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Amegah AK, Boachie J, Näyhä S, Jaakkola JJK. Association of biomass fuel use with reduced body weight of adult Ghanaian women. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2020; 30:670-679. [PMID: 30804452 DOI: 10.1038/s41370-019-0129-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/21/2019] [Accepted: 02/05/2019] [Indexed: 06/09/2023]
Abstract
The association of biomass fuel use with body weight has never been investigated. We therefore examined the effect of biomass fuel use on body weight of adult Ghanaian women. Data from the 2014 Ghana Demographic and Health Survey, a nationally representative population-based survey was analysed for this study. A total of 4751 women who had anthropometric (height and weight) data qualified for inclusion in this study. In linear regression modelling, charcoal use resulted in 3.08 kg (95% CI: 2.04, 4.12) and 0.81 kg/m2 (95%CI: 0.29, 1.33) reduction in weight and body mass index (BMI), respectively, compared to clean fuel (electricity, liquefied petroleum gas and natural gas) use. Use of wood resulted in much higher reduction in weight and BMI. In modified Poisson regression, charcoal users had 19% (Adjusted Prevalence Ratio [aPR] = 0.81; 95%CI: 0.71, 0.92) and 29% (aPR = 0.71; 95%CI: 0.61, 0.83) decreased risk of overweight and obesity, respectively, compared to clean fuel users. Wood users had much higher decreased risk of overweight and obesity. In conclusion, biomass fuel use was associated with reduced body weight and BMI of Ghanaian women and is the first report on the relationship. However, it is important that our findings are confirmed and the biological mechanisms elucidated through rigorous study designs.
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Affiliation(s)
- A Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Johnmark Boachie
- Public Health Research Group, Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Simo Näyhä
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
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James BS, Shetty RS, Kamath A, Shetty A. Household cooking fuel use and its health effects among rural women in southern India-A cross-sectional study. PLoS One 2020; 15:e0231757. [PMID: 32339177 PMCID: PMC7185712 DOI: 10.1371/journal.pone.0231757] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 04/01/2020] [Indexed: 11/18/2022] Open
Abstract
The use of biomass fuel is associated with the deterioration of human health and women are more likely to develop health conditions due to their exposure to indoor air pollution during cooking. This study was conducted to assess the pattern of fuel used for cooking in households as well as to determine the association between the types of fuel used with respect to socio-demographic characteristics and health status of women. A community based cross-sectional survey was conducted between August 2016 and September 2018 in four rural areas and one semi-urban area of Udupi district, Karnataka, India. The study comprised 587 families including 632 women. A pre-tested semi-structured questionnaire was used to collect data on the type of fuel as well as self-reported health conditions. Overall, 72.5% of the families used biomass, where 67.2% families were currently using both biomass and liquefied petroleum gas while only biomass was used in 5.3% of the families for cooking. Among women, being ever exposed to biomass fuel was significantly associated with their age, literacy level, occupation and socio-economic status (p < 0.001). Those who were exposed to biomass fuel showed a significant association with self-reported ophthalmic (AOR = 3.85; 95% CI: 1.79–8.29), respiratory (OR = 5.04; 95% CI: 2.52–10.07), cardiovascular (OR = 6.07; 95% CI: 1.88–19.67), dermatological symptoms /conditions (AOR = 3.67; 95% CI: 1.07–12.55) and history of adverse obstetric outcomes (AOR = 2.45; 95% CI: 1.08–5.57). A positive trend was observed between cumulative exposure to biomass in hour-years and various self-reported health symptoms/conditions (p < 0.001). It was observed that more than two-thirds of women using biomass fuel for cooking were positively associated with self-reported health symptoms. Further longitudinal studies are essential to determine the level of harmful air pollutants in household environment and its association with various health conditions among women in this region.
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Affiliation(s)
| | - Ranjitha S. Shetty
- Department of Community Medicine, Manipal Academy of Higher Education, Kasturba Medical College Manipal, Manipal, Karnataka, India
- * E-mail:
| | - Asha Kamath
- Department of Data Science, Manipal Academy of Higher Education, Prasanna School of Public Health, Manipal, Karnataka, India
| | - Avinash Shetty
- Department of Community Medicine, Manipal Academy of Higher Education, Kasturba Medical College Manipal, Manipal, Karnataka, India
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Mazorra J, Sánchez-Jacob E, de la Sota C, Fernández L, Lumbreras J. A comprehensive analysis of cooking solutions co-benefits at household level: Healthy lives and well-being, gender and climate change. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 707:135968. [PMID: 31869607 DOI: 10.1016/j.scitotenv.2019.135968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 11/26/2019] [Accepted: 12/05/2019] [Indexed: 05/05/2023]
Abstract
Three billion people (>40% of the world's population) lack access to clean cooking solutions, including 2.5 billion people that still rely on the traditional use of biomass for cooking. In urban contexts, the rate of access to clean cooking solutions is normally higher than in rural contexts due to greater availability of these solutions. The relevance of providing access to clean cooking solutions (SDG 7) is linked to several associated co-benefits that contribute to a wide range of Sustainable Development Goals (SDGs). Therefore, this paper shows a comprehensive analysis of multiple co-benefits of a clean cooking solution intervention. Health (SDG 3), gender (SDG 5) and climate change (SDG 13) co-benefits were analysed and compared through a cost-benefit analysis using a comprehensive approach in a case study in the Casamance Natural Subregion, located in Western Africa. The most important co-benefits were related to gender (SDG 5), representing 60-97% of the total economic benefits. Climate change co-benefits (SDG 13) were also relevant, representing 3-40% of the total economic benefits. Health co-benefits (SDG 3) were very limited for this case study, representing <1% of the total economic benefits. Considering these results, implications for urban settings were discussed in the light of the "making the available clean" or "making the clean available" strategies.
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Affiliation(s)
- Javier Mazorra
- Innovation and Technology for Development Centre at the Technical University of Madrid (itdUPM), ETSI Agrónomica, Alimentaria y de Biosistemas de la UPM, Av. Complutense s/n, Ciudad Universitaria, 28040 Madrid, Spain.
| | - Eduardo Sánchez-Jacob
- Department of Chemical and Environmental Engineering, Higher Technical School of Industrial Engineering, Technical University of Madrid (UPM), c/ José Gutiérrez Abascal, 2, 28006 Madrid, Spain
| | - Candela de la Sota
- Innovation and Technology for Development Centre at the Technical University of Madrid (itdUPM), ETSI Agrónomica, Alimentaria y de Biosistemas de la UPM, Av. Complutense s/n, Ciudad Universitaria, 28040 Madrid, Spain
| | - Luz Fernández
- Innovation and Technology for Development Centre at the Technical University of Madrid (itdUPM), ETSI Agrónomica, Alimentaria y de Biosistemas de la UPM, Av. Complutense s/n, Ciudad Universitaria, 28040 Madrid, Spain
| | - Julio Lumbreras
- Innovation and Technology for Development Centre at the Technical University of Madrid (itdUPM), ETSI Agrónomica, Alimentaria y de Biosistemas de la UPM, Av. Complutense s/n, Ciudad Universitaria, 28040 Madrid, Spain; Department of Chemical and Environmental Engineering, Higher Technical School of Industrial Engineering, Technical University of Madrid (UPM), c/ José Gutiérrez Abascal, 2, 28006 Madrid, Spain; Harvard Kennedy School of Government, 79 JFK St, Cambridge 02138, MA, USA
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Budhathoki SS, Tinkari BS, Bhandari A, Dhimal M, Zhou H, Ghimire A, Basnet O, Wrammert J, KC A. The Association of Childhood Pneumonia with Household Air Pollution in Nepal: Evidence from Nepal Demographic Health Surveys. Matern Child Health J 2020; 24:48-56. [PMID: 31981064 PMCID: PMC7048702 DOI: 10.1007/s10995-020-02882-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Childhood pneumonia is a major cause of mortality worldwide while household air pollution (HAP) is a major contributor to childhood pneumonia in low and middle-income countries. This paper presents the prevalence trend of childhood pneumonia in Nepal and assesses its association with household air pollution. METHODS The study analysed data from the 2006, 2011 and 2016 Nepal Demographic Health Surveys (NDHS). It calculated the prevalence of childhood pneumonia and the factors that cause household air pollution. The association of childhood pneumonia and HAP was assessed using univariate and multi-variate analysis. The population attributable fraction (PAF) of indoor pollution for causing pneumonia was calculated using 2016 NDHS data to assess the burden of pneumonia attributable to HAP factors. RESULTS The prevalence of childhood pneumonia decreased in Nepal between 2006 and 2016 and was higher among households using polluting cooking fuels. There was a higher risk of childhood pneumonia among children who lived in households with no separate kitchens in 2011 [Adjusted risk ratio (ARR) 1.40, 95% CI 1.01-1.97] and in 2016 (ARR 1.93, 95% CI 1.14-3.28). In 2016, the risk of children contracting pneumonia in households using polluting fuels was double (ARR 1.98, 95% CI 1.01-3.92) that of children from households using clean fuels. Based on the 2016 data, the PAF for pneumonia was calculated as 30.9% for not having a separate kitchen room and 39.8% for using polluting cooking fuel. DISCUSSION FOR PRACTICE Although the occurrence of childhood pneumonia in Nepal has decreased, the level of its association with HAP remained high.
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Affiliation(s)
- Shyam Sundar Budhathoki
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
- Golden Community, Lalitpur, Nepal
| | - Bhim Singh Tinkari
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Amit Bhandari
- Society of Public Health Physicians Nepal, Kathmandu, Nepal
| | | | - Hong Zhou
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Anup Ghimire
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Johan Wrammert
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Ashish KC
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Effects and acceptability of implementing improved cookstoves and heaters to reduce household air pollution: a FRESH AIR study. NPJ Prim Care Respir Med 2019; 29:32. [PMID: 31417087 PMCID: PMC6695425 DOI: 10.1038/s41533-019-0144-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/10/2019] [Indexed: 12/27/2022] Open
Abstract
The objective was to evaluate the effectiveness and acceptability of locally tailored implementation of improved cookstoves/heaters in low- and middle-income countries. This interventional implementation study among 649 adults and children living in rural communities in Uganda, Vietnam and Kyrgyzstan, was performed after situational analyses and awareness programmes. Outcomes included household air pollution (PM2.5 and CO), self-reported respiratory symptoms (with CCQ and MRC-breathlessness scale), chest infections, school absence and intervention acceptability. Measurements were conducted at baseline, 2 and 6–12 months after implementing improved cookstoves/heaters. Mean PM2.5 values decrease by 31% (to 95.1 µg/m3) in Uganda (95%CI 71.5–126.6), by 32% (to 31.1 µg/m3) in Vietnam (95%CI 24.5–39.5) and by 65% (to 32.4 µg/m3) in Kyrgyzstan (95%CI 25.7–40.8), but all remain above the WHO guidelines. CO-levels remain below the WHO guidelines. After intervention, symptoms and infections diminish significantly in Uganda and Kyrgyzstan, and to a smaller extent in Vietnam. Quantitative assessment indicates high acceptance of the new cookstoves/heaters. In conclusion, locally tailored implementation of improved cookstoves/heaters is acceptable and has considerable effects on respiratory symptoms and indoor pollution, yet mean PM2.5 levels remain above WHO recommendations.
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Onakomaiya D, Gyamfi J, Iwelunmor J, Opeyemi J, Oluwasanmi M, Obiezu-Umeh C, Dalton M, Nwaozuru U, Ojo T, Vieira D, Ogedegbe G, Olopade C. Implementation of clean cookstove interventions and its effects on blood pressure in low-income and middle-income countries: systematic review. BMJ Open 2019; 9:e026517. [PMID: 31092656 PMCID: PMC6530298 DOI: 10.1136/bmjopen-2018-026517] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE A review of the implementation outcomes of clean cookstove use, and its effects on blood pressure (BP) in low-income and middle-income countries (LMICs). DESIGN Systematic review of studies that reported the effect of clean cookstove use on BP among women, and implementation science outcomes in LMICs. DATA SOURCES We searched PubMed, Embase, INSPEC, Scielo, Cochrane Library, Global Health and Web of Science PLUS. We conducted searches in November 2017 with a repeat in May 2018. We did not restrict article publication date. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included only studies conducted in LMICs, published in English, regardless of publication year and studies that examined the use of improved or clean cookstove intervention on BP. Two authors independently screened journal article titles, abstracts and full-text articles to identify those that included the following search terms: high BP, hypertension and or household air pollution, LMICs, cookstove and implementation outcomes. RESULTS Of the 461 non-duplicate articles identified, three randomised controlled trials (RCTs) (in Nigeria, Guatemala and Ghana) and two studies of pre-post design (in Bolivia and Nicaragua) met eligibility criteria. These articles evaluated the effect of cookstove use on BP in women. Two of the three RCTs reported a mean reduction in diastolic BP of -2.8 mm Hg (-5.0, -0.6; p=0.01) for the Nigerian study; -3.0 mm Hg; (-5.7, -0.4; p=0.02) for the Guatemalan study; while the study conducted in Ghana reported a non-significant change in BP. The pre-post studies reported a significant reduction in mean systolic BP of -5.5 mm Hg; (p=0.01) for the Bolivian study, and -5.9 mm Hg (-11.3, -0.4; p=0.05) for the Nicaraguan study. Implementation science outcomes were reported in all five studies (three reported feasibility, one reported adoption and one reported feasibility and adoption of cookstove interventions). CONCLUSION Although this review demonstrated that there is limited evidence on the implementation of clean cookstove use in LMICs, the effects of clean cookstove on BP were significant for both systolic and diastolic BP among women. Future studies should consider standardised reporting of implementation outcomes.
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Affiliation(s)
- Deborah Onakomaiya
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Joyce Gyamfi
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Juliet Iwelunmor
- Behavioral Science and Health Education, Saint Louis University College for Public Health and Social Justice, Saint Louis, Missouri, USA
| | - Jumoke Opeyemi
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Mofetoluwa Oluwasanmi
- Behavioral Science and Health Education, Saint Louis University College for Public Health and Social Justice, Saint Louis, Missouri, USA
| | - Chisom Obiezu-Umeh
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Milena Dalton
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Ucheoma Nwaozuru
- Behavioral Science and Health Education, Saint Louis University College for Public Health and Social Justice, Saint Louis, Missouri, USA
| | - Temitope Ojo
- College of Global Health, New York University, New York City, New York, USA
| | - Dorice Vieira
- College of Global Health, New York University, New York City, New York, USA
- NYU Health Science Library, NYU School of Medicine, New York City, New York, USA
| | - Gbenga Ogedegbe
- Population Health, NYU Langone Health, New York City, New York, USA
| | - Christopher Olopade
- Center for Global Health, University of Chicago, Chicago, Illinois, USA
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
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57
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A Cost-Effective Air Quality Supervision Solution for Enhanced Living Environments through the Internet of Things. ELECTRONICS 2019. [DOI: 10.3390/electronics8020170] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We spend about 90% of our lives in indoor living environments. Thus, it is essential to provide indoor air quality monitoring for enhanced living environments. Advances in networking, sensors, and embedded devices have made monitoring and supply of assistance possible to people in their homes. Technological advancements have made possible the building of smart devices with significant capabilities for sensing and connecting, but also provide several improvements in ambient assisted living system architectures. Indoor air quality assumes an important role in building productive and healthy indoor environments. In this paper, the authors present an Internet of Things system for real-time indoor air quality monitoring named iAir. This system is composed by an ESP8266 as the communication and processing unit and a MICS-6814 sensor as the sensing unit. The MICS-6814 is a metal oxide semiconductor sensor capable of detecting several gases such as carbon monoxide, nitrogen dioxide, ethanol, methane, and propane. The iAir system also provides a smartphone application for data consulting and real-time notifications. Compared to other solutions, the iAir system is based on open-source technologies and operates as a totally Wi-Fi system, with several advantages such as its modularity, scalability, low cost, and easy installation. The results obtained are very promising, representing a meaningful contribution for enhanced living environments as iAir provides real-time monitoring for enhanced ambient assisted living and occupational health.
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Thakur M, Nuyts PAW, Boudewijns EA, Flores Kim J, Faber T, Babu GR, van Schayck OCP, Been JV. Impact of improved cookstoves on women's and child health in low and middle income countries: a systematic review and meta-analysis. Thorax 2018; 73:1026-1040. [PMID: 29925674 DOI: 10.1136/thoraxjnl-2017-210952] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 05/07/2018] [Accepted: 05/28/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Improved biomass cookstoves may help reduce the substantial global burden of morbidity and mortality due to household air pollution (HAP) that disproportionately affects women and children in low and middle income countries (LMICs). DESIGN Systematic review and meta-analysis of (quasi-)experimental studies identified from 13 electronic databases (last update: 6 April 2018), reference and citation searches and via expert consultation. SETTING LMICs PARTICIPANTS: Women and children INTERVENTIONS: Improved biomass cookstoves MAIN OUTCOME MEASURES: Low birth weight (LBW), preterm birth, perinatal mortality, paediatric acute respiratory infections (ARIs) and COPD among women. RESULTS We identified 53 eligible studies, including 24 that met prespecified design criteria. Improved cookstoves had no demonstrable impact on paediatric lower ARIs (three studies; 11 560 children; incidence rate ratio (IRR)=1.02 (95% CI 0.84 to 1.24)), severe pneumonia (two studies; 11 061 children; IRR=0.88 (95% CI 0.39 to 2.01)), LBW (one study; 174 babies; OR=0.74 (95% CI 0.33 to 1.66)) or miscarriages, stillbirths and infant mortality (one study; 1176 babies; risk ratio (RR) change=15% (95% CI -13 to 43)). No (quasi-)experimental studies assessed preterm birth or COPD. In observational studies, improved cookstoves were associated with a significant reduction in COPD among women: two studies, 9757 participants; RR=0.74 (95% CI 0.61 to 0.90). Reductions in cough (four studies, 1779 participants; RR=0.72 (95% CI 0.60 to 0.87)), phlegm (four studies, 1779 participants; RR=0.65 (95% CI 0.52 to 0.80)), wheezing/breathing difficulty (four studies; 1779 participants; RR=0.41 (95% CI 0.29 to 0.59)) and conjunctivitis (three studies, 892 participants; RR=0.58 (95% CI 0.43 to 0.78)) were observed among women. CONCLUSION Improved cookstoves provide respiratory and ocular symptom reduction and may reduce COPD risk among women, but had no demonstrable child health impact. REGISTRATION PROSPERO: CRD42016033075.
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Affiliation(s)
- Megha Thakur
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Public Health Foundation of India, Indian Institute of Public Health-Hyderabad, Bangalore, India
| | - Paulien A W Nuyts
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Esther A Boudewijns
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Javier Flores Kim
- Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Timor Faber
- Division of Neonatology, Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Giridhara R Babu
- Public Health Foundation of India, Indian Institute of Public Health-Hyderabad, Bangalore, India
| | - Onno C P van Schayck
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Jasper V Been
- Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.,Division of Neonatology, Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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59
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Meier BM, Das I, Jagger P. A 'burning opportunity' for human rights: using human rights as a catalyst for policies to mitigate the health risk of household air pollution. JOURNAL OF HUMAN RIGHTS AND THE ENVIRONMENT 2018; 9:89-106. [PMID: 30467559 PMCID: PMC6241317 DOI: 10.4337/jhre.2018.01.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
With over 3 billion people dependent on traditional cooking and heating technologies, efforts to address the health burden of exposure to household air pollution (HAP), as well as other sociodemographic impacts associated with energy poverty, are central to sustainable development objectives. Yet despite overwhelming scientific consensus on the health burden of HAP exposure, particularly harms to impoverished women and children in developing countries, advocates currently lack a human rights framework to mitigate HAP exposure through improved access to cleaner household energy systems. This article examines the role of human rights in framing state obligations to mitigate HAP exposure, supporting environmental health for the most vulnerable through intersectional obligations across the human right to health, the collective right to development, and women's and children's rights. Drawing from human rights advocacy employed in confronting the public health harms of tobacco, we argue that rights-based civil society advocacy can structure the multi-sectoral policies necessary to address the impacts of HAP exposure and energy poverty, facilitating accountability for human rights implementation through international treaty bodies, national judicial challenges and local political advocacy. We conclude that there is a pressing need to build civil society capacity for a rights-based approach to cleaner household energy policy as a means to alleviate the environmental health effects of energy poverty.
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Affiliation(s)
| | - Ipsita Das
- University of North Carolina at Chapel Hill, USA
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60
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Landrigan PJ, Fuller R, Acosta NJR, Adeyi O, Arnold R, Basu NN, Baldé AB, Bertollini R, Bose-O'Reilly S, Boufford JI, Breysse PN, Chiles T, Mahidol C, Coll-Seck AM, Cropper ML, Fobil J, Fuster V, Greenstone M, Haines A, Hanrahan D, Hunter D, Khare M, Krupnick A, Lanphear B, Lohani B, Martin K, Mathiasen KV, McTeer MA, Murray CJL, Ndahimananjara JD, Perera F, Potočnik J, Preker AS, Ramesh J, Rockström J, Salinas C, Samson LD, Sandilya K, Sly PD, Smith KR, Steiner A, Stewart RB, Suk WA, van Schayck OCP, Yadama GN, Yumkella K, Zhong M. The Lancet Commission on pollution and health. Lancet 2018; 391:462-512. [PMID: 29056410 DOI: 10.1016/s0140-6736(17)32345-0] [Citation(s) in RCA: 1660] [Impact Index Per Article: 276.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 05/09/2017] [Accepted: 08/02/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Philip J Landrigan
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | | | - Olusoji Adeyi
- Department of Health, Nutrition, and Population Global Practice, The World Bank, Washington, DC, USA
| | - Robert Arnold
- Department of Chemical and Environmental Engineering, University of Arizona, Tucson, AZ, USA
| | - Niladri Nil Basu
- Faculty of Agricultural and Environmental Sciences, McGill University, Montreal, Canada
| | | | - Roberto Bertollini
- Scientific Committee on Health, Environmental and Emerging Risks of the European Commission, Luxembourg City, Luxembourg; Office of the Minister of Health, Ministry of Public Health, Doha, Qatar
| | - Stephan Bose-O'Reilly
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of LMU Munich, Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | | | - Patrick N Breysse
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas Chiles
- Department of Biology, Boston College, Chestnut Hill, MA, USA
| | | | | | - Maureen L Cropper
- Department of Economics, University of Maryland, College Park, MD, USA; Resources for the Future, Washington, DC, USA
| | - Julius Fobil
- Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Valentin Fuster
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | | | - Andy Haines
- Department of Social and Environmental Health Research and Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - David Hunter
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mukesh Khare
- Department of Civil Engineering, Indian Institute of Technology, Delhi, India
| | | | - Bruce Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Bindu Lohani
- Centennial Group, Washington, DC, USA; The Resources Center, Lalitpur, Nepal
| | - Keith Martin
- Consortium of Universities for Global Health, Washington, DC, USA
| | - Karen V Mathiasen
- Office of the US Executive Director, The World Bank, Washington, DC, USA
| | | | | | | | - Frederica Perera
- Columbia Center for Children's Environmental Health, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Janez Potočnik
- UN International Resource Panel, Paris, France; SYSTEMIQ, London, UK
| | - Alexander S Preker
- Department of Environmental Medicine and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, USA; Health Investment & Financing Corporation, New York, NY, USA
| | | | - Johan Rockström
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | | | - Leona D Samson
- Department of Biological Engineering and Department of Biology, Center for Environmental Health Sciences, Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Kirk R Smith
- Environmental Health Sciences Division, School of Public Health, University of California, Berkeley, CA, USA
| | - Achim Steiner
- Oxford Martin School, University of Oxford, Oxford, UK
| | - Richard B Stewart
- Guarini Center on Environmental, Energy, and Land Use Law, New York University, New York, NY, USA
| | - William A Suk
- Division of Extramural Research and Training, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Onno C P van Schayck
- Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Gautam N Yadama
- School of Social Work, Boston College, Chestnut Hill, MA, USA
| | - Kandeh Yumkella
- United Nations Industrial Development Organization, Vienna, Austria
| | - Ma Zhong
- School of Environment and Natural Resources, Renmin University of China, Beijing, China
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van Gemert FA, Kirenga BJ, Gebremariam TH, Nyale G, de Jong C, van der Molen T. The complications of treating chronic obstructive pulmonary disease in low income countries of sub-Saharan Africa. Expert Rev Respir Med 2018; 12:227-237. [PMID: 29298106 DOI: 10.1080/17476348.2018.1423964] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION In most low and middle-income countries, chronic obstructive pulmonary disease (COPD) is on the rise. Areas covered: Unfortunately, COPD is a neglected disease in these countries. Taking sub-Saharan Africa as an example, in rural areas, COPD is even unknown regarding public awareness and public health planning. Programs for the management of COPD are poorly developed, and the quality of care is often of a low standard. Inhaled medication is often not available or not affordable. Tobacco smoking is the most common encountered risk factor for COPD. However, in sub-Saharan Africa, household air pollution is another major risk factor for the development of COPD. Communities are also exposed to a variety of other risk factors, such as low birth weight, malnutrition, severe childhood respiratory infections, occupational exposures, outdoor pollution, human-immunodeficiency virus and tuberculosis. All these factors contribute to the high burden of poor respiratory health in sub-Saharan Africa. Expert commentary: A silent growing epidemic of COPD seems to be unravelling. Therefore, prevention and intervention programs must involve all the stakeholders and start as early as possible. More research is needed to describe, define and inform treatment approaches, and natural history of biomass-related COPD.
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Affiliation(s)
- Frederik A van Gemert
- a Groningen Research Institute for asthma and COPD (GRIAC) , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.,b Makerere University Lung Institute (MLI), Mulago Hospital , Kampala , Uganda
| | - Bruce J Kirenga
- a Groningen Research Institute for asthma and COPD (GRIAC) , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.,b Makerere University Lung Institute (MLI), Mulago Hospital , Kampala , Uganda.,c Department of Medicine , Makerere University , Kampala , Uganda
| | - Tewodros Haile Gebremariam
- d Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine , Addis Ababa University, College of Health Science , Addis Ababa , Ethiopia
| | - George Nyale
- e Respiratory and Infectious Disease Unit , Kenyatta National Referral & Teaching Hospital , Nairobi , Kenya.,f Kenya Association of Physicians for Tuberculosis and other Lung Disease (KAPTLD) , Nairobi , Kenya
| | - Corina de Jong
- a Groningen Research Institute for asthma and COPD (GRIAC) , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Thys van der Molen
- a Groningen Research Institute for asthma and COPD (GRIAC) , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.,b Makerere University Lung Institute (MLI), Mulago Hospital , Kampala , Uganda
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Kianmehr M, Hajavi J, Gazeri J. Assessment of DNA damage in blood lymphocytes of bakery workers by comet assay. Toxicol Ind Health 2017; 33:726-735. [PMID: 28862089 DOI: 10.1177/0748233717712408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The comet assay is widely used in screening and identification of genotoxic effects of different substances on people in either their working or living environment. Exposure to fuel smoke leads to DNA damage and ultimately different types of cancer. Using a comet assay, the present study aimed to assess peripheral blood lymphocyte DNA damage in people working in bakeries using natural gas, kerosene, diesel, or firewood for fuel compared to those in the control group. The subjects of this study were 55 people in total who were divided into four experimental groups, each of which comprised of 11 members (based on the type of fuel used), and one control group comprised of 11 members. Using CometScore, the subjects' peripheral blood lymphocytes were examined for DNA damage. All bakers, that is, experimental subjects, showed significantly greater peripheral blood lymphocyte DNA damage compared to the individuals in the control group. There was greater peripheral blood lymphocyte DNA damage in bakers who had been using firewood for fuel compared to those using other types of fuel to such an extent that tail moments (µm) for firewood-burning bakers was 4.40 ± 1.98 versus 1.35 ± 0.84 for natural gas, 1.85 ± 1.33 for diesel, and 2.19 ± 2.20 for kerosene. The results indicated that burning firewood is the greatest inducer of peripheral blood lymphocytes DNA damage in bakers. Nonetheless, there was no significant difference in peripheral blood lymphocyte DNA damage among diesel and kerosene burning bakers.
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Affiliation(s)
- Mojtaba Kianmehr
- 1 Department of Medical Physics, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Jafar Hajavi
- 2 Department of Basic Sciences, Faculty of Allied Medicine, Gonabad University of Medical Sciences, Gonabad, Iran.,3 Immunology Research Center, Medical School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Gazeri
- 4 Department of Humanities, University of Gonabad, Gonabad, Iran
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Nakao M, Yamauchi K, Ishihara Y, Omori H, Ichinnorov D, Solongo B. Effects of air pollution and seasons on health-related quality of life of Mongolian adults living in Ulaanbaatar: cross-sectional studies. BMC Public Health 2017. [PMID: 28645332 PMCID: PMC5481926 DOI: 10.1186/s12889-017-4507-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Ulaanbaatar, Mongolia, is known as severely air-polluted city in the world due to increased coal consumption in the cold season. The health effects of air pollution in Mongolia such as mortality, morbidity and symptoms have been previously reported. However, the concept of health-related quality of life (HR-QoL), which refers to the individual’s perception of well-being, should also be included as an adverse health outcome of air pollution. Methods Surveys on the Mongolian people living in Ulaanbaatar were performed in the warm and cold seasons. Self-completed questionnaires on the subjects’ HR-QoL, data from health checkups and pulmonary function tests by respiratory specialists were collected for Mongolian adults aged 40–79 years (n = 666). Ambient PM2.5 and PM10 were concurrently sampled and the components were analyzed to estimate the source of air pollution. Results In logistic regression analyses, respiratory symptoms and smoke-rich fuels were associated with reduced HR-QoL (> 50th percentile vs. ≤ 50th percentile). PM 2.5 levels were much higher in the cold season (median 86.4 μg/m3 (IQR: 58.7–121.0)) than in the warm season (12.2 μg/m3 (8.9–21.2). The receptor model revealed that the high PM2.5 concentration in the cold season could be attributed to solid fuel combustion. The difference in HR-QoL between subjects with and without ventilatory impairment was assessed after the stratification of the subjects by season and household fuel type. There were no significant differences in HR-QoL between subjects with and without ventilatory impairment regardless of household fuel type in the warm season. In contrast, subjects with ventilatory impairment who used smoke-rich fuel in the cold season had a significantly lower HR-QoL. Conclusions Our study showed that air pollution in Ulaanbaatar worsened in the cold season and was estimated to be contributed by solid fuel combustion. Various aspects of HR-QoL in subjects with ventilatory impairment using smoke-rich fuels deteriorated only in the cold season while those with normal lung function did not. These results suggest that countermeasures or interventions by the policymakers to reduce coal usage would improve HR-QoL of the residents of Ulaanbaatar, especially for those with ventilatory impairment in the winter months. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4507-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Motoyuki Nakao
- Department of Public Health, School of Medicine, Kurume University, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Keiko Yamauchi
- Department of Public Health, School of Medicine, Kurume University, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Yoko Ishihara
- Department of Public Health, School of Medicine, Kurume University, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan.
| | - Hisamitsu Omori
- Department of Biomedical Laboratory Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Dashtseren Ichinnorov
- Department of Respiratory Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Bandi Solongo
- Department of Respiratory Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
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Quansah R, Semple S, Ochieng CA, Juvekar S, Armah FA, Luginaah I, Emina J. Effectiveness of interventions to reduce household air pollution and/or improve health in homes using solid fuel in low-and-middle income countries: A systematic review and meta-analysis. ENVIRONMENT INTERNATIONAL 2017; 103:73-90. [PMID: 28341576 DOI: 10.1016/j.envint.2017.03.010] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 03/12/2017] [Accepted: 03/14/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Cookstove intervention programs have been increasing over the past two (2) decades in Low and Middle Income Countries (LMICs) across the globe. However, there remains uncertainty regarding the effects of these interventions on household air pollution concentrations, personal exposure concentrations and health outcomes. OBJECTIVES The primary objective was to determine if household air pollution (HAP) interventions were associated with improved indoor air quality (IAQ) in households in LMICs. Given the potential impact of HAP interventions on health, a secondary objective was to evaluate the effectiveness of HAP interventions to improve health in populations receiving these interventions. DATA SOURCES OVID Medline, Ovid Embase, SCOPUS and PubMED were searched from their inception until December 2015 with no restrictions on study design. The WHO Global database of household air pollution measurements and Members' archives were also reviewed together with the reference lists of identified reviews and relevant articles. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTION We considered randomized controlled trials, or non-randomized control trials, or before-and-after studies; original studies; studies conducted in a LMIC (based on the United Nations Human Development Report released in March 2013 (World Bank, 2013); interventions that were explicitly aimed at improving IAQ and/or health from solid fuel use; studies published in a peer-reviewed journal or student theses or reports; studies that reported on outcomes which was indicative of IAQ or/and health. There was no restriction on the type of comparator (e.g. household receiving plancha vs. household using traditional cookstove) used in the intervention study. STUDY APPRAISAL AND SYNTHESIS METHODS Five review authors independently used pre-designed data collection forms to extract information from the original studies and assessed risk of bias using the Effective Public Health Practice Project (EPHPP). We computed standardized weighted mean difference (SMD) using random-effects models. Heterogeneity was computed using the Q and I2-statistics. We examined the influence of various characteristics on the study-specific effect estimates by stratifying the analysis by population type, study design, intervention type, and duration of exposure monitoring. The trim and fill method was used to assess the potential impact of missing studies. RESULTS Fifty-five studies met our a priori inclusion criteria and were included in the systematic review. Fifteen studies provided 43 effect estimates for our meta-analysis. The largest improvement in HAP was observed for average particulate matter (PM) (SMD=1.57) concentrations in household kitchens (1.03), followed by daily personal average concentrations of PM (1.18), and carbon monoxide (CO) concentrations in kitchens. With respect to personal PM, significant improvement was observed in studies of children (1.26) and studies monitoring PM for ≥24h (1.32). This observation was also noted in terms of studies of kitchen concentrations of CO. A significant improvement was also observed for kitchen levels of PM in both adult populations (1.56) and in RCT/cohort designs (1.59) involving replacing cookstoves without chimneys. Our findings on health outcomes were inconclusive. LIMITATIONS, CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS We observed high statistical between study variability in the study-specific estimate. Thus, care should be taken in concluding that HAP interventions - as currently designed and implemented - support reductions in the average kitchen and personal levels of PM and CO. Further, there is limited evidence that current stand-alone HAP interventions yield any health benefits. Post-intervention levels of pollutants were generally still greatly in excess of the relevant WHO guideline and thus a need to promote cleaner fuels in LMICs to reduce HAP levels below the WHO guidelines. SYSTEMATIC REVIEW REGISTRATION NUMBER The review has been registered with PROSPERO (registration number CRD42014009768).
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Affiliation(s)
- Reginald Quansah
- Biological, Environmental & Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana; Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
| | - Sean Semple
- Respiratory Intervention Group, Institute of Applied Health Science, University of Aberdeen, Aberdeen, Scotland
| | | | - Sanjar Juvekar
- KEM Hospital Research Centre, Pune, India; INDEPTH Network, Accra, Ghana
| | | | - Isaac Luginaah
- Department of Geography, Western University, Ontario, Canada
| | - Jacques Emina
- INDEPTH Network, Accra, Ghana; Department of Population and Development Studies, University of Kinshasa, Kinshasa, People's Republic of Congo
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Abdalla S, Abdel Aziz M, Basheir I. Association of sociodemographic and household characteristics with non-fatal burns among children under the age of 10 years in Sudan: an exploratory secondary analysis of the Sudan Household Health Survey 2010. Inj Prev 2017; 23:377-382. [DOI: 10.1136/injuryprev-2016-042208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/06/2016] [Accepted: 01/18/2017] [Indexed: 11/04/2022]
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Islami F, Torre LA, Drope JM, Ward EM, Jemal A. Global Cancer in Women: Cancer Control Priorities. Cancer Epidemiol Biomarkers Prev 2017; 26:458-470. [PMID: 28183824 DOI: 10.1158/1055-9965.epi-16-0871] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/08/2016] [Indexed: 11/16/2022] Open
Abstract
This review is an abbreviated version of a report prepared for the American Cancer Society Global Health department and EMD Serono, Inc., a subsidiary of Merck KGaA, Darmstadt, Germany, which was released at the Union for International Cancer Control World Cancer Congress in Paris in November 2016. The original report can be found at https://www.cancer.org/health-care-professionals/our-global-health-work/global-cancer-burden/global-burden-of-cancer-in-women.html. Staff in the Intramural Research Department of the American Cancer Society designed and conducted the study, including analysis, interpretation, and presentation of the review. The funding sources had no involvement in the study design, data analysis and interpretation, or preparation of the reviewThe global burden of cancer in women has recently received much attention, but there are few comprehensive reviews of the burden and policy approaches to reduce it. This article, second in series of two, summarizes the most important cancer control priorities with specific examples of proven interventions, with a particular focus on primary prevention in low- and middle-income countries (LMIC). There are a number of effective cancer control measures available to countries of all resource levels. Many of these measures are extremely cost-effective, especially in the case of tobacco control and vaccination. Countries must prioritize efforts to reduce known cancer risk factors and make prevention accessible to all. Effective treatments and palliative care are also needed for those who develop cancer. Given scarce resources, this may seem infeasible in many LMICs, but past experience with other diseases like HIV, tuberculosis, and malaria have shown that it is possible to make affordable care accessible to all. Expansion of population-based cancer registries and research in LMICs are needed for setting cancer control priorities and for determining the most effective interventions. For LMICs, all of these activities require support and commitment from the global community. Cancer Epidemiol Biomarkers Prev; 26(4); 458-70. ©2017 AACRSee related article by Torre et al. in this CEBP Focus section, "Global Cancer in Women."
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Affiliation(s)
- Farhad Islami
- Intramural Research, American Cancer Society, Atlanta, Georgia.
| | - Lindsey A Torre
- Intramural Research, American Cancer Society, Atlanta, Georgia
| | - Jeffrey M Drope
- Intramural Research, American Cancer Society, Atlanta, Georgia
| | | | - Ahmedin Jemal
- Intramural Research, American Cancer Society, Atlanta, Georgia
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Amegah AK, Näyhä S, Jaakkola JJK. Do biomass fuel use and consumption of unsafe water mediate educational inequalities in stillbirth risk? An analysis of the 2007 Ghana Maternal Health Survey. BMJ Open 2017; 7:e012348. [PMID: 28174221 PMCID: PMC5306511 DOI: 10.1136/bmjopen-2016-012348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Numerous studies have explored the association between educational inequalities and stillbirth but most have failed to elaborate how low educational attainment leads to an increased risk of stillbirth. We hypothesised that use of biomass fuels and consumption of unsafe water related to low educational attainment could explain the stillbirth burden in Ghana attributable to socioeconomic disadvantage. METHODS Data from the 2007 Ghana Maternal Health Survey, a nationally representative population-based survey were analysed for this study. Of the10 370 women aged 15-49 years interviewed via structured questionnaires for the survey, 7183 primiparous and multiparous women qualified for inclusion in the present study. RESULTS In a logistic regression analysis that adjusted for age, area of residence, marital status and ethnicity of women, lower maternal primary education was associated with a 62% (OR=1.62; 95% CI 1.04 to 2.52) increased lifetime risk of stillbirth. Biomass fuel use and consumption of unsafe water mediated 18% and 8% of the observed effects, respectively. Jointly these two exposures explained 24% of the observed effects. The generalised additive modelling revealed a very flat inverted spoon-shaped smoothed curve which peaked at low levels of schooling (2-3 years) and confirms the findings from the logistic regression analysis. CONCLUSIONS Our results show that biomass fuel use and unsafe water consumption could be important pathways through which low maternal educational attainment leads to stillbirths in Ghana and similar developing countries. Addressing educational inequalities in developing countries is thus essential for ensuring household choices that curtail environmental exposures and help improve pregnancy outcomes.
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Affiliation(s)
- A Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Simo Näyhä
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
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Abstract
Household air pollution is a leading cause of disability-adjusted life years in Southeast Asia and the third leading cause of disability-adjusted life years globally. There are at least sixty sources of household air pollution, and these vary from country to country. Indoor tobacco smoking, construction material used in building houses, fuel used for cooking, heating and lighting, use of incense and various forms of mosquito repellents, use of pesticides and chemicals used for cleaning at home, and use of artificial fragrances are some of the various sources that contribute to household air pollution. Household air pollution affects all stages of life with multi-systemic health effects, and its effects are evident right from pre-conception to old age.
In utero exposure to household air pollutants has been shown to have health effects which resonate over the entire lifetime. Exposures to indoor air pollutants in early childhood also tend to have repercussions throughout life. The respiratory system bears the maximum brunt, but effects on the cardiovascular system, endocrine system, and nervous system are largely underplayed. Household air pollutants have also been implicated in the development of various types of cancers. Identifying household air pollutants and their health implications helps us prepare for various health-related issues. However, the real challenge is adopting changes to reduce the health effects of household air pollution and designing innovative interventions to minimize the risk of further exposure. This review is an attempt to understand the various sources of household air pollution, the effects on health, and strategies to deal with this emergent risk factor of global mortality and morbidity.
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Affiliation(s)
| | - Sundeep Salvi
- Chest Research Foundation, Kalyaninagar, Pune, India
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