagnosed with hypertension, and subjects working in the northern districts of Beijing had larger changes in blood pressure, and the effect sizes were 0.477-mmHg (95% CI: 0.286-0.669), 0.851-mmHg (95% CI: 0.306-1.397, and 0.672-mmHg (95% CI: 0.405-0.940). The findings suggested that exposure to PM2.5 had adverse effects on blood pressure, especially among males and hypertensive patients.
Collapse
Affiliation(s)
- Licheng Zhang
- School of Public Health, Capital Medical University & Beijing Municipal Key Laboratory of Clinical Epidemiology, No.10 Xitoutiao, Youanmen Wai Street, Fengtai District, Beijing, 100069, China
| | - Ji An
- School of Public Health, Capital Medical University & Beijing Municipal Key Laboratory of Clinical Epidemiology, No.10 Xitoutiao, Youanmen Wai Street, Fengtai District, Beijing, 100069, China
| | - Xue Tian
- School of Public Health, Capital Medical University & Beijing Municipal Key Laboratory of Clinical Epidemiology, No.10 Xitoutiao, Youanmen Wai Street, Fengtai District, Beijing, 100069, China
| | - Mengyang Liu
- School of Public Health, Capital Medical University & Beijing Municipal Key Laboratory of Clinical Epidemiology, No.10 Xitoutiao, Youanmen Wai Street, Fengtai District, Beijing, 100069, China
| | - Lixin Tao
- School of Public Health, Capital Medical University & Beijing Municipal Key Laboratory of Clinical Epidemiology, No.10 Xitoutiao, Youanmen Wai Street, Fengtai District, Beijing, 100069, China
| | - Xiangtong Liu
- School of Public Health, Capital Medical University & Beijing Municipal Key Laboratory of Clinical Epidemiology, No.10 Xitoutiao, Youanmen Wai Street, Fengtai District, Beijing, 100069, China
| | - Xiaonan Wang
- School of Public Health, Capital Medical University & Beijing Municipal Key Laboratory of Clinical Epidemiology, No.10 Xitoutiao, Youanmen Wai Street, Fengtai District, Beijing, 100069, China
| | - Deqiang Zheng
- School of Public Health, Capital Medical University & Beijing Municipal Key Laboratory of Clinical Epidemiology, No.10 Xitoutiao, Youanmen Wai Street, Fengtai District, Beijing, 100069, China
| | - Xiuhua Guo
- School of Public Health, Capital Medical University & Beijing Municipal Key Laboratory of Clinical Epidemiology, No.10 Xitoutiao, Youanmen Wai Street, Fengtai District, Beijing, 100069, China
| | - Yanxia Luo
- School of Public Health, Capital Medical University & Beijing Municipal Key Laboratory of Clinical Epidemiology, No.10 Xitoutiao, Youanmen Wai Street, Fengtai District, Beijing, 100069, China.
| |
Collapse
|
22
|
Exposure to Wood Smoke and Associated Health Effects in Sub-Saharan Africa: A Systematic Review. Ann Glob Health 2020; 86:32. [PMID: 32211302 PMCID: PMC7082829 DOI: 10.5334/aogh.2725] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Observational studies suggest that exposure to wood smoke is associated with a variety of adverse health effects in humans. Objective We aimed to summarise evidence from sub-Saharan Africa on levels of exposure to pollutants in wood smoke and the association between such exposures and adverse health outcomes. Methods PubMed and Google scholar databases were searched for original articles reporting personal exposure levels to pollutants or health outcomes associated with wood smoke exposure in Sub-Saharan African population. Results Mean personal PM2.5 and carbon monoxide levels in the studies ranged from 26.3 ± 1.48 μg/m3 to 1574 ± 287μg/m3 and from 0.64 ± 2.12 ppm to 22 ± 2.4 ppm, respectively. All the reported personal PM2.5 exposure levels were higher than the World Health Organization's Air Quality Guideline (AQG) for 24-hour mean exposure. Use of wood fuels in domestic cooking is the major source of wood smoke exposure in this population. Occupational exposure to wood smoke included the use of wood fuels in bakery, fish drying, cassava processing and charcoal production. Females were exposed to higher levels of these pollutants than males of the same age range. Major determinants for higher exposure to wood smoke in SSA included use of unprocessed firewood, female gender and occupational exposure. We recorded strong and consistent associations between exposure to wood smoke and respiratory diseases including acute respiratory illness and impaired lung function. Positive associations were reported for increased blood pressure, low birth weight, oesophageal cancer, sick building syndrome, non-syndromic cleft lip and/or cleft palate and under-five mortality. Conclusion There is high level of exposure to wood smoke in SSA and this exposure is associated with a number of adverse health effects. There is urgent need for aggressive programs to reduce wood smoke exposure in this population.
Collapse
|
23
|
Okello S, Amir A, Bloomfield GS, Kentoffio K, Lugobe HM, Reynolds Z, Magodoro IM, North CM, Okello E, Peck R, Siedner MJ. Prevention of cardiovascular disease among people living with HIV in sub-Saharan Africa. Prog Cardiovasc Dis 2020; 63:149-159. [PMID: 32035126 PMCID: PMC7237320 DOI: 10.1016/j.pcad.2020.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 02/07/2023]
Abstract
As longevity has increased for people living with HIV (PLWH) in the United States and Europe, there has been a concomitant increase in the prevalence of cardiovascular disease (CVD) risk factors and morbidity in this population. Whereas the availability of HIV antiretroviral therapy has resulted in dramatic increases in life expectancy in sub-Saharan Africa (SSA), where over two thirds of PLWH reside, if and how these trends impact the epidemiology of CVD is less clear. In this review, we describe the current state of the science on how both HIV and its treatment impact CVD risk factors and outcomes among PLWH in sub-Saharan Africa, including regional factors (unique to SSA) likely to differentiate these relationships from the global North. We then outline how current regional guidelines address CVD prevention among PLWH and which clinical and structural interventions are best poised to confront the co-epidemics of HIV and CVD in the region. We conclude with a discussion of key research gaps that need to be addressed to optimally develop an actionable public health response.
Collapse
Affiliation(s)
- Samson Okello
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Medicine, University of Virginia Health Systems, Charlottesville, VA, USA.
| | - Abdallah Amir
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; Department of Neurology, Mayo Clinic, Phoenix/Scottsdale, AZ, USA
| | - Gerald S Bloomfield
- Duke Clinical Research Institute, Durham, NC, USA; Duke Global Health Institute, Durham, NC, USA; Duke University Medical Center, Durham, NC, USA
| | - Katie Kentoffio
- Department of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Henry M Lugobe
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Zahra Reynolds
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Itai M Magodoro
- Departments of Medicine & Diagnostic Radiology, McGill University Health Center, Montreal, QC, Canada; Division of Cardiology, University of Cape Town, Cape Town, South Africa
| | - Crystal M North
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Robert Peck
- The Center for Global Health, Weill Cornell Medical Center for Global Health, New York, USA; Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Mark J Siedner
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| |
Collapse
|
24
|
Joubert BR, Mantooth SN, McAllister KA. Environmental Health Research in Africa: Important Progress and Promising Opportunities. Front Genet 2020; 10:1166. [PMID: 32010175 PMCID: PMC6977412 DOI: 10.3389/fgene.2019.01166] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 10/23/2019] [Indexed: 12/16/2022] Open
Abstract
The World Health Organization in 2016 estimated that over 20% of the global disease burden and deaths were attributed to modifiable environmental factors. However, data clearly characterizing the impact of environmental exposures and health endpoints in African populations is limited. To describe recent progress and identify important research gaps, we reviewed literature on environmental health research in African populations over the last decade, as well as research incorporating both genomic and environmental factors. We queried PubMed for peer-reviewed research articles, reviews, or books examining environmental exposures and health outcomes in human populations in Africa. Searches utilized medical subheading (MeSH) terms for environmental exposure categories listed in the March 2018 US National Report on Human Exposure to Environmental Chemicals, which includes chemicals with worldwide distributions. Our search strategy retrieved 540 relevant publications, with studies evaluating health impacts of ambient air pollution (n=105), indoor air pollution (n = 166), heavy metals (n = 130), pesticides (n = 95), dietary mold (n = 61), indoor mold (n = 9), per- and polyfluoroalkyl substances (PFASs, n = 0), electronic waste (n = 9), environmental phenols (n = 4), flame retardants (n = 8), and phthalates (n = 3), where publications could belong to more than one exposure category. Only 23 publications characterized both environmental and genomic risk factors. Cardiovascular and respiratory health endpoints impacted by air pollution were comparable to observations in other countries. Air pollution exposures unique to Africa and some other resource limited settings were dust and specific occupational exposures. Literature describing harmful health effects of metals, pesticides, and dietary mold represented a context unique to Africa. Studies of exposures to phthalates, PFASs, phenols, and flame retardants were very limited. These results underscore the need for further focus on current and emerging environmental and chemical health risks as well as better integration of genomic and environmental factors in African research studies. Environmental exposures with distinct routes of exposure, unique co-exposures and co-morbidities, combined with the extensive genomic diversity in Africa may lead to the identification of novel mechanisms underlying complex disease and promising potential for translation to global public health.
Collapse
Affiliation(s)
- Bonnie R Joubert
- National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, United States
| | | | - Kimberly A McAllister
- National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, United States
| |
Collapse
|
25
|
Wang J, Cao H, Sun D, Qi Z, Guo C, Peng W, Sun Y, Xie Y, Liu X, Li B, Luo Y, Pan Y, Li Y, Zhang L. Associations between ambient air pollution and mortality from all causes, pneumonia, and congenital heart diseases among children aged under 5 years in Beijing, China: A population-based time series study. ENVIRONMENTAL RESEARCH 2019; 176:108531. [PMID: 31226628 DOI: 10.1016/j.envres.2019.108531] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND Previous studies have mainly focused on the associations between particulate matters and infant mortality. However, evidence regarding the associations between gaseous pollutants and mortality among children aged <5 years remains sparse. OBJECTIVES The aim of this study was to investigate the associations between ambient air pollution and death among children aged <5 years in Beijing, China, and explore the impact of age, gender and specific causes of death on these associations. METHODS Concentrations of ambient air pollution and the number of deaths among children aged <5 years in Beijing from January 2014 to September 2016 were extracted from authoritative electronic databases. The associations were estimated for a single-month lag from the current month up to the previous 5 months (lag0-lag5) and moving averages of the current and previous months (lag01-lag05) using generalized additive Poisson regression (adjusted for time trends, season, meteorological variables and holidays). Subgroup analyses related to age, gender and specific diseases were performed. Two-pollutant models were used to evaluate the possible role of single pollutants. RESULTS Sulfur dioxide (SO2), nitrogen dioxide (NO2) and carbon monoxide (CO) demonstrated the strongest associations with death among children aged <5 years at lag0, and the estimates decreased or even turned negative with the increasing lag periods. For an interquartile range increase in SO2, NO2 and CO at lag0, the odds ratios (OR) were 1.332 (95% CI 1.152-1.539), 1.383 (95% CI 1.113-1.718) and 1.273 (95% CI 1.028-1.575). However, CO lost significance after adjusting for SO2 and NO2, and PM2.5 gained significance (OR 1.548, 95% CI 1.061-2.258) after adjusting for PM10. The ORs for SO2 and NO2 remained the most stable across all two-pollutant models. The associations for children aged 1-5 years were stronger than those reported for infants at lag0 but lower at the other lag months. The pollutant associations were stronger for congenital heart disease-related death than overall and pneumonia-related death. We did not find significant differences in terms of gender. CONCLUSION Exposure to air pollution may increase the incidence of death among children aged <5 years. SO2 and NO2 may be the most stable pollutants reflecting associations between air pollution and death, deserving further attention. Children with congenital heart diseases are more susceptible to air pollution. Therefore, it is urgent to implement the clean air targets established by WHO and reduce the exposure of children to air pollution.
Collapse
Affiliation(s)
- Jing Wang
- Department of Children's Health Care, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China; Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Han Cao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Dianqin Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Zifan Qi
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Chunyue Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Wenjuan Peng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Yanyan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Yunyi Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Xiaohui Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Bingxiao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Yanxia Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Ying Pan
- Department of Children's Health Care, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China
| | - Yichen Li
- Department of Children's Health Care, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China.
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China.
| |
Collapse
|
26
|
Onakomaiya D, Gyamfi J, Iwelunmor J, Opeyemi J, Oluwasanmi M, Obiezu-Umeh C, Dalton M, Nwaozuru U, Ojo T, Vieira D, Ogedegbe G, Olopade C. Implementation of clean cookstove interventions and its effects on blood pressure in low-income and middle-income countries: systematic review. BMJ Open 2019; 9:e026517. [PMID: 31092656 PMCID: PMC6530298 DOI: 10.1136/bmjopen-2018-026517] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE A review of the implementation outcomes of clean cookstove use, and its effects on blood pressure (BP) in low-income and middle-income countries (LMICs). DESIGN Systematic review of studies that reported the effect of clean cookstove use on BP among women, and implementation science outcomes in LMICs. DATA SOURCES We searched PubMed, Embase, INSPEC, Scielo, Cochrane Library, Global Health and Web of Science PLUS. We conducted searches in November 2017 with a repeat in May 2018. We did not restrict article publication date. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included only studies conducted in LMICs, published in English, regardless of publication year and studies that examined the use of improved or clean cookstove intervention on BP. Two authors independently screened journal article titles, abstracts and full-text articles to identify those that included the following search terms: high BP, hypertension and or household air pollution, LMICs, cookstove and implementation outcomes. RESULTS Of the 461 non-duplicate articles identified, three randomised controlled trials (RCTs) (in Nigeria, Guatemala and Ghana) and two studies of pre-post design (in Bolivia and Nicaragua) met eligibility criteria. These articles evaluated the effect of cookstove use on BP in women. Two of the three RCTs reported a mean reduction in diastolic BP of -2.8 mm Hg (-5.0, -0.6; p=0.01) for the Nigerian study; -3.0 mm Hg; (-5.7, -0.4; p=0.02) for the Guatemalan study; while the study conducted in Ghana reported a non-significant change in BP. The pre-post studies reported a significant reduction in mean systolic BP of -5.5 mm Hg; (p=0.01) for the Bolivian study, and -5.9 mm Hg (-11.3, -0.4; p=0.05) for the Nicaraguan study. Implementation science outcomes were reported in all five studies (three reported feasibility, one reported adoption and one reported feasibility and adoption of cookstove interventions). CONCLUSION Although this review demonstrated that there is limited evidence on the implementation of clean cookstove use in LMICs, the effects of clean cookstove on BP were significant for both systolic and diastolic BP among women. Future studies should consider standardised reporting of implementation outcomes.
Collapse
Affiliation(s)
- Deborah Onakomaiya
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Joyce Gyamfi
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Juliet Iwelunmor
- Behavioral Science and Health Education, Saint Louis University College for Public Health and Social Justice, Saint Louis, Missouri, USA
| | - Jumoke Opeyemi
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Mofetoluwa Oluwasanmi
- Behavioral Science and Health Education, Saint Louis University College for Public Health and Social Justice, Saint Louis, Missouri, USA
| | - Chisom Obiezu-Umeh
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Milena Dalton
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Ucheoma Nwaozuru
- Behavioral Science and Health Education, Saint Louis University College for Public Health and Social Justice, Saint Louis, Missouri, USA
| | - Temitope Ojo
- College of Global Health, New York University, New York City, New York, USA
| | - Dorice Vieira
- College of Global Health, New York University, New York City, New York, USA
- NYU Health Science Library, NYU School of Medicine, New York City, New York, USA
| | - Gbenga Ogedegbe
- Population Health, NYU Langone Health, New York City, New York, USA
| | - Christopher Olopade
- Center for Global Health, University of Chicago, Chicago, Illinois, USA
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
27
|
Sogunuru GP, Kario K, Shin J, Chen C, Buranakitjaroen P, Chia YC, Divinagracia R, Nailes J, Park S, Siddique S, Sison J, Soenarta AA, Tay JC, Turana Y, Zhang Y, Hoshide S, Wang J. Morning surge in blood pressure and blood pressure variability in Asia: Evidence and statement from the HOPE Asia Network. J Clin Hypertens (Greenwich) 2019; 21:324-334. [PMID: 30525279 PMCID: PMC8030409 DOI: 10.1111/jch.13451] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/05/2018] [Indexed: 08/02/2023]
Abstract
Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases. To effectively prevent end-organ damage, maintain vascular integrity and reduce morbidity and mortality, it is essential to decrease and adequately control blood pressure (BP) throughout each 24-hour period. Exaggerated early morning BP surge (EMBS) is one component of BP variability (BPV), and has been associated with an increased risk of stroke and cardiovascular events, independently of 24-hour average BP. BPV includes circadian, short-term and long-term components, and can best be documented using out-of-office techniques such as ambulatory and/or home BP monitoring. There is a large body of evidence linking both BPV and EMBS with increased rates of adverse cardio- and cerebrovascular events, and end-organ damage. Differences in hypertension and related cardiovascular disease rates have been reported between Western and Asian populations, including a higher rate of stroke, higher prevalence of metabolic syndrome, greater salt sensitivity and more common high morning and nocturnal BP readings in Asians. This highlights a need for BP management strategies that take into account ethnic differences. In general, long-acting antihypertensives that control BP throughout the 24-hour period are preferred; amlodipine and telmisartan have been shown to control EMBS more effectively than valsartan. Home and ambulatory BP monitoring should form an essential part of hypertension management, with individualized pharmacotherapy to achieve optimal 24-hour BP control particularly the EMBS and provide the best cardio- and cerebrovascular protection. Future research should facilitate better understanding of BPV, allowing optimization of strategies for the detection and treatment of hypertension to reduce adverse outcomes.
Collapse
Affiliation(s)
- Guru P. Sogunuru
- MIOT International HospitalChennaiIndia
- College of Medical SciencesKathmandu UniversityBharatpurNepal
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Jinho Shin
- Faculty of Cardiology ServiceHanyang University Medical CenterSeoulKorea
| | - Chen‐Huan Chen
- Department of MedicineFaculty of Medicine, National Yang‐Ming UniversityTaipeiTaiwan
| | - Peera Buranakitjaroen
- Department of MedicineFaculty of Medicine Siriraj Hospital, Mahidol UniversityBangkokThailand
| | - Yook C. Chia
- Depatment of Medical Sciences, School of Healthcare and Medical SciencesSunway UniversityBandar SunwaySelangor Darul EhsanMalaysia
| | - Romeo Divinagracia
- University of the East Ramon Magsaysay Memorial Medical Center IncQuezon CityPhilippines
| | - Jennifer Nailes
- University of the East Ramon Magsaysay Memorial Medical Center IncQuezon CityPhilippines
| | - Sungha Park
- Division of CardiologyCardiovascular Hospital, Yonsei Health SystemSeoulKorea
| | | | - Jorge Sison
- Department of MedicineMedical Center ManilaManilaPhilippines
| | - Arieska A. Soenarta
- Department Cardiology and Vascular MedicineUniversity of Indonesia‐National Cardiovascular Center, Harapan KitaJakartaIndonesia
| | - Jam C. Tay
- Department of General MedicineTan Tock Seng HospitalSingaporeSingapore
| | - Yuda Turana
- Department of NeurologyFaculty of Medicine, Atma Jaya Catholic University of IndonesiaJakartaIndonesia
| | - Yuqing Zhang
- Divisions of Hypertension and Heart FailureFu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Ji‐Guang Wang
- Department of Hypertension, Centre for Epidemiological Studies and Clinical TrialsThe Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | | |
Collapse
|
28
|
Amegah AK. Proliferation of low-cost sensors. What prospects for air pollution epidemiologic research in Sub-Saharan Africa? ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 241:1132-1137. [PMID: 30029322 DOI: 10.1016/j.envpol.2018.06.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/11/2018] [Accepted: 06/15/2018] [Indexed: 05/22/2023]
Abstract
Addressing the worsening urban air quality situation in Sub-Saharan Africa (SSA) is proving increasingly difficult owing to paucity of data on air pollution levels and also, lack of local evidence on the magnitude of the associated health effects. There is therefore the urgent need to expand air quality monitoring (AQM) networks in SSA to enable the conduct of high quality epidemiologic studies to help inform policies aimed at addressing air pollution and the associated health effects. In this commentary, I explore the prospects that the proliferation of low-cost sensors in recent times holds for air pollution epidemiologic research in SSA. This commentary is timely because most SSA governments do not see investments in air pollution control that requires assembling a network of sophisticated and prohibitively expensive instrumentation for AQM as necessary for improving and protecting public health. I conclude that, in a region that is bereft of air pollution data, the growing influx of low-cost sensors represents an excellent opportunity for bridging the data gap to inform air pollution control policies and regulations for public health protection. However, it is essential that only the most promising sensor technologies that performs creditably well in the harsh environmental conditions of the region are promoted.
Collapse
Affiliation(s)
- A Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana.
| |
Collapse
|
29
|
Heffernan KS. What is the (particulate) matter with biomass fuel use? Indoor air toxicants and central haemodynamic burden. Heart 2018; 104:1478-1479. [DOI: 10.1136/heartjnl-2018-313036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
|
30
|
Alexander DA, Northcross A, Karrison T, Morhasson-Bello O, Wilson N, Atalabi OM, Dutta A, Adu D, Ibigbami T, Olamijulo J, Adepoju D, Ojengbede O, Olopade CO. Pregnancy outcomes and ethanol cook stove intervention: A randomized-controlled trial in Ibadan, Nigeria. ENVIRONMENT INTERNATIONAL 2018; 111:152-163. [PMID: 29216559 DOI: 10.1016/j.envint.2017.11.021] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Household air pollution (HAP) exposure has been linked to adverse pregnancy outcomes. OBJECTIVES A randomized controlled trial was undertaken in Ibadan, Nigeria to determine the impact of cooking with ethanol on pregnancy outcomes. METHODS Three-hundred-twenty-four pregnant women were randomized to either the control (continued cooking using kerosene/firewood stove, n=162) or intervention group (received ethanol stove, n=162). Primary outcome variables were birthweight, preterm delivery, intrauterine growth restriction (IUGR), and occurrence of miscarriage/stillbirth. RESULTS Mean birthweights for ethanol and controls were 3076 and 2988g, respectively; the difference, 88g, (95% confidence interval: -18g to 194g), was not statistically significant (p=0.10). After adjusting for covariates, the difference reached significance (p=0.020). Rates of preterm delivery were 6.7% (ethanol) and 11.0% (control), (p=0.22). Number of miscarriages was 1(ethanol) vs. 4 (control) and stillbirths was 3 (ethanol) vs. 7 (control) (both non-significant). Average gestational age at delivery was significantly (p=0.015) higher in ethanol-users (39.2weeks) compared to controls (38.2weeks). Perinatal mortality (stillbirths and neonatal deaths) was twice as high in controls compared to ethanol-users (7.9% vs. 3.9%; p=0.045, after adjustment for covariates). We did not detect significant differences in exposure levels between the two treatment arms, perhaps due to large seasonal effects and high ambient air pollution levels. CONCLUSIONS Transition from traditional biomass/kerosene fuel to ethanol reduced adverse pregnancy outcomes. However, the difference in birthweight was statistically significant only after covariate adjustment and the other significant differences were in tertiary endpoints. Our results are suggestive of a beneficial effect of ethanol use. Larger trials are required to validate these findings.
Collapse
Affiliation(s)
- Donee A Alexander
- Department of Medicine and Center for Global Health, University of Chicago, Chicago, IL, United States
| | - Amanda Northcross
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Theodore Karrison
- Department of Public Health Sciences, University of Chicago, United States
| | | | - Nathaniel Wilson
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Omolola M Atalabi
- Department of Radiology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Anindita Dutta
- Department of Medicine and Center for Global Health, University of Chicago, Chicago, IL, United States
| | - Damilola Adu
- Healthy Life for All Foundation, Ibadan, Nigeria
| | | | | | - Dayo Adepoju
- Healthy Life for All Foundation, Ibadan, Nigeria
| | - Oladosu Ojengbede
- Department of Obstetrics and Gynecology, University of Ibadan, Ibadan, Nigeria
| | - Christopher O Olopade
- Department of Medicine and Center for Global Health, University of Chicago, Chicago, IL, United States.
| |
Collapse
|