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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.

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


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.


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

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