Effects of Traffic-Related Outdoor Air Pollution on Respiratory Illness and Mortality in Children, Taking Into Account Indoor Air Pollution, in Indonesia

Kashima, Saori; Yorifuji, Takashi; Tsuda, Toshihide; Ibrahim, Juliani; Doi, Hiroyuki

doi:10.1097/jom.0b013e3181d44e3f

Cited by 25 publications

(18 citation statements)

References 22 publications

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“…The study found urban children were at slightly higher risk of death than children from rural areas, which was similar to previous similar studies in Bangladesh and Indonesia [24, 25]; despite the fact that the majority of the households in rural Pakistan rely on solids fuels mainly due to the unavailability of better alternatives [44, 45]. An intervention study in Pakistan investigating indoor particulate matter (PM) concentrations in developing countries reported that PM was considerably higher in urban kitchens as rural kitchens were more ventilated than urban ones [46].…”

Section: Discussionsupporting

confidence: 91%

Household air pollution from use of cooking fuel and under-five mortality: The role of breastfeeding status and kitchen location in Pakistan

2017

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Household air pollution (HAP) mainly from cooking fuel is one of the major causes of respiratory illness and deaths among young children in low and middle-income countries like Pakistan. This study investigates for the first time the association between HAP from cooking fuel and under-five mortality using the 2013 Pakistan Demographic and Health Survey (PDHS) data. Multi-level logistic regression models were used to examine the association between HAP and under-five mortality in a total of 11,507 living children across four age-groups (neonatal aged 0–28 days, post-neonatal aged 1–11 months, child aged 12–59 months and under-five aged 0–59 months). Use of cooking fuel was weakly associated with total under-five mortality (OR = 1.22, 95%CI = 0.92–1.64, P = 0.170), with stronger associations evident for sub-group analyses of children aged 12–59 months (OR = 1.98, 95%CI = 0.75–5.25, P = 0.169). Strong associations between use of cooking fuel and mortality were evident (ORs >5) in those aged 12–59 months for households without a separate kitchen using polluting fuels, and in children whose mother never breastfed. The results of this study suggest that HAP from cooking fuel is associated with a modest increase in the risk of death among children under five years of age in Pakistan, but particularly in those aged 12–59 months, and those living in poorer socioeconomic conditions. To reduce exposure to cooking fuel which is a preventable determinant of under-five mortality in Pakistan, the challenge remains to promote behavioural interventions such as breastfeeding in infancy period, keeping young children away from the cooking area, and improvements in housing and kitchen design.

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Section: Discussionsupporting

confidence: 91%

Household air pollution from use of cooking fuel and under-five mortality: The role of breastfeeding status and kitchen location in Pakistan

2017

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“…A total of 21 studies reported on non-fatal ALRI, without defining severity, including one RCT [24], 4 cross-sectional [25-28], 11 case-control [29-39] and 5 cohort studies [40-44], summarized by study design in Additional File 3, Table 1(a). The RCT by Hanna et al was not eligible as the outcome measures did not allow distinction of upper and lower respiratory infections [45].…”

Section: Resultsmentioning

confidence: 99%

Control of household air pollution for child survival: estimates for intervention impacts

et al. 2013

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Background Exposure to household air pollution (HAP) from cooking with solid fuels affects 2.8 billion people in developing countries, including children and pregnant women. The aim of this review is to propose intervention estimates for child survival outcomes linked to HAP. Methods Systematic reviews with meta-analysis were conducted for ages 0-59 months, for child pneumonia, adverse pregnancy outcomes, stunting and all-cause mortality. Evidence for each outcome was assessed against Bradford-Hill viewpoints, and GRADE used for certainty about intervention effect size for which all odds ratios (OR) are presented as protective effects. Results Reviews found evidence linking HAP exposure with child ALRI, low birth weight (LBW), stillbirth, preterm birth, stunting and all-cause mortality. Most studies were observational and rated low/very low in GRADE despite strong causal evidence for some outcomes; only one randomised trial was eligible.Intervention effect (OR) estimates of 0.64 (95% CI: 0.55, 0.75) for ALRI, 0.71 (0.65, 0.79) for LBW and 0.66 (0.54, 0.81) for stillbirth are proposed, specific outcomes for which causal evidence was sufficient. Exposure-response evidence suggests this is a conservative estimate for ALRI risk reduction expected with sustained, low exposure. Statistically significant protective ORs were also found for stunting [OR=0.79 (0.70, 0.89)], and in one study of pre-term birth [OR=0.70 (0.54, 0.90)], indicating these outcomes would also likely be reduced. Five studies of all-cause mortality had an OR of 0.79 (0.70, 0.89), but heterogenity precludes a reliable estimate for mortality impact. Although interventions including clean fuels and improved solid fuel stoves are available and can deliver low exposure levels, significant challenges remain in achieving sustained use at scale among low-income households. Conclusions Reducing exposure to HAP could substantially reduce the risk of several child survival outcomes, including fatal pneumonia, and the proposed effects could be achieved by interventions delivering low exposures. Larger impacts are anticipated if WHO air quality guidelines are met. To achieve these benefits, clean fuels should be adopted where possible, and for other households the most effective solid fuel stoves promoted. To strengthen evidence, new studies with thorough exposure assessment are required, along with evaluation of the longer-term acceptance and impacts of interventions.

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“…Signs of sepsis and pneumonia in young babies are notoriously subtle and difficult to recognise,15 and so many studies of HAP exposure in neonates have focused on mortality rather than infection. With use of results from two studies, Bruce and colleagues16 calculated a pooled odds ratio (OR) of 1·14 (95% CI 0·87–1·48) for neonatal mortality in households using solid fuels;17,18 both studies included kerosene in the reference (clean fuel) group. Since then, Epstein and colleagues19 reported that neonatal death in India was strongly associated with household use of coal (18·54, 6·31–54·45) and might be associated with kerosene, but the OR for kerosene crosses the null, so the risk is not clear (2·30, 0·95–5·55).…”

Section: Respiratory Infectionsmentioning

confidence: 99%

Respiratory risks from household air pollution in low and middle income countries

Gordon¹,

Bruce²,

Grigg³

et al. 2014

The Lancet Respiratory Medicine

775

592

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A third of the world’s population uses solid fuel derived from plant material (biomass) or coal for cooking, heating, or lighting. These fuels are smoky, often used in an open fire or simple stove with incomplete combustion, and result in a large amount of household air pollution when smoke is poorly vented. Air pollution is the biggest environmental cause of death worldwide, with household air pollution accounting for about 3·5–4 million deaths every year. Women and children living in severe poverty have the greatest exposures to household air pollution. In this Commission, we review evidence for the association between household air pollution and respiratory infections, respiratory tract cancers, and chronic lung diseases. Respiratory infections (comprising both upper and lower respiratory tract infections with viruses, bacteria, and mycobacteria) have all been associated with exposure to household air pollution. Respiratory tract cancers, including both nasopharyngeal cancer and lung cancer, are strongly associated with pollution from coal burning and further data are needed about other solid fuels. Chronic lung diseases, including chronic obstructive pulmonary disease and bronchiectasis in women, are associated with solid fuel use for cooking, and the damaging effects of exposure to household air pollution in early life on lung development are yet to be fully described. We also review appropriate ways to measure exposure to household air pollution, as well as study design issues and potential effective interventions to prevent these disease burdens. Measurement of household air pollution needs individual, rather than fixed in place, monitoring because exposure varies by age, gender, location, and household role. Women and children are particularly susceptible to the toxic effects of pollution and are exposed to the highest concentrations. Interventions should target these high-risk groups and be of sufficient quality to make the air clean. To make clean energy available to all people is the long-term goal, with an intermediate solution being to make available energy that is clean enough to have a health impact.

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Effects of Traffic-Related Outdoor Air Pollution on Respiratory Illness and Mortality in Children, Taking Into Account Indoor Air Pollution, in Indonesia

Abstract: Exposure to traffic-related outdoor air pollution would increase adverse health effects after adjusting for indoor air pollution. Furthermore, indoor air pollution could exacerbate the effects of outdoor air pollution.

Cited by 25 publications

References 22 publications

Household air pollution from use of cooking fuel and under-five mortality: The role of breastfeeding status and kitchen location in Pakistan

Household air pollution from use of cooking fuel and under-five mortality: The role of breastfeeding status and kitchen location in Pakistan

Control of household air pollution for child survival: estimates for intervention impacts

Respiratory risks from household air pollution in low and middle income countries

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