Household air pollution, chronic respiratory disease and pneumonia in Malawian adults: A case-control study

Abstract

Background: Four million people die each year from diseases caused by exposure to household air pollution. There is an association between exposure to household air pollution and pneumonia in children (half a million attributable deaths a year); however, whether this is true in adults is unknown. We conducted a case-control study in urban Malawi to examine the association between exposure to household air pollution and pneumonia in adults. Methods: Hospitalized patients with radiologically confirmed pneumonia (cases) and healthy community controls underwent 48 hours of ambulatory and household particulate matter (µg/m 3) and carbon monoxide (ppm) exposure monitoring. Multivariate logistic regression, stratified by HIV status, explored associations between these and other potential risk factors with pneumonia. Results: 145 (117 HIV-positive; 28 HIV-negative) cases and 253 (169 HIV-positive; 84 HIV-negative) controls completed follow up. We found no evidence of association between household air pollution exposure and pneumonia in HIV-positive (e.g. ambulatory particulate matter adjusted odds ratio [aOR] 1.00 [95% CI 1.00–1.01, p=0.141]) or HIV-negative (e.g. ambulatory particulate matter aOR 1.00 [95% CI 0.99–1.01, p=0.872]) participants. Chronic respiratory disease was associated with pneumonia in both HIV-positive (aOR 28.07 [95% CI 9.29–84.83, p<0.001]) and HIV-negative (aOR 104.27 [95% CI 12.86–852.35, p<0.001]) participants. Conclusions: We found no evidence that exposure to household air pollution is associated with pneumonia in Malawian adults. In contrast, chronic respiratory disease was strongly associated with pneumonia.

Etiology and Risk Factors for Mortality in an Adult Community-acquired Pneumonia Cohort in Malawi

“…Ethical approval was provided by the Research Ethics Committees of University of Malawi College of Medicine (P.11/12/1309) and Liverpool School of Tropical Medicine (13.02). Some patients participated in linked case-control studies describing the impact of HIV on influenza severity (21) and the association of indoor air pollution exposure with pneumonia (22).…”

Pneumonia and Exposure to Household Air Pollution in Children Under the Age of 5 Years in Rural Malawi

“…19 This conclusion is also consistent with the findings of our other recently published work from Malawi that has found no evidence that exposure to household air pollution was associated with pneumonia in adults, with respiratory symptoms or lung function in children and adults, or with the rate of decline on lung function in adults. 17,[22][23][24][25] The strengths of this study include that it is the largest longitudinal study of personal exposure to CO and COHb levels in children in rural Africa and that, as part of CAPS, it benefited from the randomized controlled trial design, conduct, completeness of quality-assured data collection, and analysis. Lost to follow-up and use of an aggregate endpoint (total pneumonia episodes) may impact the accuracy of estimated associations, but the main limitation is the lack of tools to measure personal exposure to PM 2.5 in young children in a straightforward and cost-effective way that can be done frequently for prolonged durations of time on large numbers of participants.…”

“… 19 This conclusion is also consistent with the findings of our other recently published work from Malawi that has found no evidence that exposure to household air pollution was associated with pneumonia in adults, with respiratory symptoms or lung function in children and adults, or with the rate of decline on lung function in adults. 17 , 22 , 23 , 24 , 25 …”

Restrictive Ventilatory Patterns in Residents of Continuing Care Retirement Communities

“…A multidirectional relationship has important clinical and therapeutic implications. Restrictive breathing has been identified as a biologically plausible and modifiable risk factor for the increased risk of pneumonia, decreased functional activity, and immobility (Jary et al, 2017; Kochi et al, 2018; Salhi, Troosters, Behaegel, Joos, & Derom, 2010). Strength training for the upper torso, scapular wall slides, postural taping (Greig, Bennell, Briggs, & Hodges, 2008), and spinal extension exercises (Ball, Cagle, Johnson, Lucasey, & Lukert, 2009) can be tailored and tested to determine their effect on improving posture, lung capacity, and respiratory function, and ultimately reduce RVP among CCRC residents.…”