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Wellcome Open Res. 2017 Oct 24;2:103. doi: 10.12688/wellcomeopenres.12621.1. eCollection 2017.

Household air pollution, chronic respiratory disease and pneumonia in Malawian adults: A case-control study.

Author information

1
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi.
2
Liverpool School of Tropical of Medicine, Liverpool, L3 5QA, UK.
3
Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK.
4
Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK.
5
Lancaster Medical School, Lancaster University, Lancaster, LA1 4YW, UK.
6
College of Medicine, University of Malawi, Chichiri, Blantyre 3, Malawi.
7
Queen Elizabeth Central Hospital, Chichiri, Blantyre 3, Malawi.

Abstract

Background: Four million people die each year from diseases caused by exposure to household air pollution. There is an association between exposure to household air pollution and pneumonia in children (half a million attributable deaths a year); however, whether this is true in adults is unknown. We conducted a case-control study in urban Malawi to examine the association between exposure to household air pollution and pneumonia in adults. Methods: Hospitalized patients with radiologically confirmed pneumonia (cases) and healthy community controls underwent 48 hours of ambulatory and household particulate matter (µg/m 3) and carbon monoxide (ppm) exposure monitoring. Multivariate logistic regression, stratified by HIV status, explored associations between these and other potential risk factors with pneumonia. Results: 145 (117 HIV-positive; 28 HIV-negative) cases and 253 (169 HIV-positive; 84 HIV-negative) controls completed follow up. We found no evidence of association between household air pollution exposure and pneumonia in HIV-positive (e.g. ambulatory particulate matter adjusted odds ratio [aOR] 1.00 [95% CI 1.00-1.01, p=0.141]) or HIV-negative (e.g. ambulatory particulate matter aOR 1.00 [95% CI 0.99-1.01, p=0.872]) participants. Chronic respiratory disease was associated with pneumonia in both HIV-positive (aOR 28.07 [95% CI 9.29-84.83, p<0.001]) and HIV-negative (aOR 104.27 [95% CI 12.86-852.35, p<0.001]) participants. Conclusions: We found no evidence that exposure to household air pollution is associated with pneumonia in Malawian adults. In contrast, chronic respiratory disease was strongly associated with pneumonia.

KEYWORDS:

Carbon monoxide; Chronic respiratory disease; Household air pollution; Malawi; Particulate matter; Pneumonia; Sub-Saharan Africa

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