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Makgalemane MR, Patrick S, Shirinde J. Respiratory conditions and health symptoms associated with air pollution amongst children aged six years and below in Melusi Informal Settlement, Tshwane Metropolitan Municipality, South Africa: a cross-sectional study. BMC Public Health 2024; 24:2038. [PMID: 39080586 PMCID: PMC11290171 DOI: 10.1186/s12889-024-19324-w] [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: 03/14/2024] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Respiratory conditions and health symptoms associated with air pollution in children are a major public health concern, as their immune systems and lungs are not yet fully developed. This study aimed to assess self-reported respiratory conditions and health symptoms associated with air pollution sources amongst children aged six years and below in Melusi informal settlement, Tshwane Metropolitan Municipality, South Africa. METHODS With a quantitative cross-sectional study design, parents/caregivers of children aged six years and below (n = 300) from eight Early Childhood Development Centres were invited to participate in the study. This study employed complete sampling, and data was collected using the modified International Study of Asthma and Allergies in Children. The chi-square and multiple logistic regression models were used to analyze data, with p < 0.05 in the adjusted odds ratios considered as being statistically significant. RESULTS Three models were run to examine the predictors of wheezing in the past 12 months, dry cough, and itchy-watery eyes. The model for asthma was excluded, as only seven participants reported having asthma. Wheeze in the past 12 months was associated with participants living in the area for more than three years (OR 2.96 95%CI: 1.011-8.674). Furthermore, having a dog in the house in the past 12 months was associated with wheeze in the past 12 months (OR 5.98 95%CI: 2.107-16.967). There was an association between duration of stay in a residence and dry cough prevalence (OR 5.63 95%CI: 2.175-14.584). Trucks always or frequently passing near homes was associated with itchy-watery eyes (OR 3.27 95%CI: 1.358-7.889). 59% (59%) of participants perceived the indoor air quality in their homes to be good, while 6% perceived it as poor. In contrast, 36% of participants perceived the outdoor air quality to be good, and 19.7% perceived it as poor. CONCLUSION The association between perceived air pollution exposure, self-reported respiratory conditions, and health symptoms amongst children is complex. Further research is required to better understand the multifaceted nature of air pollution and its impact on the health of children.
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Affiliation(s)
- Moipoti Ruth Makgalemane
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, 31 Bophelo Road, Gezina, 0001, Pretoria, South Africa.
| | - Sean Patrick
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, 31 Bophelo Road, Gezina, 0001, Pretoria, South Africa
| | - Joyce Shirinde
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, 31 Bophelo Road, Gezina, 0001, Pretoria, South Africa
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Weary TE, Pappas T, Tusiime P, Tuhaise S, Ross E, Gern JE, Goldberg TL. High frequencies of nonviral colds and respiratory bacteria colonization among children in rural Western Uganda. Front Pediatr 2024; 12:1379131. [PMID: 38756971 PMCID: PMC11096560 DOI: 10.3389/fped.2024.1379131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Respiratory illness is the most common childhood disease globally, especially in developing countries. Previous studies have detected viruses in approximately 70-80% of respiratory illnesses. Methods In a prospective cohort study of 234 young children (ages 3-11 years) and 30 adults (ages 22-51 years) in rural Western Uganda sampled monthly from May 2019 to August 2021, only 24.2% of nasopharyngeal swabs collected during symptomatic disease had viruses detectable by multiplex PCR diagnostics and metagenomic sequencing. In the remaining 75.8% of swabs from symptomatic participants, we measured detection rates of respiratory bacteria Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae by quantitative PCR. Results 100% of children tested positive for at least one bacterial species. Detection rates were 87.2%, 96.8%, and 77.6% in children and 10.0%, 36.7%, and 13.3% for adults for H. influenzae, M. catarrhalis, and S. pneumoniae, respectively. In children, 20.8% and 70.4% were coinfected with two and three pathogens, respectively, and in adults 6.7% were coinfected with three pathogens but none were coinfected with two. Detection of any of the three pathogens was not associated with season or respiratory symptoms severity, although parsing detection status by symptoms was challenged by children experiencing symptoms in 80.3% of monthly samplings, whereas adults only reported symptoms 26.6% of the time. Pathobiont colonization in children in Western Uganda was significantly more frequent than in children living in high-income countries, including in a study of age-matched US children that utilized identical diagnostic methods. Detection rates were, however, comparable to rates in children living in other Sub-Saharan African countries. Discussion Overall, our results demonstrate that nonviral colds contribute significantly to respiratory disease burden among children in rural Uganda and that high rates of respiratory pathobiont colonization may play a role. These conclusions have implications for respiratory health interventions in the area, such as increasing childhood immunization rates and decreasing air pollutant exposure.
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Affiliation(s)
- Taylor E. Weary
- Department of Pathobiological Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI, United States
| | - Tressa Pappas
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | | | | | | | - James E. Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Tony L. Goldberg
- Department of Pathobiological Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI, United States
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Weary TE, Tusiime P, Tuhaise S, Mandujano Reyes JF, Ross E, Gern JE, Goldberg TL. Respiratory disease patterns in rural Western Uganda, 2019-2022. Front Pediatr 2024; 12:1336009. [PMID: 38650995 PMCID: PMC11033374 DOI: 10.3389/fped.2024.1336009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction Respiratory disease is a major cause of morbidity and mortality in the developing world, but prospective studies of temporal patterns and risk factors are rare. Methods We studied people in rural Western Uganda, where respiratory disease is pervasive. We followed 30 adults (ages 22-51 years; 534 observations) and 234 children (ages 3-11 years; 1,513 observations) between May 2019 and July 2022 and collected monthly data on their respiratory symptoms, for a total of 2,047 case records. We examined associations between demographic and temporal factors and respiratory symptoms severity. Results The timing of our study (before, during, and after the emergence of COVID-19) allowed us to document the effects of public health measures instituted in the region. Incidence rates of respiratory symptoms before COVID-19 lockdown were 568.4 cases per 1,000 person-months in children and 254.2 cases per 1,000 person-months in adults. These rates were 2.6 times higher than the 2019 global average for children but comparable for adults. Younger children (ages 3-6 years) had the highest frequencies and severities of respiratory symptoms. Study participants were most likely to experience symptoms in February, which is a seasonal pattern not previously documented. Incidence and severity of symptoms in children decreased markedly during COVID-19 lockdown, illustrating the broad effects of public health measures on the incidence of respiratory disease. Discussion Our results demonstrate that patterns of respiratory disease in settings such as Western Uganda resemble patterns in developed economies in some ways (age-related factors) but not in others (increased incidence in children and seasonal pattern). Factors such as indoor air quality, health care access, timing of school trimesters, and seasonal effects (rainy/dry seasons) likely contribute to the differences observed.
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Affiliation(s)
- Taylor E. Weary
- Department of Pathobiological Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI, United States
| | | | | | | | | | - James E. Gern
- Department of Pediatrics, University of Wisconsin Hospital and Clinics, Madison, WI, United States
| | - Tony L. Goldberg
- Department of Pathobiological Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI, United States
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Aguilera J, Konvinse K, Lee A, Maecker H, Prunicki M, Mahalingaiah S, Sampath V, Utz PJ, Yang E, Nadeau KC. Air pollution and pregnancy. Semin Perinatol 2023; 47:151838. [PMID: 37858459 PMCID: PMC10843016 DOI: 10.1016/j.semperi.2023.151838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Increased fossil fuel usage and extreme climate change events have led to global increases in greenhouse gases and particulate matter with 99% of the world's population now breathing polluted air that exceeds the World Health Organization's recommended limits. Pregnant women and neonates with exposure to high levels of air pollutants are at increased risk of adverse health outcomes such as maternal hypertensive disorders, postpartum depression, placental abruption, low birth weight, preterm birth, infant mortality, and adverse lung and respiratory effects. While the exact mechanism by which air pollution exerts adverse health effects is unknown, oxidative stress as well as epigenetic and immune mechanisms are thought to play roles. Comprehensive, global efforts are urgently required to tackle the health challenges posed by air pollution through policies and action for reducing air pollution as well as finding ways to protect the health of vulnerable populations in the face of increasing air pollution.
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Affiliation(s)
- Juan Aguilera
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, School of Public Health, El Paso, Texas
| | | | - Alexandra Lee
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Palo Alto, CA
| | - Holden Maecker
- Institute for Immunity, Transplantation, and Infection, School of Medicine, Stanford University, Stanford, CA
| | - Mary Prunicki
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Shruthi Mahalingaiah
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA; Division of Reproductive Endocrinology and Infertility, Department of OB/GYN, Massachusetts General Hospital, Boston, MA
| | - Vanitha Sampath
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Paul J Utz
- Department of Medicine, Stanford University, Palo Alto, CA
| | - Emily Yang
- Department of Medicine, Stanford University, Palo Alto, CA
| | - Kari C Nadeau
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA.
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Vanker A. 'Let Africa Breath': air pollution, environmental exposures and lung health - an ongoing challenge. Thorax 2023; 78:1061-1062. [PMID: 37524390 DOI: 10.1136/thorax-2023-220454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Affiliation(s)
- Aneesa Vanker
- Department of Paediatrics and Child Health and SAMRC unit on Child and Adolescent Health, University of Cape Town, Rondebosch, Western Cape, South Africa
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Amadu I, Seidu AA, Mohammed A, Duku E, Miyittah MK, Ameyaw EK, Hagan JE, Musah MH, Ahinkorah BO. Assessing the combined effect of household cooking fuel and urbanicity on acute respiratory symptoms among under-five years in sub-Saharan Africa. Heliyon 2023; 9:e16546. [PMID: 37346351 PMCID: PMC10279788 DOI: 10.1016/j.heliyon.2023.e16546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/02/2023] [Accepted: 05/18/2023] [Indexed: 06/23/2023] Open
Abstract
Background This study sought to investigate the association between urbanicity (rural-urban residency), the use of solid biomass cooking fuels and the risk of Acute Respiratory Infections (ARIs) among children under the age of 5 in sub-Saharan Africa (SSA). Methods Cross-sectional data from the most recent surveys of the Demographic and Health Survey Program conducted in 31 sub-Saharan African countries were pooled for the analysis. The outcome variables, cough and rapid short breath were derived from questions that asked mothers if their children under the age of 5 suffered from cough and short rapid breath in the past two weeks preceding the survey. To examine the associations, multivariable negative log-log regression models were fitted for each outcome variable. Results Higher odds ratios of cough occurred among children in urban households that use unclean cooking fuel (aOR = 1.05 95% CI = 1.01, 1.08). However, lower odds ratios were observed for rural children in homes that use clean cooking fuel (aOR = 0.93 95% CI = 0.87, 0.99) relative to children in urban homes using clean cooking fuel. We also found higher odds ratios of short rapid breaths among children in rural households that use unclean cooking fuel compared with urban residents using clean cooking fuel (aOR = 1.12 95% CI = 1.08, 1.17). Conclusion Urbanicity and the use of solid biomass fuel for cooking were associated with an increased risk of symptoms of ARIs among children under five years in SSA. Thus, policymakers and stakeholders need to design and implement strategies that minimize children's exposure to pollutants from solid biomass cooking fuel. Such interventions could reduce the burden of respiratory illnesses in SSA and contribute to the realization of Sustainable Development Goal 3.9, which aims at reducing the number of diseases and deaths attributable to hazardous chemicals and pollution of air, water and soil.
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Affiliation(s)
- Iddrisu Amadu
- Africa Centre of Excellence in Coastal Resilience (ACECoR)-Centre for Coastal Management, University of Cape Coast, Cape Coast, Ghana
- Department of Fisheries and Aquatic Sciences, School of Biological Sciences, College of Agriculture and Natural Sciences, University of Cape Coast, Ghana
- Emperiks Research, NT0085, Tamale, Ghana
| | - Abdul-Aziz Seidu
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Box 256, Ghana
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Queensland, Australia
| | - Aliu Mohammed
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Eric Duku
- Africa Centre of Excellence in Coastal Resilience (ACECoR)-Centre for Coastal Management, University of Cape Coast, Cape Coast, Ghana
- Department of Fisheries and Aquatic Sciences, School of Biological Sciences, College of Agriculture and Natural Sciences, University of Cape Coast, Ghana
- Hen Mpoano (Our Coast), Takoradi P.O. Box AX 296, Ghana
| | - Michael K. Miyittah
- Africa Centre of Excellence in Coastal Resilience (ACECoR)-Centre for Coastal Management, University of Cape Coast, Cape Coast, Ghana
- Department of Environmental Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Hong Kong
| | - John Elvis Hagan
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Bielefeld University, Bielefeld, Germany
| | - Mohammed Hafiz Musah
- Department of Health Information Management, Tamale Teaching Hospital, Tamale, Ghana
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Sarfo JO, Amoadu M, Gyan TB, Osman AG, Kordorwu PY, Adams AK, Asiedu I, Ansah EW, Amponsah-Manu F, Ofosu-Appiah P. Acute lower respiratory infections among children under five in Sub-Saharan Africa: a scoping review of prevalence and risk factors. BMC Pediatr 2023; 23:225. [PMID: 37149597 PMCID: PMC10163812 DOI: 10.1186/s12887-023-04033-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/25/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Acute lower respiratory tract infections (ALRTIs) among children under five are still the leading cause of mortality among this group of children in low and middle-income countries (LMICs), especially countries in sub-Saharan Africa (SSA). This scoping review aims to map evidence on prevalence and risk factors associated with ALRTIs among children under 5 years to inform interventions, policies and future studies. METHODS A thorough search was conducted via four main databases (PubMed, JSTOR, Web of Science and Central). In all, 3,329 records were identified, and 107 full-text studies were considered for evaluation after vigorous screening and removing duplicates, of which 43 were included in this scoping review. FINDINGS Findings indicate a high prevalence (between 1.9% to 60.2%) of ALRTIs among children under five in SSA. Poor education, poverty, malnutrition, exposure to second-hand smoke, poor ventilation, HIV, traditional cooking stoves, unclean fuel usage, poor sanitation facilities and unclean drinking water make children under five more vulnerable to ALRTIs in SSA. Also, health promotion strategies like health education have doubled the health-seeking behaviours of mothers of children under 5 years against ALRTIs. CONCLUSION ALRTIs among children under five still present a significant disease burden in SSA. Therefore, there is a need for intersectoral collaboration to reduce the burden of ALRTIs among children under five by strengthening poverty alleviation strategies, improving living conditions, optimising child nutrition, and ensuring that all children have access to clean water. There is also the need for high-quality studies where confounding variables in ALRTIs are controlled.
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Affiliation(s)
- Jacob Owusu Sarfo
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Mustapha Amoadu
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana.
| | - Thomas Boateng Gyan
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Ganiyu Osman
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Peace Yaa Kordorwu
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Abdul Karim Adams
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Immanuel Asiedu
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Edward Wilson Ansah
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
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Anake WU, Nnamani EA. Indoor air quality in day-care centres: a global review. AIR QUALITY, ATMOSPHERE, & HEALTH 2023; 16:997-1022. [PMID: 36819788 PMCID: PMC9930043 DOI: 10.1007/s11869-023-01320-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 01/31/2023] [Indexed: 05/23/2023]
Abstract
A healthy indoor environment is critical for children due to the severe effect of poor indoor air quality (IAQ) on their overall well-being. Day-care centres (DCCs) are important indoor microenvironments for children apart from their homes. Therefore, monitoring IAQ in this microenvironment is vital because of the vulnerability of the occupants. This review gives a global overview of the predominant indoor chemical pollutant levels monitored in DCCs, compares their concentration with available regulations for IAQ, evaluates the sources and health risk effects of chemical pollutants and proposes strategies for enhancing IAQ in DCCs. Thirty-seven (37) articles were used based on specific stated inclusion and exclusion criteria. Continents like Europe and Asia have the most published studies in indoor DCCs. The decreasing trend of pollutants examined in most studies include particulate matter > carbon dioxide > formaldehyde > carbon monoxide > total volatile organic compounds > volatile organic compounds > nitrogen dioxide > ozone > benzene > sulphur dioxide = radon. Particulate matter in the size and mass concentration range of PM10 (0.116-1920.71 μg/m3) > PM2.5 (0.279.2-260.74 μg/m3) was the most investigated pollutant. While nitrogen dioxide, radon and carbon monoxide were consistent with the existing national and international reference values for IAQ across the continents, exceedances occurred in other pollutants. The limited number of indoor chemical pollutant studies suggests the need for more comprehensive studies on IAQ in DCC globally. Further studies should highlight the availability of low-cost sensors and mobile analytical equipment that will promote affordable ground-level data accessibility. Supplementary Information The online version contains supplementary material available at 10.1007/s11869-023-01320-5.
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Affiliation(s)
- Winifred U. Anake
- Department of Chemistry, College of Science & Technology, Covenant University, Km10 Idiroko Road, Ota, Nigeria
| | - Esther A. Nnamani
- Department of Chemistry, College of Science & Technology, Covenant University, Km10 Idiroko Road, Ota, Nigeria
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Jestin-Guyon N, Ouaalaya EH, Harison MT, Ravahatra K, Rakotomizao J, Raharimanana RN, Rakotoson JL, Rajaoarifetra J, Rakotoarisoa JCA, Rasamimanana G, Randriamananjara C, Ravalison B, Andrianarisoa A, Ralison A, Andriambololona R, Charpin D, Rakotomanga JDDM, Rakotondrabe ID, Rasoafaranirina MO, Rakotondravola ZM, Rakotoson A, Rakotondriaka JR, Nandimbiniaina A, Ratsirahonana O, Feno P, Razafindramboa M, Rahoelina B, Tschopp JM, Coutaz M, Garrone S, L'Her P, Raherison-Semjen C. Impact of biomass fuel smoke on respiratory health of children under 15 years old in Madagascar. Respir Med Res 2023; 83:100989. [PMID: 37043971 DOI: 10.1016/j.resmer.2023.100989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/15/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Children exposed to biomass used in households are at risk to develop diseases or respiratory symptoms. In Madagascar more than 95% of households use it daily. The main objective is to study the impact of chronic exposure to biomass on respiratory health of children under 15 years old in Madagascar. METHODS Descriptive cross-sectional study conducted with questionnaires among urban and rural population of Antananarivo and Mahajanga provinces between 2016 and 2017. Variables were collected: number of hours spent in kitchen per day, respiratory symptoms and spirometric data. Categorized symptoms score and exposure index expressing chronic exposure to biomass were analyzed with multinomial logistic regression models. RESULTS Of the 661 children included in the analysis, 27.7% had 1 respiratory symptom and 29.3% had 2 or more respiratory symptoms. Moderate exposure index (aOR=1.57; CI95%=[1.30-1.89]; p<0.001) and high exposure index (aOR=1.76; CI95%=[1.39-2.24]; p<0.001) were significantly associated with 1 respiratory symptom, adjusted with provinces, household members and visitors smoking, perceived discomfort related to air pollution and birthweight. Exposure index was not significantly associated with an increased risk of having 2 or more respiratory symptoms (p = 0.754). CONCLUSION Respiratory symptoms were associated with exposure to biomass, living in coastal areas, birthweight, tobacco and perceived discomfort related to air pollution. Recommendations and actions must be implemented in order to improve respiratory health related to biomass among children.
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DeLay K, Lin EZ, Koelmel JP, Bornman R, Obida M, Chevrier J, Godri Pollitt KJ. Personal air pollutant exposure monitoring in South African children in the VHEMBE birth cohort. ENVIRONMENT INTERNATIONAL 2022; 170:107524. [PMID: 36260950 PMCID: PMC9982749 DOI: 10.1016/j.envint.2022.107524] [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] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
The burden of disease associated with environmental exposures disproportionately impacts residents of low- and middle-income countries. Children living in rural regions of these countries may experience higher exposure to insecticides from indoor residual spraying used for malaria control and household air pollution. This study evaluated environmental exposures of children living in a rural region of South Africa. Quantifying exposure levels and identifying characteristics that are associated with exposure in this geographic region has been challenging due to limitations with available monitoring techniques. Wearable passive samplers have recently been shown to be a convenient and reliable tool for assessing personal exposures. In this study, a passive sampler wristband, known as Fresh Air wristband, was worn by 49 children (five-years of age) residing in the Limpopo province of South Africa. The study leveraged ongoing research within the Venda Health Examination of Mothers, Babies, and their Environment (VHEMBE) birth cohort. A wide range of chemicals (35 in total) were detected using the wristbands, including polycyclic aromatic hydrocarbons (PAHs), organochlorine pesticides, phthalates, and organophosphate esters (OPEs) flame retardants. Higher concentrations of PAHs were observed among children from households that fell below the food poverty threshold, did not have access to electric cookstoves/burners, or reported longer times of cooking or burning materials during the sampling period. Concentrations of p,p'-DDD and p,p'-DDT were also found to be elevated for children from households falling below the food poverty threshold as well as for children whose households were sprayed for malaria control within the previous 1.5 years. This study demonstrates the feasibility of using passive sampler wristbands as a non-invasive method for personal exposure assessment of children in rural regions of South Africa to complex mixtures environmental contaminants derived from a combination of sources. Future studies are needed to further identify and understand the effects of airborne environmental contaminants on childhood development and strategies to mitigate exposures.
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Affiliation(s)
- Kayley DeLay
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT 06520, USA; Department of Chemical and Environmental Engineering, Yale School of Engineering and Applied Sciences, New Haven, CT 06520, USA
| | - Elizabeth Z Lin
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT 06520, USA
| | - Jeremy P Koelmel
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT 06520, USA
| | - Riana Bornman
- University of Pretoria Institute for Sustainable Malaria Control and School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Muvhulawa Obida
- University of Pretoria Institute for Sustainable Malaria Control and School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Jonathan Chevrier
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.
| | - Krystal J Godri Pollitt
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT 06520, USA; Department of Chemical and Environmental Engineering, Yale School of Engineering and Applied Sciences, New Haven, CT 06520, USA.
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Glenn BE, Espira LM, Larson MC, Larson PS. Ambient air pollution and non-communicable respiratory illness in sub-Saharan Africa: a systematic review of the literature. Environ Health 2022; 21:40. [PMID: 35422005 PMCID: PMC9009030 DOI: 10.1186/s12940-022-00852-0] [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: 10/21/2021] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Aerosol pollutants are known to raise the risk of development of non-communicable respiratory diseases (NCRDs) such as asthma, chronic bronchitis, chronic obstructive pulmonary disease, and allergic rhinitis. Sub-Saharan Africa's rapid pace of urbanization, economic expansion, and population growth raise concerns of increasing incidence of NCRDs. This research characterizes the state of research on pollution and NCRDs in the 46 countries of Sub-Saharan Africa (SSA). This research systematically reviewed the literature on studies of asthma; chronic bronchitis; allergic rhinitis; and air pollutants such as particulate matter, ozone, NOx, and sulfuric oxide. METHODS We searched three major databases (PubMed, Web of Science, and Scopus) using the key words "asthma", "chronic bronchitis", "allergic rhinitis", and "COPD" with "carbon monoxide (CO)", "sulfuric oxide (SO)", "ozone (O3)", "nitrogen dioxide (NO2)", and "particulate matter (PM)", restricting the search to the 46 countries that comprise SSA. Only papers published in scholarly journals with a defined health outcome in individuals and which tested associations with explicitly measured or modelled air exposures were considered for inclusion. All candidate papers were entered into a database for review. RESULTS We found a total of 362 unique research papers in the initial search of the three databases. Among these, 14 met the inclusion criteria. These papers comprised studies from just five countries. Nine papers were from South Africa; two from Malawi; and one each from Ghana, Namibia, and Nigeria. Most studies were cross-sectional. Exposures to ambient air pollutants were measured using spectrometry and chromatography. Some studies created composite measures of air pollution using a range of data layers. NCRD outcomes were measured by self-reported health status and measures of lung function (spirometry). Populations of interest were primarily schoolchildren, though a few studies focused on secondary school students and adults. CONCLUSIONS The paucity of research on NCRDs and ambient air pollutant exposures is pronounced within the African continent. While capacity to measure air quality in SSA is high, studies targeting NCRDs should work to draw attention to questions of outdoor air pollution and health. As the climate changes and SSA economies expand and countries urbanize, these questions will become increasingly important.
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Affiliation(s)
- Bailey E. Glenn
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA USA
| | - Leon M. Espira
- Center for Global Health Equity, University of Michigan, Ann Arbor, USA
| | | | - Peter S. Larson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA USA
- Social Environment and Health Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI USA
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI USA
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Larson PS, Espira L, Glenn BE, Larson MC, Crowe CS, Jang S, O’Neill MS. Long-Term PM 2.5 Exposure Is Associated with Symptoms of Acute Respiratory Infections among Children under Five Years of Age in Kenya, 2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052525. [PMID: 35270217 PMCID: PMC8909525 DOI: 10.3390/ijerph19052525] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 02/06/2023]
Abstract
Introduction: Short-term exposures to air pollutants such as particulate matter (PM) have been associated with increased risk for symptoms of acute respiratory infections (ARIs). Less well understood is how long-term exposures to fine PM (PM2.5) might increase risk of ARIs and their symptoms. This research uses georeferenced Demographic Health Survey (DHS) data from Kenya (2014) along with a remote sensing based raster of PM2.5 concentrations to test associations between PM2.5 exposure and ARI symptoms in children for up to 12 monthly lags. Methods: Predicted PM2.5 concentrations were extracted from raster of monthly averages for latitude/longitude locations of survey clusters. These data and other environmental and demographic data were used in a logistic regression model of ARI symptoms within a distributed lag nonlinear modeling framework (DLNM) to test lag associations of PM2.5 exposure with binary presence/absence of ARI symptoms in the previous two weeks. Results: Out of 7036 children under five for whom data were available, 46.8% reported ARI symptoms in the previous two weeks. Exposure to PM2.5 within the same month and as an average for the previous 12 months was 18.31 and 22.1 µg/m3, respectively, far in excess of guidelines set by the World Health Organization. One-year average PM2.5 exposure was higher for children who experienced ARI symptoms compared with children who did not (22.4 vs. 21.8 µg/m3, p < 0.0001.) Logistic regression models using the DLNM framework indicated that while PM exposure was not significantly associated with ARI symptoms for early lags, exposure to high concentrations of PM2.5 (90th percentile) was associated with elevated odds for ARI symptoms along a gradient of lag exposure time even when controlling for age, sex, types of cooking fuels, and precipitation. Conclusions: Long-term exposure to high concentrations of PM2.5 may increase risk for acute respiratory problems in small children. However, more work should be carried out to increase capacity to accurately measure air pollutants in emerging economies such as Kenya.
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Affiliation(s)
- Peter S. Larson
- Social Environment and Health Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, USA
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48105, USA; (C.S.C.); (M.S.O.)
- Correspondence: (P.S.L.); (L.E.); Tel.: +1-734-730-2372 (P.S.L.)
| | - Leon Espira
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI 48105, USA
- Correspondence: (P.S.L.); (L.E.); Tel.: +1-734-730-2372 (P.S.L.)
| | - Bailey E. Glenn
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, USA;
| | | | - Christopher S. Crowe
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48105, USA; (C.S.C.); (M.S.O.)
| | - Seoyeon Jang
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48105, USA;
| | - Marie S. O’Neill
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48105, USA; (C.S.C.); (M.S.O.)
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48105, USA;
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Koelmel JP, Lin EZ, DeLay K, Williams AJ, Zhou Y, Bornman R, Obida M, Chevrier J, Godri Pollitt KJ. Assessing the External Exposome Using Wearable Passive Samplers and High-Resolution Mass Spectrometry among South African Children Participating in the VHEMBE Study. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:2191-2203. [PMID: 35089017 DOI: 10.1021/acs.est.1c06481] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Children in low- and middle-income countries are often exposed to higher levels of chemicals and are more vulnerable to the health effects of air pollution. Little is known about the diversity, toxicity, and dynamics of airborne chemical exposures at the molecular level. We developed a workflow employing state-of-the-art wearable passive sampling technology coupled with high-resolution mass spectrometry to comprehensively measure 147 children's personal exposures to airborne chemicals in Limpopo, South Africa, as part of the Venda Health Examination of Mothers, Babies, and Their Environment (VHEMBE). 637 environmental exposures were detected, many of which have never been measured in this population; of these 50 airborne chemical exposures of concern were detected, including pesticides, plasticizers, organophosphates, dyes, combustion products, and perfumes. Biocides detected in wristbands included p,p'-dichlorodiphenyltrichloroethane (p,p'-DDT), p,p'-dichlorodiphenyldichloroethane (p,p'-DDD), p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE), propoxur, piperonyl butoxide, and triclosan. Exposures differed across the assessment period with 27% of detected chemicals observed to be either higher or lower in the wet or dry seasons.
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Affiliation(s)
- Jeremy P Koelmel
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut 06520, United States
| | - Elizabeth Z Lin
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut 06520, United States
| | - Kayley DeLay
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut 06520, United States
| | - Antony J Williams
- Center for Computational Toxicology and Exposure, Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, North Carolina 27711, United States
| | - Yakun Zhou
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut 06520, United States
| | - Riana Bornman
- University of Pretoria Institute for Sustainable Malaria Control and School of Health Systems and Public Health, University of Pretoria, Pretoria 0028, South Africa
| | - Muvhulawa Obida
- University of Pretoria Institute for Sustainable Malaria Control and School of Health Systems and Public Health, University of Pretoria, Pretoria 0028, South Africa
| | - Jonathan Chevrier
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, Québec H3A 1A2, Canada
| | - Krystal J Godri Pollitt
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut 06520, United States
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Chaya S, Zar HJ, Gray DM. Lung Function in Preschool Children in Low and Middle Income Countries: An Under-Represented Potential Tool to Strengthen Child Health. Front Pediatr 2022; 10:908607. [PMID: 35769219 PMCID: PMC9234953 DOI: 10.3389/fped.2022.908607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/10/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The burden of respiratory disease is high in low-middle income countries (LMIC). Pulmonary function tests are useful as an objective measure of lung health and to track progression. Spirometry is the commonest test, but its use is limited in preschool children. Other lung function methods have been developed but their use in LMIC has not been well described. AIM To review the use of preschool lung function testing in children in LMIC, with particular reference to feasibility and clinical applications. METHODS Electronic databases "PubMed", "Scopus"," Web of Science", and "EBSCO host" were searched for publications in low and middle income countries on preschool lung function testing, including spirometry, fractional exhaled nitric oxide (FeNO), oscillometry, interrupter technique, tidal breathing and multiple breath washout (MBW), from 1 January 2011 to 31 January 2022. Papers in English were included and those including only children ≥6 years were excluded. RESULT A total of 61 papers from LMIC in Asia, South America, Africa, Eurasia or the Middle East were included. Of these, 40 included spirometry, 7 FeNO, 15 oscillometry, 2 interrupter technique, and 2 tidal breathing. The papers covered test feasibility (19/61), clinical application (46/61) or epidemiological studies (13/61). Lung function testing was successful in preschool children from LMIC. Spirometry was the most technically demanding and success gradually increased with age. CONCLUSION Preschool lung function testing is under-represented in LMIC for the burden of respiratory disease. These tests have the potential to strengthen respiratory care in LMIC, however access needs to be improved.
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Affiliation(s)
- Shaakira Chaya
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Diane M Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Cai YS, Gibson H, Ramakrishnan R, Mamouei M, Rahimi K. Ambient Air Pollution and Respiratory Health in Sub-Saharan African Children: A Cross-Sectional Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189729. [PMID: 34574653 PMCID: PMC8467583 DOI: 10.3390/ijerph18189729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/11/2021] [Accepted: 09/13/2021] [Indexed: 02/03/2023]
Abstract
Ambient air pollution is projected to become a major environmental risk in sub-Saharan Africa (SSA). Research into its health impacts is hindered by limited data. We aimed to investigate the cross-sectional relationship between particulate matter with a diameter ≤ 2.5 μm (PM2.5) and prevalence of cough or acute lower respiratory infection (ALRI) among children under five in SSA. Data were collected from 31 Demographic and Health Surveys (DHS) in 21 SSA countries between 2005–2018. Prior-month average PM2.5 preceding the survey date was assessed based on satellite measurements and a chemical transport model. Cough and ALRI in the past two weeks were derived from questionnaires. Associations were analysed using conditional logistic regression within each survey cluster, adjusting for child’s age, sex, birth size, household wealth, maternal education, maternal age and month of the interview. Survey-specific odds ratios (ORs) were pooled using random-effect meta-analysis. Included were 368,366 and 109,664 children for the analysis of cough and ALRI, respectively. On average, 20.5% children had reported a cough, 6.4% reported ALRI, and 32% of children lived in urban areas. Prior-month average PM2.5 ranged from 8.9 to 64.6 μg/m3. Pooling all surveys, no associations were observed with either outcome in the overall populations. Among countries with medium-to-high Human Development Index, positive associations were observed with both cough (pooled OR: 1.022, 95%CI: 0.982–1.064) and ALRI (pooled OR: 1.018, 95%CI: 0.975–1.064) for 1 μg/m3 higher of PM2.5. This explorative study found no associations between short-term ambient PM2.5 and respiratory health among young SSA children, necessitating future analyses using better-defined exposure and health metrics to study this important link.
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Affiliation(s)
- Yutong Samuel Cai
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX3 9DU, UK; (H.G.); (M.M.); (K.R.)
- Deep Medicine Programme, Oxford Martin School, University of Oxford, Oxford OX1 3BD, UK
- Informal Cities Programme, Oxford Martin School, University of Oxford, Oxford OX1 3BD, UK
- Correspondence:
| | - Harry Gibson
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX3 9DU, UK; (H.G.); (M.M.); (K.R.)
- Deep Medicine Programme, Oxford Martin School, University of Oxford, Oxford OX1 3BD, UK
- Informal Cities Programme, Oxford Martin School, University of Oxford, Oxford OX1 3BD, UK
| | - Rema Ramakrishnan
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK;
| | - Mohammad Mamouei
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX3 9DU, UK; (H.G.); (M.M.); (K.R.)
- Deep Medicine Programme, Oxford Martin School, University of Oxford, Oxford OX1 3BD, UK
- Informal Cities Programme, Oxford Martin School, University of Oxford, Oxford OX1 3BD, UK
| | - Kazem Rahimi
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX3 9DU, UK; (H.G.); (M.M.); (K.R.)
- Deep Medicine Programme, Oxford Martin School, University of Oxford, Oxford OX1 3BD, UK
- Informal Cities Programme, Oxford Martin School, University of Oxford, Oxford OX1 3BD, UK
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Mir Alvarez C, Hourcade R, Lefebvre B, Pilot E. A Scoping Review on Air Quality Monitoring, Policy and Health in West African Cities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239151. [PMID: 33297562 PMCID: PMC7730241 DOI: 10.3390/ijerph17239151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 12/22/2022]
Abstract
Ambient air pollution is a global health threat that causes severe mortality and morbidity from respiratory, cardiovascular, and other diseases. Its impact is especially concerning in cities; as the urban population increases, especially in low- and middle-income countries, large populations risk suffering from these health effects. The Economic Community of West African States (ECOWAS) comprises 15 West African countries, in which many cities are currently experiencing fast growth and industrialization. However, government-led initiatives in air quality monitoring are scarce in ECOWAS countries, which makes it difficult to effectively control and regulate air quality and subsequent health issues. A scoping study was performed following the Arksey and O’Malley methodological framework in order to assess the precise status of air quality monitoring, related policy, and legislation in this region. Scientific databases and gray literature searches were conducted, and the results were contrasted through expert consultations. It was found that only two ECOWAS countries monitor air quality, and most countries have insufficient legislation in place. Public health surveillance data in relation to air quality data is largely unavailable. In order to address this, improved air quality surveillance, stricter and better-enforced regulations, regional cooperation, and further research are strongly suggested for ECOWAS.
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Affiliation(s)
- Celia Mir Alvarez
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Maastricht University, 6229 ER Maastricht, The Netherlands;
- University Rennes, EHESP, CNRS, ARENES–UMR 6051, F-35000 Rennes, France; (R.H.); (B.L.)
| | - Renaud Hourcade
- University Rennes, EHESP, CNRS, ARENES–UMR 6051, F-35000 Rennes, France; (R.H.); (B.L.)
| | - Bertrand Lefebvre
- University Rennes, EHESP, CNRS, ARENES–UMR 6051, F-35000 Rennes, France; (R.H.); (B.L.)
| | - Eva Pilot
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Maastricht University, 6229 ER Maastricht, The Netherlands;
- Correspondence: ; Tel.: +31-620311075
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