[Show abstract][Hide abstract] ABSTRACT: 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.
The Lancet Respiratory Medicine 10/2014; 2(10). DOI:10.1016/S2213-2600(14)70168-7 · 9.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This article is a review of the pollution of water, air and the effect of climate change on the health of the Peruvian population. A major air pollutant is particulate matter less than 2.5 μ (PM 2.5). In Lima, 2,300 premature deaths annually are attributable to this pollutant. Another problem is household air pollution by using stoves burning biomass fuels, where excessive indoor exposure to PM 2.5 inside the household is responsible for approximately 3,000 annual premature deaths among adults, with another unknown number of deaths among children due to respiratory infections. Water pollution is caused by sewage discharges into rivers, minerals (arsenic) from various sources, and failure of water treatment plants. In Peru, climate change may impact the frequency and severity of El Niño Southern Oscillation (ENSO), which has been associated with an increase in cases of diseases such as cholera, malaria and dengue. Climate change increases the temperature and can extend the areas affected by vector-borne diseases, have impact on the availability of water and contamination of the air. In conclusion, Peru is going through a transition of environmental risk factors, where traditional and modern risks coexist and infectious and chronic problems remain, some of which are associated with problems of pollution of water and air.
Revista peruana de medicina experimental y salud publica 09/2014; 31(3):547-56.
[Show abstract][Hide abstract] ABSTRACT: Background
Exposure to pollution from biomass fuel has been associated with low birthweight in some studies. Few studies have included exposure-response analyses.
We conducted a case-control study of biomass fuel use and reproductive outcome at high altitude in Peru. Cases (n=101) were full term births who were SGA (birth weight <10th percentile for gestational age). Controls (n=101) had a birthweight ≥10th percentile, and were matched to cases on birth week and residence. Biomass fuel use during pregnancy was determined by questionnaire. Carbon monoxide (CO) in the kitchen was measured in a subgroup (n=72). Logistic regression was used to estimate the effects of biofuel and CO on the risk of SGA, controlling for maternal education and parity.
Among cases, 30%, 27% and 44% used gas, gas+biomass, and biomass, respectively, while the figures for controls were 39%, 33%, and 29%. The adjusted odds ratio (OR) for biomass fuel alone compared with gas alone was 4.5 (95% CI: 1.3, 15.5, p=0.02), while the OR for biomass+gas vs. gas alone was 2.1 (0.80–5.5) (p=0.13). Among the subgroup with measured CO, the mean 48-h kitchen CO levels were 4.8, 2.2 and 0.4 ppm for biofuel only, biofuel+gas, and gas respectively. ORs by increasing tertile of CO level were 1.0, 1.16, and 3.53 (test for trend, p=0.02). The exposure-response trend corresponds well with one other study with analogous data.
Despite limited sample size, our data suggest that maternal exposure to biomass smoke and CO, at high altitude, is associated with SGA among term births.
Environmental Research 04/2014; 130:29–33. DOI:10.1016/j.envres.2014.01.008 · 4.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: ABSTRACT While evidence suggests associations between maternal exposure to air pollution and adverse birth outcomes, pregnant women's exposure to household air pollution in developing countries is understudied. Personal exposures of pregnant women (n = 100) in Trujillo, Peru to air pollutants and their indoor concentrations were measured. The effects of stove-use related characteristics and ambient air pollution on exposure were determined using mixed-effects models. Significant differences in 48-hr kitchen concentrations of particulate matter (PM2.5), carbon monoxide (CO), and nitrogen dioxide (NO2) concentrations were observed across fuel-types (p < 0.05). Geometric mean PM2.5 concentrations were 112 μg/m (3) (CLs: 52, 242 μg/m(3)) and 42 μg/m(3) (21, 82 μg/m(3)) in homes were wood and gas were used respectively. PM2.5 exposure was at levels which recent exposure-response analyses suggest may not result in substantial reduction in health risks even in homes where cleaner burning gas stoves were used.
Archives of Environmental and Occupational Health 11/2013; 70(1). DOI:10.1080/19338244.2013.807761 · 0.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Nearly half of the world's population is exposed to household air pollution (HAP) due to long hours spent in close proximity to unvented cooking fires. We aimed to use PM2.5 and CO measurements to characterize exposure to cookstove generated woodsmoke in real time among control (n=10) and intervention (n=9) households in San Marcos, Cajamarca Region, Peru. Real time personal particulate matter with an aerodynamic diameter ≤2.5 µm (PM2.5), and personal and kitchen carbon monoxide (CO) samples were taken. Control households used a number of stoves including open fire and chimney stoves while intervention households used study-promoted chimney stoves. Measurements were categorized into lunch (9am - 1pm) and dinner (3pm - 7pm) periods, where applicable, to adjust for a wide range of sampling periods (2.8- 13.1hrs). During the 4-h time periods, mean personal PM2.5 exposures were correlated with personal CO exposures during lunch (r=0.67 p=0.024 n=11) and dinner (r=0.72 p=0.0011 n=17) in all study households. Personal PM2.5 exposures and kitchen CO concentrations were also correlated during lunch (r=0.76 p=0.018 n=9) and dinner (r=0.60 p=0.018 n=15). CO may be a useful indicator of PM during 4-h time scales measured in real time, particularly during high woodsmoke exposures, particularly during residential biomass cooking.
[Show abstract][Hide abstract] ABSTRACT: Levoglucosan, a sugar anhydride and a combustion breakdown product of cellulose is a dominant organic constituent of particles in woodsmoke. After exposure, levoglucosan is excreted unmetabolized in urine.
Urinary levoglucosan was assessed as a biomarker of occupational woodsmoke exposure among wildland firefighters.
Urine samples were collected from wildland firefighters before and after their work-shifts on days when they worked at prescribed burns. A total of 97 pairs of pre- and post-shift urine samples were collected from 19 firefighters over 10 prescribed burn shifts. The urine samples were analyzed to determine whether there was an increase in the concentration of levoglucosan from pre- to post-shift after the firefighters had worked at the prescribed burns.
Overall, there was an increase in both the urinary volume-based and creatinine corrected levoglucosan concentrations from pre- to post-shift (P < 0.05). However, the direction of change in the concentrations was not consistent. There were increases in urinary levoglucosan concentration from pre- to post-shift in 63% of the person-day samples, and in only 58% of the person-day samples for the creatinine corrected concentrations.
Although there was an overall increase in urinary concentrations of levoglucosan, results suggest that other sources apart from woodsmoke affected the urinary levels of this biomarker in wildland firefighters. Therefore, urinary levoglucosan may not be effective as a biomarker of woodsmoke exposure in this setting.
International journal of occupational and environmental health 10/2013; 19(4):304-10. DOI:10.1179/2049396713Y.0000000037 · 1.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Measurement of biological indicators of physiological change may be useful in evaluating the effectiveness of stove models, which are intended to reduce indoor smoke exposure and potential health effects. Objectives: We examined changes in exhaled carbon monoxide (CO), percentage carboxy-hemoglobin, and total hemoglobin in response to the installation of a chimney stove model by the Juntos National Program in Huayatan, Peru in 2008. Methods: Biomarkers were measured in a convenience sample comprising 35 women who met requirements for participation, and were measured before and three weeks after installation of a chimney stove. The relationships between exposure to indoor smoke and biomarker measurements were also analyzed using simple linear regression models. Results: Exhaled CO reduced from 6·71 ppm (95% CI 5·84–7·71) to 3·14 ppm (95% CI 2·77–3·66) three weeks after stove installation (P < 0·001) while % COHb reduced from 1·76% (95% CI 1·62–1·91) to 1·18% (95% CI 1·12–1·25; P < 0·001). Changes in exhaled CO and % COHb from pre- to post-chimney stove installation were not correlated with corresponding changes in exposure to CO and PM2·5 even though the exposures also reduced after stove installation. Conclusion: Exhaled CO and % COHb both showed improvement with reduction in concentration after the installation of the chimney cook stoves, indicating a positive physiological response subsequent to the intervention.
International journal of occupational and environmental health 10/2013; 19(4):325-331. DOI:10.1179/2049396713Y.0000000039 · 1.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Nearly half of the world's population is exposed to household air pollution (HAP) due to long hours spent in close proximity to unvented cooking fires. The effect of woodsmoke exposure on oxidative stress was examined by investigating the association between woodsmoke exposure and biomarkers of DNA oxidation (8-hydroxy-2'-deoxyguanosine [8-OHdG]) and lipid peroxidation (8-isoprostane) among control and intervention stove users. HAP exposure assessment was conducted within the framework of a community-randomized controlled trial of 51 communities in San Marcos Province, Cajamarca Region, Peru. The first morning urine voids after 48h HAP exposure assessment from a subset of 45 control and 39 intervention stove users were analyzed for 8-OHdG and 8-isoprostane. General linear models and correlation analyses were performed. Urinary oxidative stress biomarkers ranged from 11.2 to 2270.0μg/g creatinine (median: 132.6μg/g creatinine) for 8-OHdG and from 0.1 to 4.5μg/g creatinine (median: 0.8μg/g creatinine) for 8-isoprostane among all study subjects (n=84). After controlling for the effects of traffic in the community and eating food exposed to fire among all subjects, cooking time was weakly, but positively associated with urinary 8-OHdG (r=0.29, p=0.01, n=80). Subjects' real-time personal CO exposures were negatively associated with 8-OHdG, particularly the maximum 30-second CO exposure during the sampling period (r=-0.32, p=0.001, n=73). 48h time integrated personal PM2.5 was negatively, but marginally associated with urinary 8-isoprostane (r=-0.21, p=0.09, n=69) after controlling for the effect of distance of homes to the road. Urinary 8-isoprostane levels reported in the available literature are comparable to results found in the current study. However there were relatively high levels of urinary 8-OHdG compared to data in the available literature for 8-OHdG excretion. Results suggest a sustained systemic oxidative stress among these Peruvian women chronically exposed to wood smoke.
Environment international 09/2013; 60C:112-122. DOI:10.1016/j.envint.2013.08.013 · 5.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Nearly 3 billion people worldwide rely on solid fuel combustion to meet basic household energy needs. Resulting exposure to air pollution is estimated to cause 4.5% of the global burden of disease. Large variability and a lack of resources for research and development have resulted in highly uncertain exposure estimates. The objective of this paper is to identify research priorities for exposure assessment that will more accurately and precisely define exposure-response relationships of household air pollution necessary to inform future cleaner-burning cookstove dissemination programs.
As part of a May 2011 international workshop, an expert group characterized the state of the science and developed recommendations for exposure assessment of household air pollution.
The following priority research areas were identified to explain variability and reduce uncertainty of household air pollution exposure measurements: improved characterization of spatial and temporal variability for studies examining both short- and long-term health effects; development and validation of measurement technology and approaches to conduct complex exposure assessments in resource-limited settings with a large range of pollutant concentrations; and development and validation of biomarkers for estimating dose. Addressing these priority research areas, which will inherently require an increased allocation of resources for cookstove research, will lead to better characterization of exposure-response relationships.
Although the type and extent of exposure assessment will necessarily depend on the goal and design of the cookstove study, without improved understanding of exposure-response relationships, the level of air pollution reduction necessary to meet the health targets of cookstove interventions will remain uncertain.
Environmental Health Perspectives 07/2013; 121(10). DOI:10.1289/ehp.1206429 · 7.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Wildland firefighters are occupationally exposed to elevated levels of woodsmoke. Eighteen wildland firefighters were monitored for their personal exposure to particulate matter with median aerodynamic diameter of 2.5 microns (PM2.5), levoglucosan (LG), and carbon monoxide (CO) at 30 prescribed burns at the Savannah River Site, South Carolina. Linear mixed effect models were used to investigate the effect on exposure of various factors and to examine whether the firefighters were able to qualitatively estimate their own exposures. Exposure to PM2.5 and CO was higher when firefighters performed 'holding' tasks compared with 'lighting' duties, whereas exposures to CO and LG were higher when burns were in compartments with predominantly pine vegetation (P < 0.05). Exposures to PM2.5 (64-2068 µg m(-3)) and CO (0.02-8.2 p.p.m.) fell within the ranges observed in previous studies. Some recommended shorter term exposure limits for CO were exceeded in a few instances. The very low LG:PM2.5 ratios in some samples suggest that the exposures of wildland firefighters to pollutants at prescribed burns may be substantially impacted by non-woodsmoke sources. The association of the qualitative exposure estimation of the firefighters with actual PM2.5 and CO measurements (P < 0.01) indicates that qualitative estimation may be used to assess exposure in epidemiology studies.
[Show abstract][Hide abstract] ABSTRACT: Background
In developing countries, deficiencies in essential micronutrients are common, particularly in pregnant women. Although, biochemical indicators of diet and nutrition are useful to assess nutritional status, few studies have examined such indicators throughout pregnancy in women in developing countries.
The primary objective of this study was to assess the nutritional status of 78 Peruvian women throughout pregnancy for 16 different nutritional indicators including fat-soluble vitamins and carotenoids, iron-status indicators, and selenium. Venous blood samples from which serum was prepared were collected during trimesters one (n = 78), two (n = 65), three (n = 62), and at term via the umbilical cord (n = 52). Questionnaires were completed to determine the demographic characteristics of subjects. Linear mixed effects models were used to study the associations between each maternal indicator and the demographic characteristics.
None of the women were vitamin A and E deficient at any stage of pregnancy and only 1/62 women (1.6%) was selenium deficient during the third trimester. However, 6.4%, 44% and 64% of women had ferritin levels indicative of iron deficiency during the first, second and third trimester, respectively. Statistically significant changes (p ≤ 0.05) throughout pregnancy were noted for 15/16 nutritional indicators for this Peruvian cohort, with little-to-no association with demographic characteristics. Three carotenoids (beta-carotene, beta-cryptoxanthin and trans-lycopene) were significantly associated with education status, while trans-lycopene was associated with age and beta-cryptoxanthin with SES (p < 0.05). Concentrations of retinol, tocopherol, beta-cryptoxanthin, lutein + zeaxanthin and selenium were lower in cord serum compared with maternal serum (p < 0.05). Conversely, levels of iron status indicators (ferritin, transferrin saturation and iron) were higher in cord serum (p < 0.05).
The increasing prevalence of iron deficiency throughout pregnancy in these Peruvian women was expected. It was surprising though not to find deficiencies in other nutrients. The results highlight the importance of continual monitoring of women throughout pregnancy for iron deficiency which could be caused by increasing fetal needs and/or inadequate iron intake as pregnancy progresses.
[Show abstract][Hide abstract] ABSTRACT: Air emissions from animal feeding operations have become a growing concern for producers and their neighbors. Much work has been done to quantify emission rates; however, little information has been provided about air quality downwind from these facilities. This study investigates PM2.5 (particulate matter = 2.5 µm in diameter) levels as they dissipate from the exhaust fans of selected commercial, tunnel-ventilated, broiler houses in Northeast Georgia. PM2.5 was measured in real time using aerosol monitors and from a time-integrated basis using cyclone samplers. Data were taken over a 4-week period and filtered for wind direction and internal instrument calibration checks. Results indicate a rapid dissipation of fine particulates as the distance from the source increases. When compared to nearby monitoring data, particulate levels appear to be near background levels at distances greater than 30 m.
The Journal of Applied Poultry Research 06/2013; 22(2):351-360. DOI:10.3382/japr.2012-00646 · 0.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Wildland firefighters in the United States are occupationally exposed to high levels of woodsmoke. Results from experimental studies show that exposure to woodsmoke induces inflammation. A study was conducted to investigate the effect of occupational woodsmoke exposure on inflammatory biomarkers in firefighters working at prescribed burns. Twelve U.S. Forest Service wildland firefighters at the Savannah River Site, South Carolina, volunteered to give blood samples during four prescribed burns between February and March 2011. Twenty-four paired (pre- and post-work shift) blood samples were collected using dried blood spot method to facilitate repeated sample collection. Inflammatory biomarker concentrations in blood samples were measured using the Meso Scale Discovery multi-spot assay system. Concurrent personal PM(2.5) and CO monitoring of firefighters was conducted. Linear mixed models were used to test whether cross-work shift differences occurred in the following inflammatory biomarkers: IL-1β, IL-8, CRP, SAA, ICAM-1, and VCAM-1. IL-8 showed a significant cross-work shift difference as indicated by a post/pre-work shift ratio of 1.70 (95% CL: 1.35, 2.13; p = 0.0012). Concentrations of IL-8, CRP, and ICAM-1 increased in >50% of samples across work shift. Firefighters who lighted fires as opposed to other work tasks had the largest cross-work shift increase in IL-8. A significant cross-work shift increase in IL-8 in blood samples was observed in healthy wildland firefighters working at prescribed burns. Further research is needed to understand the physiological responses underlying the adverse effects of woodsmoke exposure, and the dose-response relationship between woodsmoke exposure and inflammatory responses.
Journal of Occupational and Environmental Hygiene 04/2013; 10(4):173-80. DOI:10.1080/15459624.2012.760064 · 1.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Household air pollution (HAP) from indoor burning of biomass or coal is a leading global cause of morbidity and mortality, mostly due to its association with acute respiratory infection in children, chronic respiratory and cardiovascular diseases in adults. Interventions that have significantly reduced exposure to HAP improve health outcomes and may reduce mortality. However, we lack robust, specific and field-ready biomarkers to identify populations at greatest risk, and to monitor the effectiveness of interventions. New scientific approaches are urgently needed to develop biomarkers of human exposure that accurately reflect exposure or effect. In this perspective, we describe the global need for such biomarkers, the aims of biomarker development, and the state of development of tests which have the potential for rapid transition from laboratory bench to field use.
[Show abstract][Hide abstract] ABSTRACT: Nearly half of the world's population is exposed to household air pollution (HAP) due to long hours spent in close proximity to biomass-fueled fires.
We compare CO exposures and concentrations among study promoted intervention stove users and control stove users in San Marcos Province, Cajamarca region, Peru.
Passive CO diffusion tubes were deployed over a 48-hour sampling period to measure kitchen CO concentrations and personal mother and child CO exposures in 197 control and 182 intervention households.
Geometric means (95% CI) for child, mother, and kitchen measurements were 1·1 (0·9-1·2), 1·4 (1·3-1·6), and 7·3 (6·4-8·3) ppm in control households, and 1·0 (0·9-1·1), 1·4 (1·3-1·6), and 7·3 (6·4-8·2) ppm among intervention households, respectively.
With no significant differences between control and intervention CO measurements, results suggest that intervention stove maintenance may be necessary for long-term reductions in CO exposures.
International journal of occupational and environmental health 03/2013; 19(1):43-54. DOI:10.1179/2049396712Y.0000000014 · 1.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although the production and use of some persistent organic pollutants (POPs) have been banned or highly restricted, human exposure remains a subject of investigation due to their environmental persistence. Physiological changes during pregnancy may affect the disposition of POPs in the mother's body, and thus fetal exposure. Changes in serum concentrations of organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) across pregnancy trimesters, and trans-placental transfer to the fetus were investigated. Seventy-nine pregnant women in Trujillo, Peru were recruited in the first trimester of pregnancy, and provided blood samples for the analysis of 35 PCB congeners, 9 OCPs, and 11 polybrominated biphenyl diethers (PBDEs). Subsequently, maternal blood samples were collected in the second (n=64) and third trimesters (n=59), and cord blood samples (n=50) were collected at delivery. There were statistically significant changes across trimesters (p<0.05) for both fresh weight (increase) and lipid adjusted concentrations (decrease) of hexachlorobenzene (HCB), 2,2-Bis(4-chlorophenyl)-1,1-dichloroethene (p,p'-DDE), PCB-74, 118, 138-158, 153, 170, 180 and 194. Fresh weight concentrations of these POPs increased from first to third trimester by 10-28%. On the other hand lipid adjusted concentrations decreased from first to third trimester by 16-28%. Serum lipids increased from first to third trimester by 53% indicating the dilution of the POPs in the lipids. Concentrations of 2,2-Bis(4-chlorophenyl)-1,1,1-trichloroethane (p,p'-DDT), its metabolite p,p'-DDE, PCB-118, 138-158, 153, 170 and 180 above their limits of detection were measured in >60% of cord serum samples. Intra-individual correlations in maternal serum concentrations were high for most of the POPs (ρ=0.62-0.99; p<0.05) while correlations between maternal and cord serum concentrations were also high (ρ=0.68-0.99; p<0.05). Results indicate that the disposition in the body and blood concentrations of POPs may change during pregnancy, and show trans-placental transfer of DDT, DDE and PCBs.
[Show abstract][Hide abstract] ABSTRACT: Experimental studies indicate that exposure to woodsmoke could induce oxidative stress. However studies have not been conducted among the general population and specialized occupational groups despite the existence of elevated woodsmoke exposure situations. Therefore, we investigated whether there were across workshift changes in oxidative stress biomarkers among wildland firefighters who are occupationally exposed to elevated levels of woodsmoke. We collected pre- and post-workshift urine samples from 19 wildland firefighters before and after prescribed burns. We measured malondialdehyde (MDA) and 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxo-dG) in the samples, and analyzed whether there were cross-shift changes in their levels, and the relationships between the changes and the length of firefighting career, age of firefighter, and quantified workshift exposure to particulate matter. Overall no significant cross-shift change was observed for 8-oxodG or MDA in the urine samples of the firefighters. Changes in both biomarkers were also not associated with PM(2.5), which was used as a marker of exposure. However, overall unadjusted geometric mean 8-oxo-dG levels in the samples (31μg/g creatinine) was relatively higher compared to those measured in healthy individuals in many occupational or general population studies. Additionally, cross-shift changes in 8-oxo-dG excretion were dependent on the length of firefighting career (p=0.01) or age of the subject (p=0.01). Significant increases in 8-oxo-dG level from pre-shift to post-shift were observed for those who had been firefighters for 2years or less. The results indicate that oxidative stress response measured as cross-shift changes in 8-oxo-dG may depend on age or the length of a firefighter's career. These results suggest the need to investigate the longer term health effects of cumulative exposure of woodsmoke exposure among wildland firefighters, because increased body burden of oxidative stress is a risk factor for many diseases and is theorized to be involved in aging.
Science of The Total Environment 02/2013; 449C:269-275. DOI:10.1016/j.scitotenv.2013.01.075 · 4.10 Impact Factor