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Sharma SK, Kurmi OP, Lab B, Chappuis F, Heller O, Lohani S, Gautam P, Hall I, Bolton CE. Respiratory morbidity in Nepali communities: a cross-sectional analysis. Epidemiology 2021. [DOI: 10.1183/13993003.congress-2021.pa3509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Chaudhary N, Yadav SN, Kalra SK, Pathak S, Gupta BK, Shrestha S, Patel M, Satia I, Sadhra S, Bolton CE, Kurmi OP. Prognostic factors associated with small for gestational age babies in a tertiary care hospital of Western Nepal: A cross-sectional study. Health Sci Rep 2021; 4:e250. [PMID: 33614985 PMCID: PMC7883381 DOI: 10.1002/hsr2.250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/07/2021] [Accepted: 01/21/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Small for gestational age (SGA) is common among newborns in low-income countries like Nepal and has higher immediate mortality and morbidities. OBJECTIVES To study the prevalence and prognostic factors of SGA babies in Western Nepal. METHODS A cross-sectional study (November 2016-October 2017) was conducted in a tertiary care hospital in Western Nepal. Socio-demographic, lifestyle factors including diet, and exposures including smoking and household air pollution in mothers who delivered newborns appropriate for gestational age (AGA), SGA and large for gestational age (LGA) were recorded. Logistic regression was carried out to find the odds ratio of prognostic factors after adjusting for potential confounders. RESULTS Out of 4000 delivered babies, 77% (n = 3078) were AGA, 20.3% (n = 813) were SGA and 2.7% (n = 109) were LGA. The proportion of female-SGA was greater in comparison to male-SGA (n = 427, 52.5% vs n = 386, 47.5%). SGA babies were born to mothers who had term, preterm, and postterm delivery in the following proportions 70.1%, 19.3%, and 10.6%, respectively. The average weight gain (mean ± SD) by mothers in AGA pregnancies was 10.3 ± 2.4 kg, whereas in SGA were 9.3 ± 2.4 kg. In addition to low socioeconomic status (OR 1.9, 95% CI 1.1, 3.2), other prognostic factors associated with SGA were lifestyle factors such as low maternal sleep duration (OR 5.1, CI 3.6, 7.4) and monthly or less frequent meat intake (OR 5.0, CI 3.2, 7.8). Besides smoking (OR 8.8, CI 2.1, 36.3), the other major environmental factor associated with SGA was exposure to household air pollution (OR 5.4, 4.1, 6.9) during pregnancy. Similarly, some of the adverse health conditions associated with a significantly higher risk of SGA were anemia, oligohydramnios, and gestational diabetes. CONCLUSIONS SGA is common in Western Nepal and associated with several modifiable prognostic factors.
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Affiliation(s)
- Nagendra Chaudhary
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
| | - Shree Narayan Yadav
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
- Department of PediatricsChitwan Medical CollegeBharatpurNepal
| | - Suresh Kumar Kalra
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
| | - Santosh Pathak
- Department of PediatricsChitwan Medical CollegeBharatpurNepal
| | - Binod Kumar Gupta
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
| | - Sandeep Shrestha
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
| | - Matthew Patel
- The Royal College of Surgeons in IrelandDublinIreland
| | - Imran Satia
- Division of Respirology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Steven Sadhra
- Institute of Clinical SciencesCollege of Medical and Dental Sciences, University of BirminghamBirminghamUK
| | - Charlotte Emma Bolton
- NIHR Nottingham Biomedical Research CentreSchool of Medicine, University of NottinghamNottinghamUK
| | - Om Prakash Kurmi
- Division of Respirology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Faculty of Health and Life SciencesUniversity of CoventryCoventryUK
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Ekezie W, Jenkins AR, Hall IP, Evans C, Koju R, Kurmi OP, Bolton CE. The burden of chronic respiratory diseases in adults in Nepal: A systematic review. Chron Respir Dis 2021; 18:1479973121994572. [PMID: 34227410 PMCID: PMC8264743 DOI: 10.1177/1479973121994572] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/07/2021] [Accepted: 01/23/2021] [Indexed: 12/11/2022] Open
Abstract
While chronic lung disease causes substantial global morbidity and mortality, global estimates have primarily been based on broad assumptions. Specific country data from low-income countries such as Nepal are limited. This review assessed primary evidence on chronic respiratory disease burden among adults in Nepal. A systematic search was performed in June 2019 (updated May 2020) for studies through nine databases. High levels of heterogeneity deemed a narrative synthesis appropriate. Among 27 eligible studies identified, most were low-moderate quality with cross-sectional and retrospective study design. Chronic lung diseases identified were chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis and restrictive lung diseases. Studies were categorised as: (i) community-based, (ii) hospital-based and (iii) comorbidity-related and disease burden. Reported disease prevalence varied widely (COPD, 1.67-14.3%; asthma, 4.2-8.9%). The prevalence of airflow obstruction was higher among rural dwellers (15.8%) and those exposed to household air pollution from domestic biomass burning as opposed to liquid petroleum gas users (Odds Ratio: 2.06). Several comorbidities, including hypertension and diabetes mellitus added to the disease burden. The review shows limited literature on lung disease burden in Nepal. Publications varied in terms of overall quality. Good quality research studies with prospective cohorts related to respiratory conditions are required.
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Affiliation(s)
- Winifred Ekezie
- NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, Nottingham, UK
- Division of Epidemiology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Alex Robert Jenkins
- NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ian Philip Hall
- NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, Nottingham, UK
| | - Catrin Evans
- Nottingham Centre for Evidence Based Healthcare, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Rajendra Koju
- Department of Medicine, Dhulikhel Hospital, Dhulikhel, Nepal
| | - Om Prakash Kurmi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Charlotte Emma Bolton
- NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, Nottingham, UK
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Chaudhary N, Lama S, Mahato SK, Agrawa N, Pathak S, Kurmi OP, Bhatia B, Agarwal KN. Re: Clinico-radiological Observations in Meconium Aspiration Syndrome - Letter to The Editor. JNMA J Nepal Med Assoc 2018. [PMID: 31065130 PMCID: PMC8959367 DOI: 10.31729/jnma.3834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Nagendra Chaudhary
- Department of Pediatrics, Universal College of Medical Sciences, Bhairahawa, Nepal;Centre for Population Health Research, Bhairahawa, Nepal
| | - Susana Lama
- Sanjeevani Hospital & IVF Centre, Biratnagar, Nepal
| | | | - Nikhil Agrawa
- Vayodha Hospital Pvt. Ltd., Balkhu Chowk, Kathmandu, Nepal
| | - Santosh Pathak
- Department of Pediatrics, Chitwan Medical College, Bharatpur, Nepal
| | - Om Prakash Kurmi
- Department of Population Health Research Institute (PHRI), McMaster University, Hamilton, Canada;Centre for Population Health Research, Bhairahawa, Nepal
| | - Baldev Bhatia
- Department of Pediatrics, Heritage Institute of Medical Sciences, Varanasi, India
| | - Kailash Nath Agarwal
- Department of Pediatrics, Universal College of Medical Sciences, Bhairahawa, Nepal
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Chan KH, Bennett DA, Lam KBH, Kurmi OP, Chen Z. P2544Risk of cardiovascular death by long-term solid fuel use for cooking and implications of switching to clean fuels: a prospective cohort study of 340,000 chinese adults. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K H Chan
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - D A Bennett
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - K B H Lam
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - O P Kurmi
- McMaster University, Population Health Research Institute, Hamilton, Canada
| | - Z Chen
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
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Lama S, Mahato SK, Chaudhary N, Agrawal N, Pathak S, Kurmi OP, Bhatia B, Agarwal KN. Clinico-radiological Observations in Meconium Aspiration Syndrome. JNMA J Nepal Med Assoc 2018. [DOI: 10.31729/jnma.3340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Introduction: To understand and report the prevalence of meconium aspiration syndrome and the clinico-radiological features in a tertiary care hospital of western Nepal.
Methods: An observational study carried out for a year in 2014-15 in all babies with MAS. Clinical and radiological profiles of MAS in relation to gender, gestational age, mode of delivery, birth weight, Apgar score, thickness of meconium, age at admission and the immediate outcome were studied.
Results: Out of 584 admitted newborns (male=389; female=186) during the study period, 78 (13.4%) had meconium aspiration syndrome with male: female ratio of 1.2:1. Majority of babies admitted to NICU had thick meconium [n=52 (66.7%)]. There was no statistical significant difference in various parameters such as Apgar score at 1 and 5 minutes, respiratory distress, birth asphyxia, duration of oxygen use, MAS severity and chest x-ray in those with thick MAS compared to thin. Among all newborns with MAS, 59% (n=46) had abnormal radiological findings with over two-folds in those with thick MAS (71.7%)] compared to thin (28%). Hyperinflation (47.8%), diffuse patchy infiltration (37%), consolidation (21.7%) collapse (8.7%), right lung fissure (6.5%) and pneumothorax (8.7%) were the abnormal radiological findings seen in MAS babies. The odds of having APGAR score at 1 minute at least 7 or more was twice unlikely in those having thick meconium compared to thin (P=0.02)
Conclusions: Thick meconium is relatively common with more significant abnormal radiological findings and low Apgar score.
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Lama S, Mahato SK, Chaudhary N, Agrawal N, Pathak S, Kurmi OP, Bhatia B, Agarwal KN. Clinico-radiological Observations in Meconium Aspiration Syndrome. JNMA J Nepal Med Assoc 2018; 56:510-515. [PMID: 30058634 PMCID: PMC8997330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION To understand and report the prevalence of meconium aspiration syndrome and the clinico-radiological features in a tertiary care hospital of western Nepal. METHODS An observational study carried out for a year in 2014-15 in all babies with MAS. Clinical and radiological profiles of MAS in relation to gender, gestational age, mode of delivery, birth weight, Apgar score, thickness of meconium, age at admission and the immediate outcome were studied. RESULTS Out of 584 admitted newborns (male=389; female=186) during the study period, 78 (13.4%) had meconium aspiration syndrome with male: female ratio of 1.2:1. Majority of babies admitted to NICU had thick meconium [n=52 (66.7%)]. There was no statistical significant difference in various parameters such as Apgar score at 1 and 5 minutes, respiratory distress, birth asphyxia, duration of oxygen use, MAS severity and chest x-ray in those with thick MAS compared to thin. Among all newborns with MAS, 59% (n=46) had abnormal radiological findings with over two-folds in those with thick MAS (71.7%)] compared to thin (28%). Hyperinflation (47.8%), diffuse patchy infiltration (37%), consolidation (21.7%) collapse (8.7%), right lung fissure (6.5%) and pneumothorax (8.7%) were the abnormal radiological findings seen in MAS babies. The odds of having APGAR score at 1 minute at least 7 or more was twice unlikely in those having thick meconium compared to thin (P=0.02) Conclusions: Thick meconium is relatively common with more significant abnormal radiological findings and low Apgar score.
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Affiliation(s)
- Susana Lama
- Department of Pediatrics, Universal College of
Medical Sciences, Bhairahawa, Nepal
| | - Shyam Kumar Mahato
- Department of Pediatrics, Universal College of
Medical Sciences, Bhairahawa, Nepal
| | - Nagendra Chaudhary
- Department of Pediatrics, Universal College of
Medical Sciences, Bhairahawa, Nepal,Centre for Population Health
Research, Bhairahawa, Nepal,Correspondence: Dr. Nagendra Chaudhary, Department of
Pediatrics, Universal College of Medical Sciences, Bhairahawa, Nepal.
, Phone : +977-9857012029
| | - Nikhil Agrawal
- Department of Pediatrics, Universal College of
Medical Sciences, Bhairahawa, Nepal
| | - Santosh Pathak
- Department of Pediatrics, Chitwan Medical
College, Bharatpur, Nepal
| | - Om Prakash Kurmi
- Nuffield Department of Population Health, Clinical
Trial Service Unit & Epidemiological Studies Unit, University of
Oxford, Oxford, UK,Centre for Population Health
Research, Bhairahawa, Nepal
| | - Baldev Bhatia
- Department of Pediatrics, Heritage Institute of
Medical Sciences, Varanasi, India
| | - Kailash Nath Agarwal
- Department of Pediatrics, Universal College of
Medical Sciences, Bhairahawa, Nepal
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Pathak S, Chaudhary N, Dhakal P, Mahato SK, Shrestha S, Bhatia BD, Bansal AK, Kurmi OP, Agarwal KN. Gestational Age Specific Postnatal Growth Curves for Singleton Babies in Tertiary Hospital of Western Nepal. JNMA J Nepal Med Assoc 2017. [DOI: 10.31729/jnma.3105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Introduction: Measurement of birth weight (BW), crown heel length (CHL), head circumference (HC) and chest circumference used to assess the intrauterine growth of a baby vary with altitude, race, gender, socio economic status, maternal size, and maternal diseases. The study aimed to construct centile charts for BW, CHL and HC for new born at different gestational ages in western Nepal.
Methods: This was a descriptive cross sectional study done over a period of 15 months in a tertiary care hospital of western Nepal. BW, length, HC and CC were measured within 12-24 hours of birth. Gestational age was estimated from first day of last menstrual period, maternal ultrasonology and New Ballard’s scoring system. Microsoft 2007 Excel and SPSS-16 was used for data analysis. Cole’s Lambda Mu Sigma method was used for constructing centile curves.
Results: Out of 2000 babies analysed, 1910 samples were used to construct smoothed intrauterine growth curve of BW, CHL, and HC from 33-42 weeks of gestation. 57.35% (1147) were male, mean gestational age was 38.13 ±2.44 weeks, where 21.5% were preterm and 1.7% post term. The means of BW, CHL, HC and CC were 2744.78 gm, 47.80 cm, 33.18 cm, and 30.20 cm with standard deviations of 528.29, 3.124, 1.78, and 2.35 respectively. These data vary as compared to the Kathmandu data, in case of birth weight for 10th and 90th centiles, and at 90th centile in case of length.
Conclusions: This necessitates the update in the existing growth charts and develop in different geographical regions of a country.
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Pathak S, Chaudhary N, Dhakal P, Mahato SK, Shrestha S, Bhatia BD, Bansal AK, Kurmi OP, Agarwal KN. Gestational Age Specific Postnatal Growth Curves for Singleton Babies in A Tertiary Hospital of Western Nepal. JNMA J Nepal Med Assoc 2017; 56:325-330. [PMID: 29255314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION Measurement of birth weight, crown-heel length, head circumference and chest circumference used to assess the intrauterine growth of a baby vary with altitude, race, gender, socioeconomic status, maternal size, and maternal diseases. The study aimed to construct centile charts for birth weight, crown-heel length and head circumference for new born at different gestational ages in Western Nepal. METHODS This was a descriptive cross-sectional study done over a period of 15 months in a tertiary care hospital of Western Nepal. Birth weight, length, head circumference and chest circumference were measured within 12-24 hours of birth. Gestational age was estimated from the first day of last menstrual period and New Ballard's scoring system. Microsoft 2007 Excel and SPSS-16 was used for data analysis. Cole's Lambda Mu Sigma method was used for constructing centile curves. RESULTS Out of 2000 babies analysed, 1910 samples were used to construct smoothed intrauterine growth curve of birth weight, crown-heel length, and head circumference from 33-42 weeks of gestation. Among all, 1147 (57.35%) were male and 853 (42.65%) were female, mean gestational age was 38.13±2.44 weeks. The means of birth weight, crown-heel length, head and chest circumference were 2744.78 gm, 47.80 cm, 33.18 cm, and 30.20 cm with standard deviations of 528.29, 3.124, 1.78, and 2.35 respectively. CONCLUSIONS This necessitates the update in the existing growth charts and development in different geographical regions of a country.
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Affiliation(s)
- Santosh Pathak
- Department of Pediatrics, Chitwan Medical College, Bharatpur, Nepal
| | - Nagendra Chaudhary
- Department of Pediatrics, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Prativa Dhakal
- Department of Nursing, Chitwan Medical College, Bharatpur, Nepal
| | - Shyam Kumar Mahato
- Department of Pediatrics, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Sandeep Shrestha
- Department of Pediatrics, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Bal Dev Bhatia
- Department of Pediatrics, Heritage Institute of Medical Sciences, Varanasi, India
| | - Ajay Kumar Bansal
- University College of Medical Sciences (UCMS-GTBH), Delhi, Shahdara, India
| | - Om Prakash Kurmi
- Nuffield Department of Population Health, Clinical Trial Service Unit & Epidemiological Studies Unit, University of Oxford, United Kingdom
| | - Kailash Nath Agarwal
- Department of Pediatrics, Universal College of Medical Sciences, Bhairahawa, Nepal
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Bartington SE, Bakolis I, Devakumar D, Kurmi OP, Gulliver J, Chaube G, Manandhar DS, Saville NM, Costello A, Osrin D, Hansell AL, Ayres JG. Patterns of domestic exposure to carbon monoxide and particulate matter in households using biomass fuel in Janakpur, Nepal. Environ Pollut 2017; 220:38-45. [PMID: 27707597 PMCID: PMC5157800 DOI: 10.1016/j.envpol.2016.08.074] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 08/08/2016] [Accepted: 08/27/2016] [Indexed: 05/21/2023]
Abstract
Household Air Pollution (HAP) from biomass cooking fuels is a major cause of morbidity and mortality in low-income settings worldwide. In Nepal the use of open stoves with solid biomass fuels is the primary method of domestic cooking. To assess patterns of domestic air pollution we performed continuous measurement of carbon monoxide (CO) and particulate Matter (PM2.5) in 12 biomass fuel households in Janakpur, Nepal. We measured kitchen PM2.5 and CO concentrations at one-minute intervals for an approximately 48-h period using the TSI DustTrak II 8530/SidePak AM510 (TSI Inc, St. Paul MN, USA) or EL-USB-CO data logger (Lascar Electronics, Erie PA, USA) respectively. We also obtained information regarding fuel, stove and kitchen characteristics and cooking activity patterns. Household cooking was performed in two daily sessions (median total duration 4 h) with diurnal variability in pollutant concentrations reflecting morning and evening cooking sessions and peak concentrations associated with fire-lighting. We observed a strong linear relationship between PM2.5 measurements obtained by co-located photometric and gravimetric monitoring devices, providing local calibration factors of 4.9 (DustTrak) and 2.7 (SidePak). Overall 48-h average CO and PM2.5 concentrations were 5.4 (SD 4.3) ppm (12 households) and 417.6 (SD 686.4) μg/m3 (8 households), respectively, with higher average concentrations associated with cooking and heating activities. Overall average PM2.5 concentrations and peak 1-h CO concentrations exceeded WHO Indoor Air Quality Guidelines. Average hourly PM2.5 and CO concentrations were moderately correlated (r = 0.52), suggesting that CO has limited utility as a proxy measure for PM2.5 exposure assessment in this setting. Domestic indoor air quality levels associated with biomass fuel combustion in this region exceed WHO Indoor Air Quality standards and are in the hazardous range for human health.
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Affiliation(s)
- S E Bartington
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - I Bakolis
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London W2 1PG, UK; Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London SE5 8AF, UK; Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London SE5 8AF, UK
| | - D Devakumar
- UCL Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - O P Kurmi
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, Old Road Campus, Oxford OX3 7LF, UK
| | - J Gulliver
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London W2 1PG, UK
| | - G Chaube
- Mother and Infant Research Activities (MIRA), Kathmandu 44600, Nepal
| | - D S Manandhar
- Mother and Infant Research Activities (MIRA), Kathmandu 44600, Nepal
| | - N M Saville
- UCL Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - A Costello
- UCL Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - D Osrin
- UCL Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - A L Hansell
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London W2 1PG, UK; Imperial College Healthcare NHS Trust, London, UK
| | - J G Ayres
- Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Abstract
BACKGROUND Population-based studies of the occupational contribution to chronic obstructive pulmonary disease generally rely on self-reported exposures to vapours, gases, dusts and fumes (VGDF), which are susceptible to misclassification. AIMS To develop an airborne chemical job exposure matrix (ACE JEM) for use with the UK Standard Occupational Classification (SOC 2000) system. METHODS We developed the ACE JEM in stages: (i) agreement of definitions, (ii) a binary assignation of exposed/not exposed to VGDF, fibres or mists (VGDFFiM), for each of the individual 353 SOC codes and (iii) assignation of levels of exposure (L; low, medium and high) and (iv) the proportion of workers (P) likely to be exposed in each code. We then expanded the estimated exposures to include biological dusts, mineral dusts, metals, diesel fumes and asthmagens. RESULTS We assigned 186 (53%) of all SOC codes as exposed to at least one category of VGDFFiM, with 23% assigned as having medium or high exposure. We assigned over 68% of all codes as not being exposed to fibres, gases or mists. The most common exposure was to dusts (22% of codes with >50% exposed); 12% of codes were assigned exposure to fibres. We assigned higher percentages of the codes as exposed to diesel fumes (14%) compared with metals (8%). CONCLUSIONS We developed an expert-derived JEM, using a strict set of a priori defined rules. The ACE JEM could also be applied to studies to assess risks of diseases where the main route of occupational exposure is via inhalation.
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Affiliation(s)
- S S Sadhra
- Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK,
| | - O P Kurmi
- CTSU, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - H Chambers
- Centre for Workplace Health, Health and Safety Laboratory, Harpur Hill, Buxton SK17 9JN, UK
| | - K B H Lam
- Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - D Fishwick
- Centre for Workplace Health, Health and Safety Laboratory, Harpur Hill, Buxton SK17 9JN, UK
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Abstract
More than half the world's population still rely on burning biomass fuels to heat and light their homes and cook food. Household air pollution, a common component of which is inhalable particulate matter (PM), emitted from biomass burning is associated with increased vulnerability to respiratory infection and an enhanced risk of developing chronic obstructive pulmonary disease. In the light of an emerging hypothesis linking chronic PM exposure during childhood and increased vulnerability to respiratory diseases in adulthood, in a chain of events involving oxidative stress, reduced immunity and subsequent infection, the aim of this study was to characterise the oxidative potential (OP) of PM collected during the burning of wood and mixed biomass, whilst cooking food in the Kathmandu Valley, Nepal. Our assessments were based on the capacity of the particles to deplete the physiologically relevant antioxidants from a validated, synthetic respiratory tract lining fluid (RTLF). Incubation of mixed biomass and wood smoke particles suspensions with the synthetic RTLF for 4 h resulted in a mean loss of ascorbate of 64.76 ± 16.83% and 83.37 ± 14.12% at 50 μg/ml, respectively. Reduced glutathione was depleted by 49.29 ± 15.22% in mixed biomass and 65.33 ± 13.01% in wood smoke particles under the same conditions. Co-incubation with the transition metal chelator diethylenetriaminepentaacetate did not inhibit the rate of ascorbate oxidation, indicating a negligible contribution by redox-active metals in these samples. The capacity of biomass smoke particles to elicit oxidative stress certainly has the potential to contribute towards negative health impacts associated with traditional domestic fuels in the developing world.
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Affiliation(s)
- O P Kurmi
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford , Oxford , UK
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Devakumar D, Semple S, Osrin D, Yadav SK, Kurmi OP, Saville NM, Shrestha B, Manandhar DS, Costello A, Ayres JG. Biomass fuel use and the exposure of children to particulate air pollution in southern Nepal. Environ Int 2014; 66:79-87. [PMID: 24533994 PMCID: PMC3989062 DOI: 10.1016/j.envint.2014.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 01/15/2014] [Accepted: 01/17/2014] [Indexed: 05/05/2023]
Abstract
The exposure of children to air pollution in low resource settings is believed to be high because of the common use of biomass fuels for cooking. We used microenvironment sampling to estimate the respirable fraction of air pollution (particles with median diameter less than 4 μm) to which 7-9 year old children in southern Nepal were exposed. Sampling was conducted for a total 2649 h in 55 households, 8 schools and 8 outdoor locations of rural Dhanusha. We conducted gravimetric and photometric sampling in a subsample of the children in our study in the locations in which they usually resided (bedroom/living room, kitchen, veranda, in school and outdoors), repeated three times over one year. Using time activity information, a 24-hour time weighted average was modeled for all the children in the study. Approximately two-thirds of homes used biomass fuels, with the remainder mostly using gas. The exposure of children to air pollution was very high. The 24-hour time weighted average over the whole year was 168 μg/m(3). The non-kitchen related samples tended to show approximately double the concentration in winter than spring/autumn, and four times that of the monsoon season. There was no difference between the exposure of boys and girls. Air pollution in rural households was much higher than the World Health Organization and the National Ambient Air Quality Standards for Nepal recommendations for particulate exposure.
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Affiliation(s)
- D Devakumar
- UCL Institute for Global Health, 30 Guilford St., London WC1N 1EH, UK.
| | - S Semple
- University of Aberdeen Scottish Centre for Indoor Air, Division of Applied Health Sciences, Royal Aberdeen Children's Hospital, Westburn Road, Aberdeen AB25 2ZD, UK
| | - D Osrin
- UCL Institute for Global Health, 30 Guilford St., London WC1N 1EH, UK
| | - S K Yadav
- Mother and Infant Research Activities, Thapathali, PO Box 921, Kathmandu, Nepal
| | - O P Kurmi
- Clinical Trial Services Unit and Epidemiological Studies Unit, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, UK
| | - N M Saville
- UCL Institute for Global Health, 30 Guilford St., London WC1N 1EH, UK
| | - B Shrestha
- Mother and Infant Research Activities, Thapathali, PO Box 921, Kathmandu, Nepal
| | - D S Manandhar
- Mother and Infant Research Activities, Thapathali, PO Box 921, Kathmandu, Nepal
| | - A Costello
- UCL Institute for Global Health, 30 Guilford St., London WC1N 1EH, UK
| | - J G Ayres
- Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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14
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Abstract
The aim of this systematic review was to quantify the impact of biomass fuel and coal use on lung cancer and to explore reasons for heterogeneity in the reported effect sizes. A systematic review of primary studies reporting the relationship between solid fuel use and lung cancer was carried out, based on pre-defined criteria. Studies that dealt with confounding factors were used in the meta-analysis. Fuel types, smoking, country, cancer cell type and sex were considered in sub-group analyses. Publication bias and heterogeneity were estimated. The pooled effect estimate for coal smoke as a lung carcinogen (OR 1.82, 95% CI 1.60-2.06) was greater than that from biomass smoke (OR 1.50, 95% CI 1.17-1.94). The risk of lung cancer from solid fuel use was greater in females (OR 1.81, 95% CI 1.54-2.12) compared to males (OR 1.16, 95% CI 0.79-1.69). The pooled effect estimates were 2.33 (95% CI 1.72-3.17) for adenocarcinoma, 3.58 (1.58-8.12) for squamous cell carcinoma and 1.57 (1.38-1.80) for tumours of unspecified cell type. These findings suggest that in-home burning of both coal and biomass is consistently associated with an increased risk of lung cancer.
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Affiliation(s)
- Om Prakash Kurmi
- School of Population and Health Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
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15
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Abstract
Many environmental factors, both indoors and outdoors, can cause or worsen respiratory disease. Although in many cases individuals have little influence over environmental exposures (e.g., weather conditions), there are many (such as environmental tobacco smoke (ETS) and outdoor air pollution) where interventions can improve health. While for environmental exposures such as air pollution, remediation largely devolves to the government, for exposures such as ETS advice to individuals in these settings will confer benefit. Climate change has begun to feature more and more in the context of health but how this may affect pulmonary disease remains debatable. It is possible that heat associated changes in allergen exposures may be more than counterbalanced by potential reductions in cold related exacerbations of diseases such as COPD. An improved assessment of environmental exposures is key in how we approach the effects of the environment on lung disease which would allow better understanding of gene-environment interactions and how remediation might influence population health for the better.
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Affiliation(s)
- O P Kurmi
- Department of Environmental and Occupational Medicine, Liberty Safe Work Research Centre, University of Aberdeen, Aberdeen, UK
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