Air pollution and maternal, newborn and child health

• Main Authors: Patrick Opiyo Owili, 帕崔克
• Other Authors: Hsien-Wen Kuo
• Format: Others
• Language: en_US
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/qjefc6

博士 === 國立陽明大學 === 環境科技博士學位學程 === 106 === Background: Indoor and ambient air pollution as a result of exposure to secondhand tobacco smoke, cooking fuel and particulate matter (PM2.5) leads to serious health outcomes among the population, and yet, few studies have assessed its effect on under-five and maternal mortality in Sub-Saharan Africa. Therefore, we investigated the association between exposure to secondhand tobacco smoke, cooking fuel and PM2.5 and risk of under-five and maternal mortality in Sub-Saharan Africa (SSA). Methods: The most recent cross-sectional data of the Demographic Health Survey in SSA countries (n = 783,691), the World Bank, and the spectral derivate of aerosol optical depth (AOD) from Moderate Resolution Imaging Spectroradiometer (MODIS) products were used. Cox proportional hazard models, Generalized Linear Mixed-Effect Models, and Generalized Additive Mixed-Effect Models were employed to determine the association between exposure to secondhand tobacco smoke and cooking fuel (with age as the time-to-event indicator) and PM2.5 and the risk of under-five and maternal mortality in SSA, respectively. Results: The association between tobacco smoke exposure and the risk of under-five mortality attenuated in eight countries (Bukina Faso, Benin, Congo, Gabon, Guinea, Liberia, Togo, and Zambia) after adjustment, while the hazard ratios (HR) of daily exposure to tobacco smoke in Kenya (HR =1.40; 95% CI, 1.16-1.70) and Namibia (HR = 1.40; 1.07-1.83) grew. The children in rural areas in SSA were 1.08 (95% CI, 1.04-1.13) times more likely to die than their urban peers. In general, the exposure to household tobacco smoke was associated with an increased risk of under-five mortality in SSA (HR =1.09; 95% CI, 1.06-1.13). On the other hand, the adjusted hazard ratios for charcoal and biomass cooking fuel were 1.21 (95% CI, 1.10-1.34) and 1.20 (95% CI, 1.08-1.32), respectively, compared to clean fuels. There was no positive interaction between biomass cooking fuel and smoking. For PM2.5, four types were identified (i.e. mineral dust, anthropogenic pollutant, biomass burning and mixture aerosols. The results demonstrate that biomass PM2.5 increased the rate of under-five mortality in Western and Central Africa, each by 2%, and maternal mortality in Central Africa by 19%. Anthropogenic PM2.5 increased under-five and maternal deaths in Northern Africa by 5% and 10%, respectively, and maternal deaths by 4% in Eastern Africa. Dust PM2.5 increased under-five deaths in Northern, Western, and Central Africa by 3%, 1%, and 10%, respectively. Mixture PM2.5 only increased under-five deaths and maternal deaths in Western (incidence rate ratio = 1.01, p < 0.10) and Eastern Africa (incidence rate ratio = 1.06, p < 0.01), respectively. Conclusions: This study provided evidence of a positive association between exposure to household tobacco smoke and risk of under-five mortality in SSA. Also, the findings indicated that use of charcoal and biomass were associated with the risk of under-five mortality in SSA. Moreover, the types of ambient PM2.5 were found to be significantly associated with under-five and maternal mortality in Africa where the exposure level usually exceeds the World Health Organization’s (WHO) standards. Appropriate policy actions on protective and control measures suggested should therefore be developed and implemented accordingly.