Predictors of personal exposure to black carbon among women in southern semi-rural Mozambique

By Ariadna Curto, David Donaire-Gonzalez, Maria N. Manaca, Raquel González, Charfudin Sacoor, Ioar Rivashi, Mireia Gascon, Gregory A. Wellenius, Xavier Querol, Jordi Sunyer, Eusébio Macete, Clara Menéndez, Cathryn Tonne

Environmental International, To be published October 2019


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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Home Smoke Exposure and Health-Related Quality of Life in Children with Acute Respiratory Illness

By Johnson, BS, Karen M Wilson, MD, MPH, Chuan Zhou, PhD, David P Johnson, MD, Chén C Kenyon, MD, MSHP, Joel S Tieder, MD, MPH, Andrea Dean, MD, Rita Mangione-Smith, MD, MPH, Derek J Williams, MD, MPH


Journal of Hospital Medicine, April 2019


This study aims to assess whether secondhand smoke (SHS) exposure has an impact on health-related quality of life (HRQOL) in children with acute respiratory illness (ARI). This study was nested within a multicenter, prospective cohort study of children (two weeks to 16 years) with ARI (emergency department visits for croup and hospitalizations for croup, asthma, bronchiolitis, and pneumonia) between July 1, 2014 and June 30, 2016. Subjects were surveyed upon enrollment for sociodemographics, healthcare utilization, home SHS exposure (0 or ≥1 smoker in the home), and child HRQOL (Pediatric Quality of Life Physical Functioning Scale) for both baseline health (preceding illness) and acute illness (on admission). Data on insurance status and medical complexity were collected from the Pediatric Hospital Information System database. Multivariable linear mixed regression models examined associations between SHS exposure and HRQOL

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Global, national, and urban burdens of paediatric asthma incidence attributable to ambient NO2 pollution: estimates from global datasets

By Pattanun Achakulwisut, Michael Brauer,  Perry Hystad, Susan C Anenberg

The Lancet Planetary Health, April 10, 2019  


Globally, we estimated that 4·0 million (95% uncertainty interval [UI] 1·8–5·2) new paediatric asthma cases could be attributable to NO2 pollution annually; 64% of these occur in urban centres. This burden accounts for 13% (6–16) of global incidence. Regionally, the greatest burdens of new asthma cases associated with NO2 exposure per 100 000 children were estimated for Andean Latin America (340 cases per year, 95% UI 150–440), high-income North America (310, 140–400), and high-income Asia Pacific (300, 140–370). Within cities, the greatest burdens of new asthma cases associated with NO2 exposure per 100 000 children were estimated for Lima, Peru (690 cases per year, 95% UI 330–870); Shanghai, China (650, 340–770); and Bogota, Colombia (580, 270–730). Among 125 major cities, the percentage of new asthma cases attributable to NO2 pollution ranged from 5·6% (95% UI 2·4–7·4) in Orlu, Nigeria, to 48% (25–57) in Shanghai, China. This contribution exceeded 20% of new asthma cases in 92 cities. We estimated that about 92% of paediatric asthma incidence attributable to NO2 exposure occurred in areas with annual average NO2 concentrations lower than the WHO guideline of 21 parts per billion.


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The disgraceful neglect of childhood pneumonia

Prepared for the report, Air pollution and child health: prescribing clean air. Published in The Lancet Global Health, 12 November 2018. 


"Lower respiratory tract infections, by which we usually mean pneumonia, are the second leading cause of death in under-5s worldwide, and the leading cause in Africa. Air pollution is just one of many poverty-linked risk factors, others being undernutrition, poor hygiene, limited or no breastfeeding, and lack of access to vaccines. In turn, death rates in those who succumb to infection are much higher in impoverished regions than in higher-income ones owing to slow care seeking (stemming from poor health education or geographical or financial barriers to care), diagnostic failure, and inappropriate treatment.


The WHO report recognises that the issue of air pollution, particularly ambient air pollution, is largely a high-level issue for governments and regions, and its recommendations for health professionals centre around awareness-raising, research, advocacy, and prescribing of household-level solutions (such as switching to cleaner fuels, where possible). But what about the other, potentially more tractable, risk factors and system failures that contribute to pneumonia’s standing as a barely surpassed killer of children?"

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Nigeria: respiratory health in Africa's most populous nation

by Ray Cavanaugh

Published in The Lancet Respiratory Medicine, 28 June 2018


“With 190 million people, Nigeria has by far the highest population of any African nation and recently overtook South Africa as the continent's largest economy. The recent growth of industry and population, combined with low levels of regulation enforcement, have seen Nigerian cities become some of the world's most polluted. This issue affects an increasing proportion of Nigerians: since the nation obtained independence in 1960, the segment of its population living in urban areas has more than trebled, climbing from 15% to 49%.”


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