Improving Child Survival Through Environmental and Nutritional Interventions

Gakidou, Emmanuela; Oza, Shefali; Fuertes, Cecilia Vidal; Li, Amy Y.; Lee, Diana K.; Sousa, Angelica; Hogan, Margaret C.; Hoorn, Stephen Vander; Ezzati, Majid

doi:10.1001/jama.298.16.1876

Cited by 110 publications

(94 citation statements)

References 38 publications

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“…Although in rural areas better ventilation may be able to reduce exposure to indoor air pollution from solid fuels, our results on the role of both household and community biomass use indicate that population-based reduction in solid fuel use is necessary for reducing air pollution exposure and its health effects in developing country cities, also supported by the recent evaluation of the Dublin coal sale ban (22). As seen in our data and in previous studies (8,9,23), in Accra and in other developing country cities, biomass use is indeed more common in low-income households and communities. Fuel price and the initial cost of stove price are likely to be one of the reasons for this pattern, which should be addressed through policies that facilitate financial access to cleaner fuel for the poor.…”

Section: Discussionsupporting

confidence: 84%

“…Following previous analyses of household data in developing countries (23,26), we measured household and community SES using an index based on housing characteristics, water and waste systems, and ownership of durable assets, using the questionnaire data and data from the Ghana 2000 Population and Housing Census. Details of data and SES analyses are provided in SI Text.…”

Section: Methodsmentioning

confidence: 99%

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Household and community poverty, biomass use, and air pollution in Accra, Ghana

Zhou

Dionisio

Arku³

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

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Many urban households in developing countries use biomass fuels for cooking. The proportion of household biomass use varies among neighborhoods, and is generally higher in low socioeconomic status (SES) communities. Little is known of how household air pollution varies by SES and how it is affected by biomass fuels and traffic sources in developing country cities. In four neighborhoods in Accra, Ghana, we collected and analyzed geo-referenced data on household and community particulate matter (PM) pollution, SES, fuel use for domestic and small-commercial cooking, housing characteristics, and distance to major roads. Cooking area PM was lowest in the high-SES neighborhood, with geometric means of 25 (95% confidence interval, 21-29) and 28 (23-33) μg/m 3 for fine and coarse PM (PM 2.5 and PM 2.5-10 ), respectively; it was highest in two low-SES slums, with geometric means reaching 71 (62-80) and 131 (114-150) μg/m 3 for fine and coarse PM. After adjustment for other factors, living in a community where all households use biomass fuels would be associated with 1.5-to 2.7-times PM levels in models with and without adjustment for ambient PM. Community biomass use had a stronger association with household PM than household's own fuel choice in crude and adjusted estimates. Lack of regular physical access to clean fuels is an obstacle to fuel switching in low-income neighborhoods and should be addressed through equitable energy infrastructure. sustainable development | urbanization | global health | household energy | Africa T he populations of cities in the developing world are growing, with sub-Saharan Africa having the highest urban population growth rate worldwide (1). Some urban environmental health risks in the developing world are similar to those in high-income countries, such as the role of transportation as a determinant of particulate matter (PM) pollution levels and spatial patterns (2-5). Urban environmental health risks in developing countries also have some unique features, including high exposure to multiple risks in low-income "slum" neighborhoods (6, 7). A feature of urban PM pollution that, with few exceptions, is unique to developing countries is the widespread household use of biomass fuels (8, 9). Therefore, PM pollution in urban homes may be because of household or neighborhood biomass use in addition to sources that are also found in high-income countries, such as transportation and industrial pollution.The patterns and sources of indoor air pollution in high-income countries have been studied (10-12). There is also increasing attention to residential indoor air quality in developing countries, including the concentrations of various pollutants, their sources, and the role of ventilation (13-15). However, most current studies of biomass fuels and household air pollution in developing countries have focused on the indoor environment in rural areas, where biomass is the most common or even universal household fuel. There are few studies of household PM in developing country cities, especially in ...

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Section: Discussionsupporting

confidence: 84%

Section: Methodsmentioning

confidence: 99%

Household and community poverty, biomass use, and air pollution in Accra, Ghana

Zhou

Dionisio

Arku³

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

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“…Wealth quintiles were derived from the household ownership of durable goods, dwelling characteristics (type of floors, walls and cooking stove), and access to services (improved water, sanitation and cooking fuel) for a total of 21 assets. Household economic status was determined using a dichotomous hierarchical ordered probit model, based on ownership of these selected assets and access to certain services (Ferguson et al, 2003;Gakidou et al, 2007;Hosseinpoor et al, 2005). This model returns a summary index between 0 (low ownership/access) and 1 (high), whose quintiles are entered into the logistic regression as a covariate.…”

Section: Methodsmentioning

confidence: 99%

Diseases of the Rich? The Social Patterning of Hypertension in Six Low- and Middle-Income Countries

et al. 2016

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Introduction.Hypertension and non-communicable diseases (NCDs) are not as yet priority issues for international development. This is surprising, since NCDs already account for a higher share of mortality and illness in low and middle income countries (LMICs) than infectious diseases do, and are set to rapidly increase (WHO, 2010). Referring to the broader policy literature, the papers identifies reasons for this general neglect. These include a general perception that, in contrast to high income countries, in LMICs NCDs disproportionately affect relatively wealthy groups. Drawing on survey data for six countries, we examine the validity of this perception with particular reference to hypertension prevalence, awareness and effective control. In conclusion, we considers the wider applications of its findings for agenda-setting for NCDs in global health. NCDs, hypertension and international development priorities.NCDs include a range of health conditions, such as cardio-vascular diseases, cancers and diabetes. In 2008 they accounted for 63 per cent of all deaths globally, and 80 per cent of these deaths occurred in LMICs (WHO, 2010). In all world regions except Africa the number of deaths caused by NCDs in 2008 already exceeded those caused by infectious, maternal, perinatal and nutritional diseases combined. It is projected that this will be the case for Africa by 2030 (WHO, 2010. NCDs also account for around half the global burden of illness and disability (Beaglehole et al, 2011).Hypertension is by some distance the leading risk factor for NCDs. WHO estimates that in 2008 hypertension was responsible for about 13 per cent of all global deaths (WHO, 2010).

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“…Globally, solid fuel use (SFU) is highest in developing countries ( Figure 1), and is closely related to poverty 16 and other associated household environmental health risks. 18 SFU is greatest in rural areas, reaching 95 % or more in many subSaharan African countries, but is also common in urban areas with up to 70 % SFU in cities of the least developed countries.…”

Section: Protection Against Heat and Coldmentioning

confidence: 99%

“…So for example a program to provide clean water and sanitation together with clean household fuels and nutritional interventions to children younger than 5 in three regions (Latin America and the Caribbean, sub-Saharan Africa and South Asia) at 50 % coverage would yield 30-75 % greater heath benefits if targeted first at poor households than if the same program of interventions was targeted towards the wealthier households. 18 …”

Section: Targeting Low-income Groupsmentioning

confidence: 99%

Promoting Health and Advancing Development through Improved Housing in Low-Income Settings

et al. 2012

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There is major untapped potential to improve health in low-income communities through improved housing design, fittings, materials and construction. Adverse effects on health from inadequate housing can occur through a range of mechanisms, both direct and indirect, including as a result of extreme weather, household air pollution, injuries or burns, the ingress of disease vectors and lack of clean water and sanitation. Collaborative action between public health professionals and those involved in developing formal and informal housing could advance both health and development by addressing risk factors for a range of adverse health outcomes. Potential trade-offs between design features which may reduce the risk of some adverse outcomes whilst increasing the risk of others must be explicitly considered.

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Improving Child Survival Through Environmental and Nutritional Interventions

Cited by 110 publications

References 38 publications

Household and community poverty, biomass use, and air pollution in Accra, Ghana

Household and community poverty, biomass use, and air pollution in Accra, Ghana

Diseases of the Rich? The Social Patterning of Hypertension in Six Low- and Middle-Income Countries

Promoting Health and Advancing Development through Improved Housing in Low-Income Settings

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