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The exposure of infants and children to carbon monoxide from biomass fuels in The Gambia: a measurement and modeling study

Journal of Exposure Science & Environmental Epidemiology volume 22, pages 173–181 (2012)Cite this article

Abstract

Smoke from biomass fuels is a risk factor for pneumonia, the leading cause of child death worldwide. Although particulate matter (PM) is the metric of choice for studying the health effects of biomass smoke, measuring children's PM exposure is difficult. Carbon monoxide (CO), which is easier to measure, can be used as a proxy for PM exposure. We measured the exposure of children ≤5 years of age in The Gambia to CO using small, passive, color stain diffusion tubes. We conducted multiple CO measurements on a subset of children to measure day-to-day exposure variability. Usual CO exposure was modeled using a mixed effects model, which also included individual and household level exposure predictors. Mean measured CO exposure for 1181 children (n=2263 measurements) was 1.04±1.46 p.p.m., indicating that the Gambian children in this study on average have a relatively low CO exposure. However, 25% of children had exposures of 1.3 p.p.m. or higher. CO exposure was higher during the rainy months (1.33±1.62 p.p.m.). Burning insect coils, using charcoal, and measurement done in the rainy season were associated with higher exposure. A parsimonious model with fuel, season, and other PM sources as covariates explained 39% of between-child variation in exposure and helped remove within-child variability.

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References

  • Armstrong J.R., and Campbell H. Indoor air pollution exposure and lower respiratory infections in young Gambian children. Int J Epidemiol 1991: 20 (2): 424–429.

    Article  CAS  Google Scholar 

  • Balakrishnan K., Sankar S., Parikh J., Padmavathi R., Srividya K., and Venugopal V., et al. Daily average exposures to respirable particulate matter from combustion of biomass fuels in rural households of southern India. Environ Health Perspect 2002: 110: 1069–1075.

    Article  Google Scholar 

  • Black R.E., Cousens S., Johnson H.L., Lawn J.E., Rudan I., and Bassani D.G., et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010: 375 (9730): 1969–1987.

    Article  Google Scholar 

  • Brewster D., and Greenwood B. Seasonal variation of paediatric diseases in The Gambia, West Africa. Ann Trop Paediatr 1993: 13 (2): 133–146.

    Article  CAS  Google Scholar 

  • Bruce N., McCracken J., Albalak R., Schei M.A., Smith K.R., and Lopez V., et al. Impact of improved stoves, house construction and child location on levels of indoor air pollution exposure in young Guatemalan children. J Expo Anal Environ Epidemiol 2004: 14 (Suppl 1): S26–S33.

    Article  CAS  Google Scholar 

  • Dasgupta S., Huq M., Khaliquzzaman M., Pandey K., and Wheeler D. Who suffers from indoor air pollution? Health Policy Plan 2006: 21 (6): 444–458.

    Article  Google Scholar 

  • de Francisco A., Morris J., Hall A.J., Armstrong Schellenberg J.R.M., and Greenwood B.M. Risk factors for mortality from acute lower respiratory tract infections in young Gambian children. Int J Epidemiol 1993: 22: 1174–1182.

    Article  CAS  Google Scholar 

  • Dherani M., Pope D., Mascarenhas M., Smith K.R., Weber M., and Bruce N. Indoor air pollution from unprocessed solid fuel use and pneumonia risk in children aged under five years: a systematic review and meta-analysis. Bull World Health Organ 2008: 86 (5): 390–398C.

    Article  Google Scholar 

  • Dionisio K.L., Howie S., Fornace K.M., Chimah O., Adegbola R.A., and Ezzati M. Measuring the exposure of infants and children to indoor air pollution from biomass fuels in the Gambia. Indoor Air 2008: 18 (4): 317–327.

    Article  CAS  Google Scholar 

  • Ezzati M., and Kammen D.M. Indoor air pollution from biomass combustion and acute respiratory infections in Kenya. Lancet 2001: 358 (9282): 619–624.

    Article  CAS  Google Scholar 

  • Ezzati M., Saleh H., and Kammen D.M. The contributions of emissions and spatial microenvironments to exposure to indoor air pollution from biomass combustion in Kenya. Environ Health Perspect 2000: 108 (9): 833–839.

    Article  CAS  Google Scholar 

  • Filmer D., and Pritchett L.H. Estimating wealth effects without expenditure data-or tears: an application to educational enrollments in states of India. Demography 2001: 38 (1): 115–132.

    CAS  PubMed  Google Scholar 

  • Gelman A., and Hill J. Data Analysis Using Regression and Multilevel/Hierarchical Models. Cambridge University Press, New York, 2007.

    Google Scholar 

  • Honaker J., King G., and Blackwell M. Amelia II: A Program for Missing Data. http://gking.harvard.edu/amelia. Accessed 2010.

  • Honaker J., and King G. What to do about missing values in time series cross-section data. Am J Pol Sci 2010: 54 (2): 561–581.

    Article  Google Scholar 

  • King G., Honaker J., Joseph A., and Scheve K. Analyzing incomplete political science data: an alternative algorithm for multiple imputation. Am Pol Sci Rev 2001: 95: 49–69.

    Google Scholar 

  • Laird N.M., and Ware J.H. Random-effects models for longitudinal data. Biometrics 1982: 38 (4): 963–974.

    Article  CAS  Google Scholar 

  • McCracken J.P., Schwartz J., Bruce N., Mittleman M., Ryan L.M., and Smith K.R. Combining individual- and group-level exposure information: child carbon monoxide in the Guatemala Woodstove Randomized Control Trial. Epidemiology 2009: 20 (1): 127–136.

    Article  Google Scholar 

  • Mestl H.E.S., Aunan K., Seip H.M., Wang S., Zhao Y., and Zhang D. Urban and rural exposure to indoor air pollution from domestic biomass and coal burning across China. Sci Total Environ 2007: 377: 12–26.

    Article  CAS  Google Scholar 

  • Naeher L.P., Smith K.R., Leaderer B.P., Neufield L., and Mage D.T. Carbon monoxide as a tracer for assessing exposures to particulate matter in wood and gas cookstove households of highland Guatemala. Environ Sci Technol 2001: 35: 575–581.

    Article  CAS  Google Scholar 

  • Northcross A., Chowdhury Z., McCracken J., Canuz E., and Smith K.R. Estimating personal PM2.5 exposures using CO measurements in Guatemalan households cooking with wood fuel. J Environ Monit 2010: 12: 873–878.

    Article  CAS  Google Scholar 

  • O’Dempsey T.J., McArdle T.F., Morris J., Lloyd-Evans N., Baldeh I., and Laurence B.E., et al. A study of risk factors for pneumococcal disease among children in a rural area of West Africa. Int J Epidemiol 1996: 25 (4): 885–893.

    Article  Google Scholar 

  • Selwyn B.J. The epidemiology of acute respiratory tract infection in young children: comparison of findings from several developing countries. Rev Infect Dis 1990: 12 (Suppl 8): S870–S888.

    Article  Google Scholar 

  • Smith K.R., Mehta S., and Maeusezahl-Feuz M. Indoor air pollution from household solid fuel use. Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. World Health Organization, Geneva, 2004, 1435–1493.

    Google Scholar 

  • Wagstaff A. Socioeconomic inequalities in child mortality: comparisons across nine developing countries. Bull World Health Organ 2000: 78: 19–29.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Xu R. Measuring explained variation in linear mixed effects models. Stat Med 2003: 22 (22): 3527–3541.

    Article  Google Scholar 

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Acknowledgements

This work was supported by a grant from the National Institute of Environmental Health Sciences (1R21ES017855-01). We thank the households who participated in the study for their help and hospitality, our field workers and field supervisors for valuable assistance in data collection, the Biomedical Engineering Department at the MRC for technical assistance throughout the study, Jose Vallarino for information on methods and instruments for personal exposure measurement, and Mariel Finucane for advice on presentation of statistical results. We also thank Grant Mackenzie for operational support, Kim Mulholland, Philip Hill, Brian Greenwood, and Peter Smith for advice on case–control study design, and Nigel Bruce and Kirk Smith for advice on exposure measurement.

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Authors and Affiliations

  1. Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA

    Kathie L Dionisio

  2. Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA

    Kathie L Dionisio & John D Spengler

  3. Child Survival Theme, Medical Research Council, The Gambia Unit, Fajara, The Gambia

    Stephen R C Howie, Simon Donkor, Osaretin Chimah, Claire Oluwalana, Readon C Ideh, Bernard Ebruke & Richard A Adegbola

  4. Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA

    Francesca Dominici

  5. Veterinary Epidemiology and Public Health Group, Royal Veterinary College, London, UK

    Kimberly M Fornace

  6. Bill & Melinda Gates Foundation, Seattle, Washington, USA

    Richard A Adegbola

  7. Department of Epidemiology and Biostatistics, MRC-HPA Center for Environment and Health, Imperial College London, London, UK

    Majid Ezzati

  8. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College of London, London, UK

    Majid Ezzati

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  1. Kathie L Dionisio
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  12. Majid Ezzati
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Correspondence to Majid Ezzati.

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Supplementary Information accompanies the paper on the Journal of Exposure Science and Environmental Epidemiology website

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Dionisio, K., Howie, S., Dominici, F. et al. The exposure of infants and children to carbon monoxide from biomass fuels in The Gambia: a measurement and modeling study. J Expo Sci Environ Epidemiol 22, 173–181 (2012). https://doi.org/10.1038/jes.2011.47

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