Passive Smoking and Disease Severity in Childhood Pneumonia Under 5 Years of Age

By Tugba Sismanlar Eyuboglu,  Ayse Tana Aslan, Mehmet Kose, Sevgi Pekcan,  Melih Hangul, Ozlem Gulbahar, Mehmet Cingirt, Tuga Bedir Demirdag, Hasan Tezer, Isıl Irem Budakoglu,.

Journal of Tropical Pediatrics, November 27, 2019

Between December 2015 and April 2016, children aged less than 5 years with pneumonia and age-matched healthy controls were included in this study, which was conducted at three tertiary pediatric pulmonology centers. A questionnaire was given to the parents regarding demographic data and smoking status at home. Urinary cotinine/creatinine ratio (CCR) was measured. The data from the pneumonia and control groups, as well as children with mild and severe pneumonia within the pneumonia group, were compared.

 

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Particulate air pollution in Ho Chi Minh city and risk of hospital admission for acute lower respiratory infection (ALRI) among young children

By Ly Thi Mai Luong,Tran Ngoc Dang, Nguyen Thi Thanh Huong, Dung Phung, Long K.Trane, Do Van Dung, Phong K.Thaie

 

Environmental Pollution, October 18, 2019

 

High levels of air pollutants in Vietnam, especially particulate matters including PM2.5, can be important risk factors for respiratory diseases among children of the country. However, few studies on the effects of ambient air pollution on human health have been conducted in Vietnam so far. The aim of this study is to examine the association between PM2.5 and hospital admission due to acute lower respiratory infection (ALRI) among children aged < 5 years old in Ho Chi Minh city, the largest city of Vietnam. Data relating PM2.5 and hospital admission were collected from February 2016–December 2017 and a time series regression analysis was performed to examine the relationship between PM2.5 and hospital admission including the delayed effect up to three days prior to the admission. We found that each 10 μg/m3 increase in PM2.5 was associated with an increase of 3.51 (95%CI: 0.96–6.12) risk of ALRI admission among children. According to the analysis, male children are more sensitive to exposure to PM2.5 than females, while children exposed to PM2.5 are more likely to be infected with acute bronchiolitis than with pneumonia. The study demonstrated that young children in HCMC are at increased risk of ALRI admissions due to the high level of PM2.5 concentration in the city's ambient air..

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Lung health and exposure to air pollution in Malawian children (CAPS): a cross-sectional study.

By Sarah Rylance, Rebecca Nightingale, Andrew Naunje, Frank Mbalume, Chris Jewell, John R Balmes, Jonathan Grigg, Kevin Mortimer. Published in Thorax. August 29, 2019.   

 

Non-communicable lung disease and exposure to air pollution are major problems in sub-Saharan Africa. A high burden of chronic respiratory symptoms, spirometric abnormalities and air pollution exposures has been found in Malawian adults; whether the same would be true in children is unknown. This cross-sectional study of children aged 6-8 years, in rural Malawi, included households from communities participating in the Cooking and Pneumonia Study (CAPS), a trial of cleaner-burning biomass-fuelled cookstoves. We assessed; chronic respiratory symptoms, anthropometry, spirometric abnormalities (using Global Lung Initiative equations) and personal carbon monoxide (CO) exposure. Prevalence estimates were calculated, and multivariable analyses were done. We recruited 804 children (mean age 7.1 years, 51.9% female), including 476 (260 intervention; 216 control) from CAPS households. Chronic respiratory symptoms (mainly cough (8.0%) and wheeze (7.1%)) were reported by 16.6% of children. Average height-for-age and weight-for-age z-scores were -1.04 and -1.10, respectively. Spirometric abnormalities (7.1% low forced vital capacity (FVC); 6.3% obstruction) were seen in 13.0% of children. Maximum CO exposure and carboxyhaemoglobin levels (COHb) exceeded WHO guidelines in 50.1% and 68.5% of children, respectively. Children from CAPS intervention households had lower COHb (median 3.50% vs 4.85%, p=0.006) and higher FVC z-scores (-0.22 vs -0.44, p=0.05) than controls. The substantial burden of chronic respiratory symptoms, abnormal spirometry and air pollution exposures in children in rural Malawi is concerning; effective prevention and control strategies are needed. Our finding of potential benefit in CAPS intervention households calls for further research into clean-air interventions to maximise healthy lung development in children.

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Ambient air pollution is associated with pediatric pneumonia: a time-stratified case-crossover study in an urban area.

By Chi-Yung Cheng, Shih-Yu Cheng, Chien-Chih Chen, Hsiu-Yung Pan, Kuan-Han Wu & Fu-Jen Cheng. Published in Environmental Health. August 28, 2019.   

 

Pneumonia, the leading reason underlying childhood deaths, may be triggered or exacerbated by air pollution. To date, only a few studies have examined the association of air pollution with emergency department (ED) visits for pediatric pneumonia, with inconsistent results. Therefore, we aimed to elucidate the impact of short-term exposure to particulate matter (PM) and other air pollutants on the incidence of ED visits for pediatric pneumonia. PM2.5, PM10, and other air pollutant levels were measured at 11 air quality-monitoring stations in Kaohsiung City, Taiwan, between 2008 and 2014. Further, we extracted the medical records of non-trauma patients aged ≤17 years and who had visited an ED with the principal diagnosis of pneumonia. A time-stratified case–crossover study design was employed to determine the hazard effect of air pollution in a total of 4024 patients. The single-pollutant model suggested that per interquartile range increment in PM2.5, PM10, nitrogen dioxide (NO2), and sulfur dioxide (SO2) on 3 days before the event increased the odds of pediatric pneumonia by 14.0% [95% confidence interval (CI), 5.1–23.8%], 10.9% (95% CI, 2.4–20.0%), 14.1% (95% CI, 5.0–24.1%), and 4.5% (95% CI, 0.8–8.4%), respectively. In two-pollutant models, PM2.5 and NO2 were significant after adjusting for PM10 and SO2. Subgroup analyses showed that older children (aged ≥4 years) were more susceptible to PM2.5 (interaction p = 0.024) and children were more susceptible to NO2 during warm days (≥26.5 °C, interaction p = 0.011). Short-term exposure to PM2.5 and NO2 possibly plays an important role in pediatric pneumonia in Kaohsiung, Taiwan. Older children are more susceptible to PM2.5, and all children are more susceptible to NO2 during warm days.

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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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Impact of improved cookstoves on women's and child health in low and middle income countries: a systematic review and meta-analysis

by Thakur M, Nuyts PAW, Boudewijns EA, Flores Kim J, Faber T, Babu GR, van Schayck OCP, Been JV.

Published in Thorax, BMJ, June 20, 2018.

 

Improved biomass cookstoves may help reduce the substantial global burden of morbidity and mortality due to household air pollution (HAP) that disproportionately affects women and children in low and middle income countries (LMICs).

 

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Acute effects of ambient air pollution on lower respiratory infections in Hanoi children: an eight-year time series study

by authors Nhung NTT, Schindler C, Dien TM, Probst-Hensch N, Perez L, Künzli N.

 

Lower respiratory diseases are the most frequent causes of hospital admission in children worldwide. This is especially true in developing countries. Daily exposure to air pollution is associated with lower respiratory diseases. This association has been observed in many time-series studies. However, investigations in low-and-middle-income countries such as Vietnam remain sparse.

 

Researchers aimed to investigate the short-term association of ambient air pollution with daily counts of hospital admissions due to pneumonia, bronchitis and asthma among children aged 0-17 in Hanoi, Vietnam. The impact of age, gender and season on these associations was also explored.

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Kitchen PM2.5 concentrations and child acute lower respiratory infection in Bhaktapur, Nepal: The importance of fuel type

Bates MN, Pokhrel AK, Chandyo RK, Valentiner-Branth P, Mathisen M, Basnet S, Strand TA, Burnett RT, Smith KR.

 

Solid fuels are used by approximately 3 billion people for cooking around the world. A smaller number of people use kerosene. These fuels types have been linked to the incidence of acute lower respiratory infection (ALRI) in children. Previous work in Bhaktapur, Nepal showed comparable relationships of biomass and kerosene cooking fuels with ALRI in young children compared to those using electricity for cooking. Researchers examined the relationship of kitchen PM2.5 concentrations to ALRI in these households.

 

ALRI cases and controls (age-matched) were enrolled from a cohort of children aged 2-35 months. 24-hour PM2.5 was measured once in the kitchen of each study participant. Primary analysis was done with conditional logistic regression, with PM2.5 measures specified both continuously and as quartiles.

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The impact of Pakistan's population growth on respiratory health

The impact of Pakistan's population growth on respiratory health
Ray Cavanaugh discusses Pakistan's recent population growth and its effects on the health of its citizens with Ahmad Rafay Alam, an environmental lawyer who lives in Lahore, Pakistan's second largest city. Furthermore, Alam identifies limitations to what we think we know about pollution and respiratory health in Pakistan. "One of the more problematic aspects of air pollution in Pakistan is that scant reliable data exists. Owing to this lack of reliable data, Alam admits he does not know how long...
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Inyenyeri raises more money in 6 months than the entire cookstove sector has raised in a single year

By following the "razorblade model," this Rwandan company that provides cookstoves to households at no cost in exchange for customers buying their wood fuel pellets, announced at the Clean Cooking Forum in New Delhi, India, that it has raised more than $20 million in loans, grants, and the sale of carbon credits. Inyenyeri cookstoves reduce emissions by 98-99 percent compared to wood or charcoal stoves, the company says, making their stoves the highest performing (Tier 4) for indoor emissions as defined by the World Health Organization. Radha Muthiah, CEO of the Global Alliance for Clean Cookstoves: "If the Sustainable Development Goals are truly not going to leave anyone behind, we have to address this issue of clean cooking. If we are looking to ensure a world where growth is sustainable for our planet, we have to address the issue of clean cooking. If we are to engage women inclusively and equitably in all of our societies and on productive engagement, we have to address this issue of cooking ... If this issue is invested in, it can provide a transformative rate of return given how it intersects with 10 of the 17 SDGs." Find the full article at: https://www.devex.com/news/can-these-stovers-finally-crack-the-clean-cooking-problem-89537

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A cleaner burning biomass-fueled cookstove intervention to prevent pneumonia in children under 5 years old in rural Malawi (the Cooking and Pneumonia Study): a cluster randomised controlled trial

The Cooking and Pneumonia Study enrolled 10,750 children from 8,626 households between Dec 9, 2013, and Feb 28, 2016. The pneumonia incidence rate in the intervention group was 15·76 per 100 child-years and in the control group 15·58 per 100 child-years. Cooking-related serious adverse events (burns) were seen in 19 children; nine in the intervention and ten (one death) in the control group.In comparing the effects of a cleaner burning biomass-fuelled cookstove intervention to continuation of open fire cooking on pneumonia in children living in two rural districts, Chikhwawa and Karonga, of Malawi, the authors ""found no evidence that ... cleaner burning biomass-fuelled cookstoves reduced the risk of pneumonia in young children in rural Malawi." The authors explained the lack of cookstove effect on pneumonia in terms of exposure to other sources of air pollution, including rubbish burning and tobacco smoke, that could have overwhelmed any potential effects of the cookstoves. "It is also possible," said the authors, "that the cookstoves used simply did not reduce emissions sufficiently to have an effect."They conclude: "An important implication of these observations is that tackling any individual source of air pollution exposure in isolation is unlikely to be effective for improving health; an integrated approach to achieving clean air that tackles rubbish disposal, tobacco smoking, and other exposures, as well as robust cleaner cooking solutions (eg, cleaner stoves and fuels) that achieve a high rate of acceptance is probably needed to deliver health benefits."

 

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UNICEF releases new report on air pollution and child health

Clear the Air for Children, released today by UNICEF, points out that around 300 million children live in areas where the air is toxic – exceeding international limits by at least six times – and that children are uniquely vulnerable to air pollution, breathing faster than adults on average and taking in more air relative to their body weight. The report also notes that air pollution is a major contributing factor in the deaths of around 600,000 children under age 5 every year and threatens the health, lives and futures of millions more. What does this report say about pneumonia?1. Almost one million children die from pneumonia each year, more than half of which are directly related to air pollution.2. Air pollution also contributes to at least half of all pneumonia cases. Evidence suggests that air pollution can cause oxidative stress and inflammation in the smaller airways, leading to the exacerbation of asthma and chronic bronchitis, airway obstruction and decreased gas exchange. It can also undermine normal lung antimicrobial defense functions by interfering with the clearance and inactivation of bacteria in the lung tissue. 3. Studies show that halving of indoor air pollution exposure with a chimney stove rather than open fires reduced severe pneumonia by 33 percent.4. Nitrogen oxides (NOX) are one of the principal pollutants that result from fossil fuel combustion and occur close to roads and factories, or indoors where gas is used for cooking. Nitrogen oxides plays a significant role in the exacerbation of pneumonia, asthma, bronchial symptoms, lung inflammation and reduction in overall lung function.It concludes with a set of concrete steps to take so that children can breathe clean, safe air.

 

Access the full report here. 

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