Free hardware based system for air quality and CO2 monitoring

Due to the increase in air pollution, especially in Latin American countries of low and middle income, great environmental and health risks have been generated, highlighting that there is more pollution in closed environments. Given this problem, it has been proposed to develop a system based on free hardware for monitoring air quality and CO2, in order to reduce the levels of air pollution in a closed environment, improving the quality of life of people and contributing to the awareness of the damage caused to the environment by the hand of man himself. The system is based on V-Model, complemented with a ventilation prototype implemented with sensors and an application for its respective monitoring. The sample collected in the present investigation was non-probabilistic, derived from the reports of air indicators during 15 days with specific schedules of 9am, 1pm and 6pm. The results obtained indicated that the air quality decreased to 670 ppm, as well as the collection time decreased to 5 seconds and finally the presence of CO2 was reduced to 650 ppm after the implementation of the system, achieving to be within the standards recommended by the World Health Organization

Reducing childhood illness - fostering growth : an integrated home-based intervention package (IHIP) to improve indoor-air pollution, drinking water quality and child nutrition

Child mortality attributable to pneumonia, diarrhoea and malnutrition accounts globally for the majority of 8.8 million annual deaths. More than half of these deaths are preventable. Available and effective interventions include safe water supply, household water treatment, improved chimney stoves and personal- and home-hygiene and -health messages. In Peru, the current health services reform is focused on shifting responsibilities to peripheral levels; thus, empowering community organisations to manage primary health care services, including health promotion and preventive measures at household level. The current political situation and policy framework to integrate effective preventive interventions that can be delivered at family level, prompted us to test the efficacy of a package of health interventions to reduce childhood illness burden at rural household level. The goal of this PhD thesis was to assess the efficacy of an Integrated Environmental Home-based-Intervention Package (IHIP), comprised of an improved chimney stoves, access to safe drinking water from solar radiation household water treatment (SODIS), and hygiene education interventions, to reduce morbidity of acute respiratory infections, diarrhoea and poor growth of rural Peruvian children under three years of age. We implemented a community-randomised control field trial (cRCT) in 51 community’s clusters of the San Marcos Province, Cajamarca Region, Peru. The cRCT was divided as follows: * Set-up, community selection and participatory intervention development: A pilot study was carried out for the selection of the interventions. These were adapted to local customs. The participatory phase is described in detail in Chapters 4 & 5. * Randomization, enrolment and baseline data collection: Chapter 6 describes the randomisation, enrolment and baseline in detail. * Carbon monoxide (CO) and Particulate Matter (PM2.5) household air quality assessment: Chapter 7 & 8 describe the efficacy of the OPTIMA-improved stove in improving household air quality in comparison to traditional open fire stoves. * Morbidity surveillance and field data acquisition: Morbidity data on the daily occurrence of signs and symptoms diarrhoea and respiratory illnesses of children was collected weekly. Anthropometric every two months and microbial data every 6 months. Chapter 9 describes the IHIP impact on morbidity reduction. * Workshops for a community-driven sustainable dessimination: Chapter 10 describes the community workshops and dissemination processes and dynamics within a socio-ecological framework. Our community-randomised control trial demonstrated that IHIP reduced 22% per year of child diarrhoea (RR 0.78, 95% CI: 0.49-1.05) and found an odds ratio of 0.71 for diarrhoea prevalence (OR 0.71, 95%, CI: 0.47, 1.06). No effects on the frequency of acute lower respiratory infections (RR 0.99, 95% CI: 0.59, 1.65) or child’s growth rates were found when comparing study arms. We identified three reasons for this moderate diarrhoea reduction: i) hand-washing promotion was universally found in our setting, since it is being promoted by the health care centre; ii) SODIS compliance was moderate: only one third of the beneficiaries were using the method regularly; and iii) the increased awareness for the child’s needs linked to the control intervention, could induce improved child care behaviour. The lack of effect on ALRI, could be linked to insufficient reduction in exposure to household air pollutants and high health service utilisation due to cultural beliefs and health seeking behavoiur. The household air pollution assessment study revealed only moderate reductions of 45% and 27% reduction of PM2.5 and CO, respectively for mothers’ personal exposure. This result was achieved in the best working stoves only. This may most likely not be sufficient to reduce impact on physician-diagnosed pneumonia. Community participatory meetings and surveys revealed that people’s decisions on adopting household-level environmental and hygiene interventions, was not only based on individual perceptions of their potential gains, but also depended on peer pressure and social network relations. Individual perceptions regarding pollution levels of water and household air (transparent, odourless water vs dirty air environments) influenced perceived gains and the adoption of certain interventions. Access to information and encouragement from health-care providers and programme implementers also increased adoption. The IHIP had several additional benefits beyond health outcomes. Mother’s expressed that the stoves could reduce cooking time and wood consumption, which translated into cost saving. They also could perform other task while cooking. Regarding the kitchen sink, the mothers expressed it facilitated handwashing, and washing of utensils with detergent, generating a cleaner kitchen environment that fostered home and food hygiene. We believe that the IHIP package motivated families to improve the kitchen living area in general. The high acceptance and sustained use was not only observed in the IHIP families but also in non-participating families that had copied the OPTIMA-improved stove after the community engagement in the desimination activities. We can also conclude that the IHIP package added to the family status, improved quality of life and impacted on their livelihoods, by empowering the beneficiary families. In conclusion, through this project we envisaged to demonstrate how an integrated package could be implemented at the household level in rural areas of Peru and its effect on health, quality of life and livelihoods. However, behaviour change for keeping maintanence of the interventions and use is necessary to achieve compliance, replication and sustainability

Revealing the air pollution burden associated with internal Migration in Peru

This study aims to quantify changes in outdoor (ambient) air pollution exposure from different migration patterns within Peru and quantify its effect on premature mortality. Data on ambient fine particulate matter (PM2.5) was obtained from the National Aeronautics and Space Administration (NASA). Census data was used to calculate rates of within-country migration at the district level. We calculated differences in PM2.5 exposure between "current" (2016-2017) and "origin" (2012) districts for each migration patterns. Using an exposure-response relationship for PM2.5 extracted from a meta-analysis, and mortality rates from the Peruvian Ministry of Health, we quantified premature mortality attributable to each migration pattern. Changes in outdoor PM2.5 exposure were observed between 2012 and 2016 with highest levels of PM2.5 in the Department of Lima. A strong spatial autocorrelation of outdoor PM2.5 values (Moran's I = 0.847, p-value=0.001) was observed. In Greater Lima, rural-to-urban and urban-to-urban migrants experienced 10-fold increases in outdoor PM2.5 exposure in comparison with non-migrants. Changes in outdoor PM2.5 exposure due to migration drove 137.1 (95%CI: 93.2, 179.4) premature deaths related to air pollution, with rural-urban producing the highest risk of mortality from exposure to higher levels of ambient air pollution. Our results demonstrate that the rural-urban and urban-urban migrant groups have higher rates of air pollution-related deaths

Understanding the rise of cardiometabolic diseases in low- and middle-income countries

Increases in the prevalence of noncommunicable diseases (NCDs), particularly cardiometabolic diseases such as cardiovascular disease, stroke and diabetes, and their major risk factors have not been uniform across settings: for example, cardiovascular disease mortality has declined over recent decades in high-income countries but increased in low- and middle-income countries (LMICs). The factors contributing to this rise are varied and are influenced by environmental, social, political and commercial determinants of health, among other factors. This Review focuses on understanding the rise of cardiometabolic diseases in LMICs, with particular emphasis on obesity and its drivers, together with broader environmental and macro determinants of health, as well as LMIC-based responses to counteract cardiometabolic diseases

Evidence for an association of prenatal exposure to particulate matter with clinical severity of Autism Spectrum Disorder

Early-life exposure to air pollutants, including ozone (O3), particulate matter (PM2.5 or PM10, depending on diameter of particles), nitrogen dioxide (NO2) and sulfur dioxide (SO2) has been suggested to contribute to the etiology of Autism Spectrum Disorder (ASD). In this study, we used air quality monitoring data to examine whether mothers of children with ASD were exposed to high levels of air pollutants during critical periods of pregnancy, and if higher exposure levels may lead to a higher clinical severity in their offspring. We used public data from the Portuguese Environment Agency to estimate exposure to these pollutants during the first, second and third trimesters of pregnancy, full pregnancy and first year of life of the child, for 217 subjects with ASD born between 2003 and 2016. These subjects were stratified in two subgroups according to clinical severity, as defined by the Autism Diagnostic Observational Schedule (ADOS). For all time periods, the average levels of PM2.5, PM10 and NO2 to which the subjects were exposed were within the admissible levels defined by the European Union. However, a fraction of these subjects showed exposure to levels of PM2.5 and PM10 above the admissible threshold. A higher clinical severity was associated with higher exposure to PM2.5 (p = 0.001), NO2 (p = 0.011) and PM10 (p = 0.041) during the first trimester of pregnancy, when compared with milder clinical severity. After logistic regression, associations with higher clinical severity were identified for PM2.5 exposure during the first trimester (p = 0.002; OR = 1.14, 95%CI: 1.05–1.23) and full pregnancy (p = 0.04; OR = 1.07, 95%CI: 1.00–1.15) and for PM10 (p = 0.02; OR = 1.07, 95%CI: 1.01–1.14) exposure during the third trimester. Exposure to PM is known to elicit neuropathological mechanisms associated with ASD, including neuroinflammation, mitochondrial disruptions, oxidative stress and epigenetic changes. These results offer new insights on the impact of earlylife exposure to PM in ASD clinical severity.This work was supported by Fundaçao ˜ para a Ciˆencia e a Tecnologia (FCT), through funding to the project “Gene-environment interactions in Autism Spectrum Disorder” (Grant PTDC/MED-OUT/28937/2017) and to Research Center Grants UIDB/04046/2020 and UIDP/04046/2020 (to BioISI) and UIDB/00006/2020 (to Centro de Estatística e Aplicaçoes ˜ da Universidade de Lisboa). Joao ˜ Xavier Santos is a fellow of the BioSys PhD Program and an awardee of a scholarship funded by FCT with reference PD/BD/114,386/2016.info:eu-repo/semantics/publishedVersio

NITROGEN DIOXIDE AND HOUSEHOLD AIR POLLUTION FROM BIOMASS AND LIQUEFIED PETROLEUM GAS COOKSTOVES

Problem Statement: Household air pollution (HAP) from biomass cookstoves is a leading contributor to the global burden of disease. Current research and intervention efforts have focused on PM2.5 and CO as the pollutants from biomass emissions that are most relevant to public health. However, little is known about the emissions, exposures, and health effects of nitrogen dioxide (NO2) from biomass cookstoves or from cleaner-cooking alternatives. This dissertation aimed to 1) characterize NO2 concentrations in kitchens with biomass cookstoves, 2) examine the multi-pollutant exposure-response relationships between PM2.5, CO, and NO2 and lung function among women with biomass stoves, and 3) evaluate the longitudinal impact of a liquefied petroleum gas (LPG) stove intervention on NO2 concentrations. Methods: We conducted a randomized, controlled field trial of a biomass-to-LPG cookstove intervention among women with biomass cookstoves in Puno, Peru. In the first manuscript, we measured NO2 kitchen area concentrations and personal exposures in homes with biomass cookstoves at baseline. In the second manuscript, we measured lung function via spirometry, PM2.5, and CO, and we analyzed the multi-pollutant exposure-response associations between pollutants and lung function at baseline. In the third manuscript, we measured NO2 kitchen area concentrations and personal exposure in both arms of the intervention trial throughout the intervention period to assess the longitudinal impact of a biomass-to-LPG intervention on NO2 exposures. Results: In our first study, we observed high NO2 concentrations in homes with biomass cookstoves which far exceed WHO indoor hourly and annual guidelines. In our second study, we observed independent associations between lung function parameters and both NO2 and CO. In our third study, we found that a biomass-to-LPG intervention reduced NO2 exposures, but kitchen area NO2 concentrations in homes with LPG stoves remained above WHO guidelines. Conclusions: Biomass cookstoves in the Peruvian Andes produce NO2 emissions which far exceed WHO guidelines. These exposures may have negative effects on respiratory function, independent of PM2.5 and CO. While LPG stoves reduced NO2 exposure, indoor concentrations remained above WHO guidelines. Further research is warranted to inform the promotion of LPG stoves as a safe and effective public health intervention