For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
20
views
14
references
 Top references
cited by
22
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      310
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Noncommunicable Respiratory Disease and Air Pollution Exposure in Malawi (CAPS). A Cross-Sectional Study

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Rationale: Noncommunicable respiratory diseases and exposure to air pollution are thought to be important contributors to morbidity and mortality in sub-Saharan African adults.

          Objectives: We set out to explore the prevalence and determinants of noncommunicable respiratory disease among adults living in Chikhwawa District, Malawi.

          Methods: We performed a cross-sectional study among adults in communities participating in a randomized controlled trial of a cleaner-burning biomass-fueled cookstove intervention (CAPS [Cooking and Pneumonia Study]) in rural Malawi. We assessed chronic respiratory symptoms, spirometric abnormalities, and personal exposure to air pollution (particulate matter <2.5 μm in aerodynamic diameter [PM 2.5] and carbon monoxide [CO]). Weighted prevalence estimates were calculated; multivariable and intention-to-treat analyses were done.

          Measurements and Main Results: One thousand four hundred eighty-one participants (mean [SD] age, 43.8 [17.8] yr; 57% female) were recruited. The prevalence of chronic respiratory symptoms, spirometric obstruction, and restriction were 13.6% (95% confidence interval [CI], 11.9–15.4), 8.7% (95% CI, 7.0–10.7), and 34.8% (95% CI, 31.7–38.0), respectively. Median 48-hour personal PM 2.5 and CO exposures were 71.0 μg/m 3 (interquartile range [IQR], 44.6–119.2) and 1.23 ppm (IQR, 0.79–1.93), respectively. Chronic respiratory symptoms were associated with current/ex-smoking (odds ratio [OR], 1.59; 95% CI, 1.05–2.39), previous tuberculosis (OR, 2.50; 95% CI, 1.04–15.58), and CO exposure (OR, 1.46; 95% CI, 1.04–2.05). Exposure to PM 2.5 was not associated with any demographic, clinical, or spirometric characteristics. There was no effect of the CAPS intervention on any of the secondary trial outcomes.

          Conclusions: The burden of chronic respiratory symptoms, abnormal spirometry, and air pollution exposures in adults in rural Malawi is of considerable potential public health importance. We found little evidence that air pollution exposures were associated with chronic respiratory symptoms or spirometric abnormalities and no evidence that the CAPS intervention had effects on the secondary trial outcomes. More effective prevention and control strategies for noncommunicable respiratory disease in sub-Saharan Africa are needed.

          Clinical trial registered with www.isrctn.com (ISRCTN 59448623).

          Related collections

          Most cited references14

          • Record: found
          • Abstract: found
          • Article: not found

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

          Stephen Gordon, Nigel G. Bruce, Jonathan Grigg … (2014)
          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.
          Article 0 comments Cited 319 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            An official American Thoracic Society public policy statement: Novel risk factors and the global burden of chronic obstructive pulmonary disease.

            Mark Eisner, Nicholas Anthonisen, David Coultas … (2010)
            Although cigarette smoking is the most important cause of chronic obstructive pulmonary disease (COPD), a substantial proportion of COPD cases cannot be explained by smoking alone. To evaluate the risk factors for COPD besides personal cigarette smoking. We constituted an ad hoc subcommittee of the American Thoracic Society Environmental and Occupational Health Assembly. An international group of members was invited, based on their scientific expertise in a specific risk factor for COPD. For each risk factor area, the committee reviewed the literature, summarized the evidence, and developed conclusions about the likelihood of it causing COPD. All conclusions were based on unanimous consensus. The population-attributable fraction for smoking as a cause of COPD ranged from 9.7 to 97.9%, but was less than 80% in most studies, indicating a substantial burden of disease attributable to nonsmoking risk factors. On the basis of our review, we concluded that specific genetic syndromes and occupational exposures were causally related to the development of COPD. Traffic and other outdoor pollution, secondhand smoke, biomass smoke, and dietary factors are associated with COPD, but sufficient criteria for causation were not met. Chronic asthma and tuberculosis are associated with irreversible loss of lung function, but there remains uncertainty about whether there are important phenotypic differences compared with COPD as it is typically encountered in clinical settings. In public health terms, a substantive burden of COPD is attributable to risk factors other than smoking. To prevent COPD-related disability and mortality, efforts must focus on prevention and cessation of exposure to smoking and these other, less well-recognized risk factors.
            Article 0 comments Cited 310 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              COPD and chronic bronchitis risk of indoor air pollution from solid fuel: a systematic review and meta-analysis.

              Om Kurmi, George W Smith, Padam Simkhada … (2010)
              Over half the world is exposed daily to the smoke from combustion of solid fuels. Chronic obstructive pulmonary disease (COPD) is one of the main contributors to the global burden of disease and can be caused by biomass smoke exposure. However, studies of biomass exposure and COPD show a wide range of effect sizes. The aim of this systematic review was to quantify the impact of biomass smoke on the development of COPD and define reasons for differences in the reported effect sizes. A systematic review was conducted of studies with sufficient statistical power to calculate the health risk of COPD from the use of solid fuel, which followed standardised criteria for the diagnosis of COPD and which dealt with confounding factors. The results were pooled by fuel type and country to produce summary estimates using a random effects model. Publication bias was also estimated. There were positive associations between the use of solid fuels and COPD (OR=2.80, 95% CI 1.85 to 4.0) and chronic bronchitis (OR=2.32, 95% CI 1.92 to 2.80). Pooled estimates for different types of fuel show that exposure to wood smoke while performing domestic work presents a greater risk of development of COPD and chronic bronchitis than other fuels. Despite heterogeneity across the selected studies, exposure to solid fuel smoke is consistently associated with COPD and chronic bronchitis. Efforts should be made to reduce exposure to solid fuel by using either cleaner fuel or relatively cleaner technology while performing domestic work.
              Article 0 comments Cited 147 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Journal
                Journal ID (nlm-ta): Am J Respir Crit Care Med
                Journal ID (iso-abbrev): Am. J. Respir. Crit. Care Med
                Journal ID (publisher-id): ajrccm
                Title: American Journal of Respiratory and Critical Care Medicine
                Publisher: American Thoracic Society
                ISSN (Print): 1073-449X
                ISSN (Electronic): 1535-4970
                Publication date (Print and electronic): 1 March 2019
                Publication date (Electronic): 1 March 2019
                Publication date (Print): 1 March 2019
                Publication date PMC-release: 1 March 2019
                Volume: 199
                Issue: 5
                Pages: 613-621
                Affiliations
                [ 1 ]Liverpool School of Tropical Medicine, Liverpool, United Kingdom
                [ 2 ]Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
                [ 3 ]Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
                [ 4 ]University of California, Berkeley, California
                [ 5 ]National Heart and Lung Institute, Imperial College, London, United Kingdom; and
                [ 6 ]University of California, San Francisco, San Francisco, California
                Author notes
                Correspondence and requests for reprints should be addressed to Kevin Mortimer, Ph.D., Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK. E-mail: kevin.mortimer@ 123456lstmed.ac.uk .
                [*]

                Co–first authors.

                [‡]

                Co–senior authors.

                [§]

                J.B. is Associate Editor of AJRCCM. His participation complies with American Thoracic Society requirements for recusal from review and decisions for authored works.

                Author information
                http://orcid.org/0000-0001-5636-8531
                http://orcid.org/0000-0002-8118-8871
                Article
                Publisher-manuscript ID: 201805-0936OC
                DOI: 10.1164/rccm.201805-0936OC
                PMC ID: 6396863
                PubMed ID: 30141966
                SO-VID: 54136ed0-14be-43e7-a3eb-1786d3a1fbb8
                Copyright © Copyright © 2019 by the American Thoracic Society
                License:

                This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 18 May 2018
                Date accepted : 22 August 2018
                Related
                Page count
                Figures: 3, Tables: 6, Pages: 9
                Categories
                Subject: Original Articles
                Subject: Environmental and Occupational Lung Disease

                Keywords: household air pollution,malawi,chronic obstructive pulmonary disease,cooking and pneumonia study,cookstove
                Data availability:
                Keywords: household air pollution, malawi, chronic obstructive pulmonary disease, cooking and pneumonia study, cookstove

                Comments

                Comment on this article

                scite_

                Similar content310

                See all similar

                Cited by25

                See all cited by

                Most referenced authors2,586

                See all reference authors