M S Kelly1, K E Wirth2, J Madrigano3, K A Feemster4, C K Cunningham5, T Arscott-Mills6, S Boiditswe7, S S Shah8, R Finalle9, A P Steenhoff10. 1. Botswana-UPenn Partnership, Gaborone, Botswana; Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA;Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA. 2. Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA. 3. Department of Environmental and Occupational Health, Rutgers School of Public Health, Piscataway, New Jersey, USA. 4. Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 5. Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA. 6. Botswana-UPenn Partnership, Gaborone, Botswana; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 7. Botswana-UPenn Partnership, Gaborone, Botswana. 8. Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 9. Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 10. Botswana-UPenn Partnership, Gaborone, Botswana; Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Abstract
SETTING: Tertiary hospital in Gaborone, Botswana. OBJECTIVE: To examine whether exposure to wood smoke worsens outcomes of childhood pneumonia. DESIGN: Prospective cohort study of children aged 1-23 months meeting clinical criteria for pneumonia. Household use of wood as a cooking fuel was assessed during a face-to-face questionnaire with care givers. We estimated crude and adjusted risk ratios (RRs) and 95% confidence intervals (CIs) for treatment failure at 48 h by household use of wood as a cooking fuel. We assessed for effect modification by age (1-5 vs. 6-23 months) and malnutrition (none vs. moderate vs. severe). RESULTS: The median age of the 284 enrolled children was 5.9 months; 17% had moderate or severe malnutrition. Ninety-nine (35%) children failed treatment at 48 h and 17 (6%) died. In multivariable analyses, household use of wood as a cooking fuel increased the risk of treatment failure at 48 h (RR 1.44, 95%CI 1.09-1.92, P = 0.01). This association differed by child nutritional status (P = 0.02), with a detrimental effect observed only among children with no or moderate malnutrition. CONCLUSIONS: Exposure to wood smoke worsens outcomes for childhood pneumonia. Efforts to prevent exposure to smoke from unprocessed fuels may improve pneumonia outcomes among children.
SETTING: Tertiary hospital in Gaborone, Botswana. OBJECTIVE: To examine whether exposure to wood smoke worsens outcomes of childhood pneumonia. DESIGN: Prospective cohort study of children aged 1-23 months meeting clinical criteria for pneumonia. Household use of wood as a cooking fuel was assessed during a face-to-face questionnaire with care givers. We estimated crude and adjusted risk ratios (RRs) and 95% confidence intervals (CIs) for treatment failure at 48 h by household use of wood as a cooking fuel. We assessed for effect modification by age (1-5 vs. 6-23 months) and malnutrition (none vs. moderate vs. severe). RESULTS: The median age of the 284 enrolled children was 5.9 months; 17% had moderate or severe malnutrition. Ninety-nine (35%) children failed treatment at 48 h and 17 (6%) died. In multivariable analyses, household use of wood as a cooking fuel increased the risk of treatment failure at 48 h (RR 1.44, 95%CI 1.09-1.92, P = 0.01). This association differed by child nutritional status (P = 0.02), with a detrimental effect observed only among children with no or moderate malnutrition. CONCLUSIONS: Exposure to wood smoke worsens outcomes for childhood pneumonia. Efforts to prevent exposure to smoke from unprocessed fuels may improve pneumonia outcomes among children.
Authors: Mukesh Dherani; Daniel Pope; Maya Mascarenhas; Kirk R Smith; Martin Weber; Nigel Bruce Journal: Bull World Health Organ Date: 2008-05 Impact factor: 9.408
Authors: Jonathan A Bernstein; Neil Alexis; Charles Barnes; I Leonard Bernstein; Jonathan A Bernstein; Andre Nel; David Peden; David Diaz-Sanchez; Susan M Tarlo; P Brock Williams Journal: J Allergy Clin Immunol Date: 2004-11 Impact factor: 10.793
Authors: Lisa M McNally; Prakash M Jeena; Kavitha Gajee; Stanley A Thula; A Willem Sturm; Sharon Cassol; Andrew M Tomkins; Hoosen M Coovadia; David Goldblatt Journal: Lancet Date: 2007-04-28 Impact factor: 79.321
Authors: Kirk R Smith; John P McCracken; Martin W Weber; Alan Hubbard; Alisa Jenny; Lisa M Thompson; John Balmes; Anaité Diaz; Byron Arana; Nigel Bruce Journal: Lancet Date: 2011-11-12 Impact factor: 79.321
Authors: Sweta M Patel; Lisa Spees; Marek Smieja; Kathy Luinstra; Andrew P Steenhoff; Kristen A Feemster; Tonya Arscott-Mills; Sefelani Boiditswe; Mohamed Z Patel; Samir S Shah; Coleen K Cunningham; Matthew S Kelly Journal: Pediatr Infect Dis J Date: 2019-05 Impact factor: 2.129