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Special Issue "Lung Health, Tuberculosis, and Air Pollution in Low- and Middle-Income Countries"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environmental Health".

Deadline for manuscript submissions: closed (31 October 2018)

Special Issue Editors

Guest Editor
Dr. Kevin Mortimer

Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
Website | E-Mail
Phone: 00447980958309
Interests: household air pollution; chronic respiratory disease; asthma; Africa
Guest Editor
Dr. Alison Lee

Icahn School of Medicine at Mount Sinai, New York, NY, USA
Website | E-Mail
Interests: household air pollution; environmental exposures across the life course; lung function trajectory; asthma/COPD; Africa

Special Issue Information

Dear Colleagues,

Non-communicable lung diseases, tuberculosis (TB), and pneumonia are leading causes of morbidity and mortality worldwide. Most of this burden falls on the world’s poorest people living in low- and middle-income countries. Non-communicable lung diseases like asthma and chronic obstructive pulmonary disease (COPD) affect approximately 1 in 10 people around the world. Asthma is the commonest chronic disease in childhood. World Health Organization (WHO) data indicate that over 10 million people became ill from TB in 2016, of whom 1.7 million died. Pneumonia is the leading cause of death amongst children under the age of 5 outside the neonatal period. The inhalation of polluted air—including household air pollution, outdoor air pollution, and air pollution from tobacco smoke—is a major cause of lung disease, causing around 13 million deaths globally each year.

Although it is recognized that household air pollution is associated with adverse health outcomes, this issue has received little attention from the research community in relation to the magnitude of the problem, largely because it primarily affects the world’s poor. Around three billion people use solid fuels (animal dung, crop residues, wood, charcoal, coal) to provide energy for their day-to-day cooking and heating needs, including around 700 million people in sub-Saharan Africa. These dirty-burning fuels produce large amounts of partial combustion substances that cause high levels of air pollution both indoors in households and outdoors. The WHO estimates that over four million people die every year as a result of exposure to household air pollution. The morbidity and mortality associated with exposure to household air pollution are linked with poverty and, as such, are a problem especially for the rural poor and for people living in sub-Saharan Africa.

In recognition of the magnitude of the global health challenges represented by lung diseases, tuberculosis, and air pollution, the International Journal of Environmental Research and Public Health devotes this Special Issue to recent findings in “Lung Health, Tuberculosis, and Air Pollution in Low- and Middle-Income Countries”.

You are invited to submit manuscripts to be considered for publication in this Special Issue. We will particularly welcome submissions from sub-Saharan Africa.

Dr. Kevin Mortimer
Dr. Alison Lee
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Lung diseases
  • Tuberculosis
  • Household air pollution
  • Outdoor air pollution
  • Biomass fuel
  • Low- and middle-income countries
  • Sub-Saharan Africa

Published Papers (13 papers)

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Research

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Open AccessArticle Household Air Pollution Is Associated with Chronic Cough but Not Hemoptysis after Completion of Pulmonary Tuberculosis Treatment in Adults, Rural Eastern Democratic Republic of Congo
Int. J. Environ. Res. Public Health 2018, 15(11), 2563; https://doi.org/10.3390/ijerph15112563 (registering DOI)
Received: 16 October 2018 / Revised: 10 November 2018 / Accepted: 12 November 2018 / Published: 15 November 2018
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Abstract
Little is known about the respiratory health damage related to household air pollution (HAP) in survivors of pulmonary tuberculosis (PTB). In a population-based cross-sectional study, we determined the prevalence and associated predictors of chronic cough and hemoptysis in 441 randomly selected PTB survivors
[...] Read more.
Little is known about the respiratory health damage related to household air pollution (HAP) in survivors of pulmonary tuberculosis (PTB). In a population-based cross-sectional study, we determined the prevalence and associated predictors of chronic cough and hemoptysis in 441 randomly selected PTB survivors living in 13 remote health zones with high TB burden in the South Kivu province of the Democratic Republic of Congo (DRC). Trained community and health-care workers administered a validated questionnaire. In a multivariate logistic regression, chronic cough was independently associated with HAP (adjusted odds ratios (aOR) 2.10, 95% CI: 1.10–4.00) and PTB treatment >6 months (aOR 3.80, 95% CI: 1.62–8.96). Among women, chronic cough was associated with cooking ≥3 h daily (aOR 2.74, 95% CI: 1.25–6.07) and with HAP (aOR 3.93, 95% CI: 1.15–13.43). Independent predictors of hemoptysis were PTB retreatment (aOR 3.04, 95% CI: 1.04–5.09) and ignorance of treatment outcome (aOR 2.24, 95% CI: 1.09–4.58) but not HAP (aOR 1.86, 95% CI: 0.61–5.62). Exposure to HAP proved a major risk factor for chronic cough in PTB survivors, especially in women. This factor is amenable to intervention. Full article
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Open AccessArticle Exposure to Household Air Pollution from Biomass Cookstoves and Levels of Fractional Exhaled Nitric Oxide (FeNO) among Honduran Women
Int. J. Environ. Res. Public Health 2018, 15(11), 2544; https://doi.org/10.3390/ijerph15112544
Received: 21 September 2018 / Revised: 26 October 2018 / Accepted: 7 November 2018 / Published: 13 November 2018
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Abstract
Household air pollution is estimated to be responsible for nearly three million premature deaths annually. Measuring fractional exhaled nitric oxide (FeNO) may improve the limited understanding of the association of household air pollution and airway inflammation. We evaluated the cross-sectional association of FeNO
[...] Read more.
Household air pollution is estimated to be responsible for nearly three million premature deaths annually. Measuring fractional exhaled nitric oxide (FeNO) may improve the limited understanding of the association of household air pollution and airway inflammation. We evaluated the cross-sectional association of FeNO with exposure to household air pollution (24-h average kitchen and personal fine particulate matter and black carbon; stove type) among 139 women in rural Honduras using traditional stoves or cleaner-burning Justa stoves. We additionally evaluated interaction by age. Results were generally consistent with a null association; we did not observe a consistent pattern for interaction by age. Evidence from ambient and household air pollution regarding FeNO is inconsistent, and may be attributable to differing study populations, exposures, and FeNO measurement procedures (e.g., the flow rate used to measure FeNO). Full article
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Open AccessArticle Short-Term Effects of Ambient Air Pollution on Hospitalization for Respiratory Disease in Taiyuan, China: A Time-Series Analysis
Int. J. Environ. Res. Public Health 2018, 15(10), 2160; https://doi.org/10.3390/ijerph15102160
Received: 27 August 2018 / Revised: 29 September 2018 / Accepted: 30 September 2018 / Published: 1 October 2018
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Abstract
In this study, we estimated the short-term effects of ambient air pollution on respiratory disease hospitalization in Taiyuan, China. Daily data of respiratory disease hospitalization, daily concentration of ambient air pollutants and meteorological factors from 1 October 2014 to 30 September 2017 in
[...] Read more.
In this study, we estimated the short-term effects of ambient air pollution on respiratory disease hospitalization in Taiyuan, China. Daily data of respiratory disease hospitalization, daily concentration of ambient air pollutants and meteorological factors from 1 October 2014 to 30 September 2017 in Taiyuan were included in our study. We conducted a time-series study design and applied a generalized additive model to evaluate the association between every 10-μg/m3 increment of air pollutants and percent increase of respiratory disease hospitalization. A total of 127,565 respiratory disease hospitalization cases were included in this study during the present period. In single-pollutant models, the effect values in multi-day lags were greater than those in single-day lags. PM2.5 at lag02 days, SO2 at lag03 days, PM10 and NO2 at lag05 days were observed to be strongly and significantly associated with respiratory disease hospitalization. No significant association was found between O3 and respiratory disease hospitalization. SO2 and NO2 were still significantly associated with hospitalization after adjusting for PM2.5 or PM10 into two-pollutant models. Females and younger population for respiratory disease were more vulnerable to air pollution than males and older groups. Therefore, some effective measures should be taken to strengthen the management of the ambient air pollutants, especially SO2 and NO2, and to enhance the protection of the high-risk population from air pollutants, thereby reducing the burden of respiratory disease caused by ambient air pollution. Full article
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Open AccessArticle Short Telomere Length as a Biomarker Risk of Lung Cancer Development Induced by High Radon Levels: A Pilot Study
Int. J. Environ. Res. Public Health 2018, 15(10), 2152; https://doi.org/10.3390/ijerph15102152
Received: 3 September 2018 / Revised: 21 September 2018 / Accepted: 24 September 2018 / Published: 30 September 2018
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Abstract
Long-term exposure to radon has been determined to be the second leading cause of lung cancer after tobacco smoking. However, an in-depth study of this topic has not been explicitly carried out in Chiang Mai (Thailand). This paper presents the results of an
[...] Read more.
Long-term exposure to radon has been determined to be the second leading cause of lung cancer after tobacco smoking. However, an in-depth study of this topic has not been explicitly carried out in Chiang Mai (Thailand). This paper presents the results of an indoor radon level measurement campaign in dwellings of Chiang Mai using total of 110 detectors (CR-39) during one year. The results show that the average radon levels varied from 35 to 219 Bq/m3, with an overall average of 57 Bq/m3. The finding also shows that the average value is higher than the global average value of 39 Bq/m3. In addition, to examine the cause of lung cancer development among people with risk of chronic exposure to radon during their lifetime, 35 non-smoker lung cancer patients and 33 healthy nonsmokers were analyzed for telomere length. As expected, telomere length was significantly shorter in lung cancer patients than in healthy nonsmokers. Among healthy nonsmokers, the telomere length was significantly shorter in a high radon group than in an unaffected low radon group. To the best of our knowledge, our research provides the first attempt in describing the shortened telomeres in areas with high levels of environmental radon that might be related to lung cancer development. Full article
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Open AccessArticle Health Risks Associated with Occupational Exposure to Ambient Air Pollution in Commercial Drivers: A Systematic Review
Int. J. Environ. Res. Public Health 2018, 15(9), 2039; https://doi.org/10.3390/ijerph15092039
Received: 12 August 2018 / Revised: 13 September 2018 / Accepted: 15 September 2018 / Published: 18 September 2018
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Abstract
Ambient air pollution is a major global health problem and commercial drivers are particularly exposed to it. As no systematic assessment of the health risks associated with occupational exposure to ambient air pollution in this population had yet been carried out, we conducted
[...] Read more.
Ambient air pollution is a major global health problem and commercial drivers are particularly exposed to it. As no systematic assessment of the health risks associated with occupational exposure to ambient air pollution in this population had yet been carried out, we conducted a systematic review using a protocol-driven strategy. Papers published from inception to April 20, 2018 in MEDLINE, EMBASE, CINAHL, African journals online, the Cochrane library, ISRCTN WHO ICTRP, and the Web of Science and Scopus databases were screened for inclusion by two independent reviewers. Original articles with at least an available abstract in English or French were included. The initial search retrieved 1454 published articles of which 20 articles were included. Three studies reported a significant difference in white blood cells (106/L) among commercial motorcyclists compared to rural inhabitants (5.041 ± 1.209 vs. 5.900 ± 1.213, p = 0.001), an increased risk of lung cancer (RR = 1.6, 95%CI 1.5–1.8) in bus drivers and an increased standardized mortality ratio (SMR) in bus drivers from Hodgkin’s lymphoma (SMR 2.17, 95%CI 1.19–3.87) compared to white-collar workers. Other studies also found that drivers had more oxidative DNA damage and chromosome breaks. Four papers failed to demonstrate that the drivers were more exposed to air pollution than the controls. Three other studies also reported no significant difference in lung function parameters and respiratory symptoms. The genetic polymorphisms of detoxifying enzymes were also not homogeneously distributed compared to the controls. There is some evidence that occupational exposure to ambient air pollution among commercial drivers is associated with adverse health outcomes, but the existing literature is limited, with few studies on small sample size, methodological weaknesses, and contradictory findings—thus, further research is recommended. Full article
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Open AccessArticle Socio-Cultural Reasons and Community Perceptions Regarding Indoor Cooking Using Biomass Fuel and Traditional Stoves in Rural Ethiopia: A Qualitative Study
Int. J. Environ. Res. Public Health 2018, 15(9), 2035; https://doi.org/10.3390/ijerph15092035
Received: 7 August 2018 / Revised: 10 September 2018 / Accepted: 14 September 2018 / Published: 18 September 2018
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Abstract
Around three billion people in the world and 90% of the rural households in low-and middle-income countries are exposed to wood smoke with varying exposure levels and resulting health risks. We aimed to explore perceptions of the community towards indoor cooking and the
[...] Read more.
Around three billion people in the world and 90% of the rural households in low-and middle-income countries are exposed to wood smoke with varying exposure levels and resulting health risks. We aimed to explore perceptions of the community towards indoor cooking and the socio-cultural barriers to bring change in Butajira, rural Ethiopia. We conducted a qualitative study involving ten separate focus group discussions with purposively selected members of the community and two key informant interviews with health extension workers. Content analysis was carried out using ATLAS.ti software. Participants reported the use of fuel wood and traditional three-stone cook stove to cook food. Economic status, lack of commitment, cultural views and concern along with safety and security issues were found to be barriers to change from traditional to cleaner methods of cooking. The community perceived wood smoke to have effects on their eyes and respiratory health, though they culturally viewed it as beneficial for postpartum mothers and newborns, avoiding bad smell and insects and in order to strengthen the fabric of their houses. Health education at community level is essential in order to bring about change in the cultural views and cooking behaviors focusing on opening windows and keeping young children away during cooking. Full article
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Open AccessFeature PaperArticle The Cooking and Pneumonia Study (CAPS) in Malawi: A Cross-Sectional Assessment of Carbon Monoxide Exposure and Carboxyhemoglobin Levels in Children under 5 Years Old
Int. J. Environ. Res. Public Health 2018, 15(9), 1936; https://doi.org/10.3390/ijerph15091936
Received: 18 June 2018 / Revised: 22 August 2018 / Accepted: 30 August 2018 / Published: 5 September 2018
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Abstract
Household air pollution is estimated to cause half a million deaths from pneumonia in children worldwide. The Cooking and Pneumonia Study (CAPS) was conducted to determine whether the use of cleaner-burning biomass-fueled cookstoves would reduce household air pollution and thereby the incidence of
[...] Read more.
Household air pollution is estimated to cause half a million deaths from pneumonia in children worldwide. The Cooking and Pneumonia Study (CAPS) was conducted to determine whether the use of cleaner-burning biomass-fueled cookstoves would reduce household air pollution and thereby the incidence of pneumonia in young children in rural Malawi. Here we report a cross-sectional assessment of carbon monoxide (CO) exposure and carboxyhemoglobin (COHgB) levels at recruitment to CAPS. Mean (SD; range) 48-h CO exposure of 1928 participating children was 0.90 (2.3; 0–49) ppm and mean (SD; range) COHgB level was 5.8% (3.3; 0–20.3). Higher mean CO and COHgB levels were associated with location (Chikhwawa versus Chilumba) (OR 3.55 (1.73–7.26)); (OR 2.77 (1.08–7.08)). Correlation between mean CO and COHgB was poor (Spearman’s ρ = 0.09, p < 0.001). The finding of high COHgB levels in young children in rural Malawi that are at levels at which adverse neurodevelopmental and cognitive effects occur is of concern. Effective approaches for reducing exposure to CO and other constituents of air pollution in rural sub-Saharan African settings are urgently needed. Full article
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Open AccessArticle Respiratory Health Status of Workers in a Bottling Factory in Benin City, Nigeria
Int. J. Environ. Res. Public Health 2018, 15(9), 1919; https://doi.org/10.3390/ijerph15091919
Received: 15 July 2018 / Revised: 28 August 2018 / Accepted: 29 August 2018 / Published: 4 September 2018
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Abstract
Introduction: There is a paucity of data on the respiratory health status of workers in bottling factories in Benin City, Nigeria. Such data will help to drive future studies and influence policy development on occupational health and safety in the country. This
[...] Read more.
Introduction: There is a paucity of data on the respiratory health status of workers in bottling factories in Benin City, Nigeria. Such data will help to drive future studies and influence policy development on occupational health and safety in the country. This study assesses the respiratory symptoms and spirometric indices of exposed workers and controls. Methods: Respiratory symptoms and spirometric parameters of 18 workers on routine mandatory annual lung screening were assessed using the modified MRC (Medical Research Council) questionnaire and spirometer respectively, according to the European Respiratory Society and American Thoracic Society (ERS/ATS) guidelines. Results: The mean age of workers was 35.1 ± 6.7 years. Workers and controls were similar in age, sex, BMI (Body Mass Index) and health status (p > 0.05). Respiratory symptoms were significantly higher among workers compared to controls. Overall, the result was statistically significant in the variables of wheeze in a smoky or dusty environment, presence of at least one respiratory symptom, better symptoms at weekends and better symptoms during holidays (p < 0.05). In particular, 6 (33.3%) exposed workers had wheeze in a smoky or dusty environment, 9 (50.0%) exposed workers reported at least one respiratory symptom compared with 2 (11.1%) controls, 5 (27.8%) had better symptoms at weekends, and 7 (38.9%) had better symptoms at holidays (p < 0.05). Generally, the reported frequency of respiratory symptoms among exposed workers were: cough (22.2%), sputum production (5.6%), breathlessness (11.1%) and wheeze (44.4%). Similarly, workers had significantly lower spirometric indices than controls, particularly in forced expiratory volume in 1 s (FEV1), FEV1/forced vital capacity (FVC) ratio and forced expiratory flow between 25% and 75% of FVC (FEF 25–75%) measurements. Conclusions: This study provides evidence of adverse respiratory health effects among bottling factory workers which requires further investigation. Full article
Open AccessArticle Questionnaires for Lung Health in Africa across the Life Course
Int. J. Environ. Res. Public Health 2018, 15(8), 1615; https://doi.org/10.3390/ijerph15081615
Received: 9 July 2018 / Accepted: 23 July 2018 / Published: 31 July 2018
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Abstract
Respiratory infections remain a leading cause of morbidity and mortality in many low and middle-income countries but non-communicable disease rates are rising fast. Prevalence studies have been primarily symptom-focused, with tools developed in countries in the Global North such as the United States
[...] Read more.
Respiratory infections remain a leading cause of morbidity and mortality in many low and middle-income countries but non-communicable disease rates are rising fast. Prevalence studies have been primarily symptom-focused, with tools developed in countries in the Global North such as the United States and the United Kingdom. Systematic study in sub-Saharan African populations is necessary to accurately reflect disease risk factors present in these populations. We present tools for such studies, developed as part of the International Multidisciplinary Programme to Address Lung Health and TB in Africa (‘IMPALA’), which includes lay representatives. At a preliminary meeting, the adequacy and suitability of existing tools was discussed and a new questionnaire set proposed. Individual questionnaires were developed, and an expert panel considered content and criterion validity. Questionnaires underwent a cross-cultural adaptation process, incorporating translation and contextual ‘sense-checking’, through the use of pre-established lay focus groups in Malawi, before consensus-approval by project collaborators. The complete set of research questionnaires, providing information on lung health symptoms and a relevant range of potential risk factors for lung disease, is now available online. In developing the tools, cultural and contextual insights were important, as were translational considerations. The process benefitted from a foundation in expert knowledge, starting with validated tools and internationally respected research groups, and from a coordinated collaborative approach. We present and discuss a newly devised, contextually appropriate set of questionnaires for non-communicable lung disease research in Africa that are now available in open access for all to use. Full article
Open AccessCommunication The Effect of PM2.5 from Household Combustion on Life Expectancy in Sub-Saharan Africa
Int. J. Environ. Res. Public Health 2018, 15(4), 748; https://doi.org/10.3390/ijerph15040748
Received: 11 March 2018 / Revised: 4 April 2018 / Accepted: 10 April 2018 / Published: 13 April 2018
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Abstract
Household fuel combustion, especially using solid combustibles (biomass and fossil fuels), for cooking and other activities produces emissions that contribute to concentrations of indoor as well as outdoor air pollutants such as particulate matter with diameter smaller than 2.5 μm (PM2.5)
[...] Read more.
Household fuel combustion, especially using solid combustibles (biomass and fossil fuels), for cooking and other activities produces emissions that contribute to concentrations of indoor as well as outdoor air pollutants such as particulate matter with diameter smaller than 2.5 μm (PM2.5) that deteriorate health and likely affect life expectancy (LEX). This study investigates the impact of PM2.5 from household combustion on LEX considering several covariates while controlling for ambient PM2.5 generated by other sectors. The generalized method of moments (GMM) model and the panel cointegration model were applied to a dataset of 43 Sub-Saharan Africa (SSA) countries over the time period of 1995–2010. Both approaches provide similar results indicating that household PM2.5 is significantly and negatively associated with higher aggregate LEX in the long-run, and, to a greater degree for female’s. Also, among the control variables, PM2.5 from the transport sector has a greater influence on male’s LEX. Thus, efforts should be combined to reduce household PM2.5 since lower levels are associated with increased LEX. Full article
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Open AccessArticle Cooking Fuels in Lagos, Nigeria: Factors Associated with Household Choice of Kerosene or Liquefied Petroleum Gas (LPG)
Int. J. Environ. Res. Public Health 2018, 15(4), 641; https://doi.org/10.3390/ijerph15040641
Received: 4 March 2018 / Revised: 26 March 2018 / Accepted: 28 March 2018 / Published: 31 March 2018
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Abstract
Cooking with dirty-burning fuels is associated with health risk from household air pollution. We assessed the prevalence of and factors associated with the use of cooking fuels, and attitudes and barriers towards use of liquefied petroleum gas (LPG). This was a cross-sectional, population-based
[...] Read more.
Cooking with dirty-burning fuels is associated with health risk from household air pollution. We assessed the prevalence of and factors associated with the use of cooking fuels, and attitudes and barriers towards use of liquefied petroleum gas (LPG). This was a cross-sectional, population-based survey conducted in 519 households in Lagos, Nigeria. We used a structured questionnaire to obtain information regarding choice of household cooking fuel and the attitudes towards the use of LPG. Kerosene was the most frequently used cooking fuel (n = 475, 91.5%; primary use n = 364, 70.1%) followed by charcoal (n = 159, 30.6%; primary use n = 88, 17%) and LPG (n = 86, 16.6%; primary use n = 63, 12.1%). Higher level of education, higher income and younger age were associated with LPG vs. kerosene use. Fuel expenditure on LPG was significantly lower than for kerosene ( N (Naira) 2169.0 ± 1507.0 vs. N 2581.6 ± 1407.5). Over 90% of non-LPG users were willing to switch to LPG but cited safety issues and high cost as potential barriers to switching. Our findings suggest that misinformation and beliefs regarding benefits, safety and cost of LPG are important barriers to LPG use. An educational intervention program could be a cost-effective approach to improve LPG adoption and should be formally addressed through a well-designed community-based intervention study. Full article

Review

Jump to: Research

Open AccessReview Potential Diagnostic Properties of Chest Ultrasound in Thoracic Tuberculosis—A Systematic Review
Int. J. Environ. Res. Public Health 2018, 15(10), 2235; https://doi.org/10.3390/ijerph15102235
Received: 8 August 2018 / Revised: 28 September 2018 / Accepted: 2 October 2018 / Published: 12 October 2018
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Abstract
Background: Chest ultrasound (CUS) has been shown to be a sensitive and specific imaging modality for pneumothorax, pneumonia, and pleural effusions. However, the role of chest ultrasound in the diagnosis of thoracic tuberculosis (TB) is uncertain. We performed a systematic search in
[...] Read more.
Background: Chest ultrasound (CUS) has been shown to be a sensitive and specific imaging modality for pneumothorax, pneumonia, and pleural effusions. However, the role of chest ultrasound in the diagnosis of thoracic tuberculosis (TB) is uncertain. We performed a systematic search in the medical literature to better define the potential role and value of chest ultrasound in diagnosing thoracic tuberculosis. Aim: To describe existing literature with regard to the diagnostic value of chest ultrasound in thoracic tuberculosis. Methods: MEDLINE, EMBASE, and Scopus databases were searched for relevant articles. We included studies that used chest ultrasound for the diagnosis or management of any form of thoracic tuberculosis, including pulmonary, pleural, mediastinal, and military forms. Results: We identified five main fields of chest ultrasound application: (1) Detection, characterization, and quantification of TB; (2) detection of residual pleural thickening after evacuation; (3) chest ultrasound-guided needle biopsy; (4) identification of pathologic mediastinal lymph nodes in children; and (5) identification of parenchymal ultrasound patterns. Effusion was also detected, in early stages, with signs of organization in 24–100% of patients. A low to moderate (10–23%), false negative rate was reported for chest ultrasound-guided needle biopsy. CUS was able to identify mediastinal lymph nodes in as many as 67% of patients with negative chest radiography. Conclusions: Very few studies with important methodological limitations analyze the role of chest ultrasound in the diagnosis of TB. The scarce available data suggests potential targets of future diagnostic or feasibility trials, such as the detection of tuberculosis–related pleural effusion, residual pleural thickening, lymphadenopathy, TB parenchymal patterns, or the use of CUS in biopsy guidance. Full article
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Open AccessReview The Early Recognition and Management of Sepsis in Sub-Saharan African Adults: A Systematic Review and Meta-Analysis
Int. J. Environ. Res. Public Health 2018, 15(9), 2017; https://doi.org/10.3390/ijerph15092017
Received: 18 August 2018 / Revised: 9 September 2018 / Accepted: 13 September 2018 / Published: 15 September 2018
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Abstract
Sepsis is a common cause of morbidity and mortality in sub-Saharan African adults. Standardised management pathways have been documented to improve the survival of adults with sepsis from high-resource settings. Our aim was to assess the current evidence base for early sepsis interventions
[...] Read more.
Sepsis is a common cause of morbidity and mortality in sub-Saharan African adults. Standardised management pathways have been documented to improve the survival of adults with sepsis from high-resource settings. Our aim was to assess the current evidence base for early sepsis interventions (recognition, empirical antibiotics, and resuscitation) in resource-poor settings of sub-Saharan Africa. We searched MEDLINE, EMBASE and CINHAL Plus databases to identify interventional studies for the early recognition and management of sepsis in sub-Saharan Africa (1 January 2000 to 1 August 2018) using a protocol-driven search strategy: adults, protocolised care pathway, and sub-Saharan Africa. We identified 725 publications of which three met criteria for final selection. Meta-analysis from two randomised controlled trials demonstrated that mortality was increased by ‘early goal-directed therapy’ interventions that increased fluid resuscitation (R.R. 1.26, 95% C.I. 1.00–1.58, p = 0.045; I2 53%). The third observational cohort study demonstrated improved survival after implementation of protocolised management for sepsis (mortality 33.0% vs. 45.7%, p = 0.005). No study incorporated standardised protocols for empirical antibiotic administration. High rates of pneumonia and mycobacteraemia were reported. There has been little research into the early recognition and management of sepsis in sub-Saharan Africa. Interventional trials of early goal-directed therapy have, to date, increased mortality. There is an urgent need to develop effective strategies to improve outcomes for adults with sepsis in sub-Saharan Africa. Full article
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