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Enyew HD, Hailu AB, Mereta ST. Effect of a chimney-fitted improved stove on pregnancy outcomes in Northwest Ethiopia: a randomized controlled trial. BMC Pregnancy Childbirth 2024; 24:192. [PMID: 38475748 PMCID: PMC10936082 DOI: 10.1186/s12884-024-06363-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Exposure to household air pollution during pregnancy has been linked to adverse pregnancy outcomes. Improved stove was implemented in Ethiopia to reduce this exposure and related health problems. However, the effects of improved stove interventions on pregnancy outcomes remains uncertain. METHOD Individually randomized stove replacement trial was conducted among 422 households in six low-income rural kebeles of Northwestern Ethiopia. Pregnant women without known health conditions were recruited at ≤ 24 weeks gestation and randomized to an intervention or control group with a 1:1 ratio. A baseline survey was collected and a balance test was done. Two-sided independent samples t-test for continuous outcomes and chi-square for categorical variables were used to compare the effect of the intervention between the groups. Mean differences with 95% CIs were calculated and a p-value of < 0.05 was considered statistically significant. RESULT In this study, the mean birth weight was 3065 g (SD = 453) among the intervention group and not statistically different from 2995 g (SD = 541) of control group. After adjusting for covariates, infants born from intervention group weighed 55 g more [95% CI: - 43 to 170) than infants born from the control group, but the difference was not statistically significant (P = 0.274). The respective percentages for low birth weight were 8% and 10.3% for intervention and control groups respectively (P = 0.346). However, the average gestational age at delivery was higher among improved stove users (38 weeks (SD = 8.2) compared to control groups 36.5 weeks (SD = 9.6) with statistically significant difference at 0.91 weeks (95% CI: 0.52 to 1.30 weeks, p < 0.001). The corresponding difference in risk ratio for preterm birth is 0.94 (95% CI:0.92 to 0.97; p < 0.001). The percentages for maternal complications, stillbirth, and miscarriage in the intervention group were not statistically different from the control group. CONCLUSIONS While the increase in average birth weight among babies born to mothers using improved stoves was not statistically significant, babies had a longer gestational age on average, offering valuable health benefits. However, the study didn't find a significant impact on other pregnancy outcomes like stillbirth, miscarriage, or maternal complications. TRIAL REGISTRATION The study was registered at the Pan African Clinical Trial Registry website under the code PACTR202111534227089, ( https://pactr.samrc.ac.za/ (Identifier). The first trial registration date was (11/11/2021).
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Affiliation(s)
- Habtamu Demelash Enyew
- College of Health Sciences, Department of Public Health, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Abebe Beyene Hailu
- Institution of Health, Department of Environmental Health Science and Technology, Jimma University, Jimma, Ethiopia
| | - Seid Tiku Mereta
- Institution of Health, Department of Environmental Health Science and Technology, Jimma University, Jimma, Ethiopia
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Habtamu D, Abebe B, Seid T. Health risk perceptions of household air pollution and perceived benefits of improved stoves among pregnant women in rural Ethiopia: a mixed method study. BMJ Open 2023; 13:e072328. [PMID: 37648392 PMCID: PMC10471873 DOI: 10.1136/bmjopen-2023-072328] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE Since community perceptions of the risk of biomass smoke and the benefits of improved stoves play a critical role in behaviour change to the uptake and sustainable utilisation of improved stoves, we aimed to assess the level of health risk perception on kitchen smoke and benefits of using improved stoves among pregnant women. DESIGN A community-based cross-sectional mixed method study. SETTING In six kebeles of a low-income rural community of South Gondar Zone, Northwestern Ethiopia. PARTICIPANTS All 455 households with pregnant women aged 18-38 years, in their first-trimester or second-trimester gestation, exclusively use traditional biomass-fuelled or locally modified mud stoves, and the primary cook in her household were included. But completed data were obtained only from 422 households. RESULT From 422 completed data, more than half, 63% (95% CI 58% to 68%) had high-level health risk perception of household air pollution, and nearly three-fourths, 74% (95% CI 70% to 79%) of the respondents perceived that using improved stove had benefits for their families. Participants in the 32-38 years age group, rich in asset index, presence of under-five children, being a member of any women group and large family size were positively associated with high-level health risk perception. Whereas respondents in the 18-24 years age group, presence of under-five children, husbands of primary or higher education, high health risk perception and not happy with the current stove were positively associated with perceived benefits of using an improved stove. CONCLUSION The observed level of health risk perception of biomass smoke and the benefits of using improved stoves may help to adopt effective intervention measures. This study also suggests that for successful intervention, clean cooking programmes and policies must consider many local factors influencing health risk perception and benefits of using improved stoves. TRIAL REGISTRATION NUMBER ACTR202111534227089.
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Affiliation(s)
| | - Beyene Abebe
- Department of Environmental Health Science and Technology, Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
| | - Tiku Seid
- Department of Environmental Health Science and Technology, Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
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Soja SM, Wegener R, Kille N, Castell S. Merging citizen science with epidemiology: design of a prospective feasibility study of health events and air pollution in Cologne, Germany. Pilot Feasibility Stud 2023; 9:28. [PMID: 36814323 PMCID: PMC9944383 DOI: 10.1186/s40814-023-01250-0] [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: 09/26/2022] [Accepted: 01/17/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Citizen science as an approach to merge society and science is not a new paradigm. Yet it is not common in public health, epidemiology, or medical sciences. SMARAGD (Sensors for Measuring Aerosols and ReActive Gases to Deduce health effects) assesses air pollution at participants' homes or workplaces in Cologne, Germany, as feasibility study with a citizen science approach. Personal exposure to air pollutants is difficult to study, because the distribution of pollutants is heterogeneous, especially in urban areas. Targeted data collection allows to establish connections between air pollutant concentration and the health of the study population. Air pollution is among the most urgent health risks worldwide. Yet links of individualized pollution levels and respiratory infections remain to be validated, which also applies for the feasibility of the citizen science approach for epidemiological studies. METHODS We co-designed a prospective feasibility study with two groups of volunteers from Cologne, Germany. These citizen scientists and researchers determined that low-cost air-quality sensors (hereafter low-cost sensors) were to be mounted at participants' homes/workplaces to acquire stationary data. The advantage of deploying low-cost sensors is the achievable physical proximity to the participants providing health data. Recruitment started in March 2021 and is currently ongoing (as of 09/22). Sensor units specifically developed for this study using commercially available electronic sensor components will measure particulate matter and trace gases such as ozone, nitrogen oxides, and carbon monoxide. Health data are collected using the eResearch system "Prospective Management and Monitoring-App" (PIA). Due to the ongoing SARS-CoV-2 pandemic, we also focus on COVID-19 as respiratory infection. DISCUSSION Citizen science offers many benefits for science in general but also for epidemiological studies. It provides scientific information to society, enables scientific thinking in critical discourses, can counter anti-scientific ideologies, and takes into account the interests of society. However, it poses many challenges, as it requires extensive resources from researchers and society and can raise concerns regarding data protection and methodological challenges such as selection bias.
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Affiliation(s)
- Sara-Marie Soja
- grid.7490.a0000 0001 2238 295XDepartment for Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, Brunswick, Lower Saxony 38124 Germany
| | - Robert Wegener
- grid.8385.60000 0001 2297 375XForschungszentrum Jülich, Institute for Energy and Climate Research, IEK-8: Troposphere, Wilhelm-Johnen-Straße, Jülich, North Rhine-Westphalia 52428 Germany
| | - Natalie Kille
- grid.8385.60000 0001 2297 375XForschungszentrum Jülich, Institute for Energy and Climate Research, IEK-8: Troposphere, Wilhelm-Johnen-Straße, Jülich, North Rhine-Westphalia 52428 Germany
| | - Stefanie Castell
- Department for Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, Brunswick, Lower Saxony, 38124, Germany. .,German Centre for Infection Research (DZIF), Inhoffenstr. 7, Brunswick, Lower Saxony, 38124, Germany.
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Household fuel use and its association with potential respiratory pathogens among healthy mothers and children in Ethiopia. PLoS One 2022; 17:e0277348. [DOI: 10.1371/journal.pone.0277348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 10/26/2022] [Indexed: 11/12/2022] Open
Abstract
Background
Over 90% of Ethiopians still rely on solid fuels for cooking food. The pollution from the burning process causes adverse respiratory outcomes including respiratory infections. This study aimed to assess the association of the pollution with nasopharyngeal occurrence of potential pathogens.
Methods
We conducted a comparative cross-sectional study in urban and rural settings in Ethiopia in 2016. Questionnaire-based data were collected from 168 mothers and 175 children aged below two years. Multiplex real-time PCR assays were performed on nasopharyngeal secretions for detection of bacteria and viruses and for the identification of pneumococcal serotypes/groups.
Results
High rates of bacteria and viruses in the nasopharynx were detected by PCR among both the children and the mothers. Among the detected viruses, enterovirus was more commonly detected among rural children than among children from urban areas. Streptococcus pneumoniae and Haemophilus influenzae were both more prevalent among children and mothers from rural areas compared with urban groups and among those using solid fuels compared with cleaner fuel users. Children from rural households using solid fuels and children whose mothers had educational status below high school had four times higher odds for detection of S. pneumoniae compared with those households using cleaner energy or those children having mothers with a higher educational status, respectively. One or more serotype/serogroup was identified in about 40% of the samples that were positive for pneumococci. Out of all identified serotypes/serogroups, 43% in the children and 45% in the mothers belonged to PCV13, indicating the larger majority of detected pneumococci being non-PCV13 serotypes.
Conclusion
This study presented a high carriage rate of S. pneumoniae and H. influenzae among both children and their mothers, especially in rural areas and among solid fuel users. Thus, interventions should target cleaner energy sources to the public and promote maternal education.
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Estimating the burden of disease attributable to household air pollution from cooking with solid fuels in South Africa for 2000, 2006 and 2012. S Afr Med J 2022; 112:718-728. [DOI: 10.7196/samj.2022.v112i8b.16474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Indexed: 02/22/2023] Open
Abstract
Background. Household air pollution (HAP) due to the use of solid fuels for cooking is a global problem with significant impacts on human health, especially in low- and middle-income countries. HAP remains problematic in South Africa (SA). While electrification rates have improved over the past two decades, many people still use solid fuels for cooking owing to energy poverty.Objectives. To estimate the disease burden attributable to HAP for cooking in SA over three time points: 2000, 2006 and 2012. Methods. Comparative risk assessment methodology was used. The proportion of South Africans exposed to HAP was assessed and assigned the estimated concentration of particulate matter with a diameter <2.5 μg/m3(PM2.5) associated with HAP exposure. Health outcomes and relative risks associated with HAP exposure were identified. Population-attributable fractions and the attributable burden of disease due to HAP exposure (deaths, years of life lost, years lived with disability and disability-adjusted life years (DALYs)) for SA were calculated. Attributable burden was estimated for 2000, 2006 and 2012. For the year 2012, we estimated the attributable burden at provincial level.Results. An estimated 17.6% of the SA population was exposed to HAP in 2012. In 2012, HAP exposure was estimated to have caused 8 862 deaths (95% uncertainty interval (UI) 8 413 - 9 251) and 1.7% (95% UI 1.6% - 1.8%) of all deaths in SA, respectively. Loss of healthy life years comprised 208 816 DALYs (95% UI 195 648 - 221 007) and 1.0% of all DALYs (95% UI 0.95% - 1.0%) in 2012, respectively. Lower respiratory infections and cardiovascular disease contributed to the largest proportion of deaths and DALYs. HAP exposure due to cooking varied across provinces, and was highest in Limpopo (50.0%), Mpumalanga (27.4%) and KwaZulu-Natal (26.4%) provinces in 2012. Age standardised burden measures showed that these three provinces had the highest rates of death and DALY burden attributable to HAP.Conclusion. The burden of disease from HAP due to cooking in SA is of significant concern. Effective interventions supported by legislation and policy, together with awareness campaigns, are needed to ensure access to clean household fuels and improved cook stoves. Continued and enhanced efforts in this regard are required to ensure the burden of disease from HAP is curbed in SA.
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Estimating the burden of disease attributable to ambient air pollution (ambient PM2.5 and ambient ozone) in South Africa for 2000, 2006 and 2012. S Afr Med J 2022; 112:705-717. [DOI: 10.7196/samj.2022.v112i8b.16483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Indexed: 11/08/2022] Open
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Keulers L, Dehghani A, Knippels L, Garssen J, Papadopoulos N, Folkerts G, Braber S, van Bergenhenegouwen J. Probiotics, prebiotics, and synbiotics to prevent or combat air pollution consequences: The gut-lung axis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 302:119066. [PMID: 35240267 DOI: 10.1016/j.envpol.2022.119066] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 05/26/2023]
Abstract
Air pollution exposure is a public health emergency, which attributes globally to an estimated seven million deaths on a yearly basis We are all exposed to air pollutants, varying from ambient air pollution hanging over cities to dust inside the home. It is a mixture of airborne particulate matter and gases that can be subdivided into three categories based on particle diameter. The smallest category called PM0.1 is the most abundant. A fraction of the particles included in this category might enter the blood stream spreading to other parts of the body. As air pollutants can enter the body via the lungs and gut, growing evidence links its exposure to gastrointestinal and respiratory impairments and diseases, like asthma, rhinitis, respiratory tract infections, Crohn's disease, ulcerative colitis, and abdominal pain. It has become evident that there exists a crosstalk between the respiratory and gastrointestinal tracts, commonly referred to as the gut-lung axis. Via microbial secretions, metabolites, immune mediators and lipid profiles, these two separate organ systems can influence each other. Well-known immunomodulators and gut health stimulators are probiotics, prebiotics, together called synbiotics. They might combat air pollution-induced systemic inflammation and oxidative stress by optimizing the microbiota composition and microbial metabolites, thereby stimulating anti-inflammatory pathways and strengthening mucosal and epithelial barriers. Although clinical studies investigating the role of probiotics, prebiotics, and synbiotics in an air pollution setting are lacking, these interventions show promising health promoting effects by affecting the gastrointestinal- and respiratory tract. This review summarizes the current data on how air pollution can affect the gut-lung axis and might impact gut and lung health. It will further elaborate on the potential role of probiotics, prebiotics and synbiotics on the gut-lung axis, and gut and lung health.
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Affiliation(s)
- Loret Keulers
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Universiteitsweg 99, 3584, CG, Utrecht, the Netherlands; Danone Nutricia Research, Uppsalalaan 12, 3584, CT, Utrecht, the Netherlands.
| | - Ali Dehghani
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Universiteitsweg 99, 3584, CG, Utrecht, the Netherlands
| | - Leon Knippels
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Universiteitsweg 99, 3584, CG, Utrecht, the Netherlands; Danone Nutricia Research, Uppsalalaan 12, 3584, CT, Utrecht, the Netherlands
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Universiteitsweg 99, 3584, CG, Utrecht, the Netherlands; Danone Nutricia Research, Uppsalalaan 12, 3584, CT, Utrecht, the Netherlands
| | - Nikolaos Papadopoulos
- Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Oxford Road M13 9PL, Manchester, United Kingdom
| | - Gert Folkerts
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Universiteitsweg 99, 3584, CG, Utrecht, the Netherlands
| | - Saskia Braber
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Universiteitsweg 99, 3584, CG, Utrecht, the Netherlands
| | - Jeroen van Bergenhenegouwen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Universiteitsweg 99, 3584, CG, Utrecht, the Netherlands; Danone Nutricia Research, Uppsalalaan 12, 3584, CT, Utrecht, the Netherlands
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Sundararajan R, D’Couto H, Mugerwa J, Tayebwa M, Lam N, Wallach E, Wiens M, Ponticiello M, Stanistreet D, Tsai AC, Vallarino J, Allen JG, Muyanja D, Shrime MG, Nuwagira E, Lai PS. Use, cost-effectiveness, and end user perspectives of a home solar lighting intervention in rural Uganda: a mixed methods, randomized controlled trial. ENVIRONMENTAL RESEARCH LETTERS : ERL [WEB SITE] 2022; 17:015002. [PMID: 35295194 PMCID: PMC8923618 DOI: 10.1088/1748-9326/ac3f05] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Energy poverty is prevalent in resource-limited settings, leading households to use inefficient fuels and appliances that contribute to household air pollution. Randomized controlled trials of household energy interventions in low and middle income countries have largely focused on cooking services. Less is known about the adoption and impact of clean lighting interventions. We conducted an explanatory sequential mixed methods study as part of a randomized controlled trial of home solar lighting systems in rural Uganda in order to identify contextual factors determining the use and impact of the solar lighting intervention. We used sensors to track usage, longitudinally assessed household lighting expenditures and health-related quality of life, and performed cost-effectiveness analyses. Qualitative interviews were conducted with all 80 trial participants and coded using reflexive thematic analysis. Uptake of the intervention solar lighting system was high with daily use averaging 8.23 ± 5.30 hours per day. The intervention solar lighting system increased the EQ5D index by 0.025 [95% CI 0.002 - 0.048] and led to an average monthly reduction in household lighting costs by -1.28 [-2.52, -0.85] US dollars, with higher savings in users of fuel-based lighting. The incremental cost-effectiveness ratio for the solar lighting intervention was $2025.72 US dollars per quality adjusted life year (QALY) gained making the intervention cost-effective when benchmarked against the gross domestic product (GDP) per capita in Uganda. Thematic analysis of qualitative data from individual interviews showed that solar lighting was transformative and associated with numerous benefits that fit within a Social Determinants of Health (SDOH) framework. The benefits included improved household finances, improved educational performance of children, increased household safety, improved family and community cohesion, and improved perceived household health. Our findings suggest that household solar lighting interventions may be a cost-effective approach to improve health-related quality of life by addressing SDOH.
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Affiliation(s)
- Radhika Sundararajan
- Department of Emergency Medicine, Weill Cornell Medicine, 525 East 68 street, New York, New York, 10065 USA
- Weill Cornell Center for Global Health, 402 East 67 Street, New York, New York 10065 USA
| | - Helen D’Couto
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114 USA
| | - Joseph Mugerwa
- Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda
| | - Mellon Tayebwa
- Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda
| | - Nicholas Lam
- Schatz Energy Research Center, Humboldt University, 1 Harpst Street, Arcata, California USA
| | - Eli Wallach
- Schatz Energy Research Center, Humboldt University, 1 Harpst Street, Arcata, California USA
| | - Matthew Wiens
- University of British Columbia, 2329 West Mall, Vancouver, British Columbia Canada
| | - Matthew Ponticiello
- Weill Cornell Center for Global Health, 402 East 67 Street, New York, New York 10065 USA
| | - Debbi Stanistreet
- Royal College of Surgeons in Ireland, 123 Saint Stephen’s Green, Saint Peter’s, Dublin, Ireland
| | - Alexander C. Tsai
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114 USA
- Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts, 02115 USA
| | - Jose Vallarino
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, Massachusetts, 02115 USA
| | - Joseph G. Allen
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, Massachusetts, 02115 USA
| | - Daniel Muyanja
- Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda
| | - Mark G Shrime
- Royal College of Surgeons in Ireland, 123 Saint Stephen’s Green, Saint Peter’s, Dublin, Ireland
| | - Edwin Nuwagira
- Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda
| | - Peggy S. Lai
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114 USA
- Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts, 02115 USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, Massachusetts, 02115 USA
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Abstract
Purpose for Review Since the coronavirus SARS-CoV-2 outbreak in China in late 2019 turned into a global pandemic, numerous studies have reported associations between environmental factors, such as weather conditions and a range of air pollutants (particulate matter, nitrogen dioxide, ozone, etc.) and the first wave of COVID-19 cases. This review aims to offer a critical assessment of the role of environmental exposure risk factors on SARS-CoV-2 infections and COVID-19 disease severity. Recent Findings In this review, we provide a critical assessment of COVID-19 risk factors, identify gaps in our knowledge (e.g., indoor air pollution), and discuss methodological challenges of association and causation and the impact lockdowns had on air quality. In addition, we will draw attention to ethnic and socioeconomic factors driving viral transmission related to COVID-19. The complex role angiotensin-converting enzyme 2 (ACE2) plays in COVID-19 and future promising avenues of research are discussed. Summary To demonstrate causality, we stress the need for future epidemiologic studies integrating personal air pollution exposures, detailed clinical COVID-19 data, and a range of socioeconomic factors, as well as in vitro and in vivo mechanistic studies.
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Raju S, Siddharthan T, McCormack MC. Indoor Air Pollution and Respiratory Health. Clin Chest Med 2021; 41:825-843. [PMID: 33153698 DOI: 10.1016/j.ccm.2020.08.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Worldwide, more than 4 million deaths annually are attributed to indoor air pollution. This largely preventable exposure represents a key target for reducing morbidity and mortality worldwide. Significant respiratory health effects are observed, ranging from attenuated lung growth and development in childhood to accelerated lung function decline and is determined by chronic obstructive pulmonary disease later in life. Personal exposure to household air pollutants include household characteristics, combustion of solid fuels, cooking practices, and household pest allergens. This review outlines important sources of indoor air pollution, their respiratory health effects, and strategies to reduce household pollution and improve lung health across the globe.
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Affiliation(s)
- Sarath Raju
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Johns Hopkins School of Medicine, 1830 East Monument Street Fifth Floor, Baltimore, MD, 21287, USA.
| | - Trishul Siddharthan
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Johns Hopkins School of Medicine, 1830 East Monument Street Fifth Floor, Baltimore, MD, 21287, USA
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Johns Hopkins School of Medicine, 1830 East Monument Street Fifth Floor, Baltimore, MD, 21287, USA
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Chan KH, Xia X, Ho KF, Guo Y, Kurmi OP, Du H, Bennett DA, Bian Z, Kan H, McDonnell J, Schmidt D, Kerosi R, Li L, Lam KBH, Chen Z. Regional and seasonal variations in household and personal exposures to air pollution in one urban and two rural Chinese communities: A pilot study to collect time-resolved data using static and wearable devices. ENVIRONMENT INTERNATIONAL 2021; 146:106217. [PMID: 33129001 PMCID: PMC7786640 DOI: 10.1016/j.envint.2020.106217] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/23/2020] [Accepted: 10/13/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND Previous studies of the health impact of ambient and household air pollution (AAP/HAP) have chiefly relied on self-reported and/or address-based exposure modelling data. We assessed the feasibility of collecting and integrating detailed personal exposure data in different settings and seasons. METHODS/DESIGN We recruited 477 participants (mean age 58 years, 72% women) from three (two rural [Gansu/Henan] and one urban [Suzhou]) study areas in the China Kadoorie Biobank, based on their previously reported fuel use patterns. A time-resolved monitor (PATS+CO) was used to measure continuously for 120-hour the concentration of fine particulate matter (PM2.5) at personal and household (kitchen and living room) levels in warm (May-September 2017) and cool (November 2017-January 2018) seasons, along with questionnaires on participants' characteristics (e.g. socio-demographic, and fuel use) and time-activity (48-hour). Parallel local ambient monitoring of particulate matter (PM1, PM2.5 and PM10) and gaseous pollutants (CO, ozone, nitrogen oxides) was conducted using regularly-calibrated devices. The air pollution exposure data were compared by study sites and seasons. FINDINGS Overall 76% reported cooking at least weekly (regular-cooks), and 48% (urban 1%, rural 65%) used solid fuels (wood/coal) for cooking. Winter heating was more common in rural sites than in urban site (74-91% vs 17% daily), and mainly involved solid fuels. Mixed use of clean and solid fuels was common for cooking in rural areas (38%) but not for heating (0%). Overall, the measured mean PM2.5 levels were 2-3 fold higher in the cool than warm season, and in rural (e.g. kitchen: Gansuwarm_season = 142.3 µg/m3; Gansucool_season = 508.1 µg/m3; Henanwarm_season = 77.5 µg/m3; Henancool_season = 222.3 µg/m3) than urban sites (Suzhouwarm_season = 41.6 µg/m3; Suzhoucool_season = 81.6 µg/m3). The levels recorded tended to be the highest in kitchens, followed by personal, living room and outdoor. Time-resolved data show prominent peaks consistently recorded in the kitchen at typical cooking times, and sustained elevated PM2.5 levels (> 100 µg/m3) were observed in rural areas where use of solid fuels for heating was common. DISCUSSION Personal air pollution exposure can be readily assessed using a low-cost time-resolved monitor in different settings, which, in combination with other personal and health outcome data, will enable reliable assessment of the long-term health effects of HAP/AAP exposures in general populations.
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Affiliation(s)
- Ka Hung Chan
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Xi Xia
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Kin-Fai Ho
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Yu Guo
- Chinese Academy of Medical Sciences, China
| | - Om P Kurmi
- Faculty Research Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, UK
| | - Huaidong Du
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Derrick A Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Zheng Bian
- Chinese Academy of Medical Sciences, China
| | - Haidong Kan
- School of Public Health, Fudan University, China
| | - John McDonnell
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Dan Schmidt
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Rene Kerosi
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, Peking University, China
| | - Kin Bong Hubert Lam
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK.
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, UK
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12
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Tran VV, Park D, Lee YC. Indoor Air Pollution, Related Human Diseases, and Recent Trends in the Control and Improvement of Indoor Air Quality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2927. [PMID: 32340311 PMCID: PMC7215772 DOI: 10.3390/ijerph17082927] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 12/22/2022]
Abstract
Indoor air pollution (IAP) is a serious threat to human health, causing millions of deaths each year. A plethora of pollutants can result in IAP; therefore, it is very important to identify their main sources and concentrations and to devise strategies for the control and enhancement of indoor air quality (IAQ). Herein, we provide a critical review and evaluation of the major sources of major pollutant emissions, their health effects, and issues related to IAP-based illnesses, including sick building syndrome (SBS) and building-related illness (BRI). In addition, the strategies and approaches for control and reduction of pollutant concentrations are pointed out, and the recent trends in efforts to resolve and improve IAQ, with their respective advantages and potentials, are summarized. It is predicted that the development of novel materials for sensors, IAQ-monitoring systems, and smart homes is a promising strategy for control and enhancement of IAQ in the future.
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Affiliation(s)
- Vinh Van Tran
- Department of BioNano Technology, Gachon University, 1342 Seongnam-Daero, Sujeong-Gu, Seongnam-Si, Gyeonggi-do 13120, Korea;
- Institute of Research and Development, Duy Tan University, Da Nang 550000, Vietnam
| | - Duckshin Park
- Korea Railroad Research Institute (KRRI), 176 Cheoldobakmulkwan-ro, Uiwang-si 16105, Gyeonggi-do, Korea
| | - Young-Chul Lee
- Department of BioNano Technology, Gachon University, 1342 Seongnam-Daero, Sujeong-Gu, Seongnam-Si, Gyeonggi-do 13120, Korea;
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13
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Hosgood HD, Klugman M, Matsuo K, White AJ, Sadakane A, Shu XO, Lopez-Ridaura R, Shin A, Tsuji I, Malekzadeh R, Noisel N, Bhatti P, Yang G, Saito E, Rahman S, Hu W, Bassig B, Downward G, Vermeulen R, Xue X, Rohan T, Abe SK, Broët P, Grant EJ, Dummer TJB, Rothman N, Inoue M, Lajous M, Yoo KY, Ito H, Sandler DP, Ashan H, Zheng W, Boffetta P, Lan Q. The establishment of the Household Air Pollution Consortium (HAPCO). ATMOSPHERE 2019; 10:10.3390/atmos10070422. [PMID: 32064123 PMCID: PMC7021252 DOI: 10.3390/atmos10070422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Household air pollution (HAP) is of public health concern with ~3 billion people worldwide (including >15 million in the US) exposed. HAP from coal use is a human lung carcinogen, yet the epidemiological evidence on carcinogenicity of HAP from biomass use, primarily wood, is not conclusive. To robustly assess biomass's carcinogenic potential, prospective studies of individuals experiencing a variety of HAP exposures are needed. We have built a global consortium of 13 prospective cohorts (HAPCO: Household Air Pollution Consortium) that have site- and disease-specific mortality and solid fuel use data, for a combined sample size of 587,257 participants and 57,483 deaths. HAPCO provides a novel opportunity to assess the association of HAP with lung cancer death while controlling for important confounders such as tobacco and outdoor air pollution exposures. HAPCO is also uniquely positioned to determine the risks associated with cancers other than lung as well as non-malignant respiratory and cardiometabolic outcomes, for which prospective epidemiologic research is limited. HAPCO will facilitate research to address public health concerns associated with HAP-attributed exposures by enabling investigators to evaluate sex-specific and smoking status-specific effects under various exposure scenarios.
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Affiliation(s)
- H. Dean Hosgood
- Department of Epidemiology and Population Health, Albert
Einstein College of Medicine, Bronx, NY, 10461, United States
| | - Madelyn Klugman
- Department of Epidemiology and Population Health, Albert
Einstein College of Medicine, Bronx, NY, 10461, United States
| | - Keitaro Matsuo
- Division of Epidemiology and Prevention, Aichi Cancer
Center Research Institute; Nagoya, 464-8681, Japan
| | - Alexandra J. White
- Epidemiology Branch, National Institute of Environmental
Health Science, Research Triangle Park, NC 27709, United States
| | - Atsuko Sadakane
- Department of Epidemiology, Radiation Effects Research
Foundation, Hiroshima 732-0815, Japan
| | - Xiao-Ou Shu
- Vanderbilt Institute for Global Health, Vanderbilt
University School of Medicine, Nashville, TN 37203-1738, United States
| | - Ruy Lopez-Ridaura
- National Institute of Public Health, Cuernavaca, Morelos,
62100, Mexico
| | - Aesun Shin
- Department of Preventative Medicine, Seoul National
University College of Medicine, Seoul 03080, Korea
| | - Ichiro Tsuji
- Division of Epidemiology, Department of Health Informatics
and Public Health, Tohoku University Graduate School of Medicine, Miyagi 980-8575,
Japan
| | - Reza Malekzadeh
- Digestive Diseases Research Institute, Tehran University of
Medical Sciences, Tehran, 14117, Iran
| | - Nolwenn Noisel
- CARTaGENE, Centre de Recherche du CHU Sainte-Justine,
Montreal, Quebec, H3T 1C5, Canada
| | | | - Gong Yang
- Center for Health Services, Vanderbilt University School
of Medicine, Nashville, TN, 37203-1738, United States
| | - Eiko Saito
- Division of Cancer Statistics and Integration, Center for
Cancer Control and Information Services, National Cancer Center, Tokyo, 104-0045,
Japan
| | - Shafiur Rahman
- Department of Global Health Policy, Graduate School of
Medicine, University of Tokyo, Tokyo, 113-8654, Japan
| | - Wei Hu
- Occupational and Environmental Epidemiology Branch,
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda MD
20892-7240
| | - Bryan Bassig
- Occupational and Environmental Epidemiology Branch,
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda MD
20892-7240
| | - George Downward
- Institute for Risk Assessment Services, Utrecht
University, Utrecht, 3508, The Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Services, Utrecht
University, Utrecht, 3508, The Netherlands
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert
Einstein College of Medicine, Bronx, NY, 10461, United States
| | - Thomas Rohan
- Department of Epidemiology and Population Health, Albert
Einstein College of Medicine, Bronx, NY, 10461, United States
| | - Sarah K Abe
- Epidemiology and Prevention Group, Center for Public
Health Sciences, National Cancer Center, Tokyo, 104-0045, Japan
| | - Philippe Broët
- CARTaGENE, Centre de Recherche du CHU Sainte-Justine,
Montreal, Quebec, H3T 1C5, Canada
| | - Eric J. Grant
- Department of Epidemiology, Radiation Effects Research
Foundation, Hiroshima 732-0815, Japan
| | - Trevor J. B. Dummer
- School of Population and Public Health, University of
British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Nat Rothman
- Occupational and Environmental Epidemiology Branch,
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda MD
20892-7240
| | - Manami Inoue
- Epidemiology and Prevention Group, Center for Public
Health Sciences, National Cancer Center, Tokyo, 104-0045, Japan
| | - Martin Lajous
- National Institute of Public Health, Cuernavaca, Morelos,
62100, Mexico
- Department of Global Health and Population, Harvard T.H.
Chan School of Public Health, Boston, MA
| | - Keun-Young Yoo
- Department of Preventative Medicine, Seoul National
University College of Medicine, Seoul 03080, Korea
| | - Hidemi Ito
- Division of Epidemiology and Prevention, Aichi Cancer
Center Research Institute; Nagoya, 464-8681, Japan
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental
Health Science, Research Triangle Park, NC 27709, United States
| | - Habib Ashan
- Department of Health Sciences, The University of Chicago,
Chicago, IL, 60637, United States
| | - Wei Zheng
- Center for Health Services, Vanderbilt University School
of Medicine, Nashville, TN, 37203-1738, United States
| | - Paolo Boffetta
- The Tisch Cancer Institute, Mount Sinai School of
Medicine, New York, NY 10029-6574, United States
- Department of Medical and Surgical Sciences, University
of Bologna, Bologna, 40126, Italy
| | - Qing Lan
- Occupational and Environmental Epidemiology Branch,
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda MD
20892-7240
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14
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Katoto PDMC, Byamungu L, Brand AS, Mokaya J, Strijdom H, Goswami N, De Boever P, Nawrot TS, Nemery B. Ambient air pollution and health in Sub-Saharan Africa: Current evidence, perspectives and a call to action. ENVIRONMENTAL RESEARCH 2019; 173:174-188. [PMID: 30913485 DOI: 10.1016/j.envres.2019.03.029] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 05/20/2023]
Abstract
BACKGROUND People from low- and middle-income countries are disproportionately affected by the global burden of adverse health effects caused by ambient air pollution (AAP). However, data from Sub-Saharan Africa (SSA) are still scarce. We systematically reviewed the literature to describe the existing knowledge on AAP and health outcomes in SSA. METHODS We searched PubMed, Medline-OVID, EMBASE and Scopus databases to identify studies of AAP and health outcomes published up to November 15, 2017. We used a systematic review approach to critically analyze and summarize levels of outdoor air pollutants, and data on health effects associated with AAP. We excluded occupational and indoor exposure studies. RESULTS We identified 60 articles, with 37 only describing levels of AAP and 23 assessing the association between air pollution and health outcomes. Most studies (75%) addressing the relation between AAP and disease were cross-sectional. In general, exposure data were only obtained for selected cities in the framework of temporary international collaborative research initiatives without structural long-term continuation. Measurements of AAP revealed 10-20 fold higher levels than WHO standards. Of the 23 studies reporting health effects, 14 originated from South Africa, and most countries within SSA contributed no data at all. No studies, except from South Africa, were based on reliable morbidity or mortality statistics at regional or country level. The majority of studies investigated self-reported respiratory symptoms. Children and the elderly were found to be more susceptible to AAP. CONCLUSION AAP and its negative health effects have been understudied in SSA compared with other continents. The limited direct measurements of air pollutants indicate that AAP in SAA cities is high compared with international standards. Efforts are needed to monitor AAP in African cities, to identify its main sources, and to reduce adverse health effects by enforcing legislation.
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Affiliation(s)
- Patrick D M C Katoto
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Department of Internal Medicine, Faculty of Medicine, and Expertise Centre on Mining Governance (CEGEMI), Catholic University of Bukavu, Bukavu, Congo.
| | - Liliane Byamungu
- Department of Pediatric, Faculty of Medicine and Health Sciences, University of KwaZulu Natal, Durban, South Africa.
| | - Amanda S Brand
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Jolynne Mokaya
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Kenya Medical Research Institute, Nairobi, Kenya.
| | - Hans Strijdom
- Division of Medical Physiology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Nandu Goswami
- Department of Physiology and Otto Loewi Research Centre, Medical University of Graz, Austria.
| | - Patrick De Boever
- Environmental Risk and Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium; Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium.
| | - Tim S Nawrot
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium.
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
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15
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Simkovich SM, Goodman D, Roa C, Crocker ME, Gianella GE, Kirenga BJ, Wise RA, Checkley W. The health and social implications of household air pollution and respiratory diseases. NPJ Prim Care Respir Med 2019; 29:12. [PMID: 31028270 PMCID: PMC6486605 DOI: 10.1038/s41533-019-0126-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 03/05/2019] [Indexed: 12/29/2022] Open
Abstract
Approximately three billion individuals are exposed to household air pollution (HAP) from the burning of biomass fuels worldwide. Household air pollution is responsible for 2.9 million annual deaths and causes significant health, economic and social consequences, particularly in low- and middle-income countries. Although there is biological plausibility to draw an association between HAP exposure and respiratory diseases, existing evidence is either lacking or conflicting. We abstracted systematic reviews and meta-analyses for summaries available for common respiratory diseases in any age group and performed a literature search to complement these reviews with newly published studies. Based on the literature summarized in this review, HAP exposure has been associated with acute respiratory infections, tuberculosis, asthma, chronic obstructive pulmonary disease, pneumoconiosis, head and neck cancers, and lung cancer. No study, however, has established a causal link between HAP exposure and respiratory disease. Furthermore, few studies have controlled for tobacco smoke exposure and outdoor air pollution. More studies with consistent diagnostic criteria and exposure monitoring are needed to accurately document the association between household air pollution exposure and respiratory disease. Better environmental exposure monitoring is critical to better separate the contributions of household air pollution from that of other exposures, including ambient air pollution and tobacco smoking. Clinicians should be aware that patients with current or past HAP exposure are at increased risk for respiratory diseases or malignancies and may want to consider earlier screening in this population.
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Affiliation(s)
- Suzanne M Simkovich
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Dina Goodman
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Christian Roa
- Center for Global Non-Communicable Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mary E Crocker
- Center for Global Non-Communicable Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Sleep Medicine, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Gonzalo E Gianella
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
- Servicio de Neumología, Unidad de Cuidados Intensivos, Clinica Ricardo Palma, Lima, Peru
| | - Bruce J Kirenga
- Makerere Lung Institute, Makerere University, Kampala, Uganda
- Pulmonology Unit, Department of Medicine, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Robert A Wise
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
- Center for Global Non-Communicable Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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16
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Chan KH, Kurmi OP, Bennett DA, Yang L, Chen Y, Tan Y, Pei P, Zhong X, Chen J, Zhang J, Kan H, Peto R, Lam KBH. Solid Fuel Use and Risks of Respiratory Diseases. A Cohort Study of 280,000 Chinese Never-Smokers. Am J Respir Crit Care Med 2019; 199:352-361. [PMID: 30235936 PMCID: PMC6363974 DOI: 10.1164/rccm.201803-0432oc] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 09/21/2018] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Little evidence from large-scale cohort studies exists about the relationship of solid fuel use with hospitalization and mortality from major respiratory diseases. OBJECTIVES To examine the associations of solid fuel use and risks of acute and chronic respiratory diseases. METHODS A cohort study of 277,838 Chinese never-smokers with no prior major chronic diseases at baseline. During 9 years of follow-up, 19,823 first hospitalization episodes or deaths from major respiratory diseases, including 10,553 chronic lower respiratory disease (CLRD), 4,398 chronic obstructive pulmonary disease (COPD), and 7,324 acute lower respiratory infection (ALRI), were recorded. Cox regression yielded adjusted hazard ratios (HRs) for disease risks associated with self-reported primary cooking fuel use. MEASUREMENTS AND MAIN RESULTS Overall, 91% of participants reported regular cooking, with 52% using solid fuels. Compared with clean fuel users, solid fuel users had an adjusted HR of 1.36 (95% confidence interval, 1.32-1.40) for major respiratory diseases, whereas those who switched from solid to clean fuels had a weaker HR (1.14, 1.10-1.17). The HRs were higher in wood (1.37, 1.33-1.41) than coal users (1.22, 1.15-1.29) and in those with prolonged use (≥40 yr, 1.54, 1.48-1.60; <20 yr, 1.32, 1.26-1.39), but lower among those who used ventilated than nonventilated cookstoves (1.22, 1.19-1.25 vs. 1.29, 1.24-1.35). For CLRD, COPD, and ALRI, the HRs associated with solid fuel use were 1.47 (1.41-1.52), 1.10 (1.03-1.18), and 1.16 (1.09-1.23), respectively. CONCLUSIONS Among Chinese adults, solid fuel use for cooking was associated with higher risks of major respiratory disease admissions and death, and switching to clean fuels or use of ventilated cookstoves had lower risk than not switching.
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Affiliation(s)
- Ka Hung Chan
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Om P. Kurmi
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Derrick A. Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, United Kingdom
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, United Kingdom
| | - Yunlong Tan
- Chinese Academy of Medical Sciences, Beijing, China
| | - Pei Pei
- Chinese Academy of Medical Sciences, Beijing, China
| | - Xunfu Zhong
- Pengzhou Center for Disease Control and Prevention, Pengzhou, China
| | | | - Jun Zhang
- Suzhou Center for Disease Control and Prevention, Suzhou, China; and
| | - Haidong Kan
- School of Public Health, Fudan University, Shanghai, China
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Kin Bong Hubert Lam
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - on behalf of the China Kadoorie Biobank Collaborative Group
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, United Kingdom
- Chinese Academy of Medical Sciences, Beijing, China
- Pengzhou Center for Disease Control and Prevention, Pengzhou, China
- Pengzhou People’s Hospital, Pengzhou, China
- Suzhou Center for Disease Control and Prevention, Suzhou, China; and
- School of Public Health, Fudan University, Shanghai, China
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17
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Sesan T, Jewitt S, Clifford M, Ray C. Toilet training: what can the cookstove sector learn from improved sanitation promotion? INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2018; 28:667-682. [PMID: 30068235 DOI: 10.1080/09603123.2018.1503235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Within the domain of public health, commonalities exist between the sanitation and cookstove sectors. Despite these commonalities and the grounds established for cross-learning between both sectors, however, there has not been much evidence of knowledge exchange across them to date. Our paper frames this as a missed opportunity for the cookstove sector, given the capacity for user-centred innovation and multi-scale approaches demonstrated in the sanitation sector. The paper highlights points of convergence and divergence in the approaches used in both sectors, with particular focus on behaviour change approaches that go beyond the level of the individual. The analysis highlights the importance of the enabling environment, community-focused approaches and locally specific contextual factors in promoting behavioural change in the sanitation sector. Our paper makes a case for the application of such approaches to cookstove interventions, especially in light of their ability to drive sustained change by matching demand-side motivations with supply-side opportunities. Abbreviation: DALY: Disability-adjusted life year; CHC: Community Health Club; CLTS: Community-Led Total Sanitation; HAP: Household air pollution; BM-WASH: Integrated Behavioural Model for Water, Sanitation and Hygiene; ICS: Improved cookstove; LPG: Liquefied petroleum gas; NBA: Nirmal Bharat Abhiyan; NGO: Non:governmental organisation; OD: Open defecation; ODF: Open defecation free; HAST: Participatory Hygiene and Sanitation Transformation; RANAS: Risks, Attitudes, Norms, Abilities and Self-regulation RCT: Randomised controlled trial; (Sani) FOAM: Focus, Opportunity, Ability and Motivation; SBM: Swachh Bharat Mission; TSC: Total Sanitation Campaign; WASH: Water, Sanitation and Hygiene.
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Affiliation(s)
- Temilade Sesan
- a Centre for Petroleum, Energy Economics and Law , University of Ibadan , Oyo State , Nigeria
| | - Sarah Jewitt
- b School of Geography , University of Nottingham , UK
| | - Mike Clifford
- c Faculty of Engineering , University of Nottingham , UK
| | - Charlotte Ray
- c Faculty of Engineering , University of Nottingham , UK
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18
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Siddharthan T, Grigsby MR, Goodman D, Chowdhury M, Rubinstein A, Irazola V, Gutierrez L, Miranda JJ, Bernabe-Ortiz A, Alam D, Kirenga B, Jones R, van Gemert F, Wise RA, Checkley W. Association between Household Air Pollution Exposure and Chronic Obstructive Pulmonary Disease Outcomes in 13 Low- and Middle-Income Country Settings. Am J Respir Crit Care Med 2018; 197:611-620. [PMID: 29323928 PMCID: PMC6005243 DOI: 10.1164/rccm.201709-1861oc] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/11/2018] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Forty percent of households worldwide burn biomass fuels for energy, which may be the most important contributor to household air pollution. OBJECTIVES To examine the association between household air pollution exposure and chronic obstructive pulmonary disease (COPD) outcomes in 13 resource-poor settings. METHODS We analyzed data from 12,396 adult participants living in 13 resource-poor, population-based settings. Household air pollution exposure was defined as using biomass materials as the primary fuel source in the home. We used multivariable regressions to assess the relationship between household air pollution exposure and COPD outcomes, evaluated for interactions, and conducted sensitivity analyses to test the robustness of our findings. MEASUREMENTS AND MAIN RESULTS Average age was 54.9 years (44.2-59.6 yr across settings), 48.5% were women (38.3-54.5%), prevalence of household air pollution exposure was 38% (0.5-99.6%), and 8.8% (1.7-15.5%) had COPD. Participants with household air pollution exposure were 41% more likely to have COPD (adjusted odds ratio, 1.41; 95% confidence interval, 1.18-1.68) than those without the exposure, and 13.5% (6.4-20.6%) of COPD prevalence may be caused by household air pollution exposure, compared with 12.4% caused by cigarette smoking. The association between household air pollution exposure and COPD was stronger in women (1.70; 1.24-2.32) than in men (1.21; 0.92-1.58). CONCLUSIONS Household air pollution exposure was associated with a higher prevalence of COPD, particularly among women, and it is likely a leading population-attributable risk factor for COPD in resource-poor settings.
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Affiliation(s)
- Trishul Siddharthan
- Division of Pulmonary and Critical Care and
- Center for Global Non-Communicable Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Matthew R. Grigsby
- Division of Pulmonary and Critical Care and
- Center for Global Non-Communicable Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Dina Goodman
- Division of Pulmonary and Critical Care and
- Center for Global Non-Communicable Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Adolfo Rubinstein
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Laura Gutierrez
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases and
- Departamento de Medicina, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases and
- Departamento de Medicina, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Dewan Alam
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Bruce Kirenga
- Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Rupert Jones
- Plymouth University, Plymouth, United Kingdom; and
| | - Frederick van Gemert
- University of Groningen, University Medical Centre Groningen, Harlingen, the Netherlands
| | | | - William Checkley
- Division of Pulmonary and Critical Care and
- Center for Global Non-Communicable Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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19
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Muthumbi E, Lowe BS, Muyodi C, Getambu E, Gleeson F, Scott JAG. Risk factors for community-acquired pneumonia among adults in Kenya: a case-control study. Pneumonia (Nathan) 2017; 9:17. [PMID: 29209590 PMCID: PMC5702239 DOI: 10.1186/s41479-017-0041-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 10/17/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Pneumonia is a leading cause of morbidity and mortality among adults worldwide; however, the risk factors for community-acquired pneumonia in Africa are not well characterized. METHODS The authors recruited 281 cases of community-acquired pneumonia and 1202 hospital controls among patients aged ≥15 years who attended Kilifi District Hospital/Coast Provincial General Hospital in Kenya between 1994 and 6. Cases were admissions with an acute illness with ≥2 respiratory signs and evidence of consolidation on a chest radiograph. Controls were patients without signs of pneumonia, frequency matched by age, sex and hospital. Risk factors related to socio-demographic factors, drug use, clinical history, contact patterns and exposures to indoor air pollution were investigated by questionnaire, anthropometric measurements and laboratory assays. Associations were evaluated using a hierarchical logistic regression model. RESULTS Pneumonia was associated with human immunodeficiency virus (HIV) infection (Odds Ratio [OR] 2.06, 95% CI 1.44-3.08), anemia (OR 1.91, 1.31-2.74), splenomegaly (OR 2.04, 95% CI 1.14-3.41), recent history of pneumonia (OR 4.65, 95% CI 1.66-12.5), history of pneumonia >2 years previously (OR 17.13, 95% CI 5.01-60.26), coryza in the 2 weeks preceding hospitalization (OR 2.09, 95% CI 1.44-3.03), current smoking (2.19, 95% CI 1.39-3.70), use of khat (OR 3.44, 95% CI 1.72-7.15), use of snuff (OR 2.67, 95% CI 1.35-5.49) and contact with several animal species. Presence of a Bacillus Calmette-Guerin (BCG) scar was associated with protection (OR 0.51, 95% CI 0.32-0.82). The risk factors varied significantly by sex. CONCLUSION Pneumonia in Kenyan adults was associated with global risk factors, such as HIV and smoking, but also with specific local factors like drug use and contact with animals. Intervention strategies should account for sex-specific differences in risk factors.
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Affiliation(s)
- Esther Muthumbi
- KEMRI-Wellcome Trust Research Programme, Center for Geographical Medicine Research Coast, Kilifi, Kenya
| | - Brett S. Lowe
- KEMRI-Wellcome Trust Research Programme, Center for Geographical Medicine Research Coast, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | | | | | - Fergus Gleeson
- Department of Radiology, Churchill Hospital, University of Oxford, Oxford, UK
| | - J. Anthony G. Scott
- KEMRI-Wellcome Trust Research Programme, Center for Geographical Medicine Research Coast, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Jary HR, Aston S, Ho A, Giorgi E, Kalata N, Nyirenda M, Mallewa J, Peterson I, Gordon SB, Mortimer K. Household air pollution, chronic respiratory disease and pneumonia in Malawian adults: A case-control study. Wellcome Open Res 2017; 2:103. [PMID: 29387802 PMCID: PMC5730861 DOI: 10.12688/wellcomeopenres.12621.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2017] [Indexed: 11/20/2022] Open
Abstract
Background: Four million people die each year from diseases caused by exposure to household air pollution. There is an association between exposure to household air pollution and pneumonia in children (half a million attributable deaths a year); however, whether this is true in adults is unknown. We conducted a case-control study in urban Malawi to examine the association between exposure to household air pollution and pneumonia in adults. Methods: Hospitalized patients with radiologically confirmed pneumonia (cases) and healthy community controls underwent 48 hours of ambulatory and household particulate matter (µg/m
3) and carbon monoxide (ppm) exposure monitoring. Multivariate logistic regression, stratified by HIV status, explored associations between these and other potential risk factors with pneumonia. Results: 145 (117 HIV-positive; 28 HIV-negative) cases and 253 (169 HIV-positive; 84 HIV-negative) controls completed follow up. We found no evidence of association between household air pollution exposure and pneumonia in HIV-positive (e.g. ambulatory particulate matter adjusted odds ratio [aOR] 1.00 [95% CI 1.00–1.01, p=0.141]) or HIV-negative (e.g. ambulatory particulate matter aOR 1.00 [95% CI 0.99–1.01, p=0.872]) participants. Chronic respiratory disease was associated with pneumonia in both HIV-positive (aOR 28.07 [95% CI 9.29–84.83, p<0.001]) and HIV-negative (aOR 104.27 [95% CI 12.86–852.35, p<0.001]) participants. Conclusions: We found no evidence that exposure to household air pollution is associated with pneumonia in Malawian adults. In contrast, chronic respiratory disease was strongly associated with pneumonia.
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Affiliation(s)
- Hannah R Jary
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi.,Liverpool School of Tropical of Medicine, Liverpool, L3 5QA, UK
| | - Stephen Aston
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi.,Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK
| | - Antonia Ho
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi.,Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK
| | - Emanuele Giorgi
- Lancaster Medical School, Lancaster University, Lancaster, LA1 4YW, UK
| | - Newton Kalata
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi
| | - Mulinda Nyirenda
- College of Medicine, University of Malawi, Chichiri, Blantyre 3, Malawi.,Queen Elizabeth Central Hospital, Chichiri, Blantyre 3, Malawi
| | - Jane Mallewa
- College of Medicine, University of Malawi, Chichiri, Blantyre 3, Malawi.,Queen Elizabeth Central Hospital, Chichiri, Blantyre 3, Malawi
| | - Ingrid Peterson
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi
| | - Stephen B Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi.,Liverpool School of Tropical of Medicine, Liverpool, L3 5QA, UK
| | - Kevin Mortimer
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi.,Liverpool School of Tropical of Medicine, Liverpool, L3 5QA, UK
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