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Lim S, Said B, Zurba L, Mosler G, Addo-Yobo E, Adeyeye OO, Arhin B, Evangelopoulos D, Fapohunda VT, Fortune F, Griffiths CJ, Hlophe S, Kasekete M, Lowther S, Masekela R, Mkutumula E, Mmbaga BT, Mujuru HA, Nantanda R, Mzati Nkhalamba L, Ngocho JS, Ojo OT, Owusu SK, Shaibu S, Ticklay I, Grigg J, Barratt B. Characterising sources of PM 2·5 exposure for school children with asthma: a personal exposure study across six cities in sub-Saharan Africa. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:17-27. [PMID: 38000380 PMCID: PMC10716619 DOI: 10.1016/s2352-4642(23)00261-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Air pollution is the second largest risk to health in Africa, and children with asthma are particularly susceptible to its effects. Yet, there is a scarcity of air pollution exposure data from cities in sub-Saharan Africa. We aimed to identify potential exposure reduction strategies for school children with asthma living in urban areas in sub-Saharan Africa. METHODS This personal exposure study was part of the Achieving Control of Asthma in Children in Africa (ACACIA) project. Personal exposure to particulate matter (PM) was monitored in school children in six cities in sub-Saharan Africa (Blantyre, Malawi; Durban, South Africa; Harare, Zimbabwe; Kumasi, Ghana; Lagos, Nigeria; and Moshi, Tanzania). Participants were selected if they were aged 12-16 years and had symptoms of asthma. Monitoring was conducted between June 21, and Nov 26, 2021, from Monday morning (approximately 1000 h) to Friday morning (approximately 1000 h), by use of a bespoke backpack with a small air pollution monitoring unit with an inbuilt Global Positioning System (GPS) data logger. Children filled in a questionnaire detailing potential sources of air pollution during monitoring and exposures were tagged into three different microenvironments (school, commute, and home) with GPS coordinates. Mixed-effects models were used to identify the most important determinants of children's PM2·5 (PM <2·5 μm in diameter) exposure. FINDINGS 330 children were recruited across 43 schools; of these, 297 had valid monitoring data, and 1109 days of valid data were analysed. Only 227 (20%) of 1109 days monitored were lower than the current WHO 24 h PM2·5 exposure health guideline of 15 μg/m3. Children in Blantyre had the highest PM2·5 exposure (median 41·8 μg/m3), whereas children in Durban (16·0 μg/m3) and Kumasi (17·9 μg/m3) recorded the lowest exposures. Children had significantly higher PM2·5 exposures at school than at home in Kumasi (median 19·6 μg/m3vs 14·2 μg/m3), Lagos (32·0 μg/m3vs 18·0 μg/m3), and Moshi (33·1 μg/m3vs 23·6 μg/m3), while children in the other three cities monitored had significantly higher PM2·5 exposures at home and while commuting than at school (median 48·0 μg/m3 and 43·2 μg/m3vs 32·3 μg/m3 in Blantyre, 20·9 μg/m3 and 16·3 μg/m3vs 11·9 μg/m3 in Durban, and 22·7 μg/m3 and 25·4 μg/m3vs 16·4 μg/m3 in Harare). The mixed-effects model highlighted the following determinants for higher PM2·5 exposure: presence of smokers at home (23·0% higher exposure, 95% CI 10·8-36·4), use of coal or wood for cooking (27·1%, 3·9-56·3), and kerosene lamps for lighting (30·2%, 9·1-55·2). By contrast, 37·2% (95% CI 22·9-48·2) lower PM2·5 exposures were found for children who went to schools with paved grounds compared with those whose school grounds were covered with loose dirt. INTERPRETATION Our study suggests that the most effective changes to reduce PM2·5 exposures in these cities would be to provide paving in school grounds, increase the use of clean fuel for cooking and light in homes, and discourage smoking within homes. The most efficient way to improve air quality in these cities would require tailored interventions to prioritise different exposure-reduction policies in different cities. FUNDING UK National Institute for Health and Care Research.
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Affiliation(s)
- Shanon Lim
- MRC Centre for Environment and Health, Environmental Research Group, Imperial College London, London, UK; Department of Civil and Environmental Engineering, Faculty of Engineering, The University of Auckland, Auckland, New Zealand
| | - Bibie Said
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kibong'oto Infectious Disease Hospital, Hai, Tanzania
| | | | - Gioia Mosler
- Centre for Genomics and Child Health, Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Emmanuel Addo-Yobo
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Olayinka Olufunke Adeyeye
- Department of Medicine, Lagos State University College of Medicine, and Lagos State University Teaching Hospital, Ikeja Lagos, Nigeria
| | | | - Dimitris Evangelopoulos
- MRC Centre for Environment and Health, Environmental Research Group, Imperial College London, London, UK
| | - Victoria Temitope Fapohunda
- Department of Medicine, Lagos State University College of Medicine, and Lagos State University Teaching Hospital, Ikeja Lagos, Nigeria
| | - Farida Fortune
- Centre for Oral immunobiology and Regenerative Medicine, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chris J Griffiths
- Asthma UK Centre for Applied Research, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sbekezelo Hlophe
- Department of Paediatrics and Child Health, Nelson R Mandela School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Marian Kasekete
- University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | | | - Refiloe Masekela
- Department of Paediatrics and Child Health, Nelson R Mandela School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | | | - Blandina Theophil Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Hilda Angela Mujuru
- University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Rebecca Nantanda
- Makerere University Lung Institute, Makerere College of Health Sciences, Kampala Uganda
| | | | - James S Ngocho
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Oluwafemi Tunde Ojo
- Department of Medicine, Lagos State University College of Medicine, and Lagos State University Teaching Hospital, Ikeja Lagos, Nigeria
| | | | - Sunshine Shaibu
- Department of Medicine, Lagos State University College of Medicine, and Lagos State University Teaching Hospital, Ikeja Lagos, Nigeria
| | - Ismail Ticklay
- University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Benjamin Barratt
- MRC Centre for Environment and Health, Environmental Research Group, Imperial College London, London, UK; NIHR NPRU in Environmental Exposures and Health, Imperial College London, London, UK.
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Kaali S, Jack DW, Mujtaba MN, Chillrud SN, Ae-Ngibise KA, Kinney PL, Boamah Kaali E, Gennings C, Colicino E, Osei M, Wylie BJ, Agyei O, Quinn A, Asante KP, Lee AG. Identifying sensitive windows of prenatal household air pollution on birth weight and infant pneumonia risk to inform future interventions. ENVIRONMENT INTERNATIONAL 2023; 178:108062. [PMID: 37392730 PMCID: PMC10911234 DOI: 10.1016/j.envint.2023.108062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/02/2023] [Accepted: 06/22/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Prenatal household air pollution impairs birth weight and increases pneumonia risk however time-varying associations have not been elucidated and may have implications for the timing of public health interventions. METHODS The Ghana Randomized Air Pollution and Health Study (GRAPHS) enrolled 1,414 pregnant women from Kintampo, Ghana and measured personal carbon monoxide (CO) exposure four times over pregnancy. Birth weight was measured within 72-hours of birth. Fieldworkers performed weekly pneumonia surveillance and referred sick children to study physicians. The primary pneumonia outcome was one or more physician-diagnosed severe pneumonia episode in the first year of life. We employed reverse distributed lag models to examine time-varying associations between prenatal CO exposure and birth weight and infant pneumonia risk. RESULTS Analyses included n = 1,196 mother-infant pairs. In models adjusting for child sex; maternal age, body mass index (BMI), ethnicity and parity at enrollment; household wealth index; number of antenatal visits; and evidence of placental malaria, prenatal CO exposures from 15 to 20 weeks gestation were inversely associated with birth weight. Sex-stratified models identified a similar sensitive window in males and a window at 10-weeks gestation in females. In models adjusting for child sex, maternal age, BMI and ethnicity, household wealth index, gestational age at delivery and average postnatal child CO exposure, CO exposure during 34-39 weeks gestation were positively associated with severe pneumonia risk, especially in females. CONCLUSIONS Household air pollution exposures in mid- and late- gestation are associated with lower birth weight and higher pneumonia risk, respectively. These findings support the urgent need for deployment of clean fuel stove interventions beginning in early pregnancy.
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Affiliation(s)
- Seyram Kaali
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Bono East Region, Kintampo, Ghana.
| | - Darby W Jack
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, 722 W 168(th) Street, New York, NY 10032, USA
| | - Mohammed N Mujtaba
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Bono East Region, Kintampo, Ghana
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory at Columbia University, Palisades, NY, USA
| | - Kenneth A Ae-Ngibise
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Bono East Region, Kintampo, Ghana
| | - Patrick L Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Ellen Boamah Kaali
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Bono East Region, Kintampo, Ghana
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Musah Osei
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Bono East Region, Kintampo, Ghana
| | - Blair J Wylie
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Oscar Agyei
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Bono East Region, Kintampo, Ghana
| | - Ashlinn Quinn
- Berkeley Air Monitoring Group, Fort Collins, CO, USA
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Bono East Region, Kintampo, Ghana
| | - Alison G Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Hu B, Tang J, Xu G, Shao D, Huang H, Li J, Chen H, Chen J, Zhu L, Chen S, Shen B, Jin L, Xu L. Combined exposure to PM 2.5 and PM 10 in reductions of physiological development among preterm birth: a retrospective study from 2014 to 2017 in China. Front Public Health 2023; 11:1146283. [PMID: 37564430 PMCID: PMC10410271 DOI: 10.3389/fpubh.2023.1146283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/12/2023] [Indexed: 08/12/2023] Open
Abstract
Background Preterm birth (PTB) has been linked with ambient particulate matter (PM) exposure. However, data are limited between physiological development of PTB and PM exposure. Methods Trimester and season-specific PM exposure including PM2.5 and PM10 was collected from Jiaxing between January 2014 and December 2017. Information about parents and 3,054 PTB (gestational age < 37 weeks) outcomes such as weight (g), head circumference (cm), chest circumference (cm), height (cm) and Apgar 5 score were obtained from birth records. We used generalized linear models to assess the relationship between PTB physiological developmental indices and PM2.5, PM10 and their combined exposures. A binary logistic regression model was performed to assess the association between exposures and low birth weight (LBW, < 2,500 g). Results Results showed that there were 75.5% of low birth weight (LBW) infants in PTB. Decreased PM2.5 and PM10 levels were found in Jiaxing from 2014 to 2017, with a higher PM10 level than PM2.5 each year. During the entire pregnancy, the highest median concentration of PM2.5 and PM10 was in winter (61.65 ± 0.24 vs. 91.65 ± 0.29 μg/m3) followed by autumn, spring and summer, with statistical differences in trimester-specific stages. After adjusting for several potential factors, we found a 10 μg/m3 increase in joint exposure of PM2.5 and PM10 during the entire pregnancy associated with reduced 0.02 week (95%CI: -0.05, -0.01) in gestational age, 7.9 g (95%CI: -13.71, -2.28) in birth weight, 0.8 cm in height (95%CI: -0.16, -0.02), 0.05 cm (95%CI: -0.08, - 0.01) in head circumference, and 0.3 (95%CI: -0.04, -0.02) in Apgar 5 score, except for the chest circumference. Trimester-specific exposure of PM2.5 and PM10 sometimes showed an opposite effect on Additionally, PM2.5 (OR = 1.37, 95%CI: 1.11, 1.68) was correlated with LBW. Conclusion Findings in this study suggest a combined impact of fine particulate matter exposure on neonatal development, which adds to the current understanding of PTB risk and health.
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Affiliation(s)
- Bo Hu
- Department of Preventive Medicine, Forensic and Pathology Laboratory, Institute of Forensic Science, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, China
- Department of Pathology and Key-Innovative Discipline Molecular Diagnostics, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing University, Jiaxing, Zhejiang, China
| | - Jie Tang
- Department of Preventive Medicine, Forensic and Pathology Laboratory, Institute of Forensic Science, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, China
- Department of Pathology and Key-Innovative Discipline Molecular Diagnostics, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing University, Jiaxing, Zhejiang, China
| | - Guangtao Xu
- Department of Preventive Medicine, Forensic and Pathology Laboratory, Institute of Forensic Science, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, China
| | - Dongliang Shao
- Department of Neonatal Intensive Care Unit, Jiaxing Maternity and Child Health Care Hospital, Jiaxing University, Jiaxing, Zhejiang, China
| | - Huafei Huang
- Department of Neonatal Intensive Care Unit, Jiaxing Maternity and Child Health Care Hospital, Jiaxing University, Jiaxing, Zhejiang, China
| | - Jintong Li
- Department of Preventive Medicine, Forensic and Pathology Laboratory, Institute of Forensic Science, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, China
| | - Huan Chen
- Department of Preventive Medicine, Forensic and Pathology Laboratory, Institute of Forensic Science, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, China
| | - Jie Chen
- Department of Preventive Medicine, Forensic and Pathology Laboratory, Institute of Forensic Science, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, China
| | - Liangjin Zhu
- Department of Preventive Medicine, Forensic and Pathology Laboratory, Institute of Forensic Science, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, China
| | - Shipiao Chen
- Department of Preventive Medicine, Forensic and Pathology Laboratory, Institute of Forensic Science, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, China
| | - Bin Shen
- Department of Preventive Medicine, Forensic and Pathology Laboratory, Institute of Forensic Science, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, China
| | - Limin Jin
- Department of Pathology and Key-Innovative Discipline Molecular Diagnostics, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing University, Jiaxing, Zhejiang, China
| | - Long Xu
- Department of Preventive Medicine, Forensic and Pathology Laboratory, Institute of Forensic Science, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, China
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Näsänen-Gilmore PK, Koivu AM, Hunter PJ, Muthiani Y, Pörtfors P, Heimonen O, Kajander V, Ashorn P, Ashorn U. A modular systematic review of antenatal interventions targeting modifiable environmental exposures in improving low birth weight. Am J Clin Nutr 2023; 117 Suppl 2:S160-S169. [PMID: 37331762 DOI: 10.1016/j.ajcnut.2022.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Low birth weight (LBW) increases the risk of short- and long-term morbidity and mortality from early life to adulthood. Despite research effort to improve birth outcomes the progress has been slow. OBJECTIVE This systematic search and review of English language scientific literature on clinical trials aimed to compare the efficacy antenatal interventions to reduce environmental exposures including a reduction of toxins exposure, and improving sanitation, hygiene, and health-seeking behaviors, which target pregnant women to improve birth outcomes. METHODS We performed eight systematic searches in MEDLINE (OvidSP), Embase (OvidSP), Cochrane Database of Systematic Reviews (Wiley Cochrane Library), Cochrane Central Register of Controlled Trials (Wiley Cochrane Library), CINAHL Complete (EbscoHOST) between 17 March 2020 and 26 May 2020. RESULTS Four documents identified describe interventions to reduce indoor air pollution: two randomised controlled trials (RCTs), one systematic review and meta-analysis (SRMA) on preventative antihelminth treatment and one RCT on antenatal counselling against unnecessary caesarean section. Based on the published literature, interventions to reduce indoor air pollution (LBW: RR: 0.90 [0.56, 1.44], PTB: OR: 2.37 [1.11, 5.07]) or preventative antihelminth treatment (LBW: RR: 1.00 [0.79, 1.27], PTB: RR: 0.88 [0.43, 1.78]) are not likely to reduce the risk of LBW or Preterm birth (PTB). Data is insufficient on antenatal counselling against caesarian-sections. For other interventions, there is lack of published research data from RCTs. CONCLUSIONS We conclude that there is a paucity of evidence from RCT on interventions that modify environmental risk factors during pregnancy to potentially improve birth outcomes. Magic bullets approach might not work and that it would be important to study the effect of the broader interventions, particularly in LMIC settings. Global interdisciplinary action to reduce harmful environmental exposures, is likely to help to reach global targets for LBW reduction and sustainably improve long-term population health.
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Affiliation(s)
- Pieta K Näsänen-Gilmore
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Finnish Institute for Health and Welfare, FI-00271, Helsinki, Finland.
| | - Annariina M Koivu
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Yvonne Muthiani
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pia Pörtfors
- Finnish Institute for Health and Welfare, FI-00271, Helsinki, Finland
| | - Otto Heimonen
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Viivi Kajander
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Jabin N, Rahman MM, Salam MT, Sharna TI, Franklin M, Bailey MJ, Alderete TL, Ahmed A, Quaiyum MA, Islam T. Cohort profile: Bangladesh Cook Stove Pregnancy Cohort Study (CSPCS). BMJ Open 2023; 13:e068539. [PMID: 37164456 PMCID: PMC10174037 DOI: 10.1136/bmjopen-2022-068539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
PURPOSE The Cook Stove Pregnancy Cohort Study (CSPCS) was designed to assess the effects of biomass fuel use on household air pollution (HAP) as well as the effects of HAP (fine particulate matter, PM2.5) on birth outcomes and acute lower respiratory infection (ALRI) among infants in Bangladesh. PARTICIPANTS We recruited 903 women within 18 weeks of pregnancy from rural and semiurban areas of Bangladesh between November 2016 and March 2017. All women and their infants (N=831 pairs) were followed until 12 months after delivery and a subset have undergone respiratory and gut microbiota analysis. METHODS Questionnaires were administered to collect detailed sociodemographic, medical, nutritional and behavioural information on the mother-child dyads. Anthropometric measurements and biological samples were also collected, as well as household PM2.5 concentrations. FINDINGS TO DATE Published work in this cohort showed detrimental effects of biomass fuel and health inequity on birth outcomes. Current analysis indicates high levels of household PM2.5 being associated with cooking fuel type and infant ALRI. Lastly, we identified distinct gut and respiratory microbial communities at 6 months of age. FUTURE PLANS This study provides an economical yet effective framework to conduct pregnancy cohort studies determining the health effects of adverse environmental exposures in low-resource countries. Future analyses in this cohort include assessing the effect of indoor PM2.5 levels on (1) physical growth, (2) neurodevelopment, (3) age of first incidence and frequency of ALRI in infants and (4) the development of the respiratory and gut microbiome. Additional support has allowed us to investigate the effect of in utero exposure to metals on infant neurodevelopment in the first year of life.
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Affiliation(s)
- Nusrat Jabin
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Md Mostafijur Rahman
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Muhammad T Salam
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
- Department of Psychiatry, Kern Medical Center, Bakersfield, California, USA
| | | | - Meredith Franklin
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Maximilian J Bailey
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Tanya L Alderete
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Anisuddin Ahmed
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - M A Quaiyum
- Projohnmo Research Foundation (PRF), Dhaka, Bangladesh
| | - Talat Islam
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
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Balakrishnan K, Steenland K, Clasen T, Chang H, Johnson M, Pillarisetti A, Ye W, Naeher LP, Diaz-Artiga A, McCracken JP, Thompson LM, Rosa G, Kirby MA, Thangavel G, Sambandam S, Mukhopadhyay K, Puttaswamy N, Aravindalochanan V, Garg S, Ndagijimana F, Hartinger S, Underhill LJ, Kearns KA, Campbell D, Kremer J, Waller L, Jabbarzadeh S, Wang J, Chen Y, Rosenthal J, Quinn A, Papageorghiou AT, Ramakrishnan U, Howards PP, Checkley W, Peel JL. Exposure-response relationships for personal exposure to fine particulate matter (PM 2·5), carbon monoxide, and black carbon and birthweight: an observational analysis of the multicountry Household Air Pollution Intervention Network (HAPIN) trial. Lancet Planet Health 2023; 7:e387-e396. [PMID: 37164515 PMCID: PMC10186177 DOI: 10.1016/s2542-5196(23)00052-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/19/2023] [Accepted: 03/02/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Household air pollution (HAP) from solid fuel use is associated with adverse birth outcomes, but data for exposure-response relationships are scarce. We examined associations between HAP exposures and birthweight in rural Guatemala, India, Peru, and Rwanda during the Household Air Pollution Intervention Network (HAPIN) trial. METHODS The HAPIN trial recruited pregnant women (9-<20 weeks of gestation) in rural Guatemala, India, Peru, and Rwanda and randomly allocated them to receive a liquefied petroleum gas stove or not (ie, and continue to use biomass fuel). The primary outcomes were birthweight, length-for-age, severe pneumonia, and maternal systolic blood pressure. In this exposure-response subanalysis, we measured 24-h personal exposures to PM2·5, carbon monoxide, and black carbon once pre-intervention (baseline) and twice post-intervention (at 24-28 weeks and 32-36 weeks of gestation), as well as birthweight within 24 h of birth. We examined the relationship between the average prenatal exposure and birthweight or weight-for-gestational age Z scores using multivariate-regression models, controlling for the mother's age, nulliparity, diet diversity, food insecurity, BMI, the mother's education, neonate sex, haemoglobin, second-hand smoke, and geographical indicator for randomisation strata. FINDINGS Between March, 2018, and February, 2020, 3200 pregnant women were recruited. An interquartile increase in the average prenatal exposure to PM2·5 (74·5 μg/m3) was associated with a reduction in birthweight and gestational age Z scores (birthweight: -14·8 g [95% CI -28·7 to -0·8]; gestational age Z scores: -0·03 [-0·06 to 0·00]), as was an interquartile increase in black carbon (7·3 μg/m3; -21·9 g [-37·7 to -6·1]; -0·05 [-0·08 to -0·01]). Carbon monoxide exposure was not associated with these outcomes (1·7; -3·1 [-12·1 to 5·8]; -0·003 [-0·023 to 0·017]). INTERPRETATION Continuing efforts are needed to reduce HAP exposure alongside other drivers of low birthweight in low-income and middle-income countries. FUNDING US National Institutes of Health (1UM1HL134590) and the Bill & Melinda Gates Foundation (OPP1131279).
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Affiliation(s)
- Kalpana Balakrishnan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India.
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA
| | - Howard Chang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | | | - Ajay Pillarisetti
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Wenlu Ye
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Luke P Naeher
- Department of Environmental Health Sciences, University of Georgia, Athens, GA, USA
| | - Anaite Diaz-Artiga
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - John P McCracken
- Department of Environmental Health Sciences, University of Georgia, Athens, GA, USA
| | - Lisa M Thompson
- Rollins School of Public Health and Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Ghislaine Rosa
- Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Miles A Kirby
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Gurusamy Thangavel
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Sankar Sambandam
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Krishnendu Mukhopadhyay
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Naveen Puttaswamy
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Vigneswari Aravindalochanan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Sarada Garg
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | | | - Stella Hartinger
- Division of Pulmonary and Critical Care, School of Medicine and Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Lindsay J Underhill
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO, USA
| | - Katherine A Kearns
- Department of Environmental Health Sciences, University of Georgia, Athens, GA, USA
| | - Devan Campbell
- Department of Environmental Health Sciences, University of Georgia, Athens, GA, USA
| | - Jacob Kremer
- Department of Environmental Health Sciences, University of Georgia, Athens, GA, USA
| | - Lance Waller
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Shirin Jabbarzadeh
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Jiantong Wang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Yunyun Chen
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Joshua Rosenthal
- Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | | | - Aris T Papageorghiou
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | | | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine and Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
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O’Sharkey K, Xu Y, Chavez T, Johnson M, Cabison J, Rosales M, Grubbs B, Toledo-Corral CM, Farzan SF, Bastain T, Breton CV, Habre R. In-utero personal exposure to PM 2.5 impacted by indoor and outdoor sources and birthweight in the MADRES cohort. ENVIRONMENTAL ADVANCES 2022; 9:100257. [PMID: 36778968 PMCID: PMC9912940 DOI: 10.1016/j.envadv.2022.100257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND In-utero exposure to outdoor particulate matter with aerodynamic diameter less than 2.5 μm (PM2.5) is linked with low birthweight. However, previous results are mixed, likely due to measurement error introduced by estimating personal exposure from ambient data. This study investigated the effect of total personal PM2.5 exposure on birthweight and whether it differed when it was more heavily impacted by sources of indoor vs outdoor origin in the MADRES cohort study. METHODS Personal PM2.5 exposure was measured in 205 pregnant women in the 3rd trimester using 48 h integrated, filter-based sampling. Linear regression was used to test the association between personal PM2.5 exposure and birthweight, adjusting for key covariates. Interactions of PM2.5 with variables representing indoor sources of PM2.5, home ventilation, or time spent indoors tested whether the effect of total PM2.5 on birthweight varied when it was more impacted by sources of indoor vs outdoor origin. RESULTS In a sample of largely Hispanic (81%) pregnant women, total personal PM2.5 was not significantly associated with birthweight (β = 38.6 per 1SD increase in PM2.5; 95% CI:-21.1, 98.2). This association however, differed by home type (single family home: 156.9 (26.9, 287.0), 2-4 attached units:-16.6 (-111.9, 78.7), 5+ units:-62.6 (-184.9, 59.6), missing: 145.4 (-4.1, 294.9), interaction p = 0.028) and by household air conditioner use (none of the time: -27.6 (-101.5, 46.3) vs. some of the time: 139.9 (42.9, 237.0), interaction p = 0.008) Additionally, the effect of personal PM2.5 on birthweight varied by time spent indoors (none or little of the time: - 45.1 (-208.3, 118.1) vs. most or all of the time: 57.1 (-7.3, 121.6), interaction p = 0.255). CONCLUSIONS While no significant association between total personal PM2.5 exposure and birthweight was found, there was evidence that multi-unit housing (vs. single-family homes), candle and/or incense smoke, and greater outdoor source contributions to personal PM2.5 were more strongly associated with lower birthweight.
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Affiliation(s)
- Karl O’Sharkey
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
| | - Yan Xu
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, United States
| | - Thomas Chavez
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
| | - Mark Johnson
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
| | - Jane Cabison
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
| | - Marisela Rosales
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
| | - Brendan Grubbs
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
| | - Claudia M. Toledo-Corral
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
- Department of Health Sciences, California State University Northridge, Northridge, CA, United States
| | - Shohreh F. Farzan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
| | - Theresa Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
| | - Rima Habre
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N Soto St Rm 102M, Los Angeles, CA 90089, United States
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, United States
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8
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Jabin N, Salam MT, Rahman MM, Sharna TI, Franklin M, Ahmed A, Quaiyum MA, Islam T. Social inequality influences the impact of household air pollution on birth outcomes. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 822:153405. [PMID: 35092774 PMCID: PMC8969117 DOI: 10.1016/j.scitotenv.2022.153405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND Studies demonstrated associations between maternal exposure to household air pollution from cooking and increased risk of adverse birth outcomes in offspring; however, the modifying effect of socioeconomic status (SES) on this association has not been explored. OBJECTIVES In a cohort of pregnant women with 800 single live births between 2016 and 2017 in rural and semi urban areas of Bangladesh, we tested the hypotheses that kitchen location and cooking fuel type affect birth outcomes (birth weight, low birth weight [LBW] and small for gestational age [SGA]) and these associations vary by SES. METHODS Demographic characteristics including SES, kitchen location and fuel type were assessed in prenatal visits. Neonatal anthropometric measurements were recorded within 72 h of births. We performed multivariable linear and logistic regressions adjusting for potential confounders to test the study hypotheses. RESULTS For newborns from households with indoor kitchens, adjusted mean birth weight was 65.13 g (95% confidence interval [CI]: -118.37, -11.90) lower and the odds of LBW and SGA were 58% (odds ratio [OR]:1.58, 95% CI: 1.12, 2.24) and 41% (OR: 1.41, 95% CI: 1.05, 1.92) higher compared to those born in households with outdoor kitchens. We found SES significantly modified the associations between kitchen location and birth outcomes in households using biomass fuels. Newborns from low SES households with indoor kitchens had 89 g lower birth weight and a higher odds of being born with LBW (OR: 2.08, 95% CI 1.23, 3.58), and SGA (OR: 1.70, 95% CI 1.06, 2.76) than those born in high SES households using outdoor kitchens. CONCLUSIONS In areas with poor access or affordability to clean fuel such as in our study population, cooking in an outdoor kitchen can reduce the burden of LBW and SGA, particularly for low SES households. Promoting outdoor kitchens is a possible intervention strategy to mitigate adverse birth outcomes.
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Affiliation(s)
- Nusrat Jabin
- Department of Population and Public Health Sciences, University of Southern California, USA
| | - Muhammad T Salam
- Department of Population and Public Health Sciences, University of Southern California, USA; Department of Psychiatry, Kern Medical, Bakersfield, CA, USA
| | - Md Mostafijur Rahman
- Department of Population and Public Health Sciences, University of Southern California, USA
| | - Tasnia Ishaque Sharna
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, (icddr,b), Bangladesh
| | - Meredith Franklin
- Department of Population and Public Health Sciences, University of Southern California, USA
| | - Anisuddin Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, (icddr,b), Bangladesh
| | - M A Quaiyum
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, (icddr,b), Bangladesh
| | - Talat Islam
- Department of Population and Public Health Sciences, University of Southern California, USA.
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9
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Younger A, Alkon A, Harknett K, Jean Louis R, Thompson LM. 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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Affiliation(s)
- Ashley Younger
- University of California, San Francisco (UCSF), School of Nursing, United States.
| | - Abbey Alkon
- University of California, San Francisco (UCSF), School of Nursing, United States
| | - Kristen Harknett
- University of California, San Francisco (UCSF), Department of Social and Behavioral Sciences, United States
| | | | - Lisa M Thompson
- Emory University Nell Hodgson Woodruff School of Nursing, United States
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10
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A Review of Air Pollution Mitigation Approach Using Air Pollution Tolerance Index (APTI) and Anticipated Performance Index (API). ATMOSPHERE 2022. [DOI: 10.3390/atmos13030374] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Air pollution is a global environmental issue, and there is an urgent need for sustainable remediation techniques. Thus, phytoremediation has become a popular approach to air pollution remediation. This paper reviewed 28 eco-friendly indigenous plants based on both the air pollution tolerance index (APTI) and anticipated performance index (API), using tolerance level and performance indices to evaluate the potential of most indigenous plant species for air pollution control. The estimated APTI ranged from 4.79 (Syzygium malaccense) to 31.75 (Psidium guajava) among the studied indigenous plants. One of the selected plants is tolerant, and seven (7) are intermediate to air pollution with their APTI in the following order: Psidium guajava (31.75) > Swietenia mahogany (28.08) > Mangifera indica L. (27.97) > Ficus infectoria L. (23.93) > Ficus religiosa L. (21.62) > Zizyphus Oenoplia Mill (20.06) > Azadirachta indica A. Juss. (19.01) > Ficus benghalensis L. (18.65). Additionally, the API value indicated that Mangifera indica L. ranges from best to good performer; Ficus religiosa L. and Azadirachta indica A. Juss. from excellent to moderate performers; and Cassia fistula L. from poor to very poor performer for air pollution remediation. The Pearson correlation shows that there is a positive correlation between API and APTI (R2 = 0.63), and this implies that an increase in APTI increases the API and vice versa. This paper shows that Mangifera indica L., Ficus religiosa L., and Azadirachta indica A. Juss. have good potential for sustainable reduction in air pollution for long-term management and green ecomanagement development.
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11
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Shezi B, Jafta N, Asharam K, Tularam H, Jeena P, Naidoo RN. Maternal exposure to indoor PM 2.5 and associated adverse birth outcomes in low socio-economic households, Durban, South Africa. INDOOR AIR 2022; 32:e12934. [PMID: 34546595 DOI: 10.1111/ina.12934] [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: 03/01/2021] [Revised: 08/30/2021] [Accepted: 09/11/2021] [Indexed: 06/13/2023]
Abstract
The association between in utero exposure to indoor PM2.5 and birth outcomes is not conclusive. We assessed the association between in utero exposure to indoor PM2.5 , birth weight, gestational age, low birth weight, and/or preterm delivery. Homes of 800 pregnant women were assessed using a structured walkthrough questionnaire. PM2.5 measurements were undertaken in 300 of the 800 homes for a period of 24 h. Repeated sampling was conducted in 30 of these homes to determine PM2.5 predictors that can reduce within-and/or between-home variability. A predictive model was used to estimate PM2.5 levels in unmeasured homes (n = 500). The mean (SD) for PM2.5 was 37 µg/m3 (29) with a median of 28µg/m3 . The relationship between PM2.5 exposure, birth weight, gestational age, low birth weight, and preterm delivery was assessed using multivariate linear and logistic regression models. We explored infant sex as a potential effect modifier, by creating an interaction term between PM2.5 and infant sex. The odds ratio of low birth weight and preterm delivery was 1.75 (95%CI: 1.47, 2.09) and 1.21 (95%CI: 1.06, 1.39), respectively, per interquartile increase (18 µg/m3 ) in PM2.5 exposure. The reduction in birth weight and gestational age was 75 g (95%CI: 107.89, 53.15) and 0.29 weeks (95%CI: 0.40, 0.19) per interquartile increase in PM2.5 exposure. Infant sex was an effect modifier for PM2.5 on birth weight and gestational age, and the reduction in birth weight and gestational age was 103 g (95%CI: 142.98, 64.40) and 0.38 weeks (95% CI: 0.53, 0.23), respectively, for boys, and 54 g (95%CI: 91.78,15.62) and 0.23 weeks (95%CI:0.37, 0.08), respectively, for girls. Exposure to PM2.5 is associated with adverse pregnancy outcomes. To protect the population during their reproductive period, public health policy should focus on indoor PM2.5 levels.
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Affiliation(s)
- Busisiwe Shezi
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Environment and Health Research Unit, South African Medical Research Council, Durban, South Africa
| | - Nkosana Jafta
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Kareshma Asharam
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Hasheel Tularam
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Prakash Jeena
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Rajen N Naidoo
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Abera A, Friberg J, Isaxon C, Jerrett M, Malmqvist E, Sjöström C, Taj T, Vargas AM. Air Quality in Africa: Public Health Implications. Annu Rev Public Health 2021; 42:193-210. [PMID: 33348996 DOI: 10.1146/annurev-publhealth-100119-113802] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This review highlights the importance of air quality in the African urban development process. We address connections between air pollution and (a) rapid urbanization, (b) social problems, (c) health impacts, (d) climate change, (e) policies, and (f) new innovations. We acknowledge that air pollution levels in Africa can be extremely high and a serious health threat. The toxic content of the pollution could relate to region-specific sources such as low standards for vehicles and fuels, cooking with solid fuels, and burning household waste. We implore the pursuit of interdisciplinary research to create new approaches with relevant stakeholders. Moreover, successful air pollution research must regard conflicts, tensions, and synergies inherent to development processes in African municipalities, regions, and countries. This includes global relationships regarding climate change, trade, urban planning, and transportation. Incorporating aspects of local political situations (e.g., democracy) can also enhance greater political accountability and awareness about air pollution.
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Affiliation(s)
- Asmamaw Abera
- Department of Public Health, Addis Ababa University, 9086 Addis Ababa, Ethiopia
| | - Johan Friberg
- Division of Nuclear Physics, Faculty of Engineering, Lund University, 223 63 Lund, Sweden
| | - Christina Isaxon
- Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Lund University, 223 62 Lund, Sweden;
| | - Michael Jerrett
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, California 90095, USA
| | - Ebba Malmqvist
- Division of Occupational and Environmental Medicine, Lund University, 221 00 Lund, Sweden;
| | - Cheryl Sjöström
- Centre for Environmental and Climate Science, Lund University, 221 00 Lund, Sweden
| | - Tahir Taj
- Division of Occupational and Environmental Medicine, Lund University, 221 00 Lund, Sweden
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13
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Boamah-Kaali E, Jack DW, Ae-Ngibise KA, Quinn A, Kaali S, Dubowski K, Oppong FB, Wylie BJ, Mujtaba MN, Gould CF, Gyaase S, Chillrud S, Owusu-Agyei S, Kinney PL, Asante KP, Lee AG. Prenatal and Postnatal Household Air Pollution Exposure and Infant Growth Trajectories: Evidence from a Rural Ghanaian Pregnancy Cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:117009. [PMID: 34842444 PMCID: PMC8629028 DOI: 10.1289/ehp8109] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 05/26/2023]
Abstract
BACKGROUND The exposure-response association between prenatal and postnatal household air pollution (HAP) and infant growth trajectories is unknown. OBJECTIVES To evaluate associations between prenatal and postnatal HAP exposure and stove interventions on growth trajectories over the first year of life. METHODS The Ghana Randomized Air Pollution and Health Study enrolled n=1,414 pregnant women at ≤24wk gestation from Kintampo, Ghana, and randomized them to liquefied petroleum gas (LPG), improved biomass, or open fire (control) stoves. We quantified HAP exposure by repeated, personal prenatal and postnatal carbon monoxide (CO) and, in a subset, fine particulate matter [PM with an aerodynamic diameter of ≤2.5μm (PM2.5)] assessments. Length, weight, mid-upper arm circumference (MUAC) and head circumference (HC) were measured at birth, 3, 6, 9, and 12 months; weight-for-age, length-for-age (LAZ), and weight-for-length z (WLZ)-scores were calculated. For each anthropometric measure, we employed latent class growth analysis to generate growth trajectories over the first year of life and assigned each child to a trajectory group. We then employed ordinal logistic regression to determine associations between HAP exposures and growth trajectory assignments. Associations with stove intervention arm were also considered. RESULTS Of the 1,306 live births, 1,144 had valid CO data and anthropometric variables measured at least once. Prenatal HAP exposure increased risk for lower length [CO odds ratio (OR)= 1.17, 95% CI: 1.01, 1.35 per 1-ppm increase; PM2.5 OR= 1.07, 95% CI: 1.02, 1.13 per 10-μg/m3 increase], lower LAZ z-score (CO OR= 1.15, 95% CI: 1.01, 1.32 per 1-ppm increase) and stunting (CO OR= 1.25, 95% CI: 1.08, 1.45) trajectories. Postnatal HAP exposure increased risk for smaller HC (CO OR= 1.09, 95% CI: 1.04, 1.13 per 1-ppm increase), smaller MUAC and lower WLZ-score (PM2.5 OR= 1.07, 95% CI: 1.00, 1.14 and OR= 1.09, 95% CI: 1.01, 1.19 per 10-μg/m3 increase, respectively) trajectories. Infants in the LPG arm had decreased odds of having smaller HC and MUAC trajectories as compared with those in the open fire stove arm (OR= 0.58, 95% CI: 0.37, 0.92 and OR= 0.45, 95% CI: 0.22, 0.90, respectively). DISCUSSION Higher early life HAP exposure (during pregnancy and through the first year of life) was associated with poorer infant growth trajectories among children in rural Ghana. A cleaner-burning stove intervention may have improved some growth trajectories. https://doi.org/10.1289/EHP8109.
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Affiliation(s)
- Ellen Boamah-Kaali
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Darby W. Jack
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York, USA
| | - Kenneth A. Ae-Ngibise
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Ashlinn Quinn
- Fogarty International Center, National Institutes of Health, Bethesda Maryland, USA
| | - Seyram Kaali
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Kathryn Dubowski
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Felix B. Oppong
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Blair J Wylie
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mohammed N. Mujtaba
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Carlos F. Gould
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York, USA
| | - Stephaney Gyaase
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Steven Chillrud
- Lamont-Doherty Earth Observatory at Columbia University, Palisades, New York, USA
| | - Seth Owusu-Agyei
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Patrick L. Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Alison G. Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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14
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Quinn AK, Adjei IA, Ae-Ngibise KA, Agyei O, Boamah-Kaali EA, Burkart K, Carrión D, Chillrud SN, Gould CF, Gyaase S, Jack DW, Kaali S, Kinney PL, Lee AG, Mujtaba MN, Oppong FB, Owusu-Agyei S, Yawson A, Wylie BJ, Asante KP. Prenatal household air pollutant exposure is associated with reduced size and gestational age at birth among a cohort of Ghanaian infants. ENVIRONMENT INTERNATIONAL 2021; 155:106659. [PMID: 34134048 PMCID: PMC8628363 DOI: 10.1016/j.envint.2021.106659] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/06/2021] [Accepted: 05/18/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND Low birth weight and prematurity are important risk factors for death and disability, and may be affected by prenatal exposure to household air pollution (HAP). METHODS We investigate associations between maternal exposure to carbon monoxide (CO) during pregnancy and birth outcomes (birth weight, birth length, head circumference, gestational age, low birth weight, small for gestational age, and preterm birth) among 1288 live-born infants in the Ghana Randomized Air Pollution and Health Study (GRAPHS). We evaluate whether evidence of malaria during pregnancy, as determined by placental histopathology, modifies these associations. RESULTS We observed effects of CO on birth weight, birth length, and gestational age that were modified by placental malarial status. Among infants from pregnancies without evidence of placental malaria, each 1 ppm increase in CO was associated with reduced birth weight (-53.4 g [95% CI: -84.8, -21.9 g]), birth length (-0.3 cm [-0.6, -0.1 cm]), gestational age (-1.0 days [-1.8, -0.2 days]), and weight-for-age Z score (-0.08 standard deviations [-0.16, -0.01 standard deviations]). These associations were not observed in pregnancies with evidence of placental malaria. Each 1 ppm increase in maternal exposure to CO was associated with elevated odds of low birth weight (LBW, OR 1.14 [0.97, 1.33]) and small for gestational age (SGA, OR 1.14 [0.98, 1.32]) among all infants. CONCLUSIONS Even modest reductions in exposure to HAP among pregnant women could yield substantial public health benefits, underscoring a need for interventions to effectively reduce exposure. Adverse associations with HAP were discernible only among those without evidence of placental malaria, a key driver of impaired fetal growth in this malaria-endemic area.
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Affiliation(s)
- Ashlinn K Quinn
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Oscar Agyei
- Kintampo Health Research Centre, Kintampo, Ghana
| | | | | | - Daniel Carrión
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven N Chillrud
- Mailman School of Public Health, Columbia University, New York, NY, USA; Lamont-Doherty Earth Observatory of Columbia University, Palisades, NY, USA
| | - Carlos F Gould
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Darby W Jack
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Seyram Kaali
- Kintampo Health Research Centre, Kintampo, Ghana
| | | | - Alison G Lee
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Kintampo, Ghana; Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Abena Yawson
- Kintampo Health Research Centre, Kintampo, Ghana
| | - Blair J Wylie
- Beth Israel Deaconess Medical Center, Boston, MA, USA.
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15
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Cho HJ, Lee SH, Lee SY, Kim HC, Kim HB, Park MJ, Yoon J, Jung S, Yang SI, Lee E, Ahn K, Kim KW, Suh DI, Sheen YH, Won HS, Lee MY, Kim SH, Lee KJ, Choi SJ, Kwon JY, Jun JK, Choi KY, Hong SJ. Mid-pregnancy PM 2.5 exposure affects sex-specific growth trajectories via ARRDC3 methylation. ENVIRONMENTAL RESEARCH 2021; 200:111640. [PMID: 34302828 DOI: 10.1016/j.envres.2021.111640] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/15/2021] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
Prenatal particulate matter <2.5 μm (PM2.5) is associated with adverse birth growth. However, the longitudinal growth impacts have been little studied, and no mechanistic relationships have been described. We investigated the association between prenatal PM2.5 exposure and growth trajectories, and the possible role of epigenetics. We enrolled 1313 neonates with PM2.5 data measured by ordinary kriging from the COhort for Childhood Origin of Asthma and allergic diseases, followed up at 1, 3, and 5 years to evaluate growth. Differential DNA methylation and pyrosequencing of cord blood leukocytes was evaluated according to the prenatal PM2.5 levels and birth weight (BW). PM2.5 exposure during the second trimester (T2) caused the lowest BW in both sexes, further adjusted for indoor PM2.5 levels [female, aOR 1.39 (95% CI 1.05-1.83); male, aOR 1.36 (95% CI 1.04-1.79)]. Bayesian distributed lag models with indoor PM2.5 adjustments revealed a sensitive window for BW effects at 10-26 weeks gestation, but only in females. Latent class mixture models indicated that a persistently low weight-for-height percentile trajectory was more prevalent in the highest PM2.5 exposure quartile at T2 in females, compared to a persistently high trajectory (36.5% vs. 20.3%, P = 0.022). Also, in the females only, the high PM2.5 and low BW neonates showed significantly greater ARRDC3 methylation changes. ARRDC3 methylation was also higher only in females with low weight at 5 years of age. Higher fetal PM2.5 exposure during T2 may cause a decreased growth trajectory, especially in females, mediated by ARRDC3 hyper-methylation-associated energy metabolism.
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Affiliation(s)
- Hyun-Ju Cho
- Department of Pediatrics, International St. Mary's Hospital, Catholic Kwandong University, Incheon, South Korea
| | - Seung-Hwa Lee
- Asan Institute for Life Science, University of Ulsan College of Medicine, Seoul, South Korea
| | - So-Yeon Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Humidifier Disinfectant Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hwan-Cheol Kim
- Department of Occupational and Environmental Medicine, Inha University School of Medicine, Incheon, South Korea
| | - Hyo-Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Min Jee Park
- Department of Pediatrics, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, South Korea
| | - Jisun Yoon
- Department of Pediatrics, MediplexSejong Hospital, South Korea
| | - Sungsu Jung
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Song-I Yang
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Environmental Health Center for Atopic Disease, Samsung Medical Center, Seoul, South Korea
| | - Kyung Won Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Youn Ho Sheen
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mi-Young Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Soo Hyun Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Kyung-Ju Lee
- Department of Obstetrics and Gynecology, Korea University Medical Center, Seoul, South Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ja-Young Kwon
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Kil-Yong Choi
- Department of Environmental Energy Engineering, Anyang University, Anyang, South Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Humidifier Disinfectant Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Ali MU, Yu Y, Yousaf B, Munir MAM, Ullah S, Zheng C, Kuang X, Wong MH. Health impacts of indoor air pollution from household solid fuel on children and women. JOURNAL OF HAZARDOUS MATERIALS 2021; 416:126127. [PMID: 34492921 DOI: 10.1016/j.jhazmat.2021.126127] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/12/2021] [Accepted: 05/12/2021] [Indexed: 05/11/2023]
Abstract
The inefficient and incomplete combustion of solid fuel (SF) is associated with high levels of indoor air pollutants leading to 3.55 million deaths annually. The risk is higher in women and children, due to their higher exposure duration and unique physical properties. The current article aims to provide a critical overview regarding the use of solid fuel, its associated pollutants, their toxicity mechanisms and, most importantly the associated health impacts, especially in women and children. Pollutants associated with SF mostly include polycyclic aromatic hydrocarbons, particulate matter, nitrous oxide, carbon monoxide and sulfur dioxide, and their concentrations are two- to threefold higher in indoor environments. These pollutants can lead to a variety of health risks by inducing different toxicity mechanisms, such as oxidative stress, DNA methylation, and gene activation. Exposed children have an increased prevalence of low birth weight, acute lower respiratory tract infections, anemia and premature mortality. On the other hand, lung cancer, chronic obstructive pulmonary disease and cardiovascular diseases are the major causes of disability and premature death in women. Indoor air pollution resulting from SF combustion is a major public health threat globally. To reduce the risks, it is important to identify future research gaps and implement effective interventions and policies.
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Affiliation(s)
- Muhammad Ubaid Ali
- Guangdong Provincial Key Laboratory of Soil and Groundwater Pollution Control, and State Environmental Protection Key Laboratory of Integrated Surface Water-Groundwater Pollution Control, School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen, China.
| | - Yangmei Yu
- Consortium on Health, Environment, Education and Research (CHEER), Department of Science and Environmental Studies, The Education University of Hong Kong, Hong Kong, China.
| | - Balal Yousaf
- Department of Environment Engineering, Middle East Technical University, Ankara 06800, Turkey; CAS-Key Laboratory of Crust-Mantle Materials and the Environments, School of Earth and Space Sciences, University of Science and Technology of China, Hefei 230026, China.
| | - Mehr Ahmed Mujtaba Munir
- CAS-Key Laboratory of Crust-Mantle Materials and the Environments, School of Earth and Space Sciences, University of Science and Technology of China, Hefei 230026, China.
| | - Sami Ullah
- Department of Forestry, Shaheed Benazir Bhutto University Sheringal, Dir Upper, KPK, Pakistan.
| | - Chunmiao Zheng
- Guangdong Provincial Key Laboratory of Soil and Groundwater Pollution Control, and State Environmental Protection Key Laboratory of Integrated Surface Water-Groundwater Pollution Control, School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen, China.
| | - Xingxing Kuang
- Guangdong Provincial Key Laboratory of Soil and Groundwater Pollution Control, and State Environmental Protection Key Laboratory of Integrated Surface Water-Groundwater Pollution Control, School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen, China.
| | - Ming Hung Wong
- Guangdong Provincial Key Laboratory of Soil and Groundwater Pollution Control, and State Environmental Protection Key Laboratory of Integrated Surface Water-Groundwater Pollution Control, School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen, China; Consortium on Health, Environment, Education and Research (CHEER), Department of Science and Environmental Studies, The Education University of Hong Kong, Hong Kong, China.
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Nishihama Y, Jung CR, Nakayama SF, Tamura K, Isobe T, Michikawa T, Iwai-Shimada M, Kobayashi Y, Sekiyama M, Taniguchi Y, Yamazaki S. Indoor air quality of 5,000 households and its determinants. Part A: Particulate matter (PM 2.5 and PM 10-2.5) concentrations in the Japan Environment and Children's Study. ENVIRONMENTAL RESEARCH 2021; 198:111196. [PMID: 33939980 DOI: 10.1016/j.envres.2021.111196] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 06/12/2023]
Abstract
Exposure to particulate matter (PM) is one of the important risk factors for morbidity and mortality. Although PM concentrations have been assessed using air quality monitoring stations or modelling, few studies have measured indoor PM in large-scale birth cohorts. The Japan Environment and Children's Study (JECS) measured indoor and outdoor air quality in approximately 5000 households when the participating children were aged 1.5 and 3 years. PM was collected using portable pumps for 7 days (total of 24 h), inside and outside each home. Prediction models for indoor PM concentrations were built using data collected at age 1.5 years and post-validated against data collected at age 3 years. Median indoor/outdoor PM2.5 and PM10-2.5 concentrations at age 1.5 years [3 years] were 12.9/12.7 [12.5/11.3] μg/m3 and 5.0/6.3 [5.1/6.1] μg/m3, respectively. Random forest regression analysis found that the major predictors of indoor PM2.5 were indoor PM10-2.5, outdoor PM2.5, indoor smoking, observable smoke and indoor/outdoor temperature. Indoor PM2.5, outdoor PM10-2.5, indoor humidity and opening room windows were important predictors of indoor PM10-2.5 concentrations. Indoor benzene, acetaldehyde, ozone and nitrogen dioxide concentrations were also found to predict indoor PM2.5 and PM10-2.5 concentrations, possibly due to the formation of secondary organic aerosols. These findings demonstrate the importance of reducing outdoor PM concentrations, avoiding indoor smoking, using air cleaner in applicable and diminishing sources of VOCs that could form secondary organic aerosols, and the resulting models can be used to predict indoor PM concentrations for the rest of the JECS cohort.
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Affiliation(s)
- Yukiko Nishihama
- Japan Environment and Children's Study Programme Office, Health and Environmental Risk Division, National Institute for Environmental Studies, Tsukuba, Japan
| | - Chau-Ren Jung
- Japan Environment and Children's Study Programme Office, Health and Environmental Risk Division, National Institute for Environmental Studies, Tsukuba, Japan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Shoji F Nakayama
- Japan Environment and Children's Study Programme Office, Health and Environmental Risk Division, National Institute for Environmental Studies, Tsukuba, Japan.
| | - Kenji Tamura
- Japan Environment and Children's Study Programme Office, Health and Environmental Risk Division, National Institute for Environmental Studies, Tsukuba, Japan
| | - Tomohiko Isobe
- Japan Environment and Children's Study Programme Office, Health and Environmental Risk Division, National Institute for Environmental Studies, Tsukuba, Japan
| | - Takehiro Michikawa
- Japan Environment and Children's Study Programme Office, Health and Environmental Risk Division, National Institute for Environmental Studies, Tsukuba, Japan; Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Miyuki Iwai-Shimada
- Japan Environment and Children's Study Programme Office, Health and Environmental Risk Division, National Institute for Environmental Studies, Tsukuba, Japan
| | - Yayoi Kobayashi
- Japan Environment and Children's Study Programme Office, Health and Environmental Risk Division, National Institute for Environmental Studies, Tsukuba, Japan
| | - Makiko Sekiyama
- Japan Environment and Children's Study Programme Office, Health and Environmental Risk Division, National Institute for Environmental Studies, Tsukuba, Japan
| | - Yu Taniguchi
- Japan Environment and Children's Study Programme Office, Health and Environmental Risk Division, National Institute for Environmental Studies, Tsukuba, Japan
| | - Shin Yamazaki
- Japan Environment and Children's Study Programme Office, Health and Environmental Risk Division, National Institute for Environmental Studies, Tsukuba, Japan
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18
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Carvalho MA, Hettfleisch K, Rodrigues AS, Benachi A, Vieira SE, Saldiva SRDM, Saldiva PHN, Francisco RPV, Bernardes LS. Association between exposure to air pollution during intrauterine life and cephalic circumference of the newborn. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:9701-9711. [PMID: 33151495 DOI: 10.1007/s11356-020-11274-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/15/2020] [Indexed: 06/11/2023]
Abstract
It has been observed that air pollution can affect newborn health due to the negative effects of pollutants on pregnancy development. However, few studies have evaluated the impact of maternal exposure to urban air pollution on head circumference (HC) at birth. Reduced head growth during pregnancy may be associated with neurocognitive deficits in childhood. The objectives of this study were to evaluate the association between maternal exposure to air pollution and HC at birth and to provide context with a systematic review to investigate this association. This was a prospective study of low-risk pregnant women living in São Paulo, Brazil. Exposure to pollutants, namely, nitrogen dioxide (NO2) and ozone (O3), was measured during each trimester using passive personal samplers. We measured newborn HC until 24 h after birth. We used multiple linear regression models to evaluate the association between pollutants and HC while controlling for known determinants of pregnancy. To perform the systematic review, four different electronic databases were searched through November 2018: CENTRAL, EMBASE, LILACS, and MEDLINE. We selected longitudinal or transversal designs associating air pollution and HC at birth. Two reviewers evaluated the inclusion criteria and risk of bias and extracted data from the included papers. Thirteen studies were selected for the systematic review. We evaluated 391 patients, and we did not observe a significant association between air pollution and HC. Regarding the systematic review, 13 studies were selected for the systematic review, 8 studies showed an inverse association between maternal exposure to pollutants and HC, 4 showed no association, and one observed a direct association. In the city of São Paulo, maternal exposure to pollutants was not significantly associated with HC at birth. The systematic review suggested an inverse association between air pollution and HC at birth.
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Affiliation(s)
- Mariana Azevedo Carvalho
- Department of Obstetrics and Gynecology, São Paulo University Medical School, 255, Av. Dr. Enéas de Carvalho Aguiar, São Paulo, 05403-900, Brazil
| | - Karen Hettfleisch
- Department of Obstetrics and Gynecology, São Paulo University Medical School, 255, Av. Dr. Enéas de Carvalho Aguiar, São Paulo, 05403-900, Brazil
| | - Agatha S Rodrigues
- Department of Obstetrics and Gynecology, São Paulo University Medical School, 255, Av. Dr. Enéas de Carvalho Aguiar, São Paulo, 05403-900, Brazil
- Department of Statistics, Federal University of Espírito Santo, Vitória, Brazil
| | - Alexandra Benachi
- Department of Ob-GYN and Reproductive Medecine, Antoine Beclere Hospital, Assistance Publique-Hopitaux de Paris, 92141, Clamart, France
| | - Sandra Elisabete Vieira
- Department of Pediatrics, São Paulo University Medical School, 255, Av. Dr. Enéas de Carvalho Aguiar, São Paulo, 05403-900, Brazil
| | - Silvia R D M Saldiva
- Health Institute, State Health Secretariat, 590, Rua Santo Antônio, São Paulo, 01314-000, Brazil
| | - Paulo Hilário N Saldiva
- Institute of Advanced Studies of the University of São Paulo, 455, Av. Dr Arnaldo, São Paulo, 01246-903, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Department of Obstetrics and Gynecology, São Paulo University Medical School, 255, Av. Dr. Enéas de Carvalho Aguiar, São Paulo, 05403-900, Brazil
| | - Lisandra Stein Bernardes
- Department of Obstetrics and Gynecology, São Paulo University Medical School, 255, Av. Dr. Enéas de Carvalho Aguiar, São Paulo, 05403-900, Brazil.
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Shezi B, Jafta N, Naidoo RN. 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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Affiliation(s)
- Busisiwe Shezi
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- South African Medical Research Council, Environment and Health Research Unit, Durban, South Africa
| | - Nkosana Jafta
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Rajen N Naidoo
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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20
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Grajeda LM, Thompson LM, Arriaga W, Canuz E, Omer SB, Sage M, Azziz-Baumgartner E, Bryan JP, McCracken JP. Effectiveness of Gas and Chimney Biomass Stoves for Reducing Household Air Pollution Pregnancy Exposure in Guatemala: Sociodemographic Effect Modifiers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217723. [PMID: 33105825 PMCID: PMC7660060 DOI: 10.3390/ijerph17217723] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 12/18/2022]
Abstract
Household air pollution (HAP) due to solid fuel use during pregnancy is associated with adverse birth outcomes. The real-life effectiveness of clean cooking interventions has been disappointing overall yet variable, but the sociodemographic determinants are not well described. We measured personal 24-h PM2.5 (particulate matter <2.5 µm in aerodynamic diameter) thrice in pregnant women (n = 218) gravimetrically with Teflon filter, impactor, and personal pump setups. To estimate the effectiveness of owning chimney and liquefied petroleum gas (LPG) stoves (i.e., proportion of PM2.5 exposure that would be prevented) and to predict subject-specific typical exposures, we used linear mixed-effects models with log (PM2.5) as dependent variable and random intercept for subject. Median (IQR) personal PM2.5 in µg/m3 was 148 (90-249) for open fire, 78 (51-125) for chimney stove, and 55 (34-79) for LPG stoves. Adjusted effectiveness of LPG stoves was greater in women with ≥6 years of education (49% (95% CI: 34, 60)) versus <6 years (26% (95% CI: 5, 42)). In contrast, chimney stove adjusted effectiveness was greater in women with <6 years of education (50% (95% CI: 38, 60)), rural residence (46% (95% CI: 34, 55)) and lowest SES (socio-economic status) quartile (59% (95% CI: 45, 70)) than ≥6 years education (16% (95% CI: 22, 43)), urban (23% (95% CI: -164, 42)) and highest SES quartile (-44% (95% CI: -183, 27)), respectively. A minority of LPG stove owners (12%) and no chimney owner had typical exposure below World Health Organization Air Quality guidelines (35 μg/m3). Although having a cleaner stove alone typically does not lower exposure enough to protect health, understanding sociodemographic determinants of effectiveness may lead to better targeting, implementation, and adoption of interventions.
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Affiliation(s)
- Laura M. Grajeda
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala; (E.C.); (J.P.M.)
- Correspondence:
| | - Lisa M. Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA;
| | - William Arriaga
- Regional Hospital, Ministry of Public Health Social Assistance of Guatemala, Quetzaltenango 09001, Guatemala;
| | - Eduardo Canuz
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala; (E.C.); (J.P.M.)
| | - Saad B. Omer
- Yale Institute for Global Health, Schools of Public Health & Medicine, Yale University, New Haven, CT 06510, USA;
| | - Michael Sage
- Division of Environmental Hazards and Health Effects, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA;
| | | | - Joe P. Bryan
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA;
- Centers for Disease Control and Prevention, Central American Regional Office, Guatemala City 01015, Guatemala
| | - John P. McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala; (E.C.); (J.P.M.)
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21
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Cooking fuels use and carotid intima-media thickness during early pregnancy of women in Myanmar. PLoS One 2020; 15:e0236151. [PMID: 32726349 PMCID: PMC7390349 DOI: 10.1371/journal.pone.0236151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fuels burned in households for cooking cause indoor air pollution, exposing those who are cooking. Despite the mounting evidence of the effects of fuels use on health, few studies focus on the effect of cooking fuels have on carotid intima-media thickness (CIMT), a surrogate atherosclerosis biomarker in the early stages of pregnancy. This study aimed to examine the association between the use of cooking fuels and CIMT during early trimester of pregnancy among cooking women in Myanmar. METHODOLOGY In this cross-sectional study, a part of an ongoing birth cohort analysis, a total of 192 cooking pregnant women over 18 years with gestational weeks less than 18 were recruited from 15 rural health centers in Nay Pyi Taw from September to November 2019. Sociodemographic data, residential data, and fuels use data were collected with semi-structured questionnaires in face-to-face interviews. Anthropometric, hemodynamic, blood lipids, and ultrasound CIMT measurements were performed under standard protocols. Multiple linear regression was modeled to explore associations. RESULTS The study included 70 firewood fuel users, 26 charcoal fuel users, and 96 electricity fuel users. Following adjustments for potential confounding factors, firewood use was significantly associated with the increase of all CIMT analyzed. Importantly, a greater increase of mean CIMT of the right common carotid artery (RCCA; β = 0.033 mm; 95%CI: 0.006, 0.058; P<0.05) had significant association with charcoal use compared to firewood use (β = 0.029 mm; 95%CI: 0.010, 0.049; P<0.05). CONCLUSIONS Our findings demonstrate that the indoor use of cooking fuels that cause indoor air pollution, such as firewood and charcoal, is a considerable risk factor for human health and is associated with increased CIMT, wherein charcoal use contributes to more increase of mean CIMT of the RCCA. Measures to prevent health risks related to the use of such fuels should be instituted early on during pregnancy.
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22
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Pratiti R, Vadala D, Kalynych Z, Sud P. Health effects of household air pollution related to biomass cook stoves in resource limited countries and its mitigation by improved cookstoves. ENVIRONMENTAL RESEARCH 2020; 186:109574. [PMID: 32668541 DOI: 10.1016/j.envres.2020.109574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/20/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Household air pollution (HAP) related to cooking is associated with significant global morbidity and mortality. An estimated three billion people worldwide are exposed to cooking related HAP caused by solid fuel combustion. This exposure is highest for the vulnerable population of women and children resulting in significant cumulative health effects. METHODS A literature review was conducted for health effects of household air pollution related to biomass cookstoves in resource limited countries and to evaluate the effect of improved cookstoves on these health effects. We searched PubMed, Embase and Cochrane Library. We conducted searches in January 2018 with a repeat in February 2020. We included only studies conducted in resource limited countries, published in English, irrespective of publication year and studies that examined the health effects of HAP and/or studied the effects of improved cookstove (IC). Two authors independently screened journal article titles, abstracts and full-text articles to identify those that included the following search term: biomass cookstoves and health risks. We also assessed the limitations of IC with barriers to their uptake. RESULTS Health effects associated with HAP mostly include increased blood pressure (BP), dyspnea, childhood pneumonia, lung cancer, low birthweight and cardiovascular diseases. Being a global problem with divergent environmental factors including wide variety of fuel used, housing condition, foods prepared, climatic condition and social factors; most solutions though efficient seems inadequate. Improved cookstove (IC) mitigates emissions and improves short term health, though few randomized long-term studies could substantiate its long-standing continuance and health benefits. CONCLUSION There is ample data about the health effects of HAP, with some benefit with IC intervention for elevated blood pressure, dyspnea symptoms, mutagenicity and cardiovascular diseases. IC does not have any benefit in pregnancy outcomes or children health.
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Affiliation(s)
- Rebecca Pratiti
- McLaren HealthCare, G-3245 Beecher Rd, Flint, MI, 48532, USA.
| | - David Vadala
- McLaren HealthCare, G-3245 Beecher Rd, Flint, MI, 48532, USA
| | - Zirka Kalynych
- McLaren HealthCare, G-3245 Beecher Rd, Flint, MI, 48532, USA
| | - Parul Sud
- McLaren HealthCare, G-3245 Beecher Rd, Flint, MI, 48532, USA
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Shezi B, Jafta N, Asharam K, Tularam H, Barregård L, Naidoo RN. Predictors of urban household variability of indoor PM 2.5 in low socio-economic communities. ENVIRONMENTAL SCIENCE. PROCESSES & IMPACTS 2020; 22:1423-1433. [PMID: 32469021 DOI: 10.1039/d0em00035c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In epidemiological studies, levels of PM2.5 need to be estimated over time and space. Because of logistical constraints, very few studies have been conducted to assess the variability within and across homes and the predictors of this variability. This study evaluated within- and between-home variability of indoor PM2.5 and identified predictors for PM2.5 in homes of mothers participating in the urban Mother and Child in the Environment birth cohort study in Durban, South Africa. Thirty homes were selected from 300 homes that were previously sampled for PM2.5. Two measurements of PM2.5 levels were conducted in each home within a 1 week interval in both warm and cold seasons (four samplings per home) using Airmetrics MiniVol samplers. A linear mixed-effect model was used to evaluate within- and between-home variability and to identify fixed effects (predictors) that result in reduced variability. The PM2.5 levels in the 30 homes ranged from 2 to 303 μg m-3. The within-home variability accounted for 94% of the total variability in the log-transformed PM2.5 levels for the 30 homes. The fixed effects extracted from the repeated samplings in the present study were used to improve a previously developed multivariable linear regression model for 300 homes, and thereby increased the R2 from 0.50 to 0.54. Inclusion of fixed-effects in multivariable linear regression models resulted in a reasonably robust model that can be used to predict PM2.5 levels in unmeasured homes of the cohort.
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Affiliation(s)
- Busisiwe Shezi
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa. and South African Medical Research Council, Environment and Health Research Unit, Johannesburg, South Africa
| | - Nkosana Jafta
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Kareshma Asharam
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Hasheel Tularam
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Lars Barregård
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Sweden
| | - Rajen N Naidoo
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
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24
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Woolley K, Bartington SE, Pope FD, Price MJ, Thomas GN, Kabera T. Biomass cooking carbon monoxide levels in commercial canteens in Kigali, Rwanda. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2020; 76:75-85. [PMID: 32400286 DOI: 10.1080/19338244.2020.1761279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Carbon monoxide (CO) is harmful to human health, yet there is limited evidence concerning emissions associated with biomass fuel cooking in occupational settings. Real-time 48-hour monitoring of CO concentrations at breathing height, was undertaken in staff and student kitchen and serving areas of two commercial canteens. We characterized two diurnal CO peaks coinciding with cooking activities. Peak CO concentrations of 255.5 ppm and 1-hour average of 76.3 ppm (IQR: 57.8-109.0 ppm) were observed in the student kitchen; the staff kitchen levels were 208.5 ppm, and 76.3 ppm (IQR: 52.5-114.0 ppm), respectively. High magnitude CO concentrations (8-hour average: 40.7 ppm SD: 40.0 ppm) which exceed World Health Organisation (WHO) Indoor Air Quality standards were observed. Further investigation of personal exposure and health impacts among kitchen staff is required, to inform interventions in this setting.
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Affiliation(s)
- Katherine Woolley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Francis D Pope
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Malcolm J Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Telesphore Kabera
- College of Science and Technology, University of Rwanda, Kigali, Rwanda
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25
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Clasen T, Checkley W, Peel JL, Balakrishnan K, McCracken JP, Rosa G, Thompson LM, Barr DB, Clark ML, Johnson MA, Waller LA, Jaacks LM, Steenland K, Miranda JJ, Chang HH, Kim DY, McCollum ED, Davila-Roman VG, Papageorghiou A, Rosenthal JP. Design and Rationale of the HAPIN Study: A Multicountry Randomized Controlled Trial to Assess the Effect of Liquefied Petroleum Gas Stove and Continuous Fuel Distribution. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:47008. [PMID: 32347766 PMCID: PMC7228119 DOI: 10.1289/ehp6407] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND Globally, nearly 3 billion people rely on solid fuels for cooking and heating, the vast majority residing in low- and middle-income countries (LMICs). The resulting household air pollution (HAP) is a leading environmental risk factor, accounting for an estimated 1.6 million premature deaths annually. Previous interventions of cleaner stoves have often failed to reduce exposure to levels that produce meaningful health improvements. There have been no multicountry field trials with liquefied petroleum gas (LPG) stoves, likely the cleanest scalable intervention. OBJECTIVE This paper describes the design and methods of an ongoing randomized controlled trial (RCT) of LPG stove and fuel distribution in 3,200 households in 4 LMICs (India, Guatemala, Peru, and Rwanda). METHODS We are enrolling 800 pregnant women at each of the 4 international research centers from households using biomass fuels. We are randomly assigning households to receive LPG stoves, an 18-month supply of free LPG, and behavioral reinforcements to the control arm. The mother is being followed along with her child until the child is 1 year old. Older adult women (40 to < 80 years of age) living in the same households are also enrolled and followed during the same period. Primary health outcomes are low birth weight, severe pneumonia incidence, stunting in the child, and high blood pressure (BP) in the older adult woman. Secondary health outcomes are also being assessed. We are assessing stove and fuel use, conducting repeated personal and kitchen exposure assessments of fine particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ), carbon monoxide (CO), and black carbon (BC), and collecting dried blood spots (DBS) and urinary samples for biomarker analysis. Enrollment and data collection began in May 2018 and will continue through August 2021. The trial is registered with ClinicalTrials.gov (NCT02944682). CONCLUSIONS This study will provide evidence to inform national and global policies on scaling up LPG stove use among vulnerable populations. https://doi.org/10.1289/EHP6407.
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Affiliation(s)
- Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, Tamil Nadu, India
| | - John P. McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Ghislaine Rosa
- Department of Disease Control, Faculty of Infections and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Lisa M. Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Dana Boyd Barr
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Maggie L. Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | | | - Lance A. Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lindsay M. Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kyle Steenland
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Howard H. Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Dong-Yun Kim
- Office of Biostatistics Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Eric D. McCollum
- Eudowood Division of Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Victor G. Davila-Roman
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Aris Papageorghiou
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | - Joshua P. Rosenthal
- Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - HAPIN Investigators
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, Tamil Nadu, India
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
- Department of Disease Control, Faculty of Infections and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
- Berkeley Air Monitoring Group, Berkeley, California, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Office of Biostatistics Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Eudowood Division of Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
- Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
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26
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Tadevosyan A, Mikulski MA, Baber Wallis A, Rubenstein L, Abrahamyan S, Arestakesyan L, Hovsepyan M, Reynolds SJ, Fuortes LJ. 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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Affiliation(s)
- Artashes Tadevosyan
- Department of Public Health and Healthcare Organization, Yerevan State Medical University, Yerevan, Armenia
| | - Marek A Mikulski
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Anne Baber Wallis
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Linda Rubenstein
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Satenik Abrahamyan
- Department of Public Health and Healthcare Organization, Yerevan State Medical University, Yerevan, Armenia
| | - Lusine Arestakesyan
- Department of Public Health and Healthcare Organization, Yerevan State Medical University, Yerevan, Armenia
| | - Marina Hovsepyan
- Arabkir Joint Medical Center- Institute of Child and Adolescent Health, Yerevan, Armenia
| | - Steve J Reynolds
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Laurence J Fuortes
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA, USA
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27
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Joubert BR, Mantooth SN, McAllister KA. Environmental Health Research in Africa: Important Progress and Promising Opportunities. Front Genet 2020; 10:1166. [PMID: 32010175 PMCID: PMC6977412 DOI: 10.3389/fgene.2019.01166] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 10/23/2019] [Indexed: 12/16/2022] Open
Abstract
The World Health Organization in 2016 estimated that over 20% of the global disease burden and deaths were attributed to modifiable environmental factors. However, data clearly characterizing the impact of environmental exposures and health endpoints in African populations is limited. To describe recent progress and identify important research gaps, we reviewed literature on environmental health research in African populations over the last decade, as well as research incorporating both genomic and environmental factors. We queried PubMed for peer-reviewed research articles, reviews, or books examining environmental exposures and health outcomes in human populations in Africa. Searches utilized medical subheading (MeSH) terms for environmental exposure categories listed in the March 2018 US National Report on Human Exposure to Environmental Chemicals, which includes chemicals with worldwide distributions. Our search strategy retrieved 540 relevant publications, with studies evaluating health impacts of ambient air pollution (n=105), indoor air pollution (n = 166), heavy metals (n = 130), pesticides (n = 95), dietary mold (n = 61), indoor mold (n = 9), per- and polyfluoroalkyl substances (PFASs, n = 0), electronic waste (n = 9), environmental phenols (n = 4), flame retardants (n = 8), and phthalates (n = 3), where publications could belong to more than one exposure category. Only 23 publications characterized both environmental and genomic risk factors. Cardiovascular and respiratory health endpoints impacted by air pollution were comparable to observations in other countries. Air pollution exposures unique to Africa and some other resource limited settings were dust and specific occupational exposures. Literature describing harmful health effects of metals, pesticides, and dietary mold represented a context unique to Africa. Studies of exposures to phthalates, PFASs, phenols, and flame retardants were very limited. These results underscore the need for further focus on current and emerging environmental and chemical health risks as well as better integration of genomic and environmental factors in African research studies. Environmental exposures with distinct routes of exposure, unique co-exposures and co-morbidities, combined with the extensive genomic diversity in Africa may lead to the identification of novel mechanisms underlying complex disease and promising potential for translation to global public health.
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Affiliation(s)
- Bonnie R Joubert
- National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, United States
| | | | - Kimberly A McAllister
- National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, United States
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28
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Lyon-Caen S, Siroux V, Lepeule J, Lorimier P, Hainaut P, Mossuz P, Quentin J, Supernant K, Meary D, Chaperot L, Bayat S, Cassee F, Valentino S, Couturier-Tarrade A, Rousseau-Ralliard D, Chavatte-Palmer P, Philippat C, Pin I, Slama R, Study Group TS. Deciphering the Impact of Early-Life Exposures to Highly Variable Environmental Factors on Foetal and Child Health: Design of SEPAGES Couple-Child Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3888. [PMID: 31615055 PMCID: PMC6843812 DOI: 10.3390/ijerph16203888] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/20/2019] [Accepted: 10/02/2019] [Indexed: 12/16/2022]
Abstract
In humans, studies based on Developmental Origins of Health and Disease (DOHaD) concept and targeting short half-lived chemicals, including many endocrine disruptors, generally assessed exposures from spot biospecimens. Effects of early-life exposure to atmospheric pollutants were reported, based on outdoor air pollution levels. For both exposure families, exposure misclassification is expected from these designs: for non-persistent chemicals, because a spot biospecimen is unlikely to capture exposure over windows longer than a few days; for air pollutants, because indoor levels are ignored. We developed a couple-child cohort relying on deep phenotyping and extended personal exposure assessment aiming to better characterize the effects of components of the exposome, including air pollutants and non-persistent endocrine disruptors, on child health and development. Pregnant women were included in SEPAGES couple-child cohort (Grenoble area) from 2014 to 2017. Maternal and children exposure to air pollutants was repeatedly assessed by personal monitors. DNA, RNA, serum, plasma, placenta, cord blood, meconium, child and mother stools, living cells, milk, hair and repeated urine samples were collected. A total of 484 pregnant women were recruited, with excellent compliance to the repeated urine sampling protocol (median, 43 urine samples per woman during pregnancy). The main health outcomes are child respiratory health using early objective measures, growth and neurodevelopment. Compared to former studies, the accuracy of assessment of non-persistent exposures is expected to be strongly improved in this new type of birth cohort tailored for the exposome concept, with deep phenotyping and extended exposure characterization. By targeting weaknesses in exposure assessment of the current approaches of cohorts on effects of early life environmental exposures with strong temporal variations, and relying on a rich biobank to provide insight on the underlying biological pathways whereby exposures affect health, this design is expected to provide deeper understanding of the interplay between the Exposome and child development and health.
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Affiliation(s)
- Sarah Lyon-Caen
- Inserm, CNRS, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, IAB (Institute for Advanced Biosciences) Joint Research Center, University Grenoble Alpes, 38700 Grenoble, France.
| | - Valérie Siroux
- Inserm, CNRS, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, IAB (Institute for Advanced Biosciences) Joint Research Center, University Grenoble Alpes, 38700 Grenoble, France.
| | - Johanna Lepeule
- Inserm, CNRS, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, IAB (Institute for Advanced Biosciences) Joint Research Center, University Grenoble Alpes, 38700 Grenoble, France.
| | - Philippe Lorimier
- Biological Ressources Centre (CRB), Grenoble University Hospital, 38700 La Tronche, France.
| | - Pierre Hainaut
- Inserm, CNRS, Team of Tumor Molecular Pathology and Biomarkers, IAB (Institute for Advanced Biosciences) Joint Research Center, University Grenoble Alpes, 38700 Grenoble, France.
| | - Pascal Mossuz
- Biological Ressources Centre (CRB), Grenoble University Hospital, 38700 La Tronche, France.
| | - Joane Quentin
- Inserm, CNRS, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, IAB (Institute for Advanced Biosciences) Joint Research Center, University Grenoble Alpes, 38700 Grenoble, France.
- Pediatric Department, Grenoble University Hospital, 38700 La Tronche, France.
| | - Karine Supernant
- Inserm, CNRS, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, IAB (Institute for Advanced Biosciences) Joint Research Center, University Grenoble Alpes, 38700 Grenoble, France.
| | - David Meary
- CNRS, LPNC UMR 5105, University Grenoble Alpes, 38000 Grenoble, France.
| | - Laurence Chaperot
- Inserm, CNRS, Team of Immunobiology and Immunotherapy in Chronic Diseases, IAB (Institute for Advanced Biosciences) Joint Research Center, University Grenoble Alpes, 38700 Grenoble, France.
- Etablissement Français du Sang Auvergne-Rhône-Alpes, Research and Development Laboratory, 38700 Grenoble, France.
| | - Sam Bayat
- Pediatric Department, Grenoble University Hospital, 38700 La Tronche, France.
- Inserm UA7, Synchrotron Radiation for Biomedicine Laboratory (STROBE), University Grenoble Alpes, 38000 Grenoble, France.
| | - Flemming Cassee
- National Institute for Public Health and the Environment, 3720 Bilthoven, The Netherlands.
- Institute of Risk Assessment Studies, Utrecht University, 3508 Utrecht, The Netherlands.
| | - Sarah Valentino
- UMR BDR, INRA, ENVA, Université Paris Saclay, 78350 Jouy-en-Josas, France.
| | | | | | | | - Claire Philippat
- Inserm, CNRS, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, IAB (Institute for Advanced Biosciences) Joint Research Center, University Grenoble Alpes, 38700 Grenoble, France.
| | - Isabelle Pin
- Inserm, CNRS, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, IAB (Institute for Advanced Biosciences) Joint Research Center, University Grenoble Alpes, 38700 Grenoble, France.
- Pediatric Department, Grenoble University Hospital, 38700 La Tronche, France.
| | - Rémy Slama
- Inserm, CNRS, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, IAB (Institute for Advanced Biosciences) Joint Research Center, University Grenoble Alpes, 38700 Grenoble, France.
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Curto A, Donaire-Gonzalez D, Manaca MN, González R, Sacoor C, Rivas I, Gascon M, Wellenius GA, Querol X, Sunyer J, Macete E, Menéndez C, Tonne C. Predictors of personal exposure to black carbon among women in southern semi-rural Mozambique. ENVIRONMENT INTERNATIONAL 2019; 131:104962. [PMID: 31301586 DOI: 10.1016/j.envint.2019.104962] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/06/2019] [Accepted: 06/23/2019] [Indexed: 05/22/2023]
Abstract
Sub-Saharan Africa (SSA) has the highest proportion of people using unclean fuels for household energy, which can result in products of incomplete combustion that are damaging for health. Black carbon (BC) is a useful marker of inefficient combustion-related particles; however, ambient air quality data and temporal patterns of personal exposure to BC in SSA are scarce. We measured ambient elemental carbon (EC), comparable to BC, and personal exposure to BC in women of childbearing age from a semi-rural area of southern Mozambique. We measured ambient EC over one year (2014-2015) using a high-volume sampler and an off-line thermo-optical-transmission method. We simultaneously measured 5-min resolved 24-h personal BC using a portable MicroAeth (AE51) in 202 women. We used backwards stepwise linear regression to identify predictors of log-transformed 24-h mean and peak (90th percentile) personal BC exposure. We analyzed data from 187 non-smoking women aged 16-46 years. While daily mean ambient EC reached moderate levels (0.9 μg/m3, Standard Deviation, SD: 0.6 μg/m3), daily mean personal BC reached high levels (15 μg/m3, SD: 19 μg/m3). Daily patterns of personal exposure revealed a peak between 6 and 7 pm (>35 μg/m3), attributable to kerosene-based lighting. Key determinants of mean and peak personal exposure to BC were lighting source, kitchen type, ambient EC levels, and temperature. This study highlights the important contribution of lighting sources to personal exposure to combustion particles in populations that lack access to clean household energy.
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Affiliation(s)
- Ariadna Curto
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - David Donaire-Gonzalez
- Institute for Risk Assessment Sciences (IRAS), Division of Environmental Epidemiology (EEPI), Utrecht University, Utrecht, the Netherlands; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Maria N Manaca
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | - Raquel González
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Charfudin Sacoor
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | - Ioar Rivas
- Institute for Environmental Assessment and Water Research (IDÆA-CSIC), Barcelona, Spain; MRC-PHE Centre for Environment & Health, Environmental Research Group, King's College London, London, UK
| | - Mireia Gascon
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Xavier Querol
- Institute for Environmental Assessment and Water Research (IDÆA-CSIC), Barcelona, Spain
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Eusébio Macete
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | - Clara Menéndez
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Cathryn Tonne
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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30
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North CM, MacNaughton P, Lai PS, Vallarino J, Okello S, Kakuhikire B, Tsai AC, Castro MC, Siedner MJ, Allen JG, Christiani DC. Personal carbon monoxide exposure, respiratory symptoms, and the potentially modifying roles of sex and HIV infection in rural Uganda: a cohort study. Environ Health 2019; 18:73. [PMID: 31429759 PMCID: PMC6701123 DOI: 10.1186/s12940-019-0517-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 08/12/2019] [Indexed: 05/04/2023]
Abstract
BACKGROUND Most of the global burden of pollution-related morbidity and mortality is believed to occur in resource-limited settings, where HIV serostatus and sex may influence the relationship between air pollution exposure and respiratory morbidity. The lack of air quality monitoring networks in these settings limits progress in measuring global disparities in pollution-related health. Personal carbon monoxide monitoring may identify sub-populations at heightened risk for air pollution-associated respiratory morbidity in regions of the world where the financial cost of air quality monitoring networks is prohibitive. METHODS From September 2015 through May 2017, we measured 48-h ambulatory carbon monoxide (CO) exposure in a longitudinal cohort of HIV-infected and uninfected adults in rural southwestern Uganda. We fit generalized mixed effects models to identify correlates of CO exposure exceeding international air quality thresholds, quantify the relationship between CO exposure and respiratory symptoms, and explore potential effect modification by sex and HIV serostatus. RESULTS Two hundred and sixty study participants completed 419 sampling periods. Personal CO exposure exceeded international thresholds for 50 (19%) participants. In covariate-adjusted models, living in a home where charcoal was the main cooking fuel was associated with CO exposure exceeding international thresholds (adjusted odds ratio [AOR] 11.3, 95% confidence interval [95%CI] 4.7-27.4). In sex-stratified models, higher CO exposure was associated with increased odds of respiratory symptoms among women (AOR 3.3, 95%CI 1.1-10.0) but not men (AOR 1.3, 95%CI 0.4-4.4). In HIV-stratified models, higher CO exposure was associated with increased odds of respiratory symptoms among HIV-infected (AOR 2.5, 95%CI 1.01-6.0) but not HIV-uninfected (AOR 1.4, 95%CI 0.1-14.4) participants. CONCLUSIONS In a cohort in rural Uganda, personal CO exposure frequently exceeded international thresholds, correlated with biomass exposure, and was associated with respiratory symptoms among women and people living with HIV. Our results provide support for the use of ambulatory CO monitoring as a low-cost, feasible method to identify subgroups with heightened vulnerability to pollution-related respiratory morbidity in resource-limited settings and identify subgroups that may have increased susceptibility to pollution-associated respiratory morbidity.
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Affiliation(s)
- Crystal M. North
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | | | - Peggy S. Lai
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Jose Vallarino
- Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Samson Okello
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Mbarara University of Science and Technology, Mbarara, Uganda
- University of Virginia Health System, Charlottesville, USA
| | | | - Alexander C. Tsai
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard Medical School, Boston, MA USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Mark J. Siedner
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard Medical School, Boston, MA USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joseph G. Allen
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - David C. Christiani
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
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Socioeconomic determinants of community knowledge and practice in relation to malaria in high- and low-transmission areas of central India. J Biosoc Sci 2019; 52:317-329. [PMID: 31296270 DOI: 10.1017/s0021932019000440] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study was undertaken with an aim of exploring community knowledge and treatment practices related to malaria and their determinants in high- and low-transmission areas of central India. A community-based cross-sectional study was carried out between August 2015 and January 2016 in two high- and two low-malaria-endemic districts of central India. A total of 1470 respondents were interviewed using a pre-tested structured interview schedule. Respondents residing in high-transmission areas with higher literacy levels, and of higher socioeconomic status, were found to practise more modern preventive measures than those living in low-transmission areas with low literacy levels and who were economically poor. Level of literacy, socioeconomic status and area (district) of residence were found to be the main factors affecting people's knowledge of malaria aetiology and clinical features, and prevention and treatment practices, in this community in central India.
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Yuan L, Zhang Y, Gao Y, Tian Y. Maternal fine particulate matter (PM 2.5) exposure and adverse birth outcomes: an updated systematic review based on cohort studies. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:13963-13983. [PMID: 30891704 DOI: 10.1007/s11356-019-04644-x] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/19/2019] [Indexed: 04/16/2023]
Abstract
Exposure to ambient air pollutants during pregnancy may be associated with numerous side health effects and adverse birth outcomes. Growing numbers of studies have explored a possible linkage between prenatal exposure to PM2.5 (particulate matter with aerodynamic diameter ≤ 2.5 μm) and impacts on fetal development. We aimed to conduct a systematic review based on published cohort studies to summarize evidence regarding the association between maternal PM2.5 exposure and birth outcomes, including birth weight, low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA). Eligible studies meeting the following criterion were selected: PM2.5 exposure during pregnancy and live birth singletons, certain presentation of sample sizes, and quantitative evaluation of the associations between exposure and outcomes. Among the 42 selected studies, 23 evaluated the impact of prenatal PM2.5 exposure on birth weight of infants while 12 of them provided a significantly negative association for exposure and birth weight. Twenty-one studies aimed to identify the possible relationship between maternal exposure and LBW and 8 studies proved significant associations. Among 18 studies that explored the correlation between prenatal exposure and PTB, 9 reached a consistent conclusion that gestational exposure would add to the risk of PTB. Nine studies assessed the impact of PM2.5 on SGA and 5 of them demonstrated a significant effect. So far, linkages between maternal PM2.5 exposure during varied gestational stages and multiple adverse birth outcomes have been observed in many studies. A summary of them will be meaningful for further research on maternal exposure and adverse birth outcomes.
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Affiliation(s)
- Lei Yuan
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, 280 South Chongqing Road, Shanghai, 200025, China
| | - Yan Zhang
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, 280 South Chongqing Road, Shanghai, 200025, China
| | - Yu Gao
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, 280 South Chongqing Road, Shanghai, 200025, China.
| | - Ying Tian
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, 280 South Chongqing Road, Shanghai, 200025, China.
- MOE and Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Shezi B, Jafta N, Sartorius B, Naidoo RN. Developing a predictive model for fine particulate matter concentrations in low socio-economic households in Durban, South Africa. INDOOR AIR 2018; 28:228-237. [PMID: 28983961 DOI: 10.1111/ina.12432] [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: 02/22/2017] [Accepted: 09/30/2017] [Indexed: 06/07/2023]
Abstract
In low-resource settings, there is a need to develop models that can address contributions of household and outdoor sources to population exposures. The aim of the study was to model indoor PM2.5 using household characteristics, activities, and outdoor sources. Households belonging to participants in the Mother and Child in the Environment (MACE) birth cohort, in Durban, South Africa, were randomly selected. A structured walk-through identified variables likely to generate PM2.5 . MiniVol samplers were used to monitor PM2.5 for a period of 24 hours, followed by a post-activity questionnaire. Factor analysis was used as a variable reduction tool. Levels of PM2.5 in the south were higher than in the north of the city (P < .05); crowding and dwelling type, household emissions (incense, candles, cooking), and household smoking practices were factors associated with an increase in PM2.5 levels (P < .05), while room magnitude and natural ventilation factors were associated with a decrease in the PM2.5 levels (P < .05). A reasonably robust PM2.5 predictive model was obtained with model R2 of 50%. Recognizing the challenges in characterizing exposure in environmental epidemiological studies, particularly in resource-constrained settings, modeling provides an opportunity to reasonably estimate indoor pollutant levels in unmeasured homes.
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Affiliation(s)
- B Shezi
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - N Jafta
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - B Sartorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - R N Naidoo
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Steenland K, Pillarisetti A, Kirby M, Peel J, Clark M, Checkley W, Chang HH, Clasen T. Modeling the potential health benefits of lower household air pollution after a hypothetical liquified petroleum gas (LPG) cookstove intervention. ENVIRONMENT INTERNATIONAL 2018; 111:71-79. [PMID: 29182949 PMCID: PMC5801118 DOI: 10.1016/j.envint.2017.11.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/01/2017] [Accepted: 11/22/2017] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Improved biomass and advanced fuel cookstoves can lower household air pollution (HAP), but levels of fine particulate matter (PM2.5) often remain above the World Health Organization (WHO) recommended interim target of 35μg/m3. METHODS Based on existing literature, we first estimate a range of likely levels of personal PM2.5 before and after a liquefied petroleum gas (LPG) intervention. Using simulations reflecting uncertainty in both the exposure estimates and exposure-response coefficients, we estimate corresponding expected health benefits for systolic blood pressure (SBP) in adults, birthweight, and pneumonia incidence among children <2years old. We also estimate potential avoided premature mortality among those exposed. RESULTS Our best estimate is that an LPG stove intervention would decrease personal PM2.5 exposure from approximately 270μg/m3 to approximately 70μg/m3, due to likely continued use of traditional open-fire stoves. We estimate that this decrease would lead to a 5.5mmHg lower SBP among women over age 50, a 338g higher birthweight, and a 37% lower incidence of severe childhood pneumonia. We estimate that decreased SBP, if sustained, would result in a 5%-10% decrease in mortality for women over age 50. We estimate that higher birthweight would reduce infant mortality by 4 to 11 deaths per 1000 births; for comparison, the current global infant mortality rate is 32/1000 live births. Reduced exposure is estimated to prevent approximately 29 cases of severe pneumonia per year per 1000 children under 2, avoiding approximately 2-3 deaths/1000 per year. However, there are large uncertainties around all these estimates due to uncertainty in both exposure estimates and in exposure-response coefficients; all health effect estimates include the null value of no benefit. CONCLUSIONS An LPG stove intervention, while not likely to lower exposure to the WHO interim target level, is still likely to offer important health benefits.
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Affiliation(s)
- Kyle Steenland
- Rollins School of Public Health, Emory U., Atlanta, Georgia.
| | - Ajay Pillarisetti
- Environmental Health Sciences, University of California, Berkeley, United States
| | - Miles Kirby
- Rollins School of Public Health, Emory U., Atlanta, Georgia
| | - Jennifer Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Maggie Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Will Checkley
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Howard H Chang
- Rollins School of Public Health, Emory U., Atlanta, Georgia
| | - Thomas Clasen
- Rollins School of Public Health, Emory U., Atlanta, Georgia
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Carter E, Norris C, Dionisio KL, Balakrishnan K, Checkley W, Clark ML, Ghosh S, Jack DW, Kinney PL, Marshall JD, Naeher LP, Peel JL, Sambandam S, Schauer JJ, Smith KR, Wylie BJ, Baumgartner J. Assessing Exposure to Household Air Pollution: A Systematic Review and Pooled Analysis of Carbon Monoxide as a Surrogate Measure of Particulate Matter. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:076002. [PMID: 28886596 PMCID: PMC5744652 DOI: 10.1289/ehp767] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 05/08/2023]
Abstract
BACKGROUND Household air pollution from solid fuel burning is a leading contributor to disease burden globally. Fine particulate matter (PM2.5) is thought to be responsible for many of these health impacts. A co-pollutant, carbon monoxide (CO) has been widely used as a surrogate measure of PM2.5 in studies of household air pollution. OBJECTIVE The goal was to evaluate the validity of exposure to CO as a surrogate of exposure to PM2.5 in studies of household air pollution and the consistency of the PM2.5-CO relationship across different study settings and conditions. METHODS We conducted a systematic review of studies with exposure and/or cooking area PM2.5 and CO measurements and assembled 2,048 PM2.5 and CO measurements from a subset of studies (18 cooking area studies and 9 personal exposure studies) retained in the systematic review. We conducted pooled multivariate analyses of PM2.5-CO associations, evaluating fuels, urbanicity, season, study, and CO methods as covariates and effect modifiers. RESULTS We retained 61 of 70 studies for review, representing 27 countries. Reported PM2.5-CO correlations (r) were lower for personal exposure (range: 0.22-0.97; median=0.57) than for cooking areas (range: 0.10-0.96; median=0.71). In the pooled analyses of personal exposure and cooking area concentrations, the variation in ln(CO) explained 13% and 48% of the variation in ln(PM2.5), respectively. CONCLUSIONS Our results suggest that exposure to CO is not a consistently valid surrogate measure of exposure to PM2.5. Studies measuring CO exposure as a surrogate measure of PM exposure should conduct local validation studies for different stove/fuel types and seasons. https://doi.org/10.1289/EHP767.
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Affiliation(s)
- Ellison Carter
- Institute on the Environment, University of Minnesota , St. Paul, Minnesota, USA
| | - Christina Norris
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University , Montreal, Quebec, Canada
| | - Kathie L Dionisio
- National Exposure Research Laboratory, U.S. Environmental Protection Agency , Research Triangle Park, North Carolina, USA
| | - Kalpana Balakrishnan
- Department Environmental Health Engineering, Sri Ramachandra University , Porur, Chennai, India
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University , Baltimore, Maryland, USA
- Program in Global Disease Epidemiology and Control, Department of International Heath, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA
| | - Maggie L Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University , Fort Collins, Colorado, USA
| | - Santu Ghosh
- Department Environmental Health Engineering, Sri Ramachandra University , Porur, Chennai, India
| | - Darby W Jack
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University , New York, New York, USA
| | - Patrick L Kinney
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University , New York, New York, USA
| | - Julian D Marshall
- Department of Civil and Environmental Engineering, University of Washington , Seattle, Washington, USA
| | - Luke P Naeher
- Department of Environmental Health Science, College of Public Health, The University of Georgia , Athens, Georgia, USA
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University , Fort Collins, Colorado, USA
| | - Sankar Sambandam
- Department Environmental Health Engineering, Sri Ramachandra University , Porur, Chennai, India
| | - James J Schauer
- Environmental Chemistry & Technology Program, University of Wisconsin-Madison , Madison, Wisconsin, USA
- Department of Civil & Environmental Engineering, University of Wisconsin-Madison , Madison, Wisconsin, USA
| | - Kirk R Smith
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley , Berkeley, California, USA
| | - Blair J Wylie
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts, USA
| | - Jill Baumgartner
- Institute on the Environment, University of Minnesota , St. Paul, Minnesota, USA
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University , Montreal, Quebec, Canada
- Institute for Health and Social Policy, McGill University , Montreal Quebec, Canada
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N. Mbanya V, K. C. Sridhar M. PM<sub>10</sub> Emissions from Cooking Fuels in Nigerian Households and Their Impact on Women and Children. Health (London) 2017. [DOI: 10.4236/health.2017.913126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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