Targeting Household Air Pollution for Curbing the Cardiovascular Disease Burden: A Health Priority in Sub-Saharan Africa.
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ABSTRACT:
SUBMITTER: Noubiap JJ
PROVIDER: S-EPMC8031568 | biostudies-literature |
REPOSITORIES: biostudies-literature
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| S-EPMC10864747 | biostudies-literature
Project description:BackgroundGlobally, over four million deaths are attributed to exposure to household air pollution (HAP) annually. Evidence of the association between exposure to HAP and under-five mortality in sub-Saharan Africa (SSA) is insufficient. We assessed the association between exposure to HAP and under-five mortality risk in 14 SSA countries.MethodsWe pooled Demographic and Health Survey (DHS) data from 14 SSA countries (N = 164376) collected between 2015 and 2018. We defined exposure to HAP as the use of biomass fuel for cooking in the household. Under-five mortality was defined as deaths before age five. Data were analyzed using mixed effects logistic regression models.ResultsOf the study population, 73% were exposed to HAP and under-five mortality was observed in 5%. HAP exposure was associated with under-five mortality, adjusted odds ratio (OR) 1.33 (95% confidence interval (CI) [1.03-1.71]). Children from households who cooked inside the home had higher risk of under-five mortality compared to households that cooked in separate buildings [0.85 (0.73-0.98)] or outside [0.75 (0.64-0.87)]. Lower risk of under-five mortality was also observed in breastfed children [0.09 (0.05-0.18)] compared to non-breastfed children.ConclusionsHAP exposure may be associated with an increased risk of under-five mortality in sub-Saharan Africa. More carefully designed longitudinal studies are required to contribute to these findings. In addition, awareness campaigns on the effects of HAP exposure and interventions to reduce the use of biomass fuels are required in SSA.
| S-EPMC7643379 | biostudies-literature
Project description:BackgroundThe Global Burden of Disease (GBD) studies have transformed global understanding of health risks by producing comprehensive estimates of attributable disease burden, or the current disease that would be eliminated if a risk factor did not exist. Yet many have noted the greater policy significance of avoidable burden, or the future disease that could actually be eliminated if a risk factor were eliminated today. Avoidable risk may be considerably lower than attributable risk if baseline levels of exposure or disease are declining, or if a risk factor carries lagged effects on disease. As global efforts to deliver clean cookstoves accelerate, a temporal estimation of avoidable risk due to household air pollution (HAP) becomes increasingly important, particularly in light of the rapid uptake of modern stoves and ongoing epidemiologic transitions in regions like South and Southeast Asia.Methods and findingsWe estimate the avoidable burden associated with HAP using International Futures (IFs), an integrated forecasting system that has been used to model future global disease burdens and risk factors. Building on GBD and other estimates, we integrated a detailed HAP exposure estimation and exposure-response model into IFs. We then conducted a counterfactual experiment in which HAP exposure is reduced to theoretical minimum levels in 2015. We evaluated avoidable mortality and DALY reductions for the years 2015 to 2024 relative to a Base Case scenario in which only endogenous changes occurred. We present results by cause and region, looking at impacts on acute lower respiratory infection (ALRI) and four noncommunicable diseases (NCDs). We found that just 2.6% of global DALYs would be averted between 2015 and 2024, compared to 4.5% of global DALYs attributed to HAP in the 2010 GBD study, due in large part to the endogenous tendency towards declining traditional stove usage in the IFs base case forecast. The extent of diminished impact was comparable for ALRI and affected NCDs, though for different reasons. ALRI impacts diminish due to the declining burden of ALRI in the base case forecast, particularly apparent in South Asia and Southeast Asia. Although NCD burdens are rising in regions affected by HAP, the avoidable risk of NCD nonetheless diminishes due to lagged effects. Because the stove transition and the decline of ALRI are proceeding more slowly in Sub-Saharan Africa, avoidable impacts would also be more persistent (3.9% of total DALY due to HAP) compared to South Asia (3.6%) or Southeast Asia (2.5%).ConclusionsOur results illustrate how a temporal dynamic calculation of avoidable risk may yield different estimates, compared to a static attributable risk estimate, of the global and regional burden of disease. Our results suggest a window of rising and falling opportunity for HAP interventions that may have already closed in Southeast Asia and may be closing quickly in South Asia, but may remain open longer in Sub-Saharan Africa. A proper accounting of global health priorities should apply an avoidable risk framework that considers the role of ongoing social, economic and health transitions in constantly altering the disease and risk factor landscape.
| S-EPMC4794200 | biostudies-literature
Project description:Wood is commonly used for residential heating, but there are limited evidence-based interventions for reducing wood smoke exposures in the indoor environment. The Asthma Randomized Trial of Indoor Wood Smoke (ARTIS) study was designed to assess the efficacy of residential interventions to reduce indoor PM exposure from wood stoves. As part of a three-arm randomized placebo-controlled trial, two household-level interventions were evaluated: wood stove changeouts and air filtration units. Exposure outcomes included indoor measures such as continuous PM2.5, particle counts, and carbon monoxide. Median indoor PM2.5 concentration was 17.5 μg/m3 in wood-burning homes prior to interventions. No significant reductions in PM2.5 concentrations were observed in the 40 homes receiving the placebo filter intervention. Sixteen homes received the wood stove changeout and showed no significant changes in PM2.5 or particle counts. PM2.5 concentrations were reduced by 68% in the filter intervention homes. Relative to placebo, air filtration unit homes had an overall PM2.5 reduction of 63% (95% CI: 47-75%). Relative to the wood stove changeout, the filtration unit intervention was more efficacious and less expensive, yet compliance issues indicated a need for the evaluation of additional strategies for improving indoor air quality in homes using wood stoves.
| S-EPMC6384090 | biostudies-literature
Project description:ObjectiveUndernutrition and anaemia (the commonest micronutrient deficiency), continue to remain prevalent and persistent in sub-Saharan Africa (SSA) alongside a rising prevalence of overweight and obesity. However, there has been little research on the co-existence of all three conditions in the same household in recent years. The current study examines the co-existence and correlates of the different conditions of household burden of malnutrition in the same household across SSA.SettingThe study involved twenty-three countries across SSA who conducted Demographic and Health Surveys between 2008 and 2017.ParticipantsThe analytical sample includes 145 020 households with valid data on the nutritional status of women and children pairs (i.e. women of reproductive age; 15-49 years and children under 5 years).DesignLogistic regression analyses were used to determine household correlates of household burden of malnutrition.ResultsAnaemia was the most common form of household burden of malnutrition, affecting about seven out of ten households. Double and triple burden of malnutrition, though less common, was also found to be present in 8 and 5 % of the households, respectively. The age of the household head, location of the household, access to improved toilet facilities and household wealth status were found to be associated with various conditions of household burden of malnutrition.ConclusionsThe findings of the current study reveal that both double and triple burden of malnutrition is of public health concern in SSA, thus nutrition and health interventions in SSA must not be skewed towards addressing undernutrition only but also address overweight/obesity and anaemia.
| S-EPMC9991556 | biostudies-literature
Project description:BackgroundHousehold air pollution (HAP) due to biomass cooking fuel use is an important risk factor for a range of diseases, especially among adult women who are primary cooks, in India. About 80% of rural households in India use biomass fuel for cooking. The aim of this study is to estimate the attributable cases (AC) for four major diseases/conditions associated with biomass cooking fuel use among adult Indian women.MethodsWe used the population attributable fraction (PAF) method to calculate the AC of chronic bronchitis, tuberculosis (TB), cataract, and stillbirths due to exposure to biomass cooking fuel. A number of data sources were accessed to obtain population totals and disease prevalence rates. A meta-analysis was conducted to obtain adjusted pooled odds ratios (ORs) for strength of association. Using this, PAF and AC were calculated using a standard formula. Results were presented as number of AC and 95% confidence intervals (CI).ResultsThe fixed effects pooled OR obtained from the meta-analysis were 2.37 (95% CI: 1.59, 3.54) for chronic bronchitis, 2.33 (1.65, 3.28) for TB, 2.16 (1.42, 3.26) for cataract, and 1.26 (1.12, 1.43) for stillbirths. PAF varied across conditions being maximum (53%) for chronic bronchitis in rural areas and least (1%) for cataract in older age and urban areas. About 2.4 (95% CI: 1.4, 3.1) of 5.6 m cases of chronic bronchitis, 0.3 (0.2, 0.4) of 0.76 m cases of TB, 5.0 (2.8, 6.7) of 51.4 m cases of cataract among adult Indian women and 0.02 (0.01, 0.03) of 0.15 m stillbirths across India are attributable to HAP due to biomass cooking fuel. These estimates should be cautiously interpreted in the light of limitations discussed which relate to exposure assessment, exposure characterization, and age-specific prevalence of disease.ConclusionsHAP due to biomass fuel has diverse and major impacts on women's health in India. Although challenging, incorporating the agenda of universal clean fuel access or cleaner technology within the broader framework of rural development will go a long way in reducing disease burden.
| S-EPMC4221659 | biostudies-literature
Project description:BackgroundApproximately 2.8 billion people cook with solid fuels. Research has focused on the health impacts of indoor exposure to fine particulate pollution. Here, for the 2010 Global Burden of Disease project (GBD 2010), we evaluated the impact of household cooking with solid fuels on regional population-weighted ambient PM2.5 (particulate matter ≤ 2.5 μm) pollution (APM2.5).ObjectivesWe estimated the proportion and concentrations of APM2.5 attributable to household cooking with solid fuels (PM2.5-cook) for the years 1990, 2005, and 2010 in 170 countries, and associated ill health.MethodsWe used an energy supply-driven emissions model (GAINS; Greenhouse Gas and Air Pollution Interactions and Synergies) and source-receptor model (TM5-FASST) to estimate the proportion of APM2.5 produced by households and the proportion of household PM2.5 emissions from cooking with solid fuels. We estimated health effects using GBD 2010 data on ill health from APM2.5 exposure.ResultsIn 2010, household cooking with solid fuels accounted for 12% of APM2.5 globally, varying from 0% of APM2.5 in five higher-income regions to 37% (2.8 μg/m3 of 6.9 μg/m3 total) in southern sub-Saharan Africa. PM2.5-cook constituted > 10% of APM2.5 in seven regions housing 4.4 billion people. South Asia showed the highest regional concentration of APM2.5 from household cooking (8.6 μg/m3). On the basis of GBD 2010, we estimate that exposure to APM2.5 from cooking with solid fuels caused the loss of 370,000 lives and 9.9 million disability-adjusted life years globally in 2010.ConclusionsPM2.5 emissions from household cooking constitute an important portion of APM2.5 concentrations in many places, including India and China. Efforts to improve ambient air quality will be hindered if household cooking conditions are not addressed.
| S-EPMC4256045 | biostudies-literature
Project description:BackgroundDecades of intervention programs that replaced traditional biomass stoves with cleaner-burning technologies have failed to meet the World Health Organization (WHO) interim indoor air quality target of 35-μg m-3 for PM2.5. Many attribute these results to continued use of biomass stoves and poor outdoor air quality, though the relative impacts of these factors have not been empirically quantified.MethodsWe measured 496 days of real-time stove use concurrently with outdoor and indoor air pollution (PM2.5) in 150 rural households in Sichuan, China. The impacts of stove use patterns and outdoor air quality on indoor PM2.5 were quantified. We also estimated the potential avoided cardiovascular mortality in southwestern China associated with transition from traditional to clean fuel stoves using established exposure-response relationships.ResultsMean daily indoor PM2.5 was highest in homes using both wood and clean fuel stoves (122 μg m-3), followed by exclusive use of wood stoves (106 μg m-3) and clean fuel stoves (semi-gasifiers: 65 μg m-3; gas or electric: 55 μg m-3). Wood stoves emitted proportionally higher indoor PM2.5 during ignition, and longer stove use was not associated with higher indoor PM2.5. Only 24% of days with exclusive use of clean fuel stoves met the WHO indoor air quality target, though this fraction rose to 73% after subtracting the outdoor PM2.5 contribution. Reduced PM2.5 exposure through exclusive use of gas or electric stoves was estimated to prevent 48,000 yearly premature deaths in southwestern China, with greater reductions if local outdoor PM2.5 is also reduced.ConclusionsClean stove and fuel interventions are not likely to reduce indoor PM2.5 to the WHO target unless their use is exclusive and outdoor air pollution is sufficiently low, but may still offer some cardiovascular benefits.
| S-EPMC7615186 | biostudies-literature
Project description:Background3 billion people worldwide rely on polluting fuels and technologies for domestic cooking and heating. We estimate the global, regional, and national health burden associated with exposure to household air pollution.MethodsFor the systematic review and meta-analysis, we systematically searched four databases for studies published from database inception to April 2, 2020, that evaluated the risk of adverse cardiorespiratory, paediatric, and maternal outcomes from exposure to household air pollution, compared with no exposure. We used a random-effects model to calculate disease-specific relative risk (RR) meta-estimates. Household air pollution exposure was defined as use of polluting fuels (coal, wood, charcoal, agricultural wastes, animal dung, or kerosene) for household cooking or heating. Temporal trends in mortality and disease burden associated with household air pollution, as measured by disability-adjusted life-years (DALYs), were estimated from 2000 to 2017 using exposure prevalence data from 183 of 193 UN member states. 95% CIs were estimated by propagating uncertainty from the RR meta-estimates, prevalence of household air pollution exposure, and disease-specific mortality and burden estimates using a simulation-based approach. This study is registered with PROSPERO, CRD42019125060.Findings476 studies (15·5 million participants) from 123 nations (99 [80%] of which were classified as low-income and middle-income) met the inclusion criteria. Household air pollution was positively associated with asthma (RR 1·23, 95% CI 1·11-1·36), acute respiratory infection in both adults (1·53, 1·22-1·93) and children (1·39, 1·29-1·49), chronic obstructive pulmonary disease (1·70, 1·47-1·97), lung cancer (1·69, 1·44-1·98), and tuberculosis (1·26, 1·08-1·48); cerebrovascular disease (1·09, 1·04-1·14) and ischaemic heart disease (1·10, 1·09-1·11); and low birthweight (1·36, 1·19-1·55) and stillbirth (1·22, 1·06-1·41); as well as with under-5 (1·25, 1·18-1·33), respiratory (1·19, 1·18-1·20), and cardiovascular (1·07, 1·04-1·11) mortality. Household air pollution was associated with 1·8 million (95% CI 1·1-2·7) deaths and 60·9 million (34·6-93·3) DALYs in 2017, with the burden overwhelmingly experienced in low-income and middle-income countries (LMICs; 60·8 million [34·6-92·9] DALYs) compared with high-income countries (0·09 million [0·01-0·40] DALYs). From 2000, mortality associated with household air pollution had reduced by 36% (95% CI 29-43) and disease burden by 30% (25-36), with the greatest reductions observed in higher-income nations.InterpretationThe burden of cardiorespiratory, paediatric, and maternal diseases associated with household air pollution has declined worldwide but remains high in the world's poorest regions. Urgent integrated health and energy strategies are needed to reduce the adverse health impact of household air pollution, especially in LMICs.FundingBritish Heart Foundation, Wellcome Trust.
| S-EPMC7564377 | biostudies-literature
Project description:AimsAmbient air pollution is a major health risk, leading to respiratory and cardiovascular mortality. A recent Global Exposure Mortality Model, based on an unmatched number of cohort studies in many countries, provides new hazard ratio functions, calling for re-evaluation of the disease burden. Accordingly, we estimated excess cardiovascular mortality attributed to air pollution in Europe.Methods and resultsThe new hazard ratio functions have been combined with ambient air pollution exposure data to estimate the impacts in Europe and the 28 countries of the European Union (EU-28). The annual excess mortality rate from ambient air pollution in Europe is 790 000 [95% confidence interval (95% CI) 645 000-934 000], and 659 000 (95% CI 537 000-775 000) in the EU-28. Between 40% and 80% are due to cardiovascular events, which dominate health outcomes. The upper limit includes events attributed to other non-communicable diseases, which are currently not specified. These estimates exceed recent analyses, such as the Global Burden of Disease for 2015, by more than a factor of two. We estimate that air pollution reduces the mean life expectancy in Europe by about 2.2 years with an annual, attributable per capita mortality rate in Europe of 133/100 000 per year.ConclusionWe provide new data based on novel hazard ratio functions suggesting that the health impacts attributable to ambient air pollution in Europe are substantially higher than previously assumed, though subject to considerable uncertainty. Our results imply that replacing fossil fuels by clean, renewable energy sources could substantially reduce the loss of life expectancy from air pollution.
| S-EPMC6528157 | biostudies-literature