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Household polluting cooking fuels and adverse birth outcomes: An updated systematic review and meta-analysis. Front Public Health 2023; 11:978556. [PMID: 36935726 PMCID: PMC10020710 DOI: 10.3389/fpubh.2023.978556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Background and aim The current study aimed to clarify the association between household polluting cooking fuels and adverse birth outcomes using previously published articles. Methods In this systematic review and meta-analysis, a systematic literature search in PubMed, Embase, Web of Science, and Scopus databases were undertaken for relevant studies that had been published from inception to 16 January 2023. We calculated the overall odds ratio (OR) and 95% confidence interval (CI) for adverse birth outcomes [low birth weight (LBW), small for gestational age (SGA), stillbirth, and preterm birth (PTB)] associated with polluting cooking fuels (biomass, coal, and kerosene). Subgroup analysis and meta-regression were also conducted. Results We included 16 cross-sectional, five case-control, and 11 cohort studies in the review. Polluting cooking fuels were found to be associated with LBW (OR: 1.37, 95% CI: 1.24, 1.52), SGA (OR: 1.48, 95% CI: 1.13, 1.94), stillbirth (OR: 1.38, 95% CI: 1.23, 1.55), and PTB (OR: 1.27, 95% CI: 1.19, 1.36). The results of most of the subgroup analyses were consistent with the main results. In the meta-regression of LBW, study design (cohort study: P < 0.01; cross-sectional study: P < 0.01) and sample size (≥ 1000: P < 0.01) were the covariates associated with heterogeneity. Cooking fuel types (mixed fuel: P < 0.05) were the potentially heterogeneous source in the SGA analysis. Conclusion The use of household polluting cooking fuels could be associated with LBW, SGA, stillbirth, and PTB. The limited literature, observational study design, exposure and outcome assessment, and residual confounding suggest that further strong epidemiological evidence with improved and standardized data was required to assess health risks from particular fuels and technologies utilized.
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The psychological status mediates the effect of indoor air pollution on recurrent spontaneous abortion. ENVIRONMENTAL RESEARCH 2022; 215:114220. [PMID: 36049508 DOI: 10.1016/j.envres.2022.114220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/30/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Indoor air pollution (IAP) exposure and psychological status have been recognized as important risk factors for adverse pregnancy outcomes, but their mediating effects on recurrent spontaneous abortion (RSA) have not been analyzed. Therefore, the purpose of this study is to explore the association between IAP and RSA and to examine the mediating effect of psychological status on their association. METHODS This study included 830 RSA cases and 2156 controls in Gansu province, China. The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) questionnaires were used to collect information on participants' psychological status. The IAP exposure was collected by the survey on cooking fuel use, kitchen ventilation characteristics, cooking styles, and indoor smoking, etc. Multivariable logistic regression was used to examine the associations between IAP exposure and RSA. The mediation analysis was used to evaluate the mediation effects of IAP and psychological status on RSA while controlling for confounding. RESULTS Among these cases, 16.87% cooked with unclean cooking fuel (UCF) and 37.00% lacked cooking ventilation, which was much higher than the controls. Active smoking and the use of UCF were associated with RSA, with an odds ratio (OR) of 3.374 [95% confidence interval (CI): 1.510-7.541] and 1.822 (95% CI: 1.328-2.500), respectively. We found that the use of a range hood was a protective factor for RSA, with an OR of 0.590 (95% CI: 0.463-0.752). There was a significant mediation effect of depression on the association between IAP and RSA, which accounted for 5.61%-9.22% of the total effect of IAP on RSA. CONCLUSION The IAP may be an important risk factor for RSA, which may be intensified by the poor psychological status, and the use of ventilation equipment when cooking is a protective factor for RSA.
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Biomass fuel use and birth weight among term births in Nigeria. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000419. [PMID: 36962417 PMCID: PMC10022098 DOI: 10.1371/journal.pgph.0000419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/22/2022] [Indexed: 11/18/2022]
Abstract
Despite the high burden of household air pollution from biomass fuel in sub-Saharan Africa, the association of prenatal biomass fuel exposure and birth weight as a continuous variable among term births has not been extensively studied. In this study, our primary aim is to estimate the association between biomass cooking fuel and birth weight among term births in Kaduna, northwestern Nigeria. For replication, we also evaluated this association in a larger and nationally representative sample from the 2018 Nigerian Demographic and Health Survey (DHS). Our primary analysis included 1,514 mother-child pairs recruited from Kaduna, in northwestern Nigeria, using the Child Electronic Growth Monitoring System (CEGROMS). Replication analysis was conducted using data from 6,975 mother-child pairs enrolled in 2018 Nigerian DHS. The outcome variable was birth weight, and the exposure was cooking fuel type, categorized in CEGROMS as liquefied petroleum gas, kerosene, or biomass fuel, and in the DHS as low pollution fuel, kerosene, or biomass fuel. We estimated covariate adjusted associations between birth weight and biomass fuel exposure in CEGROMS using linear regression and using linear mixed model in the DHS. In CEGROMS, adjusting for maternal age, education, parity, BMI at birth, and child sex, mothers exposed to biomass fuel gave birth to infants who were on average 113g lighter (95% CI -196 to -29), than those using liquified petroleum gas. In the 2018 Nigeria DHS data, compared to low pollution fuel users, mothers using biomass had infants weighing 50g (95% CI -103 to 2) lower at birth. Exposure to biomass cooking fuel was associated with lower birth weight in our study of term newborns in Kaduna, Nigeria. Data from the nationally representative DHS provide some support for these findings.
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Adverse birth outcomes associated with household air pollution from unclean cooking fuels in low- and middle-income countries: A systematic review. ENVIRONMENTAL RESEARCH 2022; 204:112274. [PMID: 34710435 DOI: 10.1016/j.envres.2021.112274] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/08/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
Approximately 3.8 billion people in low- and middle-income countries use unclean fuels as a source of primary cooking fuel as well as for heating. For pregnant women, the toxic chemicals produced by combustion of unclean fuels not only affect women's health directly, but particulate matter and carbon monoxide are absorbed in maternal blood and cross the placental barrier impairing fetal tissue growth. PRISMA 2009 guidelines were used for this systematic review. The inclusion criteria were quantitative, peer reviewed journal articles published within a date range of May 1, 2013-June 12, 2021 examining birth outcomes related to household air pollution from type of cooking fuel in low- and middle-income countries. The quality of available evidence was evaluated using the Office of Health Assessment and Translation (OHAT) risk of bias rating tool. Of the 553 studies screened, 23 satisfied the inclusion criteria. Of the studies that met the inclusion criteria, 14 were cross-sectional, 5 cohort, 1 case-control and 3 randomized control trials conducted across 15 different countries. A range of birth outcomes are reported across studies including birthweight (19), small for gestational age (6), spontaneous abortion (3), preterm birth (6), stillbirth (7) and neonatal mortality (6). The reviewed studies presented evidence for an increased risk of low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA), stillbirth, neonatal mortality and reduction in birthweight with solid fuel and kerosene use compared to cleaner fuels like gas and LPG. Systematically reviewing the evidence and risk of bias ratings illuminated several gaps in the current literature related to exposure assessment, outcome measurement and adequacy of adjustment for confounding.
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Maternal exposure to cooking smoke and risk of low birth weight in India. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 774:145717. [PMID: 33609837 DOI: 10.1016/j.scitotenv.2021.145717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/22/2021] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
Over half of the households in India are using unclean cooking fuels (UCF) and exposed to harmful pollutants that has adverse effects on weight of new born baby. Though studies examined the contextual determinants of birth weight, the association of cooking practices and kitchen location with low birth weight (LBW) is limited in India. This paper investigates the comprehensive effects of household air pollution (HAP) on LBW, mean birth weight (MBW) and birth size in India. Data from 93,721 full-term singleton births from the fourth round of National Family Health Survey, conducted during 2015-16 is used in the analyses. Binary logistic and linear regression methods were used to assess the effect of cooking practices on the outcome variables. Children born in households using clean cooking fuels (CCF) (2877 g, 95% CI: 2876-2877) had 80 g higher birth weight compared with UCF (2797 g, 95% CI: 2796-2798). Households using UCF and cooking without separate kitchen (2779 g, 95% CI:2778-2780) had 59 g and 98 g lower MBW as compared to the households using UCF and cooking in separate kitchen (2817 g, 95% CI:2816-2818) and CCF respectively. Significant associations of LBW observed with the place of cooking and cooking practices but no significant association found for cooking fuels. The HAP from poor cooking practices is associated with risks of LBW in India. Transition from unclean to clean fuels, provision of the separate kitchen should be encouraged to reduce the maternal exposure to HAP and improve birth outcomes.
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Understanding the association between gradient of cooking fuels and low birth weight in India. SSM Popul Health 2021; 13:100732. [PMID: 33511265 PMCID: PMC7815993 DOI: 10.1016/j.ssmph.2021.100732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/14/2020] [Accepted: 12/20/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Birth weight is positively associated with physical and cognitive development of children and adversely associated with the use of unclean cooking fuels. Though studies have examined the contextual determinants of birth weight, no attempt has been made to understand the association of gradient of cooking fuels with birth weight in India. The objective of this paper is to understand the association of type of cooking fuel with low birth weight in India. METHODS Unit data from the fourth round of the National Family Health Survey (NFHS) (2015-16), covering 8206 singleton births from four states of India, was used in the analysis. These states reported more than 80% of birth weights by way of health cards issued by a public authority. Linear regression analysis was used to estimate mean birth weight, adjusting for confounders. We computed a new wealth index, excluding electricity and cooking fuels, using principal component analysis to capture the economic gradient of cooking fuel. RESULTS Our results suggest a strong gradient of cooking fuels on mean birth weight. The adjusted mean birth weight in households using electricity was 2957 g (95% CI: 2939-2975). It was 2908 g (95% CI: 2907-2910) for LPG, 2792 g (95% CI: 2784-2801) for biogas, 2819 g (95% CI: 2809-2829) for kerosene, 2841 g (95% CI: 2816-2866) for coal/lignite/charcoal, and 2834 g (95% CI: 2831-2836) in households using biomass. A difference of 165 g in predicted mean birth weight was found among children born in households that used electricity in relation to those that used biogas. The difference in relation to kerosene, coal/lignite/charcoal, and biomass was 138 g, 116 g, and 123 g respectively. Significant differences in mean birth weight were also observed by wealth quintiles, mother's underweight, social groups, birth interval, and mother's anemia status. CONCLUSION Findings from the study suggest to strengthen the policies on access to clean fuels and meet the interconnected goals of sustainable development.
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Exposure assessment of indoor particulate matter during pregnancy: a narrative review of the literature. REVIEWS ON ENVIRONMENTAL HEALTH 2020; 35:427-442. [PMID: 32598324 DOI: 10.1515/reveh-2020-0009] [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: 01/31/2020] [Accepted: 05/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim of this review was to summarize the evidence of the exposure assessment approaches of indoor particulate matter (PM) during pregnancy and to recommend future focus areas. CONTENT Exposure to indoor PM during pregnancy is associated with adverse birth outcomes. However, many questions remain about the consistency of the findings and the magnitude of this effect. This may be due to the exposure assessment methods used and the challenges of characterizing exposure during pregnancy. Exposure is unlikely to remain constant over the nine-month period. Pregnant females' mobility and activities vary - for example, employment status may be random among females, but among those employed, activities are likely to be greater in the early pregnancy than closer to the delivery of the child. SUMMARY Forty three studies that used one of the five categories of indoor PM exposure assessment (self-reported, personal air monitoring, household air monitoring, exposure models and integrated approaches) were assessed. Our results indicate that each of these exposure assessment approaches has unique characteristics, strengths, and weaknesses. While questionnaires and interviews are based on self-report and recall, they were a major component in the reviewed exposure assessment studies. These studies predominantly used large sample sizes. Precision and detail were observed in studies that used integrated approaches (i. e. questionnaires, measurements and exposure models). OUTLOOK Given the limitations presented by these studies, exposure misclassification remains possible because of personal, within and between household variability, seasonal changes, and spatiotemporal variability during pregnancy. Therefore, using integrated approaches (i. e. questionnaire, measurements and exposure models) may provide better estimates of PM levels across trimesters. This may provide precision for exposure estimates in the exposure-response relationship.
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Effects of Air Pollution on the Risk of Low Birth Weight in a Cold Climate. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10186399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
There is accumulating evidence that prenatal exposure to air pollution disturbs fetal growth and development, but little is known about these effects in cold climates or their season-specific or joint effects. Our objective was to assess independent and joint effects of prenatal exposure to specific air pollutants on the risk of low birth weight (LBW). We utilized the 2568 children of the Espoo Cohort Study, born between 1984 and 1990 and living in the City of Espoo. We conducted stratified analyses for births during warm and cold seasons separately. We analyzed the effect estimates using multi-pollutant Poisson regression models with risk ratio (RR) as the measure of effect. The risk of LBW was related to exposure to CO (adjusted RR 1.44, 95% confidence interval [CI]: 1.04–2.00) and exposure to O3 in the spring–summer season (1.82, 1.11–2.96). There was also evidence of synergistic effects between CO and O3 (relative risk due to interaction (RERI), all year 1.08, 95% CI: 0.27–4.94, spring–summer 3.97, 2.17–25.85) and between PM2.5 and O3 (all year 0.72, −0.07–3.60, spring–summer 2.80, 1.36–19.88). We present new evidence of both independent and joint effects of prenatal exposure to low levels of air pollution in a cold climate on the risk of LBW.
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Association of adverse birth outcomes with exposure to fuel type use: A prospective cohort study in the northern region of Ghana. Heliyon 2020; 6:e04169. [PMID: 32551393 PMCID: PMC7287244 DOI: 10.1016/j.heliyon.2020.e04169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/30/2020] [Accepted: 06/05/2020] [Indexed: 11/28/2022] Open
Abstract
We aimed to investigate the potential associations between exposure to fuel types for cooking and birth outcomes in Northern Region of Ghana. Third trimester pregnant women were recruited during antenatal visit to the hospital and followed-up till delivery. Three questionnaires were administered covering baseline information, exposure to fuel types, and birth outcomes. Adjusting for potential confounding factors, log binomial regression model was applied to investigate the association between low birth weights (LBW), preterm birth and perinatal deaths in mothers and fuel types. Of the 1626 participants recruited at baseline, about 1323 women in the delivery period completed the study. At delivery period, maternal mean (SD) age was 27.3 (5.2) years. Mothers who used charcoal and firewood for cooking had 1.47 times (95% CI 1.04–2.05) and 1.18 times (95% CI 0.83–1.69) increased in risk of preterm birth respectively after controlling for potential confounding variables. Although, non-significant, mothers who used charcoal had 1.34 times (95% CI 0.45–3.97) increased risk in LBW, while those who used firewood had 1.23 times (95% CI 0.41–3.71) risk in LBW. Similarly, babies of mothers who used charcoal and those who used firewood respectively had 1.72 times (95% CI 0.52–5.65) and 1.70 times (95% CI 0.49–5.92) risk in small for gestational age after controlling for maternal BMI at first visit and anemia. Lastly, mothers who used charcoal and those who used firewood respectively had 1.87 times (95% CI 0.29–11.64) and 2.02 times (95% CI 0.31–13.04) increased risk in perinatal mortality after controlling for potential confounding variables. We observed a significant association between charcoal and preterm birth. Also, we observed a non-significant association between charcoal and firewood users and LBW, SGA and perinatal mortality respectively, compared to those using gas or electricity. This suggests cooking with charcoal and firewood could have health consequences on the outcome of pregnancy.
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Open fire ovens and effects of in-home lavash bread baking on carbon monoxide exposure and carboxyhemoglobin levels among women in rural Armenia. INDOOR AIR 2020; 30:361-369. [PMID: 31724228 PMCID: PMC9514389 DOI: 10.1111/ina.12623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/28/2019] [Accepted: 11/11/2019] [Indexed: 05/16/2023]
Abstract
Lavash is a traditional flatbread commonly baked at home by women in Armenia and other Middle Eastern and Caucasus countries. The baking process follows centuries' old recipes and is done primarily in open fire ovens. Data are limited regarding the impact of baking on indoor air quality and health outcomes. This study aimed at assessing the effects of lavash baking on household air pollution and cardiovascular outcomes among women who bake lavash in rural Armenia. A convenience sample of 98 bakers, all women, never-smokers, representing 36 households were enrolled. Carbon monoxide (CO) concentrations and carboxyhemoglobin (COHb) levels were monitored before, during, and/or after baking. As expected, exposure to concentrations of CO peaking at/or above 35-ppm during baking was more likely to occur in homes with fully enclosed and poorly ventilated baking rooms, compared to those with three or fewer walls and/or one or more windows. Bakers in homes where CO concentrations peaked at/or above 35-ppm were more likely to have an increase in post-baking COHb levels compared to those in homes with lower CO concentrations.
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Effects of Physical Activity During Pregnancy on Neonatal Birth Weight. Sci Rep 2019; 9:6000. [PMID: 30979921 PMCID: PMC6461641 DOI: 10.1038/s41598-019-42473-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/18/2019] [Indexed: 11/23/2022] Open
Abstract
We assessed the prevalence of adherence to the American College of Obstetricians and Gynecologists (ACOG) recommendations regarding physical activity during pregnancy among Sri Lankan women and explored the relationship between physical activity during pregnancy and neonatal birth weight. In total, 141 pregnant women (gestational age, 18–24 weeks) were included from October to December 2015 and followed up until delivery. A validated questionnaire regarding physical activity during pregnancy was administered in the second and third trimesters. Activities were grouped by type (household/caregiving, occupational, transportation, sports/exercise, and inactivity) and intensity {sedentary [<1.5 metabolic equivalents (METs)], light intensity [1.5–2.9 METs], moderate intensity [3.0–6.0 METs], and vigorous intensity [>6.0 METs]}. Women were categorised as active or inactive based on the ACOG recommendations. In total, 79.1% and 45.2% of women met the guidelines in the second and third trimesters, respectively. The overall time spent and total energy expenditure was significantly higher in the second trimester (p < 0.001). We found no relationship between physical activity during pregnancy and neonatal birth weight. This study indicates that a considerable reduction of time and total energy expenditure occur as pregnancy progresses. Physical activity during pregnancy does not appear to significantly affect neonatal birth weight.
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Household air pollution as an important factor in the complex relationship between altitude and COPD. Eur Respir J 2019; 53:53/2/1802454. [PMID: 30759422 DOI: 10.1183/13993003.02454-2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 01/09/2019] [Indexed: 11/05/2022]
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Association between prenatal exposure to cooking oil fumes and full-term low birth weight is mediated by placental weight. ENVIRONMENTAL RESEARCH 2018; 167:622-631. [PMID: 30172195 DOI: 10.1016/j.envres.2018.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Evidence regarding the association between prenatal exposure to cooking oil fumes (COF) and full-term low birth weight (FTLBW) is still controversial, and the mechanism remains unclear. This study thus aims to explore the association of prenatal COF exposure with off-spring FT-LBW as well as the mediating role of placenta in their association. METHODS A case-control study enrolling 266 pregnant women delivering FTLBW newborns (cases) and 1420 delivering normal birth weight (NBW) newborns (controls) was conducted. Information on prenatal COF exposure, socio-demographics, and obstetric conditions were collected at the Women's and Children's Hospitals of Shenzhen and Foshan in Guangdong, China. Linear and hierarchical logistic regression models were undertaken to explore the associations among COF exposure, placenta and birth weight, as well as the mediation effect of placental weight. RESULTS After controlling for potential confounders, prenatal COF exposure was significantly associated with the higher risk of FT-LBW (OR = 1.31, 95% CI= 1.06-1.63) and the lower placental weight (ß = -0.12, 95% CI= -0.23 ~ -0.005). Compared with mothers who never cooked, those cooking sometimes (OR= 2.99, 95% CI= 1.48-6.04) or often (OR= 3.41, 95% CI= 1.40-8.34) showed a higher risk of FT-LBW, and likewise, those cooking for less than half an hour (OR= 2.08, 95% CI= 1.14-3.79) or cooking between half to an hour (OR= 2.48, 95% CI= 1.44-4.29) were also more likely to exhibit FT-LBW. Different cooking methods including pan-frying (OR= 2.24, 95% CI= 1.30-3.85) or deep-frying (OR= 1.78, 95% CI= 1.12-2.85) during pregnancy were associated with increased FT-LBW risks as well. The further mediation analysis illustrated that placental weight mediated 15.96% (95% CI: 12.81~28.80%) and 15.90% (95% CI= 14.62%~16.66%) of the associations of cooking during pregnancy and frequency of prenatal COF exposure, respectively, with FT-LBW.
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Effects of Prenatal Tobacco and Wood-Fuel Smoke Exposure on Birth Weight in Sri Lanka. Healthcare (Basel) 2017; 5:healthcare5040064. [PMID: 28954431 PMCID: PMC5746698 DOI: 10.3390/healthcare5040064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/17/2017] [Accepted: 09/23/2017] [Indexed: 11/22/2022] Open
Abstract
Low birth weight is a key public health problem in many developing countries, including Sri Lanka. Indoor air pollution from tobacco smoke and kitchen-fuel smoke are among the major contributors to low birth weight, factors of which there are little awareness of in Sri Lanka. We evaluated the effect of passive smoking and kitchen-fuel smoke exposure on birth weight. Seventy-six pregnant women were included in the study. Data were collected by questionnaire, and exposure assessment was conducted using a breath carbon monoxide monitor. Women exposed to second-hand tobacco smoke daily had a significantly lower mean gestational age at delivery (mean ± standard error [SE]: 38.0 ± 0.5 weeks) than women who were exposed to second-hand tobacco smoke only once a week (mean ± SE: 39.3 ± 0.3 weeks) (p < 0.05). Women who were exposed to tobacco smoke every day delivered neonates with significantly lower mean birth weight (mean ± SE: 2703 ± 135 g) than women who were only exposed once a week (mean ± SE: 3125 ± 147 g) (p < 0.05). A one-minute increase in cooking time in a kitchen without a chimney increased women’s expired air carbon monoxide concentration by 0.038 ppm (p = 0.006). Long-term exposure to wood-fuel smoke in a kitchen without a chimney can increase the risk of inhaling high concentrations of carbon monoxide.
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Biomass Cooking Fuels and Health Outcomes for Women in Malawi. ECOHEALTH 2017; 14:7-19. [PMID: 27800583 PMCID: PMC5357447 DOI: 10.1007/s10393-016-1190-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 09/05/2016] [Accepted: 09/26/2016] [Indexed: 05/05/2023]
Abstract
In sub-Saharan Africa, biomass fuels account for approximately 90% of household energy consumption. Limited evidence exists on the association between different biomass fuels and health outcomes. We report results from a cross-sectional sample of 655 households in Malawi. We calculated odds ratios between hypothesized determinants of household air pollution (HAP) exposure (fuel, stove type, and cooking location) and five categories of health outcomes (cardiopulmonary, respiratory, neurologic, eye health, and burns). Reliance on high- or low-quality firewood or crop residue (vs. charcoal) was associated with significantly higher odds of shortness of breath, difficulty breathing, chest pains, night phlegm, forgetfulness, dizziness, and dry irritated eyes. Use of high-quality firewood was associated with significantly lower odds of persistent phlegm. Cooks in rural areas (vs. urban areas) had significantly higher odds of experiencing shortness of breath, persistent cough, and phlegm, but significantly lower odds of phlegm, forgetfulness, and burns. With deforestation and population pressures increasing reliance on low-quality biomass fuels, prevalence of HAP-related cardiopulmonary and neurologic symptoms will likely increase among cooks. Short- to medium-term strategies are needed to secure access to high-quality biomass fuels given limited potential for scalable transitions to modern energy.
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Influence of air pollution on exhaled carbon monoxide levels in smokers and non-smokers. A prospective cross-sectional study. ENVIRONMENTAL RESEARCH 2017; 152:496-502. [PMID: 27712837 DOI: 10.1016/j.envres.2016.09.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The poor air quality and cigarette smoking are the most important reasons for increased carbon monoxide (CO) level in exhaled air. However, the influence of high air pollution concentration in big cities on the exhaled CO level has not been well studied yet. OBJECTIVES To evaluate the impact of smoking habit and air pollution in the place of living on the level of CO in exhaled air. METHODS Citizens from two large cities and one small town in Poland were asked to complete a survey disclosing their place of residence, education level, work status and smoking habits. Subsequently, the CO level in their exhaled air was measured. Air quality data, obtained from the Regional Inspectorates of Environmental Protection, revealed the differences in atmospheric CO concentration between locations. RESULTS 1226 subjects were divided into 4 groups based on their declared smoking status and place of living. The average CO level in exhaled air was significantly higher in smokers than in non-smokers (p<0.0001) as well as in non-smokers from big cities than non-smokers from small ones (p<0.0001). Created model showed that non-smokers from big cities have odds ratio of 125.3 for exceeding CO cutoff level of 4ppm compared to non-smokers from small towns. CONCLUSIONS The average CO level in exhaled air is significantly higher in smokers than non-smokers. Among non-smokers, the average exhaled CO level is significantly higher in big city than small town citizens. These results suggest that permanent exposure to an increased concentration of air pollution and cigarette smoking affect the level of exhaled CO.
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Association of tobacco use and other determinants with pregnancy outcomes: a multicentre hospital-based case-control study in Karachi, Pakistan. BMJ Open 2016; 6:e012045. [PMID: 27650766 PMCID: PMC5051420 DOI: 10.1136/bmjopen-2016-012045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The study aimed to identify the effects of maternal tobacco consumption during pregnancy and other factors on birth outcomes and obstetric complications in Karachi, Pakistan. DESIGN A multicentre hospital-based case-control study. SETTING Four leading maternity hospitals of Karachi. PARTICIPANTS A random sample of 1275 women coming to the gynaecology and obstetric department of selected hospitals for delivery was interviewed within 48 hours of delivery from wards. Cases were women with adverse birth outcomes and obstetric complications, while controls were women who had normal uncomplicated delivery. PRIMARY AND SECONDARY OUTCOME MEASURES Adverse birth outcomes (preterm delivery, low birth weight, stillbirth, low Apgar score) and obstetric complications (antepartum haemorrhage, caesarean section, etc). RESULTS Final multiple logistic regression analysis revealed that with every 1 year increase in age the odds of being a case was 1.03 times as compared with being a control. Tobacco use (adjusted OR (aOR): 2.24; 95% CI 1.56 to 3.23), having no slits in the kitchen (proxy indicator for indoor air pollution) (aOR=1.90; 95% CI 1.05 to 3.43), gravidity (aOR=0.83; 95% CI 0.73 to 0.93), non-booked hospital cases (aOR=1.87; 95% CI 1.38 to 2.74), history of stillbirth (aOR=4.06; 95% CI 2.36 to 6.97), miscarriages (aOR=1.91; 95% CI 1.27 to 2.85) and preterm delivery (aOR=6.04; 95% CI 2.52 to 14.48) were significantly associated with being a case as compared with control. CONCLUSIONS This study suggests that women who had adverse pregnancy outcomes were more likely to have exposure to tobacco, previous history of adverse birth outcomes and were non-booked cases. Engagement of stakeholders in tobacco control for providing health education, incorporating tobacco use in women in the tobacco control policy and designing interventions for tobacco use cessation is warranted. Prenatal care and health education might help in preventing such adverse events.
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Effects of air pollution on human health and practical measures for prevention in Iran. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:65. [PMID: 27904610 PMCID: PMC5122104 DOI: 10.4103/1735-1995.189646] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 03/01/2016] [Accepted: 05/24/2016] [Indexed: 01/27/2023]
Abstract
Air pollution is a major concern of new civilized world, which has a serious toxicological impact on human health and the environment. It has a number of different emission sources, but motor vehicles and industrial processes contribute the major part of air pollution. According to the World Health Organization, six major air pollutants include particle pollution, ground-level ozone, carbon monoxide, sulfur oxides, nitrogen oxides, and lead. Long and short term exposure to air suspended toxicants has a different toxicological impact on human including respiratory and cardiovascular diseases, neuropsychiatric complications, the eyes irritation, skin diseases, and long-term chronic diseases such as cancer. Several reports have revealed the direct association between exposure to the poor air quality and increasing rate of morbidity and mortality mostly due to cardiovascular and respiratory diseases. Air pollution is considered as the major environmental risk factor in the incidence and progression of some diseases such as asthma, lung cancer, ventricular hypertrophy, Alzheimer's and Parkinson's diseases, psychological complications, autism, retinopathy, fetal growth, and low birth weight. In this review article, we aimed to discuss toxicology of major air pollutants, sources of emission, and their impact on human health. We have also proposed practical measures to reduce air pollution in Iran.
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Neonatal anthropometry at 3400 m above sea level compared with INTERGROWTH 21st standards*. J Matern Fetal Neonatal Med 2016; 30:155-158. [DOI: 10.3109/14767058.2016.1163682] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Risk of Adverse Pregnancy Outcomes among Women Practicing Poor Sanitation in Rural India: A Population-Based Prospective Cohort Study. PLoS Med 2015; 12:e1001851. [PMID: 26151447 PMCID: PMC4511257 DOI: 10.1371/journal.pmed.1001851] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 05/29/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The importance of maternal sanitation behaviour during pregnancy for birth outcomes remains unclear. Poor sanitation practices can promote infection and induce stress during pregnancy and may contribute to adverse pregnancy outcomes (APOs). We aimed to assess whether poor sanitation practices were associated with increased risk of APOs such as preterm birth and low birth weight in a population-based study in rural India. METHODS AND FINDINGS A prospective cohort of pregnant women (n = 670) in their first trimester of pregnancy was enrolled and followed until birth. Socio-demographic, clinical, and anthropometric factors, along with access to toilets and sanitation practices, were recorded at enrolment (12th week of gestation). A trained community health volunteer conducted home visits to ensure retention in the study and learn about study outcomes during the course of pregnancy. Unadjusted odds ratios (ORs) and adjusted odds ratios (AORs) and 95% confidence intervals for APOs were estimated by logistic regression models. Of the 667 women who were retained at the end of the study, 58.2% practiced open defecation and 25.7% experienced APOs, including 130 (19.4%) preterm births, 95 (14.2%) births with low birth weight, 11 (1.7%) spontaneous abortions, and six (0.9%) stillbirths. Unadjusted ORs for APOs (OR: 2.53; 95% CI: 1.72-3.71), preterm birth (OR: 2.36; 95% CI: 1.54-3.62), and low birth weight (OR: 2.00; 95% CI: 1.24-3.23) were found to be significantly associated with open defecation practices. After adjustment for potential confounders such as maternal socio-demographic and clinical factors, open defecation was still significantly associated with increased odds of APOs (AOR: 2.38; 95% CI: 1.49-3.80) and preterm birth (AOR: 2.22; 95% CI: 1.29-3.79) but not low birth weight (AOR: 1.61; 95% CI: 0.94-2.73). The association between APOs and open defecation was independent of poverty and caste. Even though we accounted for several key confounding factors in our estimates, the possibility of residual confounding should not be ruled out. We did not identify specific exposure pathways that led to the outcomes. CONCLUSIONS This study provides the first evidence, to our knowledge, that poor sanitation is associated with a higher risk of APOs. Additional studies are required to elucidate the socio-behavioural and/or biological basis of this association so that appropriate targeted interventions might be designed to support improved birth outcomes in vulnerable populations. While it is intuitive to expect that caste and poverty are associated with poor sanitation practice driving APOs, and we cannot rule out additional confounders, our results demonstrate that the association of poor sanitation practices (open defecation) with these outcomes is independent of poverty. Our results support the need to assess the mechanisms, both biological and behavioural, by which limited access to improved sanitation leads to APOs.
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